bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identifying Children With Chronic Arthritis Based on Chief Complaints: Absence of Predictive Value for Musculoskeletal Pain as an Indicator of Rheumatic Disease in Children
Authors: McGhee Julie L. , Burks Frank N. , Sheckels Julie L. , Jarvis James N. 
Published: August 2004

Objective. To examine complaints for which children were referred to a pediatric rheumatology service and to determine whether there are specific complaints that are more likely to indicate the presence of chronic arthritis or chronic, systemic inflammatory disease.Methods. A retrospective chart review of 414 children referred to the pediatric rheumatology service at the Children’s Hospital of Oklahoma from April 1998 to July 2001.Results. Musculoskeletal pain was the most common complaint for which children were referred (n = 226). Of these, 111 had musculoskeletal pain as an isolated complaint. One of these children had a chronic inflammatory disease. Another 115 children had pain as 1 of several reasons for seeking a rheumatology consultation, including positive results on laboratory tests (antinuclear antibody, erythrocyte sedimentation rate, and rheumatoid factor). Nineteen of these children had a chronic inflammatory disease, including 12 with juvenile rheumatoid arthritis (JRA). Thus, musculoskeletal pain as a presenting complaint had a strong negative predictive value for the presence of either JRA (0.95) or any other chronic inflammatory disease that might be characterized by arthritis. Children who were referred, in part, because of positive antinuclear antibody and/or rheumatoid factor tests were no more likely to have a chronic inflammatory disease than children who did not include such results as a reason for referral. Joint swelling, in contrast, was the most likely complaint to be associated with a diagnosis of JRA.Conclusions. Musculoskeletal pain was the most common reason for referral to our pediatric rheumatology clinic. However, isolated musculoskeletal pain, in the absence of other signs or symptoms, is almost never a presenting complaint of children with chronic forms of arthritis. Children with arthritis more commonly present with complaints of joint swelling and/or gait disturbance. Neither ANA nor rheumatoid factor evaluations were useful in evaluating children with musculoskeletal complaints.
Attitudes of Pediatric Residents Toward Ethical Issues Associated With Genetic Testing in Children
Authors: Rosen Ami , Wallenstein Sylvan , McGovern Margaret M. 
Published: August 2004

Objective. To assess the attitudes of pediatric residents toward molecular genetic testing and some associated ethical issues that accompany its use in pediatric patients.Methods. A questionnaire study of pediatric residents (n = 160; response rate: 40%) enrolled in training programs at 3 New York metropolitan area hospitals was designed to determine their attitudes toward genetic testing in children and adolescents. The study instrument presented 2 clinical vignettes that described scenarios where a pediatric patient was at risk for being affected with or a carrier of a genetic disorder. Residents returned the questionnaire anonymously.Results. Most pediatric residents recognized the importance of educating family members (95%) and at-risk individuals (89%) about the inheritance pattern of the disorders they were at risk for. However, a substantial number would order predictive testing for Huntington disease in a child at the request of a parent (39% at age 10 and 52% at age 17), and more than half would order fragile X carrier studies on the cognitively normal sister of an affected male (56%).Conclusions. An effort must be made to educate all physicians during their residency training about the ethical issues associated with genetic testing. For pediatric residents, such education must include instruction on the complexities associated with offering such testing in this age group.
Are Research Ethics Standards Satisfied in Pediatric Journal Publications?
Authors: Weil Eric , Nelson Robert M. , Ross Lainie Friedman 
Published: August 2004

