bluuebunny/crossref_metadata_2025_split huggingface dataset:
Repeated School-based Screening for Sexually Transmitted Diseases: A Feasible Strategy for Reaching Adolescents
Authors: Cohen Deborah A. , Nsuami Malanda , Martin David H. , Farley Thomas A. 
Published: August 2004

Objectives.To determine whether repeated school-based screening and treatment for chlamydia and gonorrhea will decrease the prevalence of infection among students.Design.At three high schools serving over 2000 students, all 9th through 12th grade students were given the opportunity to be tested during three consecutive school years for chlamydia and gonorrhea, using urine ligase chain reaction tests. Five comparable schools with 5063 students enrolled served as wait-listed controls.Setting.Eight urban public high schools in Louisiana.Participants.Annually, 52% to 65% of all enrolled students participated; among those enrolled in schools for ≥2 years, 83.4% of students were tested at least once.Intervention.Education of all students; counseling and treatment of infected students with oral single-dose antibiotic therapy.Main Outcome Measure.Prevalence of Chlamydia trachomatis and gonorrhea infection.Results.At first test, 286 (11.5%) of 2497 girls and 143 (6.2%) of 2308 boys were infected with chlamydia, and 48 (2.5%) of 1883 girls and 19 (1.2%) of 1628 boys had gonorrhea. Over 90% of infections were asymptomatic. With repeated testing, chlamydia prevalence among boys dropped to half the rate of comparison schools (3.2% vs 6.4%). Among girls chlamydia prevalence declined only slightly (10.3% vs 11.9% in comparison schools).Conclusion.There are high rates of asymptomatic sexually transmitted diseases (STDs) in the general urban school population. Repeated screening and treatment are associated with declines in chlamydia prevalence among boys. Expansion of STD screening and treatment programs to school settings is likely to be a critical component of a national strategy to control bacterial STDs.
Evaluation of an Evidence-based Guideline for Bronchiolitis
Authors: Perlstein Paul H. , Kotagal Uma R. , Bolling Christopher , Steele Robert , Schoettker Pamela J. , Atherton Harry D. , Farrell Michael K. 
Published: August 2004

Objective.To describe the effect of implementing an evidence-based clinical practice guideline for the inpatient care of infants with bronchiolitis at the Children's Hospital Medical Center in Cincinnati, Ohio.Methodology.A multidisciplinary team generated the guideline for infants ≤1 year old who were admitted to the hospital with a first-time episode of typical bronchiolitis. The guideline was implemented January 15, 1997, and data on all patients admitted with bronchiolitis from that date through March 27, 1997, were compared with data on similar patients admitted in the same periods in the years 1993 through 1996. Data were extracted from hospital charts and clinical and financial databases. They included LOS and use and costs of resources ancillary to bed occupancy.Results.After implementation of the guideline, admissions decreased 29% and mean LOS decreased 17%. Nasopharyngeal washings for respiratory syncytial virus were obtained in 52% fewer patients. Twenty percent fewer chest radiographs were ordered. There were significant reductions in the use of all respiratory therapies, with a 30% decrease in the use of at least 1 β-agonist inhalation therapy. In addition, 51% fewer repeated inhalations were administered. Mean costs for all resources ancillary to bed occupancy decreased 37%. Mean costs for respiratory care services decreased 77%.Conclusions.An evidence-based clinical practice guideline for managing bronchiolitis was highly successful in modifying care during its first year of implementation.guideline, bronchiolitis, evidence-based medicine, pediatrics, outcome research.
Resolution of HIV-Associated Nephrotic Syndrome With Highly Active Antiretroviral Therapy Delivered by Gastrostomy Tube
Authors: Viani Rolando M. , Dankner Wayne M. , Muelenaer Penelope A. , Spector Stephen A. 
Published: August 2004

