bluuebunny/crossref_metadata_2025 huggingface dataset:
Family-Centered, Community-Based, Coordinated Care for Children With Special Needs
Authors: NARKEWICZ RICHARD M.
Published: December 2021

Assuring that all children with special health care needs have access to family-centered, community-based, coordinated care, as described by Brewer et al in this issue of Pediatrics, is a timely and commendable goal that the American Academy of Pediatrics (AAP) shares. Pediatricians have a major role to play in the shaping of these services and assuring their accessibility by the children who need them.

Last winter, the AAP held three task force meetings to discuss the role of pediatricians vis-á-vis the case manager/care coordinator. A consensus emerged from these meetings that a variety of roles should be available to pediatricians, depending upon the child's diagnosis, the pediatrician's training and interest, the skills of the family, and the community services available.
Skateboard Injuries
Authors:   COMMITTEE ON ACCIDENT AND POISON PREVENTION
Published: December 2021

Skateboards are again increasing in popularity (Time, June 6, 1988, pp 90-91). Not surprisingly, the increased use of skateboards is accompanied by a resurgence in the number of related injuries. Pediatricians informed about skateboard injuries can help to prevent needless injury.

In the last skateboard injury epidemic, the annual incidence of injuries peaked at 150,000 in 1977. The rate subsequently decreased to 16,000 injuries in 1983. Since that time, skateboard injuries had increased sharply: 19,000 in 1984, 37,000 in 1985, and 81,000 in 1986. According to data from the Consumer Product Safety Commission, in 1984 and 1985, 36 children are known to have died as a result of injuries sustained while riding skateboards.

Analysis of Consumer Product Safety Commission data from 1984 to 1985 indicates the following salient features of the current outbreak. Of recorded skateboard injuries during this period: (1) 88% involved skateboarders less than 20 years of age, 45% involved 10- to 14-year-old children; (2) 88% involving skateboarders younger than 20 years of age involved boys or young men; (3) 74% were to the extremities, 17% to the head and neck, and 9% to the trunk; (4) severe injuries were uncommon; moderate injuries were most common in all age groups. However, the severity of injuries increased with decreasing age. Moderate or severe injuries accounted for half of the injuries to children older than 9 years, two thirds of the injuries to children 5 to 9 years, and more than three fourths of the injuries to children 0 to 4 years of age; (5) the likelihood of injury to the head and neck increased as the age of the injured decreased.
More on Taurine
Authors: TYSON JON E. , MIZE CHARLES , LASKY ROBERT
Published: December 2021

In a recent commentary, Perlman called for further study of the effects of taurine and expressed reservations about our randomized trial of taurine supplementation for infants weighing ≤1300 g at birth. We agree with the need for further investigation but would like to respond to his criticism that our sampling of patients was biased and that our statistical analyses were inappropriate.

What Perlman contends is a methodologic problem and a selection bias is, in fact, the careful selection of patients for the specific question under investigation.
Massive Hepatomegaly, Steatosis, and Secondary Plasma Carnitine Deficiency in an Infant With Cystic Fibrosis
Authors: Treem William R. , Stanley Charles A.
Published: December 2021

Hepatomegaly and steatosis are common findings in children with cystic fibrosis and are most often attributed to malnutrition. An infant fed a carnitine-free soy formula is described. Massive hepatomegaly and steatosis developed in the baby at a time of severe viral respiratory illness, prolonged fasting, hypoglycemia, and hypoketonuria. The infant was found to have secondary plasma carnitine deficiency and excessive loss of carnitine in the urine as part of a more generalized renal tubular dysfunction accompanying vitarain D deficiency and secondary hyperparathyroidism. With correction of the metabolic abnormalities and institution of a high carnitine diet, the hepatomegaly disappeared, plasma carnitine returned to normal levels, and the renal carnitine loss ceased. The findings suggest that secondary carnitine deficiency may play a role in fatty infiltration of the liver in patients with cystic fibrosis, especially during times of severe fasting stress.
PREDICTION—THAT'S WHAT IT'S ALL ABOUT
Authors: Student
Published: December 2021

Can you predict something new you didn't know? That is the real proof of a theory.
Hospitalization of Children With Status Asthmaticus: A Review
Authors: Richards Warren
Published: December 2021

A review of hospital admissions of patients with status asthmaticus at the Childrens Hospital of Los Angeles showed a marked increase in admissions in recent years. Asthma mortality did not increase. Patients tended to be young, boys, and black as compared with patients admitted to a general hospital. Interviews with 100 patients and/or their parents admitted between February and June 1988 indicated that the majority of patients had frequent, severe, and/or disabling symptoms and a significant number were undertreated. Forty-five percent of these patients and 46% of all patients admitted between January 1986 and October 1988 because of status asthmaticus also had sinusitis, otitis, or pneumonitis.
Optimum Needle Length for Diphtheria-Tetanus-Pertussis Inoculation of Infants
Authors: HICK JOHN F. , CHARBONEAU J. WILLIAM , BRAKKE DUANE M. , GOERGEN BARBARA
Published: December 2021

There is no consensus about the most appropriate needle length for injection of diphtheria-tetanus-pertussis (DTP) vaccine in infants. IM administration with a 2.54 to 3.17 cm (1- to 1 ¼-in) needle was recommended according to the 1982 Red Book. A specific recommendation for needle length was deleted from the 1986 Red Book, although IM administration was still recommended. This route is preferred because of the known risk of sterile abscess formation related to subcutaneous administration of the DTP vaccine.

