bluuebunny/crossref_metadata_2025 huggingface dataset:
Drug Use Among Adolescent Mothers: Profile of Risk
Authors: Amaro Hortensia , Zuckerman Barry , Cabral Howard
Published: December 2021

Adolescent pregnancy and adolescent drug use are important clinical and public health problems. Yet, few studies have systematically investigated the patterns of substance use among pregnant and parenting adolescents. Because adverse outcomes are not found uniformly for all adolescent mothers, use of illicit drugs may be a key factor in determining which mothers and their infants will have poor outcomes. In this study, the patterns of drug use are described and differences in the demographic and psychosocial profile among 253 pregnant adolescents are investigated. Results obtained from interviews and urine assay for marijuana and cocaine indicate that lifetime use was 84% for alcohol, 62% for marijuana, and 23% for cocaine, whereas use in the past year was 40% for marijuana and 17% for cocaine. Compared with nonusers, pregnant adolescent drug users were more likely to be North American black, have a history of elective abortion and venereal disease, report more negative life events and violence during pregnancy, and receive more support from the father of the baby who was more likely to use marijuana and cocaine (P < .01). Furthermore, according to logistic regression analysis results after controlling for age and ethnicity, adolescents who used illicit substances in the past year were three times more likely to have a male partner who used marijuana or cocaine and were two times more likely to have a history of venereal disease compared with nonusers. The findings suggest that drug use, whether as a mechanism or a marker, is associated with social and medical characteristics that are likely to contribute to negative outcomes among adolescent mothers and their infants. Targeted prevention and intervention efforts to this high-risk group of adolescent mothers need to be developed and evaluated.
HOW WE LOOK TO OUR PATIENTS
Authors: Goldbloom Alan L. , Goldbloom Richard B.
Published: December 2021

Dear Dr. Goldbloom

I want to be a doctor but I can't even look at spit. Do you get paid a lot of money? I want to have a lot of money. So I can get a big house and a nice car. Do you have to look at a lot of sick things? I want to be a doctor because I want to help people too. From Eric. P.S. What kind of car do you have?
Injury Research: Where Should We Go From Here?
Authors: RIVARA FREDERICK P. , WOLF MARSHA E.
Published: December 2021

The injury research field is beginning to come of age. There now exists a formal organization within the federal government for injury research (the Division of Injury Epidemiology and Control of the Centers for Disease Control), growing funding by federal and private foundations, and an increasing body of literature (199 articles since 1986). A blue ribbon panel has issued a report on the status of the injury problem and outlined areas for research. Little attention, however, has been paid to the type of research studies that are needed. The history of the injury field has been marked by studies that are nearly all of the same type-descriptive epidemiology.
HERE'S A FLAKY IDEA THAT WORKED, 1898
Authors: M. R. J.
Published: December 2021

It began in 1898 as a health nostrum for the rich, but it soon would become the food for the masses and make its inventors household names.

The corn flake was developed by Will K. and John H. Kellogg at their Battle Creek, Mich., sanitarium, a health resort run under the auspices of the Seventh Day Adventist Church. Since 1876, the Kelloggs had offered ground wheat and other "natural" foods to wealthy patrons. But the trouble with many grainbased health foods, then as now, was that they lacked taste, or even tasted bitter. To solve the problem, the Kelloggs steamed the corn kernel's grit, or heart, from its hull, dried the grit, then cooked it under pressure, adding malt flavoring and sugar. This mix was then dried and "flaked" by passing it through rollers.

The flakes were a hit with the clients of the "San," as it was called; one, C.W. Post, would later offer his own brand of corn flakes to the public. In 1906, Will Kellogg founded the Battle Creek Toasted Corn Flake Co. and began promoting corn flakes aggressively; he did so over the objections of his physician brother, who believed that advertising the flakes violated medical ethics. (Will later was expelled from the Adventist church for worldliness, and he and his brother quit speaking in 1909).

An ad in the July 1906 Ladies' Home Journal for W.K. Kellogg's corn flakes brought a flood of new orders, and output at Battle Creek soared to 2,900 cases a day from 33 a day earlier in the year. Today, there are some 200 brands competing in the $5-billion-a-year U.S. dried-cereal market. At the top is Kellogg's Corn Flakes.
Bone Marrow Transplants: Neither Ethical nor Imperative?!
Authors: FURMAN LYDIA
Published: December 2021

In the thoughtful essay by Durbin (Pediatrics. 1988;82:774-783) concerning bone marrow transplantation, she speaks of the "ethical imperative" for bone marrow transplantation. Yet, she notes that patients who undergo bone marrow transplantation have a high mortality rate and that survivors, especially children, suffer a "variety of long-term side effects." I would like to play devil's advocate and suggest that bone marrow transplantation in its current state may be neither ethical nor imperative as a therapy for dying children and that at the very least we need to take a long, hand look at when it is appropriate and how the technology is being developed.
Acquired Immunodeficiency Syndrome and Adolescents: Knowledge, Attitudes, Beliefs, and Behaviors in a New York City Adolescent Minority Population
Authors: Goodman Elizabeth , Cohall Alwyn T.
Published: December 2021

