bluuebunny/crossref_metadata_2025 huggingface dataset:
Fecal Coliform Contamination in Child Day-Care Centers
Authors: Holaday Bonnie , Pantell Robert , Lewis Catherine , Gilliss Catherine
Published: December 2021

Enteropathogens associated with outbreaks of diarrhea in child day-care centers can be spread by the fecal-oral route through hands or environmental objects that are contaminated. The purpose of this study was to determine the prevalence of fecal coliform contamination in day-care centers. During a 6-month period, on four separate occasions, cultures were taken from environmental surfaces and the hands of children and teachers at six licensed day-care centers. Fecal coliforms were recovered from 64 (9.5%) of the 675 surfaces sampled. Recovery rate was not influenced by the socioeconomic status of the clientele, time of year, or presence of children who were not toilet trained. All children wore paper diapers. Recovery rates did differ significantly for different areas: the kitchen showed a relatively high recovery rate (19%), and toys and toilets showed remarkably low rates (2% and 4%, respectively). Centers with formal hand-washing procedures had lower recovery rates than those without such practices. We also demonstrated a high recovery rate from hands of staff (16%); 6% of cultures taken from children's hands were positive. Contamination of hands and classroom objects is a potential source for transmitting enteric diseases among children in day-care centers.
Hand Washing and Infection Control in Day-Care Centers
Authors: Soto Julio C. , Guy Micheline , Belanger Lise
Published: December 2021

To assure maximum and permanent efficacy of handwashing a suitable technique should be offered within a comprehensive health-education program.
Environmental Factors to Consider When Designing and Maintaining a Child's Day-Care Environment
Authors: Staes Catherine , Balk Sophie , Ford Kathleen , Passantino Richard J. , Torrice Antonio
Published: December 2021

While each panel participant approached the issue of environmental quality from a different viewpoint, they all agreed that children differ from adults with respect to their susceptibility to and interactions with their environment. Also, these differences must be considered when people create environments for child care. More research is needed to answer many important questions. Many hazards can be prevented or controlled, if recognized, and early childhood development can be enhanced through informed decisions made during the design and maintenance of CCCs. People from disciplines of public health, architecture, and interior design must work together to provide healthy and stimulating environments for our nation's children.
Managing Stress and Burnout at Work: A Cognitive Group Intervention Program for Directors of Day-Care Centers
Authors: Kushnir Talma , Milbauer Varda
Published: December 2021

There is considerable epidemiological evidence that occupational stress contributes to the etiology and expression of a wide variety of health and behavior outcomes such as cardiovascular disease morbidity and mortality, immunological processes, psychosomatic impairment, and affective disorders.1 As much as 60% of absence from work may be stress related.2 Recently, occupational burnout was found to be correlated with health problems ranging in severity from increased frequency of upper respiratory infections2 to increased risk for cardiovascular diseases.3 Such findings constitute the rationale for including stress- and burnout-prevention efforts in many health-promotion models. This paper describes a stress- and burnout-prevention workshop focusing on psychological coping skills for directors of child day-care centers. As far as we could tell, this program, which took place in Israel in 1991, was the only reported program within this particular work setting.

Directing a day-care center is highly demanding, entailing full responsibility for the effective functioning and well-being of staff and children. In Israel, this may amount to about 20 care givers and as many as 140 infants and children under 4 years of age. The centers, often geared to cater for young newcomers from developing countries and children from socially deprived neighborhoods, are open 8 to 9 hours a day, 6 days per week. Because the director has educational and administrative functions, she is closely supervised by two supervisors who frequently issue conflicting instructions. She also coordinates routinely with many governmental agencies and maintains close contact with parents. The job thus requires intense involvement with people, a feature that has been recognized as a major source of occupational burnout.4
The Science Behind the American Public Health Association/American Academy of Pediatrics National Health and Safety Guidelines for Child-Care Programs
Authors: Aronson Susan S.
Published: December 2021

THE DEVELOPMENT OF THE APHA/AAP STANDARDS

In 1992, the American Public Health Association (APHA) and the American Academy of Pediatrics (AAP) published the long-awaited Caring for Our Children—National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs.1 This publication was the product of a 4-year effort involving many experts in child health and safety and day-care providers. The standards document provides a national consensus on approaches to reducing diseases and injury and promoting prevention among children and providers in group-care settings.