No systematic surveys have been conducted among practitioners to establish the most commonly used needle length for DTP shots. We informally surveyed the five largest pediatric clinics in the Minneapolis-St Paul area and found that four of five clinics used a 1.58-cm (⅝-in) needle.
Should Blood Cultures Be Obtained in the Evaluation of Young Febrile Children Without Evident Focus of Bacterial Infection? A Decision Analysis of Diagnostic Management Strategies
Authors: Kramer Michael S. , Lane David A. , Mills Elaine L.
Published: December 2021

The technique of decision analysis was used to compare the benefits (prevention of major infectious sequelae of bacteremia) and risks (unnecessary hospitalization and intravenous antibiotic treatment of children whose bacteremia would have resolved spontaneously, discomfort of venipuncture) of alternative diagnostic management strategies in the evaluation of children 3 to 24 months of age with fever (rectal temperature ≥39°C) of acute (≤4 days) onset and without evident focus of bacterial infection. The diagnostic strategies compared at the initial visit were blood culture in all, blood culture in none, and selective blood culture (restricted to children judged to be at high risk). Probability estimates were based on published epidemiologic studies and case series, and utilities were elicited from mothers of 3-to 24-month-old children and from pediatricians. Based on initial probabilities and utilities, the "no blood culture" strategy had the highest expected utility, followed closely by the "selective blood culture" strategy, with the "blood culture all" strategy a distant third. Sensitivity analyses based on increased risk of major infectious sequelae or of bacteremia had no effect on the ranking of the three initial management options. Eliminating the "disutility" of venipuncture or augmenting the disutility of major infectious sequelae also failed to alter the ranking. Even when an extreme relative disutility for major sequelae was assumed, the "blood culture all" strategy was not favored. Thus, the risk of unnecessary hospitalization and intravenous antibiotic treatment of the relatively large number of children whose bacteremia spontaneously resolves appears to outweigh the benefit of preventing serious infectious sequelae in the few children in whom positive blood culture results permit timely intervention. The explicitness and coherence of the decision analysis approach should help in developing a rational diagnostic approach to the young febrile child.
Summary of the Annual Meeting of the Section on Pediatric Urology, October 30-November 2, 1987: Update on Subjects of Current Interest to Pediatricians
Authors: Rabinowitz Ronald , Hensle Terry W.
Published: December 2021

The Section on Urology of the American Academy of Pediatrics met for 3 days in conjunction with the 56th Annual Meeting of the Academy in New Orleans, Louisiana. Throughout the meeting, numerous research papers were presented along with clinical reports. This meeting has become the premier pediatric urology meeting and attracts worldwide attendance and participation. The growth of clinical and research aspects of pediatric urology has long been promoted by the recipient of this year's Pediatric Urology Medal, John K. Lattimer.

URETEROPELVIC JUNCTION OBSTRUCTION

The problem of neonatal ureteropelvic junction obstruction, its evaluation, and the criteria for intervention are areas of intense interest to both the pediatric urologist and the primary care pediatrician.
Progress in the Classification of Severe Combined Immunodeficiency
Authors: REGUEIRO JOSE R. , PEREZ-ACIEGO PALOMA , MANZANARES JAVIER , GARCIA-HERNANDEZ GLORIA , ARNAIZ-VILLENA ANTONIO
Published: December 2021

Severe combined immunodeficiency is a heterogeneous group of disorders occurring mostly in infants with severe and potentially fatal defects of both cell-mediated and humoral immunity. Failure to thrive, intractable diarrhea, and pneumonia are their most prominent clinical features. However, although great progress has been made, only one of these syndromes is presently understood at the molecular level, namely, the adenosine deaminase deficiency, for which gene therapy is therefore under investigation. severe combined immunodeficiency in all other patients (about 80%) is mainly classified according to the absolute circulating T and B cell numbers, which show considerable variation: absent T and B cells with marked leukopenia (reticular dysgenesis); very low or absent T and B cells (Swiss-type severe combined immunodeficiency); low T and normal B cell numbers. In addition to these formal subgroups, several variants have been described that add to the classification difficulties in this area (ie, cell-mediated immunity defects with normal circulating B cells and immunoglobulin levels or Nezelof syndrome; severe combined immunodeficiency with normal T and B cell numbers).
Hypothyroidism With Thyroxine-Binding Gobulin Excess
Authors: LEUNG ALEXANDER K. C. , MCARTHUR ROBERT G.
Published: December 2021

Since our letter was printed in January 1989, we have come across an additional example of thyroxine-binding globulin (TBG) excess associated with hypothyroidism.

