bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dexamethasone Treatment of Virilizing Congenital Adrenal Hyperplasia: The Ability to Achieve Normal Growth
Authors: Rivkees Scott A. , Crawford John D. 
Published: August 2004

Objective.To assess whether treatment of virilizing congenital adrenal hyperplasia (CAH) with long-acting glucocorticoids is associated with favorable growth outcomes.Method.We examined the long-term growth of 17 boys and 9 girls with CAH treated with dexamethasone (.27 ± .01 mg/m2/day).Results.For individuals with comparable bone age (BA) and chronological age (CA) at the onset of dexamethasone therapy, males were 2.8 ± .8 years (mean ± standard error of the mean;n = 13) and females were 2.4 ± 1.0 years (n = 6). Males were treated for 7.3 ± 1.1 years (ΔCA) over which time the change in BA (ΔBA) was 7.0 ± 1.3 years, and the change in height age (ΔHA) was 6.9 ± 1.1 years. Females were treated for 6.8 ± 1.3 years, over which time the ΔBA was 6.5 ± 1.0 years, and the ΔHA was 6.3 ± .8 years. During treatment 17 ketosteroid excretion rates were normal for age and 17-hydroxyprogesterone values were 69.6 ± 18 ng/dL. Testicular enlargement was first detected at 10.7 ± .8 years and breast tissue at 9.9 ± 1.2 years. Three boys and 1 girl had final heights of 171.8 ± 6 cm and 161 cm, respectively, compared with midparental heights of 176.1 ± 4.1 cm and 160 cm. Predicted adult heights for 6 other boys and 5 girls were 176.8 ± 2.0 cm and 161.4 ± 2.8 cm, respectively, compared with midparental heights of 174.6 ± 1.4 cm and 158.2 ± 2.0 cm. Statural outcomes were less favorable for 7 children started on dexamethasone when BAs were considerably advanced, although height predictions increased during therapy.Conclusions.These observations show that children treated with dexamethasone for CAH can achieve normal growth with the convenience of once-a-day dosing in most cases. congenital adrenal hyperplasia, dexamethasone, growth.
Factors Influencing Infant Visits to Emergency Departments
Authors: Sharma Vidya , Simon Stephen D. , Bakewell Janice M. , Ellerbeck Edward F. , Fox Michael H. , Wallace Dennis D. 
Published: August 2004

Objectives.To follow the 1995 birth cohort of infants, born in the State of Missouri, through their first birthday to: 1) examine their rates of visits to emergency departments (EDs), 2) identify predictors of any ED visit, 3) examine rates of nonurgent ED visits, and 4) identify predictors of nonurgent visits.Methods.This was a retrospective population cohort study. Using deterministic linkage procedures, 2 databases at the Missouri Department of Health (DOH; (the patient abstract database and the birth registry database) were linked by DOH personnel. International Classification of Diseases, Ninth Revision-Clinical Modification codes for ED visits were classified as emergent, urgent, or nonurgent by 2 researchers. Eight newborn characteristics were chosen for analysis. Negative binomial regression was used to examine the rates and predictors of both total and nonurgent ED visits.Results.There were 935 total ED visits and 153 nonurgent ED visits per 1000 infant years. The average number of visits was .94, with 59% of infants having no visits, 21% having 1 ED visit, and 20% having 2 or more visits.Factors associated with increases in both total and nonurgent ED visits were Medicaid, self-pay, black race, rural region, presence of birth defects, and a nursery stay of &gt;2 days. Significant interactions were found between Medicaid and race and Medicaid and rural regions on rates of ED use and nonurgent use.The highest rate of ED use, 1.8 per person year, was seen in white, rural infants on Medicaid, and the lowest rate (.4 per person year) was seen in urban white infants not on Medicaid. The highest rates of nonurgent use, .3 per person year, were among urban and rural Medicaid infants of both races and among black infants on commercial insurance. The lowest nonurgent rate, .04 per person year, was seen in white urban infants on commercial insurance.Conclusion.Infants in the State of Missouri have high rates of ED visits. Nonurgent visits are only a small portion of ED visits and cannot explain large variations in ED usage. Increased ED use by Medicaid patients may reflect continuing difficulties in accessing primary care.
Using a Health Concerns Checklist as a Bridge From Reason for Encounter to Diagnosis of Girls Attending an Adolescent Health Service
Authors: Wilf-Miron Rachel , Glasser Saralee , Sikron Fabienne , Barell Vita 
Published: August 2004