Consumer protection initiatives are needed because market-place forces are inadequate to ensure a health environment for children in child care. Over the past two decades, a growing number of investigators have documented the increased occurrence of infectious diseases2-4 and injuries,5-7 and missed opportunities for health protection and promotion in child care.8 Despite the tendency to focus on reports of negative health outcomes, children and families thrive in early childhood programs that provide safe, nurturing care and developmentally appropriate education. Day-to-day excellence in child care depends on committed, well-educated care givers who work in a child-friendly and staff-friendly environment.

In the US, good child care is limited. Few parents can afford the full cost of care. Most lack the knowledge, skills, or objectivity to critically evaluate the care they choose for their children. Convenience, availability, and affordability motivate parents when they choose child care. Parents are pressured to meet occupational expectations, and tend to overlook significant risks in their children's child-care arrangements. Even parents who are pediatricians (who are expected to be well-versed in child development, health, and safety) ignore hazards and poor quality when rating convenient and available child-care arrangements (Aronson S, unpublished data).
Triglyceride and High-Density Lipoprotein Cholesterol: Predicting Disorders in Parents From Their Children
Authors: Polonsky Sheldon M. , Simbartl Loretta A. , Sprecher Dennis L.
Published: December 2021

Objective. To determine whether lipid disorders can be predicted in parents after such disorders are identified initially in their children. Although this relation has been well determined for children with high cholesterol or low-density lipoprotein cholesterol (LDL-C), it has not been as well described for disorders involving triglycerides (TG) or high-density lipoprotein cholesterol (HDL-C), or their interaction with LDL-C.

Methods. Serum lipid values were obtained from 232 families in the comparison population of a large genetics study. Subjects were classified into four groups based on their lipid status: 1) isolated LDL-C disorder, defined by a high LDL-C level and normal TG and HDL-C levels; 2) isolated TG/HDL-C disorder, defined by either high TG, low HDL-C, or both, and normal LDL-C; 3) combined disorder, defined by high LDL-C in addition to either high TG, low HDL-C, or both; and 4) normal, defined by the absence of any of the above disorders. The frequencies of these disorders were noted in both parents and children, and logistic regression analyses were conducted to determine whether the presence of these disorders in at least one child in the family could predict similar disorders in the parents.

Results. Children with isolated LDL-C or TG/HDL-C disorder were more likely to have parents with the same disorder as themselves (P = .002 and P = .04, respectively). Children with the combined disorder were more likely to have parents with any lipid disorder (P = .009), but especially isolated LDL-C (P = .002) and isolated TG/HDL-C (P = .05).

Conclusion. A classification scheme defining disorders of TG and HDL-C, LDL-C, or a combination can be useful for predicting lipid disorders in parents after such disorders are identified initially in their children.
Serologic, Virologic, and Histologic Characteristics of Chronic Phase Hepatitis C Virus Disease in Children Infected by Transfusion
Authors: Matsuoka Suguru , Tatara Katsuyoshi , Hayabuchi Yasunobu , Taguchi Yoshiyuki , Mori Kazuhiro , Kuroda Yasuhiro , Honda Hirohito , Itou Susumu , Yuasa Yasuto
Published: December 2021

Objective. We studied the time course of hepatic dysfunction, seropositivity to hepatitis C virus (HCV) antibodies, viremia, and histologic evidence of hepatic injury to evaluate the course of HCV infection in children infected by blood transfusion.

Patients and methods. Twenty-nine patients (ages 4 to 18 years) who underwent open-heart surgeries for congenital heart disease were grouped into three categories based on alterations in serum alanine aminotransferase (ALT) levels: Group A, acute infection; Group B, subacute infection; and Group C, chronic infection.

Results. In Group C, all 13 patients had detectable HCV RNA in serum. In contrast, all patients in Group A had no detectable HCV RNA. In Group B, one of nine patients had detectable HCV RNA and two of four patients examined had persistent chronic hepatitis by histologic criteria. Antibodies directed against C100-3 antigen or core-antigen were more useful than second-generation HCV antibody assays in determining the relationship between viremia and immunologic response. Infection with HCV genotype II and the presence of higher HCV RNA copy numbers were associated with histologic evidence of hepatic damage.

