bluuebunny/crossref_metadata_2025_split huggingface dataset:
Inhaled budesonide in acute asthma
Authors: Singhi SC , Banerjee S , Nanjundaswamy HM 
Published: March 2003

Objective: To evaluate the efficacy of aerosolized budesonide therapy (with metered dose inhaler and spacer) early in the emergency room treatment of acute moderate exacerbations of bronchial asthma in children. Design: Randomized, double‐blind, placebo‐controlled trial. Setting: Paediatric Emergency Service of an urban teaching hospital and a tertiary case referral centre. Study population: Sixty children between 3 and 12 years of age with an acute moderate exacerbation of asthma. Intervention: All patients received humidified oxygen (5–8 L/min by Venturi® mask; Hudson Respiratory Care, Temecula, CA, USA), nebulized salbutamol (0.15 mg/kg in 3 mL saline) and were randomized to receive either budesonide (400 μg) or placebo inhalation (MDI and spacer) at half hourly intervals for three doses. If there was an inadequate response or no response to treatment at the end of 2 h, oxygen and salbutamol therapy were continued and the patient was given one of dose intravenous hydrocortisone and was started on an aminophylline infusion. If there was no response at the end of a further 4 h, the patient was hospitalized. Initial evaluation and monitoring: Colour, respiratory rate (RR), heart rate, accessory muscle usage, chest retraction, wheeze, oxygen saturation (by pulse oximetery) and peak expiratory flow rate (PEFR) was recorded at admission and thereafter at hourly intervals for 3 h or until till the child recovered. The need for oxygen therapy after 2 h and need for hospitalization were recorded. Main results: Both groups showed a significant improvement in respiratory status at the end of 2 h. However, children in the intervention group showed greater improvements in RR and PEFR (P &lt; 0.05) and respiratory distress score (P < 0.1). A significantly lower proportion of the intervention group patients required oxygen therapy for more than 2 h (23%vs 50%; P &lt; 0.05) and aminophylline infusion and systemic corticosteroid therapy (7%vs 27%; P &lt; 0.05). None of the children in the budesonide group, in contrast to 23% of those in the placebo group, required hospitalization (P < 0.05). The length of hospital stay (i.e. time taken to recover from acute asthma) was significantly shorter in the intervention group (3.2 Â± 2.5 h) than in the placebo group (7.8 Â± 11.3 h; P < 0.01). Conclusion: Aerosolized budesonide therapy (with MDI and spacer) together with nebulized salbutamol early in the emergency room treatment of acute moderate exacerbations of asthma helped in early recovery and decreased the need for hospitalization. It may be worthwhile calculating this regimen for home‐based early treatment of acute exacerbations.
Residual bladder dysfunction 2 to 10 years after acute transverse myelitis
Authors: Cheng W , Chiu RW , Tam PKH 
Published: March 2003

Objective: Acute transverse myelitis (ATM) is a relatively rare condition in children. The recovery rate is reported to be generally complete. In the current study, the long‐term urological outcome of children with ATM was assessed. Methodology: The medical records of children with ATM admitted to Queen Mary Hospital, Hong Kong, over the last 15 years, were reviewed. Results: The median age of the five children with ATM at the time of onset was 6 years (range = 2–12 years). The median length of follow up was 5 years (2–10 years). Four children recovered completely from paraparesis; two had no urinary symptoms with normal micturition. However, video‐urodynamic studies 3 years after the acute onset revealed that four out of the five children, including one without any urinary symptom, suffered from residual bladder dysfunction – two from contractile neurogenic bladder and two from intermediate type of neurogenic bladder. Conclusions: Residual bladder dysfunction is common in children suffering from ATM despite improvement of paraparesis and apparent lack of urological symptoms. Long‐term follow up of urological function in these patients is recommended.
Medicalizing normality? Management of irritability in babies
Authors: Armstrong Kl , Previtera N , Mccallum Rn 
Published: March 2003