Objective.We assessed the extent to which a health concerns checklist (HCC) helps bridge the gap between the reason for encounter (RFE) described by girls entering an adolescent health service and the ultimate diagnosis.Methods.The sample, 547 consecutive 12- to 18-year-old girls visiting an adolescent health service, first underwent a structured intake procedure, including a self-administered form on which they described their RFEs and other health concerns, as well as a psychosocial interview and medical evaluation performed by staff members. The RFEs, HCC items, and diagnoses, grouped into somatic, sexuality-related, and psychosocial categories, were then compared.Results.Among the 399 girls expressing specific RFEs on entering the clinic, one-third were diagnosed with psychosocial disorders and one-fifth with sexuality-related concerns. Of the patients receiving a sexuality-related diagnosis, 57% presented with a sexuality-related request; another 26% noted it on the checklist. For those diagnosed with psychosocial problems, 22% stated this as the RFE, and another 50% indicated it on the HCC. The contribution of the HCC to the diagnosis was higher among adolescents not stating a specific RFE.Conclusion.The findings highlight the HCC's contribution in identifying health problems, especially among adolescents who find it difficult to verbalize sensitive issues.
Necrotizing Enterocolitis in Neonates With Congenital Heart Disease: Risk Factors and Outcomes
Authors: McElhinney Doff B. , Hedrick Holly L. , Bush David M. , Pereira Gilberto R. , Stafford Perry W. , Gaynor J. William , Spray Thomas L. , Wernovsky Gil 
Published: August 2004

Objective.
Necrotizing enterocolitis (NEC) is primarily a disease of the premature infant. Among children born at term, however, congenital heart disease may be an important predisposing factor for this condition. To determine risk factors for NEC in patients with congenital heart disease, we conducted a case–control study of neonates with cardiac disease admitted to the cardiac intensive care unit at our center during the 4-year period from January 1995 to December 1998.

Methods.
Cardiac diagnosis and age at admission were analyzed for association with NEC among the 643-patient inception cohort. Demographic, preoperative, and operative variables were recorded retrospectively in 21 neonates with congenital heart disease who developed NEC and 70 control neonates matched by diagnosis and age at admission. Using parametric and nonparametric analysis, cases and controls were compared with respect to previously identified risk factors for NEC.

Results.
Among the entire cohort of 643 neonates with heart disease admitted to the cardiac intensive care unit, diagnoses of hypoplastic left heart syndrome (odds ratio [OR] = 3.8 [1.6–9.1]) and truncus arteriosus or aortopulmonary window (OR = 6.3 [1.7–23.6]) were independently associated with development of NEC by multivariable analysis. In the case–control analysis, earlier gestational age at birth (36.7 ± 2.7 weeks vs 38.1 ± 2.3 weeks), prematurity (OR = 3.9 [1.2–12.5]), highest dose of prostaglandin &gt;0.05 μg/kg/minute (OR = 3.9 [1.2–12.5]), and episodes of low cardiac output (meeting specific laboratory criteria) or clinical shock (OR = 6.5 [1.8–23.5]) correlated with the development of NEC. Earlier gestational age and episodes of low output were the only factors that remained significantly associated with NEC by multivariable analysis. Although there was no difference in hospital mortality between patients with and without NEC, mean hospital stay was significantly longer in those who developed NEC (36 ± 22 days vs 19 ± 14 days).

