bluuebunny/crossref_metadata_2025_split huggingface dataset:
Response of Homocysteine, Cystathionine, and Methylmalonic Acid to Vitamin Treatment in Dialysis Patients
Authors: Obeid Rima , Kuhlmann Martin K , Köhler Hans , Herrmann Wolfgang 
Published: November 2004

AbstractBackground: Hyperhomocysteinemia is observed in &gt;80% of hemodialysis patients and is considered a risk factor for cardiovascular disease. Vitamin treatment lowers total homocysteine (tHcy) concentrations in plasma and may therefore reduce the associated risk. Current treatment strategies have not achieved normalization of tHcy in the majority of dialysis patients.Methods: We administered folic acid (5 mg) plus vitamin B6 (50 mg) and B12 (0.7 mg) intravenously to 38 hyperhomocysteinemic patients (tHcy &gt;18 μmol/L) after each dialysis treatment. The treatment phase lasted 1 month, and serum concentrations of tHcy, methylmalonic acid (MMA), and cystathionine were measured at weeks 0, 2, 4, 6, 8, and 24.Results: The median serum tHcy concentration decreased significantly, from 26.1 μmol/L at baseline to 13.2 μmol/L at week 4. The median change in tHcy after 4 weeks was 13.4 μmol/L (−51%) compared with baseline. Serum MMA and cystathionine concentrations were reduced by 28% and 26%, respectively, but neither was normalized at 4 weeks. Backward-elimination stepwise regression analysis revealed that higher concentrations of tHcy, MMA, and cystathionine and lower folate at baseline predict changes of tHcy after treatment. Twenty weeks after vitamin withdrawal, tHcy concentrations returned to values comparable to baseline (median, 24.8 μmol/L).Conclusions: The combination of folic acid, vitamin B12, and vitamin B6 used in this study normalized serum concentrations of tHcy in almost all of our hyperhomocysteinemic dialysis patients. This regimen may be used to investigate the effects of homocysteine normalization on cardiovascular outcomes in hemodialysis patients.
Nonadherence With Pediatric Human Immunodeficiency Virus Therapy as Medical Neglect
Authors: Roberts Gretchen M. , Wheeler J. Gary , Tucker Nancy C. , Hackler Chris , Young Karen , Maples Holly D. , Darville Toni 
Published: November 2004

Objective. To examine the results of an interventionist approach applied to human immunodeficiency virus (HIV)-infected children for whom caregiver nonadherence was suspected as the cause of treatment failure.Methods. The medical records of a cohort of 16 perinatally HIV-infected children whose care was managed at the Arkansas Children’s Hospital Pediatric HIV Clinic for an uninterrupted period of ≥3 years were reviewed through July 2003. Data collected included date of birth, dates of and explanations for clinic visits and hospitalizations, dates of laboratory evaluations, CD4+ T cell percentages, plasma HIV-1 RNA levels, antiretroviral medications, viral resistance tests (eg, phenotype and genotype), and physician-initiated interventions to enhance adherence to the medication regimen. A stepwise interventionist approach was undertaken when patients continued to demonstrate high viral loads, despite documented viral sensitivity to the medication regimen and caregivers’ insistence that medications were being administered regularly. Step 1 was prescribing a home health nurse referral, step 2 was administering directly observed therapy (DOT) while the patient was hospitalized for 4 days, and step 3 was submitting a physician-initiated medical neglect report to the Arkansas Department of Human Services.Results. The results for 6 patients for whom this stepwise approach was initiated are reported. Home health nurse referrals failed to result in sustained improvements in adherence in all 6 cases. Viral load assays performed before and after DOT provided an objective measure of the effect of adherence, with 12 hospitalizations resulting in a mean ± SD decrease in HIV RNA levels of 1.09 ± 0.5 log10 copies per mL, with a range of 0.6 to 2.1 log10 copies per mL. Four families responded to DOT hospitalization, and sustained decreases in the respective patients’ viral loads were noted. In 2 cases, medical neglect reports were submitted when DOT did not result in improved adherence. These patients were eventually placed in foster care, with subsequent improvements in their viral loads and CD4+ T cell percentages.Conclusions. Nonadherence with antiretroviral therapy can be established on the basis of persistently elevated HIV RNA levels that decrease with DOT. Nonadherence poses a danger to the child that is grave and potentially irreversible. Caregivers should be offered all available resources to help them adhere to a sound treatment plan. In cases of demonstrated inability to provide needed care, it is necessary to consider seeking child protection, even for apparently healthy children.
Low-Normal Gestational Age as a Predictor of Asthma at 6 Years of Age
Authors: Raby Benjamin A. , Celedón Juan C. , Litonjua Augusto A. , Phipatanakul Wanda , Sredl Diane , Oken Emily , Ryan Louise , Weiss Scott T. , Gold Diane R. 
Published: November 2004

