bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Dose-Response Study of OROS Methylphenidate in Children With Attention-Deficit/Hyperactivity Disorder
Authors: Stein Mark A. , Sarampote Christopher S. , Waldman Irwin D. , Robb Adelaide S. , Conlon Charles , Pearl Phillip L. , Black David O. , Seymour Karen E. , Newcorn Jeffrey H. 
Published: August 2004

Objective. OROS methylphenidate HCL (MPH) is a recently developed long-acting stimulant medication used to treat attention-deficit/hyperactivity disorder (ADHD). This study was conducted to examine dosage effects on ADHD symptoms and stimulant side effects and to explore potential moderating effects of ADHD subtype.Methods. Children with ADHD combined type (ADHD-CT) or predominantly inattentive type (ADHD-PI; n = 47), ages 5 to 16 years, underwent a placebo-controlled, crossover trial using forced titration with weekly switches at 3 dosage levels. Parent and teacher ratings of ADHD symptoms were used to evaluate efficacy. In addition, vital signs and standardized measures of stimulant side effects were obtained weekly.Results. Parent ratings were more sensitive to treatment effects than teacher ratings. ADHD symptoms and Clinical Global Impressions Severity Index ratings at each dose condition differed significantly from placebo and baseline ratings, which did not differ from one another. For those with ADHD-CT, there was a clear linear dose-response relationship, with clinically significant reductions in ADHD Rating Scale-IV scores occurring in two thirds to three fourths of the subjects during either 36- or 54-mg dose conditions. Children with ADHD-PI, conversely, were more likely to respond optimally to lower doses and derived less benefit from higher doses, with 60% displaying significant improvement on the ADHD Rating Scale-IV at 36 mg or lower. Mild stimulant side effects were reported during placebo and at all dosage levels. With the exception of insomnia and decreased appetite, which were more common at higher doses, parent report of side effects was not related to dose. In addition, younger and smaller children were more likely to display sleep difficulties and decreased appetite at the higher dose levels Although pulse rate increased slightly with increasing dose, there were no dose effects on blood pressure.Conclusions. In children with ADHD-CT, the most common subtype of ADHD, increasing doses of stimulant medication were associated with increased improvement of inattention and hyperactivity symptoms. In children with ADHD-PI, symptom improvement occurred at lower doses and less benefit was derived from higher doses. In both ADHD subtypes, higher doses were associated with parent ratings of increased insomnia and decreased appetite.
Increased Prevalence of Familial Autoimmunity in Probands With Pervasive Developmental Disorders
Authors: Sweeten Thayne L. , Bowyer Suzanne L. , Posey David J. , Halberstadt Gary M. , McDougle Christopher J. 
Published: August 2004

Objectives. Increased prevalence of familial autoimmune disease is a common finding among probands with various autoimmune disorders. Autistic disorder (autism) is a highly genetic disorder with known immune and immunogenetic abnormalities. Previous research has found an increased frequency of autoimmune disorders in families with autistic probands. We further investigated this association by determining the frequency of autoimmune disorders in families that have probands with pervasive developmental disorders (PDDs), including autism, compared with 2 control groups.Methods. Three well-defined study groups, including 1) families that have a child with a PDD, 2) families that have a child with an autoimmune disorder, and 3) families with a healthy control child, constituted the sample. A questionnaire inquiring about which first- and second-degree family members had received a diagnosis of having specific autoimmune disorders was completed by 101 families in each group.Results. The frequency of autoimmune disorders was significantly higher in families of the PDD probands compared with families of both the autoimmune and healthy control probands. Autoimmunity was highest among the parents of PDD probands compared with parents of the healthy control subjects. Hypothyroidism/Hashimoto’s thyroiditis and rheumatic fever were significantly more common in families with PDD probands than in the healthy control families.Conclusions. Autoimmunity was increased significantly in families with PDD compared with those of healthy and autoimmune control subjects. These preliminary findings warrant additional investigation into immune and autoimmune mechanisms in autism.
Bullying Among Young Adolescents: The Strong, the Weak, and the Troubled
Authors: Juvonen Jaana , Graham Sandra , Schuster Mark A. 
Published: August 2004

