bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mycoplasma Disease and Acute Chest Syndrome in Sickle Cell Disease
Authors: Neumayr Lynne , Lennette Evelyne , Kelly Dana , Earles Ann , Embury Stephen , Groncy Paula , Grossi Mauro , Grover Ranjeet , McMahon Lillian , Swerdlow Paul , Waldron Peter , Vichinsky Elliott 
Published: August 2004

Background. Acute chest syndrome (ACS) is the leading cause of hospitalization, morbidity, and mortality in patients with sickle cell disease. Radiographic and clinical findings in ACS resemble pneumonia; however, etiologies other than infectious pathogens have been implicated, including pulmonary fat embolism (PFE) and infarction of segments of the pulmonary vasculature. The National Acute Chest Syndrome Study Group was designed to identify the etiologic agents and clinical outcomes associated with this syndrome.
Methods. Data were analyzed from the prospective study of 671 episodes of ACS in 538 patients with sickle cell anemia. ACS was defined as a new pulmonary infiltrate involving at least 1 complete segment of the lung, excluding atelectasis. In addition, the patients had to have chest pain, fever &gt;38.5C, tachypnea, wheezing, or cough. Samples of blood and deep sputum were analyzed for evidence of bacteria, viruses, and PFE. Mycoplasma pneumoniae infection was determined by analysis of paired serologies. Detailed information on patient characteristics, presenting signs and symptoms, treatment, and clinical outcome were collected.
Results. Fifty-one (9%) of 598 episodes of ACS had serologic evidence of M pneumoniae infection. Twelve percent of the 112 episodes of ACS occurring in patients younger than 5 years were associated with M pneumoniae infection. At the time of diagnosis, 98% of all patients with M pneumoniae infection had fever, 78% had a cough, and 51% were tachypneic. More than 50% developed multilobar infiltrates and effusions, 82% were transfused, and 6% required assisted ventilation. The average hospital stay was 10 days. Evidence of PFE with M pneumoniae infection was seen in 5 (20%) of 25 patients with adequate deep respiratory samples for the PFE assay. M pneumoniae and Chlamydia pneumoniae was found in 16% of patients with diagnostic studies for C pneumoniae. Mycoplasma hominis was cultured in 10 (2%) of 555 episodes of ACS and occurred more frequently in older patients, but the presenting symptoms and clinical course was similar to those with M pneumoniae.
Conclusions. M pneumoniae is commonly associated with the ACS in patients with sickle cell anemia and occurs in very young children. M hominis should be considered in the differential diagnosis of ACS. Aggressive treatment with broad-spectrum antibiotics, including 1 from the macrolide class, is recommended for all patients as well as bronchodilator therapy, early transfusion, and respiratory support when clinically indicated.
Lack of Effect of Fluticasone Propionate Aqueous Nasal Spray on the Hypothalamic-Pituitary-Adrenal Axis in 2- and 3-Year-Old Patients
Authors: Galant Stanley P. , Melamed Isaac R. , Nayak Anjuli S. , Blake Kathryn V. , Prillaman Barbara A. , Reed Kenneth D. , Cook Cindy K. , Philpot Edward E. , Rickard Kathleen A. 
Published: August 2004

Objective. Fluticasone propionate aqueous nasal spray (FP) at the highest recommended doses does not affect hypothalamic-pituitary-adrenal (HPA) axis function in adults or older children, but its potential effects in children younger than 4 years have not been previously studied. This randomized, double-blind, placebo-controlled study evaluated the effects of FP on HPA axis function measured by 12-hour urinary-free cortisol levels in children 2 to 3 years of age.
Methods. Patients ages 2 to 3 years with symptoms of allergic rhinitis were administered FP 200 μg/day (FP200 QD) or vehicle placebo for 6 weeks.
Results. The FP200 QD group (n = 33) was equivalent to the placebo group (n = 32) in mean change from baseline in the primary safety measure of 12-hour creatinine-corrected urinary-free cortisol concentration (geometric mean difference [standard error; SE] for placebo—FP200 QD = 0.96 [1.20]; 95% confidence interval 0.66, 1.39) at the end of the treatment period. The adjusted geometric mean change from baseline value was 0.98 for FP200 QD (SE = 1.14) and 0.94 for placebo (SE = 1.15); a value of 1.0 reflects no change from baseline. Cough and fever were the most common adverse events reported in either group.
Conclusions. FP200 QD was equivalent to placebo with respect to effects on HPA axis function measured by 12-hour urinary-free cortisol in 2- and 3-year-old patients. FP200 QD was well-tolerated in these very young children with allergic rhinitis.
Quality of Life in Childhood Migraines: Clinical Impact and Comparison to Other Chronic Illnesses
Authors: Powers Scott W. , Patton Susana R. , Hommel Kevin A. , Hershey Andrew D. 
Published: August 2004

