bluuebunny/crossref_metadata_2025_split huggingface dataset:
Videotape Increases Parent Knowledge About Poliovirus Vaccines and Choices of Polio Vaccination Schedules
Authors: Dunn Ruth Ann , Shenouda Pamela E. , Martin Denny R. , Schultz Abbigail J. 
Published: August 2004

Objective. To study the effect of an educational videotape about poliovirus vaccines and choices of schedules for parents/guardians of children starting the polio vaccination series.Design. Prospective, randomized trial comparing two educational interventions.Setting. Five pediatric offices (two university-based, two health maintenance organization staff models, and one private practice) and a local health department immunization clinic in the greater Lansing, MI, area.Participants. A total of 287 parents/guardians of 2- to 3-month-olds presenting for well-child care and due for the first set of immunizations including poliovirus vaccine.Interventions. Parents/guardians were randomized to read the vaccine information statement (VIS) alone or to read the VIS and view a 15-minute videotape about polio vaccination and choices of schedules produced by Michigan State University. The intervention groups were similar by race/ethnicity, education, and relationship to the child.Outcome Measures. Change in knowledge about the risk of poliomyelitis in the United States, transmission of poliomyelitis, characteristics of the two poliovirus vaccines, and choices of polio vaccination schedules; and parent opinion on effectiveness of the interventions, as measured by pre- and postintervention questionnaires.Results. Both interventions resulted in increased test scores of knowledge. However, videotape viewers scored significantly higher on their posttest compared with parents/guardians assigned to VIS only. This significant increase was noted across all practice types, two of three major racial/ethnic groups, and educational levels. (The increase for Hispanic parents/guardians approached significance). Reading the VIS did not improve posttest scores for videotape viewers. Reading the VIS did improve posttest scores for those assigned to VIS only, but these scores still were not as high as for videotape viewers who did not read the VIS.Conclusions. This study demonstrated that a complicated discussion of risks/benefits of two vaccines and their schedules of administration could be communicated effectively via a videotaped presentation. In addition, the videotape was more effective than VIS alone in increasing short-term knowledge, regardless of practice type, race/ethnicity, or educational level. As immunization schedules increase in complexity and parents are asked to make more choices, videotaped information may be a better method to achieve the goal of truly informed consent.
Palivizumab, a Humanized Respiratory Syncytial Virus Monoclonal Antibody, Reduces Hospitalization From Respiratory Syncytial Virus Infection in High-risk Infants
Authors:   The IMpact-RSV Study Group
Published: August 2004

Objective.
To determine the safety and efficacy of prophylaxis with palivizumab in reducing the incidence of hospitalization because of respiratory syncytial virus (RSV) infection in high-risk infants.

Methods.
A randomized, double-blind, placebo-controlled trial was conducted at 139 centers in the United States, the United Kingdom, and Canada. During the 1996 to 1997 RSV season, 1502 children with prematurity (≤35 weeks) or bronchopulmonary dysplasia (BPD) were randomized to receive 5 injections of either palivizumab (15 mg/kg) or an equivalent volume of placebo by intramuscular injection every 30 days. The primary endpoint was hospitalization with confirmed RSV infection. Children were followed for 150 days (30 days from the last injection). Those with hospitalization as a result of RSV infection were evaluated for total number of days in the hospital, total days with increased supplemental oxygen, total days with moderate or severe lower respiratory tract illness, and incidence and total days of intensive care and mechanical ventilation. The incidence of hospitalization for respiratory illness not caused by RSV and the incidence of otitis media were also evaluated. The placebo and palivizumab groups were balanced at entry for demographics and RSV risk factors. Ninety-nine percent of children in both groups completed the protocol and ∼93% received all five scheduled injections.