Conclusion. An abnormal ALT value is frequently associated with viremia, and biochemically resolved acute infection reflects clearance of HCV. However, a normal ALT does not always reflect an absence of hepatocyte damage and HCV replication in patients with subacute disease. The measures outlined in this study are useful indicators of disease activity during the chronic phase of post-transfusion HCV infection.
Reduction of Elevated LDL-Cholesterol Levels of 4- to 10-Year-Old Children Through Home-Based Dietary Education
Authors: Shannon Barbara M. , Martel Juliann K. , Achterberg Cheryl L. , Smiciklas-Wright Helen S. , Tershakovec Andrew M. , Cortner Jean A. , Stallings Virginia A. , Stolley Paul D.
Published: December 2021

Objective. To assess the effects of a home-based, parent-child autotutorial (PCAT) dietary education program on the dietary knowledge, lipid consumption, and plasma low density lipoprotein-cholesterol (LDL-C) of 4- to 10-year-old children with elevated plasma LDL-C.

Methods. "At-risk" children (screening total cholesterol, (TC), exceeded 4.55 mmol/L and average LDL-C from two fasting samples was between 2.77 and 4.24 mmol/L for boys or 2.90 and 4.24 mmol/L for girls) were randomized to the PCAT program (N = 88), for dietary counseling with a registered dietitian (N = 86), or to an at-risk control group (N = 87). Dietary knowledge, diet, and LDL-C of these groups were assessed at baseline and after the educational period (3-month follow-up). The knowledge and diet of a not-at-risk (TC below 4.22 and 4.34 mmol/L for boys and girls, respectively) control group (N = 81) was also assessed and compared with that of the at-risk control group.

Results. At the 3-month follow-up, the PCAT children's knowledge scores had increased three times more than those of the counseling and at-risk control groups (P < .001). Mean grams of total and saturated fat consumed by PCAT and counseling groups declined while that of the at-risk control group increased slightly; these differences were significant (P < .05). The mean LDL-C decline of the PCAT group was significantly different (P < .05) from the decline of the at-risk control group (0.26 vs 0.09 mmol/L), and approached significance (P = .07) when compared with that of the counseling group (0.26 vs 0.11 mmol/L). The at-risk control group's knowledge and diet did not differ from that of the not-at-risk group.

Conclusion. The PCAT program offers a mechanism for providing effective dietary education to children with elevated cholesterol and to their families.
Prenatal Detection of Neuroblastoma—A Noninvasive Approach
Authors: Morgan Elaine
Published: December 2021

In the September 1993 issue of Pediatrics, Ho et al presented the experience of the Dana-Farber Cancer Institute in the management and outcome of 11 infants with neuroblastoma detected by prenatal ultrasound.1 Those patients demonstrated favorable biology and were managed with operative resection. One patient with progressive disease responded to chemotherapy. All patients had a good outcome.

I have similarly reported one patient with prenatally detected neuroblastoma managed at Children's Memorial Hospital in Chicago. This patient is being reported with two additional cases in association with Drs Saylors, Cohn, and Brodeur.2
Lidocaine Adrenaline Tetracaine Gel Versus Tetracaine Adrenaline Cocaine Gel for Topical Anesthesia in Linear Scalp and Facial Lacerations in Children Aged 5 to 17 Years
Authors: Ernst Amy A , Marvez Eduardo , Nick Todd G. , Chin Eric , Wood Edmond , Gonzaba W. Thomas
Published: December 2021

Study objective. The purpose of the present study is to compare LAT gel (4% lidocaine, 1:2000 adrenaline, 0.5% tetracaine) to TAC gel (0.5% tetracaine, 1:2000 adrenaline, 11.8% cocaine) for efficacy, side effects, and costs in children aged 5 to 17 years with facial or scalp lacerations.

Design. Randomized, prospective, double-blinded clinical trial.

Setting. Inner-city Emergency Department with an Emergency Medicine residency program.

Patients or other participants. Children aged 5 to 17 years with linear lacerations of the face or scalp.

