bluuebunny/crossref_metadata_2025 huggingface dataset:
The Relationship Among Television Watching, Physical Activity, and Body Composition of Young Children
Authors: DuRant Robert H. , Baranowski Tom , Johnson Maribeth , Thompson William O.
Published: December 2021

Purpose. Television watching has been reported to be associated with obesity, resting energy expenditure, and lower daily physical activity among both children and adolescents. However, most of these studies were based on self report or data collected in laboratory settings. This study examined the relationship among observed time of television watching, observed physical activity level and body composition among 3- or 4-year-old children.

Methods. African-American (41.4%), Mexican-American (23%), and Anglo-American (35.6%) children (N = 191, males = 90) from the Texas site of the Studies of Child Activity and Nutrition program were observed from 6 to 12 hours per day up to 4 days over 1 year. Activity level each minute of the day was measured with the Children's Activity Rating Scale (interobserver reliability = .84 ± .001). The interobserver reliability of time of television watching was .96 ± .08.

Results. The median of the longest number of consecutive minutes of television watching was 15 (range = 1 to 79). The median percent of minutes of television watching of total observed minutes was 14.8% (0% to 58%) and the median percent of minutes of inside minutes was 17.9% (0% to 80.9%). There were no gender or ethnic differences in time watching television or physical activity during television watching. Physical activity during television watching was lowest during the longest bout of television watching (\l=x_\ = 1.48 ± .28) compared to outside minutes (\l=x_\ = 2.38 ± .21), inside non-television minutes (\l=x_\ = 1.96 ± .13) and inside television minutes (\l=x_\ = 1.65 ± .18). The level of physical activity during television-watching times was highest (P <.0031) during October and November and lowest during March, April, June, and July. Longest bout of television watching and percent of minutes watching television to total observed minutes were inversely associated with mean physical activity, percent of minutes of physical activity levels 3, 4, or 5, and percent of physical activity levels 4 or 5. Percent of television watching to inside minutes was negatively correlated with physical activity levels 4 or 5. Television-watching behavior was not associated with body composition.

Conclusions. Television watching was weakly negatively correlated with physical activity levels, and physical activity was lower during television-watching than non-television-watching time in this sample of children. Television viewing behavior was not associated with body composition.
The Rate of Increase in Blood Pressure in Children 5 Years of Age Is Related to Changes in Aerobic Fitness and Body Mass Index
Authors: Shea Steven , Basch Charles E. , Gutin Bernard , Stein Aryeh D. , Contento Isobel R. , Irigoyen Matilde , Zybert Patricia
Published: December 2021

Objective. To determine whether changes in aerobic fitness and body mass index are related to the age-related rise in blood pressure in healthy preschool children.

Study design. Longitudinal analyses of 196 free-living children aged 5 years at baseline who were followed over a mean of 19:7 months. Aerobic fitness was assessed using a treadmill All measures were obtained on multiple occasions at scheduled visits as part of a longitudinal cohort study.

Setting. An inner-city medical center.

Outcome measures. Blood pressure was measured using an automated Dinamap device.

Results. Mean systolic blood pressure was 95.3 mmHg (SD 8.38) at baseline and increased by 4.46 mmHg per year. Mean diastolic blood pressure was 53.9 mmHg (SD 5.81) at baseline and did not change significantly. Children in the highest quintile of increase in fitness had a significantly smaller increase in systolic blood pressure compared to children in the lowest quintile (2.92 vs 5.10 mmHg/year; P = .03). Children in the lowest quintile of increase in body mass index did not differ significantly in rate of increase in systolic blood pressure compared to children in the highest quintile (3.92 vs 4.96 mmHg/year). In a multiple regression model including baseline systolic blood pressure, fitness, height, body mass index, and other covariates, greater increase in fitness (P = .03) and lesser increase in body mass index (P < .01) were associated with lower rates of increase in systolic blood pressure. In a similar multivariate analysis, an increase in fitness was also associated with a lower rate of increase in diastolic blood pressure (P = .02)

Conclusion. Young children who increase their aerobic fitness or decrease their body mass index reduce the rate of the age-related increase in blood pressure. These observations may have implications for development of interventions directed at the primary prevention of hypertension.
Immunization Referral Practices of Pediatricians in the United States
Authors: Ruch-Ross Holly S. , O'Connor Karen G.
Published: December 2021

Objective. Concerned about alarmingly low rates of immunization among some young US children as well as disturbing trends in vaccine availability and delivery, the American Academy of Pediatrics sought to examine national trends in referral for immunization among US pediatricians.

Methods. A self-administered eight-page questionnaire on issues in childhood immunization was mailed to a random sample of the AAP's 36 000 US resident members. Four rounds of the survey yielded a sample size of 1246, for a response rate of 77%.