In this survey, the knowledge, attitudes, beliefs, and behaviors concerning acquired immunodeficiency syndrome (AIDS) in a group (N = 196) of innercity adolescents in New York City were assessed. Sexual activity was the major risk factor for AIDS in this population; 58% of the adolescents had engaged in sexual intercourse; 12% of these had never used contraception. There were small reported rates of homosexuality, anal intercourse, and prostitution. Of respondents, 22% reported alcohol use and 22% had tried recreational drugs. None had ever taken drugs intravenously. Knowledge of human immunodeficiency virus (HIV) transmission was generally good, although there were prominent misconceptions. For example, 52% of the adolescents believed that donating blood could transmit HIV. Of respondents, 47% "never" or "rarely" worried about the disease. Of the total group, 39% reported behavior changes because of concern about AIDS in the previous 6 months. Those who changed behaviors tended to have a greater perceived risk, worry more frequently about the disease, and have a better knowledge of means of HIV transmission. Of those reporting behavior changes, 66% (25% of the total study group) claimed to be using condoms currently, and 16% (6% of the total study group) claimed to be abstemious. More black adolescents than Hispanic adolescents instituted behavior changes. Of black female adolescents, 71% were sexually active, as compared with 30% of Hispanic female adolescents. Assessment of beliefs in methods of risk reduction indicated that although female adolescents were more likely to believe that condoms were a good way to decrease their risk of acquiring HIV, those who were sexually active were less likely than men to institute the behavior change of insisting on condom use or of having their partners use condoms the last time they had sexual intercourse. Of sexually active female adolescents, 73% did not insist on condom use the last time they had sexual relations, whereas 51% of sexually active male adolescents did use a condom. These adolescent women were not using their knowledge concerning HIV transmission and protection to alter behavior effectively and thereby decrease their risk. Also, 21% of respondents spontaneously claimed that they would commit suicide if they tested positive for the HIV antibody. Other motivational and educational strategies besides education, targeting female adolescents, must be used and the consequences of the use of the HIV antibody test must be carefully considered in this age group.
Adverse Events During Interhospital Transport: Physiologic Deterioration Associated With Pretransport Severity of Illness
Authors: Kanter Robert K. , Tompkins Joy M.
Published: December 2021

The relationship between severity of illness or injury before interhospital transport and the incidence of physiologic deterioration during transport was studied in 117 pediatric patients. Transports were done by referring hospital personnel. Pretransport severity was expressed as the Pediatric Risk of Mortality score for all patients and as the Modified Injury Severity Score for trauma patients. For 71 patients with Pediatric Risk of Mortality scores less than 10, deterioration during transport occurred in 3 (4%) and hospital mortality occurred in 2 (3%). For 10 victims of trauma with Modified Injury Severity Scores less than 10, none had deterioration during transport or hospital mortality. The rare occurrence of serious problems related to transport in low-risk patients indicates that referring hospital personnel are capable of safely transporting such patients. The incidence of physiologic deterioration during transport was significantly greater (P < .01) with greater pretransport severity of illness or injury. Failure to intubate the trachea was not a major preventable cause of deterioration. The most common preventable problem occurred for 6 of 79 patients with endotracheal tubes that became occluded with secretions, leading to cyanosis in 2 patients. Our data concerning high-risk patients with specified pretransport severity provide a basis for comparison for further evaluation of the benefit of specialized pediatric transport services.
Iron Deficiency Anemia: Adverse Effects on Infant Psychomotor Development
Authors: Walter Tomas , De Andraca Isidora , Chadud Patricia , Perales Carmen G.
Published: December 2021

In a double-blind, placebo-control prospective cohort study of 196 infants from birth to 15 months of age, assessment was made at 12 months of age of the relationship between iron status and psychomotor development, the effect of a short-term (10-day) trial of oral iron vs placebo, and the effect of long-term (3 months) oral iron therapy. Development was assessed with the mental and psychomotor indices and the infant behavior record of the Bayley Scales of Infant Development in 39 anemic, 30 control, and 127 nonanemic iron-deficient children. Anemic infants had significantly lower Mental and Psychomotor Developmental Index scores than control infants or nonanemic iron-deficient infants (one-way analysis of variance, P < .0001). Control infants and nonanemic iron-deficient infants performed comparably. No difference was noted between the effect of oral administration of iron or placebo after 10 days or after 3 months of iron therapy. Among anemic infants a hemoglobin concentration < 10.5 g/dL and duration of anemia of > 3 months were correlated with significantly lower motor and mental scores (P < .05). Anemic infants failed specifically in language capabilities and body balance-coordination skills when compared with controls. These results, in a design in which intervening variables were closely controlled, suggest that when iron deficiency progrsses to anemia, but not before, adverse influences in the performance of developmental tests appear and persist for at least 3 months despite correction of anemia with iron therapy. If these impairments prove to be long standing, prevention of iron deficiency anemia in early infancy becomes the only way to avoid them.
CAESAREAN SECTION BY AN OX (1885)
Authors: C. T. E.
Published: December 2021

In scanning medical journals of the nineteenth century I have come across a number of bizarre anecdotal clinical reports. None, however, has yet equaled the case cited below.

The following case is probably unique in the medical literature. My memory is refreshed from notes taken by DR. MEANS, who saw the case with me in consultation.