Background. The requirements for institutional review board (IRB) review and informed consent (IC) for research involving human subjects have existed for more than 2 decades. Although many studies document them poorly, most published research undergoes IRB review and has IC procedures. Less is known about research published in pediatric journals, and how child health research is determined to be exempt.
Method. All full-length articles published in the paper edition of 3 pediatric journals between January and December 2000 were examined. Articles were excluded if they were case studies, meta-analyses, lacked empirical data, or did not include at least 1 US researcher or US subjects. The remaining articles were examined to determine if they documented IRB review and IC mechanisms. If either or both of these features were missing, authors were asked to participate voluntarily in a survey. In addition, all exempt articles were examined to determine if the exemptions were in accordance with the federal regulations for the protection of human subjects.
Results. Three hundred seventy-nine of 575 articles met inclusion criteria. One hundred ninety-seven (52.0%) documented IRB review, 164 (43.3%) documented IC, and 131 (34.6%) properly documented the presence of both IRB review and IC. Two hundred fifty-one researchers were surveyed to clarify IRB review and/or IC mechanisms. Approximately 13.5% of the research had not undergone IRB review, and 12.4% had not had their consent methods reviewed by an IRB. We found that between 26.9% and 39.8% of exempted research did not meet federal regulations requirements.
Conclusions. We found that most research underwent IRB review and had a consent mechanism despite the lack of documentation in the articles. We also found that most research that did not undergo IRB review would have been exempt under current guidelines. However, a significant number of IRB- and researcher-exempted research were inappropriately classified. Improving research ethics standards will require additional education for researchers and IRB members, and greater adherence of researchers (and editors) to the journals’ guidelines on these issues.
Invasive Pneumococcal Disease and Hemolytic Uremic Syndrome
Authors: Brandt John , Wong Craig , Mihm Susan , Roberts Joan , Smith Jodi , Brewer Eileen , Thiagarajan Ravi , Warady Bradley 
Published: August 2004

Objective. Severe pneumococcal infections have been associated with hemolytic uremic syndrome (HUS), usually with a poor clinical outcome when compared with Escherichia coli O157 gastroenteritis-associated (D+) HUS. We examined our experience with 12 cases of Streptococcus pneumoniae-associated HUS (SP-HUS) and compare it with a cohort of diarrhea-associated HUS (D+ HUS).Methods. A retrospective case survey compared 2 unrelated groups of HUS patients. Demographic factors, clinical indices of disease severity, and outcome were used to compare the 2 groups of HUS patients.Results. Twelve children with SP-HUS were studied. Pneumococcal pneumonia with empyema was the most common precipitating illness (67%), pneumococcal meningitis was present in 17% of children, pneumonia with bacteremia in 8%, and both pneumonia and meningitis in 8%. SP-HUS patients were younger than D+ HUS patients (22.1 vs 49 months) and had more severe renal and hematologic disease than D+ HUS patients. Compared with D+ HUS patients, SP-HUS patients were more likely to require dialysis (75% vs 59%) and had a longer duration of hospitalization (33.2 vs 16.1 days) and duration of thrombocytopenia (11.6 vs 6.8 days). SP-HUS patients were also more likely to require platelet transfusions (83% vs 47%) and needed more platelet (4.7 vs 0.5) and packed red blood cell transfusions (7.8 vs 2.0). The 2 groups did not differ significantly in the incidence of extrarenal HUS complications. There were no deaths in either group. Seven patients have been seen for long-term follow-up; 2 developed end-stage renal disease, and 5 have normal renal function.Conclusions. HUS is a rare but severe complication of invasive pneumococcal infection. Although disseminated intravascular coagulation can also occur in these children, the treatment and follow-up may be different in the 2 conditions. Children with pneumococcal disease and severe hematologic or renal abnormalities should be investigated for evidence of HUS.
Crossover Trial of Analgesic Efficacy of Glucose and Pacifier in Very Preterm Neonates During Subcutaneous Injections
Authors: Carbajal Ricardo , Lenclen Richard , Gajdos Vincent , Jugie Myriam , Paupe Alain 
Published: August 2004