Background. Perinatal factors, including gestational age and birth weight, influence the development of atopy in early life. However, the role of these factors in the development of asthma in later life among children who do not develop perinatal respiratory disease remains unclear.
Methods. Four hundred fifty-four infants who had a history of allergy or asthma in at least 1 parent, were born in the 36th week of gestation or later, and did not develop perinatal respiratory distress were monitored for at least 6 years. Associations between predictor variables and asthma and wheeze were assessed with multivariate logistic regression and repeated-event analyses.
Results. Although we previously observed a relationship between low birth weight and persistent wheeze in the first 1 year of life, we did not observe similar associations between low birth weight and asthma at 6 years of age (odds ratio [OR]: 1.05; 95% confidence interval [CI]: 0.40–2.73). However, a strong relationship was found between low-normal gestational age and asthma at 6 years of age (OR: 4.7; 95% CI: 2.1–10.5). The effects of low-normal gestational age were significantly greater among boys than among girls (boys: OR: 8.15; 95% CI: 2.98–22.3; girls: OR: 1.90; 95% CI: 0.38–13.83). Longitudinal analysis of the relationship between gestational age and wheeze during the 6 years of observation confirmed these gender differences.
Conclusions. Among children at high risk of developing atopic disease, late prematurity might be an important additional determinant of asthma later in life, and these effects are gender specific.
Healthy Steps: A Case Study of Innovation in Pediatric Practice
Authors: Zuckerman Barry , Parker Steven , Kaplan-Sanoff Margot , Augustyn Marilyn , Barth Michael C. 
Published: November 2004

Healthy Steps (HS) represents a significant innovation in the way pediatric primary care can be delivered. Based on the standards and principles of Bright Futures and the American Academy of Pediatrics Health Supervision Guidelines, HS enhances and expands traditional pediatric care by including a child development specialist (Healthy Steps specialist) as part of the pediatric practice team. Services offered by this person, typically a nurse, early childhood educator, or social worker, include more time to spend discussing preventive issues during well-child visits, home visits, a telephone information line exclusively addressing developmental and behavioral concerns, new written materials, and more seamless linkages to community resources and parent support groups.
The original HS cohort consisted of 15 pediatric practices in a variety of settings (private practices, health centers, pediatric training programs). Evaluated for the effects of HS on their family were 3737 intervention and comparison families. HS families received significantly more preventive and developmental services, compared to families in the control group. HS families were also less likely to be dissatisfied with their pediatric primary care. Additionally, HS had a positive impact on parenting in many areas including adherence to health visits, nutritional practices, developmental stimulation, appropriate disciplinary techniques, and correct sleeping position. Other outcome measures (such as initiation or duration of breastfeeding, child development knowledge, sense of competence, and reports of child language development at 2 years of age) did not differ between intervention and comparison group.
Compared to other early childhood intervention efforts, HS offers a comparable positive impact on parenting at a relatively inexpensive cost: an estimated $400 per family per year (compared to $4500 from Early Head Start). Approximately 3 years after the evaluation of HS ended, 10 of the original 24 sites are still in operation, and an additional 24 sites have started up. Although funding and reimbursement remain an important barrier, continued growth of HS suggests an abiding interest in this approach to expand and enhance preventive and developmental care in pediatric primary care.
A Population-Based Comparison of Clinical and Outcome Characteristics of Young Children With Serious Inflicted and Noninflicted Traumatic Brain Injury
Authors: Keenan Heather T. , Runyan Desmond K. , Marshall Stephen W. , Nocera Mary Alice , Merten David F. 
Published: November 2004