Objective. Despite the high prevalence of headaches in youths, quality of life (QOL) has not been well examined. We examined QOL in a clinical sample of children with headaches and compared it with children with other chronic diseases.
Methods. A survey study was conducted of 572 consecutive patients (mean age, 11.4 ± 3.6 years) who presented with headaches to a children’s headache center. Children and parents completed the Pediatric Quality of Life Inventory, Version 4.0 and a standardized headache assessment. Results were compared with established norms for healthy and chronically ill children.
Results. Most patients (99%) had a clinical diagnosis of migraine: 85% met the International Headache Society migraine criteria, and 40% had chronic daily headaches. Total Pediatric Quality of Life Inventory, Version 4.0 score was lower for the entire group (73.1 ± 14.4) compared with healthy norms (83.0 ± 14.8) and lowest for children with chronic daily headaches (70.5 ± 15.5). The impact on QOL of children with migraine was similar to that of children with arthritis and cancer.
Conclusions. QOL of children with headaches is significantly affected by their health condition. The impact of headaches on QOL is similar to that found for other chronic illness conditions, with impairments in school and emotional functioning being the most prominent.
Parental Knowledge of Child Development and the Assignment of Tractor Work to Children
Authors: Pickett William , Marlenga Barbara , Berg Richard L. 
Published: August 2004

Objectives. Many childhood farm tractor injuries occur during the performance of work that was assigned by parents, and some tractor work is beyond the developmental capabilities of children. This has been highlighted recently by a policy statement authored by the American Academy of Pediatrics. The objective of this study was 1) to assess child development knowledge of farm parents who received a new resource, the North American Guidelines for Children’s Agricultural Tasks (NAGCAT), and 2) to determine whether this knowledge was associated with use of NAGCAT in the assignment of tractor jobs and with compliance with 2 aspects of the NAGCAT tractor guideline.Methods. Secondary analysis of data collected during a randomized controlled trial that involved 450 farms in the United States and Canada was conducted. Variables assessed included 1) parental knowledge of child development across several age groups and 3 domains of child development (physical, cognitive, and psychosocial), 2) documentation of the most common tractor jobs assigned to each child, and 3) a report of whether NAGCAT was used in assigning these tractor jobs.Results. High parental knowledge of child development was associated with enhanced use of NAGCAT and fewer violations when assigning tractor work to children. However, even in the presence of high knowledge, some farm parents still assigned to their children work that was in violation of NAGCAT.Conclusions. Educational interventions by themselves are not sufficient to remove many farm children from known occupational hazards. These findings are discussed in light of the recent policy statement on agricultural injuries from the American Academy of Pediatrics.
Preschool Vision Screening Frequency After an Office-Based Training Session for Primary Care Staff
Authors: Hered Robert W. , Rothstein Marjorie 
Published: August 2004

