bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neurodevelopmental Outcome of Infants Treated With Head Cooling and Mild Hypothermia After Perinatal Asphyxia
Authors: Battin Malcolm R. , Dezoete J. Anne , Gunn Tania R. , Gluckman Peter D. , Gunn Alistair J. 
Published: August 2004

Objectives.To determine the neurodevelopmental outcome of infants treated with head cooling with systemic hypothermia after hypoxic-ischemic encephalopathy.Study Group.Infants ≥37 weeks' gestation, who had an umbilical artery pH ≤7.09 or Apgar score ≤6 at 5 minutes, plus clinical encephalopathy. Infants with major congenital abnormalities were excluded.Trial Design.Infants were allocated to either no cooling (rectal temperature = 37.0 ± 0.2°C, n= 15), or, sequentially, to head cooling accompanied by different levels of systemic hypothermia, including minimal cooling, rectal temperature 36.5°C to 36°C (n = 6), and mild cooling, to either 35.9°C to 35.5°C (n = 6), 35 ± 0.5°C (n = 6) or 34.5 ± 0.5°C (n = 7). Head cooling was accomplished by circulating cooled water through a coil of tubing wrapped around the head for up to 72 hours. Survivors were followed up with regular neurologic examination by a neonatologist until 18 months of age, then with blinded developmental testing using the revised Bayley Scales.Results.A total of 40 term infants were enrolled from 2 to 5 hours after birth. The control and the cooled groups were not significantly different for gestation, birth weight, Apgar score, and initial pH. There were 6 early neonatal deaths (3 normothermic and 3 cooled), and 1 death in infancy associated with severe spastic cerebral palsy in a normothermic infant. Six normothermic, 1 minimally cooled, and 4 mildly cooled infants had early stage 1 encephalopathy; all but 1 had a good outcome. Among infants with early stage 2 or 3 encephalopathy, an adverse outcome was found in 4 of 9 normothermic infants (44%) and 4 of 5 minimally cooled infants (80%), whereas in the combined mildly cooled groups, an adverse outcome was found in 4 of 15 infants (26%, odds ratio 0.46 [0.08, 2.56] vs normothermia).Conclusions.The present study supports the safety of hypothermia, with no evidence of late adverse effects in any infant. Among infants with moderate to severe encephalopathy at enrollment, there was a tendency toward better outcome. These results emphasize the relatively wide range of outcomes using purely clinical criteria for enrollment. Therapeutic hypothermia should not be used outside of stringent, multicenter trials.
Adolescent Suicide Attempts: Risks and Protectors
Authors: Borowsky Iris Wagman , Ireland Marjorie , Resnick Michael D. 
Published: August 2004

Objective.In 1997, suicide was the third leading cause of death among 10- to 19-year-olds in the United States, with the greatest increases in suicide rates in the previous decade experienced by black and other minority youth. The purpose of this study was to identify risk and protective factors for suicide attempts among black, Hispanic, and white male and female adolescents.Methods.We used data from the National Longitudinal Study of Adolescent Health, conducted in 1995 and 1996. A nationally representative sample of 13 110 students in grades 7 through 12 completed 2 in-home interviews, an average of 11 months apart. We examined Time 1 factors at the individual, family, and community level that predicted or protected against Time 2 suicide attempts.Results.Perceived parent and family connectedness was protective against suicide attempts for black, Hispanic, and white girls and boys, with odds ratios ranging from 0.06 to 0.32. For girls, emotional well-being was also protective for all of the racial/ethnic groups studied, while a high grade point average was an additional protective factor for all of the boys. Cross-cutting risk factors included previous suicide attempt, violence victimization, violence perpetration, alcohol use, marijuana use, and school problems. Additionally, somatic symptoms, friend suicide attempt or completion, other illicit drug use, and a history of mental health treatment predicted suicide attempts among black, Hispanic, and white females. Weapon-carrying at school and same-sex romantic attraction were predictive for all groups of boys. Calculating the estimated probabilities of attempting suicide for adolescents with increasing numbers of risk and protective factors revealed that the presence of 3 protective factors reduced the risk of a suicide attempt by 70% to 85% for each of the gender and racial/ethnic groups, including those with and without identified risk factors.Conclusions.In these national samples of black, Hispanic, and white youth, unique and cross-cutting factors derived from a resiliency framework predicted or protected against attempting suicide. In addition to risk reduction, promotion of protective factors may offer an effective approach to primary as well as secondary prevention of adolescent suicidal behavior.
Analysis of Nonsteroidal Antiinflammatory Drugs in Meconium and Its Relation to Persistent Pulmonary Hypertension of the Newborn
Authors: Alano Maria Andrea , Ngougmna Etienne , Ostrea Enrique M. , Konduri G. Ganesh 
Published: August 2004

