bluuebunny/crossref_metadata_2025_split huggingface dataset:
Parental Evaluation of Informing Interviews for Cleft Lip and/or Palate
Authors: Byrnes Abigail L. , Berk Nancy W. , Cooper Margaret E. , Marazita Mary L. 
Published: August 2004

Objective. This study was conducted to record subjective information concerning parental experiences and preferences with regard to informing interviews for cleft lip and/or palate. The analysis of these data was intended to help informants improve the way in which such conversations are conducted.Methods. The study used a self-administered questionnaire. Study participants were the biological parents of children who had cleft lip and/or palate and were seen in the University of Pittsburgh Cleft Palate-Craniofacial Center.Results. Results revealed that parents wanted informing health professionals to be in greater control of the informing conversation, to show more caring and confidence, to show more of their own feelings, to give parents more of an opportunity to talk and show feelings, to make a greater effort to comfort parents, to provide more information, to initiate more of a discussion about the association between clefts and mental retardation/learning disabilities, and to provide more referrals to other parents during the informing interview. A positive association between the degree to which parents reported knowing the health professionals and reported satisfaction was identified for 10 dimensions of health professional behavior.Conclusions. Parents are dissatisfied with several aspects of informing interviews for cleft lip and/or palate. The results of this study suggest ways to improve informing interviews for oral-facial clefts and other congenital anomalies.
Bicycle Helmet Assessment During Well Visits Reveals Severe Shortcomings in Condition and Fit
Authors: Parkinson Gregory W. , Hike Kelly E. 
Published: August 2004

Background. Improper bicycle helmet fit increases the risk of head injury.1 Information on the rate of proper use of bicycle helmets is lacking. Promotion of helmet use is recommended at well-child and adolescent visits.2 Actual helmet assessment during such visits has not been reported.
Objectives. The primary goal of this study is to measure the proportion of children whose helmets are in proper condition and can be made to fit properly by the child and/or parent. The secondary goal is to begin to assess the value and practicality of helmet inspection during well-child and adolescent visits.
Methods. The study took place at a private pediatric office in Falmouth, Massachusetts, from June 1 through August 31, 2001. Eligible children and adolescents were those aged 4 to 18 years presenting for well examination, along with siblings present at the visit. Eligible families completed a questionnaire, then had a timed attempt to fit a helmet, followed by an assessment of helmet fit and condition against a predetermined standard.
Results. Eighty-four percent (395/473) of eligible families participated. A total of 479 participants were assessed. Eighty-eight percent of participants (419/478) owned a helmet. Reported helmet use “always” or “almost always” was 73% for bicycling (317/434), 69% for in-line skating (193/279), 58% for scootering (179/310), and 50% for skateboarding (79/158). Compared with younger children, teenagers were less likely to wear helmets for all activities. Complete pass rate for every aspect of condition and fit was 4% (20/478, 95% confidence interval: 3–6). The pass rate when the parent alone fit the helmet was 0% (0/52). Three individual aspects of fit were most problematic: 1) helmet ‘resting position’ too high on the forehead (pass rate 249/479; 52%), 2) improper strap position (pass rate 157/476; 33%), and 3) excessive movement of the helmet from front to back of the head (pass rate 247/479; 52%). Mean time for questionnaire completion was 4 (standard deviation: ±1) minutes, and 7 (standard deviation: ±3) minutes for helmet assessment.
Conclusions. Ninety-six percent of children and adolescents wore helmets in inadequate condition and/or with inadequate fit. This occurred despite a high acceptance of helmet use by this population. Initial evidence suggests that helmet assessment during well visits may be practical and valuable.
Transcranial Doppler Ultrasonography and Neurocognitive Functioning in Children With Sickle Cell Disease
Authors: Kral Mary C. , Brown Ronald T. , Nietert Paul J. , Abboud Miguel R. , Jackson Sherron M. , Hynd George W. 
Published: August 2004