Results. A majority of respondents reported referral of some patients for immunization; reported reasons for referral focused on issues of cost to the patient. Personal characteristics of pediatricians (age and gender) were not related to referral practices. Pediatricians practicing in solo or group settings were 2.8 times as likely as those in clinics or other settings to refer patients for immunization. Those in nonmetropolitan areas were nearly twice as likely as those in large metropolitan areas to refer for immunization. When setting and location were controlled, pediatricians who reported that their states had programs to provide all vaccines free or at reduced cost were much less likely to indicate that they referred patients for immunization.

Conclusions. A majority of US pediatricians refer some of their patients to other providers for immunizations because of financial reasons. Children outside of metropolitan areas may be at particular risk for problems of availability of and access to immunizations. This study raises, once again, the issue of differential health care access for children based on payment mechanisms.
Experience and Reason: Twenty-Year Follow-Up of Protective Immunity of the Oka Strain Live Varicella Vaccine
Authors: Asano Yoshizo , Suga Sadao , Yoshikawa Tetsushi , Kobayashi Ikuko , Yazaki Takehiko , Shibata Motohiro , Tsuzuki Kazuo , Ito Shigemitsu
Published: December 2021

Since the first report on the development of a live attenuated varicella vaccine in 1974, the vaccine has been studied extensively, with largely favorable results, in both healthy and leukemic children. It is now licensed in Japan, Korea, and some European countries, and is being considered for licensure in the United States. Although various clinical trials have established the safety, immunogenicity, and the efficacy of the vaccine, concern has been expressed that waning immunity in the vaccine recipients might allow the occurrence of more severe varicella later in life. We show data relevant to this concern on the approximately 20-year follow-up study of the vaccine recipients; this work further extends the experience of a long-term protective efficacy of the vaccine.
Practice Parameter: Management of Hyperbilirubinemia in the Healthy Term Newborn
Authors:   PROVISIONAL COMMITTEE ON QUALITY IMPROVEMENT,   SUBCOMMITTEE ON HYPERBILIRUBINEMIA
Published: December 2021

Each year approximately 60% of the 4 million newborns in the United States become clinically jaundiced. Many receive various forms of evaluation and treatment. Few issues in neonatal medicine have generated such long-standing controversy as the possible adverse consequences of neonatal jaundice and when to begin treatment. Questions regarding potentially detrimental neurologic effects from elevated serum bilirubin levels prompt continuing concern and debate, particularly with regard to the management of the otherwise healthy term newborn without risk factors for hemolysis. Although most data are based on infants with birth weights ≥2500 g, "term" is hereafter defined as 37 completed weeks of gestation.

Under certain circumstances, bilirubin may be toxic to the central nervous system and may cause neurologic impairment even in healthy term newborns. Most studies, however, have failed to substantiate significant associations between a specific level of total serum bilirubin (TSB) during nonhemolytic hyperbilirubinemia in term newborns and subsequent IQ or serious neurologic abnormality (including hearing impairment). Other studies have detected subtle differences in outcomes associated with TSB levels, particularly when used in conjunction with albumin binding tests and/or duration of exposure. In almost all published studies, the TSB concentration has been used as a predictor variable for outcome determinations.

Factors influencing bilirubin toxicity to the brain cells of newborn infants are complex and incompletely understood; they include those that affect the serum albumin concentration and those that affect the binding of bilirubin to albumin, the penetration of bilirubin into the brain, and the vulnerability of brain cells to the toxic effects of bilirubin.
Office-Based Counseling for Injury Prevention
Authors:   COMMITTEE ON INJURY AND POISON PREVENTION
Published: December 2021

Injury remains the leading cause of childhood and adolescent death and disability. Appropriate counseling by pediatricians can alert parents and children to many risky behaviors or environments. Appropriate behavior or environmental change by parents and children will be needed to decrease the number of children with significant injury.
Omphalocele in Down Syndrome
Authors: KARAMANOUKIAN HRATCH L. , GLICK PHILIP L.
Published: December 2021

We read with great interest the report by Reddy et al (Pediatrics 1994;93:514-515) entitled "Down Syndrome and Omphalocele: An Unrecognized Association." The authors have identified eleven instances of concurrence of Down syndrome and omphalocele in the literature, correctly conceding that their "list may very well not be exhaustive." We congratulate the authors for their honesty in their presentation. However, we feel that it is important to make several comments, particularly in regard to the association of Down syndrome and omphaloceles and to plea for a multidisciplinary approach to the care of the pregnant woman and the fetus before, during, and after delivery; especially when a pregnancy has been identified to be associated with a congenital anomaly:
LEWIS THOMAS ON CHILDHOOD
Authors: Student
Published: December 2021

[Childhood] is the time when the human brain can set to work on language, on taste, on poetry and music, with [neural] centers at its disposal that may not be available later on in life. If we did not have childhood, and we were able somehow to jump catlike from infancy to adulthood, I doubt very much that we would turn out human.
Nocturnal Enuresis and Behavioral Problems in Adolescence: A 15-Year Longitudinal Study
Authors: Fergusson David M. , Horwood L. John
Published: December 2021

Objective. This study examines the relationships between nocturnal enuresis in childhood and measures of behavioral adjustment in adolescence using data collected during the course of a 15-year longitudinal study of a birth cohort of New Zealand children.