Conclusions.
The risk of NEC in neonates with congenital heart disease is substantial. Factors associated with an elevated risk of NEC in infants with heart disease include premature birth, hypoplastic left heart syndrome, truncus arteriosus, and episodes of poor systemic perfusion or shock. Heightened suspicion is warranted in newborns with these risk factors.
Do Parents Understand Immunizations? A National Telephone Survey
Authors: Gellin Bruce G. , Maibach Edward W. , Marcuse Edgar K. ,   for the National Network for Immunization Information Steering Committee∥
Published: August 2004

Background.Immunization may now be undervalued because vaccines have largely eliminated the threat of serious infectious diseases in childhood. As the incidence of vaccine-preventable diseases has declined, concern about vaccine safety has increased. Significant erosion of public confidence in vaccine safety could lead to reduced immunization rates and a resurgence of vaccine-preventable diseases.Objective and Methods.To assess parents' understanding of vaccine-preventable diseases, vaccines, immunization practices, and policies, we conducted a telephone survey in the United States with a nationally representative sample (n = 1600) of parents with children ≤6 years of age, and expectant parents in April and May 1999.Results.Eighty-seven percent of respondents deemed immunization an extremely important action that parents can take to keep their children well. Although respondents' overall rating of immunization safety was high, a substantial minority held important misconceptions. For example, 25% believed that their child's immune system could become weakened as a result of too many immunizations, and 23% believed that children get more immunizations than are good for them. Children's health care providers were cited as the most important source of information on immunizations.Conclusions.Although the majority of parents understand the benefits of immunization and support its use, many parents have important misconceptions that could erode their confidence in vaccines. A systematic educational effort addressing common misconceptions is needed to ensure informed immunization decision-making. Physicians, nurses, and other providers of primary care have a unique opportunity to educate parents because parents see them as the most important source of information about immunizations. vaccination, immunization, pediatric, safety, health beliefs.
Predictors of Bacteremia in Febrile Children 3 to 36 Months of Age
Authors: Isaacman Daniel J. , Shults Justine , Gross Toni K. , Davis Paris H. , Harper Marvin 
Published: August 2004

Purpose.To develop an improved model for the prediction of bacteremia in young febrile children.Methods.A retrospective review was performed on patients 3 to 36 months of age seen in a children's hospital emergency department between December 1995 and September 1997 who had a complete blood count and blood culture ordered as part of their regular care. Exclusion criteria included current use of antibiotics or any immunodeficient state. Clinical and laboratory parameters reviewed included age, gender, race, weight, temperature, presence of focal bacterial infection, white blood cell count (WBC), polymorphonuclear cell count (PMN), band count, and absolute neutrophil count (ANC). Logistic regression analyses were used to identify factors associated with bacteremia, defined as growth of a pathogen in a blood culture. The model that was developed was then validated on a second dataset consisting of febrile patients 3 to 36 months of age collected from a second children's hospital (validation set).Results.There were 633 patients in the derivation set (46 bacteremic) and 9465 patients in the validation set (149 bacteremic). The mean age of patients in the derivation and validation sets were 15.8 months (95% confidence interval [CI]: 15.2–16.5) and 16.6 months (95% CI: 16.5–16.8), respectively; the mean temperatures were 39.1°C (95% CI: 39.0–39.2) and 39.8°C (95% CI: 39.7–39.8); 56% were male in the derivation set and 55% male in the validation set. Predictors of bacteremia identified by logistic regression included ANC, WBC, PMN, temperature, and gender. Receiver operator characteristic (ROC) analysis showed similar performance of ANC and WBC as predictors of bacteremia. When placed into a multivariate logistic regression model, band count was not significantly associated with bacteremia. Information regarding focal infection was available for 572 patients in the derivation set. The percentage of patients diagnosed with bacteremia with a focal bacterial infection was not significantly different from the percentage who had bacteremia without a focal bacterial infection (16/200 vs 30/372). Based on this dataset, a logistic regression formula was developed that could be used to develop a unique risk value for each patient based on temperature, gender, and ANC. When the final model was applied to the validation set, the area under the ROC curve (AUC) constructed from these data indicated that the model retained good predictive value (AUC for the derivation vs validation data = .8348 vs 0.8221, respectively).Conclusions.Use of the formulas derived here allows the clinician to estimate a child's risk for bacteremia based on temperature, ANC, and gender. This approach offers a useful alternative to predictions based on fever and WBC alone. bacteremia, detection, white blood cell.
Day-to-Day Reactogenicity and the Healthy Vaccinee Effect of Measles-Mumps-Rubella Vaccination
Authors: Virtanen Martti , Peltola Heikki , Paunio Mikko , Heinonen Olli P. 
Published: August 2004

Objective.
Revaccination policies adopted in many countries to control measles have raised various safety issues including those concerning the second vaccine dose. We performed a prospective, double-blind, crossover trial among twins receiving a measles-mumps-rubella (MMR) vaccine.