Objective: The aims of this project were to identify the scources and quality of the health advice provided to parents with irritable infants; to assess the efficacy of a residential programme in the diagnosis and management of irritable infants; and to assess the intermediate term outcome for such infants and their mothers. Methodology: All mother–infant pairs admitted during a 3 month period to a residential setting with the primary concern of infant irritability were asked to participate in the study. Pre‐admission and 3 month post‐discharge health‐care advice, investigations and treatment details were collected. Maternal mood at admission and 3 months post‐discharge was measured using the Edinburgh Postnatal Depression Scale (EPDS). On admission, infant medication for proposed cause of excess irritability was ceased, with parental consent, if it was appropriate and following full medical assessment. Individual case plans were designed by the admitting child health nurse in consultation with the mother. These included education as to normal infant behaviour, settling techniques, and establishment of routine; family issues were also explored. Results: Fifty‐one consecutive mother–infant pairs consented to participate and formed the cohort, 48 (94%) were available for follow‐up interview 3 months post‐discharge. The average age on admission was 13 weeks (range 4–28 weeks), 32 (62.7%) were male, 34 (66.7%) were first born and 45 (88.2%) lived with both their parents. A multiplicity of health professionals had been involved in the pre‐admission care, and 48 of the infants had been or were currently on medication for gastro‐oesophageal reflux disease and or colic. At the end of admission, diagnoses made were predominantly behavioural (22) and feeding problems (20). Nine infants were felt to have an organic cause for their irritability. Maternal mood improved significantly on EPDS from the time of admission (45 (86.2%) of mothers with scores ≥ 12, mean score 16.5) to post‐admission follow up (9 (18.8%) with scores ≥ 12, mean score 7.2). Conclusions: There is evidence that a proportion of babies with ‘normal’ irritability are being incorrectly diagnosed as having an organic disorder exposing them inappropriately to medication, which may be harmful, and potentially creating lifelong problems for these infants and their families.
Indicators of selenium status in Australian infants
Authors: Daniels La , Gibson Ra , Simmer Kn 
Published: March 2003

Objective: To provide the first Australian data for the commonly used indicators of selenium (Se) status including plasma and erythrocyte Se and erythrocyte glutathione peroxidase (GSHPx) activity in newborn term and preterm infants from Adelaide, South Australia. Plasma Se levels from adults from Adelaide and Tasmania are also reported. Methodology: Descriptive, cross‐sectional study of the indicators of Se status of newborn Australian preterm and term infants. Results: Mean (± SD) plasma Se concentrations in the first 5 days of life for term (n = 48) and preterm (n = 90) infants were similar at 33 ± 11 and 29 ± 14 μg/L, respectively. Glutathione peroxidase activity was lower in preterm than term infants (P < 0.001). Erythrocyte Se was lower in male (n = 74) compared with female (n = 57) infants (491 ± 98 vs 561 ± 134 ng/g Hb; P < 0.001). Adelaide adult plasma Se levels were 88 ± 20 μg/L and higher than those of adult Tasmanian blood donors (77 ± 13 μg/l, P < 0.05). Conclusions: These data indicate that values for indicators of Se status of Australian infants and adults are at the lower end of the international range. This article highlights the paucity of Australian data on the Se content in the food supply and the Se status of the Australian population. Given the increasing range and complexity of the biological roles of Se and the emerging evidence that Se may have important roles in prevention of cancer and other disorders, further data are required to clarify the Se status of Australians.
Leucocyte populations in respiratory syncytial virus‐induced bronchiolitis
Authors: Smith PK , Wang S‐Z , Dowling KD , Forsyth KD 
Published: March 2003

Objectives: To enumerate the cellular composition of the airways in infants with acute bronchiolitis. Methodology: Cells were obtained by airway lavage from the upper and lower airway and the peripheral blood of infants with respiratory syncytial virus (RSV)+ bronchiolitis, RSV– bronchiolitis and age‐matched controls. Results: Neutrophils are the predominant cells present in the upper and lower airway. Neutrophils are present at a higher number/unit volume in the airway than in the peripheral blood. Conclusions: Neutrophils, being the dominant cellular infiltrate into the airway, are likely to contribute to the pathophysiology of bronchiolitis. Therapies targeted at limiting neutrophil influx or neutrophil‐mediated damage in the airway may have a therapeutic role.
Lactase deficiency among Malaysian children with recurrent abdominal pain
Authors: Boey CCM 
Published: March 2003