In a recent article, Menon reported the case of a 21-month-old boy with developmental and growth delay and other clinical features of hypothyroidism. Investigations confirmed the diagnosis of hypothyroidism: serum thyroxine (T4) 28 nmol/L (normal range 60 to 140 nmol/L), thyroid-stimulating hormone (TSH) 100 mU/L (normal range 2 to 10 mU/L), and bone age 4 months.
Severe Perinatal Marfan Syndrome
Authors: Gross Donald M. , Robinson Luther K. , Smith Lynne T. , Glass Nancy , Rosenberg Harvey , Duvic Madeleine
Published: December 2021

The cardiovascular manifestations of the Marfan syndrome in older children and adults have been well described. Clinical, radiographic, and echocardiographic data regarding three patients with severe perinatal Marfan syndrome are described. Two of these patients had the syndrome at birth and died in infancy. The syndrome was diagnosed in the third patient at 6 months of age and the child is still alive at 3 years of age. The possible relationship among the Marfan syndrome, Ehlers-Danlos syndrome, and osteogenesis imperfecta is considered. Patients with Marfan syndrome and severe cardiorespiratory problems early in life tend to have a limited life expectancy.
Combined Internal Medicine/Pediatric Residency Training Programs
Authors: Ferrari Norman D. , Shumway James M.
Published: December 2021

Combined residency training in both internal medicine and pediatrics has become a popular choice for postgraduate education in the 1980s. Most programs are relatively new, and little is known about their specific curricular structure and what program graduates do when they complete their training. Data collected from a survey of these combined program directors are described.
PERVERSE SILENCE ABOUT `NO EFFECT FOUND'
Authors: Student
Published: December 2021

Few people outside science (and not nearly enough people inside) recognize the severe effects of biased reporting. The problem is particularly acute, almost perverse, when scientists construct experiments to test for an expected effect. Confirmations are joyfully reported; negative results are usually begrudgingly admitted. But null results—the failure to find any effect in any direction—are usually viewed as an experiment gone awry. Meticulous scientists may publish such results, but they disappear forthwith from the secondary literature (and are almost never reported in the press). Most scientists probably don't publish such results at all—who has time to write up ambiguous and unexciting data? And besides, they rationalize, maybe next week we'll have time to do the experiment again and get better results. I call such nonreporting perverse because we cannot gauge its depth and extent. Therefore, we do not know the proper relative frequencies of most effects—a monumental problem in sciences of natural history, where nearly all theoretical claims are arguments about relative frequencies, not statements about exclusivity.
MEDICARE'S MONEY PIT
Authors: Ellender Allen J.
Published: December 2021

"Let us not be so naive as to believe that the Medicare program will not be increased from year to year to the point that the government will have to impose more taxes on the little man or else take the necessary money out of the Treasury."
WHO IS AT FAULT?
Authors: Student
Published: December 2021

Doctors, lawyers, architects, and other professionals strike a bargain with society: Leave us alone, they say, and we will take care of you. . . .

But do professionals warrant the trust placed in their hands?

Headlines shout of bridges and buildings toppling. Health care costs escalate. Our children compare poorly in knowledge of science, math, and foreign languages with those of other countries. Malpractice suits skyrocket. Greed corrupts Wall Street. America has lost the industrial muscle that was once the envy of the world.

Has our army of experts, whom we entrust to take care of us, let us down?

Or, on the other hand, have we let them down, shackling them in regulations, keeping them from doing their jobs, impeding them in the free exercise of their expertise?
REVIEWS OF LAY LITERATURE ON CHILD CARE: WHAT PARENTS ARE READING
Authors: Glascoe Frances P. , Moore William R. , Henderson James , Martin Elaine D.
Published: December 2021

Leach P. Your Baby and Child: From Birth to Age Five. New York, NY: Alfred A. Knopf; 1978; list price $24.45 (#4 on the 1988 bestseller list of books on child care of the Ingram Book Co, distributors of trade books).

Addressing the effects of nature and nurture on development, Leach covers prenatal development through preschool with particular attention to infancy. Parents' roles, identical for mothers and fathers, are diverse and include controller of environments, model of ideal behavior, nurturer, and instructor. Management methods involve positive reinforcement, ignoring, and active listening; designed to be preventive, corrective, and instructive. Detailed information is given about specific practices including nutrition, stimulatory activities, illness, and education. There is some consideration of environmental forces, parenting difficulties, and the needs of exceptional children. While an intact family is not presumed, material resources are, and presence of a homemaker is advised until children reach three years of age. The text is moderately difficult to read, lacks organization and cross-referencing in the indices. However, the book is supported by numerous photographs and illustrations. The medical content was rated as fair but parents are prompted to seek medical attention appropriately.
GODS ESCHEW DEATH
Authors: Student
Published: December 2021

[At the time of impending death] some physicians show their discomfort and uneasiness either by continuing useless therapies or by detaching themselves from the case. A woman whose young grandchild died in a hospital wrote in a poem: ". . .and when he died / my eyes were dry / and gods wearing white coats / turned away."
Assessing the Need to Hospitalize Children: Pediatric Appropriateness Evaluation Protocol
Authors: Kreger Bernard E. , Restuccia Joseph D.
Published: December 2021

Rapidly increasing hospital costs have necessitated use review of hospitalized patients to improve the appropriateness (medical necessity) of hospital use. The development and testing of the Pediatric Appropriateness Evaluation Protocol, an objective, criteria-based instrument intended to assist physicians and use reviewers in making decisions regarding appropriateness of pediatric hospital admissions and days of care, are described.
Infectious Disease-Related Deaths of Low Birth Weight Infants, United States, 1968 to 1982
Authors: Jason Janine M.
Published: December 2021