Method. Data was collected on patterns of nocturnal bladder control at annual intervals to the age of 13 years. At ages 11, 13, and 15 years measures of conduct problems, attention deficit behaviors, and anxiety/withdrawal were gathered.

Results. The analysis showed that children who were bed-wettting after the age of 10 years as a result of either primary or secondary enuresis had increased rates of behavioral problems up to the age of 15 years with these children having mean behavior scores that were between .30 to .65 standard deviations higher than children who ceased bed-wetting before the age of 5 years. Regression analysis indicated that these associations were largely spurious and arose because the age of cessation of bed-wetting was correlated with a series of factors (gender, social maturity, childhood IQ, family social background, family stress, and parental conflict) that were also associated with increased rates of adolescent behavior problems. However, even after adjusting for these factors, children who were bed-wetting after the age of 10 years showed slight increases in rates of conduct problems and attention deficit behaviors up to the age of 13 years and increased rates of anxiety/withdrawal up to the age of 15 years.

Conclusions. It is concluded that bed-wetting after the age of 10 years is associated with small but detectable increases in risks of conduct problems, attention deficit behaviors, and anxiety/withdrawal in early adolescence. These results show that although it is not the case that children showing nocturnal enuresis are at markedly increased risks of serious psychiatric problems, it may be prudent to determine the extent to which children who are bed-wetting after the age of 10 years show increases in anxious or problem behaviors.
The American Board of Pediatrics: Its Origin and Early History
Authors: Brownlee Robert C.
Published: December 2021

The American Board of Pediatrics (ABP) marked its 60th anniversary in 1993. Because all of the original board members have long since passed from the scene, no one can comment on the Board's origin from firsthand experience, as Chick Koop did so well in his essay on the origins of pediatric surgery. During the first decade of my association with the ABP, however, I heard stories and bits of history from original board members and other early "movers" who were still active in the organization. Written materials were available to me, also, thanks to Borden Veeder, Bob Lawson, Ed Shaw, the ABP history committee chaired by Larry Finberg, and others who wrote about the Board.
Chylous Ascites: A Sign of Unsuspected Child Abuse
Authors: Olazagasti Juan C. , Fitzgerald Joseph F. , White Susan J. , Chong Sonny K. F.
Published: December 2021

Chylous fluid accumulation in the peritoneal cavity is associated with pathology in the lymphatic system. Primary (congenital) chylous ascites develops during the first year of life, while secondary (acquired) chylous ascites, resulting from lymphatic obstruction or trauma, can arise at any time during life. Both lead to spillage of chyle into the peritoneal cavity from ruptured lacteals and lymphatic ducts. Radiographic findings suggestive of intentional injury have been observed in most published cases of secondary chylous ascites resulting from child abuse.1-4

We present a child with chylous ascites who was initially thought to have lymphangiectasia but who was later found to be a victim of abuse.
Accepting the Unthinkable
Authors: Little George A. , Brooks John G.
Published: December 2021

The editor of this journal has drawn our attention to "an incredible story".1 He juxtaposed two 1994 New York Times articles2,3 and a letter to the editor published in 19734 that relate to an important article published in 1973.5 Comment about the matter has also appeared in Science.6

The fundamental issue is that new information concerning an original study by Steinschneider et al that focused on apnea and sudden infant death syndrome (SIDS) has emerged. It now appears that the deaths of two children of one family from the study cohort of five children of three families may have been murder.
Active and Passive Tobacco Exposure: A Serious Pediatric Health Problem
Authors: Gidding Samuel S. , Schydlower Manuel
Published: December 2021

Tobacco use and passive exposure to tobacco smoke are the most important environmental health hazards in the United States. Over 400 000 deaths each year are attributed to smoking and using other tobacco products.1 Although most of these deaths are in adults, in recent years the pediatric morbidity of tobacco use has received increasing attention. In 1992 the Environmental Protection Agency published Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders, which highlighted the adverse effects of passive smoke exposure on children.2 The Surgeon General's Report of 1994, entitled Preventing Tobacco Use Among Young People, provides a comprehensive review of the impact of cigarette smoking on youth.3
Infant Feeding Practices and Their Possible Relationship to the Etiology of Diabetes Mellitus
Authors:   Work Group on Cow's Milk Protein and Diabetes Mellitus
Published: December 2021

1. Insulin-dependent diabetes mellitus develops within a group of individuals who carry specific diabetes susceptibility traits. Because all of the potential diabetes "susceptibility genes" are not known, currently it is not possible to identify all individuals at risk. It appears, however, that a small percentage of such individuals will ever develop clinical diabetes mellitus.

2. The autoimmune destructive process may be triggered by a number of environmental events.

3. Early exposure of infants to cow's milk protein may be an important factor in the initiation of the β cell destructive process in some individuals. It is not known whether the cow's milk protein in commercially available infant formulas is associated with this process.