Objectives: To determine the prevalence of lactase deficiency among Malaysian children with recurrent abdominal pain and to describe their clinical characteristics. Methodology: Twenty‐four children referred consecutively to the University of Malaya Medical Centre who fulfilled Apley’s criteria (at least three episodes of abdominal pain severe enough to affect normal activity over a period longer than 3 months) were tested for lactase deficiency using a pocket breath test analyser (BreatH2 meter; Europa Scientific, Cheshire, England). Lactulose was used to check for hydrogen‐producing capacity. Results: There were 14 males and 10 females in the study, consisting of five Malays, 14 Chinese and five Indians. Mean age was 9.9 years. Seventeen of the 24 children (70.8%) with recurrent abdominal pain who underwent the breath hydrogen test had a positive result. In those with a negative result, subsequent lactulose administration resulted in a positive rise in breath hydrogen. None of the 24 children developed abdominal pain during the test. All the Indian subjects, 71.4% of the Chinese subjects and 40% of the Malay subjects with recurrent abdominal pain had lactase deficiency. The proportion of boys and girls with lactase deficiency was similar (71.4 vs 70.0%, respectively). There was no significant difference between lactase sufficient and deficient children with recurrent abdominal pain with regard to sex, age, ethnic group and clinical features. Following a lactose‐free diet, none of the children in the breath hydrogen positive and negative groups reported any appreciable difference in pain symptoms. Conclusions: The prevalence of lactase deficiency among this group of Malaysian children with recurrent abdominal pain was high, but lactase deficiency did not appear to play an important role in causing the symptoms.
Nasal continuous positive airway pressure and outcomes of preterm infants
Authors: De Klerk AM , De Klerk RK 
Published: March 2003

Objectives: To document the effects of changing to a primarily nasal continuous positive airway pressure (CPAP)‐based system of respiratory support on respiratory and non‐respiratory outcomes in preterm infants. Methodology: Outcomes in two groups of preterm infants with a birthweight of 1000–1499 g were compared retrospectively over a 5‐year period before (period I; n = 57) and after (period II; n = 59) the introduction of a primarily nasal CPAP‐based approach to respiratory support, modelled closely on that used at the New York Presbyterian Hospital (Columbia University), formally known as the Columbia‐Presbyterian Medical Center, in New York. Results: From period I to period II, there was a decline in the number of infants ventilated (65 vs 14%, respectively) and receiving surfactant (40 vs 12%, respectively) and in the median days of ventilation (6 vs 2, respectively) and oxygen (4 vs 2, respectively). There were decreases in chronic lung disease (CLD) at 28 days (11 vs 0%, respectively), death or CLD at 28 days (16 vs 3%, respectively), the use of pressor support (34 vs 7%, respectively), the incidence of necrotizing enterocolitis (11 vs 0%, respectively), time to reach full oral feeds (17.3 vs 13.2 days, respectively), discharge weight (2569 vs 2314 g, respectively) and average length of stay (61 vs 52.9 days, respectively). There were no differences in neurosonographic or other morbidity outcomes. Conclusions: A CPAP‐based approach to respiratory support of the preterm infant may decrease the invasiveness and duration of respiratory support and may decrease respiratory and some non‐respiratory adverse outcomes without an associated increase in neurosonographic or other morbidity outcomes. Further prospective trials are warranted.
Attitudes and practices of general practitioners in the diagnosis and management of attention‐deficit/hyperactivity disorder
Authors: Shaw KA , Mitchell GK , Wagner IJ , Eastwood HL 
Published: March 2003