Infant mortality rates in the United States are higher than in any other developed country. Low birth weight (LBW) is the primary determinant of infant mortality. Despite city, state, and federal programs to prevent LBW, decreases in infant mortality in the 1980s appear to be largely secondary to improved survival of LBW infants rather than to a decline in the rate of LBW births. Because prevention of mortality due to infectious disease is feasible, it was of interest to examine the role of infectious diseases in LBW infant mortality. US vital statistics mortality data for 1968 through 1982 were analyzed in terms of LBW infant mortality associated with infectious and noninfectious diseases. These analyses indicated that the rates of infectious disease-associated early neonatal and postneonatal LBW mortality increased during this time; late neonatal rates did not decline appreciably. Infectious diseases were associated with 4% of all LBW infant deaths in 1968; this had increased to 10% by 1982. Although LBW infant mortality rates associated with noninfectious diseases did not differ for white and black populations, infectious disease-associated mortality rates were consistently higher for blacks than whites in both metropolitan and nonmetropolitan areas. Chorioamnionitis was involved in 28% of infectious disease-associated early neonatal LBW deaths. Sepsis was an increasingly listed cause of death in all infant age periods, whereas respiratory tract infections were decreasingly listed. Necrotizing enterocolitis increased as a cause of late neonatal mortality. These data suggest that infectious diseases are an increasing cause of LBW infant mortality and these deaths occur more frequently in the black population targeted by prevention programs. More research concerning specific causes and prevention of infections in the LBW infant may help reduce US infant mortality.
Anogenital Trauma in Sexually Abused Children
Authors: Finkel Martin A.
Published: December 2021

Physical findings, when identified, lend powerful support to the validation and prosecution in child sexual abuse cases. Because of the frequent delay between the alleged molestation, disclosure, and examination, there is a need for a systematic method of identifying and interpreting the residual of anal and genital trauma after the acute signs have disappeared. The case findings of seven children who experienced acute genital and anal trauma and were observed until their injuries healed are reported.
FALSE HOPE OF HOME MONITORS?
Authors: Student
Published: December 2021

[Pediatricians] thought if you solved the apnea problem SIDS would go away. It did not. Despite untold numbers of home monitors, we don't know that SIDS has diminished anywhere.
OUR REVOLUTIONARY MEDICAL HERITAGE
Authors: Student
Published: December 2021

The aggressive approach that has characterized American medicine was evident even before the American revolution. Dr. Benjamin Rush, one of the signers of the Declaration of Independence and a doctor whose influence on American medicine lasted for decades, believed that one of the hindrances to the development of medicine had been an "undue reliance upon the powers of nature in curing disease," a thesis he blamed on Hippocrates. . . . Rush was converted to aggressive medicine during a yellow-fever epidemic, when he found that larger and larger quantities of mercury and jalap (purges) appeared to cure the patients. . . . Rush [also] believed that blood-letting was beneficial and urged his disciples to continue bleeding until four-fifths of the body's blood was removed. . . . He was imbued with the idea that even nature itself had been put under control of the American revolution.
Pediatric Emergency Medicine: A Developing Subspecialty
Authors: Li Marilyn , Baker M. Douglas , Ropp Leland J.
Published: December 2021

Questionnaires were sent to 245 North American institutions with pediatric residency programs. There was a 69% response rate. Pediatric emergency care is provided in three types of facilities: emergency departments in pediatric hospitals, separate pediatric emergency departments or combined pediatric and adult emergency departments, in multidisciplinary hospitals. There are at least 262 pediatricians practicing full-time pediatric emergency medicine. The majority work in pediatric emergency departments, an average of 30.7 clinical hours per week. There are 27 pediatric emergency medicine programs with 46 fellows in training and 117 full-time positions available for emergency pediatricians throughout North America. Varying qualifications for these positions include board eligibility in pediatrics, certification in Basic Life Support or Advanced Trauma Life Support, and a fellowship in pediatric emergency medicine. The demonstrated need for pediatricians, preferably trained in emergency care, clearly indicates that pediatric emergency medicine is a rapidly developing subspecialty of Pediatrics that will be an attractive career choice for future pediatricians.
LATENT PERIOD BETWEEN AVAILABLE TREATMENT AND ITS WIDE APPLICATION
Authors: Student
Published: December 2021

It is important to remember that advances in medical science only lead to improvements in health to the extent that they are generally applied. . . .[In Britain, for example,] there was a dramatic improvement [in the deaths of children from diphtheria] in 1941; an effective diphtheria vaccine had been commercially available from about 1922, but was not applied as an organized programme for mass immunization to the whole child population until nearly 20 years later.
Office-Based Medication Dispensing: Another Consideration
Authors: ERRAMOUSPE JOHN , BOE ROGER W. , FISCHEL DAVID R. , HARDIN CREIGHTON A. , HOGAN WILLIAM E. , YOST CHRISTEN C. , CASPERSON KERRY L.
Published: December 2021

