bluuebunny/crossref_metadata_2025 huggingface dataset:
Childhood Risk Factors for High Adult Blood Pressure: The Muscatine Study
Authors: Lauer R. M. , Clarke W. R.
Published: December 2021

In adult populations, elevated blood pressure is related to the development of occlusive atherosclerosis, stroke, and renal disease. The significance of blood pressure levels in childhood, unless extremely elevated, has not been related to disease outcomes. In this study, the risk of high blood pressure in young adult life is evaluated based on the observations of blood pressure and other factors made during the school-aged years. Subjects, 2445 in number, were first observed at ages 7 through 18 years and again between 20 and 30 years. During childhood, measurements of blood pressure, height, and weight were made in alternate years. At adult ages, the same measurements were again made and a health questionnaire was administered. According to the data, adult blood pressure is correlated with childhood blood pressure, body size, and change in ponderosity from childhood to adult life. Adult ponderosity is related to childhood ponderosity, and those who are most obese as adults show the greatest increase in weight for height from their childhood years. These observations suggest that strategies to prevent the acquisition of excess ponderosity during adolescence may be useful in preventing adult hypertension.
Diabetic Microangiopathy in Patients With Cystic Fibrosis
Authors: Sullivan Margaret M. , Denning Carolyn R.
Published: December 2021

Individuals with cystic fibrosis have a 1% to 7% incidence of insulin-dependent diabetes mellitus. The occurrence of diabetic microangiopathy in patients with cystic fibrosis has been reported recently. From 1978 to 1987, 19 patients with cystic fibrosis and diabetes mellitus were followed up. Four patients (21%) had evidence of diabetic microangiopathy. In one, peripheral neuropathy developed 5 years after the onset of diabetes mellitus, and the other 3 patients each had complications of retinopathy, nephropathy, and neuropathy which developed 10 years after the onset of diabetes mellitus. All were poorly compliant in their medical care. Significant morbidity was seen in the 3 patients with multisystem involvement—blindness, glaucoma, hypertension, and renal failure. The combination of long-standing diabetes mellitus, poor glycemic control, plus pathophysiologic features associated with cystic fibrosis may have contributed to the development of microangiopathy. The use of steroids in 4 other patients and dextrose infusions (as part of hyperalimentation) in another 4 patients precipitated or exacerbated diabetes. The data indicate that diabetic microangiopathy can occur in the individual with cystic fibrosis. Routine screening for diabetes and its complications in the population with cystic fibrosis, as well as optimal control of hyperglycemia, is warranted.
OUTCOME-ORIENTED BIAS OF PEER REVIEWERS
Authors: Student
Published: December 2021

A draft of an article was sent to all the consulting editors of the Journal of Experimental Analysis of Behavior, a periodical devoted to the work of followers of B. F. Skinner. One-third received a version interpreting the data as favorable to Skinner's ideas; one-third, a version concluding that the data opposed Skinner, and one-third, an ambiguous version. The method used was described in identical words in all versions.

[The author] reported that a majority of the editors receiving the pro-Skinner paper recommended publication, a majority of those receiving the anti-Skinner draft opposed publication. The third group split about 50-50. Even more striking, those getting the pro-Skinner interpretation rated the method as strictly scientific; those getting the critical version thought the methodology was sloppy, and the third group took a middle position. Remember that the method was described as identical for all three drafts.
Dose-Response Effects of Methylphenidate on Academic Performance and Overt Behavior in Hyperactive Children
Authors: Tannock Rosemary , Schachar Russell J. , Carr Robert P. , Logan Gordon D.
Published: December 2021

In the present study, the effects of 0.3 mg/ kg and 1.0 mg/kg of methylphenidate on the overt behavior and academic functioning of 12 children with an established diagnosis of attention deficit disorder with hyperactivity were evaluated. A double-blind, placebo-control, within-subject (crossover) design was used, in which each child was tested four times in each drug condition. Drug conditions were alternated on a bidaily basis and each child received two different drug conditions each day. The academic tasks were designed for evaluation of the relationship between task complexity and dose. Whereas overt behavior improved with increasing dose, academic functioning was improved with methylphenidate, but did not vary with either dose or task complexity. Also, investigated were potential carryover effects of a morning dose of methylphenidate on performance in the afternoon. Behavioral and academic improvements produced by a dose of 0.3 mg/kg in the morning were no longer evident in the afternoon, but a morning dose of 1.0 mg/kg produced behavioral improvements that were clinically and statistically discernible in the afternoon, although the academic improvements had dissipated.
Successful Fibrinolytic Treatment of Arterial Thrombosis and Hypertension in a Cocaine-Exposed Neonate
Authors: REZNIK VIVIAN M. , ANDERSON JACK , GRISWOLD WILLIAM R. , SEGALL MICHAEL L. , MURPHY JEROME L. , MENDOZA STANLEY A.
Published: December 2021

