bluuebunny/crossref_metadata_2025 huggingface dataset:
Folate Supplements Should Be Appropriately Labeled to Protect Consumers
Authors: Herbert Victor
Published: December 2021

Caveats are needed regarding the Academy of Pediatrics policy statement1 (in the September issue of Pediatrics) advising all women capable of becoming pregnant to take a daily over-the-counter multivitamin containing 0.4 mg of folic acid to reduce the frequency of neural tube defect (NTD) babies.

I provided similar advice in my 1992 paper, "Folate and Neural Tube Defects".2 However, in that paper I discussed important caveats. I repeated and extended those caveats at the August 12, 1993, Centers for Disease Control and Prevention (CDC) meeting on monitoring the effects of folate supplementation.
Metered-Dose Inhalers for Young Athletes With Exercise-Induced Asthma
Authors:   Committee on Sports Medicine and Fitness
Published: December 2021

Bronchoconstriction can occur in association with exercise in up to 15% of the general population, including nearly 100% of people with asthma, 35% to 40% of those with allergic rhinitis, and some who have no other evidence of allergy.1 This phenomenon, termed exercise-induced asthma (EIA), is manifested by coughing, choking, chest pain, easy fatigability, shortness of breath, wheezing, chest tightness, or any combination of these symptoms during, or especially after, exercise. In a child known to have asthma or nasal allergies, the diagnosis of EIA can usually be made on the basis of history alone. Repeated episodes of increased difficulty breathing or cough in association with physical exertion should be assumed to be EIA until proved otherwise.

Sophisticated pulmonary function testing is not necessary in the majority of cases. In the atypical case, pulmonary function testing, often in conjunction with an exercise challenge, can confirm the diagnosis.

Exercise-induced asthma is less likely to occur in a child whose asthma is well controlled,1 a goal accomplished best with attention to the role of airway inflammation as well as bronchoconstriction.2 Fortunately, EIA can be controlled in most athletes by the inhalation of a β2-agonist bronchodilator (eg, albuterol), cromolyn sodium, or both 15 to 30 minutes before exercise. These safe medications come in several different forms, but the most convenient for patients older than 2 or 3 years is the pressurized metered-dose inhaler (MDI), which is especially easy to use with the addition of a spacing device.

Cromolyn has never been thought to be effective as an ergogenic (performance-enhancing) aid,3 and only two studies have suggested the possibility that albuterol is ergogenic.4,5
THE HEALTH POLICE ARE COMING
Authors: L. J. F.
Published: December 2021

Despite all the controversy surrounding the president's proposed Health Security Act, nary a word has been heard about the significant new civil and criminal penalties included in the act. These new crimes and penalties both raise significant issues in their own right and belie the administration's claims that its plan relies on market incentives and choice.

The Health Security Act federalizes a broad range of routine crimes and torts previously dealt with by the states. Most notably, the act creates two broad new categories of federal crime, dubbed "federal health care offense" and "Health care fraud" (Sec. 5402[d]; 5401). "Health care fraud" includes, among other things, any effort to defraud a "health plan" (i.e., a private insurer, health maintenance organization or self-insured employer) or "any . . . other person" in connection with the delivery or payment of health care benefits, supplies or services. Thus the act federalizes mundane fraud cases merely because they are perpetrated on an organization that provides health care.

There will undoubtedly be shortages and waiting lists for procedures, and bribes might provide patients with a life-saving short cut. On the other side of the table, medical students, their options to enter the specialty of their choice limited by the act's quota on specialists, might seek to ensure their desired career through a well-placed gift. In a plan that ignores markets, bribery and influence peddling will be the natural result. The criminal and civil penalties in the act roll on and on. A health Insurer, HMO or self-insured employer that fails to pay daims "promptly" may be fined up to $1 million for repeat "offenses" (Sec. 5206).
SLOWING THE DETERIORATION OF ASTHMA AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE OBSERVED DURING BRONCHODILATOR THERAPY BY ADDING INHALED CORTICOSTEROIDS: A 4-YEAR PROSPECTIVE STUDY
Authors: Cvietusa Peter , Spahn Joseph , Otto William R.
Published: December 2021

Purpose of the Study. To determine if the deterioration in lung function, seen in adults with asthma or chronic obstructive pulmonary disease (COPD), could be reversed or slowed by the addition of inhaled beclomethasone. Many short-term studies have shown the benefits of inhaled steroids in asthma; in particular, their ability to improve pulmonary function, decrease bronchial hyperreactivity, and reduce symptoms. Few studies have evaluated the long-term effects of inhaled steroids on the clinical course of either asthma or COPD.

Methods. This report is an extension of a 2-year study that followed 160 patients with asthma or COPD on bronchodilator therapy alone. From this group, 56 patients who displayed a rapid decline in pulmonary function (FEV1 ≥ 80 ml/year) and a high exacerbation rate (≥1/year) were selected to receive additional treatment with beclomethasone dipropionate 400 µg two times daily over 4 years. FEV1 and airways responsiveness to histamine were measured every 6 months and at 1 and 13 months upon completion of the study. Peak flows and symptom scores were recorded weekly, and compliance, inhaler technique, and adverse affects were monitored every 3 months.