We read with interest the American Academy of Pediatrics' recommendation concerning dispensing of medications by physicians (Pediatrics. 1989;83:143-144). In 1987, dispensing of prepackaged prescriptions was a consideration at the Pocatello Children & Adolescent Clinic. A pharmacy that shared the same building as the clinic had closed in 1982. Despite the loss of the pharmacy, the need for patient convenience in obtaining medications continued. The decision was made not to purchase prepackaged prescriptions for dispensing by physicians. Instead, a community pharmacy (Future Generation Pharmacy) owned by the pediatricians was constructed.
Treatment of Bacillus Infections
Authors: BARSON WILLIAM J.
Published: December 2021

Although Bacillus species are infrequent causes of human infections, they are known to be responsible for bacteremia without focus, catheter-related bacteremia, endocarditis, endophthalmitis, cerebral spinal fluid shunt infection, meningitis, pneumonia, food poisoning, and wound infections. Feder et al recently reported their experience at Hartford Hospital from 1968 through 1985 with cerebral spinal fluid cultures positive for Bacillus species. Because Bacillus/ species have variable antibiotic susceptibilities, they correctly suggest the performance of susceptibility testing in settings where the isolate is considered to be clinically relevant.
CAUTION IN INTERPRETATION OF AMNIOTIC FLUID INDICES OF FETAL PULMONARY MATURITY
Authors: Student
Published: December 2021

When gestational age has been firmly established by standard obstetric criteria, the risks of routine amniocentesis prior to repeat caesarian section in the uncomplicated term gestation [to obtain amniotic fluid indices of fetal pulmonary maturity] outweigh the usefulness of the potentially uninformative or misleading information gained.
STATISTICS DO NOT EXPLAIN
Authors: Student
Published: December 2021

Causal explanation of associations noted in statistical analysis of basic data is beyond the scope of ordinary statistics. . . . Statistics serve no more than a fallible pattern-recognition device, and explanation of the origin of observed patterns is beyond the scope of the device.
FREE RADICAL BIOLOGY IS IN
Authors: Student
Published: December 2021

The Oxygen Society was organized on the American continent in early 1988 and adopted Free Radical Biology & Medicine as its official journal. Also during the past year the Society for Free Radical Research (SFRR) has decided to become a geographically regionalized organization, in which each member society will belong to the new "umbrella" or confederacy group to be called SFRR International.
ANYTHING GOES IN PUBLISHED ARTICLES
Authors: Student
Published: December 2021

There seems to be no study too fragmented, no hypothesis too trivial, no literature citation too biased or too egotistical, no design too warped, no methodology too bungled, no presentation of results too inaccurate, too obscure, and too contradictory, no analysis too self serving, no argument too circular, no conclusions too trivial, too trifling or too unjustified, and no grammar and syntax too offensive for a paper to end up in print.
NORTHERN MODEL
Authors: Student
Published: December 2021

The Nordic countries have long been an example for good health care; a new study sets out in detail the evidence that children are healthier in Scandinavia than almost anywhere else in the world.
CHOICE AFTER A SCIENTIFIC DISCOVERY
Authors: Student
Published: December 2021

Who would want to spend his life dancing a minuet before assembled science reporters? There are still people who do not wish to join the noise boys; they have other concerns. When you start on something new you are all alone and it is terribly dark; and then suddenly, you come face to face with the blinding whiteness of reality. There is nothing more exquisite, nothing rarer in the world. Afterward you have a choice: You stay in the laboratory hoping it will happen again—it seldom does—or you begin to travel through the country giving minstrel shows.
BUILT-IN LIMITATION OF STATISTICS
Authors: Student
Published: December 2021

"You can prove anything by statistics," is a common gibe. Its contrary is more nearly true—you can never prove anything by statistics. The statistician is dealing with the most complex cases of multiple causation. He may show the facts are in accordance with this hypothesis or that. But it is quite another thing to show all other possible hypotheses are excluded, and that the facts do not admit of any other interpretation than the particular one he may have in mind.
MODEL FOR THE WAR ON DRUGS?
Authors: M. R. J.
Published: December 2021

In 1982, after learning that 48% of its sailors aged 18 to 24 were using illicit drugs, the Navy declared war. The battle plan I directed from 1982 to 1984 reduced that percentage to less than 10% within two years; today it is less than 5%. The Navy has conducted 10 million drug tests each year. An independent survey taken in late 1983 revealed that 83% of the sailors in that age group cited random testing as the number one deterrent to drug abuse. Perhaps even more significant, about 26% said they probably would resume usage if the testing program were dropped.

To cut down on "false positive," the Navy's program has called for 6,000 quality-control urine samples to be sent to the laboratory without its knowledge each year. Not one of the more than 36,000 such "blind negative" quality-control specimens tested to date has been incorrectly labeled positive by the laboratory.

Have testing mistakes been made? Yes. However, the Navy instituted a thorough review system for any specimen that tests positive for illicit substances. It is based on a philosophy of "if there's any doubt, throw the case out," weighted in favor of the individual. The lab must never be the sole judge.

