bluuebunny/crossref_metadata_2025_split huggingface dataset:
Seeing Is Believing: What Do Boys Do When They Find a Real Gun?
Authors: Jackman Geoffrey A. , Farah Mirna M. , Kellermann Arthur L. , Simon Harold K. 
Published: August 2004

Objectives.To determine how boys behave when they find a handgun in a presumably safe environment and to compare parental expectations of their child's interest in real guns with this observed behavior.Methods.A convenience sample of 8- to 12-year-old boys was recruited from families that completed a survey on firearm ownership, storage practices, and parental perceptions. Parents were asked to rate their child's interest in real guns on a scale from 1 to 5: 1–2 = low interest, 3 = moderate interest, and 4–5 = high interest. Parents of an eligible child were asked to bring to the exercise 1 of their son's playmates and/or a sibling in the same age range. After informed parental consent was obtained, each pair or trio of boys was placed in a room with a 1-way mirror and observed for up to 15 minutes. Two water pistols and an actual .380 caliber handgun were concealed in separate drawers. The handgun contained a radio transmitter that activated a light whenever the trigger was depressed with sufficient force to discharge the firearm. After the exercise, each boy was asked whether he thought that the pistol was real or a toy. Before leaving, each child was counseled about safe behavior around guns.Results.Twenty-nine groups of boys (n= 64) took part in the study. The mean age of participants was 9.8 years. Twenty-one of the groups (72%) discovered the handgun (n = 48 boys); 16 groups (76%) handled it (n = 30 boys). One or more members in 10 of the groups (48%) pulled the trigger (n = 16 boys). Approximately half of the 48 boys who found the gun thought that it was a toy or were unsure whether it was real. Parental estimates of their child's interest in guns did not predict actual behavior on finding the handgun. Boys who were believed to have a low interest in real guns were as likely to handle the handgun or pull the trigger as boys who were perceived to have a moderate or high interest in guns. More than 90% of the boys who handled the gun or pulled the trigger reported that they had previously received some sort of gun safety instruction.Conclusion.Many 8- to 12-year-old boys will handle a handgun if they find one. Guns that are kept in homes should be stored in a manner that renders them inaccessible to children.guns, weapons, firearms, children, childhood behavior, injury prevention.
Effect of Pediatric Surgical Practice on the Treatment of Children With Appendicitis
Authors: Kokoska Evan R. , Minkes Robert K. , Silen Mark L. , Langer Jacob C. , Tracy Thomas F. , Snyder Charles L. , Dillon Patrick A. , Weber Thomas R. 
Published: August 2004

Objective.
Acute appendicitis in children is managed by both general surgeons (GSs) and pediatric surgeons (PSs). Our objective was to investigate the economics of surgical care provided by either GSs or PSs for appendicitis.

Methods.
The outcome of children within our state who underwent operative treatment for appendicitis (January 1994 to June 1997) by board-certified GSs were compared with the results of PSs. Data were sorted according to patient age and diagnosis according to the International Classification of Diseases, Ninth Revision. Analysis of variance was performed on continuous data, and χ2 analysis was performed on nominal data; data are depicted as mean ± standard error of the mean.

Results.
GSs (n = 2178) managed older children when compared with PSs (n = 1018; 11.0 ± 0.1 vs 9.1 ± 0.1 years) and less frequently treated perforated appendicitis (18.8% vs 31.9%). Independent of diagnosis (simple or perforated appendicitis), younger children (0–4 years, 5–8 years, and 9–12 years) who were treated by PSs had a significantly shorter hospital stay and/or decreased hospital charge when compared with those who were treated by GSs. However, older children (13–15 years) seemed to have comparable outcomes.

Conclusions.
Younger children with appendicitis have reduced hospital days and charges when they are treated by PSs.
Cisapride Associated With QTc Prolongation in Very Low Birth Weight Preterm Infants
Authors: Dubin Anne , Kikkert Myrna , Mirmiran Majid , Ariagno Ronald 
Published: August 2004

Objective.
No systematic study has been performed to evaluate the effect of cisapride on the QT interval in premature infants. Cisapride, which has recently been withdrawn by the Food and Drug Administration and is no longer an approved therapy, was commonly used for preterm infant care to improve the advance of enteral feedings and to reduce reflux and associated apnea. Our aim was to evaluate the effect of recommended doses of cisapride on the QT interval in this population.

Study Design.
Prospective blinded evaluation of electrocardiogram for QT, JT, QTc, and JTc measurements in 25 preterm infants before and after cisapride administration.

