bluuebunny/crossref_metadata_2025_split huggingface dataset:
Snoring in Portuguese Primary School Children
Authors: Ferreira Ana Maria , Clemente Vanda , Gozal David , Gomes Ana , Pissarra Celsa , César Helena , Coelho Isabel , Silva Carlos F. , Azevedo Maria Helena P. 
Published: August 2004

Objective.
To determine the prevalence of snoring and its potential associations with sleep problems, such as daytime symptoms, medical conditions, school performance, and behavioral disturbances in Portuguese children attending primary school.

Methods.
A previously validated questionnaire was sent to the parents of 1381 children attending primary schools in a parish of Coimbra, Portugal. To assess behavioral disturbances, the Portuguese version of Rutter's Children's Behavior Questionnaire for completion by teachers was used.

Results.
Of the 988 questionnaires returned (71.5%), complete information concerning snoring was obtained for 976 children (496 girls and 480 boys; mean age: 8.1 ± 1.5 years). Loud snoring during sleep was reported as frequent or constantly present (LSn) in 84 children (8.6%), as occasionally present in 299 children (30.6%), and as never present (NSn) by 593 children (60.8%). The LSn and NSn groups did not differ with respect to age, gender, sleep duration, time to fall asleep, frequency of night wakings, bedwetting, daytime tiredness, and school achievement. However, LSn was significantly associated with increased bedtime problems (fears and struggles), increased need for comforting activities to fall asleep, behaviors suggestive of parasomnias (sleep talking, teeth grinding, and night terrors), increased daytime sleepiness and irritability, and behavioral disturbances. Children in the LSn group were also more likely to report recurrent medical problems particularly those involving infections of the respiratory tract.

Conclusions.
Snoring is a common symptom in Portuguese children that is associated with behavioral daytime and sleep time disturbances. Children with loud snoring may benefit from early evaluation and intervention.
The Pediatrician's Role in Reducing Tobacco Exposure in Children
Authors: Stein Risa Jean , Haddock Christopher Keith , O'Byrne Kristin Koetting , Hymowitz Norman , Schwab Joseph 
Published: August 2004

Objective.Pediatricians have a unique and important role to play in the prevention and treatment of childhood and adolescent tobacco use, the protection of patients from the harmful effects of environmental tobacco smoke, and the encouragement of smoking cessation among parents. However, because recent research indicates that physician training in tobacco dependence is woefully weak and lacks a model for training, this article constructs a useful approach to this problem.Methodology.A comprehensive review of the literature served as the basis for the development of a new model for pediatrician training in tobacco dependence.Results.A comprehensive model is presented for training pediatricians in the areas of reducing infant and child exposure to environmental tobacco smoke, preventing youth smoking initiation, and providing smoking cessation assistance for adolescents and parents.Conclusions.Pediatricians have been called on to play an active role in the antitobacco arena. Because of their unique opportunity to interact with children, adolescents, and parents, pediatricians can and should be antitobacco interventionists. For this to occur, however, additional guidance should be provided to pediatricians during their training to better prepare them to carry out effective assessment and intervention practices. smoking initiation, smoking prevention, smoking cessation, environmental tobacco smoke, pediatricians.
Distribution of Accidents, Injuries, and Illnesses by Family Type
Authors: O'Connor Thomas G. , Davies Lisa , Dunn Judy , Golding Jean ,   the ALSPAC Study Team
Published: August 2004

Objective.
To investigate whether family type and psychosocial risks indexed by family type were systematically associated with differences in health outcomes in children.

Design and Subjects.
The study is based on a longitudinal, prospective study of a large (n = ∼10 000) community sample of families, the Avon Longitudinal Study of Pregnancy and Childhood.

Main Outcome Measures.
Frequency of accidents, illnesses, and medical interventions.

Results.
At 2 years of age, children in single-parent and stepfamilies were disproportionately likely to experience accidents and receive medical treatment for physical illnesses. In addition, children in single-parent families and stepfamilies were more likely to be hospitalized or receive attention from a hospital doctor for an injury or illness. Exposure to psychosocial risks also were elevated in single-parent families and stepfamilies, compared with intact or nonstepfamilies, and these factors primarily accounted for the connection between family type and children's physical health.