Objectives. Bullying and being bullied have been recognized as health problems for children because of their association with adjustment problems, including poor mental health and more extreme violent behavior. It is therefore important to understand how bullying and being bullied affect the well-being and adaptive functioning of youth. We sought to use multiple data sources to better understand the psychological and social problems exhibited by bullies, victims, and bully-victims.
Design, Setting, and Participants. Analysis of data from a community sample of 1985 mostly Latino and black 6th graders from 11 schools in predominantly low socioeconomic status urban communities (with a 79% response rate).
Main Outcome Measures. Peer reports of who bullies and who is victimized, self-reports of psychological distress, and peer and teacher reports of a range of adjustment problems.
Results. Twenty-two percent of the sample was classified as involved in bullying as perpetrators (7%), victims (9%), or both (6%). Compared with other students, these groups displayed school problems and difficulties getting along with classmates. Despite increased conduct problems, bullies were psychologically strongest and enjoyed high social standing among their classmates. In contrast, victims were emotionally distressed and socially marginalized among their classmates. Bully-victims were the most troubled group, displaying the highest level of conduct, school, and peer relationship problems.
Conclusions. To be able to intervene with bullying, it is important to recognize the unique problems of bullies, victims, and bully-victims. In addition to addressing these issues directly with their patients, pediatricians can recommend school-wide antibullying approaches that aim to change peer dynamics that support and maintain bullying.
Does Presentation Format at the Pediatric Academic Societies’ Annual Meeting Predict Subsequent Publication?
Authors: Carroll Aaron E. , Sox Colin M. , Tarini Beth A. , Ringold Sarah , Christakis Dimitri A. 
Published: August 2004

Objective. The validity of research presented at scientific meetings continues to be a concern. Presentations are chosen on the basis of submitted abstracts, which may not contain sufficient information to assess the validity of the research. The objective of this study was to determine 1) the proportion of abstracts presented at the annual Pediatric Academic Society (PAS) meeting that were ultimately published in peer reviewed journals; 2) whether the presentation format of abstracts at the meeting predicts subsequent full publication; and whether the presentation format was related to 3) the time to full publication or 4) the impact factor of the journal in which research is subsequently published.
Methods. We assembled a list of all abstracts submitted to the PAS meetings in general pediatrics categories in 1998 and 1999, using both CD-ROM and journal publications. In each year, we chose up to 80 abstracts from each presentation format (“publish only,” “poster,” “poster symposium,” “platform presentation”). We chose either 1) all abstracts in each format or 2) when there were &gt;80 abstracts, a random selection of 80 of them. We assessed each selected abstract for subsequent full publication by searching Medline in March 2003; if published, then we recorded the journal, month, and year of publication. We used logistic and linear regression to determine whether publication, time to publication, and the journal’s impact factor were associated with the abstract’s presentation format.
Results. Overall, 44.6% of abstracts presented at the PAS meeting achieved subsequent full publication within 4 to 5 years. There were significant differences between the rates of subsequent full publication of abstracts submitted but not chosen for presentation at the meeting (22.2%) and those that were chosen for presentation in poster sessions (40.0%), poster symposia (44.1%), and platform presentations (53.8%). There were no meaningful differences between the presentation formats in their mean time to publication and their mean journal impact factor.
Conclusions. PAS meeting attendees and the press should be cautious when interpreting the presentation format of an abstract as a predictor of either its subsequent publication in a peer-reviewed journal or the impact factor of the journal in which it will appear.
Screening for Retinoblastoma: Presenting Signs as Prognosticators of Patient and Ocular Survival
Authors: Abramson David H. , Beaverson Katherine , Sangani Poorab , Vora Robin A. , Lee Thomas C. , Hochberg Hilary M. , Kirszrot James , Ranjithan Murali 
Published: August 2004