Mrs. P, age 34, the mother of seven children and near full term in her eighth pregnancy, on November 16th. was gored by an infuriated ox. The horn of the beast entered at the anterior superior spinous process of the ilium, and made a rent extending to the umbilicus, and involving both the abdominal parietes and the walls of the uterus. The child was extruded through the wound in half an hour after the occurrence of the accident. When I arrived on the scene, I found the child fully delivered but remaining attached to the cord, which I ligatured and severed. There being no dilatation of either the os uteri or the vagina, I delivered the placenta through the rent and applied a bandage. The patient was almost lifeless from hemorrhage and shock, and I placed her on morphine and whisky. On the following day she was still alive and DR. MEANS was called in consultation at 9:30 a.m. The small intestines escaped from the wound on removal of the bandage, and were returned with much difficulty. The wound was now closed with interrupted sutures, a carbolized compress was applied, and the morphine and whisky continued internally. At 5:00 p.m. of the same day I found the pulse 130 and respiration 25 per minute; the abdomen was greatly distended, and the vital powers were fast becoming exhausted. On the following morning I found on my visit that the woman had expired at 10:00 o'clock of the previous night.

SHAKESPEARE speaks of MACBETH as having been torn from his mother's womb by a wild boar, but probably the statement must be charged to poetic license. I believe the case I have above reported to be the only authentic case of Caesarian section performed by a beast on record. It may be interesting to know that the child suffered little or nothing from the violent and unusual method of delivery, and is alive to-day, a vigorous and thriving boy.
Relationship of Milk Intake and Vitamin K Supplementation to Vitamin K Status in Newborns
Authors: Motohara Kunihiko , Matsukane Ikuro , Endo Fumio , Kiyota Yuji , Matsuda Ichiro
Published: December 2021

Vitamin K status was evaluated by measuring blood acarboxyprothrombin (PIVKA-II) levels on the fifth day of life. The incidence of PIVKA-II-positive infants was higher in breast-fed babies than in those given supplementary (mixed) feeding. The median of total amount of milk intake during the first 3 days was significantly lower in PIVKA-II-positive infants than in PIVKA-II-negative infants among infants given both types of feedings. In addition, there was a significant negative correlation between a positive PIVKA-II proportion and the amount of milk intake in the breast-fed babies. The minimum dose of vitamin K2, necessary to prevent a positive PIVKA-II reading was 15 µg among babies with a normal absorption potential.
DIAPER DISPOSAL WITH A CONSCIENCE
Authors: L. J. F.
Published: December 2021

Socially conscious parents . . . can now throw away their guilt along with the baby's disposable diapers.

A biodegradable diaper is being marketed by a Brookline, Mass., company, Eco-Matrix. . . . Eco-Matrix says parents can put the diapers, Nappies, in the garbage without fear that their convenience is degrading the environment.

Nappies were developed by Dafoe & Dafoe of Brantford, Ontario. Because of the development of a special plastic that is bonded to vegetable oil and to a cornstarch derivative, Nappies break down in two to seven years depending on environmental conditions. . . . The plastic outside liner on non-biodegradable diapers has a life of 300 to 500 years.

Nappies cost about $8.99 for 48 medium-sized diapers or 32 large ones.
DOGS' TEETH
Authors: L. J. F.
Published: December 2021

There's a war going on in California over who should clean dog's teeth.

According to a recent Wall Street Journal article, pet groomers who charge about $5 to clean dog's teeth say there is a veterinarian-backed conspiracy to drive them out of the dog tooth-care business. The vets, who get about $100 for dog-tooth prophylaxis, say that allowing pet groomers to clean dogs' teeth is like letting hairdressers perform surgery.

State officials, insistent that dogs' teeth should be cleaned only by licensed vets, sent in an undercover pooch to break up what they considered an illegal dog tooth cleaning operation.

The groomer and dog tooth cleaner involved promptly sued the state, noting that the state's business and veterinary-medicine codes do not prohibit groomers from cleaning dogs' teeth.

A Superior Court judge ruled that there is no wrongdoing in brushing, flossing, or even scraping a dog's teeth with metal dental instruments. He did, however, grant a state-sought injunction prohibiting groomers from using ultrasonic tooth-cleaning devices or metal scrapers above or below the gumline.

The size of the dog-tooth cleaning business is hard to estimate. According the WSJ, a good dog tooth cleaner can see easily a hundred patients a month. There are also 3000 vets in California-including a few who specialize in dog dentistry.

Both sides do agree on one thing: dogs that get their teeth cleaned regularly have fresher breath.
RICH AND ROOTLESS IN THE SUBURBS
Authors: L. J. F.
Published: December 2021

In the past year and a half, seven Pali High students have died violently in incidents involving alcohol, drugs or cars. The school now has what may be the first Alcoholic Anonymous chapter on an American high-school campus.

This is hardly your tough inner-city school. Pali High sits on a privileged plateau overlooking the Pacific Ocean in a community of mostly wealthy, welleducated parents. It is not one of those enclaves of old money, but a suburb of achievers—doctors, lawyers, entertainment figures—parents who work hard and, yes, often play hard. It is a place where students are given fast cars on their 16th birthdays and have easy access to drink and drugs.