The Navy has done all it can to make sure that the Fourth (search and seizure) and Fifth (self-incrimation) Amendments are protected. It has shown that a combination of compassion, sensitivity and clear, firm rules works.
PROSPECT FOR HELP FROM IDEAS IN INDUSTRY
Authors: Student
Published: December 2021

We are wasting our time with the theory of bad apples [in medicine] and our defensive response to it in health care today, and we can best begin by freeing ourselves from the fear, accusation, defensiveness, and naivete of an empty search for improvement through inspection and discipline. The theory of continuous improvement proved better in Japan; it is proving itself again in American industries willing to embrace it, and it holds some badly needed answers for American health care.
Assessing the Need for Transfusion of Premature Infants and Role of Hematocrit, Clinical Signs, and Erythropoietin Level
Authors: Keyes William G. , Donohue Pamela Kimzey , Spivak Jerry L. , Jones M. Douglas , Oski Frank A.
Published: December 2021

There are no clear criteria for administration of blood to premature infants. In the past, indications for transfusion have included tachypnea, tachycardia, poor weight gain, apnea, bradycardia, pallor, lethargy, decreased activity, or poor feeding. Some have suggested that erythropoietin levels may also be useful in determining the need for transfusion. Data were studied from 11 premature infants with birth weights less than 1500 g collected throughout 469 hospital days. During that period the infants received a total of 37 blood transfusions. No overall relationship was found between hematocrit of 19% to 64% and heart rate, respiratory rate, or the occurrence of bradycardia; ie, these variables proved to be clinically unreliable as indicators of hematocrit. Furthermore, no predictable effect of transfusion could be identified on heart rate, respiratory rate, or on the incidence of apnea or bradycardia. It was anticipated that frequent episodes of apnea or bradycardia might increase serum erythropoietin concentration. To the contrary, more frequent bradycardia was associated with the low erythropoietin levels because those infants tended to receive transfusions for "symptomatic" anemia. The data are consistent with the concept that "anemia of prematurity" is not predictably associated with symptoms classically attributed to anemia. Possible reasons for this are that the premature infant has a different inherent response to anemia; that it is inappropriate to extrapolate symptoms of severe acute anemia to persons with mild or moderate chronic anemia; or, most likely, that other determinants of heart rate, respiratory rate, and apnea/ bradycardia are of more importance than mild or moderate anemia.
Dieting Behavior and Eating Attitudes in Children
Authors: Maloney Michael J. , McGuire Julie , Daniels Stephen R. , Specker Bonny
Published: December 2021

Many studies document the high prevalence of dieting and abnormal eating behaviors in adolescents and young adults. The age of onset of eating disorders remains unclear because there are no published surveys of voluntary dieting and eating attitudes in young children. A total of 318 girls and boys were surveyed from two randomly chosen schools in middle-income neighborhoods. The children were equally distributed among grades 3 through 6. The survey included a children's version of the Eating Attitudes Test and a demographic and dieting questionnaire. Results showed that 45% of the children wanted to be thinner, 37% had already tried to lose weight, and 6.9% scored in the anorexia nervosa range, closely matching the published results concerning teenagers and young adult women. Several questions were isolated by univariate and multiple regression analyses that accurately (P < .05) predicted children's Eating Attitude Test scores. The fact that young children admit having diet preoccupation and atypical eating attitudes is shown in this study. It may be possible to improve early case identification of children at risk for anorexia nervosa and perhaps improve intervention strategies by focusing on the early development of dieting behavior in young children.
KIDS AS SECOND CLASS PERSONS
Authors: Student
Published: December 2021

Surrogacy contracts may foster a harmful view towards children, which sees them as objects of property rather than beings with a growing capacity for autonomy. The very insistence on having children that are genetically related to you, may given that there is no shortage of children in the world . . . reflects an attitude towards children which treats them first as a means to the realization of your project and only secondly as persons.
Immunization of Children With Sickle Cell Disease With Haemophilus influenzae Type b Polysaccharide Vaccine
Authors: Rubin Lorry G. , Voulalas Debra , Carmody Lillian
Published: December 2021

There are limited data concerning safety and immunogenicity of Haemophilus influenzae type b polysaccharide vaccine in children with sickle cell disease. Ninety-eight patients with sickle cell disease (65 with SS phenotype, 23 with SC phenotype, and 10 with Sβ-thalassemia) 1.5 to 20 years of age were given 25 µg of vaccine subcutaneously. The vaccine was well tolerated; mild side effects were observed in 6 of 98 (6.1%) children. In addition, one patient with a recent vasoocclusive crisis was hospitalized because of fever and vasoocclusive crisis 8 hours after vaccination. Prevaccination anticapsular antibody concentrations (by radioimmunoassay) were <0.15 µg/mL in 7 of 11 children 18 to 24 months of age (geometric mean 0.17 µg/mL), in 10 of 25 children 2 to 5 years of age (geometric mean 0.36 µg/mL), and in 3 of 50 patients 6 to 20 years of age (geometric mean 1.03 µg/ mL). Inadequate response (1-to 2-month postvaccination antibody level <1 µg/mL) was found in 3 of 5 children 18 to 24 months of age (geometric mean 1.74 µg/mL), in 8 of 21 children 2 to 5 years of age (geometric mean 2.20 µg/mL), and in 2 of 49 patients 6 to 20 years of age (geometric mean 18.03 µg/mL). Six months after vaccination, >1 µg/mL of antibody was present in the 2 children 6 to 20 years of age with inadequate response but not in the 7 children 2 to 5 years of age with inadequate response. In the 2- to 5-year group, there was a significant correlation of log postvaccination antibody level with prevaccination antibody level but not with age, sex, disease type, disease severity, serum IgG, IgM, or IgA, or presence or absence of Howell-Jolly bodies on blood smear. In contrast to the response of patients with sickle cell disease older than 5 years of age and of 2- to 5-year-old children without disease, H influenzae type b polysaccharide vaccine is not reliably immunogenic in children younger than 6 years of age with sickle cell disease and cannot be relied upon for protection of this age group from H influenzae type b disease.
Cosleeping and Sleep Problems in Hispanic-American Urban Young Children
Authors: Schachter Frances Fuchs , Fuchs Margot L. , Bijur Polly E. , Stone Richard K.
Published: December 2021