Objective. We examined the relationship between cerebral blood flow velocity, measured by transcranial Doppler (TCD) ultrasonography, and neurocognitive functioning.Methods. Participants were 60 children who had sickle cell disease (HbSS) and had no documented history of stroke. Children were classified according to Stroke Prevention Trial in Sickle Cell Anemia criteria (normal, conditional, and abnormal), and their performance was compared on measures of intellectual abilities, academic achievement, sustained attention/concentration, executive function, and parent and teacher ratings of executive function.Results. Children with abnormal TCD values performed more poorly than children with conditional TCD values on measures of verbal intelligence and executive function. Children with conditional TCD values performed more poorly than children with normal TCD values on measures of sustained attention/concentration and executive function. TCD values also were a significant predictor of auditory working memory in exploratory analyses.Conclusions. Our findings support the hypothesis that neurocognitive functions subserved by the frontal systems (eg, sustained attention/concentration and executive function) seem to be the most useful indices of progressive cerebrovasculopathy in children with HbSS disease.
Mortality and Neurologic, Mental, and Psychomotor Development at 2 Years in Infants Born Less Than 27 Weeks’ Gestation: The Leiden Follow-Up Project on Prematurity
Authors: Rijken Monique , Stoelhorst Gerlinde M. S. J. , Martens Shirley E. , van Zwieten Paul H. T. , Brand Ronald , Maarten Wit Jan , Veen Sylvia 
Published: August 2004

Objective. To determine the outcome of infants with a gestational age (GA) &lt;27 weeks, born in the mid-1990s.Design. Regional, prospective study; part of the Leiden Follow-Up Project on Prematurity.Setting. Three health regions in The Netherlands.Patients. A total of 266 live born infants (1996/1997) with GA &lt;32 weeks; 46 infants were &lt;27 weeks.Main outcome measures. Neurologic examination (according to Hempel) and assessment of mental and psychomotor development using the Bayley Scales of Infant Development I, at the corrected age of 2 years.Results. Mortality was 35% (16 of 46) &lt;27 weeks, compared with 6% (14 of 220) in infants with GA 27 to 32 weeks; withdrawal of treatment in 60% and 43%, respectively. Below 27 weeks mortality was higher after extra-uterine transport and pregnancy induction. Neonatal morbidity was higher in infants &lt;27 weeks compared with infants 27 to 32 weeks. Below 27 weeks postnatal use of dexamethasone and being hospitalized at term were associated with abnormal neurologic outcome; there was a higher incidence in (mild) mental developmental delay compared with the older infants. Adverse outcome (dead or abnormal neurologic, psychomotor, or mental development) in infants 23 to 24, 25, 26, and 27 to 32 weeks GA was, respectively, 92% (11 of 12), 64% (7 of 11), 35% (8 of 23), and 18% (40 of 220).Conclusions. Mortality and neonatal morbidity were higher in infants with GA &lt;27 weeks compared with infants born between 27 and 32 weeks. The high adverse outcome of infants &lt;25 weeks suggests that one should carefully weigh whether or not to aggressively resuscitate and treat these extremely premature infants.
Clinical Tolerance to Lactose in Children With Cow’s Milk Allergy
Authors: Fiocchi Alessandro , Restani Patrizia , Leo Gualtiero , Martelli Alberto , Bouygue Gabriel R. , Terracciano Luigi , Ballabio Cristina , Valsasina Renato 
Published: August 2004

Objective. Adverse reactions following the ingestion of lactose have been reported in children with cow’s milk (CM) allergy. Whether this is attributable to the contamination of lactose with CM proteins is unknown. In this paper, we assessed clinical tolerance of lactose derived from CM whey in children hypersensitive to CM from 2 university hospital pediatric departments.
Design. Twenty-four children (5 girls and 19 boys, median 25 months old; range: 2–107 months) with immediate CM allergy confirmed at history or during double-blind, placebo-controlled food challenge (DBPCFC) were enrolled. DBPCFC with CM could be conducted in 11 of 24 patients. Children with a history of immediate/delayed reactions to soy formula (SF) were excluded. Clinical tolerance to CM, SF, and SF + lactose was assessed by: 1) skin prick test with casein, lactalbumin, soy commercial allergen preparations, fresh CM, SF, SF and lactose, lactose (Official Pharmacopoeia) in 4 concentrations (0.01%, 0.1%, 1%, 10%); 2) specific serum immunoglobulin E determination by CAP system technology; 3) DBPCFC in 8 incremental doses of SF + lactose and using SF as a placebo to make up a total of 240 mL of reconstituted formula.
Results. With a positive cutoff point of ≥3 mm wheal diameter at SPT, all patients were sensitized to fresh CM, lactalbumin, and/or casein. Twenty-three of 24 patients (95.8%) were SPT-positive to CM formula, 16 of 24 to lactalbumin (66.6%), 14 of 24 to casein (58.3%), and none to SF, SF + lactose, or lactose alone at all dilutions. Complexed immunoglobulin E determinations were positive for CM in 23 of 24 cases and negative in all cases for soy. Challenge with SF + lactose was negative in all cases.
Conclusions. Even children hypersensitive to CM are clinically tolerant to lactose and can safely consume foods and drugs with lactose from bovine sources as an ingredient. Lactose exclusion is unwarranted from soy preparations on grounds of potential allergic reactions to CM protein residue.
A Cohort Study of Health Effects of Human T-Cell Lymphotropic Virus Type I Infection in Jamaican Children
Authors: Maloney Elizabeth M. , Wiktor Stefan Z. , Palmer Paulette , Cranston Beverley , Pate Ernest J. , Cohn Sylvia , Kim Norma , Miley Wendell , Thomas Terry L. , Blattner William A. , Hanchard Barrie 
Published: August 2004

