Ammonium chloride-induced acidosis exacerbates cystitis and pyelonephritis caused by uropathogenic E. coli.

Acute pyelonephritis caused by uropathogenic E. coli (UPEC) can cause renal scarring and lead to development of chronic kidney disease. Prevention of kidney injury requires an understanding of host factors and/or UPEC adaptive responses that are permissive for UPEC colonization of the urinary tract.

Metabolic acidosis exacerbates pyelonephritis in mice prone to vesicoureteral reflux.

Acute pyelonephritis is a common, serious bacterial infection in children. The prevalence of acute pyelonephritis is due at least in part to vesicoureteral reflux (VUR). Although an association between abnormalities in electrolyte and acid-base balance and pyelonephritis is common in young children, the impact of metabolic acidosis (MA) on progression of acute pyelonephritis is not fully understood.

Calculating a Continuous Metabolic Syndrome Score Using Nationally Representative Reference Values.

Objective: The prevalence of metabolic syndrome in youth varies on the basis of the classification system used, prompting implementation of continuous scores; however, the use of these scores is limited to the sample from which they were derived. We sought to describe the derivation of the continuous metabolic syndrome score using nationally representative reference values in a sample of obese adolescents and a national sample obtained from National Health and Nutrition Examination Survey (NHANES) 2011-2012.

Methods: Clinical data were collected from 50 adolescents seeking obesity treatment at a stage 3 weight management center.

Severe obstructive sleep apnea in children with elevated blood pressure.

The objective was to determine the prevalence of habitual snoring and obstructive sleep apnea (OSA) in a cohort of children referred for elevated blood pressure (BP), and to determine the association between OSA and BP elevation, learning difficulties, and behavioral problems. We performed a retrospective review of 446 consecutive new patients referred for elevated BP. One hundred four (23%) had habitual snoring.

Integrated Mental Health Training for Pediatric and Psychology Trainees Using Standardized Patient Encounters.

Primary care pediatricians and psychology practitioners who comanage mental health problems can develop interdisciplinary communication and collaborative skills from joint standardized patient encounters and debriefings, combined with brief didactics. Learners showed increased confidence in shared management of behavior health problems.

Blood Cytokine Profiles Associated with Distinct Patterns of Bronchopulmonary Dysplasia among Extremely Low Birth Weight Infants.

Objective: To explore differences in blood cytokine profiles among distinct bronchopulmonary dysplasia (BPD) patterns.

Study Design: We evaluated blood spots collected from 943 infants born at ≤1000 g and surviving to 28 days on postnatal days 1, 3, 7, 14, and 21 for 25 cytokines. Infants were assigned to the following lung disease patterns: (1) no lung disease (NLD); (2) respiratory distress syndrome without BPD; (3) classic BPD (persistent exposure to supplemental oxygen until 28 days of age); or (4) atypical BPD (period without supplemental oxygen before 28 days).

Discrepancies between medical record data and parent reported use of preventive asthma medications.

Objective: To assess whether medical record documentation reflects actual home practices regarding the administration of preventive medications to urban children with persistent asthma.

Methods: Baseline data from a prompting asthma intervention were used for this cross-sectional analysis. As part of the larger study, we enrolled children (2-12 years) with persistent asthma in the waiting room at 12 primary care offices (2009-2012).

Preventive asthma care delivery in the primary care office: missed opportunities for children with persistent asthma symptoms.

Objective: To describe which National Heart Lung and Blood Institute preventive actions are taken for children with persistent asthma symptoms at the time of a primary care visit and determine how care delivery varies by asthma symptom severity.

Methods: We approached children (2 to 12 years old) with asthma from Rochester, NY, in the waiting room at their doctor's office. Eligibility required current persistent symptoms.

Nocturnal asthma symptoms and poor sleep quality among urban school children with asthma.

Objective: The aim of this study was to describe nocturnal asthma symptoms among urban children with asthma and assess the burden of sleep difficulties between children with varying levels of nocturnal symptoms.

Methods: We analyzed baseline data from 287 urban children with persistent asthma (aged 4-10 years) enrolled in the School-Based Asthma Therapy trial; Rochester, New York. Caregivers reported on nocturnal asthma symptoms (number of nights/2 weeks with wheezing or coughing), parent quality of life (Juniper's Pediatric Asthma Caregivers Quality of Life Questionnaire), and sleep quality by using the validated Children's Sleep Habits Questionnaire.

Infant race affects application of clinical guidelines when screening for drugs of abuse in newborns.

Background: Screening for illicit drugs in newborns has privacy, social, and legal risks for families of the infants. Established drug-screening criteria may be applied in a manner that considers nonproven risk factors such as race in addition to evidence-based factors.

Objective: The goal of this study was to determine if race was used as a criterion for screening infants for intrauterine cocaine exposure.

Ambulatory care among young adults in the United States.

Background: Young adults are the most likely age group to be uninsured and have the highest prevalence of substance abuse, motor vehicle accidents, and sexually transmitted diseases, yet little is known about their use of ambulatory care.

Objective: To characterize ambulatory care of young adults.

Design: Cross-sectional data from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey.

Growth curves for cardio-metabolic risk factors in children and adolescents.

Objective: This study developed percentile curves for anthropometric (waist circumference) and cardiovascular (lipid profile) risk factors for US children and adolescents.

Study Design: A representative sample of US children and adolescents from the National Health and Nutrition Examination Survey from 1988 to 1994 (NHANES III) and the current national series (NHANES 1999-2006) were combined. Percentile curves were constructed, nationally weighted, and smoothed using the Lambda, Mu, and Sigma method.