To assess whether the traditional pediatric prohibition against cosleeping in the parental bed requires reconsideration for urban ethnic minorities, cosleeping and sleep problems were studied in a sample of Hispanic-American, east Harlem, New York City, children 6 to 48 months of age. The incidence of frequent all-night cosleeping was found to be 21%, significantly higher than the documented rate of 6% found in a representative sample of white middle-American urban children of the same age and sex. For occcasional cosleeping, however, there were no significant ethnic differences, and frequent part-night cosleeping was significantly less common than noted in the white sample. There were greater ethnic differences for sharing the parental bedroom compared with cosleeping in the parental bed, approximately 80% for Hispanic-Americans vs 10% for the white population. Within the Hispanic-American group, frequent all-night cosleeping was significantly more common among single parents and those living in multiple households and less common among infants and later-born children in the family. Frequent all-night cosleeping was also significantly associated with sleep problems.
Pediatric Rheumatology Manpower and Training: Planning for the 1990s
Authors: LEHMAN THOMAS J. A. , MAGILAVY DANIEL B. , WARREN ROBERT
Published: December 2021

According to recent estimates, 350 000 children each year will experience an acute episode of joint pain, and nearly 200 000 will have juvenile rheumatoid arthritis or another collagen vascular disease. In 1976, there were only 30 pediatric rheumatologists, and fewer than 10 inpatient centers for the care of children with rheumatic diseases in the United States. By 1986, there were pediatric rheumatology faculty in 46 (37%) of the 126 academic pediatric departments in the United States.

Recently, it was noted that several available pediatric rheumatology faculty positions remained unfilled for significant periods of time. Whether this indicated a need to train additional fellows or other problems was not clear.
Ehrlichia canis Infection in a Child
Authors: BARTON LESLIE L. , FOY THOMAS M.
Published: December 2021

Ehrlichia canis is a tick-borne rickettsia that causes disease in animals throughout the world. Its importance as a human pathogen, however, has only recently been documented. We report a child with serologically proven ehrlichiosis, to highlight differential diagnosis, to expand the spectrum of dermatologic manifestations, and to provide the first clinical evidence of therapeutic efficacy of chloramphenicol.

CASE REPORT

A 4-year-old boy from rural Missouri was admitted to the hospital on August 10, 1988, for evaluation of a fever of 2 weeks' duration. During the week before he became ill, his parents had removed numerous ticks from both the patient and the family's pet dog.
ERRATA
Authors: Selbst Steven M.
Published: December 2021

In a Letter to Editor (Pediatrics 1989;83(suppl):639-640) the following letter was misprinted and it is repeated here.

CHEST PAIN IN AN ADOLESCENT: THINK OF COCAINE!

We appreciate Dr. Schwartz' thoughtful comments about our article. Our failure to mention cocaine abuse in the discussion of chest pain was an oversight. previously, I reported the case of an adolescent who presented to our Emergency Department with acute, severe chest pain from cocaine abuse. This teenager presented long after completion of our study of 407 children with chest pain, even after our manuscript was first drafted. We were surprised by his presentation, and by the fact that no others like him had presented during our one year study period. I think it is unlikely that we missed any cocaine abusers in our group of patients with "idiopathic" chest pain. As noted previously, cocaine can cause tachycardia, pneumothorax, hypertension, and coronary artery spasm with myocardial infarction. Thus, those with subsequent chest pain will undoubtedly have acute, severe chest pain and physiologic changes. These children would have been evaluated in our Emergency Department with electrocardiograms and further studies.

I agree that a drug history and toxicologic screening for cocaine abuse should be obtained for all adolescents with severe chest pain of sudden onset. This should even be considered for some younger children as drug abuse has become more widespread in our society. However, I do not think a drug screen is indicated for all children with idiopathic chest pain, especially if their pain is chronic and the physical findings are normal.
Resurgence of Acute Rheumatic Fever
Authors: KAVEY RAE-ELLEN W. , KAPLAN EDWARD L.
Published: December 2021

Between February 1987 and September 1988, there were eight published reports of outbreaks or increases of acute rheumatic fever cases in civilian as well as in military populations in the United States. This is a change from the past decade. Because rheumatic fever is no longer a reportable disease to local or state health departments, we thought it important to attempt to ascertain the extent of this middle 1980s resurgence.