Results.
Palivizumab prophylaxis resulted in a 55% reduction in hospitalization as a result of RSV (10.6% placebo vs 4.8% palivizumab). Children with prematurity but without BPD had a 78% reduction in RSV hospitalization (8.1% vs 1.8%); children with BPD had a 39% reduction (12.8% vs 7.9%). When gender, entry age, entry weight, BPD, and gestational age were included in a logistic regression model, the effect of prophylaxis with palivizumab remained statistically significant. The palivizumab group had proportionally fewer total RSV hospital days, fewer RSV hospital days with increased oxygen, fewer RSV hospital days with a moderate/severe lower respiratory tract illness, and a lower incidence of intensive care unit admission. Palivizumab was safe and well tolerated. No significant differences were observed in reported adverse events between the two groups. Few children discontinued injections for related adverse events (0.3%). Reactions at the site of injection were uncommon (1.8% placebo vs 2.7% palivizumab); the most frequent reaction was mild and transient erythema. Mild or moderate elevations of aspartate aminotransferase occurred in 1.6% of placebo recipients and 3.6% of palivizumab recipients; for alanine aminotransferase these percentages were 2.0% and 2.3%, respectively. Hepatic and renal adverse events related to the study drug were similar in the two groups.

Conclusions.
Monthly intramuscular administration of palivizumab is safe and effective for prevention of serious RSV illness in premature children and those with BPD.
Three-Year Multicenter Surveillance of Systemic Pneumococcal Infections in Children
Authors: Kaplan Sheldon L. , Mason Edward O. , Barson William J. , Wald Ellen R. , Arditi Moshe , Tan Tina Q. , Schutze Gordon E. , Bradley John S. , Givner Laurence B. , Kim Kwang Sik , Yogev Ram 
Published: August 2004

Objective.To track antibiotic susceptibility of Streptococcus pneumoniae isolates obtained from children with systemic infections and determine outcome of treatment.Design.A 3-year (September 1993 through August 1996) prospective surveillance study of all invasive pneumococcal infections in children.Patients.Infants and children cared for at eight children's hospitals in the United States with culture-proven systemic pneumococcal infection.Results.One thousand two hundred ninety-one episodes of systemic pneumococcal infection were identified in 1255 children. An underlying illness was present in the children for 27% of the episodes. The proportion of isolates that were nonsusceptible to penicillin or ceftriaxone increased annually and nearly doubled throughout the 3-year period; for the last year the percentages of isolates nonsusceptible to penicillin and ceftriaxone were 21% and 9.3%, respectively. There was no difference in mortality between patients with penicillin-susceptible or nonsusceptible isolates. Only 1 of 742 patients with bacteremia had a repeat blood culture that was positive &gt;1 day after therapy was started. All 24 normal children with bacteremia attributable to isolates resistant to penicillin had resolution of their infection; the most common treatment regimen was a single dose of ceftriaxone followed by an oral antibiotic.Conclusions.The percentage of pneumococcal isolates nonsusceptible to penicillin and ceftriaxone increased yearly among strains recovered from children with systemic infection. Because empiric antibiotic therapy already has changed for suspected pneumococcal infections, antibiotic resistance has not been associated with increased mortality. Careful monitoring of antibiotic susceptibility and outcome of therapy is necessary to continually reassess current recommendations for treatment.
Heterogeneity of Diagnoses Presenting as Cyclic Vomiting
Authors: Li B U. K. , Murray Robert D. , Heitlinger Leo A. , Robbins Jennifer L. , Hayes John R. 
Published: August 2004

Objective.To establish the diagnostic profile in children who present with cyclic vomiting.Methods.We studied 225 children &lt;18 years of age who presented to our pediatric gastroenterology service from 1986 to 1997 with at least three discrete episodes of vomiting between which they were well. To determine the diagnoses in those presenting with a pattern of cyclic vomiting, the results of diagnostic testing and responses to various treatments were obtained from a combination of chart review and structured telephone interviews.Results.The largest diagnostic category included idiopathic cyclic vomiting syndrome (88%). Extraintestinal disorders (7%) and gastrointestinal disorders (5%) constituting the probable cause of vomiting were established in those having complete cessation of episodes after therapy. In 12%, serious surgical disorders of the gastrointestinal (malrotation), renal (acute hydronephrosis), and central nervous systems (neoplasm) were found. In 2%, serious endocrine (Addison's disease) and metabolic disorders (disorder of fatty acid oxidation) were found. Among those with idiopathic cyclic vomiting syndrome, 41% had associated disorders (gastroesophageal reflux and chronic sinusitis) that could contribute to the vomiting, but, based on a partial response to therapy, were not deemed to be the main cause. Altogether 49% had an identified disorder that probably caused or could contribute to the vomiting.Conclusions.The cyclic pattern of vomiting is a symptom complex that can be induced by heterogeneous disorders that either cause or contribute to the vomiting. Once the cyclic vomiting pattern is identified, systematic diagnostic testing is warranted to look for these underlying disorders.
Hidden Spears: Handlebars as Injury Hazards to Children
Authors: Winston Flaura K. , Shaw Kathy N. , Kreshak Allyson A. , Schwarz Donald F. , Gallagher Paul R. , Cnaan Avital 
Published: August 2004

Objectives.
To delineate the mechanism of serious bicycle handlebar-related injuries in children and make recommendations for preventive strategies.