Findings. During the first 6 months of beclomethasone treatment, both groups showed a significant improvement in pre- and postbronchodilator FEV1 with the most significant change noted in the asthma group. Thereafter, the FEV1 began to decline again, as it had in the first 2 years of the study, but at a rate that was 33% slower. In addition to slowing the decline in FEV1, inhaled beclomethasone resulted in a substantial decrease in the degree of bronchial hyperreactivity, and peak flow rates improved.
Examination Findings in Legally Confirmed Child Sexual Abuse: It's Normal to be Normal
Authors: Adams Joyce A. , Harper Katherine , Knudson Sandra , Revilla Juliette
Published: December 2021

Background. Studies of alleged victims of child sexual abuse vary greatly in the reported frequency of physical findings based on differences in definition of abuse and of "findings." This study was designed to determine the frequency of abnormal findings in a population of children with legal confirmation of sexual abuse, using a standardized classification system for colposcopic photographic findings.

Methods. Case files and colposcopic photographs of 236 children with perpetrator conviction for sexual abuse, were reviewed. The photos were reviewed blindly by a team member other than the examiner, and specific anatomical findings were noted and classified as normal to abnormal on a scale of 1 to 5. Historical and behavioral information, as well as legal outcome was recorded, and all data entered into a dBase III program. Correlations were sought between abnormal findings and other variables.

Results. The mean age of the patients was 9.0 years (range 8 months to 17 years, 11 months), with 63% reporting penile-genital contact. Genital examination findings in girls were normal in 28%, nonspecific in 49%, suspicious in 9%, and abnormal in 14% of cases. Abnormal anal findings were found in only 1% of patients. Using discriminant analysis, the two factors which significantly correlated with the presence of abnormal genital findings in girls were the time since the last incident, and a history of blood being reported at the time of the molest.

Conclusions. Abnormal genital findings are not common in sexually abused girls, based on a standardized classification system. More emphasis should be placed on documenting the child's description of the molestation, and educating prosecutors that, for children alleging abuse: "It's normal to be normal."
Parenting Behaviors and the Onset of Smoking and Alcohol Use: A Longitudinal Study
Authors: Cohen Deborah A. , Richardson Jean , LaBree Laurie
Published: December 2021

Objective. To identify which specific parenting behaviors are associated with the onset of alcohol and tobacco use and how they are associated.

Design. Prospective cohort study of two groups of preadolescents surveyed annually, the first group for 4 years, the second for 3 years.

Setting. Two public school districts in Southern California.

Subjects. 1034 fifth graders and 1266 seventh graders began the study after obtaining parental consent to complete surveys in a classroom setting. By the last measurement, attrition was 37 and 38% for the two cohorts, respectively.

Main outcome measures. The onset of tobacco or alcohol use in the last month.

Results. Children who reported that parents spent more time with them and communicated with them more frequently had lower onset rates of using alcohol and tobacco in the last month. These parental interactions lead to more positive relationships with their children. Parental monitoring and positive relations were protective factors for disruptive behavior and the selection of substance-using friends. Disruptive behavior increased the odds of adolescents drinking in the last month approximately twofold and of smoking in the last month two to fourfold.

Conclusions. This study provides further evidence that parenting behaviors are significant precursors to adolescent disruptive behavior, vulnerability to peer pressure, and subsequent substance use. Parents should be targeted in future substance use prevention programs, before their children reach adolescence.
Update on Timing of Hepatitis B Vaccination for Premature Infants and for Children With Lapsed Immunization
Authors:   Committee on Infectious Diseases
Published: December 2021

The American Academy of Pediatrics (AAP) and the United States Public Health Service have recommended immunization of all infants with hepatitis B vaccine.1,2 Although several immunization schedules have been shown to be effective in infants and children, the AAP recommends that the first dose be administered to newborns before they leave the hospital. Alternative schedules beginning between birth and 2 months of age also are acceptable and have been adopted in many practices. These recommendations were based on studies performed in numerous populations demonstrating high immunogenicity when the vaccines were administered in accordance with the manufacturers' approved doses and schedules.

In the previous AAP recommendations, similar latitude was given in the initiation of vaccine schedules for premature infants born to women who were hepatitis B surface antigen (HBsAg)-negative. For premature infants and other infants with illnesses in the first few days of life, pediatricians were advised that administration of hepatitis B vaccine could be delayed until hospital discharge, although it was implied that premature infants should receive hepatitis B vaccine at the same chronologic age as recommended for term infants.3

HEPATITIS B VACCINE IN PREMATURE INFANTS

Studies have revealed, however, that the percentage of infants that develop protective levels (≥10 mIU/mL) of antibody to HBsAg (anti-HBs) and the final anti-HBs concentrations may be lower in premature infants given the recombinant hepatitis B vaccines beginning at birth than if the initial dose is delayed until they are older or weigh more than 2000 g.4-6 In one study,4 the response rate for premature infants who received their first dose of Engerix-B vaccine at a weight of either 1000 to 1999 g or 2000 g or more was 79% and 91 %, respectively; the response rate was 100% for normal term infants.
Lead Debate Goes On
Authors: Chisholm Julian , Goldstein Gary , Cory-Slechta Deborah , Weiss Bernard , Landrigan Philip , Mushak Paul , Needleman Herbert L. , Rice Deborah , Rosen John , Silbergeld Ellen
Published: December 2021