We contacted 56 physicians by telephone, all of them pediatric cardiologists. Essentially, all practice in large referral medical centers.
Early Language Milestone Scale and Language Screening
Authors: FRANKENBURG WILLIAM K.
Published: December 2021

Walker et al made a contribution by calling attention to the importance of validation of screening tests in their article. However, the paper had three major shortcomings.

First, the authors inappropriately cite a limitation of the Denver Developmental Screening Test (DDST) based on a report by Borowitz and Glascoe. The Borowitz-Glascoe study has three major methodologic biases that invalidate its conclusions: One is failure to interpret the DDST in the prescribed manner—the authors wrongly compared their criterion tests with only one sector of the DDST.
In Reply: Expert Testimony
Authors: ROBERTSON WILLIAM O.
Published: December 2021

On behalf of the AAP's Medical Liability Committee, I thank both Drs Hendricks and Dry for taking time to comment on our guidelines for expert witness testimony. I believe, unfortunately, that both have fallen into the understandable philosophic trap of exclusive defense advocacy. Our goal through these guidelines was to aspire toward objectivity—and to avoid advocacy—advocacy for either side as society attempts to resolve medical disputes.

As a consequence, I can second Dr Hendrick's suggestion to have any expert seek an affidavit of completeness of medical records from the requesting attorney—with the caveat that such be sought from counsel for either the plaintiff or the defense.
Pharyngeal Gonorrhea Screening in Adolescents: Is It Necessary?
Authors: Brown Robert T. , Lossick Joseph G. , Mosure Debra J. , Smeltzer Michael P. , Cromer Barbara A.
Published: December 2021

A prospective study was performed to examine the prevalence of pharyngeal gonorrhea in two urban female adolescent populations and to compare pharyngeal infection with a history of orogenital activity and concurrent genital gonorrhea. Group I was drawn from a children's hospital adolescent clinic and group II was drawn from a public health clinic for sexually transmitted diseases. None of the 240 adolescents in group I had a pharyngeal culture positive for Neisseria gonorrhoeae compared with 3.4% in group II. Only 2.5% of group I had genital gonorrhea, but 33% of group II had positive genital cultures. In only two of the 20 patients with pharyngeal gonococcal infection was the pharynx the only infected site. The addition of routine pharyngeal culturing for gonorrhea yielded only 1% additional gonorrhea cases. There was a significant relationship between concurrent genital and pharyngeal gonorrhea. These findings indicate that routine screening for pharyngeal gonorrhea is not productive in some adolescent populations. A more economic approach would be to use gonorrhea treatment that is effective against both genital and pharyngeal gonorrhea or to obtain pharyngeal cultures in those adolescents returning for test-of-cure cultures after antibiotic treatment for genital gonorrhea.
ON THE EDUCATION OF HENRY ADAMS
Authors: C. T. E.
Published: December 2021

Henry Adams (1838-1918), grandson of President John Quincy Adams and great-grandson of President John Adams, in his privately-printed The Education of Henry Adams describes his father's way of educating and amusing young Henry as follows:

By way of educating and amusing the children, Mr. Adams read much aloud, and was sure to read political literature, especially when it was satirical, like the speeches of Horace Mann and the Epistles of Hosea Biglow, with great delight to the youth. So he read Longfellow and Tennyson as their poems appeared, but the children took possession of Dickens and Thackeray for themselves. Both were too modern for tastes founded on Pope and Dr. Johnson. The boy Henry soon became a desultory reader of every book he found readable, but these were commonly eighteenth-century historians because his father's library was full of them. In the want of positive instincts, he drifted into the mental indolence of history. So, too, he read shelves of eighteenth-century poetry, but when his father offered his own set of Wordsworth as a gift on condition of reading it through, he declined. Pope and Gray called on no mental effort; they were easy reading; but the boy was thirty years old before his education reached Wordsworth.
Breast-Feeding Intentions and Practice Among Hispanic Mothers in Southern California
Authors: Romero-Gwynn Eunice , Carias Lucia
Published: December 2021

Breast-feeding intentions, breast-feeding in the hospital, and breast-feeding at home were studied among 132 Hispanic mothers participating in the Expanded Food and Nutrition Education Program in southern California. There was not a large difference between total breast-feeding intention (77.7%) and total breast-feeding practice (63.8%). However, the 67.7% intention of exclusive breast-feeding drastically decreased to 19.7% and 17.2% in the hospital and at home, respectively. Formula supplementation increased by 4.5 times from intention to practice. Exclusive formula feeding increased from 10.0% to approximately 37.0% in the hospital and at home. Stepwise logistic regression identified that the likelihood of intending breast-feeding was greater for mothers who migrated from Mexico than for mothers born in the United States (odds ratio 4.75). The likelihood of breast-feeding practice was greater for mothers who initiated breast-feeding within the first 10 hours after birth as opposed to 11 or more hours (odds ratio 1.27), for mothers who had a vaginal rather than cesarean delivery (odds ratio 12.76), for mothers who did not return to work postpartum as opposed to working mothers (odds ratio 28.26), and for mothers who migrated from Mexico compared with mothers born in the United States (odds ratio 8.54). The importance of assessing and supporting mothers' breast-feeding intentions in the pre- and postpartum period is documented. Training in the clinical aspects of breast-feeding and improvement of hospital protocols is recommended. Mothers intending to breast- feed should be identified and supported.