There is no consensus regarding the specific management of HIV-associated nephrotic syndrome. We report a child whose first manifestation of human immunodeficiency virus type 1 (HIV-1) infection was nephropathy and wasting syndrome associated with profound immunodeficiency. The patient had a dramatic clinical and immunologic response to triple antiretroviral therapy delivered through a gastrostomy tube, with complete resolution of nephrotic syndrome.
A 5½-year-old African-American girl presented with a 2-week history of cough, chest pain, vomiting, loose stools, abdominal distention, anorexia, and fever. In addition, she had recurrent oral thrush. Her weight and height were below the 5th percentile. She was chronically ill, appearing with oropharyngeal thrush and pitting edema in lower extremities. She had scattered rhonchi and decreased breath sounds on both lung bases. Her abdomen was distended and diffusely tender. A chest radiograph showed consolidation of the right upper and left lower lobes with bilateral pleural effusion. Admission laboratories were consistent with nephrotic syndrome.Streptococcus pneumoniae grew from the blood culture and the child responded well to treatment with intravenous ceftriaxone. She was found to be HIV-infected, her CD4+ cell count was 3 cells/μL and her plasma HIV-1 RNA was &gt;750 000 copies/mL. A percutaneous gastrostomy tube was placed for supplemental nutrition. She was treated with stavudine, lamivudine, and nelfinavir via gastrostomy tube with good clinical response.
Twenty-one months after instituting antiretroviral therapy, her weight and height had increased to the 50th and 10th percentile respectively, and she had complete resolution of her nephrotic syndrome. Her CD4+ cell count increased to 1116 cells/μL and her viral load has remained undetectable.
HIV-1 associated nephrotic syndrome has been described in children with profound immunodeficiency. The course of untreated HIV-associated nephrotic syndrome is rapid progression to renal failure in up to 40% of the children. Regardless of the presence of renal insufficiency, if untreated, it is uniformly fatal.
A modest improvement of HIV-1 associated nephrotic syndrome has been observed in patients treated with zidovudine. Steroid and cyclosporine treatment have resulted in improved renal function but long-term use of immunosuppresive therapy has raised concerns about safety. We have described, to our knowledge, the first child with HIV-associated nephrotic syndrome who had a remarkable clinical, immunologic, and virologic response to triple-drug combination therapy given by gastrostomy tube, with complete resolution of proteinuria and normalization of the serum albumin. She also had a striking improvement in weight, height, and quality-of-life. Whether the presence of a gastrostomy tube contributed to the excellent response because of improved compliance is unknown, but warrants systematic evaluation.
Development of Guidelines for Treatment of Children With Phenylketonuria: Report of a Meeting at the National Institute of Child Health and Human Development Held August 15, 1995, National Institutes of Health, Bethesda, Maryland
Authors: Seashore Margretta Reed , Wappner Rebecca , Cho Sechin , de la Cruz Felix 
Published: August 2004

Objective.
To convene a small group of experts in diagnosis and management of PKU to discuss the following issues: the Subject Review of PKU management being performed by the American Academy of Pediatrics (AAP) Committee on Genetics (COG), the published British guidelines on PKU management, and the feasibility, suitability, and mechanism of developing PKU management guidelines for the United States.

Methods.
A 1-day meeting was held at the National Institutes of Health under the auspices of National Institute of Child Health and Human Development, convening experts in PKU diagnosis and management and members of the AAP/COG.

Results.
The group reviewed the published reports of outcomes of treatment of PKU and the British guidelines that were developed based on those data. It also reviewed the results of surveys of directors of clinics that manage PKU, parents of children with PKU, and young adults with PKU.

Conclusion.
The group supported the efforts of the AAP/COG to perform this review of PKU management. The group concluded that significant issues need to be resolved to provide sufficient information to establish US guidelines for PKU management. The establishment of such guidelines is an important next step in PKU management in the United States.
Immunization Outreach in an Inner-City Housing Development: Reminder–Recall on Foot
Authors: Goldstein Karen P. , Lauderdale Diane S. , Glushak Cai , Walter James , Daum Robert S. 
Published: August 2004

Objective.
To determine rates of immunization coverage among children 3 to 72 months of age in a large public housing development, to develop a community-based outreach program to increase coverage, and to evaluate the effect of the program.

Design.
A door-to-door canvass of the development by specially trained emergency medical technicians to enroll families, to determine immunization status from written records, and to follow-up to encourage immunizations and well-child care. The program was evaluated, comparing rates of immunization by age with an expectation based on the immunization histories before enrollment.