In his recent commentary (Pediatrics, February 1994), Harvey argued that universal screening for lead exposure, as recommended in the 1991 Centers for Disease Control statement, is wasteful of resources, and that screening in low prevalence areas should be curtailed. The value of universal screening for any disease deserves careful evaluation. This is unarguable; we live and work, after all, in a period of finite resources. It is also self-evident that a sensible judgment on this matter requires solid facts and up-to-date information.
Cytomegalovirus Infection as an Occupational Hazard Among Women Employed in Day-Care Centers
Authors: Soto Julio C. , Delage Gilles , Vincelette Jean , Belanger Lise
Published: December 2021

Data suggest that control interventions targeted toward women of child-bearing age working in day-care centers have the potential to decrease the risk for cytomegalovirus infection.
Developmentally Inappropriate Play Areas in Rural Day Care: Is It Safe to Play Outdoors?
Authors: Townley Kim F. , McKnight Robert H.
Published: December 2021

Work-in-progress that identifies mismatches between children's developmental levels and the outdoor play areas of rural day-care settings was reported. Outdoor environmental hazards were posited to be more prevalent in rural areas due to less-stringent zoning, variations of lifestyle, undereducation, high unemployment, and suboptimal health and safety standards. These environmental hazards include electric fences, farm animals, agricultural chemicals, firearms, tools, manure pits, unfenced ponds, and machinery. Principles of child development and of epidemiology were used to construct an outdoor injury hazard matrix. The Haddon Matrix was used as the basis of our matrix. Our matrix illustrated how children in rural settings might experience injuries different from those occurring in urban settings. Examples include entrapment, poisoning, falls, electrocution, burns, animal injuries, asphyxiation, and dismemberment. We believe that many risks of farm-based day care are unrecognized by persons who set standards. It remains unclear whether existing child-care standards are adequate in protecting children who receive care on family farms. We presented a checklist for evaluating sentinel hazards in outdoor play areas in rural settings. Methods to quantify the magnitude of these hazards in rural day care are under way.
The Challenge of Day-Care Health Among Children With Disabilities
Authors: Parrino Sandra S. , Thacker Stephen B.
Published: December 2021

It is not enough that people know of their responsibilities and the opportunities offered by laws and regulations; they must have information about the best way to meet their responsibilities. We do not want employers, businesses, schools, and others to feel frustrated because they are unable to get clear answers to their questions on because the kind of information needed to make successful accommodations have not been developed. Thus, we must identify and use the best ways to provide information about helping the day-care community to help our children with disabilities and their families.

We believe prevention in persons with disabilities is a moral issue. Simply stated, if we keep people alive from fatal conditions, then we must assume an obligation to promote the quality of their lives and this must begin with the quality of their health. It is no exaggeration to say that the way a society treats its citizens with disabilities is a valid measure of the quality of life in that society.

The end of the United Nations Decade of Disabled Persons should mark the beginning of a new and sustained effort to translate words into action, worldwide, as we approach a new century when disability rights become the norm in all nations throughout the world.

Never before in history have human actions so directly shaped the future, both intentionally and unintentionally, for good and for ill. And there is no better example than disability. We have the opportunity to create the future we desire—to use our best efforts to invent a future that is humane and empowering both for people with disabilities and for people at risk for disabilities, which together includes us all. An international vision for the prevention of disability and for the care of our children with disabilities in day-care settings will not come into being without sustained effort and commitment of the global public health community.
The Role of the Public Health System in Child Day-Care Health
Authors: Novello Antonia C.
Published: December 2021

Why have we not convinced our citizens that day-care for children warrants greater attention, given the demonstrated needs in day care and the importance of this issue for the future of the world? Some reasons are obvious; other issues compete for our attention. Still, our children are our future, and we increasingly depend on day-care providers to nurture and protect this investment. If that is the case, then we must empower them for the benefit of the children. Yet, before high-quality day care can even be considered for the nation's children, before appropriate resources can be brought to bear on this issue, our society must first recognize that there is a problem—the solution for which requires collective involvement of the people in your community, your state, and in your country.

Researchers must continue to do excellent science. Clinicians must continue to provide the best-quality patient care. Day-care providers must seek to continue giving the best possible care to the children entrusted to them. At the same time, if we focus only on what directly relates to our immediate responsibilities, many years will pass before high-quality day care for children becomes an integral part of our global society. The consequences of such inaction are frightening; the children deserve better.

The time has come to move forward. I challenge the CDC to convene a workshop that includes the cosponsors of this conference to begin establishing a global agenda for preventing disease and injury and promoting health in child day-care settings. All of us are eager to work with other members of the global community to continue this critical effort on behalf of our children.

When all of us go back to our states, to our communities, to other countries, to our families, our impressions will be that we came together because we had a purpose, because we had a mission, but most importantly, because we care for our children.
Natural History of Vertically Acquired Human Immunodeficiency Virus-1 Infection
Authors:   The European Collaborative Study
Published: December 2021

Objective. To describe the natural history of vertically acquired human immunodeficiency virus (HIV) infection.