Objective. To correlate 3 common presenting signs of retinoblastoma with patient and ocular survival and to assess the efficacy of current pediatric screening practices for retinoblastoma.
Methods. A retrospective study was conducted of 1831 retinoblastoma patients from our center (1914–June 2000). Patient survival (excluding deaths from other primary neoplasms) and ocular survival (presenting eyes) rates were calculated and analyzed using the Kaplan-Meier method.
Results. Leukocoria correlated with excellent patient survival (&gt;86%, 5 years) but poor ocular survival in unilateral (4%, 5 years) and bilateral patients (29%, 5 years). A total of 308 (19%) of 1654 patients presented with strabismus: patient survival was excellent (90%, 5 years), and ocular survival was poor (17%, 5 years) yet better than leukocoria. Patients who had a family history of retinoblastoma and were clinically screened for retinal tumors from birth were diagnosed younger (8 months of age) and earlier (Reese Ellsworth group 1 = 26 [58%] of 45) and had better ocular survival than nonscreened patients with a family history. More patients were initially detected by family/friends (1315 [80%] of 1632) than pediatricians (123 [8%] of 1632) or ophthalmologists (156 [10%] of 1632).
Conclusion. Most US children whose retinoblastoma is diagnosed initially present with leukocoria detected by a parent, despite routine pediatric screening for leukocoria via the red reflex test. Initial disease detection at the point of leukocoria or strabismus correlated with high patient survival rates and poor ocular survival rates for the presenting eye. Saving eyes and vision requires disease recognition before leukocoria, as demonstrated by the better ocular salvage rate among patients who had a positive family history and received clinical surveillance via early, routine dilated funduscopic examinations by an ophthalmologist.
Changes in Globus Pallidus With (Pre)Term Kernicterus
Authors: Govaert Paul , Lequin Maarten , Swarte Renate , Robben Simon , De Coo René , Weisglas-Kuperus Nynke , De Rijke Yolanda , Sinaasappel Maarten , Barkovich James 
Published: August 2004

Objective. We report serial magnetic resonance (MR) and sonographic behavior of globus pallidus in 5 preterm and 3 term infants with kernicterus and describe the clinical context in very low birth weight preterm infants. On the basis of this information, we suggest means of diagnosis and prevention.Methods. Charts and MR and ultrasound images of 5 preterm infants and 3 term infants with suspected bilirubin-associated brain damage were reviewed. Included were preterm infants with severe hearing loss, quadriplegic hypertonia, and abnormal hypersignal of globus pallidus on T2-weighted MR imaging (MRI). In 1 infant who died on day 150, the diagnosis was confirmed during the neonatal period. The others were picked up as outpatients and scanned at 12 or 22 months’ corrected age. Three instances of term kernicterus were included for comparison of serial MRI in the neonatal period and early infancy: they were caused by glucose-6-phosphate dehydrogenase deficiency, urosepsis, and dehydration plus fructose 1–6 biphosphatase deficiency.Results. Five preterm infants of 25 to 29 weeks’ gestational age presented with total serum bilirubin (TSB) levels below exchange transfusion thresholds commonly advised. Mixed acidosis was present in 3 infants around the TSB peak. The bilirubin/albumin molar ratio was &gt;0.5 in all, in the absence of displacing drugs. All failed to pass bedside hearing screen tests and had severe hearing loss on auditory brain response testing. Symmetrical homogeneous hyperechogenicity of globus pallidus was the alerting feature in 1 infant. Globus pallidus was hyperintense on T1-weighted MR images in this child. The other infants presented with severe developmental delay as a result of dyskinetic quadriplegia and hearing loss. Globus pallidus was normal on T1- but hyperintense on T2-weighted MR images at 12 or 22 months’ corrected age. Subthalamic involvement was documented in coronal fluid attenuated inversion recovery MRI in 2 infants. The term infants with classical clinical presentation in the neonatal period had MR behavior similar to the preterms, but pallidal injury was not recognized with targeted sonographic examination. Their neonatal MR images demonstrated pallidal T1 hyperintensity and mild T2 hyperintensity.Conclusion. Acidotic very low birth weight preterm infants with low serum albumin levels develop MR-confirmed pallidal injury and hearing loss facing “accepted” TSB levels. Serial MRI documents a shift from acute mainly T1 hypersignal to permanent T2 hypersignal in globus pallidus within the late neonatal period. Subthalamic and not thalamic involvement helps to differentiate from ischemic or metabolic disorder. As newborns, these infants are rigid and have severe apnea, before developing hypertonic quadriplegia in infancy.
Management of Hyperbilirubinemia in Newborns: Measuring Performance by Using a Benchmarking Model
Authors: Chou Shu-Chiung , Palmer R. Heather , Ezhuthachan Sudhakar , Newman Christine , Pradell-Boyd Brenna , Maisels M. Jeffrey , Testa Marcia A. 
Published: August 2004