Objective.The objective of this study was to detect fetal exposure to nonsteroidal antiinflammatory drugs (NSAIDs) by meconium analysis and to determine the relationship between fetal exposure to NSAIDs and the development of persistent pulmonary hypertension of the newborn (PPHN).Methods.In a case-control study of the inborn and outborn nurseries of a large urban medical center, meconium was collected from 101 newborn infants (40 with the diagnosis of PPHN based on clinical or echocardiographic criteria and 61 randomly selected, healthy, term infants [control]) and analyzed for NSAIDs (ibuprofen, naproxen, indomethacin, and aspirin) by gas chromatography/mass spectrometry. The risk of developing PPHN was determined in infants who were exposed antenatally to NSAID.Results.Infants with PPHN (n = 40) had a mean gestation of 38.9 weeks and birth weight of 3524 g, which were similar to the those of the control group (n = 61). However, the incidence of low Apgar scores (≤6) at 1 minute and 5 minutes was significantly higher in the PPHN group than in the control group. The diagnoses associated with PPHN were primary PPHN (25%), meconium aspiration syndrome (35%), respiratory distress syndrome (20%), low Apgar score/asphyxia (12.5%), and pneumonia/sepsis (8%). Mean duration of ventilator support for the PPHN group was 11 days. Nitric oxide (NO) was given to 19 infants (47.5%) for a mean duration of 25.4 hours. Fourteen of the 19 infants who were treated with NO (74%) required extracorporeal membrane oxygenation, and 2 died. The overall incidence of positive NSAID in meconium in the study population (n = 101) was 49.5%: 22.8% were positive for ibuprofen, 18.8% for naproxen, 7.9% for indomethacin, and 43.6% for aspirin. There was poor agreement (Cohen's κ = 0.09) between maternal history of NSAID use and NSAID detection in meconium. PPHN was significantly associated with 1) the presence of at least 1 NSAID in meconium (odds ratio [OR] = 21.47; 95% confidence interval [CI] = 7.12–64.71) or 2) the presence in meconium of aspirin (OR = 8.09; 95% CI = 3.27–20.10), ibuprofen (OR = 12.89; 95% CI 3.93–42.32), or naproxen (OR = 3.31; 95% CI = 1.17–9.33). By logistic regression analysis, low Apgar scores at 1 and 5 minutes and the antenatal exposure to aspirin, naproxen, and ibuprofen were significantly associated with PPHN and treatment with inhaled NO or extracorporeal membrane oxygenation.Conclusion.We confirm by meconium analysis the results of previous studies that demonstrated that the use of NSAIDs during pregnancy, particularly aspirin, ibuprofen, and naproxen, is high; is grossly underestimated by maternal history; and is significantly associated with PPHN. Thus, the easy access to over-the-counter NSAIDs of pregnant women should be reevaluated, and the potential dangers of these drugs to the newborn infant should be more effectively promoted.
Environmental Tobacco Smoke and Serum Vitamin C Levels in Children
Authors: Strauss Richard S. 
Published: August 2004

Background.
High levels of free radicals in tobacco smoke are thought to be responsible for decreased levels of serum ascorbic acid in smokers and adults exposed to environmental tobacco smoke (ETS). The association of ETS to serum ascorbic acid in children is unknown.