Conclusions.
The consequences of family transitions on children's health extend beyond traditional mental health and behavioral outcomes and include accident proneness, illness, and receipt of medical attention. The mediating processes are not entirely attributable to social class differences connected to family type and may instead be associated with a range of psychosocial risks that are more frequently found in single-parent families and stepfamilies, compared with intact or nonstepfamilies. Prevention and intervention efforts directed toward children at risk for poor behavioral and mental health adjustment secondary to family disruption should consider children's physical health and health-related behaviors.
Growth Pattern of Breastfed and Nonbreastfed Infants With Atopic Dermatitis in the First Year of Life
Authors: Agostoni Carlo , Grandi Francesca , Scaglioni Silvia , Giannı̀ Maria L. , Torcoletti Marta , Radaelli Giovanni , Fiocchi Alessandro , Riva Enrica 
Published: August 2004

Objective.The growth of infants with atopic dermatitis (AD) has been poorly investigated based on the early type of feeding. The aim of this study was to assess the growth pattern of AD infants during the first 12 months of life in comparison to healthy infants, according to the early type of feeding (breastfed or nonbreastfed).Methods.Fifty-five term AD infants (36 breastfed and 19 nonbreastfed) and 114 term healthy infants (58 breastfed and 56 nonbreastfed) were evaluated by standardized growth indices (z scores; National Center for Health Statistics-World Health Organization data) through the first 12 months of life.Results.No difference was found between AD and healthy groups at birth. In AD infants, weight (WA) and length (LA)z scores decreased with age and were significantly lower, compared with healthy infants from the second month of age onward. The difference of mean z scores between AD and healthy infants at 12 months of age was −.69 (95% confidence interval [CI]: −1.00 to −.38) for WA and −.67 (95% CI: −.98 to −.36) for LA. The growth pattern of AD infants was not influenced by the early type of feeding, whereas in the 6- to 12-month period, the delay in growth was more pronounced in patients with more severe dermatitis.Conclusions.In the first year of life, AD infants show a progressive impairment in growth irrespective of the early type of feeding. The severity of disease may be an independent factor negatively influencing growth.
Decreased Use of Neonatal Extracorporeal Membrane Oxygenation (ECMO): How New Treatment Modalities Have Affected ECMO Utilization
Authors: Hintz Susan R. , Suttner Denise M. , Sheehan Arlene M. , Rhine William D. , Van Meurs Krisa P. 
Published: August 2004

Objective:Over the last decade, several new therapies, including high-frequency oscillatory ventilation (HFOV), exogenous surfactant therapy, and inhaled nitric oxide (iNO), have become available for the treatment of neonatal hypoxemic respiratory failure. The purpose of this retrospective study was to ascertain to what extent these modalities have impacted the use of neonatal extracorporeal membrane oxygenation (ECMO) at our institution.Methods.Patients from 2 time periods were evaluated: May 1, 1993 to November 1, 1994 (group 1) and May 1, 1996 to November 1, 1997 (group 2). During the first time period (group 1), HFOV was not consistently used; beractant (Survanta) use for meconium aspiration syndrome (MAS), persistent pulmonary hypertension of the newborn (PPHN), and pneumonia was under investigation; and iNO was not yet available. During the second time period (group 2), HFOV and beractant treatment were considered to be standard therapies, and iNO was available to patients with oxygenation index (OI) ≥25 × 2 at least 30 minutes apart, or on compassionate use basis. Patients were included in the data collection if they met the following entry criteria: 1) OI &gt;15 × 1 within the first 72 hours of admission; 2) EGA ≥35 weeks; 3) diagnosis of MAS, PPHN or sepsis/pneumonia; 4) &lt;5 days of age on admission; and 5) no congenital heart disease, diaphragmatic hernia, or lethal congenital anomaly.Results.Of the 49 patient in group 1, 21 (42.8%) required ECMO therapy. Of these ECMO patients, 14 (66.6%) had received diagnoses of MAS or PPHN. Only 3 of the patients that went on to ECMO received beractant before the initiation of bypass (14.3%). All ECMO patients in group 1 would have met criteria for iNO had it been available. Of all patients in group 1, 18 (36.7%) were treated with HFOV, and 13 (26.5%) received beractant. Of the 47 patients in group 2, only 13 (27.7%) required ECMO therapy (compared with group 1). Of these ECMO patients, only 5 (38.5%) had diagnoses of MAS or PPHN, with the majority of patients (61.5%) requiring ECMO for sepsis/pneumonia, with significant cardiovascular compromise. Only 5 of these ECMO patients, all outborn, did not receive iNO before cannulation because of the severity of their clinical status on admission. Of all patients in group 2, 41 (87.2%) were treated with HFOV (compared with group 1), 42 (89.3%) received beractant (compared with group 1), and 18 (44.7%) received iNO.Conclusions.The results indicate that ECMO was used less frequently when HFOV, beractant and iNO was more commonly used. The differences in treatment modalities used and subsequent use of ECMO were statistically significant. We speculate that, in this patient population, the diagnostic composition of neonatal ECMO patients has changed over time.
Teething and Tooth Eruption in Infants: A Cohort Study
Authors: Wake Melissa , Hesketh Kylie , Lucas James 
Published: August 2004