Intervention. After informed consent was obtained patients had lacerations anesthetized with topical TAC or LAT gel according to a random numbers table.

Measurements and main results. A total of 95 patients were included in the statistical analysis with 47 receiving TAC and 48 receiving LAT. Physicians and patients/parents separately rated the overall pain of suturing using a modified multidimensional scale for pain assessment specifically for children. Patients/parents also stated the number of sutures causing pain. The power of the study to determine a ranked sum difference of 15 was 0.8. Multidimensional rating scale results and number and percentage of sutures causing pain were compared using Wilcoxon's rank sum test. According to patients no difference could be detected in percent of sutures causing pain in the LAT versus TAC group (P = .51). Using the multidimensional scale, physicians and patients/parents found LAT statistically the same as TAC in effectiveness (P = .80 for physicians and P = .71 for patients). Cost per application was $3.00 for LAT compared to $35.00 for TAC. Follow-up was accomplished in 85 of 95 participants in the study with no reported complications for either medication.

Conclusion. LAT gel worked as well as TAC gel for topical anesthesia in facial and scalp lacerations. Considering the advantages of a noncontrolled substance and less expense, LAT gel appears to be better suited than TAC gel for topical anesthesia in laceration repair in children.
Letters to the Editor
Authors: Kattwinkel John
Published: December 2021

Dr Schrager identifies a real black cloud that pervades the practice of medicine–the irresponsible expert witness. The testimony of such individuals, which may lead to the inappropriate destruction of a responsible physician's career, is all too frequently buried within the confines of a courtroom or the untranscribed records of an individual case and thus is seldom exposed. Such isolation tends to encourage the witness to testify yet again, perhaps even more irresponsibly.

Unfortunately, there are insufficient details to determine if Dr Schrager's case is an example of such irresponsibility.
Cost Implications of Event Recordings In Apnea/Bradycardia Home Monitoring: A Theoretical Analysis
Authors: Steinschneider Alfred , Santos Vicki , Freed Gary
Published: December 2021

Objectives. To evaluate the financial impact of incorporating event recordings as an integral component of home apnea/bradycardia monitoring.

Study design. This theoretical analysis examines the cost of home monitoring when medical decisions are based on an evaluation of the cardiorespiratory wave-forms surrounding each apnea/bradycardia monitor alarm (documented monitoring) compared to those based on parental observations. Data for both approaches were obtained from 155 infants referred within the first 10 days of life, because a sibling died of sudden infant death syndrome. All were followed on an impedance type apnea/bradycardia monitor with an attached event recorder. The monitor settings were 20 seconds for apnea and 80 beats per minute (bpm) for bradycardia. Parents were taught how to use the equipment, resuscitative techniques, and to complete an alarm log. The clinical protocol provided for home monitoring until there were no "episodes" (prolonged apnea or prolonged bradycardia) for 16 consecutive weeks. A polysomnogram would be obtained if an "episode" occurred. For each infant two independent approaches were used to judge the occurrence of an "episode": (1) parental report of an apnea alarm occurring during sleep or a physiologic alarm associated with skin color change or resuscitative intervention and (2) apnea ≥ 20 seconds long or bradycardia ≥ 10 seconds. The cost was calculated assuming a 4-week monitor rental fee of $350, a 4-week waveform interpretation fee of $180, and a $600 fee for performing and interpreting a polysomnogram.

Results. Episodes defined from an interpretation of the cardiorespiratory waveforms resulted in fewer diagnostic studies, a shorter period of home monitoring, and lower per patient treatment costs.

Conclusion. Despite the increased monthly cost, incorporating event recordings as an integral component of home monitoring resulted in a lower average per patient cost.
What is a Grandmother? (Written by a 9-year-old)
Authors: Riess G. R.
Published: December 2021

"A grandmother is a lady who has no children of her own, so she likes other people's little boys and girls. A grandfather is a man grandmother.

Grandmas don't have to do anything except be there. They're old, so they shouldn't play hard or run. It is enough if they drive us to the market where the pretend horse is and have lots of dimes ready. Usually grandmas are fat, but not too fat to tie kids' shoes. They wear glasses and they can take their teeth out and gums off! They don't have to be smart ... only answer questions like why dogs chase cats and how come God isn't married? They don't talk Baby Talk like visitors do because it is hard to understand and when they read to us they don't skip words or mind if it is the same story over and over again.