Methods.
Prospective cross-sectional surveillance system of seriously injured child bicyclists supplemented by in-depth, on-site crash investigation to delineate specific injury mechanisms. Interdisciplinary analyses involved engineers, clinicians, epidemiologists, and biostatisticians.

Setting.
The emergency department and in-patient trauma service of an urban level one pediatric trauma center between October 1995 and September 1997.

Participants.
Patients under 18 years of age who were treated for serious bicycle-related injuries (Abbreviated Injury Scale scores of 2 or greater).

Results.
The surveillance system identified two distinct circumstances for serious child bicyclist injury: 1) handlebar-related injuries associated with minor incidents (falls from bicycles) and 2) nonhandlebar-related injuries associated with severe incidents (bicycle-motor vehicle crashes). Crash investigations explored the minor incidents that resulted in serious handlebar-associated injuries. In the typical mechanism, as the child lost control of the bicycle and began to fall, the front wheel rotated into a plane perpendicular to the child's body. The child then landed on the end of the handlebar resulting in serious truncal injuries.

Conclusions.
A discordancy exists between the apparently minor circumstances and serious injuries sustained by child bicyclists who impact bicycle handlebars. Recognition of the mechanism of handlebar-related injuries might aid the practitioner in early diagnosis of serious abdominal injuries in child bicyclists. This injury mechanism may be avoided through bicycle redesign that would involve both limiting rotation of the front wheel and modifying the ends of handlebars. An integrated approach involving a surveillance system to identify an injury hazard supplemented by in-depth, on-site crash investigations effectively provided the detailed mechanism of injury needed to develop interventions.
Toppled Television Sets Cause Significant Pediatric Morbidity and Mortality
Authors: Bernard Philip A. , Johnston Carden , Curtis Scott E. , King William D. 
Published: August 2004

Objective.To quantify pediatric injuries and deaths that result from toppled television sets.Design.Retrospective analysis of incident files compiled by the US Consumer Product Safety Commission (CPSC) data systems and The Children's Hospital of Alabama (TCHA) inpatient medical records.Setting.United States, January 1990–June 1997. TCHA, May 1995–October 1997.Main Outcome Measures.Morbidity or mortality as a result of a television set falling onto a child.Results.Over the 7-year period from January 1990 to June 1997, 73 cases that involved falling television sets were reported to the CPSC, including 28 deaths. The mean age of all victims was 36 months (SD ± 25.4 months). The mean age of those who died was 31 months (SD ± 22 months). Females accounted for 42 incidents (58%) and 19 deaths (68%). The most common anatomic site of injury was the head, which accounted for 72% of cases investigated by CPSC personnel. Of the 14 deaths further investigated by the CPSC, head injury was responsible for 13, with a generalized crushing injury accounting for the other. Of the 45 cases in which data were available, dressers or stands were identified as the television support 76% of the time. The TCHA database yielded five additional cases, including one death, with demographics similar to the CPSC data.Conclusion.Serious injury and death can occur as a result of children toppling television sets from elevated locations in the home. The furniture on which a television set is situated is of fundamental importance. An estimate of overall risk to the population is impossible to determine from these data. In light of 73 reported cases with 28 deaths; however, injury prevention counseling and other strategies supporting in-home safety should include a secure and child-safe location for television sets. Attention should be paid to safer design and placement of this ubiquitous product. television, wounds and injuries, accidents, human, infants, children.
Human Milk Feedings and Infection Among Very Low Birth Weight Infants
Authors: Hylander Mary Ann , Strobino Donna M. , Dhanireddy Ramasubbareddy 
Published: August 2004