CASE REPORT

The patient was a 2800-g black girl delivered by primary cesarean section because of fetal distress and meconium aspiration after 42 weeks' gestation. Her mother's pregnancy had been complicated by cocaine use. The baby's Apgar score was 5 at 1 minute and 7 at 5 minutes. Maternal and neonatal urine toxicology screens were positive for cocaine, and the infant was treated with phenobarbital because of withdrawal symptoms. She was transferred to Children's Hospital and Health Center for treatment of CO2 retention and probable meconium aspiration syndrome. She was mechanically ventilated, and an umbilical artery catheter was inserted. The infant improved and was extubated after 4 days; the umbilical catheter was removed on day 8 of life. She did well until 11 days of life when she became tachypneic and acidotic with a systemic blood pressure of 130/106 mm Hg.
Taurine Supplementation of Formulas
Authors: STURMAN JOHN A. , RASSIN DAVID K.
Published: December 2021

The Special Article by Dr Gaull (Pediatrics 1989;83:433-442) was a comprehensive review of the current thoughts about functions of taurine; Dr Gaull concluded: "Experimental findings in animal models and in human cell models provide further justification for taurine supplementation of infant formulas."

Our concern is that this is not necessarily an unbiased conclusion, even though it may be a correct one. Your readers may not be aware that Dr Gaull is the personal owner of US patent 4 303 692 which covers the addition of taurine to human infant formula and stands to gain financially only if taurine supplementation of baby formula is scientifically and legally upheld.
Neonatal Prevalence of Anti-Human Immunodeficiency Virus Antibodies in California
Authors: TRACHTENBERG ALAN I. , CAPELL FRANK J. , VUGIA DUC J. , ASCHER MICHAEL S. , KIZER KENNETH W.
Published: December 2021

In a recent paper, Nicholas et al reviewed maternal seroprevalence in two eastern states and recent studies of the vertical transmission of human immunodeficiency virus (HIV). The California Department of Health Services has been interested in the question of maternal HIV infection and has been conducting a serologic survey of California newborns. In this study, heelstick specimens are blotted onto filter paper for genetic disease screening. After this legally mandated genetic disease testing is completed, the specimens are separated from identifying information and transferred to the state public health laboratory for enzyme-linked immunoassay testing of the blood spots for HIV, with confirmation of repeatedly reactive specimens by Western blot. Preliminary results from this study are now available.
In Reply: Twenty-four Hour After-Treatment Lumbar Puncture: Should It Be Done?
Authors: LEBEL MARC H. , MCCRACKEN GEORGE H.
Published: December 2021

As suggested by Dr Le, we further analyzed our data looking more specifically at potential risk factors such as young age, low CSF glucose levels, and seizures before admission (Table). Presence of seizures before admission correlated well with a more complicated hospital course and outcome. Age did not seem to be a good prognostic indicator because the neurologic outcome is not different in those younger than a year of age or in those older with the exception of hemiparesis. In a previous report for our institution, there were no differences between the characteristics of patients with prompt vs delayed CSF sterilization with respect to age, race, days of illness, positive blood cultures, seizures, and clinical severity score.
Attention Deficit Disorders and Depression
Authors: LORD GUY , BARTHEL RICHARD P.
Published: December 2021

Kelly et al drew attention to the subjective distress and low self-esteem experienced by many children with attention deficit disorder. This is a valuable contribution, in that it is all too easy to simply respond to the distress that such children cause in others (parents, teachers) as opposed to the unhappiness of the child him- or herself. Our concerns relate to the fact that the word "depression" is used only once, as a side effect of stimulant medications. Recent studies indicate a considerable overlap between the problems of children with attention deficit disorder and those in whom depression is diagnosed.
DEPRESSING STATISTICS
Authors: Student
Published: December 2021

About 7 million children do not receive routine medical care.

Only 60 percent of children under age 4 have received the complete basic series of immunizations.

The number of children with acquired immune deficiency syndrome is rapidly increasing, with 10,000 to 20,000 pediatric cases of AIDS or AIDS-related complex likely to be diagnosed in children by 1991.

Reported deaths from child abuse and neglect jumped 23 percent from 1985 to 1986, and estimated deaths range from 2,000 to 5,000 each year.
QUESTION FOR META-ANALYSTS: CAN YOU MAKE A SILKEN PURSE OUT OF A SOW'S EAR?
Authors: Student
Published: December 2021

Choice of dose [in 196 double-blind trials of treatments for rheumatoid arthritis], multiple comparisons, wrong calculation, sub-group and within-group analyses, wrong sampling units. . . , change in measurement scales before analyses, baseline difference, and selecting reporting of significant results were some of the verified or possible causes for the large proportion of results that favored the [newly proposed] drug.

Doubtful or invalid statements were found in 76% of the conclusions or abstracts. Bias consistently favored the new drug in 81 trials, and the control in only one trial.

It is not obvious how a reliable meta-analysis could be done [reliably] in these trials.
APGAR SCORE OUTMODED?
Authors: Student
Published: December 2021

Neither the decision to resuscitate nor counselling of parents about survival is [in the current era] based on the [newborn] infant's Apgar score. Moreover, inaccuracies in its calculation reduce the usefulness of attempts to correlate it with more subtle outcomes. The Apgar score has served its purpose, and should now be pensioned off.
NEW WORD IS BORN
Authors: Student
Published: December 2021

"Comittology" is the ugly new word coined by the European Commission to describe its policy of leaving decisions to the appropriate committee.
MORE TEACHERS OF BRAILLE NEEDED
Authors: Student
Published: December 2021

[There is] a severe shortage of teachers certified to instruct blind and visually impaired children. Increasing the number of teachers is one way to improve the braille skills of blind youngsters.
DIAPER DERBY
Authors: L. J. F.
Published: December 2021

Is Junior bored with his plain white diapers?