Methods.
Data were analyzed from the Third National Health and Nutrition Examination Survey, a nationally representative sample of children and adolescents (n = 2968). Comprehensive data including serum cotinine levels and family smoking patterns allowed for analysis of relationship of ETS to serum ascorbic acid levels. Data from 24-hour dietary recall also allowed for the control of vitamin C intake. Children were divided into categories of low and high ETS exposure based on levels of serum cotinine above or below 2 ng/mL. Smokers were defined by either self-report or serum cotinine &gt;15 ng/mL.

Results.
Although there was a trend for lower levels of vitamin C intake in children with higher levels of ETS exposure, this trend did not reach statistical significance. Among all children, serum ascorbic acid levels were linearly related to serum cotinine levels (r = 0.19). In addition, a dose-response relationship was observed between levels of tobacco exposure and serum ascorbic acid levels. After adjusting for age, gender, vitamin C intake, and multivitamin use, environmental tobacco exposure remained significantly associated with lower levels of serum ascorbic acid in children who were exposed to both high and low levels of ETS.

Conclusion.
Exposure of children to ETS leads to significant alterations in serum ascorbic acid levels. Therefore, this study further highlights the potential dangers of ETS to children.
Minimizing False-Positives in Universal Newborn Hearing Screening: A Simple Solution
Authors: Clemens Conrad J. , Davis Sherri A. 
Published: August 2004

Background and Objectives. The false-positive rates of previously reported universal newborn hearing screening (UNHS) programs range between 2.5% and 8%. Critics of UNHS programs have claimed that this rate is too high and might lead to a number of the negative effects produced by false-positive screening tests, namely emotional trauma, disease labeling, iatrogenesis from unnecessary testing, and increased expense in terms of time and money.We previously reported, based on some preliminary data, that as many as 80% of newborns who failed the initial hearing screen subsequently passed when they were retested the following day, before being discharged from the hospital. We now present the results of this intervention for our entire UNHS program during a 7-month period.Methods.We analyzed data from 3142 non-neonatal intensive care unit infants screened with an automated auditory brainstem response at the Women's Hospital of Greensboro from November 1, 1999 to May 31, 2000. A protocol was developed wherein all infants who failed the initial UNHS were rescreened with another automated auditory brainstem response before hospital discharge. Data collected included pass/fail rates during the inpatient stay as well as follow-up data and risk factors for congenital hearing loss.Results.Confirmed hearing loss occurred in 8 nonneonatal intensive care unit infants, a rate of 2.5/1000. Eighty percent of newborns who failed the initial hearing screen passed on rescreening before hospital discharge. This produced a false-positive rate of 0.8% and a corresponding positive predictive value of 24%. If inhospital rescreening had not occurred, our false-positive rate and positive predictive value would have been 3.9% and 6.1%, respectively.Conclusions.Our simple intervention of rescreening all infants who failed their initial UNHS before hospital discharge reduced the false-positive rate of UNHS to 0.8%. We suggest that this simple, inexpensive intervention should be instituted for all similar UNHS programs.
Vaccination Coverage and Physician Distribution in the United States, 1997
Authors: LeBaron Charles W. , Massoudi Mehran , Stevenson John , Lyons Bridget 
Published: August 2004

Background.
How many physicians are needed in the United States and how they should be allocated geographically and among specialties has been the subject of intense debate, a debate that has often focused more on costs to third-party payers and government than on benefits to health. Child health is a central aspect of public health, and immunization is one of its most cost-effective and easily measured interventions.

Objective.
To examine the association of immunization rates and delivery characteristics with the distribution of child health physicians in the United States in 1997.

Design.
Cross-sectional ecological study, using the state as the unit of analysis, immunization rates and delivery characteristics (from the National Immunization Survey) as the main outcome measures, concentration of the principal physician specialties providing routine care to children (pediatric, family, and general physicians from the American Medical Association Masterfile) as the main risk factor, while controlling for demographic and economic factors (from the Bureau of the Census and other sources).