Objective. Human T-cell lymphotropic virus type I (HTLV-I) infection in childhood is believed to play an important role in risk for adult T-cell leukemia/lymphoma. Although HTLV-I is known to be associated with infective dermatitis in childhood, other HTLV-I-associated morbidity in children has not been well studied. We sought to determine the HTLV-I-associated health effects in Jamaican children.
Methods. We compared incidence rates of several health outcomes in 28 HTLV-I-infected and 280 uninfected children clinically followed from age 6 weeks to a maximum of 10 years. Cox proportional hazards regression analysis was used to analyze these prospectively collected data, adjusting for confounding effects of other variables as necessary.
Results. HTLV-I-infected children had significantly higher incidence rates of seborrheic dermatitis (rate ratio [RR] = 4.8, 95% confidence interval [CI] = 1.9–12.5), eczema (RR = 3.1, CI = 1.2–7.9) and persistent hyperreflexia (RR = 3.7, CI = 1.6–8.2). Additionally, HTLV-I infected children had increased rates of severe anemia (RR = 2.5, CI = 0.8–7.9) and abnormal lymphocytes (RR = 2.4, CI = 0.8–7.6) that were of borderline statistical significance.
Conclusions. Our study suggests that HTLV-I-associated skin diseases of childhood may include seborrheic dermatitis and eczema. Additionally, these data suggest that persistent hyperreflexia of the lower limbs may be an early sign of HTLV-I-associated neurologic involvement in children. Expansion and continued clinical observation of this cohort would be valuable.
Hospitalization for Asthma: Atopic, Pulmonary Function, and Psychological Correlates Among Participants in the Childhood Asthma Management Program
Authors: Bacharier Leonard B. , Dawson Christopher , Bloomberg Gordon R. , Bender Bruce , Wilson Laura , Strunk Robert C. ,   for the Childhood Asthma Management Program Research Group
Published: August 2004

Background. Asthma in childhood has a significant impact on children and families, in part because of the frequent need for hospital-based care for acute exacerbations. Sensitization and exposure to inhalant allergens have been identified as risk factors for asthma hospitalization.
Objective. The Childhood Asthma Management Program (CAMP), comprised of 1041 children aged 5 to 12 with mild-to-moderate asthma, provides the opportunity to identify specific risk factors for prior hospitalization for asthma.
Methods. Data gathered during the screening period from CAMP were evaluated to elucidate differences between patients who had ever been hospitalized for asthma before enrollment in CAMP and those who had never been hospitalized.
Results. Univariate analyses indicated that prior hospitalization for asthma was associated with a younger age of asthma onset, longer duration of asthma, greater number of positive allergy skin tests, higher serum immunoglobulin E level, greater peripheral blood eosinophilia, greater recent inhaled corticosteroid use, greater airflow obstruction, greater airway hyperresponsiveness, and lower patient intelligence quotient (IQ). Gender, race, and family income did not differ between hospitalized and never-hospitalized patients. The combination of both sensitization and exposure to high levels of dog allergen (Can f1) was associated with greater likelihood of prior hospitalization. Forward multivariate logistic regression analysis identified younger age of asthma onset, longer duration of asthma, recent use of asthma controller therapy, greater airflow obstruction, and lower patient IQ as significant risk factors for prior hospitalization when all risk factors identified by univariate analysis were included in the model.
Conclusions. Children with mild-to-moderate asthma who had a past hospitalization for acute asthma had greater asthma severity, younger age of onset, and lower patient IQ at the time of entry into CAMP. They also had more markers of atopy than children without prior hospitalization, although atopy was not associated with prior hospitalization on multivariate analysis. Although we have identified these risk factors in a retrospective manner, one can speculate that the persistence of these features should alert the clinician to closely follow abnormalities on pulmonary function tests and general features of atopy to potentially identify patients at risk for future hospitalization.
The Effect of Computerized Physician Order Entry on Medication Errors and Adverse Drug Events in Pediatric Inpatients
Authors: King W. James , Paice Naomi , Rangrej Jagadish , Forestell Gregory J. , Swartz Ron 
Published: August 2004