Objective.
Many symptoms are attributed to teething in infants. There is little evidence to support these beliefs, despite their implications for clinical management. We investigated relationships between tooth eruption, fever, and teething symptoms.

Methods.
Prospective cohort study.

Participants.
Twenty-one children 6 to 24 months old attending 3 suburban long-day care centers ≥3 days/week.

Measures.
1) Daily temperature recording and examination of alveolar ridges for tooth eruption (dental therapist). 2) Daily questionnaires—symptoms over preceding 24 hours (staff and parents independently). 3) Final questionnaire—beliefs/experiences related to teething (parents).

Definitions.
Eruption day—the first day a tooth could be seen or felt. Non-toothdays–more than 28 days clear of any eruption day. Toothdays–the 5 days preceding eruption days.

Results.
Data were collected for 236 toothdays and 895 non-toothdays pertaining to 90 teeth. Child temperatures were similar on toothdays and non-toothdays (36.21 vs 36.18, paired ttest). Logistic regression adjusted for age did not show an association between toothdays and temperature (odds ratio [OR] = 1.35, 95% confidence interval [CI] = 0.80, 2.27 for high fever; OR = 1.34, 95% CI = 0.48, 3.77 for low fever). Logistic regression models allowing for within-child cluster effects and age were fitted to daily staff and parent reports of mood, wellness/illness, drooling/dribbling, sleep, diarrhea, strong diapers, red cheeks, and rashes/flushing. Only parent-reported (but not staff-reported) loose stools were significantly associated with tooth eruption (OR = 1.86, 95% CI = 1.26, 2.73). When the toothday definition was varied to 10 days preceding or 5 days surrounding tooth eruption, this single significant association was no longer apparent (OR = 1.42, 95% CI = 0.98, 2.05 and OR = 1.47, 95% CI = 0.97, 2.21, respectively). All parents retrospectively reported that their own children had suffered a range of teething symptoms.

Conclusions.
This study did not confirm the expected strong associations between tooth eruption and a range of teething symptoms in children 6 to 30 months old, although we cannot rule out the possibility that weak associations may exist (Type II error). These findings contrast with strong parent and professional beliefs to the contrary. Such beliefs may preclude optimal management of common patterns of illness and behavior in young children.teething, infants, symptoms, tooth eruption, illness.
Maternal Perceptions of Overweight Preschool Children
Authors: Baughcum Amy E. , Chamberlin Leigh A. , Deeks Cindy M. , Powers Scott W. , Whitaker Robert C. 
Published: August 2004