4. The avoidance of cow's milk protein for the first several months of life may reduce the later development of IDDM or delay its onset in susceptible individuals.

5. Research directed toward further defining the possible relationship between infant feeding practices and the development of IDDM is needed.
Guidelines for Monitoring of Anthracycline Cardiomyopathy: A Rebuttal
Authors: Steinherz Laurel J. , Graham Thomas , Hurwitz Roger , Sondheimer Henry M. , Shaffer Elizabeth M. , Schwartz Ronald G. , Sandor George , Benson Lee , Williams Roberta
Published: December 2021

The manuscript published in the March issue of Pediatrics by Lipshultz et al1 discusses and challenges the protocol recommended by the Cardiology Committee of the Children's Cancer Study Group2 (CCSG) for cardiac monitoring of patients receiving anthracyclines and modification of therapy based on the results. Lipshultz et al contend that, adopting the published recommendations would be deleterious to patient care. Their discussion, however, is supported by hypothetical inferences and selective quotation of the CCSG article and its references, rather than by data.
FAXING—150 YEARS OLD!
Authors: L. J. F.
Published: December 2021

Although the office fax machine has only become popular in the past decade, this year sees its 150th anniversary. It was patented on 27 May 1843, 30 years even before the telephone. But whereas the telephone quickly established itself as an essential tool for business, commercial success has been much longer coming for a machine that could transmit pictures and documents, within seconds, from one office to another.

The inventor of the idea was Alexander Bain, who was born in 1810. Bain, a Scotsman from a remote croft in Caithness, is reputed to have performed his early experiments using cattle jawbones for hinges, heather for springs and metal plates buried in the earth for batteries. He was apprenticed to a clockmaker in Wick and invented the first electric clock, which used electromagnetism to pull a pendulum from side to side. He then moved to London and patented his fax machine.
Respiratory Infections in Day Care
Authors: Schwartz Benjamin , Reichler Mary R. , Jereb John , Giebink G. Scott , Henderson Frederick W. , Collet Jean-Paul
Published: December 2021

Respiratory illness among children attending day care is diverse both in sites of infection and etiologic agents. Although some data are available on the epidemiology of these conditions, approaches to controlling respiratory infections still need to be developed and evaluated. Surveillance to monitor trends in rates of disease and antimicrobial resistance and to evaluate the impact of potential interventions remains important.
Injuries in Child Day Care: An Overview
Authors: Rivara Frederick P. , Sacks Jeffrey J.
Published: December 2021

Injuries in child day care are a microcosm of the overall problem of childhood injury. In 1985 the National Academy of Sciences characterized injury as the most important public health problem in America.1 Although infectious diseases account for substantial morbidity among children—including the needs for medical care and hospitalization—injury is the most common cause of serious disability and death to children. Over the last 25 years there have been remarkable reductions in morbidity and mortality from other causes of childhood death, particularly those from infections and more recently from childhood cancer.2 Unfortunately, the reduction in childhood death from injuries has been minimal.2 Thus, addressing injuries to children in child-care and other settings is a public health priority.

INCIDENCE OF INJURIES

Approximately 25% of children annually incur injuries requiring medical care, either in the emergency department or the physician's office.3 The most common injury event is a fall. Falls are a particular problem because they can result in head trauma and permanent disability. Falls are the main cause of traumatic brain injury in children and account for 55% of traumatic brain injury requiring admission to the hospital.4 Contrary to popular belief, outcomes from head injuries in children are worse than outcomes in adults.5

Comparison of injuries to children in out-of-home child care (OOHCC) and in home care (HC) requires the calculation of comparable incidence rates. All children in OOHCC also spend time in HC, so comparisons based on population denominators are not accurate. In addition, unlike most infectious diseases—for which illnesses occur following an incubation period—injuries occur immediately after the exposure.
Day-Care Injuries in the Data Base of the Canadian Hospitals Injury Reporting and Prevention Program
Authors: Mackenzie Susan G. , Sherman Gregory J.
Published: December 2021

BACKGROUND

This account of injuries suffered by children in day-care settings uses information from the data base of the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP). The aim of CHIRPP, inaugurated in 1990 by Health and Welfare Canada and the 10 Canadian pediatric hospitals, is to make an important contribution to reducing the incidence and severity of injuries in Canada. This is to be accomplished through an emergency room-based surveillance system that allows identification of existing and new injury hazards. Since the inception of CHIRPP, three general hospitals have joined the program. The data base includes a wealth of information about how injuries happen and is available to provide quick answers about injury occurrence as well as for more detailed research.