Objective. Computerized physician order entry (CPOE) has the potential to reduce patient injury resulting from medication errors. We assessed the impact of a CPOE system on medication errors and adverse drug events (ADEs) in pediatric inpatients.Design. A retrospective cohort study.Setting. Tertiary care pediatric hospital.Participants. Pediatric inpatients on 3 medical and 2 surgical wards.Intervention. CPOE system implemented on 2 medical wards and compared with 1 medical and 2 surgical wards that continued to use hand written orders.Outcome Measures. Rate of medication error and ADEs before and after CPOE implementation.Results. In 6 years, a total of 804 medication errors were identified with 18 ADEs, resulting in patient injury among 36 103 discharges and 179 183 patient days. The overall medication error rate (MER) was 4.49 per 1000 patient days. Before the introduction of CPOE, the MERs of the intervention versus control wards were indistinguishable (ratio = 0.93; 95% confidence interval [CI] = 0.76, 1.13). After the introduction of CPOE, the MER was 40% lower on the intervention than on the control wards (ratio = 0.60; 95% CI = 0.48, 0.74). On average, 490 patient days are required to see the benefit of one less medication error using CPOE. We did not demonstrate a similar effect of CPOE for ADEs (ratio of rate ratios = 1.30; 95% CI 0.47, 3.52).Conclusions. The introduction of a commercially available physician computer order entry system was associated with a significant decrease in the rate of medication errors but not ADEs in an inpatient pediatric population.
How Helpful Is Pneumatic Otoscopy in Improving Diagnostic Accuracy?
Authors: Jones Woodson S. , Kaleida Phillip H. 
Published: August 2004

Background. Pneumatic otoscopy is believed to be helpful in optimally assessing the presence or absence of middle ear effusion (MEE). Although expert clinicians teach the importance of this diagnostic skill to trainees, evidence exists that many pediatric providers do not typically perform pneumatic otoscopy.
Objective. To determine if the otoscopic accuracy within a group of clinicians improves with the pneumatic assessment when compared with the static assessment using videotaped otoendoscopic examinations (VOEs).
Methods. Residents and faculty from 2 pediatric training programs served as subjects. All viewed a set of 50 video otoscopic examinations of tympanic membranes (TMs) from a validated VOE developed previously for training purposes. The video displays each TM in a static presentation and then in a pneumatic (mobile) presentation, followed by a final static presentation. Each subject first viewed the initial static presentation of each TM and responded “yes/no” to the presence of MEE, and then viewed the pneumatic presentation of the same TM and again responded “yes/no” to the presence of MEE. We compared the accuracy of assessment for both the static and the pneumatic tests.
Results. Thirty-four pediatric residents and 6 clinical faculty participated. Accuracy (percent of total test items correct) on the pneumatic test was uniformly greater than accuracy on the static test. The mean absolute improvement in the accuracy from the static test (61%) to the pneumatic test (76%) was 15% (95% confidence interval [CI] = 12%–18%). The mean relative improvement in accuracy from the static test to the pneumatic test was 26% (95% CI = 19%–32%). Higher accuracy on the VOE was associated with greater absolute (r = 0.57) and greater relative (r = 0.47) improvement. The mean relative improvement in sensitivity and specificity from static viewing to pneumatic viewing was 24% (95% CI = 15%–33%) and 42% (95% CI = 27%–58%), respectively.
Conclusions. Using a video otoendoscopic test, we found that accurate identification of both the presence and the absence of MEE improved after pneumatic assessment of TM mobility. Providers who were more accurate at otoscopy, defined by higher video total test scores, benefited more from the pneumatic component than providers with lower scores.
Trends in Otitis Media Among Children in the United States
Authors: Auinger Peggy , Lanphear Bruce P. , Kalkwarf Heidi J. , Mansour Mona E. 
Published: August 2004