Design. This was a prospective follow-up study.

Setting. Ten centers of the European Collaborative Study participated.

Subjects. One hundred twenty-four HIV-infected children were born to women known to be infected at or before the time of delivery since 1986.

Main outcome measures. Deaths, acquired immunodeficiency syndrome (AIDS), and HIV-related symptoms and signs were assessed.

Results. In this cohort, treatment before the onset of AIDS was not universal. Less than 10% of children were treated with Zidovudine or intravenous gamma globulin before 6 months of age, with a steady increase to about 40% after 3 years of life. An estimated 23% (95% confidence interval: 15% to 31%) of infected children develop AIDS before the age of 1 year, and nearly 40% (27% to 50%) by 4 years. Ten percent (5% to 16%) die before age 1 year and 28% (16% to 41%) before age 5 years. Twenty-four months after the AIDS diagnosis, an estimated 48% (36% to 70%) of the children are still alive. Although after the age of 1 year immunologic abnormalities became increasingly common, the proportion of infected children with significant HIV-related symptoms or signs declined.

Conclusion. The progression of disease in this cohort of vertically infected children was not as fast as previously suggested, even though treatment was not widespread. Although infected children have a high risk of developing some manifestation of HIV infection early in life, serious HIV-related symptoms became less frequent with increasing age. This has important implications for health planning and care provision.
Letter to the Editor
Authors: Brown Kenneth H. , Bhutta Zulfiqar A.
Published: December 2021

In the May 1994 edition of Pediatrics, Jacobs et al reported the results of a generally well designed, randomized clinical trial in which they used either a placebo or one of several different homeopathic "medicines" for the treatment of young Nicaraguan children with acute diarrhea and mild or moderate dehydration. The results indicated that patients who received the homeopathic regimens had a significantly reduced subsequent duration of excretion of unformed stools, and (on one day only) a decreased number of unformed stools.
Pediatric Thyroid Nodules: Disease Demographics and Clinical Management as Determined by Fine Needle Aspiration Biopsy
Authors: Raab Stephen S. , Silverman Jan F. , Elsheikh Tarik M. , Thomas Patricia A. , Wakely Paul E.
Published: December 2021

Objective. The prevalence of thyroid nodularity in children has been estimated to be 1.8%. The reported prevalence of specific diseases which comprise these nodules is conflicting as evidenced by a reported range of malignancy of 2 to 50% in solitary nodules. In order to better classify pediatric (<18 years old) thyroid disease and evaluate the utility of fine needle aspiration biopsy (FNAB) in this patient population, we retrospectively reviewed 66 FNABs from 64 thyroid nodules and 2 perithyroid lymph nodes from 57 patients.

Methodology. Patients: The study was composed of 8 males and 49 females who ranged in age from 1 to 18 years old (mean = 13.1). Design: Surgical and/or clinical follow-up was obtained in all patients. The 66 FNAB diagnoses were initially classified into specific diseases. However, for the purpose of this review, the cases were classified as: 3 insufficient, 51 benign, 8 suspicious, and 4 malignant.

Results. There were no "false positives" and one "false negative" (a papillary carcinoma was misdiagnosed as a benign nodule). Overall, 10 patients (18%) had malignant thyroid lesions, including 8 papillary carcinomas and 2 follicular carcinomas. Benign diagnoses included benign nodule, cyst, lymphocytic thyroiditis, granulomatous thyroiditis, hyperplasia, and abscess.

Conclusions. The prevalence of malignancy in pediatric patients with thyroid nodules was 18%. We conclude that, because of its high diagnostic accuracy and minimal invasiveness, FNAB is useful in the management of pediatric thyroid nodules.
Energy Expenditure and Body Fat Distribution in Mohawk Children
Authors: Goran Michael I. , Kaskoun Mary , Johnson Rachel , Martinez Charlene , Kelly Benson , Hood Virginia
Published: December 2021

Objective. Epidemiologic studies suggest that Native Americans, including the Mohawk people, have a high prevalence of obesity, diabetes, and cardiovascular risk. However, current information on alterations in related variables such as energy metabolism and body composition in Native Americans is almost exclusively limited to already obese Pima adults living in the Southwest. The aim of this study was to characterize energy metabolism and body composition in young Mohawk children (17 girls, 11 boys; aged 4 to 7 years) as compared to Caucasian children (36 girls, 34 boys; aged 4 to 7 years). Total energy expenditure was measured by doubly labeled water, postprandial resting energy expenditure by indirect calorimetry, and activity energy expenditure was derived from the difference between total and resting energy expenditure. Fat and fat free mass were estimated from bioelectrical resistance, and body fat distribution was estimated from skinfolds and circumferences.

Results. There were no significant effects of ethnic background or sex on body weight, height, or body mass index. Fat free mass was significantly higher in boys and fat mass was significantly higher in girls, with no effect of ethnic background. Chest skinfold thickness, the ratio of trunk skinfolds:extremity skinfolds, and the waist:hip ratio were significantly higher in Mohawk children by 2.5 mm, 0.09 units, and 0.03 units, respectively, independent of sex and fat mass. Total energy expenditure was significantly higher in Mohawk children compared to Caucasian (100 kcal/day in girls, 150 kcal/day in boys), independent of fat free mass and sex, due to a significantly higher physical activity-related energy expenditure.