Objective:  To assess understanding of, and actual and potential roles in management of attention‐deficit/hyperactivity disorder (ADHD) among GPs.Methods:  A cross‐sectional questionnaire survey of Queensland GPs selected randomly from the Royal Australian College of General Practitioners directory of members was carried out. Main outcome measures were knowledge levels of ADHD, current management practices, referral patterns and self‐perceived information and training needs.Results:  Three hundred and ninety‐nine GPs returned a completed questionnaire (response rate 76%). Roles identified by GPs were: the provisional diagnosis of ADHD and referral to specialist services for confirmation of the diagnosis and initiation of management; assistance with monitoring progress once a management plan was in place; education of the child and their family regarding the disorder; and liaison with the school where necessary. Perceived barriers to increased involvement of GPs were: time and resource constraints of general practice; concerns regarding abuse and addiction liability of prescription stimulants; complex diagnostic issues associated with childhood behavioural problems; and lack of training and education regarding ADHD.Conclusions:  General practitioners identify a role for themselves in ADHD care that is largely supportive in nature and involves close liaison with specialist services.
Addicted schoolchildren: Prevalence and characteristics of areca nut chewers among primary school children in Karachi, Pakistan
Authors: Shah SMA , Merchant AT , Luby SP , Chotani RA 
Published: March 2003

Objectives:  To evaluate the habits of betel quid use and areca nut chewing among school‐aged children in Karachi, Pakistan. Areca nut (betel nut) is chewed by itself, in various scented preparations, and in betel quid (containing betel leaf, areca nut, slaked lime, condiments, sweeteners and sometimes tobacco) in various parts of Pakistan and India. It is associated with carcinogenesis, foreign body aspiration in children and oral submucous fibrosis, and may aggravate asthma.Methods:  We selected a stratified random sample of 160 primary school children between 4 and 16 years of age in Baba Island, Karachi.Results:  Seventy‐four per cent of the children (118/159) used areca nut and 35% (55/159) used betel quid daily. More boys chewed areca nut than girls (72% vs 30%). The proportion of areca nut users increased by grade (from 48% in first grade to 90% in fifth grade). Most areca users first tried it with a family member (42%) or a friend (26%), and most (68%) consumed three or more packets a day. Children with fathers with three or fewer years of education were more likely to use areca nut (OR 3.2; 95% CI 1.2−8.4), and children whose mothers helped with homework less likely (OR 0.5; 95% CI 0.2−0.91; P = 0.027) to use it. Boys (OR 6.6; 95% CI 2.3−18.7) and areca nut users (OR 8.8; 95% CI2.8−27.0) were more likely to use betel quid.Conclusion:  To reduce the use of areca nut, the Pakistan Government should consider imposing taxes on it, limiting advertising and actively communicating its health risks to the public.
Birthweight and stature, body mass index and fat distribution of 14‐year‐old Polish adolescents
Authors: Kozieł S , Jankowska EA 
Published: March 2003

Objectives: The relationships between intra‐uterine growth retardation and stature, relative weight and fat distribution at adolescence have not been comprehensively established. The aim of this report is to assess the effect of low birthweight on stature, relative weight and fat distribution in 14‐year‐old boys and girls from Wroclaw, Poland. Methodology: Cross‐sectional measurements of 1197 boys and 819 post‐menarcheal girls aged 13.50–14.49 years were performed during medical examinations in 1997. Stature, body mass index (BMI; kg/m2), waist‐to‐hip ratio (WHR) and waist‐to‐thigh ratio (WTR) were used in the present study. A cut‐off value of the 10th percentile of birthweight for particular gestational weeks was used in order to define subjects born small for gestational age (SGA) or appropriate for gestational age (AGA). Two‐way ANOVA was used to evaluate the effect of birthweight on anthropometric variables of 14‐year‐old adolescents, allowing for socioeconomic status (determined by the level of the mother’s education). Results: Birthweight affected stature in boys and girls (P < 0.001), BMI in boys (P < 0.05) and WHR and WTR in girls (P < 0.001 and P < 0.05, respectively). At the age of 14 years, both SGA boys and girls were shorter than their AGA peers. The SGA boys had lower BMI, whereas SGA girls accumulated more centralized fat compared with their AGA counterparts. Conclusion: Fetal growth retardation has a long‐lasting adverse effect on later physical growth. Polish SGA children do not catch up with their peers in terms of stature by adolescence. Moreover, central fat distribution, as observed among SGA girls, constitutes a significant risk for several adult degenerative diseases.
Chronic fatigue syndrome: Successful outcome of an intensive inpatient programme
Authors: Lim A , Lubitz L 
Published: March 2003