Objective. Although vision screening for preschool children is recommended for detecting amblyopia, many pediatric and family medicine practices do not screen preschool-aged children. The aim of this study was to determine the effect of a training program for primary care clinical staff on vision screening behavior and attitudes.Methods. All local pediatric and family medicine practices were mailed invitations for free training sessions in preliterate eye chart vision screening. The clinical support staff at each participating practice location received a single training session. The lead ancillary medical employee of each practice location was surveyed immediately before and after training, and again 4 to 6 months later, to determine the effect of a single training session on screening behavior and attitudes.Results. Twenty-nine (26%) of 110 practice locations received training in vision screening. Four to 6 months after training, reported screening frequency of 3-year-olds increased, but not of other ages. The reported comfort level with screening 3-year-olds and 4-year-olds was improved 4 to 6 months after training. Most practices responded that the training was beneficial and worthwhile, but lasting impact on practice behavior for the cohort was modest.Conclusions. Direct, practical training in preliterate eye chart vision screening may increase the number of 3-year-old children screened and improve clinical support staff comfort with screening preschool children. A single training session is not sufficient in itself, however, to achieve the goal of universal preschool vision screening in the primary care setting.
Group A β-Hemolytic Streptococcal Osteomyelitis in Children
Authors: Ibia Ekopimo O. , Imoisili Menfo , Pikis Andreas 
Published: August 2004

Objective Little attention has been given to acute hematogenous osteomyelitis (AHO) caused by group A β-hemolytic Streptococcus (GABHS), although up to 10% of cases are caused by this microorganism. The objective of this study was to define the clinical and laboratory characteristics of AHO caused by GABHS.Methods. Between January 1983 and June 1999, 29 patients were treated at Children’s National Medical Center with AHO caused by GABHS. The characteristics of these patients were compared with those of 28 patients with AHO caused by Streptococcus pneumoniae and those of a matched sample of 45 patients with AHO caused by Staphylococcus aureus.Results. Median ages of children with GABHS, S pneumoniae, and S aureus AHO were 36.0, 13.7, and 96.0 months, respectively. On admission, patients with GABHS AHO had a mean temperature of 38.9 ± 1.3°C and a mean white blood cell count of 17 000 ± 7800/mm3, findings similar to those from patients with S pneumoniae AHO. Patients with S aureus AHO had significantly lower admission temperature (38.1 ± 1.1°C) and white blood cell count (10 600 ± 4900/mm3). Varicella infection was the risk factor in 5 cases (17%) of GABHS AHO, whereas none of the cases of AHO caused by S pneumoniae and S aureus was associated with varicella infection. Adjacent septic arthritis occurred in 22%, 28%, and 61% of children with GABHS, S aureus, and S pneumoniae AHO, respectively. Admission erythrocyte sedimentation rate and frequency of bacteremia were similar in all groups. However, time to normalization of erythrocyte sedimentation rate was longer for GABHS and S aureus than for S pneumoniae AHO. GABHS, like S pneumoniae, affected fewer nonextremity bones compared with S aureus.Conclusions. GABHS should be considered in preschool- and early school-aged children who are suspected of having AHO and whose clinical and laboratory features are characterized by high fever and marked leukocytosis. It should also be highly considered in any child with AHO associated with varicella infection.
The Immunization Delivery Effectiveness Assessment Score: A Better Immunization Measure?
Authors: Glauber James H. 
Published: August 2004

