bluuebunny/crossref_metadata_2025_split huggingface dataset:
Measles Outbreak in Juneau, Alaska, 1996: Implications for Future Outbreak Control Strategies
Authors: Landen Michael G. , Beller Michael , Funk Elizabeth , Rolka Henry R. , Middaugh John 
Published: August 2004

Objective.To determine the most effective outbreak control strategy for school-based measles outbreaks as the proportion of children with two doses of measles-containing vaccine (MCV) increases.Setting.A school-based measles outbreak during 1996 involving 63 cases in Juneau, Alaska (population 29 288), where systematic revaccination with MCV was not implemented.Design.A retrospective evaluation using chain-of-transmission data of three possible outbreak control strategies: no school revaccination, targeted school revaccination (affected schools only), and community-wide school revaccination (all schools). Two-dose MCV coverage among students was estimated from school vaccination records and a survey issued to parents.Primary Outcome Measures.Potentially preventable cases of measles and doses of MCV administered per case prevented.Results.Two-dose MCV coverage among Juneau students was estimated to be 44% and 53% immediately before and after the outbreak, respectively. Of all the measles cases, an estimated 24 to 28 and 27 to 31 were potentially preventable by the targeted and community-wide school revaccination strategies, respectively. Either strategy might have optimally decreased the outbreak duration by 1 month, sparing one of seven affected schools and 10 of 12 unvaccinated children who had measles. Approximately 133 to 155 and 139 to 160 doses of MCV per case prevented would have been required for targeted and community-wide school revaccination, respectively.Conclusions.Either targeted or community-wide school revaccination would have been effective control strategies for this outbreak. Targeted school revaccination is probably the intervention of choice for school-based measles outbreaks in larger communities with higher two-dose MCV coverage. As two-dose MCV coverage continues to increase in the United States, public health control measures to respond to outbreaks need to be reevaluated.
Disclosure of Illness Status to Children and Adolescents With HIV Infection
Authors:   Committee on Pediatric AIDS
Published: August 2004

This Policy Statement was retired December 2015.
Many children with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome are surviving to middle childhood and adolescence. Studies suggest that children who know their HIV status have higher self-esteem than children who are unaware of their status. Parents who have disclosed the status to their children experience less depression than those who do not. This statement addresses our current knowledge and recommendations for disclosure of HIV infection status to children and adolescents.
An Evaluation of the Safety and Immunogenicity of a Five-Component Acellular Pertussis, Diphtheria, and Tetanus Toxoid Vaccine (DTaP) When Combined With aHaemophilus influenzaeType b-Tetanus Toxoid Conjugate Vaccine (PRP-T) in Taiwanese Infants
Authors: Lee Chin-Yun , Thipphawong John , Huang Li-Min , Lee Ping-Ing , Chiu Hsiu-Hui , Lin Wendy , Debois Henri , Harrison Dana , Xie Fang , Barreto Luis 
Published: August 2004