There are suburbs like this all over the nation. . . .

The students I talked to said there is absolutely no school spirit, zero. They didn't have much use for Pacific Palisades either, they said, no community loyalty. They dismissed it as a bland, moneyed place where no one had roots, one of those end-of-the-rainbow Western suburbs where dreams were supposed to come true and people were angry when they didn't, a place where there was nothing to do on weekends but party, or "rage" as they call it. . .

"I just don't think there were enough limits," he said. "Everybody's parents were trying to be so cool. . ."
IN SCIENCE PREDICTION IS EVERYTHING
Authors: Student
Published: December 2021

I have sometimes used the trick of writing the paper before the experiments were done—not publishing it, of course,—but the discipline is very good for choosing which experiments should be done.
Hyperoxemia in Newborn Infants: Detection by Pulse Oximetry
Authors: Bucher Hans-Ulrich , Fanconi Sergio , Baeckert Peter , Duc Gabriel
Published: December 2021

Pulse oximetry has been proposed as a non-invasive continuous method for transcutaneous monitoring of arterial oxygen saturation of hemoglobin (tcSO2) in the newborn infant. The reliability of this technique in detecting hyperoxemia is controversial, because small changes in saturation greater than 90% are associated with relatively large changes in arterial oxygen tension (PaO2). The purpose of this study was to assess the reliability of pulse oximetry using an alarm limit of 95% tcSO2 in detecting hyperoxemia (defined as PaO2 greater than 90 mm Hg) and to examine the effect of varying the alarm limit on reliability. Two types of pulse oximeter were studied alternately in 50 newborn infants who were mechanically ventilated with indwelling arterial lines. Three arterial blood samples were drawn from every infant during routine increase of inspired oxygen before intratracheal suction, and PaO2 was compared with tcSO2. The Nellcor N-100 pulse oximeter identified all 26 hyperoxemic instances correctly (sensitivity 100%) and alarmed falsely in 25 of 49 nonhyperoxemic instances (specificity 49%). The Ohmeda Biox 3700 pulse oximeter detected 13 of 35 hyperoxemic instances (sensitivity 37%) and alarmed falsely in 7 of 40 nonhyperoxemic instances (specificity 83%). The optimal alarm limit, defined as a sensitivity of 95% or more associated with maximal specificity, was determined for Nellcor N-100 at 96% tcSO2 (specificity 38%) and for Ohmeda Biox 3700 at 89% tcSO2 (specificity 52%). It was concluded that pulse oximeters can be highly sensitive in detecting hyperoxemia provided that type-specific alarm limits are set and a low specificity is accepted.
LISTERIOSIS
Authors: L. J. F.
Published: December 2021

Listeria monocytogenes—an uncommon human pathogen of animal origin—has some unusual properties. The organism is widespread in the environment and many animals, and has the ability to grow over a temperature range (2-42°C) that includes refrigerator temperatures. . . . The bacterium itself becomes intracellular and has an outstanding predilection for pregnant women, in whomit causes very slight or inapparent illness but may cross the placenta to kill the fetus or give rise to perinatal septicaemia or meningitis in the newborn baby....

Listeria spp are present in vegetation, water, soil, and the faeces of man and animals, so it is not surprising that they are present in food. It follows that ingestion of modest numbers of listeria causes no clinical problems in healthy people.... The infective dose is also unknown, but presumably it is lower for pregnant and immunologically compromised individuals than for the normal population....

What is very clear is that as produced, processed, and finally cross-contaminated in chicken packing plants, very nearly all chicken carcasses are contaminated with listeria, as well as with Campylobacter jejuni and salmonellae. In the past two or three years infections due to these microbes have increased almost exponentially; they are all sporadic in distribution, and all three organisms are frequently introduced into the environment of the domestic kitchen via chicken meat....

There is always complacency in the livestock industry when infective agents do not cause significant economic losses in flocks or herds—listeria, salmonellae, and campylobacters all fail to do this. Surely it is time to think of the effect on human beings.
Cervical Spine Fractures Sustained by Young Children in Forward-Facing Car Seats
Authors: Fuchs Susan , Barthel Martha J. , Flannery Ann Marie , Christoffel Katherine K.
Published: December 2021

Child passenger safety restraint laws have reduced the number of children killed or injured in motor vehicle accidents in the past few years. However, the increased used of child safety seats has brought with it an increase in the misuse of these devices. High cervical spine injuries sustained by five children less than 2 years of age while in forward-facing car seats are described. In the cases of three children, the car safety seat use was correct. Misuse of car seats and anatomic and biomechanical factors in the cervical spines of infants and young children appear to have contributed to the occurrence of these previously rare injuries. Like seat belts, car safety seats are now a factor in child passenger injury characteristics, and therefore, car safety seat design merits reevaluation. In light of this development, public and parent education by health care professionals concerning the correct use of car safety seats is necessary.
Pediatrician and Parent: A Challenge for Female Physicians
Authors: Sells Jill M. , Sells Clifford J.
Published: December 2021