Background. Childhood immunization measures, such as the Health Employer Data Information Set (HEDIS) or the National Immunization Survey, assess the percentage of children up-to-date for a specified series of vaccinations. In particular, the HEDIS assesses immunization delivery to children enrolled in managed care organizations (MCO). Such measures do not assess the timeliness of immunization delivery with reference to recommended age standards. To achieve maximal protection against vaccine-preventable diseases, children should receive all immunizations within recommended age intervals—fully “on-time.”Objective. The Immunization Delivery Effectiveness Assessment (IDEA) is a novel immunization measure that assesses, on a continuous scale, the timeliness of administration of each vaccination with reference to recommended age intervals. Specifically we ask: 1) Do absolute immunization rates differ between HEDIS and IDEA? 2) Does relative MCO performance differ when assessed by the 2 performance measures? 3) How well do MCOs perform relative to the standard of fully on-time immunization? The health services implications of using the timeliness standard to assess childhood immunization delivery is discussed.Methods. A vaccine-dose IDEA score was developed for each of the 14 vaccination events in the 4:3:1:3:3 combination series (4 diphtheria-pertussis-tetanus:3 polio:1 measles-mumps-rubella:3 Haemophilus influenzae type B:3 hepatitis B). Assessing the actual age of administration with reference to the recommended age of administration generates the vaccine-dose IDEA score. A child’s composite IDEA score is obtained by averaging the 14 vaccine-dose IDEA scores. These composite IDEA scores, when averaged among children sampled within the MCO, constitute the MCO’s immunization score.Setting. Retrospective analysis of childhood immunization datasets from a convenience sample of 6 MCOs in 5 states.Results. HEDIS rates ranged from 57% to 75%. IDEA scores ranged from 80% to 90%. Relative rankings of MCO immunization performance were different using HEDIS rates and IDEA scores, respectively. At most, 16% of children in any of these MCOs received all of their immunizations fully on-time. From 47% to 77% of children experienced at least 3 delayed immunizations.Conclusions. An immunization measure based on timeliness of administration yields both absolute and relative differences in MCO childhood immunization performance when compared with HEDIS rates. By assessing delivery of each component vaccination, the IDEA score permits more detailed analysis of immunization patterns within an MCO and focuses improvement efforts.
US Adult Attitudes and Practices Regarding Smoking Restrictions and Child Exposure to Environmental Tobacco Smoke: Changes in the Social Climate From 2000–2001
Authors: McMillen Robert C. , Winickoff Jonathan P. , Klein Jonathan D. , Weitzman Michael 
Published: August 2004

Objective. A substantial proportion of homes and automobiles serve as settings for environmental tobacco smoke (ETS) exposure, and many public settings that children frequent are still not smoke-free. Tobacco control efforts are attempting to increase smoking bans. The objective of this study was to describe the knowledge, attitudes, and practices of smokers and nonsmokers regarding smoking bans and child ETS exposure in multiple public and private settings and to report changes from 2000–2001.
Methods. Cross-sectional data from the annual Social Climate Survey of Tobacco Control were analyzed for changes in knowledge, attitudes, and practices regarding tobacco. These data were collected via automated, random-digit-dialing telephone surveys that were conducted in the summers of 2000 and 2001. The samples were weighted by race and gender to be representative of the US population.
Results. Response rates for eligible adults actually contacted were 1501 (75%) of 1876 in 2000 and 3002 (84%) of 3566 in 2001. The majority of adults, both smokers and nonsmokers, support smoking bans in a wide variety of places. The percentage of all respondents reporting the presence of smoking bans in several public and private places increased from 2000–2001: the household (69%–74%), in the presence of children (84%–88%), convenience stores (68%–74%), fast-food restaurants (52%–58%), and non-fast-food restaurants (25%–28%). Support for smoking bans also increased in shopping malls (71%–75%), fast-food restaurants (77%–80%), and indoor sporting events (78%–80%). There were no significant changes in support for smoking bans in convenience stores, restaurants, or outdoor parks. Adults’ knowledge of the harm caused by tobacco was unchanged, with the vast majority of adults recognizing the dangers of exposure to ETS from parental smoking (95%) and exposure to ETS in cars (77%).
Conclusions. Small improvements in adult attitudes and practices regarding children’s ETS exposure occurred from 2000–2001. However, a significant number of adults in the United States still report ignorance of the harmful effects of child ETS exposure, and there was no improvement in reported knowledge in this 1-year period. In contrast, a growing majority of smokers and nonsmokers favor restrictions on smoking in public settings, suggesting that states and communities have public support for broad public smoking restriction policies. There are significant roles that pediatricians can play in preventing children’s ETS exposure, through both patient and family education and by moving smoking restriction policies forward on their community’s agenda.
A Survey of Pediatricians on the Reintroduction of a Rotavirus Vaccine
Authors: Iwamoto Martha , Saari Thomas N. , McMahon Shawn R. , Yusuf Hussain R. , Massoudi Mehran S. , Stevenson John M. , Chu Susan Y. , Pickering Larry K. 
Published: August 2004