Try the magenta or orange....Or there's the subtle peach and lavender from the Los Angeles company's spring line of pastels.

So it goes in the diaper derby, where color, fancy fasteners and other features offer the best bet for getting consumers to pay a premium for a rather mundane product.

The stakes in the diaper war are high: Manufacturers sell $3.5 billion each year in the US alone. Kimberly-Clark's Huggies has 30% of the market, while P&G has 25% with Pampers and 24% with its Luvs brands.

Prices of premium diapers have climbed between 12% and 15% in the past two years, and could rise a further 4% to 6% this spring, analysts estimate.
HARSH WORDS FOR PROFESSORS
Authors: Student
Published: December 2021

The professors—working steadily and systematically—have destroyed the university as a center of learning and have desolated higher education, which no longer is higher or much of an education. . . Academic culture is not merely indifferent to teaching, it is actively hostile to it.
RULING ON PRENATAL RESPONSIBILITY OF FATHERS
Authors: Student
Published: December 2021

A man who fails to support his child's mother emotionally and financially before the child is born loses his standing in an adoption case. . . Because prenatal care of the pregnant mother and unborn child is critical to the wellbeing of the child and of society, the biological father, wed or unwed, has a responsibility to provide support during the pre-birth period.
LOWER LIMIT OF EXTRAUTERINE VIABILITY
Authors: Student
Published: December 2021

The earliest point of viability has remained unchanged at approximately 24 weeks of [human] gestation since 1973.
Anemia of a Mild Viral Infection: The Measles Vaccine as a Model
Authors: Olivares Manuel , Walter Tomas , Osorio Marcial , Chadud Patricia , Schlesinger Liana
Published: December 2021

To define the hematologic changes during a mild viral infection, 93 infants were immunized with live attenuated measles virus and studied prospectively at 0, 4, 9, 14, 21, and 30 days. Hemoglobin concentration decreased significantly by days 9 and 14. The decrease was >1.0 g/dL in 8.6% and >0.6 in 24.3% of the infants. of the nonanemic infants, 22% became anemic. Serum iron and percentage saturation of transferrin decreased, whereas serum ferritin increased significantly. Mean cell volume, iron-binding capacity, protoporphyrin, and haptoglobin did not show changes. Reticulocyte index and erythropoietin increased significantly at 30 days. Leukocyte counts, Zetacrit, and C-reactive protein did not help to predict the hemoglobin decrease. These results suggest that a mild viral infection in infants induces a significant decrease in hemoglobin that may persist for 14 to 30 days and may be difficult to distinguish from iron deficiency.
Urinary Oxalate Excretion by Very Low Birth Weight Infants Receiving Parenteral Nutrition
Authors: Campfield Thomas , Braden Gregory
Published: December 2021

Renal calcifications have been described in very low birth weight (VLBW) infants, and diuretic drugassociated hypercalciuria is believed to play a role in the pathogenesis of this lesion. Hyperoxaluria is an improtant cause of renal stone formation in children and adults. Because parenteral nutrition solutions contain the oxalate precursors ascorbate and glycine, the relationship between total parenteral nutrition administration and oxalate excretion in VLBW infants was examined. Administration of approximately 0.5 g of total parenteral nutrition protein per kilogram per day to VLBW infants was associated with an increased urinary oxalate concentration and an increased urinary oxalate to creatinine ratio, when compared with VLBW infants receiving a glucose and electrolyte solution. A further increase in urinary oxalate concentration and oxalate to creatinine ratio was noted when total parenteral nutrition protein was increased to approximately 1.5 g of protein per kilogram per day. In VLBW infants who receive total parenteral nutrition, elevated urinary oxalate concentrations may develop and may be a factor in the pathogenesis of nephrocalcinosis in these infants.
Surgery for Intractable Epilepsy: Issues and Outcome
Authors: Duchowny Michael S.
Published: December 2021

For certain forms of childhood epilepsy that remain uncontrolled despite adequate treatment with standard antiepileptic medication, surgical therapy should be considered as a potential avenue of treatment. The prognosis for seizure control after early surgery is generally favorable and is at least comparable with that of adults. Remissions are often long-standing or permanent. The results are particularly beneficial if a discrete region of abnormal epileptogenic tissue can be excised. The three major procedures—focal resection, corpus callosotomy, and hemispherectomy—have all been performed successfully in children, and their complication rates are low. With the exception of the obvious benefit conferred by alleviating seizures at a younger age, earlier surgery also improves later psychosocial status and adaptive function. By contrast, persistent seizure activity decreases the likelihood of achieving a functionally independent and economically productive adult life. The psychosocial benefits therefore constitute the most important argument in favor of early surgical intervention. Although relatively little is known about the neuropsychologic consequences of early surgery, there are few deleterious long-term cognitive or behavioral deficits if surgery is uncomplicated. However, relatively little is known about neural reorganization after early surgical excision or hemispheric disconnection, and this remains the greatest challenge for the future.
Contractures in Patients With Williams Syndrome
Authors: Kaplan Paige , Kirschner Marc , Watters Gordon , Costa M. Teresa
Published: December 2021