Background.Preterm infants are immunologically immature at birth. Previous studies have demonstrated that human milk protects against infection in full-term infants, but there are few studies of its effect for preterm infants.Objective.To examine the effect of human milk feedings on infection incidence among very low birth weight (VLBW) infants during their initial hospitalization.Study Design.The sample consisted of 212 consecutive VLBW infants admitted to the Georgetown University Medical Center neonatal intensive care unit (NICU) during 1992–1993 and surviving to receive enteral feeding. Type of feeding (human milk vs formula), presence of infection and sepsis/meningitis (clinical signs and positive cultures for pathogenic organisms), and potential confounding variables were abstracted from medical records. Multiple logistic regression was used to control for confounders.Results.The incidence of infection (human milk [29.3%] vs formula [47.2%]) and sepsis/meningitis (human milk [19.5%] vs formula [32.6%]) differed significantly by type of feeding. Major risk factors for infection were similar in both groups. Human milk feeding was independently correlated with a reduced odds of infection (odds ratio [OR] = 0.43; 95% confidence interval [CI]: 0.23–0.81), controlling for gestational age, 5-minute Apgar score, mechanical ventilation days, and days without enteral feedings; and was independently correlated with a reduced odds of sepsis/meningitis (OR = 0.47, 95% CI:0.23–0.95), controlling for gestational age, mechanical ventilation days, and days without enteral feedings.Conclusions.The incidence of any infection and sepsis/meningitis are significantly reduced in human milk-fed VLBW infants compared with exclusively formula-fed VLBW infants.
A Novel Use of Xylitol Sugar in Preventing Acute Otitis Media
Authors: Uhari Matti , Kontiokari Tero , Niemelä Marjo 
Published: August 2004

Background.
Xylitol, a commonly used sweetener, is effective in preventing dental caries. As it inhibits the growth of pneumococci, we evaluated whether xylitol could be effective in preventing acute otitis media (AOM).

Design.
Altogether, 857 healthy children recruited from day care centers were randomized to one of five treatment groups to receive control syrup (n = 165), xylitol syrup (n = 159), control chewing gum (n = 178), xylitol gum (n = 179), or xylitol lozenge (n = 176). The daily dose of xylitol varied from 8.4 g (chewing gum) to 10 g (syrup). The design was a 3-month randomized, controlled trial, blinded within the chewing gum and syrup groups. The occurrence of AOM each time the child showed any symptoms of respiratory infection was the main outcome.

Results.
Although at least one event of AOM was experienced by 68 (41%) of the 165 children who received control syrup, only 46 (29%) of the 159 children receiving xylitol syrup were affected, for a 30% decrease (95% confidence interval [CI]: 4.6%–55.4%). Likewise, the occurrence of otitis decreased by 40% compared with control subjects in the children who received xylitol chewing gum (CI: 10.0%–71.1%) and by 20% in the lozenge group (CI: −12.9%–51.4%). Thus, the occurrence of AOM during the follow-up period was significantly lower in those who received xylitol syrup or gum, and these children required antimicrobials less often than did controls. Xylitol was well tolerated.

Conclusions.
Xylitol sugar, when given in a syrup or chewing gum, was effective in preventing AOM and decreasing the need for antimicrobials.
Declining Severity Adjusted Mortality: Evidence of Improving Neonatal Intensive Care
Authors: Richardson Douglas K. , Gray James E. , Gortmaker Steven L. , Goldmann Donald A. , Pursley DeWayne M. , McCormick Marie C. 
Published: August 2004

Objectives.Declines in neonatal mortality have been attributed to neonatal intensive care. An alternative to the “better care” hypothesis is the “better babies” hypothesis; ie, very low birth weight infants are delivered less ill and therefore have better survival.Design.We ascertained outcomes of all live births &lt;1500 g in two prospective inception cohorts. We estimated mortality risk from birth weight and illness severity on admission and measured therapeutic intensity. We calculated logistic regression models to estimate the changing odds of mortality between cohorts.Patients and Setting.Two cohorts in the same two hospitals, 5 years apart (1989–1990 and 1994–1995) (totaln = 739).Results.Neonatal intensive care unit mortality declined from 17.1% to 9.5%, and total mortality declined from 31.6% to 18.4%. Cohort 2 had lower risk (higher birth weight, gestational age, and Apgar scores and lower admission illness severity for newborns ≥750 g). Risk-adjusted mortality declined (odds ratio, 0.52; confidence interval, 0.29–0.96). One third of the decline was attributable to “better babies” and two thirds to “better care.” Use of surfactant, mechanical ventilation, and pressors became more aggressive, but decreases in monitoring, procedures, and transfusions resulted in little change in therapeutic intensity.Conclusions.Mortality decreased nearly 50% for infants &lt;1500 g in 5 years. One third of this decline is attributable to improved condition on admission that reflects improving obstetric and delivery room care. Two thirds of the decline is attributable to more effective newborn intensive care, which was associated with greater aggressiveness of respiratory and cardiovascular treatments. Attribution of improved birth weight specific mortality solely to neonatal intensive care may underestimate the contribution of high-risk obstetric care in providing “better babies.”
The Effect of Investigator Compliance (Observer Bias) on Calculated Efficacy in a Pertussis Vaccine Trial
Authors: Cherry James D. , Heininger Ulrich , Stehr Klemens , Christenson Peter 
Published: August 2004