Objective.Immunologic interference particular to the Haemophilus influenzae type b (Hib) response has been observed with previous acellular pertussis-Hib combination vaccines. To test this hypothesis a clinical trial to assess the safety and immunogenicity of a five-component (pertussis toxoid [PT], filamentous hemagglutinin [FHA], pertactin [PRN], and fimbriae 2 and 3 [FIM]), pertussis vaccine combined with diphtheria and tetanus toxoids (DTaP) when given simultaneously with a lyophilized Hib-tetanus toxoid conjugate vaccine (PRP-T) in infants at 2, 4, 6, and 18 months of age was conducted. The study compared two methods of administration: both vaccines combined in a single syringe and administered as a single injection, or both vaccines administered concurrently but at separate sites of injection.Methods.Healthy 2-month-old infants were enrolled at the National Taiwan University Hospital. DTaP, PRP-T, and oral poliomyelitis vaccine (OPV) were given at 2, 4, 6, and 18 months. Reaction information was collected by telephone 2 days after each vaccination. Serum was collected at 2, 6, 7, 18, and 19 months of age.Results.One hundred thirty-five healthy infants were enrolled in Taiwan, of which 127 (94%) completed the 18-month booster: 68 received the combined vaccine and 67 the separate vaccines. All vaccines were well tolerated. No differences in rates of local and systemic reactions were seen between the two methods of administration. No serious adverse events were reported. Serologic responses were comparable between the groups. Pertussis responses (enzyme-liked immunoabsorbant assay units [EU]/mL) at 7 months were, for combined versus separate, PT (131 vs 105), FHA (116 vs 116), PRN (100 vs 77), and FIM (922 vs 702). At 19 months, pertussis results were, for combined versus separate, PT (216 vs 182), FHA (203 vs 200), PRN (263 vs 197), and FIM (892 vs 732). Only the 7-month PT response in the combined group was significantly higher (combined 131 EU/mL vs separate 105 EU/mL). After the third dose (age 6 months), all subjects achieved serologic serum antibody levels indicative of protection against Hib, diphtheria, tetanus, and poliovirus types 1, 2, and 3. In fact, 96% of children had anti-PRP levels indicative of protection (≥0.15 μg/mL) against Hib after only two doses. At 7 months, anti-PRP geometric mean titer values were 11.8 μg/mL in the combined group compared with 13.0 μg/mL in the separate group. The anti-PRP geometric mean titers after the 18-month booster were 58.5 μg/mL in the combined group versus 55.3 μg/mL in the separate group.Conclusion.The five-component DTaP vaccine may be combined with PRP-T vaccine without clinically significant immunologic interaction when given in a 2-, 4-, 6-, and 18-month schedule.
Fruit Juice Intake Is Not Related to Children's Growth
Authors: Skinner Jean D. , Carruth Betty Ruth , Moran James , Houck Kelly , Coletta Frances 
Published: August 2004

Background.Excessive fruit juice intake (&gt;12 ounces/day) has been reported to be associated with short stature and obesity in preschool children.Objective.To confirm whether excess fruit juice intake was associated with short stature and obesity in preschool children, we assessed growth parameters and fruit juice intake in 105 white children, ages 24 to 36 months.Methodology.Mothers were interviewed twice by a registered dietitian when children were age 24, 28, or 32 months (interview 1) and when children were age 28, 32, or 36 months (interview 2); interviews were assigned randomly. At each interview mothers provided 3 days of dietary data (one 24-hour recall and a 2-day food record) and the registered dietitian weighed the child and measured his/her height. Dietary data were analyzed using Nutritionist IV software. Each child's body mass index (wt/ht2) and ponderal index (wt/ht3) were calculated for each interview. Growth parameters of children consuming &lt;12 ounces/day 100% fruit juice were compared with those consuming ≥12 ounces/day using the Student's t test, χ2, Fisher's exact test, and mixed model repeated measures analyses (PROC MIXED).Results.Results consistently indicated no statistically significant differences in children's height, body mass index, or ponderal index related to fruit juice intake. Intakes of soda pop were negatively related to intakes of milk and fruit juice although intakes of milk and fruit juice were not related.Conclusions.The consistent lack of relationship between children's fruit juice intake and growth parameters in our study does not support previous recommendations to limit the intake of 100% fruit juice to &lt;12 ounces/day.
Osmoregulation and Desmopressin Pharmacokinetics in Enuretic Children
Authors: Nevéus Tryggve , Läckgren Göran , Tuvemo Torsten , Stenberg Arne 
Published: August 2004

Objective.The aim was to compare responders and nonresponders to antienuretic treatment with desmopressin with respect to pharmacokinetics and renal effects of the drug.Methods.Twelve children, aged 7.6 to 16.2 years, with nocturnal enuresis were examined. Six patients were nonresponders and 6 were responders to desmopressin treatment. The children were given 2 mg of desmopressin intravenously and plasma concentrations of the drug were monitored overnight. Urine parameters were followed for 24 hours after desmopressin administration. Ten patients also underwent a thirst provocation test.Results.Desmopressin pharmacokinetics did not differ between the groups. Neither nocturnal urine production nor morning urine osmolality after desmopressin injection differed between responders and nonresponders, whereas the responders produced significantly larger amounts of significantly less concentrated urine during the day after the injection compared with the nonresponders (urine production, 2.02 ± 0.84 and 0.77 ± 0.20 mL/kg/h; urine osmolality, 558 ± 271 and 883 ± 134 mOsm/kg). Nonresponders voided with smaller bladder volumes (2.43 ± 0.68 mL/kg body weight) than responders (4.70 ± 1.21 mL/kg). The responders produced significantly less concentrated urine than the nonresponders during the thirst provocation test (607 ± 185 and 922 ± 217 mOsm/kg, respectively).Conclusion.Intravenous desmopressin pharmacokinetics and desmopressin renal effects did not differ between responders and nonresponders to desmopressin treatment. Nonresponders had a smaller spontaneous bladder capacity and responders produced less concentrated urine.
Social, Emotional, and Behavioral Functioning of Children With Cancer
Authors: Noll Robert B. , Gartstein Maria A. , Vannatta Kathryn , Correll Judy , Bukowski William M. , Davies W. Hobart 
Published: August 2004