Objective. Rhesus-based rotavirus tetravalent vaccine (RRV-TV; RotaShield) was withdrawn voluntarily from the market in October 1999, and recommendations for use were suspended. Rotavirus infection continues to be a significant health problem affecting children worldwide. The objective of this study was to investigate whether pediatricians would either reconsider using RRV-TV or consider other, newer, and presumably safer rotavirus vaccines if they were recommended routinely and to determine factors that influence their opinion.
Methods. A questionnaire was sent to a random sample of 250 members of the Wisconsin Chapter of the American Academy of Pediatrics (AAP) and to 437 randomly selected members of the Georgia Chapter of the AAP. Nonresponders received reminder questionnaires.
Results. Of the 687 pediatricians surveyed, 384 (56%) responded. Responses from 319 eligible immunization providers were included in the final analysis. Although only 15% of respondents reported that they would give RRV-TV if it were available today, 94% reported that they would use a new rotavirus vaccine if proved to be safer than RRV-TV and if recommended by the AAP and Advisory Committee on Immunization Practices for routine use among infants. Barriers to reintroducing a rotavirus vaccine were fear of adverse reactions among 95% of pediatricians, followed by potential high vaccine cost (63%) and amount of time required to educate parents (57%).
Conclusions. Pediatricians reported that they would use a rotavirus vaccine if it was safer than RRV-TV and routinely recommended by the AAP and the Advisory Committee on Immunization Practices.
Congenital Salivary Gland Anlage Tumor of the Nasopharynx
Authors: Cohen Erik G. , Yoder Michael , Thomas Rebecca M. , Salerno Denise , Isaacson Glenn 
Published: August 2004

Objective. Nasal and upper respiratory tract obstruction in the neonatal period can result from a variety of conditions, and may present with variable symptoms. In the absence of dysmorphic features or other abnormalities, causes of nasal obstruction may be difficult to differentiate on initial examination. We report an unexpected and potentially life-threatening condition arising during the work-up of this common neonatal complaint.
Design. Case report with literature review.
Results. A male neonate presented with complaints of nasal obstruction and feeding difficulties. A common diagnostic approach to neonatal nasal obstruction was performed, resulting in an unexpected and potentially life-threatening, albeit curative, result. Cannulation of the nasal cavity to rule out choanal atresia resulted in a burst of bleeding from the nose and mouth. A finger sweep of the oropharynx produced a dislodged mass lesion. Pathology revealed a salivary gland anlage tumor of the nasopharynx.
Conclusions. The diagnosis of a nasopharyngeal mass lesion should be considered in neonates with nasal obstructive symptoms. It is wise to place an index finger in the oropharynx when passing catheters to rule out choanal atresia to feel a dislodged mass lesion before it can become an airway foreign body. Should passage of nasal catheters result in bleeding and/or respiratory distress, the possibility of a displaced mass lesion must be considered immediately to institute prompt intervention.
Successful Treatment of Bowenoid Papulosis in a 9-Year-Old Girl With Vertically Acquired Human Immunodeficiency Virus
Authors: Godfrey James C. , Vaughan Mary C. , Williams Judith V. 
Published: August 2004

A 9-year-old black girl with vertically acquired human immunodeficiency virus (HIV) and no history of condyloma acuminata presented with a 4-year history of enlarging and spreading dark brown flat papules in the perineum. Some of the lesions were confluent and extended from the clitoris to the labia majora and posteriorly to the buttocks and perianal region. A biopsy of one of the lesions showed bowenoid features. Our patient had a normal Pap smear, but vaginal and cervical biopsy specimens revealed human papillomavirus type 16.
Therapy with topical imiquimod cream every other day was started, but little improvement was noted after 2 months. Application of 25% podophyllin every 4 to 8 weeks was added, and improvement was noted within 1 month. After 1 year of treatment, the patient had complete resolution of all lesions, and she has had no further appearance of lesions.
Our case emphasizes the need for increased awareness of the potential for development of bowenoid papulosis in HIV-positive children as well as the successful treatment of our patient with topical therapy alone.