Williams syndrome is a multisystem disorder, including a characteristic facies and habitus. Intellectual, neurologic, and cardiovascular dysfunction occur; vascular disease may be progressive. Joint contractures affected 10 of a group of 20 children and young adults. In 3 of 10 patients, the contractures were severe enough to interfere with daily activities; in 3 the effect was only moderate. The contractures developed in early childhood and usually did not improve or worsen with time. Large and small joints were affected and usually were symmetrical. Their occurrence did not correlate with vascular disease. The contractures could not be attributed to a neurologic cause.
Assessing the Effectiveness of Care for Very Low Birth Weight Infants—Do We Really Need Population-Based Data?
Authors: HEINONEN KIRSTI M.
Published: December 2021

The active and vigorous care now provided for even the smallest infants has reduced both mortality and morbidity among very low birth weight (VLBW, birth weight <1500 g) infants. The efficacy of individual therapeutic elements has been documented as a part of this management, in some cases by randomized controlled clinical trials. Thus the present practices of providing respiratory, nutritional, and environmental support for VLBW infants seem to be well supported by experimental evidence, usually derived from large hospital-based experience. What—if any—additional information can be gained by relating the outcome of VLBW infants to geographic data covering all such births? In the present commentary, an attempt is made to answer this question by focusing first on two important aspects, namely, the availability and overall effectiveness of intensive care services for VLBW infants.
Transfer of Drugs and Other Chemicals Into Human Milk
Authors:   COMMITTEE ON DRUGS
Published: December 2021

Since the first publication of this statement, much new information has been published concerning the transfer of drugs and chemicals into human milk. This information, in addition to other research published before 1983, makes a revision of the previous statement necessary. In this revision, lists of the pharmacologic or chemical agents transferred into human milk and their possible effects on the infant or on lactation, if known, are provided (Tables 1 to 7). The fact that a pharmacologic or chemical agent does not appear in the Tables is not meant to imply that it is not transferred into human milk or that it does not have an effect on the infant but indicates that there are no reports in the literature. These tables should assist the physician in counseling a nursing mother regarding breast-feeding when the mother has a condition for which a drug is medically indicated.

The following questions should be considered when prescribing drug therapy to lactating women. (1) Is the drug therapy really necessary? Consultation between the pediatrician and the mother's physician can be most useful. (2) Use the safest drug; for example, acetaminophen rather than aspirin for oral analgesia. (3) If there is a possibility that a drug may present a risk to the infant (eg, phenytoin, phenobarbital), consideration should be given to measurement of blood concentrations in the nursing infant. (4) Drug exposure to the nursing infant may be minimized by having the mother take the medication just after completing a breast-feeding and/or just before the infant has his or her lengthy sleep periods.
In Reply: Internationally Adopted Children and Cytomegalovirus
Authors: HOSTETFER MARGARET K.
Published: December 2021

The prevalence of cytomegalovirus excretion in internationally adopted children was unknown before our prospective study, in which 23% of international adoptees were found to be actively shedding cytomegalovirus at the time of examination. This figure has remained constant in our subsequent prospective analysis of an additional 100 internationally adopted children.

Drs Barton and Friedman are correct in that approximately 45% of North American women of childbearing age in middle and upper income groups are not immune to cytomegalovirus.
APGAR SCORES IN PREMATURE INFANTS
Authors: Student
Published: December 2021

After controlling for birthweight and gestational age, Apgar scores did not predict morbidity in low-birthweight infants and should not be used to provide a developmental prognosis.
ANOTHER BEAUTIFUL THEORY MEETS AN UGLY FACT
Authors: Student
Published: December 2021

It's all very well to theorize about how cold fusion in a palladium cathode might take place. One could also theorize about how pigs would behave if they had wings. But pigs don't have wings.
HUSBANDS BUY EXPERT WITNESSES
Authors: Student
Published: December 2021

The threat of losing custody is the ultimate terror weapon in family wars once they hit divorce court. . .Not infrequently some psychiatrists abet injustice by allowing themselves to be bought and paid for by husbands. Too many doctors show up to testify in court for whoever pays for them—and the reality is that the larger war chest is usually possessed by the husbands.
CHILDREN WITH AIDS
Authors: L. J. F.
Published: December 2021

Hundreds of children with AIDS are suffering or dying prematurely because they are unable to obtain AZT, a drug that could prolong and improve the quality of their lives....

Experts say AZT, or azidothymidine, the only AIDS drug approved for use in adults and teen-agers, has been tested in children and shown to be just as active in them, prolonging life and even dramatically reversing mental deterioration.

Yet the Burroughs Wellcome Company, the drug's manufacturer, has not yet applied for approval to market AZT to children under the age of 12 or to make it available to them under "compassionate use" procedures before marketing approval is granted. As a result, AZT is not available in a pediatric dose, except in clinical trials, and insurance companies and government programs will not pay for its use in children...