MATERIALS AND METHODS

Each injured person (or, in the case of a child, the accompanying adult) who arrives at the emergency room of a CHIRPP hospital is asked to complete a one-page self-administered questionnaire that collects demographic information and information about when, where, and how the injury occurred. On the other side of the form the examining physician records the nature of up to three injuries and how the case was handled in the emergency room (eg, treated and released, admitted). Completed CHIRPP forms are sent to the Laboratory Centre for Disease Control, Health and Welfare Canada where the information is entered into the main CHIRPP data base, usually within 3 months of the injury's occurrence. In addition to coded information, each record includes a one-line description of how the injury happened.
Which Children Benefit the Most From Early Intervention?
Authors: Ramey Craig T. , Ramey Sharon Landesman
Published: December 2021

Recent findings from three separate studies support and extend a large and growing body of early-intervention research literature spanning 30 years. The literature is consistent in demonstrating positive developmental outcomes as a result of intensive early intervention for children of low-income and undereducated families. New analyses confirm that maternal intelligence is a key factor in children's intellectual development, especially when these children are not provided with intensive early intervention. Fortunately, children whose mothers have low IQs respond positively to intensive, high-quality early intervention, which leads to a dramatic reduction in their rates of mental retardation during the intervention program. Unresolved issues include how best routinely to identify children and families who will benefit from such programs, how early to begin programs and for how long to continue them to produce desirable developmental outcomes, and whether sufficient public and political will exists to scale-up early intervention efforts to match the magnitude of the problem in our society.
Comprehensive Services in Child-Care Settings: Prevalence and Correlates
Authors: Hofferth Sandra L. , Kisker Ellen Eliason
Published: December 2021

At the beginning of 1990, 80 000 day-care centers in the US were serving about 4 million preschool children.1 This represents threefold increase since 1976 to 1977 in the number of centers and a fourfold increase in enrollments. Approximately 118 000 regulated family day-care providers were serving about 700 000 children. There were between 550 000 and 1.1 million nonregulated family day-care homes that were serving an unknown number of children. The number of regulated family day-care homes and the number of children enrolled in those homes increased since the mid-1970s, though not as much as the number enrolled in centers. About 17% of the children enrolled in center-based programs and 5% of those enrolled in regulated family day-care homes came from families receiving public assistance. Low-income families are overrepresented in Head Start and other sponsored non-profit programs.

The fact that increasing numbers of children are enrolled in early education and care programs presents an opportunity to serve the needs of disadvantaged children who may not necessarily receive nutritious meals, environmental stimulation, developmental screening, and adequate preventive health care at home. Programs such as Head Start, for example, are required to provide a comprehensive set of services in addition to a developmentally appropriate curriculum.

In the first part of this paper we examine the general health and safety procedures followed by center staff and family day-care providers for sick children ill providers. The extent to which providers conform to health and safety provisions will be examined. For example, do providers maintain records, obtain medical releases, have the phone number of a physician, have an emergency medical plan, have a list of persons to whom the child may be released, and conduct fire drills?
Costs Associated With Gastrointestinal-Tract Illness Among Children Attending Day-Care Centers in Houston, Texas
Authors: Hardy Alison M. , Lairson David R. , Morrow Ardythe L.
Published: December 2021

Substantial costs occur each year due to infectious illness attributable to day-care center attendance by young children.1-3 Estimates of the value of work missed by parents in the US due to day-care-associated upper respiratory tract and diarrheal illness combined have ranged from $1602 million to $4003 million per year. Infectious diarrhea is one of the most common illnesses among young children. Several epidemiologic studies have shown increased risk of developing infectious diarrhea with attendance in group care, especially among children under 3 years of age.4-6 The cost burden of diarrheal illness among children attending day-care centers (DCCs) has not been adequately quantified, and few analyses have considered the effect that the type of care arrangement given ill children exerts on cost.

To estimate the cost burden of gastrointestinal-tract illness in day-care centers (DCCs), we used data collected during a 16-month cohort study of rotavirus diarrhea in four DCCs. In addition, we surveyed parents to assess factors affecting cost of illness and to assess the range of ill-child-care options used by parents.

METHODS

Selection of Day Care Centers

Four DCCs in Houston, Texas, were selected for participation in the rotavirus cohort study from a list of licensed DCCs generated by the Texas Department of Human Services. Potential study sites were centers with sufficient numbers of infants and toddlers located within a 7-mile radius of the University of Texas Medical School. Center directors gave informed consent for their centers to participate in the study.

Day-Care Center Population

From October 1989 through April 1991, children age 1-18 months with no known underlying disease in four licensed DCCs were enrolled in the rotavirus cohort study.
American Public Health Association/American Academy of Pediatrics National Health and Safety Guidelines for Child-Care Programs: Featured Standards and Implementation
Authors: Hawks Debra , Ascheim Joan , Giebink G. Scott , Graville Stacey , Solnit Albert J.
Published: December 2021

In response to the potential for illness and injury in group care for children and a growing need for national guidance on health and safety aspects of child care, the American Public Health Association (APHA) and the American Academy of Pediatrics (AAP) developed national health and safety guidelines for child-care programs. This collaborative effort culminated in the publication, Caring for Our Children—National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs.1

The APHA/AAP guidelines address the following technical content areas:

• environmental quality;

• prevention and control of infectious diseases;

• injury prevention and control;

• general health;

• nutrition;

• prevention and management of child abuse;

• staff health;

• children with special needs;

• health concerns related to social environment and child development;

• health and safety organization and administration.