Use of computed tomography to categorize the type of tracheal agenesis.

We report a case of type I tracheal agenesis with vertebral defects, anal atresia, tracheoesophageal fistula and/or esophageal atresia, radial dysplasia, renal defects, and cardiovascular defects association in which computed tomography was helpful in categorizing the diagnosis. This rare and fatal condition should always be considered when confronted with a neonate impossible to resuscitate at birth.

Learning difficulties among children separated from a parent.

Objective: To study the relationship between experiencing separation from parents and having learning difficulties among children in a community-based sample.

Methods: In 2003, parents of children entering kindergarten in the city of Rochester completed a survey assessing the child's social background, medical history, and behavioral profile. Children separated from parents for >1 month were compared with those who had never been away for >1 month on 4 validated developmental measures (range, 1-4): a learning scale, an expressive language scale, a preliteracy scale, and a speech scale.

Metabolic syndrome rates in United States adolescents, from the National Health and Nutrition Examination Survey, 1999-2002.

Objective: To report the prevalence rates of the metabolic syndrome in a nationally representative sample of adolescents in the United States using 4 previously reported definitions of the syndrome.

Study Design: Data from 12- to 19-year-old adolescents included in the National Health and Nutrition Examination Survey from 1999 to 2002 (NHANES 99-02) were analyzed by cross-sectional methods, by using 4 definitions of the metabolic syndrome previously applied to adolescents.

Results: In NHANES 99-02, the prevalence of the metabolic syndrome in all teens varied from 2.

The impact of health insurance gaps on access to care among children with asthma in the United States.

Background: Health insurance coverage is important to help assure children appropriate access to medical care and preventive services. Insurance gaps could be particularly problematic for children with asthma, since appropriate preventive care for these children depends on frequent, consistent contacts with health care providers.

Objective: The aim of this study was to determine the association between insurance gaps and access to care among a nationally representative sample of children with asthma.

Timing of vaccinations in premature infants.

Preterm infants have immunological immaturities that may impact on vaccine responses. Larger premature infants mount immune responses to vaccines that are similar to those of full term infants, but very premature infants (<30 weeks' gestation at birth) have specific defects in vaccine responsiveness. The immunogenicity of diphtheria, tetanus and pertussis antigens is similar in full term and premature infants.

Measuring quality of adolescent preventive services of health plan enrollees and school-based health center users.

Purpose: To evaluate whether quality of care provided to adolescents enrolled in a community-based managed care plan was better for those who also received some care at school-based health centers (SBHCs).

Methods: The Young Adult Health Care Survey (YAHCS) was administered to 374 adolescents (commercially insured, Medicaid-insured, and SBHC users) to assess risk behaviors, provision of preventive screening and counseling, and quality of care.

Results: SBHC users were most likely to report that their provider told them their discussions were confidential, and that they received screening/counseling on sexually transmitted diseases (STDs), HIV/AIDS, condom use, and birth control.

Barriers to reducing ETS in the homes of inner-city children with asthma.

This study assessed knowledge regarding the harm of environmental tobacco smoke (ETS) exposure and barriers to reducing ETS from the point-of-view of urban parents of asthmatic children. We conducted in-depth interviews with 15 mothers of children with asthma. All parents had good knowledge regarding the harmful effects of ETS.

National health care visit patterns of adolescents: implications for delivery of new adolescent vaccines.

Objective: To prepare for new adolescent vaccinations by examining current use of adolescent outpatient health care visits throughout the United States.

Design: Cross-sectional analysis of visits.

Setting: Outpatient hospital- and office-based practices in the United States included in the 1994-2003 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey.

Active immunization of premature and low birth-weight infants: a review of immunogenicity, efficacy, and tolerability.

Preterm infants are at increased risk of disease and hospitalization from a number of vaccine-preventable diseases. However, these same infants have immunologic immaturities that may impact vaccine responses. Larger premature infants mount immune responses to vaccines similar to those of full-term infants, but very premature infants (<28-32 weeks' gestation at birth) may have specific defects in vaccine responsiveness.

Basolateral carbonic anhydrase IV in the proximal tubule is a glycosylphosphatidylinositol-anchored protein.

Carbonic anhydrase (CA) IV facilitates HCO(3) reabsorption in the renal proximal tubule by catalyzing the reversible hydration of CO(2). CAIV is tethered to cell membranes via a glycosylphosphatidylinositol (GPI) lipid anchor. As there is basolateral as well as apical CAIV staining in proximal tubule, the molecular identity of basolateral CAIV was examined.

The impact of conjugate pneumococcal vaccination on routine childhood vaccination and primary care use in 2 counties.

Background: Pneumococcal conjugate vaccine immunization recommendations were rapidly implemented by primary care providers. Before the recommendations, concern was expressed that adding pneumococcal conjugate vaccine might result in delays in other vaccinations or preventive services.

Objectives: The study objectives were to measure whether incorporation of pneumococcal conjugate vaccine by primary care providers delayed other vaccinations or added primary health care visits.

Quantifying preventive asthma care delivered at office visits: the Preventive Asthma Care-Composite Index (PAC-CI).

Our objective was to develop a composite index to measure and quantify preventive asthma care delivered in the primary care office. We documented preventive actions used for children with asthma at the time of an office visit and weighted actions based on their intensity to create a composite index. The usefulness of the index was supported by significant correlations with several measures of symptom severity.