Conclusion. These data suggest that: 1) body fat is more centrally distributed in Mohawk relative to Caucasian children, and this effect is independent of sex and body fat content; 2) Mohawk children have a greater total energy expenditure than Caucasian children, independent of fat free mass, due to greater physical activity-related energy expenditure.
Thermophilic Amylase-Digested Rice-Electrolyte Solution in the Treatment of Acute Diarrhea in Children
Authors: Lebenthal Emanuel , Khin-Maung-U  , Rolston David D.K. , Khin-Myat-Tun  , Tin-Nu-Swe  , Thein-Thein-Myint  , Jirapinyo Pipop , Visitsuntorn Nualanong , Firmansyah Agus , Sunoto Sunoto , Bakri Achirul , Ismail Rusdi , Shin Kenji , Takita Hitoshi , Boatwright Doyle , Monte Woodrow
Published: December 2021

Objective. To compare the efficacy of an oral rehydration solution (ORS) containing short polymers of glucose derived from rice (Amylyte-ORS) and five times the caloric density of current ORS to the standard glucose-ORS (World Health Organization [WHO] = ORS) in the treatment of acute diarrhea in children.

Methods. The rice ORS (Amylyte-ORS) was obtained by adding thermophilic amylase (252 500 MW units) and salts (1.5 g NaCl, 600 mg KCl, and 150 mg CaCl2) to 100 g rice and boiling for 10 minutes in 500 mL water. This yields 250 mL Amylyte-ORS, which contains 92% to 96% short-chain glucose polymers, three to nine molecules in length, and provides 425 kcal/L, compared to 80 kcal/L for the WHO-ORS. One hundred forty-four male children, 4 months to 3 years of age, presenting with acute diarrhea and mild, moderate, or severe dehydration, were assigned by random allocation to receive either WHO-ORS or Amylyte-ORS. Data from 127 children were analyzed (57 received the WHO-ORS and 70 the Amylyte-ORS). Two children given Amylyte-ORS and 15 given the WHO-ORS were not included in the analysis because of improperly collected data or lost urine or fecal specimens. None were given antibiotics during the study. Free water and feeding were allowed after the children were rehydrated.

Results. The clinical characteristics of the children in the two treatment groups were comparable. Five children who received the WHO-ORS and three children given Amylyte-ORS were treatment failures. Amylyte-ORS reduced diarrhea duration by 15% (41.4 ± 2.5 vs 34.7 ± 1.8 hours; P < .03) compared to the WHO-ORS, regardless of the severity of dehydration. In the Amylyte-treated group, ORS requirements were significantly less (234 ± 15.2 vs 295 ± 17.6 mL/kg P < .01) and weight gain was significantly more (367.7 ± 45.1 vs 199.2 ± 38.2 g; P < .01) than in those given the WHO-ORS. The net intestinal fluid balance and total body fluid balance were similar in the two groups.

Conclusions. Amylyte-ORS efffectively rehydrates children with acute diarrhea, reduces diarrhea duration, decreases ORS requirements, and improves weight gain compared to the WHO-ORS.
Guidelines for the Ethical Conduct of Studies to Evaluate Drugs in Pediatric Populations
Authors:   Committee on Drugs
Published: December 2021

These guidelines are designed to provide a format allowing for the protection of child subjects in drug research. Research involving children carries with it additional responsibilities for the investigator, IRB, and sponsor. The additional responsibilities should not be reasons for the pharmaceutical company, IRB, or the investigator to exclude children from drug research and its potential benefits. It is hoped that these guidelines foster an increase in the number of drug investigations carried out in children, thereby improving their health care.

The AAP believes it is unethical to deny children appropriate access to existing and new therapeutic agents. It is the combined responsibility of the pediatric community, pharmaceutical industry, and regulatory agencies to conduct the necessary studies; it is the responsibility of the general public to support the necessary research in order to assure that all children have access to important medications and receive optimal drug therapy.
Medication Dispensing in Pediatric Office Practice
Authors:   Committee on Practice and Ambulatory Medicine
Published: December 2021

The changing practice of dispensing medication in pediatric offices needs ongoing evaluation to determine the extent to which patients' and practice's needs are being met. Research should assess the extent to which in-office dispensing enhances patient compliance and patient education or whether it increases or decreases patient medication errors. Pediatricians choosing to dispense medication should monitor such research carefully, review state and federal laws periodically, and evaluate recommendations from professional organizations.

The American Academy of Pediatrics holds that the practice of medication dispensing is acceptable and appropriate provided that it is legally permissible and that it is structured primarily to serve the best interests of the patient.
HOW TO PUT HYPED STUDY RESULTS UNDER A MICROSCOPE
Authors: L. J. F.
Published: December 2021

Every week medical science makes headlines with a promising new study or cure. Scientific reputations, corporate fortunes and a tide of human hopes rise and fall on such news. Studies can also stoke the general debate on this or that health benefit or risk.

Often it's hard to tell ephemeral findings from epochal breakthroughs...