While all of these content areas are important in terms of health and safety, some tend to receive more attention. Certain standards in each of the featured content areas are highlighted on the basis of the perceived significance to care givers and health professionals; the reflection of new knowledge and state of the art; possible controversy; on considerations for implementation.

HEALTH CONCERNS RELATED TO SOCIAL ENVIRONMENT AND CHILD DEVELOPMENT

This technical area describes the standards on social environment and child development in the service of promoting physical and mental health. One of the most substantial achievements was to describe the qualifications, numbers, and availability of adults caring for young children in out-of-home settings.1 The National Research Council in its report, Who Cares for America's Children?
Through My Window—Remarks at the 125th Year Celebration of Children's Hospital of Boston
Authors: Morton D. Holmes
Published: December 2021

Today we celebrate the 125th year of The Children's Hospital. We celebrate the medical care, the research, and the teaching of the men and women whose efforts made this hospital great. At this time let us also remember the children for whom they cared. This hospital, the knowledge gained here, the work done here, and the inspiration for the life-work of these great people, all of these, were gifts from children. children who were sick and suffered much to give such gifts. The Plain people call them God's Special Children and value them, love them, care for them, and remember them when they are gone. So should we.
The Use of Alternative Medicine by Children
Authors: Spigelblatt Linda , Laîné-Ammara Gisèle , Pless I. Barry , Guyver Adrian
Published: December 2021

Objective. Alternative medicine (AM) is of growing interest to the general public. Although several studies have been published concerning its use in adults, the use by children is less well known. The purpose of this study is to determine the frequency with which alternative medicine is employed in a pediatric population that also uses conventional medicine. A second goal is to investigate the sociodemographic factors that influence the choice of these forms of therapy.

Methods. Parents of children consulting the general outpatient clinic of a university hospital completed a self-administered questionnaire asking about previous use of AM for themselves or their children.

Results. Based on 1911 completed questionnaires, 208 children (11%) previously consulted one or more AM practitioners. Chiropractic, homeopathy, naturopathy, and acupuncture together accounted for 84% of use. Children who used AM differed significantly from those who only used conventional medicine in that they were older than the nonusers, their mothers were better educated, and their parents also tended to use AM.

Conclusion. The findings indicate that AM is an aspect of child health care that no longer can be ignored. Being aware of these practices will enable physicians to discuss alternative therapies with parents in order to ensure the continuity of essential conventional treatments.
Long-Term Follow-Up of 58 Patients with Histidinemia Treated With a Histidine-Restricted Diet: No Effect of Therapy
Authors: Widhaim Kurt , Virmani Kiran
Published: December 2021

Objective. There is no general agreement as to whether or not patients with histidinemia should be treated with a histidine-restricted diet because the majority of the patients are asymptomatic. Between April 1969 and December 1986 124 children with histidinemia were detected in the Austrian Neonates Screening Program and they received long-term follow-up.

Design. Fifty nine patients were treated with a histidine-restricted diet (35 mg/kg). The follow-up included determining biochemical parameters, physical examination and psychological assessment of 58 treated and 43 untreated patients. After termination of the Screening Program information about the patients' development was obtained through questionnaires and follow-up of 20 patients aged 11 to 17 years.

Results. Histidine blood levels decreased after institution of the diet, but rose again after termination of the diet. In the untreated patients histidine levels were highest at 1 year of age, decreasing with age. When the IQ scores of the treated and the untreated group were compared, significantly higher IQ scores were found in the 4-year-old and 6-year-old untreated patients (P < .05). Clinical symptoms were found in 27 patients; treated and untreated patients were equally affected. The clinical observations included speech defects, psychomotor and general retardation, emotional disturbances, recurrent respiratory infections, and miscellaneous symptoms such as atopic dermatitis.

Conclusion. We conclude that patients with histidinemia do not benefit from dietary treatment.
Perseverance Pays Off: Health Care Providers' Impact on HIV Testing Decisions by Adolescent Females
Authors: Goodman Elizabeth , Tipton Ann C. , Hecht Liza , Chesney Margaret A.
Published: December 2021

Background and objective. Although HIV counseling and testing of adolescents has increased rapidly in recent years due to increasing HIV seroprevalence rates, little is known about adolescents' use of HIV testing services. The aims of this study were to determine what proportion of high risk adolescent girls would use confidential HIV testing services linked to primary care and to explore the characteristics, beliefs, and experiences that distinguish those teenage girls who obtain HIV testing in this setting from those who do not.

Design. Prospective cohort study.

Setting. General pediatrics clinic with adolescent-specific appointments at a large urban HMO.

Participants. Convenience sample of 124 adolescent girls engaging in risky behaviors identified by chart review before regularly scheduled clinic appointments.

Intervention. Subjects completed a self-report questionnaire assessing HIV-related knowledge, attitudes, beliefs, and behaviors before the medical visit. During their provider visit, teens were counseled about their risk behaviors and the availability of HIV testing services at the clinic. Subjects were also given the opportunity to view an educational video about HIV testing designed for adolescents.