Context.Childhood obesity is a major public health problem, and prevention efforts should begin early in life and involve parents.Objective.To determine what factors are associated with mothers' failure to perceive when their preschool children are overweight.Design.Cross-sectional survey.Settings.Offices of private pediatricians and clinics of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).Participants.Six hundred twenty-two mothers with children 23 to 60 months of age.Main Outcome Measures.Maternal demographic variables, maternal self-reported height and weight, and children's measured height and weight. Mothers were asked whether they considered themselves or their children overweight.Results.Forty-five percent of mothers had low education (high school degree or less) and 55% had high education (some college or more). Obesity (body mass index: ≥30 kg/m2) was more common in the low education group of mothers (30% vs 17%), and their children tended to be more overweight (weight-for-height percentile: ≥90th; 19% vs 14%). Ninety-five percent of obese mothers believed that they were overweight, with no difference between education groups. However, 79% of mothers failed to perceive their overweight child as overweight. Among the 99 mothers with overweight children, low maternal education was associated with a failure to perceive their children as overweight after adjusting for low family income (≤185% of poverty), maternal obesity, age, and smoking plus the child's age, race, and gender (adjusted odds ratio: 6.2; 95% confidence interval: 1.7–22.5).Conclusions.Obesity was more common in mothers with less education as well as in their children. Nearly all of the obese mothers regarded themselves as overweight. However, the majority of mothers did not view their overweight children as overweight, and this misperception was more common in mothers with less education. Childhood obesity prevention efforts are unlikely to be successful without a better understanding of how mothers perceive the problem of overweight in their preschool children.
Fulminant Late-Onset Sepsis in a Neonatal Intensive Care Unit, 1988–1997, and the Impact of Avoiding Empiric Vancomycin Therapy
Authors: Karlowicz M. Gary , Buescher E. Stephen , Surka Aqil E. 
Published: August 2004

Objective.
To determine the pathogens associated with fulminant (lethal within 48 hours) late-onset sepsis (occurring after 3 days of age) in a neonatal intensive care unit (NICU) and the frequency of fulminant late-onset sepsis for the most common pathogens.

Methods.
A retrospective study was conducted of sepsis in infants in a NICU over a 10-year period (1988–1997).

Results.
There were 825 episodes of late-onset sepsis occurring in 536 infants. Thirty-four of 49 (69%; 95% confidence interval [CI]: 55%–82%) cases of fulminant late-onset sepsis were caused by Gram-negative organisms, including Pseudomonassp., 20 (42%); Escherichia coli, 5 (10%);Enterobacter sp., 4 (8%); and Klebsiellasp., 4 (8%). The frequency of fulminant sepsis was highest forPseudomonas sp., 20 of 36 (56%; 95% CI: 38%–72%) and lowest for coagulase-negative staphylococci, 4 of 277 (1%; 95%CI: 0%–4%). The very low frequency of fulminant sepsis caused by coagulase-negative staphylococci did not increase during the period when oxacillin was used instead of vancomycin as the empiric antibiotic for Gram-positive organisms.

Conclusions.
These data suggest that empiric antibiotics selected for treatment of suspected sepsis in infants &gt;3 days old need to effectively treat Gram-negative pathogens, particularlyPseudomonas sp., because these organisms, although less frequent, are strongly associated with fulminant late-onset sepsis in the NICU. Avoiding empiric vancomycin therapy seemed to be a reasonable approach to late-onset sepsis, because of the very low frequency of fulminant sepsis caused by coagulase-negative staphylococci.
Pediatric Office Emergencies and Emergency Preparedness in a Small Rural State
Authors: Heath Barry W. , Coffey Jean S. , Malone Patrick , Courtney James 
Published: August 2004

Objective.Although the frequency of pediatric office medical emergencies has been investigated in a retrospective manner, there have been no prospective studies. We examined how often pediatricians in a small rural state encountered medical emergencies in the office setting. This study included an in-office educational program and the donation of resuscitation equipment to study participants.Design and Intervention.Thirty-eight of the 40 active primary care pediatric practices in the state of Vermont participated in this study. Thirty-seven sites were surveyed retrospectively regarding office preparedness for emergencies and frequency of office emergencies. At each practice site, an educational session was provided and an office resuscitation kit was donated. Thirty-seven sites were followed prospectively for a 12-month period evaluating the incidence of office medical emergencies and the adequacy of the donated resuscitation kit.Results.Three hundred twenty-seven individuals from 38 Vermont pediatric practice sites participated. Forty-nine percent had basic life support training and 26% had pediatric advanced life support training. Sixty-seven percent of practices had a plan for office medical emergencies. Forty-six percent of practices had called local emergency medical services providers to their offices in the past year. Emergency preparedness ranged from a high of 95% of sites with oxygen to a low of 27% of sites with intraosseous needles. The estimate of the frequency of medical emergencies was .9 (standard deviation = .8) per office in the previous 12 months. In the 12-month study, there were 28 medical emergencies reported, averaging .8 (standard deviation = 1.5) emergencies per office per year. Sixty-five percent of participating sites had no emergencies in the study. Of the emergencies reported, 75% were respiratory in origin. The donated resuscitation kits proved sufficient for all of the emergencies reported.Conclusions.Serious medical emergencies are rare events in the primary care pediatric office, occurring less than once per office per year. The most common emergency situations encountered are respiratory. All of the emergencies in this study were managed effectively using a simple and relatively inexpensive resuscitation kit. We provided an emergency preparedness program for pediatric practices in a small rural state.
Longitudinal Neurologic Follow-Up in Neonatal Intensive Care Unit Survivors With Various Neonatal Morbidities
Authors: McGrath Margaret M. , Sullivan Mary C. , Lester Barry M. , Oh William 
Published: August 2004