Setting.
A Chicago public housing development, October 1993 through December 1996.

Outcome Variables.
Antigen-specific and series-specific coverage based on written records.

Results.
Of the caregivers, 92% were able to identify a primary care provider. At the time of enrollment, 37% of 1075 children were up-to-date, but that proportion varied by age with 27% of children 19 to 35 months of age being up-to-date. The program increased rates of immunization compared with the expectation from the preenrollment rates. At their final assessment, 50% of the children were up-to-date. For individual vaccines, there was a positive program effect. For example, before enrollment, 22% of children 15 months of age had received measles, mumps, and rubella vaccine. However, 39% of children who were enrolled in the program before they were 12 months of age had received their first immunizations by 15 months of age.

Conclusions.
Children in the housing development had very low rates of immunization before enrollment. An in-person intervention was effective in reaching families and determining immunization status. In the 3-year enrollment and observation period, rates of immunization increased.
Reliability and Validity of the Children's Health Survey for Asthma
Authors: Asmussen Linda , Olson Lynn M. , Grant Evalyn N. , Fagan Joanne , Weiss Kevin B. 
Published: August 2004

Objective.Describe the psychometric properties of the Children's Health Survey for Asthma (CHSA)— a condition-specific, self-report, functional health measure for parents of children 5 to 12 years of age with chronic asthma.Method.Data from two cross-sectional and one longitudinal study were used to assess internal consistency reliability, test–retest reliability, and validity of the CHSA. Over 275 parents and guardians of children with asthma completed the CHSA in one of three studies. The combined samples included a heterogenous mix of respondents by child age and race/ethnicity and parental marital and socioeconomic status. Five domain scores were computed: physical health, activity (child), activity (family), emotional health (child), and emotional health (family). Raw scale scores were transformed from 0 to 100 with higher scores indicating better or more positive outcomes.Results.Across the three samples, mean scale scores ranged from a low of 61.5 (emotional health of the child) to a high of 86.1 (activity [family]). Internal consistency reliability for each of the scales was high (Cronbach's α = .81–.92), and test–retest reliability (correlation between forms) ranged from .62 to .86. Significant differences in mean scores for four of five scales were noted between those with low versus moderate to high recent symptom activity.Conclusion.In three tests, the CHSA displays strong reliability and validity. Descriptive statistics demonstrate a range of scale scores. Internal consistency is good to excellent and short-term test–retest reliability is good for each of the five scales. Construct validity is demonstrated by the ability of CHSA to distinguish levels of disease severity, defined by symptom activity.
Technical Report: Minor Head Injury in Children
Authors: Homer Charles J. , Kleinman Lawrence 
Published: August 2004

Minor head trauma affecting children is a common reason for medical consultation and evaluation. In order to provide evidence on which to base a clinical practice guideline for the American Academy of Pediatrics, we undertook a systematic review of the literature on minor head trauma in children.Methods. Medline and Health databases were searched for articles published between 1966 and 1993 on head trauma or head injury, limited to infants, children, and adolescents. Abstracts were reviewed for relevance to mild head trauma consistent with the index case defined by the AAP subcommittee. Relevant articles were identified, reviewed, and abstracted. Additional citations were identified by review of references and expert suggestions. Unpublished data were also identified through contact with authors highlighting child-specific information. Abstracted data were summarized in evidence tables. The process was repeated in 1998, updating the review for articles published between 1993 and 1997.Results. A total of 108 articles were abstracted from 1033 abstracts and articles identified through the various search strategies. Variation in definitions precluded any pooling of data from different studies. Prevalence of intracranial injury in children with mild head trauma varied from 0% to 7%. Children with no clinical risk characteristics are at lower risk than are children with such characteristics; the magnitude of increased risk was inconsistent across studies. Computed tomography scan is most sensitive and specific for detection of intracranial abnormalities; sensitivity and specificity of skull radiographs ranged from 21% to 100% and 53% to 97%, respectively. No high quality studies tested alternative strategies for management of such children. Outcome studies are inconclusive as to the impact of minor head trauma on long-term cognitive function.Conclusions. The literature on mild head trauma does not provide a sufficient scientific basis for evidence-based recommendations about most of the key issues in clinical management. More consistent definitions and multisite assessments are needed to clarify this field.
Delivery Room Management of the Apparently Vigorous Meconium-stained Neonate: Results of the Multicenter, International Collaborative Trial
Authors: Wiswell Thomas E. , Gannon Catherine M. , Jacob Jack , Goldsmith Leonard , Szyld Edgardo , Weiss Kerry , Schutzman David , Cleary Gerard M. , Filipov Panayot , Kurlat Isabel , Caballero Carlos L. , Abassi Soraya , Sprague Daniel , Oltorf Charles , Padula Michael 
Published: August 2004