Main outcome measures. Use of HIV counseling and testing services at the clinic and HIV test results.

Results. Forty-one percent of these adolescent girls obtained HIV testing at the clinic on the day of their scheduled appointment. Univariate analysis revealed that adolescents who obtained testing had initiated sexual intercourse at a younger age (mean age 13.8 vs 14.4 years, P = .02) and were more likely to have had a prior discussion about HIV testing with a health care provider [RR = 2.02, 95% CIs (1.22, 3.36)]. Those who did not view the video were less likely to test [RR = 0.20, 95% CIs (0.07, 0.58)]. Multiple logistic regression modeling revealed that a prior discussion with a health care provider was the only independent predictor of obtaining an HIV test [OR = 3.47 95% CIs (1.26, 9.52)].

Conclusions. A significant proportion of adolescent girls engaging in risky behaviors will use confidential HIV counseling and testing services that are linked to primary care. Health care providers play an important role in helping teens address their risk for and concerns about HIV infection by engaging adolescents in repeated discussions about HIV testing.
False Positive EBNA IgM and IgG Antibody Tests for Infectious Mononucleosis in Children
Authors: Levine Dorothy , Klenk Rosemary , Morelli Alan , Hofreuter Nancy , Tilton Richard C. , Parry Michael F.
Published: December 2021

Objectives. To assess the reliability of the Monolert test, a new enzyme-linked immunosorbent assay for the diagnosis of acute infectious mononucleosis (IM).

Design. A retrospective laboratory and clinical analysis of 38 children diagnosed with acute IM.

Setting. A suburban pediatric practice in Connecticut.

Patients. Thirty-eight children (ages 18 months to 17 years) who were diagnosed with acute IM using the Monolert test during the period October 1992 to August 1993.

Results. Eighty-three percent of these children had no evidence of Epstein-Barr virus infection on subsequent investigation. The false positive results of the Monolert test could not be explained on the basis of elevated antibody titers to either cytomegalovirus or Borrelia burgdorferi.

Conclusion. Monolert is a poor screening test and is of little apparent value as a diagnostic test for acute Epstein-Barr virus infection in pediatric patients.
Evaluation of an Hygienic Intervention in Child Day-Care Centers
Authors: Kotch Jonathan B. , Faircloth Ann H. , Weigle Kristen A. , Weber David J. , Clifford Richard M. , Harms Thelma O. , Rolandelli Pamela S. , Loda Frank A. , Gallagher Philip N. , Edwards Robert W. , LaBorde Danielle , McMurray Marsha P.
Published: December 2021

The growing use of child day-care centers (CDCCs) has produced a significant rise in morbidity due to infectious diseases which carry such consequences as discomfort, disability, and parental anxiety.1,2 Haskins conservatively estimated the cost of day-care illnesses among children to be $1.8 billion.3 To this must be added the cost of parents' and care givers' excess illness attributable to CDCCs.

No published study describes a successful intervention to reduce the risk of upper respiratory disease in CDCCs. Although many research groups have advocated hand washing and diapering hygiene as a means of reducing the spread of enteric disease in CDCCs,4-11 there are only two controlled studies in the literature. In their pioneering work, Black et al showed the incidence of diarrhea in CDCCs following a rigorously monitored hand-washing program to be nearly twice that in intervention centers.12 Bartlett et al monitored the impact of hand washing in randomly assigned CDCCs and found no intervention effect. However, rates of diarrhea were significantly lower among children in the actively monitored centers regardless of intervention status.13

These studies share several limitations: the sources of incidence data were not blinded to center intervention status, the analyses did not statistically control for potential confounders, and non-independence of multiple diarrhea episodes in the same child were not accounted for. The purposes of our study were to develop a feasible, multicomponent hygienic intervention and to carefully measure its impact while controlling for sources of bias.

Use of trade names is for identification only and does not constitute endorsement by the Public Health Service, the Centers for Disease Control and Prevention, or any of the other co-sponsors of this conference.
Dural Sinus Thrombosis Complicating Subclavian Vein Catheterization: Treatment With Local Thrombolysis
Authors: Gebara Bassam M. , Goetting Mark G. , Wang Ay-Ming
Published: December 2021

Local venous thrombosis is a known complication of subclavian vein catheterization.1,2 The clot can extend to the noncatheterized ipsilateral internal jugular vein.3,4 It is usually asymptomatic, however, signs of venous congestion can occur. Dural sinus thrombosis has been reported in association with retrograd catheterization of the internal jugular vein,5 but not the subclavian vein. We report a case of symptomatic right sigmoid sinus, transverse sinus, and bilateral internal jugular vein thrombosis without subclavian vein thrombosis in an infant few hours after placement of right subclavian vein catheter.