Objective. Very preterm newborns undergo multiple invasive procedures. Nonpharmacological interventions are valuable alternatives for pain relief during minor procedures in neonates. Oral sucrose analgesia has been widely studied in term and preterm neonates during painful procedures. The analgesic effect of oral glucose in very preterm infants has not yet been reported. The objectives of this study were to assess the analgesic effect of orally administered glucose and to determine the synergetic analgesic effect of glucose and pacifiers during subcutaneous injections in very preterm neonates using a validated behavioral acute pain rating scale.
Design. Two crossover trials.
Setting. One neonatal intensive care unit in a community-based general hospital.
Methods. A prospective study was conducted in 40 very preterm neonates. Each infant received 2 treatments in a crossover manner during 2 consecutive subcutaneous injections of erythropoietin. The first trial (25 infants) was intended to compare oral 30% glucose (0.3 mL) versus placebo (0.3 mL of sterile water); the second trial (15 infants) compared oral 30% glucose (0.3 mL) versus oral 30% glucose (0.3 mL) followed by sucking a pacifier. The primary outcome measure was the evaluation of pain induced by a subcutaneous injection of erythropoietin, using Douleur Aiguë Nouveau-né scale (0 no pain, 10 maximum pain).
Results. Twenty-four infants completed the study in the first trial and 15 in the second one. Mean (95% confidence interval [CI]) gestational age, birth weight, postnatal age, and weight at inclusion for neonates in the first and second trial were, respectively, 28.1 (95% CI: 27.3–29.0) and 29.1 (95% CI: 27.8–30.4) weeks, 1036 (95% CI: 944-1128) and 995 (95% CI: 848-1141) g, 26.4 (95% CI: 22.4–30.3) and 26 (95% CI: 22.0–29.9) days, and 1234 (95% CI: 1120–1348) and 1209 (95% CI: 1059–1359) g. In the first trial, median (interquartile) pain scores for placebo and 30% glucose, respectively, were 7 (2.5–9.75) and 4.5 (1–6). In the second trial, median (interquartile) pain scores for 30% glucose and for 30% glucose plus pacifier, respectively, were 4 (2–7) and 4 (1–6).
Conclusions. A small dose of 0.3 mL of 30% oral glucose has an analgesic effect in very preterm neonates during subcutaneous injections. This effect is clinically evident because it can be detected by a behavioral pain rating scale. The synergetic analgesic effect of glucose plus sucking a pacifier is less obvious in very preterm neonates as opposed to what other studies have showed in full-term infants.
Low Compliance of Iron Supplementation in Infancy and Relation to Socioeconomic Status in Israel
Authors: Amsel Shlomo , Boaz Mona , Ballin Ami , Filk Dani , Ore Naama 
Published: August 2004

Objective. To evaluate the compliance of parents in purchasing iron-containing drugs for their infants. In addition, we looked for possible socioeconomic characteristics of the parents who prevent their infants from accessing these medications.
Design. All infants (4–12 months) whose parents bought (from January to August 1999 and from January to August 2000) the iron-containing drugs as recommended by the Israeli Ministry of Health were retrieved from a database. The socioeconomic status of the citizens was determined according to the “mean real income” (INCMV) and “relative income” (INCMS). The percentage of parents who purchased the medication from each district was compared with the socioeconomic status of this population.
Results. Forty-four pediatricians’ offices in the Tel Aviv metropolitan area were included. The data of 4929 infants was summarized. Only 27% of the parents bought the drugs. Only 11.5% to 20% of parents from the 5 highest socioeconomic classes purchased the medication compared with 43.6% to 57.1% of the parents from the 5 lowest socioeconomic classes.
Conclusion. There was low compliance by parents in obtaining iron-containing medications for their infants, mainly among parents from high socioeconomic classes.
Kawasaki Disease Before Kawasaki at Tokyo University Hospital
Authors: Shibuya Noriko , Shibuya Kazuhiko , Kato Hitoshi , Yanagisawa Masayoshi 
Published: August 2004

Objective. Kawasaki disease (KD) was first reported by Tomisaku Kawasaki in 1967 in Japan. Large-scale nationwide epidemiologic surveys have been conducted continuously by the Japan Kawasaki Disease Research Committee; however, there were very few reports of KD before 1967. This study was performed to clarify when KD appeared in Japan.Design. We investigated the medical charts of patients who had been hospitalized at Tokyo University Hospital between 1940 and 1965.Results. We identified 10 patients whose clinical signs fulfilled the criteria for KD. The ages of the patients ranged from 8 months to 5 years, and their final diagnoses were Stevens-Johnson syndrome, allergic toxic erythema, Izumi fever, scarlet fever, and cervical lymphadenitis. These 10 patients presented between 1950 and 1964, and no confirmed cases were seen between 1940 and 1949.Conclusions. Our findings suggested that KD patients were rare before 1950 in Japan.
Acute Disseminated Encephalomyelitis in Children
Authors: Murthy S. N. Krishna , Faden Howard S. , Cohen Michael E. , Bakshi Rohit 
Published: August 2004