A company official said Burroughs Wellcome was working as fast as possible to prepare material needed for Federal approval.

But Dr. Samuel Broder, director of the National Cancer Institute, who was a key figure in demonstrating that AZT could slow the spread of the AIDS virus, said he was "very disturbed" that Burroughs Wellcome had not applied for approval to market the drug to children....

Nearly, 1,800 cases of children under 12 with AIDS have been reported to the Federal Centers for Disease Control, but experts say many more have gone unreported. About 800 of these children have died. About 300 children are enrolled in clinical trials...
Risk of Injury to Children Less Than 5 Years of Age in Day Care Versus Home Care Settings
Authors: Rivara Frederick P. , DiGuiseppi Carolyn , Thompson Robert S. , Calonge Ned
Published: December 2021

Recent studies have suggested that day care may be a relatively unsafe environment. In this population-based study, the incidence of injuries in day care and home care were evaluated based on the number of hours children were exposed to each environment. In this population, 43.6% of children less than 5 years of age spent part of the year in day care. The rate of injuries in day care was 2.50 per 100 000 child-hours of exposure compared with a rate of 4.88 per 100 000 child-hours of exposure in the home environment. There were no differences in overall severity of injuries in the two groups. It was concluded that children are at no greater risk of injury in day-care settings than in the home environment.
Maternal Administration of Vitamin K Does Not Improve the Coagulation Profile of Preterm Infants
Authors: Kazzi Nadya J. , Ilagan Nestor B. , Liang Keh-Chyang , Kazzi George M. , Poland Ronald L. , Grietsell Lucille A. , Fujii Yukihiko , Brans Yves W.
Published: December 2021

The effect of maternal administration of vitamin K1 on cord blood prothrombin time, activated partial thromboplastin time, activity of factors II, VII, and X, and antigen levels of factors II and X in infants < 35 weeks' gestation was evaluated. Pregnant women in preterm labor were randomly assigned to receive 10 mg of vitamin K1 intramuscularly or no injection. If delivery did not occur in 4 days, the dose of vitamin K1 was repeated. Women who continued their pregnancy 4 days beyond the second dose received 20 mg of vitamin K1 orally daily until the end of the 34th week of gestation. The birth weights of infants ranged from 370 to 2550 g and gestational age ranged from 22 to 34 weeks. The prothrombin time, activated partial thromboplastin time, factors II, VII, and X activity, and factors II and X antigen levels were not statistically different in either group of infants. Intraventricular hemorrhage occurred in 25 of 51 control infants and 25 of 47 vitamin K-treated infants. More control infants had grade III intraventricular hemorrhage on day 1 (P = .032), but on day 3 and 14 of life, the severity of intraventricular hemorrhage was comparable in both groups. Infants in whom an intraventricular hemorrhage developed were significantly smaller, younger, and more critically ill than infants without intraventricular hemorrhage. Administration of vitamin K1 to pregnant women at < 35 weeks' gestation does not improve the hemostatic defects nor does it reduce the incidence or severity of intraventricular hemorrhage in their infants.
Fever and Petechiae in Children
Authors: Baker Raymond C. , Seguin John H. , Leslie Nancy , Gilchrist Mary J. R. , Myers Martin G.
Published: December 2021

A prospective study of patients with fever and petechiae was performed. Of 190 patients enrolled in the 1-year study, 13 (7%) had meningococcal disease. The most common bacterial association was Streptococcus pyogenes (19 patients). Viral infections were documented in 28 patients. Patients with invasive bacterial disease (group I) appeared more sick, were more likely to have signs of meningeal irritation, and were more likely to have petechiae on the lower extremities than those with less serious, nonbacteremic disease (group II). No patient in group I had petechiae only above the nipple line. Patients in group I had a significantly higher peripheral white blood cell count and absolute band form count. Although no laboratory test or physical finding was sufficiently sensitive to detect all patients with serious disease, the patient with abnormal cerebrospinal fluid, elevated white blood cell count, or elevated absolute band form count was at increased risk for invasive, bacterial disease. Conversely, the risk of serious disease was small if all of these values were in the normal range in the nonill-appearing child or if sore throat and clinical pharyngitis were present in the patient older than 3 years of age.
Thrombocytosis in Childhood: A Survey of 94 Patients
Authors: Chan Ka Wah , Kaikov Yigal , Wadsworth Louis D.
Published: December 2021

The introduction of the newer generation of electronic cell counters allows the routine reporting of platelet numbers when the peripheral blood count is requested. In a 12-month period, 100 episodes of marked thrombocytosis (platelet count more than 900 x 109/L) were found among 94 children. These patients were young (median age 9 months). All but one episode of marked thrombocytosis occurred as a phenomenon secondary to a variety of disease states. Infections, especially those involving the central nervous systems were the commonest cause of an elevated platelet count in this series. Malignant diseases alone were rarely associated with thrombocytosis of this magnitude. The elevated platelet count began to decline at a mean of 3 days after diagnosis, and no thrombotic or hemorrhagic complications were encountered. Marked thrombocytosis is a benign, common phenomenon in young children, but specific treatment is not required.
Pulmonary Function Tests and Fluid Balance in Neonates With Chronic Lung Disease During Dexamethasone Treatment
Authors: Gladstone Igor M. , Ehrenkranz Richard A. , Jacobs Harris C.
Published: December 2021