Objective:  To study the outcome of adolescents with chronic fatigue syndrome (CFS) following an intensive multi­disciplinary inpatient programme. Methods:  A follow‐up questionnaire was distributed to all 57 adolescents who had completed the CFS inpatient programme at the Austin and Repatriation Medical Centre. Results:  Forty‐two adolescents (74%) returned follow‐up questionnaires. Immediately following the programme and up to five years after the programme, the majority of participants had returned to school and were functioning better in terms of physical activity and social interactions as compared with before the programme. Before the programme, 94% of adolescents were attending school half‐time or less. Up to 5 years after the programme, 78% of adolescents were attending school full‐time or with occasional absences only. Conclusions:  A multidisciplinary inpatient programme for CFS was successful in helping to rehabilitate this group of adolescents who were significantly incapacitated prior to entering the inpatient programme.
Cost‐effectiveness of palivizumab in New Zealand
Authors: Vogel AM , McKinlay MJ , Ashton T , Lennon DR , Harding JE , Pinnock R , Graham D , Grimwood K , Pattemore PK , Schousboe M 
Published: March 2003

Objective:  To establish the preterm infant hospitalization risks from respiratory syncytial virus (RSV) in New Zealand and the net cost per hospitalization averted by palivizumab.Methods:  The 437 infants born < 32 weeks gestation in 1997 and treated at five major neonatal units were identified. Subsequent admissions during the next 2 years for bronchiolitis, pneumonia and croup were tracked, and information collected on RSV tests performed. Data on the length of stay and hospital costs were used to calculate the potential net cost per hospitalization averted associated with the use of palivizumab and the number needed to treat (NNT) to prevent one hospitalization.Results:  Estimated RSV readmission risk before 1 year corrected age in infants < 32 weeks gestation discharged home on oxygen, and those ≤ 28 weeks gestation, or between 29 and 31 weeks gestation with or without chronic lung disease was 42%, 23%, 19%, 10% and 8%, respectively. The NNT with palivizumab to prevent one hospitalization ranged from six to 26 across subgroups. Mean (range) net cost per hospitalization averted was $NZ60 000 ($28 600−$166 700). In no subgroup would prophylaxis result in net cost saving. Prophylaxis for all NZ infants ≤ 28 weeks gestation would cost approximately $1 090 000 net and prevent 29 hospitalizations annually, being equivalent to $37 000 net per hospitalization averted, with eight infants treated to prevent one hospitalization. Alternative assumptions about cost and efficacy failed to alter these findings.Conclusion:  If value is placed on preventing morbidity, the priority groups for palivizumab prophylaxis are preterm infants discharged home on oxygen, followed by preterm infants of 28 weeks gestation or less.
Fatal unintentional traumatic asphyxia in childhood
Authors: Byard RW , Hanson KA , James RA 
Published: March 2003

Objective:  The present study was undertaken to examine specific features of unintentional traumatic asphyxial deaths in childhood.Methods:  Coronial files and records at the Forensic Science Centre in Adelaide, South Australia, were examined over a 35‐year period from 1966 to 2000 for all cases of traumatic asphyxial death occurring in children under the age of 17 years.Results:  Six cases of unintentional fatal traumatic asphyxia were identified. All of the victims were boys with an age range of 2−15 years (mean 6.8 years) and all were found dead at the scene. Fatal traumatic asphyxia resulted from entrapment beneath a chest of drawers, beneath a table tennis table, between a pile of wooden pallets and a metal fence, between a conveyor belt and its frame, and under a motor vehicle (in two cases).Conclusions:  Fatal traumatic asphyxia in childhood is a rare event, with younger children commonly being trapped by furniture or by industrial equipment while playing, and older children being trapped under motor vehicles in similar circumstances to adult traumatic asphyxial deaths. Unsupervised play of young children around heavy and potentially unstable pieces of furniture may be dangerous, particularly if more than one child is present. Unsupervised play of young children in industrial yards should be avoided.