Background.In the course of a large pertussis vaccine efficacy trial we realized that investigator compliance could have a major impact on calculated vaccine efficacy.Design.In our pertussis vaccine efficacy trial, the study investigators were to monitor illness in study families by telephone every 2 weeks. If a cough illness of ≥7 days duration was noted, the study child was to be evaluated. If the cough illness persisted for ≥14 days, the child was to be referred to a central investigator. For this report we analyzed study physician evaluation rates and rates of referral to the central investigators. Physician practices were separated into three compliance categories: high, intermediate, and low. We analyzed vaccine efficacy of an acellular pertussis component DTP vaccine (DTaP) and a whole cell pertussis component DTP vaccine (DTP) by compliance category. Bordetella pertussisinfection was documented by culture of the organism in the study child or in a household contact or by a significant antibody response to pertussis toxin determined by enzyme-linked immunosorbent assay.Results.Using a clinical case definition that included both mild and typical pertussis (cough illness ≥7 days duration) efficacy of DTaP vaccine was 40% (95% confidence interval [CI] = −3–65) in the high compliance category and 78% (95% CI = 65–86) and 75% (95% CI = 53–87) in the intermediate and low compliance groups, respectively. Similar, but less marked, differences in efficacy were noted with DTP vaccine recipients. Using a clinical case definition that required ≥21 days of cough with paroxysms, whoop, or vomiting (typical pertussis) the efficacy of DTaP vaccine was 69% (95% CI = 41–83) in the high compliance category and 86% (95% CI = 76–92) and 84% (95% CI = 64–93) in the intermediate and low compliance groups, respectively. In contrast, the efficacy of DTP vaccine did not vary by compliance category using this case definition. The attack rate in children vaccinated with diphtheria and tetanus toxoids vaccine (DT) was twofold less in low compliance physician practices when compared with the rates in high and intermediate groups. The DT/DTaP and DT/DTP fold-change differences were less in the high compliance group compared with the intermediate and low compliance groups.Conclusions.Our data suggest that observer compliance (observer bias), can significantly inflate calculated vaccine efficacy. It is likely that all recently completed efficacy trials have been effected by this type of observer bias and all vaccines have considerably less efficacy against mild disease than published data suggest.
Syncope Recurrence in Children: Relation to Tilt-test Results
Authors: Salim Mubadda A. , Ware Linda E. , Barnard Marie , Alpert Bruce S. , DiSessa Thomas G. 
Published: August 2004

Objectives.To examine the intermediate-term outcome of children with syncope and its relationship to tilt test.Design.This was a retrospective study of 45 children. In 20, the tilt test was negative. Follow-up with respect to the recurrence of syncope was obtained via chart review, a mailed questionnaire, or telephone interview.Results.Follow-up data were available on 15 children whose tilt test was negative and on all 25 tilt-test positive children. Recurrent syncope was significantly greater in the positive-tilt children (13 of 25) than the negative-tilt children (2 of 15). There was no difference between the syncope-free group and the recurrent syncope group or between the tilt-positive and tilt-negative groups with respect to age at initial syncope, duration of symptoms, age at tilt test, and duration of follow-up. Children with a positive tilt test and those with recurrent syncope had more syncopal episodes before their evaluation than either the group with a negative tilt test or the group with no recurrent syncope, respectively.Conclusions.Syncope may recur after either a negative or a positive tilt test. The recurrence rate, however, is higher for the tilt-positive children.