Results.
Of the 96 689 physicians providing routine care to children, 37% were pediatric, 49% family, and 14% general physicians. Higher rates of vaccination, private sector vaccination, and increased numbers of public and private vaccination sites were all associated with the concentration of pediatricians but not of family or general physicians. The distribution of pediatricians was strongly associated with the distribution of residency positions.

Conclusions.
Pediatrician distribution is a strong correlate to immunization rates and delivery characteristics. Opportunities to affect pediatrician distribution may exist with allocation of residency positions.
Incidence Survey of Kawasaki Disease in 1997 and 1998 in Japan
Authors: Yanagawa Hiroshi , Nakamura Yosikazu , Yashiro Mayumi , Oki Izumi , Hirata Shizuhiro , Zhang Tuohong , Kawasaki Tomisaku 
Published: August 2004

Objective.To describe the results of a nationwide epidemiologic survey of Kawasaki disease for the 2-year period 1997 and 1998.Design.We sent a questionnaire to all hospitals with 100 beds or more throughout Japan (2663 hospitals) requesting data on patients with Kawasaki disease. Study items included name, sex, date of birth, date of initial hospital visit, diagnosis, address, recurrence, sibling cases, gammaglobulin treatment, and cardiac lesion in the acute stage or 1 month after onset.Results.Of the 2663 hospitals, 68.5% responded, reporting 12 966 patients—7489 males and 5477 females. Of the total patients reported, 6373 (incidence rate of 108.0 per 100 000 children &lt;5 years old) occurred in 1997, and 6593 (111.7) in 1998. More than one half of the patients (54.9%) were &lt;2 years old and 81.6% were &lt;4 years old. In males, the incidence rates of cardiac lesions were 27.2 in the acute stage and 10.1 a month after onset. In females, the rates were 16.7 and 5.2, respectively. The incidence rates of cardiac lesions were highest in the youngest age group (&lt;6 months old) both in the acute stage and 1 month after onset. The rates decreased with increasing ages. Although frequency of giant aneurysms was not high at the acute stage, it did not decrease 1 month after onset.Conclusion.The incidence rates have been steadily increasing for 11 years since 1987. The rate in 1998 was over 1.5 times higher than that in 1987. The age and sex distributions were identical in each survey. Although most of the cardiac lesions at the acute stage decreased to half or less 1 month after onset, giant aneurysms did not decrease and existed persistently after 1 month.
Psychological Adjustment of Adolescent Girls With Chronic Fatigue Syndrome
Authors: van Middendorp Henriët , Geenen Rinie , Kuis Wietse , Heijnen Cobi J. , Sinnema Gerben 
Published: August 2004

Objective.To examine psychosocial problems and adaptation of adolescent girls with chronic fatigue syndrome (CFS).Methodology.Thirty-six adolescent girls with CFS (mean age: 15.2 years; mean syndrome duration: 19.7 months) who fulfilled the criteria of the Centers for Disease Control and Prevention were examined by interviews regarding premorbid problems and by questionnaires regarding psychosocial functioning and distress, psychological attitudes, and coping resources. Data were compared with normative data.Results.Of the adolescents, 86.1% reported 1 or more premorbid problems (58.3% physical, 38.9% psychological, and 52.8% familial). Normal adjustment was reported for psychosocial self-esteem, social abilities, and attentional abilities. High adjustment to adult social standards of behavior was found, but low perceived competence in specific adolescent domains, such as athletic ability, romance, and participation in recreational activities. The girls reported predominantly internalizing problems. Normal achievement motivation, no debilitating fear of failure, and high internal locus of control were observed. Palliative reaction patterns and optimism were predominantly used as coping strategies.Conclusions.The large number of premorbid problems suggests a possible contributing factor to the onset of the syndrome, although there were no reference data of healthy adolescents. In distinct domains of psychosocial adjustment, the adolescent girls with CFS showed strengths such as adequate self-esteem and scholastic and social abilities, and weaknesses such as low competence in adolescent-specific tasks and internalizing distress, which may partly be explained by syndrome-specific somatic complaints. The use of optimistic and palliative reaction patterns as coping strategies in this patient group indicates that the patients with CFS seem to retain an active and positive outlook on life, which may result in a rather adequate psychological adaptation to the syndrome, but also in maintenance of the syndrome by exceeding the physical limits brought about by the CFS. Our results on adjustment and coping strategies may be helpful to implement (individual) rehabilitation programs.
Delayed Hypersensitivity to Tuberculin, Total Immunoglobulin E, Specific Sensitization, and Atopic Manifestation in Longitudinally Followed Early Bacille Calmette-Guérin-Vaccinated and Nonvaccinated Children
Authors: Grüber Christoph , Kulig Michael , Bergmann Renate , Guggenmoos-Holzmann Irene , Wahn Ulrich ,   the MAS-90 Study Group
Published: August 2004