Objective. To describe the epidemiologic, clinical, neuroimaging, and laboratory features; treatment; and outcome in a cohort of children with acute disseminated encephalomyelitis (ADEM).
Methods. A 6-year retrospective chart review of children with the diagnosis of ADEM was conducted.
Results. Eighteen cases were identified. Sixteen patients (88%) presented in either winter or spring. Thirteen children (72%) had a recent upper respiratory tract illness. Patients presented most often with motor deficits (77%) and secondly with altered consciousness (45%). Spinal fluid abnormalities occurred in 70%. Despite rigorous microbiologic testing, a definite microbiologic diagnosis was established only in 1 child with Epstein-Barr virus disease and probable or possible diagnoses in 3 children with Bartonella henselae, Mycoplasma pneumoniae, or rotavirus disease. Brain magnetic resonance imaging identified lesions in the cerebral cortex in 80%, in subcortical white matter in 93%, in periventricular white matter in 60%, in deep gray matter in 47%, and in brainstem in 47% of patients. Eleven patients (61%) were treated with corticosteroids, and 2 were treated with intravenous immunoglobulins. All patients survived. Three patients (17%) had long-term neurologic sequelae.
Conclusions. Epidemiologic evidence from this study suggests an infectious cause for ADEM. The agent is most likely a difficult-to-diagnose winter/spring respiratory virus. Magnetic resonance imaging was the neuroimaging study of choice for establishing the diagnosis and for following the course of the disease. Prognosis for survival and outcome was excellent. Recurrent episodes of ADEM must be differentiated from multiple sclerosis.
Weight Criticism During Physical Activity, Coping Skills, and Reported Physical Activity in Children
Authors: Faith Myles S. , Leone Mary Ann , Ayers Tim S. , Heo Moonseong , Pietrobelli Angelo 
Published: August 2004

Objective. National health guidelines advocate increased physical activity in children and adolescents, but specific goals are not being achieved. Data are needed on variables that influence children’s decision to be active or sedentary.
Methods. We tested the association of weight criticism during physical activity (WCA) with attitudes toward physical activity and reported physical activity levels in children. We also tested whether these associations were moderated by children’s ability to cope with weight criticism. Subjects were 576 fifth- through eighth-graders who completed a questionnaire on physical activity patterns, weight criticism history, and coping skills.
Results. WCA was more common among girls than boys and among heavier children. In multiple regression analyses, WCA was associated with reduced sports enjoyment, perceived activity compared with peers, and mild-intensity leisure activity. These associations, however, were moderated by problem-focused coping skills such that the relationships were attenuated in children who were better able to cope with weight criticism. Avoidant coping skills also moderated the relationship between WCA and sports enjoyment.
Conclusions. Children who are the targets of weight criticism by family and peers have negative attitudes toward sports and report reduced physical activity levels, although these relationships may be buffered by certain coping skills. Assessing WCA and related coping skills may be clinically useful for identifying barriers to physical activity in certain children (eg, the obese) and may be a potential target for interventions.
Survival, Disease Manifestations, and Early Predictors of Disease Progression Among Children With Perinatal Human Immunodeficiency Virus Infection in Thailand
Authors: Chearskul Sanay , Chotpitayasunondh Tawee , Simonds R. J. , Wanprapar Nirun , Waranawat Naris , Punpanich Warunee , Chokephaibulkit Kulkanya , Mock Philip A. , Neeyapun Kanchana , Jetsawang Bongkoch , Teeraratkul Achara , Supapol Wendy , Mastro Timothy D. , Shaffer Nathan ,   Bangkok Collaborative Perinatal HIV Transmission Study Group
Published: August 2004