Results.
Twelve of 25 infants (48%) developed repolarization abnormalities with cisapride administration: 32% of the infants (8/25) studied had QTc prolongation (≥0.450 seconds), whereas 10/25 had JTc prolongation (≥0.360 seconds). Preterm infants &lt;32 weeks significantly prolonged their QTc interval from 0.41 ± 0.02 to 0.44 ± 0.02. The QTc and/or JTc was prolonged in 54% of infants receiving 0.1 mg/kg/dose and 42% receiving 0.2 mg/kg/dose.

Conclusions.
The QTc and JTc interval significantly prolonged in preterm infants &lt;32 weeks on the recommended dose of cisapride therapy. A QTc ≥0.450 seconds developed in 32% of infants treated with cisapride, whereas the JTc prolonged in 40%. A significant percentage of infants (54%) developed prolonged QTc intervals at a dose of 0.1 mg/kg/dose. From these data we conclude that there is a higher risk of prolongation of the QTc interval and risk of arrhythmias with greater prematurity.
Infant Sleep Problems and Postnatal Depression: A Community-Based Study
Authors: Hiscock Harriet , Wake Melissa 
Published: August 2004

Objectives.To describe infant sleep patterns and investigate relationships between infant sleep problems and maternal well-being in the community setting.Design.Cross-sectional community survey.Setting.Maternal and Child Health Centers in 3 middle-class local government areas in Melbourne, Australia.Participants.Mothers of infants 6 to 12 months of age.Main Outcome Measures.Maternal well-being (Edinburgh Postnatal Depression Scale) and infant sleep problems (standardized maternal questionnaire).Results.The survey was completed by 738 mothers (94% response rate), of whom 46% reported their infant's sleep as a problem. In the univariate analyses, sleep patterns characterizing a sleep problem included the infant sleeping in the parent's bed, being nursed to sleep, taking longer to fall asleep, waking more often and for longer periods overnight, and taking shorter naps. The same sleep patterns were associated with high depression scores and tended to increase as depression scores increased.Because of positive skew, the Edinburgh Postnatal Depression Score was analyzed in 3 categories (&lt;10, 10–12, and &gt;12) using validated cutoff scores from community and clinical studies. Fifteen percent of mothers scored above 12 on the depression scale, indicating probable clinical depression, and 18% scored between 10 and 12, indicating possible clinical depression. After adjusting for potential confounders and factors significant in the univariate analyses, maternal report of an infant sleep problem remained a significant predictor of a depression score &gt;12 (odds ratio: 2.13; 95% confidence interval: 1.27,3.56) and &gt;10 (odds ratio: 2.88; 95% confidence interval: 1.93,4.31). However, mothers reporting good sleep quality, despite an infant sleep problem, were not more likely to suffer depression.Conclusions.Maternal report of infant sleep problems and depression symptoms are common in middle-class Australian communities. There is a strong association between the 2, even when known depression risk factors are taken into account. Maternal report of good sleep quality attenuates this relationship. Appropriate anticipatory guidance addressing infant sleep could potentially decrease maternal report of depressive symptoms.
The Role of Protein C, Protein S, and Resistance to Activated Protein C in Legg-Perthes Disease
Authors: Eldridge John , Dilley Anne , Austin Harland , EL-Jamil Muhydine , Wolstein Lori , Doris John , Hooper W. Craig , Meehan Peter L. , Evatt Bruce 
Published: August 2004

Objectives.
It has been hypothesized that Legg-Perthes disease is caused by repeated vascular interruptions of the blood supply to the proximal femur, which are precipitated by coagulation system abnormalities. To test this theory, we conducted a case-control study among 57 patients with Legg-Perthes disease and an equal number of community controls. We measured protein C and protein S and resistance to activated protein C (APC-R) from plasma.

Study Design.
Participants were placed into 1 of 3 mutually exclusive categories based on the control distribution: 1) normal, defined as either above or within 1 standard deviation below the expected mean; 2) low normal, defined as between 1 and 2 standard deviations below the expected mean; and 3) low, defined as &gt;2 standard deviations below the expected mean. DNA was analyzed to determine the presence of a point mutation in the factor V gene that causes APC-R.

Results.
We observed a statistically significant increased risk of Legg-Perthes disease with decreasing levels of protein C and a nearly significant increased risk with decreasing levels of protein S. The factor V gene defect was present in 5 (9%) of 55 cases and 3 (5%) of 56 controls (odds ratio 1.8, 95% confidence interval: 0.4–7.7), but the mean level on the APC-R plasma test was similar for cases and controls. Nine cases and 1 control had 2 low normal or low test results (odds ratio 13.0, 95% confidence interval: 2.2–75).