CASE REPORT

A 9-week-old girl was seen in the emergency room for lethargy, cyanosis, and apnea.
The Role of Steroids in the Management of Children with Bacterial Meningitis
Authors: Prober Charles G.
Published: December 2021

The article by Wald et al in this issue of Pediatrics addresses the potential value of adjunctive steroid therapy in the management of bacterial meningitis in children older than 8 weeks of age.1 This carefully designed and executed multicenter, randomized, controlled trial (RCT) compared the hospital course and long-term outcome of 69 dexamethasone recipients with that of 74 well-matched placebo recipients. The dose of steroids was the same as that used in three prior RCTs2,3 and the first dose was administered within 4 hours after the first dose of ceftriaxone. Unique to this study was the performance of the first audiologic evaluation within 24 hours of admission to the hospital, permitting the investigators to determine the time of onset of the most common sequela of meningitis, sensorineural hearing loss.
Medical Research: A Prescriptive View
Authors: Kramer Michael S.
Published: December 2021

Why should we do research? The word "should" here indicates that I am being prescriptive, rather than descriptive. (To be perfectly honest, these views do not even accurately describe my own research; I wish I had done a better job of following my own prescription.). If you are willing to play a collective Dante to my Virgil let me lead you up the five levels of the Mount Purgatory of Medical research, each representing a goal or reason for doing research (Fig 1).

The lowest goal for the medical researcher is Level 1, improving one's curriculum vitae. Unfortunately, all too many academics appear to be caught in pisitions where they are expected to do research in which they have no interest and which is highly unlikely to lead to one of the higher levels, and where the sole aim is to improve their CVs in preparation for promotion or tenure review. In my view, people who are doing research because they have to should be doing something else. Nor should academic departments expect all department members to be researchers, but that is a topic for another day.

Next on our upward journey is Level 2, where the goal is to derive personal satisfaction. Although it is obviously easier to recruit potential clinicians and others to a demanding activity like research when that activity is personally satisfying, Level 2 is an insufficient goal on its own to justify the time, effort, and money involved. Besides, researchers who reach one of the higher levels can gain additional satisfaction above and beyond that gained by doing the research itself.
Integration of Community Pediatricians into an Academic Department
Authors: Broffman Gregg , Stapleton F. Burder
Published: December 2021

A process of enhanced participation by community pediatricians in the programs and administration of an academic department is described. We realize that many departments incorporate volunteer faculty into their academic programs without creating a specific structure, such as our divisional classification. The customary paradigm of providing "ad hoc" opportunities and responsibilities for volunteer faculty is somewhat analogous to the traditional "quality assurance" model of management, which is responsive in nature and places the participants in a dependent relationship to the academic leadership. Creating academic division structure allows the volunteer faculty to initiate projects, create interdivisional work teams, and evaluate the results of their involvement and is more reflective of the new "continuous quality improvement" model. This system elevates the volunteer faculty into a partnership relationship with the academic faculty. The sense of ownership and opportunity for personal growth appear to be important drives for sustained community involvement. Although the benefits of our program appear promising, committed leadership within the academy and community will be required for longterm success. Re-analysis of the intramural dynamics and activities following systemic restructuring of the health care system will be of interest.
Continuous Versus Multiple Rapid Infusions of Indomethacin: Effects on Cerebral Blood Flow Velocity
Authors: Hammerman Cathy , Glaser Joram , Schimmel Michael S. , Ferber Benjamin , Kaplan Michael , Eidelman Arthur I.
Published: December 2021

Objective. Therapeutic administration of indomethacin for patent ductus arteriosus (PDA) closure has been documented to decrease cerebral blood flow velocity which may be harmful to the vulnerable premature neonate. We have therefore compared the effects of administering indomethacin by rapid injection versus slow, continuous indomethacin infusion at the same total therapeutic dose on middle cerebral artery (MCA) systolic and diastolic flow velocity, resistance index, and cerebral blood flow (as reflected by the integrated area under the curve).

Methods. Premature neonates (<1750 g) documented echocardiographically to have a PDA were randomized to receive indomethacin either by three rapid injection doses or by continuous intravenous infusion over the ensuing 36 hours, providing an equivalent total dose. Echocardiograms and transcranial color flow mapping of the MCA flow velocity were measured at baseline and serially following initiation of therapy in both groups. Effects on cerebral blood flow velocity are presented.

Results. Eighteen infants [rapid injection-1.2 ± 0.3 kg (n = 9) and continuous-1.1 ± 0.2 kg (n = 9)] were studied. In the rapid injection treated infants decreased flow velocity in the MCA as manifested by abrupt, significant decreases in systolic (to 70 ± 8% baseline) and diastolic (to 65 ± 13% baseline) flow velocity and area under the curve (to 60 ± 10% of baseline) were evident by 4 minutes and progressed to 30 minutes after treatment initiation. These changes were not observed in the group treated with continuous indomethacin. Both therapeutic modalities were equally successful in closing the ductus, although the numbers are too small to definitively determine therapeutic efficacy.

Conclusions. Slow, continuous infusion eliminated the decrease in cerebral flow velocity and appears to be effective in closing the PDA.