Background. The prevalence of repeated otitis media (OM) increased during the 1980s, but it is unknown if the increase has continued.Objectives. To determine trends in the prevalence of OM, early-onset OM, and repeated OM among US children from 1988 to 1994 and to identify factors that may explain any observed changes.Methods. The Third National Health and Nutrition Examination Survey was administered in 2 phases: phase I (1988–1991) and phase II (1991–1994), each comprising a national probability sample. OM (ever having had OM), early-onset OM (first episode at &lt;12 months of age), and repeated OM (≥3 episodes) were assessed for 8261 children &lt;6 years of age.Results. After controlling for risk factors for OM, the prevalence of OM from phase I to phase II increased from 66.7% to 69.7% (odds ratio [OR] = 1.1; 95% confidence interval [CI] = .99, 1.1), early-onset OM increased from 41.1% to 45.8% (OR = 1.1; 95% CI = 1.03, 1.2), and repeated OM increased from 34.8% to 41.1% (OR = 1.2; 95% CI = 1.1, 1.4). This observed increase corresponds to 561 000 and 720 000 more children having early-onset OM and repeated OM, respectively. Child care use, early breastfeeding termination, asthma, and access to health care did not significantly increase from phase I to phase II. The prevalence of early-onset OM and repeated OM was higher for affluent children, but the greatest increase in prevalence was among impoverished children. There was an increase in allergic conditions from phase I to phase II for poor children (22.6% to 30.2%).Conclusions. The prevalence of early-onset OM and repeated OM continued to increase among preschool children in the United States. Further research to investigate this increasing prevalence should explore changes in management practice and an increase in prevalence of allergic conditions among poor children.
Adverse Effects of Smoking on Respiratory Function in Young Adults Born Weighing Less Than 1000 Grams
Authors: Doyle Lex W. , Olinsky Anthony , Faber Brenda , Callanan Catherine 
Published: August 2004

Objective. To determine whether active smoking has an adverse impact on respiratory function of young adults of extremely low birth weight (ELBW; birth weight &lt;1000 g).Methods. This was a cohort study of 60 consecutive ELBW survivors who were born during 1977–1980 at Royal Women’s Hospital, Melbourne, Australia. Respiratory function was measured on 44 (73%) of the subjects at a mean age of 20.2 years (standard deviation: 1.0 year). Respiratory function had also been measured on 42 of the 44 subjects at 8 years of age. Respiratory function was compared between the 14 smokers and the 30 nonsmokers.Results. Several respiratory function variables reflecting airflow (the forced expired volume in 1 second [FEV1]/forced vital capacity [FVC] ratio; flow rates at 75%, 50%, and 25% of vital capacity; and mid-expiratory flow from 25% to 75% of vital capacity) were significantly diminished in smokers. The proportion with a clinically important reduction in the FEV1/FVC ratio (&lt;75%) was significantly higher in smokers (64%) than in nonsmokers (20%). There was a significantly larger decrease in the FEV1/FVC ratio between ages 8 and 20 years in the smokers (mean change: −8.2%; 95% confidence interval: −14.1% to −2.4%)Conclusions. Active smoking by young adult survivors of ELBW is associated with reduced respiratory function.
Longitudinal Changes in Growth Parameters Are Correlated With Changes in Pulmonary Function in Children With Cystic Fibrosis
Authors: Peterson Michelle L. , Jacobs David R. , Milla Carlos E. 
Published: August 2004

Objective. Nutritional status is associated with pulmonary health and survival in children with cystic fibrosis (CF). This study evaluated the weight gain pattern of children with CF in relation to the longitudinal trends of their pulmonary function. Our hypothesis was that children who experience continuous weight gain at a given rate will have better average forced expiratory volume in 1 second (FEV1) and change in FEV1 than children who have weight gain patterns that deviate from this rate, even when total weight gain seems adequate.Methods. Prospectively collected data were examined in 319 children, aged 6 to 8, who were routinely followed at the Minnesota Cystic Fibrosis Center. One to 67 measurements of weight (kg), height (cm), and FEV1 (mL) were taken per child during this 2-year period. The data were analyzed by repeated measure regression analysis and by growth pattern analysis.Results. At baseline, a 1-kg higher initial weight was associated with a 55-mL higher average FEV1. During the follow-up period, a 1-kg gain in weight was associated with an increase in FEV1 by 32 mL. Children who had a steady weight gain tended to experience greater increases in FEV1 than children who experienced periodic losses in weight.Conclusions. We established that children who weigh more and who gain weight at an appropriate and uninterrupted rate have a better FEV1 trajectory. Aggressive nutritional support to maintain growth in these children may therefore improve FEV1, which can be taken as a surrogate for better lung health, and may ultimately lead to better survival.