Pulmonary function tests and fluid balance were measured serially during treatment with dexamethasone in seven ventilator-dependent, 14- to 27-day-old infants. The infants showed no improvement in respiratory status during the prior 5 days. Birth weights ranged from 540 to 900 g, with gestational ages of 24 to 26 weeks. The decision to treat the infants with dexamethasone was made by the clinical team. Pulmonary function tests were performed prior to the first dose and then every 12 hours until extubation. Significant differences were first seen after only 12 hours of treatment. Five infants were extubated within 48 hours of starting therapy. Before extubation at 48 hours, changes were found in dynamic compliance (74% increase), total pulmonary resistance by midvolume and regression methods (38% and 35% decreases, respectively), and expiratory time constant (49% increase), with P < .01 in all cases. An increase in urine output was also observed in the first 12 hours. Improvements in chronic lung disease produced by dexamethasone are rapid and may result from dexamethasone-induced pulmonary fluid shifts.
The Secret
Authors: ZIEGLER JOHN M.
Published: December 2021

On Mother's Day 1975, just as I returned home from my second year in college, my mother told me that she was scheduled to have a lump removed from her breast and that it was thought likely to be cancerous. I told her I loved her, and we hugged each other.

The biology major understood the implications and potential outcomes. The sensitive son felt a vague sense of uneasiness.

The mass was indeed malignant, and a modified radical mastectomy was performed. All node biopsies were negative. After a 2½-year disease-free interval, and now widowed, she saw an internist for an unrelated problem.

The freshman medical student thought it ironic that he was studying for an anatomy examination covering the head and neck. The worried son had difficulty concentrating on the course work.

The node biopsy was positive; a workup for further metastasis was negative, and chemotherapy was begun. Just over one year later, during the Christmas holidays, severe, intermittent abdominal pain developed. A liver scan demonstrated several areas of decreased uptake. During the next months, despite intensification of the chemotherapeutic regimen, the cancer spread further to involve bone and brain. My mother died on April 10, 1979.

The sophomore medical student observed the erratic breathing arid palpated the diminishing pulse. The loving son held his mother's hands, told her, "I love you, Mom," and acknowledged her smile as she closed her eyes peacefully for the last time. The medical student announced to the small group of friends and family at the bedside, "There's no pulse . . . no respirations." The anguished son kissed his mother's forehead, already growing cold, and wept bitterly.
Schools and Sex Education
Authors: SENDEROWITZ JUDITH
Published: December 2021

Drs Stout and Rivara (Pediatrics. 1989;83:375-379) make some sound observations and then draw conclusions that are not only misleading and potentially damaging but also contradict their astute analysis. They correctly identify adolescent pregnancy as a "multifactorial problem" that demands a "multifactorial solution." They also note that sex education cannot, by itself, reverse the barrage of sexual influences in an adolescent's world and that we may be asking too much to expect otherwise.

Those of us at the Center for Population Options agree.
In Reply: Schools and Sex Education
Authors: RIVARA FREDERICK P. , STOUT JAMES
Published: December 2021

The purpose of our article and its conclusions were not to "excuse" physicians from providing education and services to adolescents about sexuality and pregnancy. The purpose of our study was to educate physicians about the current effectiveness of school-based programs and to stimulate further involvement of the medical community in designing, implementing, and evaluating new, innovative, and potentially more effective approaches. We agree with Ms Senderowitz that a multifactorial approach is needed and that school-based programs are but one component of a broader effort.
Untreated Bacteriuria in Asymptomatic Girls With Renal Scarring
Authors: Hansson Sverker , Jodal Ulf , Norén Lars , Bjure Jan
Published: December 2021

Recurrences of bacteriuria after treatment occur in 50% to 80% of asymptomatic patients. Previous experience with short-term treatment as well as longterm prophylaxis has been disappointing, with a significant risk of infections, ie, development of symptoms after treatment. Results with nontreatment are described in this report with reference to clinical course, renal growth, and glomerular filtration rate in 26 asymptomatic girls with established renal scarring and bacteriuria. Acute pyelonephritis was not seen in those with continuing bacteriuria or spontaneous clearance. Neither in scarred nor in unscarred kidneys did the duration of bacteriuria influence renal growth or glomerular filtration rate. Asymptomatic patients with bacteriuria may gain from nontreatment and may have a reduced risk of pyelonephritic attacks.
Acquired Immunodeficiency Syndrome Educational Program: Effects on Adolescents' Knowledge and Attitudes
Authors: Huszti Heather C. , Clopton James R. , Mason Patrick J.
Published: December 2021