Of 141 women who finished their pediatric residencies between 1960 and 1987, 84 (60%) completed questionnaires concerning their decisions regarding marriage, pregnancy, child care, and career. Eighty-three percent of the physicians were married, and 77% had natural-born children. The mean age at conception of the first child was 29 years, timing that was based on education or career stage for 51%. When the child was born, 45% of the women were employed, 20% were fellows, 17% were residents, 3% were undergraduate or medical students, and 15% were on leave. Eighty percent found supervisors and peers to be supportive of their pregnancies, but 26% believed they were penalized for their maternity leaves and 24% believed their pregnancies were actively discouraged. The mean leave taken following delivery was 12 weeks; the mean leave time considered ideal was 16 weeks. All women had used some form of day care, and 79% felt generally satisfied with its role in their children's rearing. They did more than 50% of the housework and in-home child care, with the remainder split between spouse and hired help, even though nearly two thirds were working full-time. All subjects with children would become parents again if they had to make the decision again. Eighty-one percent of respondents would go into medicine again; 79% would enter the same specialty. Most found their life-styles challenging but rewarding and, with the benefit of hindsight, would make the same choices again.
Etiology and Pathogenesis of Intraventricular Hemorrhage in Newborns
Authors: PAPE KAREN E.
Published: December 2021

The article by Miall-Allen et al is an important contribution to the status of BP control and intracranial hemorrhage in the newborn. Until 10 years ago, there were limited methods of assessment. Hemorrhagic brain lesions were diagnosed mainly by clinical criteria and postmortem examination. In the late 1970s, CT scans provided much more in vivo information. However, CT scanning is inherently difficult in the newborn. Early machines produced a significant amount of radiation and the infants had to be transported to a radiology unit. These difficulties meant that a limited number of scans were done and children were rarely sequentially exposed.
Haemophilus influenzae Type b Conjugate Vaccines: Update
Authors:   COMMITTEE ON INFECTIOUS DISEASES
Published: December 2021

The purpose of this statement is to update previous information and recommendations provided by the Committee for the use of Haemophilus influenzae type b conjugate vaccines in view of the licensure of a new product. Our initial recommendations concerned the use of PRP-D, a vaccine consisting of the capsular polysacchanide of H influenzae type b conjugated to diphtheria toxoid, which was licensed for use in December 1987.

On December 22, 1988, a second conjugate vaccine was licensed by the US Food and Drug Administration for the prevention of infections caused by H influenzae type b in children 18 months of age or olden. This newly licensed vaccine is a conjugate of H influenzae type b capsular oligosaccharide and a nontoxic mutant diphtheria toxin protein molecule called CRM197. The official designation of this vaccine is "Haemophilus b conjugate vaccine (diphtheria CRM197 protein conjugate)" and it is often referred to as HbOC.

No serious adverse reactions have been reported in clinical trials to date. Among 265 infants in the United States between 16 and 23 months of age who received HbOC, 7.2% had temperatures exceeding 38°C, 1.5% had erythema and warmth at the injection site, and 0.8% had localized swelling. Like PRP-D, HbOC is more immunogenic in 18-month-old children than are the unconjugated polysacchanide vaccines (PRP). Among 212 HbOC recipients in the study, the geometric mean anticapsular antibody concentration 1 month after immunization was 13.11 µg/mL. Moreover, 98.1% of these infants had an antibody concentration in excess of 1µg/mL, a concentration associated with protection in a Finnish field trial of unconjugated PRP.
Screening for Drugs of Abuse in Children and Adolescents
Authors:   COMMITTEE ON ADOLESCENCE,   PROVISIONAL COMMITTEE ON SUBSTANCE ABUSE,   COMMITTEE ON BIOETHICS
Published: December 2021

BACKGROUND

Increasing concern about the widespread use of psychoactive drugs has been accompanied by an increase in drug screening. Concerns about the potential harms of drug use are compounded in the pediatric population because of the diminished capacity of minors to make informed, autonomous decisions and the added possibilities of long-term effects in a developing person. The purpose of this statement is to clarify the issues and state the Academy's position on screening programs.

The abuse of psychoactive drugs among both adolescents and adults has been an issue of increasing national interest. Concerns have focused not only on the physiologic and behavioral impact of drug use upon the developing adolescent but also on the public health hazard that drug abusers may pose to others in the population.

In this statement the topic of illegal drugs (such as marijuana, cocaine, and narcotics) used for socalled "recreational" purposes, and some prescribed drugs (such as barbiturates and amphetamines) used for illicit purposes, is addressed. The focus of this statement is not on drug use in children and adolescents, which the Academy strenuously opposes but on proposals for involuntary screening for drug use, whether in schools, athletic programs, or the physician's office.

INVOLUNTARY VS VOLUNTARY SCREENING

True voluntary screening is an ambiguous concept in a population that is considered incompetent to consent. Therefore, there can only be voluntary screening among young people considered competent, such as many olden adolescents. However, it is not clear why such individuals would volunteer to be screened, because those who are using drugs will know who they are and presumably decline to be screened. Truly voluntary screening, therefore, is likely to miss detection of most drug users.
In Reply: Mortality Rates
Authors: WEGMAN MYRON E.
Published: December 2021

Dr Babson's thoughtful letter raises at least two important points about how the United States can achieve decreased infant mortality for all its citizens: (1) how significant is relative ranking among developed countries, of which some are relatively homogeneous and other heterogeneous, and (2) the importance of decreasing mortality among those US population groups with rates greater than the national average.