Everyone should try to have a Grandma especially if they don't have a television, because grandmothers are the only grownups who really ever seem to have any time for children!"
Driveway-Related Child Pedestrian Injuries: A Case-Control Study
Authors: Roberts Ian , Norton Robyn , Jackson Rodney
Published: December 2021

Objectives. To examine risk factors for driveway-related child pedestrian injuries.

Design. A community based case-control study.

Setting. The Auckland region of New Zealand.

Participants. Cases (n = 53) were children killed or hospitalized as a result of a driveway-related pedestrian injury, in the Auckland region over a period of 2 years and 2 months. Controls (n = 159) were an age-matched random sample of the child population of the Auckland region.

Results. The absence of physical separation of the driveway from the children's play area was associated with a threefold increase in the risk of driveway-related child pedestrian injury (OR = 3.50; 95% CI 1.38, 8.92). Children living in homes with shared driveways were also at significantly increased risk (OR = 3.24; 95% CI 1.22, 8.63). The population attributable risk associated with the absence of physical separation of the driveway from the children's play area was 50.0% (95% CI 24.7, 75.3).

Conclusion. The fencing of residential driveways as a strategy for the prevention of driveway-related child pedestrian injuries deserves further attention.
DOCTORS DENOUNCE US GUIDELINES ON DRUGS TO TREAT HIGH BLOOD PRESSURE
Authors: L. J. F.
Published: December 2021

A group of blood pressure experts launched an effort to overturn US guidelines on which drugs doctors should use to treat high blood pressure.

The seven experts attacked the recommendations of a National Institutes of Health advisory panel that doctors should first try treating patients with either a diuretic drug, which rids blood of excess water, or a so-called beta-blocker, which cuts the heart's pumping pressure.

The experts charged the recommendations theaten to hamstring doctors in their choice of drugs for high blood pressure patients, discouraging particularly the use of newer classes of drugs called ACE inhibitors and calcium-channel blockers. These drugs may work better and with fewer side effects and doctors should feel free to tailor their choice of drugs to each patient, they argued.

Four of the seven experts attacked the guidelines at a news conference in Dallas during the annual meeting of the American Heart Association. The news conference, which wasn't part of the meeting, coincided with publication of the October issue of the American Journal of Hypertension, edited by Dr. John H. Laragh, head of the cardiovascular center at New York Hospital. The Journal carries articles and editorials denouncing the guidelines.
Pediatric Equestrian Injuries: Assessing The Impact of Helmet Use
Authors: Bond G. Randall , Christoph Richard A. , Rodgers Bradley M.
Published: December 2021

Objective. To assess the impact of helmet use on the pattern, and severity of pediatric equestrian injuries.

Design. A prospective observational study of all children less than 15 years of age who were brought to the University of Virginia children's Emergency Department with horse-related injuries.

Results. During the two-year period of the study, 32 children were evaluated. Two children were injured when a horse stepped on them. Thirty children fell from or were thrown from a horse. Of these, 20 were wearing a helmet. Head injuries were more frequent in those patients not wearing helmets. The mean Modified Injury Severity Scale (MISS) score for riders without a helmet (12.9) was significantly higher (more severe) than that for helmeted riders (2.8). All three patients with a Glascow Coma Score <15 on arrival were not wearing a helmet at the time of injury. The frequency of hospitalization was significantly higher for those not wearing a helmet. Compared with other common mechanisms of childhood injury the mean Modified Injury Severity Scale score of injured riders was exceeded only by that of pedestrians struck by a car.

Conclusion. Equestrian injuries are more severe than those suffered from other common pediatric mechanisms. Helmet use is associated with decreased frequency and severity of central nervous system injury.
FDA APPROVES FIRST VACCINE TO PREVENT HEPATITIS A INFECTION
Authors: L. J. F.
Published: December 2021

Federal health officials yesterday licensed the first vaccine in the United States to prevent hepatitis A, a serious and common viral liver infection.