Objective. Diagnosing inflicted traumatic brain injury (TBI) in young children is difficult in practice. Comparisons of children with inflicted and noninflicted TBI may help to identify markers of inflicted TBI. The objective of this study was to compare inflicted and noninflicted TBI in terms of presenting complaints, clinical features, and hospital outcomes.Methods. The presenting complaint, clinical finding, hospital course, and outcome of all children who were aged 2 years or younger in North Carolina and were admitted to a pediatric intensive care unit or died with a TBI in 2000 and 2001 were reviewed. Clinical presentation and injury types were compared between children with inflicted and noninflicted TBI. Risk ratios were used to compare clinical and outcome characteristics between the 2 groups. Among survivors, multivariate binomial regression was used to examine the adjusted risk of a poor outcome dependent on injury type.Results. A total of 80 (52.6%) children had inflicted and 72 (47.3%) children had noninflicted TBI. Children with noninflicted TBI (not in a motor vehicle crash) were more likely to present to the emergency department asymptomatic (44.8% vs 8.3%) and to have a specific history of trauma than children with inflicted TBI. Retinal hemorrhage, metaphyseal fracture, rib fracture, and subdural hemorrhage were more commonly found in children with inflicted compared with noninflicted TBI. Skeletal survey and ophthalmologic examination combined would have missed 8 (10.0%) inflicted TBI cases.Conclusions. Manner of presentation and injury types are helpful in distinguishing inflicted TBI. Clinicians should not rule out inflicted TBI on the basis of skeletal survey and ophthalmoscopy alone but should proceed to computed tomography and/or magnetic resonance imaging.
Maternal and Infant Factors Associated With Excess Kindergarten Costs
Authors: Roth Jeffrey , Figlio David N. , Chen Yuwen , Ariet Mario , Carter Randolph L. , Resnick Michael B. , Morse Steven B. 
Published: November 2004

Objective. To estimate the excess educational costs at kindergarten from infant and maternal factors that are reported routinely at birth.Methods. Birth and school records were analyzed for all children who were born in Florida between September 1, 1990, and August 31, 1991, and entered kindergarten from 1996 through 1999 (N = 120 554). Outcome measure was cost to state, derived from base allocation for students in regular classrooms plus multiplier weights for those who were assigned to 8 mutually exclusive special education categories or who repeated kindergarten.Results. More than one quarter of the study cohort was found to be assigned to special education classes at kindergarten. Regression model estimates indicated that children who were born at &lt;1000 g (n = 380) generated 71% higher costs in kindergarten than children who were born at ≥2500 g. Children who were born at 1000 to 1499 g (n = 839) generated 49% higher costs. Other birth conditions, independent of birth weight, were associated with higher kindergarten costs: family poverty (31%), congenital anomalies (29%), maternal education less than high school (20%), and no prenatal care (14%). Because of their prevalence, family poverty and low maternal education accounted for &gt;75% of excess kindergarten costs. If 9% of infants who weighed between 1500 and 2499 g (n = 1027) could be delivered at 2500 g, then the state of Florida potentially could save $1 million in kindergarten costs. Savings of a similar magnitude might be achieved if 3% of mothers who left school without a diploma (n = 1528) were to graduate.Conclusions. Any policy recommendation aimed at reducing education costs in kindergarten must take into consideration 3 factors: the prevalence of risk conditions whose amelioration is desired, the potential cost savings associated with reducing those conditions, and the costs of amelioration. Projecting these costs from information that is available at birth can assist school districts and state agencies in allocating resources.
Long-Term Pulmonary Sequelae in Children Who Were Treated With Extracorporeal Membrane Oxygenation for Neonatal Respiratory Failure
Authors: Hamutcu Refika , Nield Toni A. , Garg Meena , Keens Thomas G. , Platzker Arnold C.G. 
Published: November 2004