Although many schools are presenting acquired immunodeficiency syndrome (AIDS) education programs for adolescents, few have evaluated the effects of the programs. The effects of two different types of program presentation, a lecture or a film, were compared to a no-program condition. Students who received the lecture demonstrated significantly greater knowledge gains than either of the other two groups. The lecture group's greater gain was maintained at the 1-month follow-up, although all three groups showed a decline in knowledge scores from posttest to follow-up. Both educational programs significantly increased students' positive attitudes toward patients with AIDS; there were no differences between the two groups. Positive attitudes decreased equally for both groups from posttest to follow-up, although these scores remained significantly more positive than the pretest scores. Students in both treatment groups showed a slight increase in positive attitudes toward practicing preventive behaviors following the programs, but those attitude scores returned to baseline levels at follow-up. Although educational programs increase knowledge and positive attitudes toward patients with AIDS, they do not appear to have a positive effect on attitudes toward practicing preventive behaviors. More intensive programs may be necessary to encourage behavioral changes.
ETHICIST ON LAWS REQUIRING BICYCLE SAFETY HELMETS
Authors: Student
Published: December 2021

A case may be made for mandating the use of helmets by children but not adults. With good evidence now in hand about the benefits of bicycle safety helmets, we need intensive educational programs. If after a few years they have failed to make much difference, stronger steps may then be taken.
COMPUTER PROGRAM
Authors: Student
Published: December 2021

A computer program, Confidence Interval Analysis (CIA), for calculating confidence intervals has been specially designed by Martin Garner. Details are available from Publishing Department, British Medical Journal, PO Box 295, London, WC1H 9TE, England.
WHEN WILL WE SEE THE LIGHT?
Authors: Student
Published: December 2021

Maternity leave is one of the hallmarks of Western European worker benefits. Over 100 countries have some kind of paid, post-childbirth leave for working parents, and the norm in Europe is five to six months. The United States, by contrast, is the only industrialized Western nation that does not guarantee job security and benefits when a woman stops working to have a child.
FALSE ACCUSATION OF CHILD ABUSE
Authors: Student
Published: December 2021

If a screening checklist [for child abuse] had 82% sensitivity for abusers and 88% specificity for controls (better than most studies) and abuse requiring protection occurred at a rate of 40 per 10,000 then 33 abusers would be identified and seven missed but 1195 false alarms would be raised. No wonder the subject hits the headlines.
Behavioral Risks for Human Immunodeficiency Virus Infection in Adolescent Medical Patients
Authors: Stiffman Arlene Rubin , Earls Felton
Published: December 2021

This paper is an examination of the extent to which adolescents in primary care indicated behavioral risk for human immunodeficiency virus infection, and the degree to which their clinic records reflected either awareness of such conditions or interventions for them. Levels of risk were assigned to the youths based on known risk factors in adult populations and arbitrarily selected natural breaks in the frequency of sexual behaviors. Of the sample, 3% were at high risk for human immunodeficiency virus infection because the adolescents engaged in prostitution, injectable drug use, male homosexual behavior, or had a sexually transmitted disease associated with genital ulcers or sores; 16% were at moderate risk because the youths had more than six sexual partners in the year preceding the interview or had nonulcerative forms of sexually transmitted disease; and the remainder were at low risk. Fewer than half of the youths at risk for human immunodeficiency virus infection sought or received help for any of their problem behaviors, while virtually all sought and received help for sexually transmitted diseases. Because a high proportion of the youths engaging in risky behaviors had sexually transmitted diseases, the most promising approach for prevention of human immunodeficiency disease infection is through health clinics that treat sexually transmitted diseases. These clinics could screen the youths for associated behavioral risk factors, and then offer preventive or interventive services.
Obesity in Black Adolescent Girls: A Controlled Clinical Trial of Treatment by Diet, Behavior Modification, and Parental Support
Authors: Wadden Thomas A. , Stunkard Albert J. , Rich Linda , Rubin Cindy J. , Sweidel Gabriele , McKinney Shortie
Published: December 2021

Recent findings indicate that nearly 50% of black American women are obese and that adolescence is a critical period for the development of their obesity. This study investigated the efficacy of a behavioral weight control program in 36 black female adolescents with a mean age of 14.0 years, weight of 95.0 kg, and height of 163.2 cm. All subjects participated in the same 16-week program but had different levels of parent participation: (1) child alone with no parent participation; (2) mother and child treated in the same session; and (3) mother and child treated in separate but concurrent session. At the end of the 16-week program, children in the three conditions lost 1.6, 3.7, and 3.1 kg, respectively. Differences among conditions were not statistically significant; however, a secondary analysis revealed that the greater the number of sessions attended by mothers, the greater their daughters' weight losses. Weight reduction was associated with significant improvements in body composition, serum total cholesterol concentrations, and psychological status. Results are discussed in terms of the need to improve the maintenance of weight loss in adolescents and to explore possible differences between black and white females in their preferred body types.
Acute Mental Status Changes in Children With Systemic Cancer
Authors: DiMario Francis J. , Packer Roger J.
Published: December 2021