Objective. To describe survival and signs of human immunodeficiency virus (HIV) infection in perinatally infected children in Thailand.Methods. At 2 large Bangkok hospitals, 295 infants born to HIV-infected mothers were enrolled at birth from November 1992 through September 1994 and followed up with clinical and laboratory evaluations every 1 to 3 months for 18 months. Infected children remained in follow-up thereafter. For the infected children, we used data collected through October 2000 to estimate survival times and compare characteristics among those whose disease progressed at rapid (died within 1 year), intermediate (died at 1–5 years), and slow (survived at least 5 years) rates.Results. None of the 213 uninfected children died during the follow-up period. Of the 68 infected children, 31 (46%) died; median survival was 60 months (95% confidence interval: 31–89 months). The most common cause of death was pneumonia (52% of deaths). Thirty-two children (47%) started antiretroviral therapy. Six children died in their first year before developing specific signs of HIV infection; all others developed signs of HIV infection between 1 and 42 months old (median: 4 months). Severe clinical (Centers for Disease Control and Prevention Class C) conditions were diagnosed in 23 children at a median age of 12 months, 15 (65%) of whom died a median of 3 months later. Compared with children whose disease progressed slowly, those whose disease progressed rapidly gained less weight by 4 months old (median 1.7 vs 2.6 kg), and their mothers had higher viral loads (median 5.1 vs 4.5 log10 copies/mL) and lower CD4+ counts (median 350 vs 470 cells/μL) at delivery.Conclusions. Among HIV-infected Thai children, survival times are longer than among children in many African countries, but shorter than among children in the United States and Europe. Signs of HIV develop early in most children. Growth failure and advanced maternal disease can predict rapid HIV disease progression and may be useful markers for treatment decisions.
Rate, Risk Factors, and Outcomes of Nosocomial Primary Bloodstream Infection in Pediatric Intensive Care Unit Patients
Authors: Yogaraj Jeya S. , Elward Alexis M. , Fraser Victoria J. 
Published: August 2004

Objective. The objective of this study was to determine the rate, risk factors, and outcomes of nosocomial primary bloodstream infection in pediatric intensive care unit (PICU) patients.
Design. Prospective cohort study.
Settings. This study was performed at St Louis Children’s Hospital, a 235-bed academic tertiary care center with a combined 22-bed medical and surgical PICU.
Patients. Subjects for this study were patients admitted to the PICU between September 1, 1999, and May 31, 2000.
Interventions. None.
Outcome Measures. Patients were monitored for the development of nosocomial bloodstream infections from the day of PICU admission until 48 hours after PICU discharge.
Results. Of 911 patients, 526 (58%) were male and 674 (74%) were white. Congenital heart disease (29%), lung disease (25%), and genetic syndrome (18%) were common. There were 65 episodes of primary bloodstream infection in 57 patients; 5 were polymicrobial and 7 patients had multiple bloodstream infections. Coagulase-negative Staphylococcus was the leading cause of bloodstream infection (n = 28), followed by Enterobacter cloacae (n = 8). The rate of bloodstream infection was 13.8 per 1000 central venous catheter days. In multiple logistic regression analysis, patients with bloodstream infection were more likely to have multiple central venous catheters (adjusted odds ratio [aOR]: 5.7; 95% confidence interval [CI]: 2.9–10.9), arterial catheters (aOR: 5.5; 95% CI: 1.8–16.3), invasive procedures performed in the PICU (aOR: 4.0; 95%CI: 2.0–7.8), and be transported out of the PICU (aOR: 3.4; 95% CI: 1.8–6.7) to the radiology or operating room suites. Severity of illness as measured by admission Pediatric Risk of Mortality score, underlying illnesses, and medications were not associated with increased risk of nosocomial bloodstream infection.
Conclusions This study identified a high rate of bloodstream infection among St Louis Children’s Hospital PICU patients. Risk factors for bloodstream infection were related more to process of care than to severity of illness. Additional research is needed to develop interventions to reduce nosocomial bloodstream infections in children.