Conclusions.
Our results support the belief that abnormalities of the coagulation system leading to a thrombophilic state play a role in Legg-Perthes disease; however, larger studies are needed before definitive recommendations for coagulation testing can be made.
Physical Activity and Bone Measures in Young Children: The Iowa Bone Development Study
Authors: Janz Kathleen F. , Burns Trudy L. , Torner James C. , Levy Steven M. , Paulos Richard , Willing Marcia C. , Warren John J. 
Published: August 2004

Objectives.
Physical activity has a beneficial effect on bone development in circumpubertal children, although its effect on younger children is uncertain. In this cross-sectional study, we examined associations between physical activity and bone measures in 368 preschool children (mean age: 5.2 years, range: 4–6 years).

Design.
Physical activity was measured using 4-day accelerometry readings, parental report of children's usual physical activity, and parental report of children's hours of daily television viewing. Total body and site-specific bone mineral content and area bone mineral density (BMD) were measured by dual energy radiograph absorptiometry.

Results.
After adjustment for age and body size, accelerometry measures of physical activity and parental report of usual physical activity were consistently and positively associated with bone mineral content and BMD in both boys and girls (r = 0.15–0.28). Television viewing was inversely associated with hip BMD in girls (r = −0.15). The proportion of variance in bone measures explained by physical activity in linear regression models ranged fromr2 = 1.5% to 9.0%. In all of these models except total body BMD, at least 1 and often several of the physical activity variables entered as independent predictors. Activity variables most likely to enter the regression models were vigorous physical activity (as determined by accelerometry) and parental ranking of child's usual physical activity.

Conclusions.
Findings indicate that there are statistically significant and, perhaps important, associations between physical activity and bone measures during early childhood, well ahead of the onset of peak bone mass. This would suggest that intervention strategies to increase physical activity in young children could contribute to optimal bone development.
A Randomized Trial Comparing Povidone-Iodine to a Chlorhexidine Gluconate-Impregnated Dressing for Prevention of Central Venous Catheter Infections in Neonates
Authors: Garland Jeffery S. , Alex Colleen P. , Mueller Chris D. , Otten Dewey , Shivpuri Chandra , Harris Mary C. , Naples Mary , Pellegrini James , Buck Rosanne K. , McAuliffe Timothy L. , Goldmann Donald A. , Maki Dennis G. 
Published: August 2004

Neonates who require a central venous catheter (CVC) for prolonged vascular access experience high rates of catheter-related bloodstream infection (CRBSI).Purpose. A multicenter randomized clinical trial was undertaken to ascertain the efficacy of a novel chlorhexidine-impregnated dressing (Biopatch Antimicrobial Dressing) on the CVC sites of neonates for the prevention of catheter tip colonization, CRBSI, and bloodstream infection (BSI) without a source.Setting. Six level III neonatal intensive care units.Patients Studied. Neonates admitted to study units who would require a CVC for at least 48 hours.Methods. Eligible infants were randomized before catheter placement to 1 of the 2 catheter site antisepsis regimens: 1) 10% povidone-iodine (PI) skin scrub, or 2) a 70% alcohol scrub followed by placement of a chlorhexidine-impregnated disk over the catheter insertion site. A transparent polyurethane dressing (Bioclusive Transparent Dressing) was used to cover the insertion site in both study groups. Primary study outcomes evaluated were catheter tip colonization, CRBSI, and BSI without an identified source.Results. Seven hundred five neonates were enrolled in the trial, 335 randomized to receive the chlorhexidine dressing and 370 to skin disinfection with PI (controls). Neonates randomized to the antimicrobial dressing group were less likely to have colonized CVC tips than control neonates (15.0% vs 24.0%, relative risk [RR]: 0.6 95% confidence interval [CI]: 0.5–0.9). Rates of CRBSI (3.8% vs 3.2%, RR: 1.2, CI: 0.5–2.7) and BSI without a source (15.2% vs 14.3%, RR: 1.1, CI: 0.8–1.5) did not differ between the 2 groups. Localized contact dermatitis from the antimicrobial dressing, requiring crossover into the PI treatment group, occurred in 15 (15.3%) of 98 exposed neonates weighing ≤1000 g. No neonates in the PI group developed contact dermatitis.Conclusion. The novel chlorhexidine-impregnated dressing, replaced weekly, was as effective as cutaneous disinfection with 10% PI and redressing the site every 3 to 7 days for preventing CRBSI and BSI without a source in critically ill neonates requiring prolonged central venous access. The risk of local contact dermatitis under the chlorhexidine dressing limits its use in low birth weight infants who require prolonged central access during the first 2 weeks of life.
Diabetic Autoimmune Markers in Children and Adolescents With Type 2 Diabetes
Authors: Hathout Eba H. , Thomas Wendy , El-Shahawy Mohamed , Nahab Fadi , Mace John W. 
Published: August 2004