Objective. Extracorporeal membrane oxygenation (ECMO) is a life-saving therapy for neonates with intractable respiratory failure, but the long-term pulmonary outcome is unknown. Our aim was to investigate the long-term pulmonary sequelae of these children.Study Design. We studied 50 children at 11.1 ± 1.1 years (mean ± SD) who had been treated with neonatal ECMO for meconium aspiration syndrome (38%), sepsis (18%), sepsis with pneumonia (12%), congenital diaphragmatic hernia (12%), congenital heart disease (8%), persistent pulmonary hypertension of the newborn (6%), and respiratory distress syndrome (4%) and 27 healthy controls (10.8 ± 1.6 years). All subjects completed a respiratory questionnaire and performed pulmonary function and graded cardiopulmonary exercise testing.Results. Neonatal ECMO survivors had hyperinflation (median residual volume: 131%), airway obstruction (median forced expired volume in 1 second: 79%), lower oxygen saturation with exercise, and lower peak oxygen consumption than controls. The ECMO group achieved similar exercise minute ventilation to controls, with more rapid and shallow breathing. ECMO survivors had an increased frequency of exercise-induced bronchospasm. Those who required higher inspired oxygen tension and ventilator pressures after weaning from ECMO had lower forced expired volume in 1 second and oxygen saturation values.Conclusion. Neonatal ECMO survivors experience lung injury lasting into later childhood. Lung dysfunction correlates with the extent and duration of barotrauma and oxygen exposure as neonates.
Physical Activity Among Children Attending Preschools
Authors: Pate Russell R. , Pfeiffer Karin A. , Trost Stewart G. , Ziegler Paula , Dowda Marsha 
Published: November 2004

Objectives. Obesity rates are increasing among children of all ages, and reduced physical activity is a likely contributor to this trend. Little is known about the physical activity behavior of preschool-aged children or about the influence of preschool attendance on physical activity. The purpose of this study was to describe the physical activity levels of children while they attend preschools, to identify the demographic factors that might be associated with physical activity among those children, and to determine the extent to which children's physical activity varies among preschools.
Methods. A total of 281 children from 9 preschools wore an Actigraph (Fort Walton Beach, FL) accelerometer for an average of 4.4 hours per day for an average of 6.6 days. Each child's height and weight were measured, and parents of participating children provided demographic and education data.
Results. The preschool that a child attended was a significant predictor of vigorous physical activity (VPA) and moderate-to-vigorous physical activity (MVPA). Boys participated in significantly more MVPA and VPA than did girls, and black children participated in more VPA than did white children. Age was not a significant predictor of MVPA or VPA.
Conclusions. Children's physical activity levels were highly variable among preschools, which suggests that preschool policies and practices have an important influence on the overall activity levels of the children the preschools serve.
Use of Incident Reports by Physicians and Nurses to Document Medical Errors in Pediatric Patients
Authors: Taylor James A. , Brownstein Dena , Christakis Dimitri A. , Blackburn Susan , Strandjord Thomas P. , Klein Eileen J. , Shafii Jaleh 
Published: November 2004

Objectives. To describe the proportion and types of medical errors that are stated to be reported via incident report systems by physicians and nurses who care for pediatric patients and to determine attitudes about potential interventions for increasing error reports.
Methods. A survey on use of incident reports to document medical errors was sent to a random sample of 200 physicians and nurses at a large children's hospital. Items on the survey included proportion of medical errors that were reported, reasons for underreporting medical errors, and attitudes about potential interventions for increasing error reports. In addition, the survey contained scenarios about hypothetical medical errors; the physicians and nurses were asked how likely they were to report each of the events described. Differences in use of incident reports for documenting medical errors between nurses and physicians were assessed with χ2 tests. Logistic regression was used to determine the association between health care profession type and likelihood of reporting medical errors.
Results. A total of 140 surveys were returned, including 74 from physicians and 66 by nurses. Overall, 34.8% of respondents indicated that they had reported &lt;20% of their perceived medical errors in the previous 12 months, and 32.6% had reported &lt;40% of perceived errors committed by colleagues. After controlling for potentially confounding variables, nurses were significantly more likely to report ≥80% of their own medical errors than physicians (odds ratio: 2.8; 95% confidence interval: 1.3–6.0). Commonly listed reasons for underreporting included lack of certainty about what is considered an error (indicated by 40.7% of respondents) and concerns about implicating others (37%). Potential interventions that would lead to increased reporting included education about which errors should be reported (listed by 65.4% of respondents), feedback on a regular basis about the errors reported (63.8%) and about individual events (51.2%), evidence of system changes because of reports of errors (55.4%), and an electronic format for reports (44.9%). Although virtually all respondents would likely report a 10-fold overdose of morphine leading to respiratory depression in a child, only 31.7% would report an event in which a supply of breast milk is inadvertently connected to a venous catheter but is discovered before any breast milk goes into the catheter.
Conclusions. Medical errors in pediatric patients are significantly underreported in incident report systems, particularly by physicians. Some types of errors are less likely to be reported than others. Information in incident reports is not a representative sample of errors committed in a children's hospital. Specific changes in the incident report system could lead to more reporting by physicians and nurses who care for pediatric patients.
Height and Social Adjustment: Are Extremes a Cause for Concern and Action?
Authors: Sandberg David E. , Bukowski William M. , Fung Caroline M. , Noll Robert B. 
Published: November 2004