Objective.
It was hypothesized that children with cancer would have more social problems and difficulties with emotional well-being than case control, same race/gender, similarly aged classmates.

Study Design.
Using a case controlled design, children with any type of cancer requiring chemotherapy except brain tumors (n = 76), currently receiving chemotherapy, ages 8 to 15, were compared with case control classroom peers (n = 76). Peer relationships, emotional well-being, and behavior were evaluated based on peer, teacher, parent, and self-report, and were compared using analysis of variance and structural equation modeling.

Results.
Relative to case controls, children with cancer were perceived by teachers as being more sociable; by teachers and peers as being less aggressive; and by peers as having greater social acceptance. Measures of depression, anxiety, loneliness, and self-concept showed no significant differences, except children with cancer reported significantly lower satisfaction with current athletic competence. There were also no significant differences in mother or father perceptions of behavioral problems, emotional well-being, or social functioning. Scores on all standardized measures were in the normal range for both groups. Comparisons of the correlation matrices of children with cancer and to the correlation matrix of the comparison children using structural equation modeling suggested they were not significantly different.

Conclusions.
Children with cancer currently receiving chemotherapy were remarkably similar to case controls on measures of emotional well-being and better on several dimensions of social functioning. These findings are not supportive of disability/stress models of childhood chronic illness and suggest considerable psychologic hardiness.
Trends in Diarrhea-associated Hospitalizations Among American Indian and Alaska Native Children, 1980–1995
Authors: Holman Robert C. , Parashar Umesh D. , Clarke Matthew J. , Kaufman Stephen F. , Glass Roger I. 
Published: August 2004

Objective. To describe trends in diarrhea- associated hospitalizations among American Indian and Alaska Native (AI/AN) children and to estimate the morbidity from rotavirus.Design. Retrospective analysis of Indian Health Service hospital discharge records.Patients. AI/AN children 1 month through 4 years of age with a diarrhea-associated diagnosis listed on the hospital discharge record.Setting. Hospitals on or near US Indian reservations from 1980 through 1995.Results. During 1980 through 1995, 21 669 diarrhea-associated hospitalizations were reported among AI/AN children. The annual incidence of diarrhea-associated hospitalizations declined by 76% from 276 per 10 000 in 1980 to 65 per 10 000 in 1995. The median length of hospital stay decreased from 4 days during 1980–1982 to 2 days during 1993–1995. Diarrhea-associated hospitalizations peaked during the winter months (October through March), especially among children 4–35 months of age, with the peaks appearing first in the Southwest during October and moving to the East in March. In the early years of the study (1980–1982), the rate of diarrhea-associated hospitalizations among AI/AN children (236 per 10 000) was greater than the national rate (136 per 10 000). By the end of the study period (1993–1995), the rate for AI/AN children (71 per 10 000) was similar to the national rate (89 per 10 000), although the rate for AI/AN infants remained higher than the national rate for infants.Conclusions. Diarrhea-associated hospitalization rates for AI/AN children have declined to a level similar to that of the national population. Rotavirus may be an important contributor to diarrheal morbidity among AI/AN children, underscoring the need for vaccines against this pathogen.
Long-term Remission for Disseminated Mycobacterium avium-intracellulare Complex Associated With Antibody Deficiency
Authors: Grouhi Masoud , Wang Elaine , Reid Brenda , Roifman Chaim M. 
Published: August 2004