Study Design.
The study comprised 1162 monozygous and heterozygous twins, each of whom randomly received placebo and then vaccine, or vice versa, 3 weeks apart, at 14 to 83 months of age. Most of the oldest children had previously been vaccinated against measles, and one half of the remainder of children had had the disease. Symptoms and signs were recorded daily on structured forms. Statistical methods included a complex analysis of the vaccine attributability of the symptoms and conditional logistic regression.

Results.
Vaccination-attributable events occurred in 6% overall. At 14 to 18 months of age, reactions developed between days 6 and 14, peaking at day 10. The clearest vaccine-attributable effect was fever exceeding 101.3 °F (38.5°C; odds ratio: 3.28; 95% confidence interval: 2.23–4.82; P &lt; .001), but the same trend was found for rash, arthralgia, conjunctivitis, staying in bed, drowsiness, and irritability. At 6 years of age, systemic reactions occurred 5 to 15 times less frequently, only arthralgia being associated with vaccination. Zygocity, gender, history of allergy, or infections did not modify reactions. Instead, respiratory symptoms developed within days postinjection to a level of 15% to 20% without subsequent decline and with no difference between vaccinees and placebo recipients.

Conclusion.
Vaccination was avoided during infections, but many small children became mildly ill within a week or so with no relation to vaccination (the healthy vaccinee effect). MMR vaccine was virtually nonreactogenic when given at 6 years of age. vaccine, measles, mumps, rubella, reactogenicity, adverse events, zygocity, healthy vaccinee effect.
Major Factors Influencing Breastfeeding Rates: Mother's Perception of Father's Attitude and Milk Supply
Authors: Arora Samir , McJunkin Cheryl , Wehrer Julie , Kuhn Phyllis 
Published: August 2004

Objective.To determine factors influencing feeding decisions, breastfeeding and/or bottle initiation rates, as well as breastfeeding duration.Setting.A family medicine practice of a 530-bed community-based hospital in northwestern Pennsylvania.Participants.All mothers whose infants received well-child care from birth to 1 year of age.Outcome Measure.A survey of 28 simple questions was developed and mailed to 245 mothers. The survey assessed: 1) demographics, 2) prenatal and postnatal care, 3) sources of breastfeeding information, 4) timing of decision, 5) preference, 6) type of feeding selected, 7) duration of breastfeeding, 8) factors influencing decisions to breastfeed and/or to bottle-feed, and 9) factors that would have encouraged bottle-feeding mothers to breastfeed.Results.The breastfeeding initiation rate was 44.3%. By the time the infant was 6 months old, only 13% of these were still breastfeeding. The decision to breastfeed or to bottle-feed was most often made before pregnancy or during the first trimester. The most common reasons mothers chose breastfeeding included: 1) benefits the infant's health, 2) naturalness, and 3) emotional bonding with the infant. The most common reasons bottle-feeding was chosen included: 1) mother's perception of father's attitude, 2) uncertainty regarding the quantity of breast milk, and 3) return to work. By self-report, factors that would have encouraged bottle-feeding mothers to breastfeed included: 1) more information in prenatal class; 2) more information from TV, magazines, and books; and 3) family support.Conclusions.To overcome obstacles, issues surrounding perceived barriers, such as father's attitude, quantity of milk, and time constraints, need to be discussed with each parent. To achieve the goal of 75% of breastfeeding mothers, extensive education regarding the benefits must be provided for both parents and optimally the grandmother by physicians, nurses, and the media before pregnancy or within the first trimester.
Targeting Lead Screening: The Ohio Lead Risk Score
Authors: Litaker David , Kippes Christopher M. , Gallagher Timothy E. , O'Connor Mary E. 
Published: August 2004

Objective.
Annual blood lead (BPb) screening is recommended for children ≤2 years of age residing in high-risk areas. Strategies for identifying these areas exist but lack specificity. We sought to develop an efficient method for identifying risk factors for undue lead exposure in children by using community variables.