On the first point, as I have pointed out in earlier articles, relative ranking is important, in my view, chiefly as indicating how much better we can do.
FROZEN OUT (IN LIMBO)
Authors: Student
Published: December 2021

Six years after two embryos were frozen and four years after the death of their biological parents in a plane crash in Chile, it has been decided that the embryos were not the legal heirs to the parents' estate estimated at $8 million at the time of their death; nor were the embryos the property of the estate, and they would not be considered relatives of the surviving family.
YUPPY POPULATION CONTROL
Authors: Student
Published: December 2021

Video baby is here. She was born last year in New York City. A couple of Upper East Side ad types brainstormed the answer for couples who want "the full, rich experience of parenthood without the mess and inconvenience of the real thing."

They made a 13-minute videotape showing a cute-as-a-button, blue-eyed 9-month-old clapping for Daddy, waving to Grandma and happily smearing porridge all over her face.
IT'S OK TO UNLEARN
Authors: Student
Published: December 2021

Somehow we must develop a method for getting `permission to unlearn'—that is, we must be allowed to feel comfortable and professional when giving more weight to the expressions of the patient than to the laboratory results; comfortable when leaving important decisions to those mainly affected by those decisions; more prepared to give heed to patients' groups as well as specialists' groups and able to accept and share our own human limitations.
UNWANTED CHILDREN
Authors: Student
Published: December 2021

Infant mortality was significantly higher among unwanted children [in Finland] than among the desired children (24.0 us 14.2 per 1000 but no difference was found among the older children up to the age of 16. The incident of CP and mental retardation (I.Q. < 71) up to the age of 14 years were 3.1 and 3.2 times higher in the unwanted children than in the desired children respectively, the differences being statistically highly significant.
CLUSTERS PROBLEM
Authors: Student
Published: December 2021

"The study could neither confirm nor deny a link between the leukemia incidents and proximity of nuclear power plants because such statistical studies, by their nature, cannot prove cause and effect." So many scientific papers end with these words. It is as if Sherlock Holmes were going out with a shattered magnifying glass and then assiduously reporting that he could not see anything.

The problem is not the intention, but the tool. A cluster is a mysterious grouping of disease, in place or time, possibly a fluke and possibly statistically "real"—that is, not due to chance alone. Statistics can determine the "real" clusters but not what the cause may be.

By definition, a statistical study sniffs at a cold trail.
Humoral Immunity and Clinical Reinfections Following Varicella Vaccine in Healthy Children
Authors: Johnson Candice , Rome Leonard P. , Stancin Terry , Kumar Mary L.
Published: December 2021

The duration of immunity following vancella-zoster vaccination in healthy children remains a critical issue. In a 3-year study of 140 OKA/Merck vaccine recipients, duration of immunity was assessed by two measures. The first was persistence of varicellazoster antibody measured by modified fluorescent antibody to membrane antigen test. Thirty-six toddler vaccinees 12 to 24 months of age had sera obtained at 6 weeks, 1 year, and 2 years. Geometric mean titer ± SD at 6 weeks was 57.7 ± 2.9; at 1 year, it was 12.4 ± 3.9; at 2 years, it was 9.9 ± 3.9. Repeated-measures analysis of variance showed a significant overall decrease in antibody titer with time (F = 30.62, P < .001). Post hoc comparisons indicated that the 6-week and 1-year titers were significantly different (P < .001), but the difference between 1 and 2 years was not (P = .138). Clinical reinfections were also examined for 3 years after vaccination. Suspected varicella cases were confirmed by a fourfold or more increase in titer. Of 84 toddlers, 68 were exposed one or more times, and 6 became reinfected. Of 49 siblings, 45 were exposed, and one became reinfected. All 7 children had < 70 vesicles and 6 of 7 were afebrile. No cases of zoster occurred. It is concluded that OKA/Merck varicella-zoster vaccination leads to antibody persistence for 2 years and the few reinfections that do occur are greatly attenuated.
Serious Respiratory Consequences of Detergent Ingestions in Children
Authors: Einhorn Arnold , Horton Lisa , Altieri Michael , Ochsenschlager Dan , Klein Bruce
Published: December 2021

After ingesting or inhaling laundry detergent powder, eight children required hospital admission. The predominant symptoms were stridor, drooling, and respiratory distress. All but one patient underwent endoscopy of the airways and the esophagus, five children were admitted to the intensive care unit, and four children required endotracheal intubation. Laundry detergent ingestions are generally considered to have minor consequences, and there exists a paucity of literature on the subject. Evidence of significant morbidity incurred because of ingestion or inhalation of sodium carbonatecontaining laundry detergent powder is presented, together with a review of the existing literature.
PLEA FROM META-ANALYSTS
Authors: Student
Published: December 2021