Objective. Growth hormone treatment of hormone-sufficient short youths is predicated on the belief that short stature is associated with social problems with peers. This study assessed peer relations and social adjustment as a function of height in a community sample.
Methods. A cross-sectional study was conducted at 1 public school district in Western New York of students of both genders who attended grades 6 to 12 (N = 956). Target groups included participants of short stature (height ≤−1.6 standard deviation, ie, ≤5th percentile for age- and gender-adjusted population norms; n = 68) and tall stature (≥1.6 standard deviation; ≥95th percentile; n = 58) and classmates of average height (between the 25th and 75th percentiles; n = 123) used for within-class comparisons. All remaining unclassified classmates (n = 704) also provided data. Self- and peer-rated assessment of social reputation and social acceptance was measured.
Results. Minimal effects of height on measures of social functioning were detected despite substantial statistical power. We detected no significant relationships between height and measures of friendship, popularity, or reputation with peers. Findings did not vary by gender of participant, by peer- or self-report, or by whether data from the entire sample were used or target groups were contrasted with comparison participants. Shorter students were perceived by peers to be younger than their age. This influence was restricted to lower grades and did not have an impact on measures of social acceptance or reputation with peers.
Conclusions. Extremes of stature in the general population—either short or tall—have minimal detectable impact on peer perceptions of social behavior, friendship, or acceptance. Findings are not supportive of the need to intervene a priori because of the potential risk of negative stature-related social sequelae. Furthermore, if problems with peer relationships are identified among short or tall youths, then factors other than stature should be considered as etiologically important.
Essential Tremor Among Children
Authors: Jankovic Joseph , Madisetty Jaswanth , Dat Vuong Kevin 
Published: November 2004

Objective. To characterize the clinical and therapeutic aspects of essential tremor (ET) among children.
Background. ET, an autosomal dominant disorder, has been studied extensively among adults, but little is known regarding its occurrence, clinical characteristics, treatment, and prognosis in pediatric populations. Often stigmatized as a disorder of the elderly, ET may be misdiagnosed among children. Previous studies of childhood-onset ET were limited by small sample sizes.
Methods. Clinical data, including gender, age at onset, family history, associated disorders, and response to treatment, were collected for consecutive patients diagnosed with childhood-onset ET at the Movement Disorders Clinic at Baylor College of Medicine.
Results. Of the 39 patients with ET, 29 (74.4%) were male. The mean age at onset was 8.8 ± 5.0 years, and the mean age at evaluation was 20.3 ± 14.4 years. A family history of tremor was noted for 79.5% of the patients. Eighteen (46.2%) had some neurologic comorbidity, such as dystonia, which was noted for 11 patients (28.2%). Only 24 of the patients (61.5%) were treated with a specific antitremor medication; 5 of the 12 patients treated with propranolol experienced improvement.
Conclusions. Concomitant movement disorders, such as dystonia, are common among patients with childhood-onset ET, which supports the concept that ET is a heterogeneous disorder. Treatment strategies used for adult patients with ET seem to be effective also for children with ET, although controlled therapeutic trials in this population of patients with ET are lacking.