Background.
There is an increase in the incidence of type 2 diabetes in children and adolescents. Absence of known diabetes autoimmune markers is sometimes required to confirm the diagnosis.

Objective.
To identify clinical and autoimmune characteristics of type 2 diabetes in a pediatric population.

Method.
We report an analysis of 48 children and adolescents with type 2 diabetes, compared with 39 randomly selected children with type 1 diabetes, diagnosed and followed at the Loma Linda University Pediatric Diabetes Center. Ethnic, familial, seasonal, and autoimmune marker characteristics are outlined. To determine the reliability of antibody testing in confirming the type of diabetes at diagnosis, we studied the incidence of positive islet cell antibodies (ICAs), glutamic acid decarboxylase antibodies (GADs), and insulin autoantibodies (IAAs) at diagnosis in both groups. ICA512, GADs, and IAAs were measured by radioimmunoassay.

Results.
The cohort with type 2 diabetes had a similar gender distribution as the group with type 1 diabetes but a significantly higher age at diagnosis. Ethnic background was significantly different between the 2 groups, predominantly Hispanic in type 2 and white in type 1. Body mass index was significantly higher in type 2 diabetes (mean = 31.24 kg/m2). Among the patients with type 2 diabetes, 33% presented in diabetic ketoacidosis, random blood glucose at diagnosis ranged from 11.4 to 22.25 mmol/L (228–445 mg/dL), fasting C-peptide levels ranged from 0.89 to 2.7 nmol/L (2.7–8.2 ng/mL; normal: &lt;1.36 nmol/L), and hemoglobin A1C was 10.8 ± 3.5% (normal: &lt;6.6%). None of these parameters was significantly different from the type 1 diabetes group. Although the incidence of diabetes antibody markers was significantly lower in type 2 versus type 1 diabetes, 8.1% of patients with type 2 diabetes had positive ICAs, 30.3% had positive GADs, and 34.8% had positive IAAs without ever being treated with insulin. In the type 2 diabetes group, none of the Hispanic patients had ICAs. However, there was no significant correlation between any of the diabetes antibodies and obesity, presence of acanthosis nigricans, or family history of diabetes. The frequency of thyroid antibodies was not significantly different from the group with type 1 diabetes. Daily insulin requirements 1 year after diagnosis were significantly lower in type 2 diabetes, ranging from 0 to 1.2 U/kg with a mean of 0.33.

Conclusion.
Absence of diabetes autoimmune markers is not a prerequisite for the diagnosis of type 2 diabetes in children and adolescents.
The Epidemiology of Mental Retardation of Unknown Cause
Authors: Croen Lisa A. , Grether Judith K. , Selvin Steve 
Published: August 2004

Objective.
To describe selected infant and maternal characteristics for children with mild and severe mental retardation (MR) of unknown cause.

Study Design.
Children with MR of unknown cause born in California between 1987 and 1994 were identified through service agency records and compared with the total population of California live births for selected characteristics recorded on the birth certificate.

Results.
For both children with mild and severe MR, risk was increased among males, low birth weight children, and children born to women of black race, older age at delivery, and lower level of education. Increased risk for mild MR was found for multiple births, second or later-born children, and children whose mothers were born outside of California. Increased risk for severe MR was observed among children born to Hispanic mothers; children born to Asian mothers also had increased risk for severe MR but decreased risk for mild MR.