Most meta-analyses will require from each study [in a review] both a point estimate of effect and an estimate of its standard error. Therefore, in the interest of facilitating future reviews, authors, referees, and editors should ensure that published extracts and reports provide both the point estimate for an association and its standard error, or confidence limits. . . . A point estimate accompanied only by a p value will not generally provide for accurate computation of a standard error estimate.
Linear Growth of Children With Nephrotic Syndrome: Effect of Alkylating Agents
Authors: Padilla Rafael , Brem Andrew S.
Published: December 2021

Growth velocity measurements were assessed in 12 children with steroid responsive but frequent relapsing or dependent nephrotic syndrome prior to and following treatment with either cyclophosphamide or chlorambucil and alternate day prednisone. Patients averaged 6 ± 3 years (mean ± SD) of age at the time of treatment. All of the patients underwent renal biopsy prior to treatment; 5 of the 12 showed mesangial proliferation; and in 10 of the 12, IgM deposits were seen within the mesangium of the glomerulus. Growth rates before treatment with the alkylating agent were 4.3 ± 1.3 cm/y increasing to 8.7 ± 2.5 cm/y (P < .001) after therapy despite the relapses that occurred in 5 of the patients in the year following treatment. Short-term side effects of the treatment were minimal. The significant increase in growth associated with diminished use of steroids makes the use of alkylating agents reasonable for children with nephrosis who show signs of decreased growth velocity.
Sleep Problems in Healthy Preadolescents
Authors: Kahn André , Van de Merckt Carine , Rebuffat Elisabeth , Mozin Marie José , Sottiaux Martine , Blum Denise , Hennart Philippe
Published: December 2021

Few data currently exist concerning the sleep problems of preadolescents. A parent report questionnaire concerning sleep habits and problems was developed. The questionnaires were completed by the parents of 1000 unscreened elementary school children attending the third, fourth, and fifth grades. The schools were randomly selected from an urban area. Of the 1000 questionnaires, 972 were completed and could be used for statistical analysis. Among the parents, 24% reported sleeping poorly and 12% regularly relied on sedatives to induce sleep. Sleep difficulties lasting more than 6 months were present in 43% of the children. In 14% (132 of 972), sleep latency was longer than 30 minutes, and more than one complete arousal occurred during the night at least two nights per week. The following variables were seen among the poor sleepers: lower parental educational and professional status, parents who were more likely to be divorced or separated, and more noise or light in the rooms where they slept. They also presented a higher incidence of somnambulism, somniloquia, and night fears (nightmares and night terrors) than the children who slept well. Boys who slept poorly were significantly more likely to have insomniac fathers (P < .010). Regular use of sedatives was described in 4% (5 of 132) of the children who slept poorly. Among the "poor sleepers," 21% (33 of 132) had failed 1 or more years at school. School achievement difficulties were encountered significantly more often among the poor sleepers than among the children without sleep problems (P = .001). Of the families with children suffering from sleep problems, 28% expressed a desire for counseling. This preliminary study suggests the need for more systematic attention by the pediatrician to the possible presence of chronic sleep problems in apparently normal preadolescents. Pediatricians could contribute to the alleviation of parental anxiety and help to limit the use of sleep medications in children.
CARNATION HALTS FORMULA CLAIMS
Authors: L. J. F.
Published: December 2021

The Carnation Company agreed yesterday to drop several claims from advertisements for its infant formula after nine states had accused the company of falsely suggesting that the formula would not cause an allergic reaction. In the agreement, Carnation said it would stop describing the product, called Good Start H.A., as hypoallergenic.

Carnation, a subsidiary of Nestle S.A., also agreed to stop citing scientific evidence for its health claims and to pay the states a total of $90,000 to cover the cost of the investigation.

The states involved in the investigation are New York, California, Illinois, Iowa, Massachusetts, Minnesota, Missouri, Texas and Wisconsin.
EMBRYOS IN A DIVORCE CASE: JOINT PROPERTY OR OFFSPRING?
Authors: L. J. F.
Published: December 2021

Maryville, Tenn.—Mary Sue Davis and Junior Lewis Davis are getting a divorce. That is a seemingly unremarkable fact in a nation where the divorce rate is climbing and where 1,183,000 couples dissolved their marriages last year.

But behind the routine talk of property rights and custody, there are large philosophical, ethical and legal questions as the Davises fight over seven frozen embryos, eggs from Mrs. Davis's body that were fertilized with Mr. Davis's sperm after other attempts at pregnancy failed.

When the trial begins in Blount County Circuit Court, the issues will be profound and troubling. When does life begin? Should an embryo be treated not as property but rather as potential life, if not life itself?