Background. Accreditors hold hospitals accountable for harm from serious newborn hyperbilirubinemia, yet standards for evaluating performance in prevention are lacking.Objective. We confirmed prognostic variables for newborn hyperbilirubinemia and developed a benchmarking model for self-evaluation of hyperbilirubinemia management.Methods. We conducted a 3-year prospective cohort study in the Henry Ford Health System (HFHS) on 5507 healthy newborns of ≥35 weeks’ gestational age. HFHS follows a rigorous protocol for hyperbilirubinemia management. Defining hyperbilirubinemia as age-specific levels of total serum bilirubin exceeding American Academy of Pediatrics criteria for considering phototherapy and severe hyperbilirubinemia as total serum bilirubin ≥20 mg/dL, we used logistic and Poisson regressions to determine predictors and estimate parameters for a benchmarking model. We compared incidence rates for severe hyperbilirubinemia from HFHS to aggregate data from 11 hospitals reported to have less rigorous management.Results. Newborns were 52.9% black, 14.4% white, 24.3% Latino, and 2.4% Asian; 30% were exclusively and 28% partially breastfed. Regression analyses revealed associations for hyperbilirubinemia and severe hyperbilirubinemia with black mothers (negative) and exclusive or partial breastfeeding and younger gestational age (positive). Male newborns and older mothers were also associated with severe hyperbilirubinemia. For all 5 variables, we found a lower risk for severe hyperbilirubinemia at HFHS than in the comparison hospital group. To compare hospitals, we developed a benchmarking model for incidence of hyperbilirubinemia adjusting for race, feeding method, and gestational age.Conclusions. Hospitals with access to newborns’ inpatient and postdischarge data can use our benchmarking model to compare their management of hyperbilirubinemia with a reference population that received rigorous care.
Fatal Pulmonary Hypertension Associated With Pertussis in Infants: Does Extracorporeal Membrane Oxygenation Have a Role?
Authors: Halasa Natasha B. , Barr Frederick E. , Johnson Joyce E. , Edwards Kathryn M. 
Published: August 2004

Objective. The deaths of 4 infants who had confirmed pertussis infection at our hospital during the past year motivated us to review their cases as well as the use of extracorporeal membrane oxygenation (ECMO) in respiratory failure caused by pertussis.Methods. Retrospective chart reviews of the 4 infants who had pertussis and died at Vanderbilt University Medical Center (VUMC) from May 2001 to May 2002 were conducted. The Extracorporeal Life Support Organization (ELSO) database is an international voluntary registry established in 1986 to compile passive reports of adult and pediatric patients placed on ECMO. We searched this database for pertussis cases and analyzed the clinical outcomes by age, ventilatory management, and measurements of cardiopulmonary status.Results. All 4 infants who died from pertussis infection at VUMC were younger than 3 months and had severe pulmonary hypertension, and ECMO therapy was considered for respiratory failure. Review of the international ELSO database, focusing only on children from 1986 to July 2002, revealed a total of 23 970 patients placed on ECMO. Since the first pertussis case treated with ECMO in 1990, a total of 61 children with pertussis have been treated with ECMO, representing an increase from 0.09% to 1% of the total cases. Mean age of the pertussis patients placed on ECMO was 88 days (1 day–2.7 years). The overall mortality was 70.5% (43 of 61) but was significantly higher for infants who were younger than 6 weeks (84%) compared with infants who were older than 6 weeks (61%). When evaluating pre-ECMO management, survivors had received significantly higher mean positive end expiratory pressures than nonsurvivors (11.1 ± 4.5 vs 7.3 ± 3.1 cmH2O) and had significantly higher serum pH than nonsurvivors (7.31 ± 0.14 vs 7.14 ± 0.19). There was no effect of duration of ECMO, positive inspiratory pressure, mean arterial pressure, ECMO mode (venoarterial vs venovenous mode), or sex on mortality.Conclusions. Although the ECMO registry is not an active surveillance system, it suggests that the numbers of children who require ECMO for pertussis have significantly increased. The high fatality rates of pertussis patients who have placed on ECMO are alarming and should stimulate reevaluation of whether this high-risk intervention is beneficial to patients with pertussis. This review, coupled with the 4 infants who died of pertussis at VUMC, suggests that improved measures are needed to prevent pertussis in infants.
Ventilator-Associated Pneumonia in Extremely Preterm Neonates in a Neonatal Intensive Care Unit: Characteristics, Risk Factors, and Outcomes
Authors: Apisarnthanarak Anucha , Holzmann-Pazgal Galit , Hamvas Aaron , Olsen Margaret A. , Fraser Victoria J. 
Published: August 2004