Objective. Disagreement exists concerning the appropriate delivery room management of the airway of vigorous meconium-stained infants. Some suggest a universal approach to intubation and suctioning of the airway in all such neonates, whereas others advocate a selective approach. We performed this investigation: 1) to assess whether intubation and suctioning of apparently vigorous, meconium-stained neonates would reduce the incidence of meconium aspiration syndrome (MAS); and 2) to determine the frequency of complications from delivery room intubation and suctioning of such infants.Methods. Inclusion criteria included: 1) gestational age ≥37 weeks; 2) birth through meconium-stained amniotic fluid of any consistency; and 3) apparent vigor immediately after birth. Subjects were randomized to be intubated and suctioned (INT) or to expectant management (EXP). Primary outcome measures included: 1) the incidence of respiratory distress, including MAS, and 2) the incidence of complications from intubation.Results. A total of 2094 neonates were enrolled from 12 participating centers (1051 INT and 1043 EXP). Meconium-stained amniotic fluid consistency was similar in both groups. Of the 149 (7.1%) infants that subsequently demonstrated respiratory distress, 62 (3.0%) had MAS and 87 (4.2%) had findings attributed to other disorders. There were no significant differences between groups in the occurrence of MAS (INT = 3.2%; EXP = 2.7%) or in the development of other respiratory disorders (INT = 3.8%; EXP = 4.5%). Of 1098 successfully intubated infants, 42 (3.8%) had a total of 51 complications of the procedure. In all cases, the complications were mild and transient in nature.Conclusions. Compared with expectant management, intubation and suctioning of the apparently vigorous meconium-stained infant does not result in a decreased incidence of MAS or other respiratory disorders. Complications of intubation are infrequent and short-lived.
Enhancing the Racial and Ethnic Diversity of the Pediatric Workforce
Authors:   Committee on Pediatric Workforce
Published: August 2004

Purpose.
This statement seeks to increase the awareness of the importance of diversity; to encourage the incorporation of principles of cultural competence into all aspects of pediatric education, training, and practice, as exemplified by practitioners, educators, and our national leadership; and finally to identify strategies for implementing this incorporation.

Key Concepts.
The increasing cultural diversity of the population has significant implications for the pediatric workforce and for the provision of pediatric health services. Diversity within the pediatric workforce will enhance the potential for pediatricians to acquire the knowledge and practice skills needed to effectively address the health and wellness needs of children and families. Support from this diversity should be integrated into all aspects of education, including providing quality education for minority students and attracting and retaining minority faculty; and should be sought through collaboration locally, regionally, and nationally with organizations and community leaders.

Anticipated Outcomes.
The Policy Statement recommendations will be used to inform educators, administrators, practitioners, and others in the development of curricula, programs, and initiatives to enhance the diversity of the pediatric workforce and increase the cultural competence of practitioners.
Persistent Pulmonary Hypertension of the Newborn in the Era Before Nitric Oxide: Practice Variation and Outcomes
Authors: Walsh-Sukys Michele C. , Tyson Jon E. , Wright Linda L. , Bauer Charles R. , Korones Sheldon B. , Stevenson David K. , Verter Joel , Stoll Barbara J. , Lemons James A. , Papile Lu-Ann , Shankaran Seetha , Donovan Edward F. , Oh William , Ehrenkranz Richard A. , Fanaroff Avroy A. 
Published: August 2004

Objectives.
In the era before widespread use of inhaled nitric oxide, to determine the prevalence of persistent pulmonary hypertension (PPHN) in a multicenter cohort, demographic descriptors of the population, treatments used, the outcomes of those treatments, and variation in practice among centers.