A major problem arises when "things get taken out of context," says Oxford University professor Richard Peto.

When researchers tease out selective results from a small subgroup, funny results can pop up. You can prove just about anything by slicing and dicing the data. Here is Peto's Proof:

Taking a landmark study of 17 000 patients that proved aspirin as an effective treatment for heart attack, Dr. Peto shows you can reach a vastly different conclusion if you simply separate patients by their astrological sign. "Aspirin appeared totally ineffective for those born under Libra or Gemini," he concludes.
STUDIES REVEAL SUGGESTIBILITY OF VERY YOUNG WITNESSES
Authors: L. J. F.
Published: December 2021

The testimony of small children has usually been considered truthful unless proved otherwise. Over the past decade such testimony has led to convictions in many child abuse cases, and the younger the child, the less likely psychologists have thought it was that information could have been fabricated. But now a series of recent studies has turned this conventional wisdom on its head.

Researchers have found new evidence that persistent questioning can lead young children to describe elaborate accounts of events that never occurred, even when at first they denied them...

Children Concoct Stories

Certain techniques often used by investigators with young children increase the likelihood of false reports, the findings show. One is persistent, repeated questioning over periods of several weeks. When sexual abuse is suspected, children are typically asked the same questions by case workers, police investigators and to results of a study by Dr. Ceci and colleagues reported last month at a meeting on emotional memory at the University of Chicago.

In the study of children from 4 to 6, parents helped researchers make a list of two events that had occurred in each child's life and eight that had not. In weekly sessions, the researchers reviewed the list with each child, asking for each event, "Has this every happened to you?"...

...By the 11th week, 56 percent of children reported at least one false event as true, and some children reported all the false events as true, Dr. Ceci said.

"The more often you ask young children to think about something, the easier it becomes for them to make something up that they think is a memory," he said.
INTERNATIONAL LACTATION CONSULTANT ASSOCIATION ANNOUNCES 1996 MANUSCRIPT COMPETITION
Authors: Auerbach K. G.
Published: December 2021

The International Lactation Consultant Association is sponsoring a competition designed to identify outstanding manuscripts relating to human lactation or breast-feeding in 1996. Authors may enter one of two categories: a Literature Review competition or a Research Paper competition. The winner in each category will receive $500 (US currency); winning manuscripts will be published in the Journal of Human Lactation. Entrants need not be members of the International Lactation Consultant Association. Students are encouraged to enter.

Competition in the Research Paper competition is open to published on unpublished authors; the Literature Review competition is limited to currently unpublished authors. The postmark deadline for entry in the 1996 competition is January 5, 1996.

To obtain guidelines for submitting a manuscript for consideration in the competition, send a self-addressed (and stamped if US) envelope to:
United States Supreme Court Rules on Expert Testimony
Authors: McAbee Gary N.
Published: December 2021

Many medical and legal commentators have expressed concern about the validity of scientific evidence that is proffered by expert witnesses at depositions and in courts of law.1,2 The sparse research that is available on the testimony of medical expert witnesses suggests that it is frequently flawed and erroneous.3

On June 28, 1993, the United States (US) Supreme Court ruled on the proper standard for admissibility of scientific evidence in the courtroom.4 Although the ruling establishes guidelines that are binding only in federal courts, it is expected that many state courts will follow the Court's ruling. This commentary reviews the Court's guidelines for admissibility of expert testimony, and expresses concern about their applicability in future cases involving scientific testimony.
Letter to the Editor
Authors: Keith C. Gregory , Doyle Lex W.
Published: December 2021

We thank Drs Good et al for their interest in our recent article. We did not find any children blinded by cortical visual impairment, although one child was suspected to have this problem in infancy, only to improve later in childhood. That child also had cerebral palsy. The children in our study have been followed-up not only by the ophthalmologist, but the majority of them have also had their growth and development assessed by an experienced follow-up team.
A HOUSEWIFE IS CONVICTED OF MURDERING HER FIVE CHILDREN
Authors: L. J. F.
Published: December 2021

For nearly a quarter century, the fact that Waneta Hoyt, a housewife in rural New York, had lost five babies to sudden deaths was taken as medical evidence that sudden infant death syndrome (SIDS) had a genetic basis.

A leading SIDS expert, Dr Alfred Steinschneider, had studied Mrs. Hoyt's last two children, and in a pioneering research article in 1972 (Pediatrics, Vol 50, Number 4, page 646) he cited them as evidence that SIDS ran in families. His study offered hope that children at risk could be identified and saved.

But some doctors found the odds of five siblings dying of SIDS impossible. For years one skeptic, Dr Linda Norton, a forensic pathologist from Dallas, mentioned the case to every district attorney she met.

Finally, one of them, Robert Simpson, listened. In 1994, Mrs. Hoyt was confronted by state troopers, and she confessed to smothering the infants with a pillow to still their crying.

On Friday a jury in Tioga County, in upstate New York, accepted Mrs. Hoyt's belated explanation of her babies' deaths and convicted the 48-year-old woman of five murders.