Mr. Davis maintains that the embryos, now in storage at the Fertility Center of Eastern Tennessee in Knoxville, are not alive and that the central issues are purely legal ones involving joint property of the marriage. His lawyer says the issue is simple: Mr. Davis does not want his wife to bear a child using the embryos after they are divorced.
Fetal and Infant Lead Exposure: Effects on Growth in Stature
Authors: Shukla Rakesh , Bornschein Robert L. , Dietrich Kim N. , Buncher C. R. , Berger Omer G. , Hammond Paul B. , Succop Paul A.
Published: December 2021

The growth of a cohort of 260 infants was prospectively followed up from birth. Blood lead and stature measurements were obtained every 3 months until 15 months of age. Fetal lead exposure was indexed by measuring lead in maternal blood during pregnancy. A longitudinal analysis revealed that covariate adjusted growth rates in stature were negatively related to the infants' postnatal blood lead concentration, as indexed by increase in average blood lead values from 3 to 15 months. However, this relationship between growth rate and change in blood lead concentration was evidenced only among those infants whose mothers had prenatal blood lead levels greater than the maternal cohort median of 7.7 γg/dL (P = .01). The expected stature of a child born to a mother with a prenatal blood lead concentration more than 7.7 γg/dL is about 2 cm shorter at 15 months of age if, postnatally, the infant incurred a 10-γg/dL blood lead increase during the 3-to 15-month interval of life, compared with an infant who has no increase.
Clinical-Epidemiologic Assessment of Patterns of Birth Defects Associated With Human Teratogens: Application to Diabetic Embryopathy
Authors: Khoury Muin J. , Becerra José E. , Cordero José F. , Erickson J. David
Published: December 2021

The concepts of sensitivity, specificity, and predictive value can be used to assess patterns of birth defects associated with human teratogens. Although sensitivity of any single defect is generally low for many known teratogens, the presence of specific defect combinations is usually predictive of the teratogen. To evaluate the patterns of birth defects associated with diabetic embryopathy, a sensitivity-specificity analysis was performed on 4929 infants with major defects ascertained by the population-based Metropolitan Atlanta Congenital Defects Program between 1968 and 1980. By reviewing hospital records, maternal insulin-dependent diabetes mellitus was confirmed in 26 infants. Patterns of defects were evaluated among infants born to mothers with insulin-dependent diabetes mellitus and compared with the rest of the Metropolitan Atlanta Congenital Defects Program case population. Multiple logistic regression analysis was used to assess defect combinations that predict for insulin-dependent diabetes mellitus. Of 26 infants, 8 had multiple defects. However, most defects and their combinations were poorly sensitive and predictive for insulin-dependent diabetes mellitus. The predictive value for insulin-dependent diabetes mellitus was greatest for the combination of vertebral and cardiovascular anomalies (6.5%). Also, several pathogenetic mechanisms were noted among patients with insulin-dependent diabetes mellitus, such as cell migration defects, cell death events, deformations, and cardiac flow lesions. The inability to find a clear-cut phenotype for diabetic embryopathy may be due to several etiologic factors and mechanisms associated with diabetic embryopathy.
BASIC CAUSES OF FAILURE
Authors: Barness Lewis A.
Published: December 2021

The greatest boon to public education will come through an improvement in social conditions. Strange as it may seem, elimination of unemployment will help our schools immeasurably. Passage of a national health plan will improve the well-being of the pupils, mentally as well as physically. Well-nourished and healthy students will provide fewer discipline problems. Furthermore, a federal campaign to provide low-cost housing would help to ameliorate the deplorable conditions in which many children live. Plants cannot grow well in barren ground.

In short, our schools cannot improve until the nation as a whole emerges from poverty and desperation of deprived Americans.
ARE WE COMING FROM OR GOING TO?
Authors: Student
Published: December 2021

William James observed that we live forwards but we understand backwards. He used this phrase to express his conviction that the creative, novelty-seeking surge of life comes first and that reflection, articulation, classification, analysis, and understanding come later.

Whether or not something constitutes progress depends not upon reaching some preexisting goal but upon the distance traveled from where we have been to where we are now. To understand something is to judge it in the light of already known criteria. In his book The Structure of Scientific Revolutions, philosopher Thomas Kuhn argues that we understand science better if we do not think of it as evolving toward anything. We need not see science "as the one enterprise that draws constantly nearer to some goal set by nature in advance." The success of science rests in how far it travels "from the community's state of knowledge at any given time."
Health Insurance Status of Adolescents in the United States
Authors: Newacheck Paul W. , McManus Margaret A.
Published: December 2021

This analysis of a sample of 15 181 adolescents aged 10 to 18 years from the National Health Interview Survey indicates that 86% of adolescents had some form of private or public health care coverage during 1984. Nevertheless, one in every seven adolescents, or nearly 4.5 million nationwide, were without any form of health insurance coverage. Adolescents without insurance coverage were concentrated in poor and near-poor households, families with little formal education, and were more likely to live in the South or West. Minorities, especially Hispanic adolescents, were less likely than white adolescents to have some form of health insurance coverage, but much of this difference was attributable to the smaller incomes of minorities. Similarly, although adolescents living in single-parent households were less likely to be insured, the reduced likelihood of coverage appears to be primarily attributable to smaller family income in single-parent households. That family economics plays a central role in determining whether an adolescent had some form of coverage was confirmed by interiew results concerning the major reasons for absence of coverage; 8 of 10 uninsured families cited economic reasons for absence of coverage. Together, these results indicate the principal barriers to obtaining health insurance are economic in nature. Public and private sector initiatives for reducing the size of the uninsured adolescent population are discussed.
MANAGED KIDS
Authors: Student
Published: December 2021

Another way that's reshaping America is the move from parenting to child management. You don't have Mom raising the kids. She gets `em till it's time for Montessori and the designer kid's clothes. And the tube in that age group has an incredible dominance in kid's lives. They're watching this thing three, four hours a day.