Design.
Logistic regression for model development in one half of the sample followed by validation of the model in the remaining half.

Methods.
The association between selected census tract characteristics from 19 Ohio counties and the BPb test results of children living in those census tracts was evaluated. The dependent variable, high-risk status, was defined as a census tract with ≥12% of BPb test results ≥10 μg/dL.

Results.
Data from 897 census tracts were available. Higher risk for lead toxicity existed in areas where: 1) ≥55% of houses were built before 1950 (adjusted odds ratio [AOR]: 10.9 [6.1,19.6]); 2) ≥35% of residents were black (AOR: 3.5 [2.0,6.3]); 3) ≥35% of residents had less than a high school education (AOR: 6.1 [3.6,10.4]); and 4) ≥50% of housing units were renter-occupied (AOR: 3.6 [2.1,6.2]). Receiver operator characteristic (ROC) curves demonstrated no significant differences after applying the model in a second dataset.

Conclusions.
Several community characteristics predict risk for lead toxicity in children and may provide a useful approach to focus lead screening, especially in communities where public health resources are limited. The approach described here may also prove helpful in identifying factors within a community associated with other environmental public health hazards for children.
Providing Pediatric Subspecialty Care: A Workforce Analysis
Authors: Stoddard Jeffrey J. , Cull William L. , Jewett Ethan A. B. , Brotherton Sarah E. , Mulvey Holly J. , Alden Errol R. ,   for the AAP Committee on Pediatric Workforce Subcommittee on Subspecialty Workforce
Published: August 2004

Objective.To provide a snapshot of pediatric subspecialty practice, examine issues pertaining to the subspecialty workforce, and analyze subspecialists' perspective on the health care market.Background.Before the effort of the Future of Pediatric Education II (FOPE II) Project, very little information existed regarding the characteristics of the pediatric subspecialty workforce. This need was addressed through a comprehensive initiative involving cooperation between subspecialty sections of the American Academy of Pediatrics and other specialty societies.Methods.Questionnaires were sent to all individuals, identified through exhaustive searches, who practiced in 17 pediatric medical and surgical subspecialty areas in 1997 and 1998. The survey elicited information about education and practice issues, including main practice setting, major professional activity, referrals, perceived competition, and local workforce requirements. The number of respondents used in the analyses ranged from 120 (plastic surgery) to 2034 (neonatology). In total, responses from 10 010 pediatric subspecialists were analyzed.Results.For 13 of the subspecialties, a medical school setting was specified by the largest number of respondents within each subspecialty as their main employment site. Direct patient care was the major professional activity of the majority of respondents in all the subspecialties, with the exception of infectious diseases. Large numbers of subspecialists reported increases in the complexity of referral cases, ranging between 20% (cardiology) and 44% (critical care), with an average of 33% across the entire sample. In all subspecialties, a majority of respondents indicated that they faced competition for services in their area (range: 55%–90%; 71% across the entire sample); yet in none of the subspecialties did a majority report that they had modified their practice as a result of competition. In 15 of the 17 subspecialties, a majority stated that there would be no need in their community over the next 3 to 5 years for additional pediatric subspecialists in their discipline. Across the entire sample, 42% of respondents indicated that they or their employer would not be hiring additional, nonreplacement pediatric subspecialists in their field in the next 3 to 5 years (range: 20%–63%).Conclusion.This survey provides the first comprehensive analysis to date on how market forces are perceived to be affecting physicians in the pediatric subspecialty workforce. The data indicate that pediatric subspecialists in most areas are facing strong competitive pressures in the market, and that the market's ability to support additional subspecialists in many areas may be diminishing.