Conclusions.
These results provide clues for understanding the underlying causes of MR and suggest that both biological and social factors are important.
Contribution of Residential Exposures to Asthma in US Children and Adolescents
Authors: Lanphear Bruce P. , Kahn Robert S. , Berger Omer , Auinger Peggy , Bortnick Steven M. , Nahhas Ramzi W. 
Published: August 2004

Context.Residential exposures are recognized risk factors for asthma, but the relative contribution of specific indoor allergens and their overall contribution to asthma among older children and adolescents in the United States are unknown.Objective.To estimate the relative contributions, population-attributable risks, and costs of residential risk factors for doctor-diagnosed asthma.Design.Nationally representative, cross-sectional survey conducted from 1988 to 1994.Setting and Participants.A total of 5384 children who were 6 to 16 years old and participated in the National Health and Nutrition Examination Survey III, a survey of the health and nutritional status of children and adults in the United States.Main Outcome Measure.Doctor-diagnosed asthma, as reported by the parent.Results.Five hundred three of 5384 children and adolescents (11.4%) had doctor-diagnosed asthma. After adjusting for age, gender, race, urban status, region of country, educational attainment of the head of household, and poverty, predictors of doctor-diagnosed asthma included a history of allergy to a pet (odds ratio [OR: 2.4; 95% confidence interval [CI]: 1.7, 3.3), presence of a pet in the household (OR: 1.5; 95% CI: 1.1, 2.1), and immediate hypersensitivity to dust mite (OR: 1.5; 95% CI: 1.05, 2.0),Alternaria (OR: 1.9; 95% CI: 1.3, 2.8), and cockroach allergens (OR: 1.4; CI: 1.04, 1.9). Family history of atopy (OR: 1.7; 95% CI: 1.1, 2.7) and diagnosis of allergic rhinitis (OR: 2.1; CI: 1.1, 3.7) were also predictors for asthma. The population-attributable risk of having 1 or more residential exposures associated with doctor-diagnosed asthma was 44.4% (95% CI: 29–60), or an estimated 2 million excess cases. The attributable cost of asthma resulting from residential exposures was $405 million (95% CI: $264–$547 million) annually.Conclusions.The elimination of identified residential exposures, if causally associated with asthma, would result in a 44% decline in doctor-diagnosed asthma among older children and adolescents in the United States.
Safety and Immunogenicity of a Recombinant Borrelia burgdorferi Outer Surface Protein A Vaccine Against Lyme Disease in Healthy Children and Adolescents: A Randomized Controlled Trial
Authors: Sikand Vijay K. , Halsey Neal , Krause Peter J. , Sood Sunil K. , Geller Richard , Van Hoecke Christian , Buscarino Charles , Parenti Dennis ,   for the Pediatric Lyme Vaccine Study Group
Published: August 2004

Objective.
A recombinant lipoprotein outer surface protein A (OspA) Lyme disease (LD) vaccine (LYMErix) has been shown to be safe and effective in preventing LD in adults and in adolescents 15 years of age and older. Children are at risk for developing LD. This clinical study was conducted to address the safety and immunogenicity of LD vaccine in children 4 to 18 years of age.

Methods.
A randomized, placebo-controlled clinical trial was conducted at 17 investigational sites in Lyme-endemic areas in the United States. Immunogenicity data from this study also were compared with data obtained from the adult efficacy study. A total of 4090 healthy children and adolescents (age range: 4–18; mean age: 10.4 years) were randomized; 4087 were vaccinated, and a subset of 301 children participated in the immunogenicity analysis. Children were randomized to receive either 30 μg of LD vaccine (N = 3063) or placebo (N = 1024) on a 0, 1, 12-month schedule. Safety assessments evaluated both solicited (local: redness, swelling, and pain; general: fever, headache, fatigue, arthralgia, and rash) and unsolicited adverse events. Serum specimens were collected at month 0 or month 2, and months 6, 12, and 13.

Results.
Solicited reactogenicity data revealed a higher incidence of local injection site reactions and general symptoms (fever, headache, fatigue, and arthralgia) in vaccine than placebo recipients. The majority of events were limited in duration (mean: 2–3 days) and were mild to moderate in severity. The total IgG anti-OspA geometric mean titer (GMT) in the pediatric vaccine recipients at month 13 was as good as and statistically higher than the GMT in the adult cohort at month 13 (27 485 enzyme-linked immunosorbent assay units [EL.U]/mL vs 8216 EL.U /mL). All of the pediatric vaccine recipients attained a level of antibody concentration ≥1400 EL.U/mL (proposed seroprotective level) compared with 90% of adults attaining levels ≥1400 EL.U/mL in the efficacy trial.

Conclusions.
LD vaccine administered on a 0, 1, 12-month schedule generally is well tolerated and immunogenic in children 4 to 18 years of age. The safety profile consists of mild to moderate local injection site reactions and flu-like symptoms of limited duration and did not worsen with subsequent injections. IgG GMT at month 13 was threefold higher than the month 13 GMT obtained in the adult efficacy study. This higher immune response in children should provide protection against LD.