Sudden infant death is real, but the import of multiple deaths can be badly misinterpreted. These deaths were certainly familial, "but not because of genetics," Dr Norton said. "It's because there was a murderer in the family."
Antibody Response of Low Birth Weight Infants to Haemophilus influenzae Type b Polyribosylribitol Phosphate-Outer Membrane Protein Conjugate Vaccine
Authors: Munoz Angel , Salvador Agnes , Brodsky Nancy L. , Arbeter Allan M. , Porat Rachel
Published: December 2021

Objective. To evaluate the effectiveness in low birth weight (LBW) infants of the currently recommended immunization schedule for conjugated Haemophilus influenzae type b (HIB) vaccine.

Methods. We quantified antibody responses in 36 preterm infants with a mean birth weight of 1060 g and a mean gestational age of 28 weeks. Infants were immunized with 0.5 mL of HIB vaccine at 2 and 4 months' postnatal age. Specific HIB antibodies were quantified on cord blood, immediately before each immunization and 2 months after the last immunization.

Results. Even though the geometric mean titers increased significantly during the study period, they were still markedly lower than values reported in term infants. After the second immunization, only 24 infants (67%) attained antibody concentrations of more than 0.25 µg/mL, defined as seropositivity. Also, only 53% of infants achieved antibody concentrations of more than 1.0 µg/mL compared with 92% as reported in term infants. Stepwise logistic regression identified gestational age of 27 weeks or less and the amount of intravenous immunoglobulin received as the significant variables influencing the antibody response after the first immunization. The incidence of side effects was negligible.

Conclusions. We conclude that LBW infants, and especially those born at 27 or less weeks' gestation, do not respond as effectively to the HIB vaccine. We speculate that reevaluation of the current immunization schedule may be required for very LBW infants.
Varicella Vaccine Guidelines
Authors: DiNicola Albert F.
Published: December 2021

The American Academy of Pediatrics' (AAP) recommendation1 to administer Varivax to patients lacking reliable histories of varicella infection is important. However, what constitutes a reliable history of previous vanicella infection? Because parents, at times, misinterpret the significance of their children's rashes; because studies2 suggest that 3% of children may be misdiagnosed as having chickenpox; and, because adolescents are at higher risk for severe complications to chickenpox, I would suggest that, in the 13 years and older age groups, one should err on the side of giving the Varivax immunization.
Teaching Deficit Disorder
Authors: Zeidner Daniel L.
Published: December 2021

It has become increasingly apparent to me, and perhaps to other pediatricians, that a new syndrome exists among adults who teach our school-aged children: Teaching Deficit Disorder, or TDD. I have observed that this diagnosis should be made on the teacher when the following classic signs and symptoms exist among one or more of his/her students: students who fidget in class constantly moving their fingers or legs, who do not pay attention, who frequently daydream, who do not complete their homework or classwork, and who frequently get out of their seats.
MEASLES, MUMPS, RUBELLA (MMR) VACCINE ADMINISTRATION IN EGG-SENSITIVE CHILDREN: SYSTEMIC REACTIONS DURING VACCINE DESENSITIZATION
Authors: Miller Betty
Published: December 2021

The authors advise that egg-allergic children should continue to have cutaneous tests done to the MMR vaccine, and careful observation during desensitization in those children with positive skin tests is advised.
EVIDENCE IN INFANTS WITH CLEFT PALATE THAT BREAST MILK PROTECTS AGAINST OTITIS MEDIA
Authors: Galant Stanley P.
Published: December 2021

Artificially fed breast milk provides variable protection against the development of otitis media in infants with cleft palate. The findings also suggest that, in infants with cleft palate, impaired eustachian tube function is not the only pathogenic factor in the development of MEE.
BRONCHIAL RESPONSIVENESS IN CHILDREN EXPOSED TO ATMOSPHERIC POLLUTION IN HONG KONG
Authors: Cvietusa Peter
Published: December 2021

The authors conclude that pollution appears to have an independent adverse effect on bronchial hyperreactivity. Population studies focusing on bronchial responsiveness can provide objective evidence that can be used to impact air quality control measures.
A CONTROLLED TRIAL OF INTRAVENOUS IMMUNE GLOBULIN FOR THE PREVENTION OF SERIOUS BACTERIAL INFECTIONS IN CHILDREN RECEIVING ZIDOVUDINE FOR ADVANCED HUMAN IMMUNODEFICIENCY VIRUS INFECTION
Authors: Fuentes David , Shearer William T.
Published: December 2021

Children with AIDS or AIDS-related complex receiving zidovudine have a decreased risk of bacterial infection when given IVIG. In this study, the benefit is most apparent in those not receiving trimethoprim- sulfamethoxazole prophylaxis.
CROSSOVER OF PLACEBO PATIENTS TO INTRAVENOUS IMMUNOGLOBULIN CONFIRMS EFFICACY FOR PROPHYLAXIS OF BACTERIAL INFECTIONS AND REDUCTION OF HOSPITALIZATIONS IN HUMAN IMMUNODEFICIENCY VIRUS-INFECTED CHILDREN
Authors: Alvarado Alan , Fuentes David , Shearer William T.
Published: December 2021

Monthly IVIG infusions reduced bacterial infections and hospitalizations in HIV-infected children. In this cohort, the benefit obtained from IVIG appeared to be independent of trimethopnim-sulfamethoxazole prophylaxis for PCP, and the benefit persisted for at least 3 years.
Parents' Attitudes Toward Firearm Injury Prevention Counseling in Urban Pediatric Clinics
Authors: Haught Karen , Grossman David , Connell Frederick
Published: December 2021

Objectives. To examine characteristics and experiences associated with gun ownership among parents of pediatric patients who attend urban pediatric clinics and to determine the receptivity of these parents to firearm injury prevention counseling.