Mycobacterium avium-intracellulare
(MAI) is a ubiquitous organism with limited virulence in the immunocompetent host. Disseminated disease is associated with a high mortality rate. Except for localized cervical adenitis, MAI disease is rare in immunocompetent children. We report a child with antibody deficiency (dysgammaglobulinemia) and disseminated MAI infection, in whom complete, long-term remission was attained with multiple antimycobacterial therapy.
The patient presented with progressive cervical lymphadenopathy and hepatomegaly at 7 years of age. A lymph node biopsy showed acid-fast bacilli and granulomas. Despite a transient response to conventional antituberculous therapy, including isoniazid and rifampin, his symptoms progressed. Cultures from blood, bone marrow, spleen, and cervical lymph node tissues revealed an MAI organism. Subsequent treatment using a combination of clarithromycin, amikacin, and ethambutol for 16 months resolved clinical symptoms, and subsequent blood culture results became negative. By the time of this report, the patient has been disease-free for 4 years.
Multiple-drug therapy is promising for the treatment of MAI in children with antibody deficiency; however, the selection of antiinfective drugs should include a member of the newer macrolide family. acquired immunodeficiency syndrome, clarithromycin, dysgammaglobulinemia, Mycobacterium avium-intracellulare, treatment.
Epidemic of Gastrointestinal Tract Infection Including Hemorrhagic Colitis Attributable to Shiga Toxin 1-producingEscherichia coli O118:H2 at a Junior High School in Japan
Authors: Hashimoto Hiroyuki , Mizukoshi Kumiko , Nishi Masami , Kawakita Tadashi , Hasui Seiryo , Kato Yasuhiro , Ueno Yoshiki , Takeya Ryohei , Okuda Norihiko , Takeda Tae 
Published: August 2004

Background.
An epidemic of gastrointestinal disturbances related to food ingestion occurred at a junior high school in Komatsu, Japan, and was caused by specifically Shiga toxin (Stx) 1-producing Escherichia coli O118:H2, which has not been reported previously in humans. No outbreak ofE coli-producing Stx 1 alone had occurred.

Methods.
A total of 526 students and 35 adult staff members who ate the same food at lunch in the school were investigated. Questionnaires about food consumption at lunch were given to all 561 subjects as well as to clinics and hospitals that had treated 79 patients. Stool specimens from 525 subjects, and food, water, and environmental specimens, including cooking utensils, were collected in an attempt to identify the pathogen.

Results.
A total of 126 subjects (22.5%) developed a diarrheal illness. The pathogen was isolated from the stool in 131 subjects, 49 of which were asymptomatic, and from a dipper. Salads served over several days were identified as high-risk from food analysis. Gastrointestinal symptoms resembled those associated with previous infections of Stx-producing E coli, but were mild. No cases of the hemolytic–uremic syndrome developed. Headache was present in 87 patients. Three patients underwent surgery for acute appendicitis during this epidemic. Four of five carriers had received an antibiotic effective against the pathogen.

Conclusions.
This outbreak of E coliO118:H2 demonstrated the clinical and epidemiologic features of infection by E coli that produces Stx 1 alone. Infections with such organisms are being recognized increasingly, and the pattern of disease observed may differ from the pattern observed with E coli O157:H7.
Prevalence, Patterns, and Correlates of Voluntary Flunitrazepam Use
Authors: Rickert Vaughn I. , Wiemann Constance M. , Berenson Abbey B. 
Published: August 2004

Objective.
To determine prevalence, patterns, and correlates of voluntary flunitrazepam use in a sample of sexually active adolescent and young adult women 14 to 26 years of age.

Design.
Cross-sectional survey.

Setting.
University-based ambulatory reproductive health clinics.

Patients or Other Participants.
There were 904 women self-identified as white, African-American, or Mexican-American.

Interventions.
None.

Main Outcome Measure.
Lifetime, frequency, patterns, and physical effects of flunitrazepam use.

Results.
Lifetime use was reported by 5.9% (n = 53) of subjects, with frequency of use ranging from 1 to 40 times. Flunitrazepam was taken most often with alcohol (74%), and 49% took this substance with other illicit drugs. Logistic regression analyses controlling for age and race/ethnicity found that users were significantly more likely than were nonusers to report lifetime use of marijuana (odds ratio [OR] = 3.6) or LSD (OR = 5.2), having a peer or partner who used flunitrazepam (OR = 21.7), pressure to use flunitrazepam when out with friends (OR = 2.7), and a mother who had at least a high school education (OR = 2.6). Finally, 10% of voluntary users reported experiencing subsequent physical or sexual victimization.