Background.Bacille Calmette-Guérin (BCG) is a strong T helper 1 incentive and, thus, may contribute to a decreased risk of T helper 2-dependent atopic disease.Objective.To investigate the natural course of specific immunoglobulin E (IgE) responses and atopic disease in BCG-vaccinated and nonvaccinated children.Participants.Seven hundred seventy-four children from a prospectively followed birth cohort.Outcome Measures.Physical examination and case history were performed at 3, 6, 12, 18, 24, 36, 48, 60, 72, and 84 months of age. Total and specific serum IgE levels to 9 common inhalant and food allergens were determined (CAP; Pharmacia, Freiburg, Germany) at 12, 24, 36, 60, 72, and 84 months of age. Purified protein derivative (PPD) skin testing was performed at 84 months.Results.Period and lifetime prevalences of atopic dermatitis and recurrent wheezing tended to be lower in the BCG-vaccinated group early in life, whereas no such trend was found after the second birthday or for allergic rhinitis. The proportion of children remaining free of clinical manifestations tended to be higher in the BCG-vaccinated group but differences decreased over time. No statistically significant differences were found for total IgE levels (median). Atopic sensitization tended to be lower among BCG-vaccinated children during the first 2 years of life. The diameter of the skin reaction to PPD did not correlate with total serum IgE. Clinical and serologic correlates of atopy were not significantly different between children with a skin test diameter of ≥5 mm and those with a smaller diameter.Conclusion.These results do not support the hypothesis that BCG vaccination in early infancy is associated with a subsequently markedly decreased risk of atopic sensitization or allergy. In addition, PPD skin test reactivity was not impaired in atopic individuals.
Solids and Formula: Association With Pattern and Duration of Breastfeeding
Authors: Hörnell Agneta , Hofvander Yngve , Kylberg Elisabeth 
Published: August 2004

Objectives.
To study changes in pattern and duration of breastfeeding associated with the introduction of solids and formula.

Study Design.
Descriptive longitudinal, prospective study.

Setting.
The participants were recruited from the maternity ward in the University Hospital in Uppsala, Sweden, between May 1989 and December 1992. A total of 15 189 infants were born during the period, 1 177 mother–infant pairs were found eligible for participation; 57% declined because of the perceived high workload.

Study Population.
Five hundred six mother–infant pairs.

Methods.
Daily recordings by the mothers on infant feeding, from the first week after delivery to the second menstruation postpartum or a new pregnancy; fortnightly home visits with structured interviews by a research assistant.

Results.
Introduction of solids was associated with no or minor changes in breastfeeding frequency and suckling duration. Breastfeeding frequency remained constant the first month after the introduction and then declined slowly, while daily suckling duration started to decline slowly when solids were introduced. Breastfeeding duration was not associated with infants' age at introduction of solids. In infants given formula, as soon as regular formula feeds started, the breastfeeding frequency and suckling duration declined swiftly. The younger an infant was at the start of regular formula feeds, the shorter the breastfeeding duration.

Conclusions.
Health care personnel and parents need to be aware that introduction of solids and introduction of formula can have very different consequences for breastfeeding. If the aim is to introduce other foods to breastfed infants under the protection of breast milk, it is important to realize that formula is also another food and needs to be treated as such.