Objective. To determine the rates, characteristics, risk factors, and outcomes of ventilator-associated pneumonia (VAP) in extremely preterm neonates in a neonatal intensive care unit (NICU).Methods. A prospective cohort study was conducted at the St Louis Children’s Hospital on all patients who had birth weight ≤2000 g and were admitted to the NICU for ≥48 hours from October 2000 to July 2001. Extremely preterm neonates were defined as neonates with estimated gestational age (EGA) &lt;28 weeks. The primary outcome was the development of VAP. Secondary outcomes were death and NICU length of stay (LOS). Multiple logistic regression was performed to determine independent predictors for VAP and mortality.Results. A total of 229 patients were enrolled. Sixty-seven (29%) had EGA &lt;28 weeks. Nineteen episodes of VAP occurred in 19 (28.3%) of 67 mechanically ventilated patients. VAP rates were 6.5 per 1000 ventilator days for patients with EGA &lt;28 weeks and 4 per 1000 ventilator days for EGA ≥28 weeks. By multivariate analysis, bloodstream infection before VAP (adjusted odds ratio: 3.5; 95% confidence interval [CI]: 1.2–10.8) was an independent risk factor for VAP after adjustment for the duration of endotracheal intubation. Ventilator-associated pneumonia (adjusted odds ratio: 3.4; 95% CI: 1.2–12.3) was an independent predictor of mortality. A strong association between VAP and mortality was observed in neonates who stayed in the NICU &gt;30 days (relative risk: 8.0; 95% CI: 1.9–35.0). Patients with VAP also had prolonged NICU LOS (median: 138 vs 82 days).Conclusions. VAP occurred at high rates in extremely preterm neonates and was associated with increased mortality. Additional studies are needed to develop interventions to prevent VAP in NICU patients.
The Impact of Preterm Birth on Hospital Inpatient Admissions and Costs During the First 5 Years of Life
Authors: Petrou Stavros , Mehta Ziyah , Hockley Christine , Cook-Mozaffari Paula , Henderson Jane , Goldacre Michael 
Published: August 2004

Objectives. To compare the cumulative use and cost of hospital inpatient services to 5 years of age by individuals divided into 4 subgroups by gestational age at birth.
Design. Costs applied to the hospital service utilization profile of each infant born in 2 areas covered by the Oxford Record Linkage Study during 1970–1993.
Setting. Oxfordshire and West Berkshire, southern United Kingdom.
Subjects. 239 694 individuals divided into 4 subgroups by gestational age at birth: &lt;28 weeks, 28 to 31 weeks, 32 to 36 weeks, ≥37 weeks.
Main Outcome Measures. Number and duration of hospital admissions during the first 5 years of life and costs, expressed in £ sterling and valued at 1998–1999 prices, of hospital inpatient services.
Results. The total duration of hospital admissions for infants born at &lt;28 and at 28 to 31 gestational weeks was 85 and 16 times that for term infants, respectively, once duration of life had been taken into account. Hospital inpatient service costs were significantly higher for preterm infants than for term infants, with the cost differences persisting throughout infancy and early and mid-childhood. Over the first 5 years of life, the adjusted mean cost difference was estimated at £14 614 (US $22 798) when infants born at &lt;28 weeks gestational age were compared with term infants and £11 958 (US $18 654) when infants born at 28 to 31 weeks gestational age were compared with term infants. Independent contributions to total cost came from being born: small for gestational age, a multiple, during the 1970s and early 1980s, to a woman of extreme maternal age or who was hospitalized antenatally, and from experiencing extended survival or childhood disease. However, preterm birth remained the strongest predictor of high cost.
Conclusions. Preterm birth is a major predictor of how much an individual will cost hospital service providers during the first 5 years of life.