Design. A focus group discussion was followed by a cross-sectional survey.

Setting. Four public pediatric clinics in a large metropolitan area were included.

Participants. A focus group discussion was held with parents and was used to develop the questionnaire, which was then distributed over a 6-week period to parents accompanying children to the clinic. The anonymous, self-administered questionnaire was completed by 510 parents or guardians, with an 88% response rate.

Results. Twenty percent of respondents reported that they had a firearm in the home. Twenty-seven percent of respondents had experienced having a family member shot. Eighty-two percent of all respondents indicated that they would find information about the safest way to store a gun helpful or very helpful. Of all respondents, 47% would follow and an additional 37% would think over a provider's advice not to keep guns in the home. Gun owners were less inclined to report that they would follow this advice (19%), but 55% of the gun owners would think over this advice. Only 6% of all respondents reported that they would ignore or be offended by such advice.

Conclusions. Children attending public urban pediatric clinics are exposed to guns in their homes, and their parents appear to be receptive to firearm injury prevention counseling from their child's health care providers.
Isolated Spinal Cord Injury as a Presentation of Child Abuse
Authors: Piatt Joseph H. , Steinberg Mary
Published: December 2021

Many, if not most, instances of severe head trauma in infancy are attributable to child abuse. Thorough post mortem examination demonstrates upper cervical spinal cord lesions in a substantial fraction of infants who die of their head injuries,1 but these spinal cord injuries are seldom recognized ante mortem. Spinal column fractures have been described as incidental findings in the setting of child abuse, but they are seldom apparent clinically.2 Spinal cord injury without spinal fracture and without head injury is a rare presentation of child abuse, and the true nature of this syndrome may escape recognition unless other characteristic signs of abuse are detected.
The Role of Dietary Fiber in the Development and Treatment of Childhood Obesity
Authors: Kimm Sue Y. S.
Published: December 2021

Childhood obesity is viewed as a public health problem in the United States because of its assumed high prevalence and increasing secular trend. The best estimate of the genetic contribution to obesity ranges from 5% to 25%. Environmental factors play a major role in obesity development. Low income and a low level of education have been associated with obesity, particularly among white women. Caloric intake as a risk factor for obesity has not been clearly established. This lack of a clear-cut association may be attributable to the problem of accurately measuring caloric intake. Several studies have linked increased total fat intake, rather than caloric intake, with obesity. Some studies have linked television viewing to obesity in children.

Obesity is rare among the populations of developing countries, where dietary fiber intake is high. Explanations for the role of dietary fiber in obesity include a reduced caloric density of the foods, a slower rate of food ingestion, and possible effects on satiety. Most studies on the role of fiber in the treatment of obesity have been somewhat limited by lack of comparison groups, inadequate sample sizes, and short durations of the observations. However, although limited, the available evidence suggests that fiber potentially could play a useful role in weight reduction. For children, fiber administration should be considered as an adjuvant therapy rather than a primary modality, because fiber might aid in promoting satiety during meals and curbing hunger between meals. More research is needed, however, to assess further the efficacy of high-fiber diets in the treatment of childhood obesity. For now, however, increasing dietary fiber as a part of a health-promoting dietary pattern presents an attractive public health possibility as a means for prevention of chronic diseases. Preventing childhood obesity could be a part of the health benefit resulting from a population-based recommendation for optimal fiber intake.
Fiber in the Diet of US Children: Results of National Surveys
Authors: Saldanha Leila G.
Published: December 2021

Objective. Because fiber intake among children in the United States is poorly documented, our objectives were to determine intakes and sources of fiber in the diets of children 2 to 18 years of age and to examine the trends.

Methods. We used the US Department of Agriculture's 1977 to 1978 and 1987 to 1988 Nationwide Food Consumption Surveys for our analysis. Children were classified by age and gender groups, 2 to 5 years, 6 to 11 years, boys 12 to 18 years, and girls 12 to 18 years. The percentages of children meeting the American Health Foundation's fiber recommendations for children were also determined.

Results. Analyses of the US Department of Agriculture's 1977-1978 and 1987-1988 survey data indicate that (1) large percentages (55% to 90%) of children are not meeting minimum fiber intake recommendations established by the American Health Foundation; (2) mean fiber intakes declined between 1977-1978 and 1987-1988; (3) fiber from fruits and vegetables declined during this period; and (4) fiber from grains, especially from ready-to-eat breakfast cereals, increased significantly. The results also show that eating breakfast contributes to meeting daily fiber recommendations.

Conclusions. Given the importance of fiber in promoting optimum gastrointestinal function in childhood and in treating chronic diseases such as heart disease, diabetes, and cancer in adulthood, the trends documented in this article are disturbing and suggest that efforts are needed to encourage the consumption of fiber-rich foods among children.