Acute changes in mental status (AMS) develop in children with cancer from a multitude of cancer- and treatment-related complications. To determine the incidence, etiology, and outcome of children with cancer who had AMS, the medical records of all children under 18 years of age with systemic cancer (excluding primary central nervous system tumors) who had AMS in our institution during the years 1981 through 1987 were reviewed. AMS developed in 89 of 815 children at risk (11%). The AMS was caused by seizures in 53 (60%), an encephalopathy in 24 (27%), and a stroke syndrome in 12 (13%). AMS occurred in 42 of 305 (14%) with leukemia, 16 of 139 (12%) with lymphoma, 14 of 136 (10%) with sarcoma, 10 of 104 (9%) with neuroblastoma, and 7 of 104 (5%) with other malignancies. Children with acute lymphocytic leukemia were more prone to having seizures (61%), while children with nonacute lymphocytic leukemia were almost equally likely to have encephalopathies, strokes, or seizures. Children with lymphoma were admitted for treatment most often with an encephalopathy (44%). Etiologies for AMS were evaluated vigorously, and one or more etiologies were identified in 80 of 89 (89%) patients. Dependent on the type of tumor, the anticancer treatment used and, timing during the course of illness AMS occurred, specific diagnoses were more likely. Neurologic morbidity and mortality were dependent on the cause of AMS. Children with seizures that were initially difficult to control were more likely to require long-term anticonvulsant therapy.
Intraosseous Fluids in Emergencies
Authors: MACGREGOR D. F. , MACNAB A. J.
Published: December 2021

To the Editor.—

Despite several publications advocating the used of intraosseous fluids in emergency situations, current use remains limited.1-3 Seigler et al4 have underlined the success of their procedure in one of the most difficult situations possible, namely, the young child with cardiopulmonary arrest in the prehospital setting. This method of intravascular access can be of value in a number of related situations where intravenous fluids are required quickly but access is limited due to circulatory collapse, severe dehydration, hemorrhage, burns, trauma, and allergy.5
Acquired Immunodeficiency Syndrome and Adolescence
Authors: GOODMAN ELIZABETH , COHALL ALWYN T.
Published: December 2021

In Reply.—

Dr Parker raises some interesting questions about a volatile and highly controversial issue. Human immunodeficiency virus screening does strike at not only the root of medical philosophy, but also the basic structure and value systems of contemporary American society. Our intent, however, was not to pose a question or argue the pros and cons of human immunodeficiency virus testing, but to make a descriptive statement of the powerful emotional response which accompanies this issue.
Infants and Children With Acquired Immunodeficiency Syndrome: Placement in Adoption and Foster Care
Authors: DIX DOUGLAS
Published: December 2021

To the Editor.—

The Task Force on Pediatrics Acquired Immunodeficiency Syndrome underestimates both the risk of human immunodeficiency virus infection in children available for adoption and foster care and the dangers in placing human immunodeficiency virus positive children in normal homes.1 Maternal transmission is only one route of human immunodeficiency virus acquisition. Many children become eligible for adoption or foster care as victims of abuse by methods that can transmit the virus. These methods include not only sexual activity with human immunodeficiency virus positive perpetrators, but battery and neglect in human immunodeficiency virus-contaminated environments.
Pseudoephedrine Dangers
Authors: CLARK RICHARD F. , CURRY STEVEN C.
Published: December 2021

To the Editor.—

Pseudoephedrine is an over-the-counter amphetamine commonly used as a decongestant. Pseudoephedrine is a mixed-acting sympathomimetic amine, causing both the release of neurotransmitters from adrenergic nerve endings and the direct stimulation of adrenergic receptors.

While overdoses of other amphetamines can produce a life-threatening adrenergic crisis comprising hypertension, tachycardia, hyperthermia, agitation, and convulsions, serious overdoses with pseudoephedrine alone are rare.1-3 We report the case of a child who suffered a generalized seizure after ingesting pseudoephedrine tablets, a finding not previously reported after isolated pseudoephedrine ingestions.
Effect of Cholestyramine on Activity of Gentamicin in Vitro
Authors: COLTMAN D. , MANN M. D. , Bowie M. D.
Published: December 2021

To the Editor.—

A combination of oral gentamicin and the basic anion exchange resin, cholestyramine is effective in the treatment of infants who have severe diarrhea for 7 days.1 Both drugs decrease the severity of the diarrhea and there is a considerable, beneficial interaction between them.2 The mode of action is not known, but we postulated that gentamicin acts by eliminating the abnormal bacterial microflora in the small bowel and cholestyramine by binding toxins or deconjugated and dehydroxylated bile salts.2
Integration of Soft Signs in Academically Normal and Academically at-Risk Children
Authors: Blondis Thomas A. , Snow Jeffrey H. , Accardo Pasquale J.
Published: December 2021

The development of motor and sensory proficiency and the integration of soft signs were analyzed for 38 children with average achievement and 29 children achieving below grade level. Motor coordination, speed, and inhibition, as well as the development of sensory function, were evaluated at the time of entrance to kindergarten and again during the first grade. The performance of both groups progressed on tasks measuring motor speed and coordination as well as tactile integration. Although the children achieving below grade level continued to perform the majority of tasks poorly in comparison with the children performing at grade level, on most of the measures they evidenced definite catch-up or greater gain than the children performing at grade level. Their progress on the motor speed and coordination tasks supports the hypothesis of a developmental lag in these areas. Results of tests of motor inhibition were notable for an absence of progression. That children achieving below grade level did not advance in this area would argue against the hypothesis of a developmental lag for all soft signs. Although results of this longitudinal study are preliminary, findings to date would allow for the possibility that both deficits and lags are responsible for the differences between the academically normal and academically at-risk children.