Objective.The purpose of this prospective longitudinal study was to examine neurocognitive and school performance outcomes of low birth weight infants with reference to neonatal morbidity and socioeconomic status. We further evaluated the cognition and school performance based on their neurologic status at the time of assessment.Methods.One hundred eighty-eight children (39 healthy full-term and 149 preterm infants) were classified into 4 subgroups based on their neonatal medical status: healthy, sick (without neurologic complications), small for gestational age, and neurologically compromised infants. Neurologic status was classified as normal, suspect, or abnormal at hospital discharge, 18 months, 30 months, 4 years, and 8 years of age. Socioeconomic status, cognitive, and school performances were assessed.Results.Neurologically, both full-term and healthy preterm groups did well during the 8-year period. There were significant fluctuations between suspect and abnormal neurologic classifications among the 3 preterm groups with neonatal complications. Preterms with neurologic abnormality during the neonatal period did the poorest with 45% of the group remaining abnormal at 8 years of age. Children who were neurologically normal had higher cognitive scores at ages 4 and 8 than those categorized as suspect or abnormal. Preterm infants with neurologic abnormality required significantly more academic resources in the school. Reading and math achievement scores were the lowest for the preterm groups classified as neurologically suspect or abnormal.Conclusions.Neonatal morbidities exert a significant impact in neurologic outcomes among preterm children during the 8 years of assessment. Compromised neurologic status adversely affects cognitive and school performances. Neonatal medical status is an important variable indicating neurocognitive and school performance outcomes in low birth weight infants.
Predictors of Asthma Three Years After Hospital Admission for Wheezing in Infancy
Authors: Reijonen Tiina Marjaana , Kotaniemi-Syrjänen Anne , Korhonen Kaj , Korppi Matti 
Published: August 2004

Objective.
To evaluate the influence of early antiinflammatory therapy in the development of asthma 3 years after hospitalization for wheezing in infancy. In addition, the effects of allergic sensitization and respiratory syncytial virus (RSV) infection on the development of asthma were investigated.

Design and Setting.
A randomized, controlled follow-up study in a university hospital that provides primary hospital care for all pediatric patients in a defined area.

Patients.
Eighty-nine infants under 2 years of age who had been hospitalized for infection associated with wheezing and followed up for 3 years.

Intervention.
Early antiinflammatory therapy was given for 16 weeks; 29 patients received cromolyn sodium and 31 received budesonide. Twenty-nine control patients received no therapy.

Outcome Measures.
Clinical diagnosis of current asthma, defined as having at least 3 episodes of physician-diagnosed wheezing and either a wheezing episode during the preceding year or ongoing antiinflammatory medication for asthma.

Results.
Fourteen (48%) patients in the former cromolyn group, 15 (48%) in the former budesonide group, and 16 (55%) in the control group had current asthma. The significant predictors of asthma were age over 12 months (risk ratio [RR] 4.1; 95% confidence interval [CI] = 1.59–10.35), history of wheezing (RR 6.8; CI = 1.35–34.43), and atopic dermatitis on study entry (RR 3.4; CI = 1.17–9.39). Skin prick test positivity at the age of 16 months significantly predicted asthma (RR 9.5; CI = 2.45–36.72). In addition, all of the 18 (20%) children sensitized with furred pet developed asthma. RSV identification (RR 0.3; CI = 0.08–0.80) and early furred pet contact at home (RR 0.3; CI 0.10–0.79) were associated with the decreased occurrence of asthma.

Conclusions.
Antiinflammatory therapy for 4 months has no influence on the occurrence of asthma 3 years after wheezing in infancy. Early sensitization to indoor allergens, especially to pets, and atopic dermatitis predict subsequent development of asthma. RSV infection in wheezing infants may have a better outcome than other infections.