Conclusions.
Voluntary use of flunitrazepam is becoming a health concern to sexually active young women who reside in the southwestern United States. Young women who have used LSD or marijuana in the past or who have a peer or partner who used this drug appear to be at the greatest risk.
How Does Home Management of Asthma Exacerbations by Parents of Inner-city Children Differ From NHLBI Guideline Recommendations?
Authors: Warman Karen L. , Silver Ellen Johnson , McCourt Mary P. , Stein Ruth E. K. 
Published: August 2004

Objectives.1) To describe the asthma morbidity, primary care practices, and asthma home management of inner-city children with asthma; 2) to determine the responses of parental caretakers to asthma exacerbations in their child; and 3) to compare these responses to the recommendations of the National Heart, Lung, and Blood Institute (NHLBI) asthma guidelines for home management of acute exacerbations of asthma.Design and Methods.A 64-item telephone survey was administered between July 1996 and June 1997 to 220 parental caretakers of 2- to 12-year-old children who had been hospitalized with asthma at an inner-city medical center from January, 1995 to February, 1996. Sociodemographics, primary care practices, asthma morbidity, and asthma home management were assessed. Parents were asked what they would do if their child “began wheezing and breathing faster than usual.”Results.Morbidity measures indicated that there were an average of 2.5 ± 4.5 emergency department visits for asthma in the last 6 months, 1.6 ± 2.2 hospitalizations for asthma in the last 12 months, and 18.1 ± 17.9 asthma-related school absences in the previous school year. Most, but not all, of the families had primary care providers and most had phone access to them. Half of the families (51%) reported having been given a written asthma action plan. Only 30% of families with children age 5 years and older had peak flow meters. In contrast, almost all families (97%) had equipment for inhalation of β-agonists. Only 39% of the 181 children with persistent symptoms were receiving daily antiinflammatory agents as recommended in the guidelines of the NHLBI. In response to the scenario of an acute exacerbation of asthma, no one mentioned that they would refer to a written plan, only 1 caretaker would measure peak flow and 36% would give β-agonists. Two percent would give oral steroids initially, and 1 additional person would do so if wheezing continued 40 minutes later. Only 4% responded that they would contact their clinician. Reports of actual practice differed from the scenario responses in that more people began β-agonists and oral steroids in response to an exacerbation in the past 6 months than said they would in response to the scenario.Conclusion.In this population of previously hospitalized inner-city children with asthma, the NHLBI guidelines for the home management of asthma exacerbations are not being followed. Interventions are needed to affect both clinician and caretaker practices.
Clinical Use of Continuous Arterial Blood Gas Monitoring in the Pediatric Intensive Care Unit
Authors: Weiss Irwin K. , Fink Stan , Harrison Rick , Feldman Jonathan D. , Brill Judith E. 
Published: August 2004

Context.
Continuous arterial blood gas monitoring is a new technology based on the combination of opto-chemical and fiber-optic detectors that can measure pH, Pco2, Po2, and temperature on a continuous basis via a sensor placed in an artery.

Objective.
To evaluate this technology in pediatric patients who would normally require frequent arterial blood gas sampling.

Design.
A criterion standard study in which the results of arterial blood gas samples measured by the laboratory analyzer were compared with the sensor readings.

Setting.
A pediatric intensive care unit of a tertiary referral center.

Patients.
Children with severe respiratory failure who required frequent arterial blood gas sampling and who had a 20-gauge arterial line in either a radial or femoral site.

Results.
Twenty-four patients with a mean age of 6.4 years (range 1–21 years) had a sensor placed. Sensors were in place for a mean of 101 ± 62 hours. Eighteen patients underwent continuous monitoring for at least 24 hours or until no longer clinically necessary. There were 414 pairs of blood gas samples obtained. The bias/precision for pH was 0.005/0.030; for Pco2, −1.8/6.3 mm Hg; and for Po2, 1.2/24 mm Hg. The correlation (r value) between the sensor readings and the blood gases were pH 0. 960, Pco2 0.927, Po2 0.813 (P &lt; .01 for all values). The bias and precision for Po2levels &lt; 70 mm Hg were 0.057/9.34 mm Hg. There were no complications from sensor placement. Continuous blood gas monitoring allowed immediate recognition of clinical changes.

Conclusion.
The continuous arterial blood gas sensor is capable of clinically accurate blood gas measurements. This technology provides the clinician with immediate data that can allow rapid interventions in unstable patients.