Study Design.
A total of 385 neonates who received ≥50% inspired oxygen and/or mechanical ventilation and had documented evidence of PPHN (2D echocardiogram or preductal or postductal oxygen difference) were tracked from admission at 12 Level III neonatal intensive care units. Demographics, treatments, and outcomes were documented.

Results.
The prevalence of PPHN was 1.9 per 1000 live births (based on 71 558 inborns) with a wide variation observed among centers (.43–6.82 per 1000 live births). Neonates with PPHN were admitted to the Level III neonatal intensive care units at a mean of 12 hours of age (standard deviation: 19 hours). Wide variations in the use of all treatments studied were found at the centers. Hyperventilation was used in 65% overall but centers ranged from 33% to 92%, and continuous infusion of alkali was used in 75% overall, with a range of 27% to 93% of neonates. Other frequently used treatments included sedation (94%; range: 77%–100%), paralysis (73%; range: 33%–98%), and inotrope administration (84%; range: 46%–100%). Vasodilator drugs, primarily tolazoline, were used in 39% (range: 13%–81%) of neonates. Despite the wide variation in practice, there was no significant difference in mortality among centers. Mortality was 11% (range: 4%–33%). No specific therapy was clearly associated with a reduction in mortality.
To determine whether the therapies were equivalent, neonates treated with hyperventilation were compared with those treated with alkali infusion. Hyperventilation reduced the risk of extracorporeal membrane oxygenation without increasing the use of oxygen at 28 days of age. In contrast, the use of alkali infusion was associated with increased use of extracorporeal membrane oxygenation (odds ratio: 5.03, compared with those treated with hyperventilation) and an increased use of oxygen at 28 days of age.

Conclusions.
Hyperventilation and alkali infusion are not equivalent in their outcomes in neonates with PPHN. Randomized trials are needed to evaluate the role of these common therapies.
The Respective Racial and Ethnic Diversity of US Pediatricians and American Children
Authors: Stoddard Jeffrey J. , Back Mary Ruth , Brotherton Sarah E. 
Published: August 2004

Background.
Much effort has been directed toward increasing the training of physicians from underrepresented minority groups, yet few direct comparisons have examined the diversity of the racial/ethnic backgrounds of the physicians relative to the patient populations they serve, either currently or into the future. This has been particularly true in the case of pediatrics, in which little information has emerged regarding the racial/ethnic backgrounds of pediatricians, yet evidence points to ever-growing diversity in the US child population.

Objective.
We embarked on a comparative analysis to examine trends in the racial and ethnic composition of pediatricians vis-a-vis the patient population they serve, America's infants, children, adolescents, and young adults.

Methods.
Data on US pediatricians sorted by racial/ethnic group came from Association of American Medical Colleges distribution data and is based on the cohort of pediatricians graduating from US medical schools between 1983 and 1989 extrapolated to the total number of pediatricians actively practicing in 1996. Data on the demographic diversity of the US child population came from the US Census Bureau. We derived pediatrician-to-child population ratios (PCPRs) specific to racial/ethnic groups to measure comparative diversity between and among groups.

Results.
Our results show that the black PCPR, currently less than one third of the white PCPR, will fall from 14.3 pediatricians per 100 000 children in 1996 to 12 by 2025. The Hispanic PCPR will fall from 16.9 in 1996 to 9.2 in 2025. The American Indian/Alaska Native PCPR will drop from 7.8 in 1996 to 6.5 by the year 2025. The PCPR specific to the Asian/Pacific Islander group will decline from 52.9 in 1996 to 26.1 in 2025. For whites, the PCPR will increase from 47.8 to 54.2 during this period. For 1996, each of the 5 PCPRs is significantly different from the comparison ratio. The same is true for 2025. For the time trend comparison (between 1996 and 2025), there is a significant difference for each ratio except for American Indian/Alaska Native.

Conclusion.
The racial and ethnic makeup of the US child population is currently far more diverse than that of the pediatricians who provide their health care services. If child population demographic projections hold true, and no substantial shifts transpire in the composition of the pediatric workforce, the disparities will increase substantially by the year 2025.