The Food and Drug Administration said it gave SmithKline Beecham P.L.C. approval to sell the vaccine. The company said it would begin distributing the vaccine, Havrix, in the next several weeks.

The United States was the 41st country to license Havrix. An FDA spokeswoman said the agency wanted to be sure that the vaccine caused no significant adverse effects. An estimated 1.3 million people in Europe and Asia have received Havrix since 1991.
Reappraisal of Lytic Cocktail/Demerol, Phenergan, and Thorazine (DPT) for the Sedation of Children
Authors:   Committee on Drugs
Published: December 2021

This Policy Statement was retired January 2005.

The DPT lytic cocktail remains a widely used sedative and analgesic for pediatric patients. Neither the combination itself nor its dosage is based on sound pharmacologic data. There is a high rate of therapeutic failure as well as a high rate of serious adverse reactions, including respiratory depression and death, associated with its use.

Even when it is effective, DPT appears to lack many of the desirable characteristics of a sedative for children. Specifically, the dose cannot be titrated easily and individually, the onset of action is significantly delayed (20 to 30 minutes), the duration of sedation is protracted (5 to 20 hours), the duration of analgesia is much shorter (1 to 3 hours), and no anxiolytic or amnestic properties exist.
Why Do Physicians Have So Much Difficulty With The English Language?
Authors: Albersheim Susan G.
Published: December 2021

Reflecting on the 1994 meeting of the Society for Pediatrics Research (SPR), one thought that disturbs me is the difficulty that we as physicians have with the use/misuse of language. I do not mean the obvious errors in the use of words. Rather it is both how we use language to influence opinion and our use of euphemisms. First, I want to elaborate on how, in practice, language influences opinion; how the words chosen to express our thoughts may have an unintentional potential to influence practice.
IMMUNOTHERAPY AS A TREATMENT OF AMERICAN CUTANEOUS LEISHMANIASIS: PRELIMINARY STUDIES IN BRAZIL
Authors: Mayrink W. , Magalhaes P. A. , Michalick M. S.M.
Published: December 2021

Treatment of American cutaneous leishmaniasis has been successful with antimony compounds for 80 years. There are certain conditions where the chemotherapy cannot be used—pregnant women and patients with heart or renal disease. A group in Brazil carried out a sequential trial (not a random controlled trial) of vaccine composed of killed parasites from five stocks of the leishmania, while another group received the traditional therapy of antimony. The immunotherapy program was intensive requiring 10 daily injections followed by a 10-day free period. Of 62 patients (aged 3 to 70 years) so treated, 47 (76%) were considered clinically cured; 41 required 2-10 of the 10-day treatment courses; and the other 6 required 11-19 courses. There were no adverse effects. Results were better in patients with single cutaneous and multiple cutaneous lesions, and less effective in those patients with mucocutaneous lesions.

The authors make the point that because leishmaniasis occurs especially in rural areas, it would be possible to give patients a supply of syringes and vials and have self-administration at home, whereas, with the antimony treatment, close supervision of patients is necessary.
Slow Prepubertal Linear Growth but Early Pubertal Growth Spurt in Patients With Shunted Hydrocephalus
Authors: Löppönen Tuija , Saukkonen Anna-Liisa , Serlo Willy , Lanning Peter , Knip Mikael
Published: December 2021

Objective. To evaluate growth and to compare anthropometric measures and the degree of physical maturation in children with shunted hydrocephalus with those in healthy children.

Methods. One hundred fourteen patients (62 male) and 73 healthy subjects (38 male) 5 to 20 years of age were analyzed for growth data and current auxology, stage of puberty, and bone age.

Results. Boys with hydrocephalus were shorter than control boys during their first 8 years of age, and no catch-up growth was observed until puberty. Girls with hydrocephalus were of the same size at birth as the control girls, but their linear growth retarded during the first years of life, leading to reduced relative height between the age of 5 to 8 years. The pubertal growth spurt occurred earlier in boys with hydrocephalus (age at midgrowth spurt, 12.1 vs 13.3 years), and a similar trend was seen in girls (10.0 vs 10.7 years). The final height was again reduced, especially in boys. Patients with hydrocephalus were more obese than control subjects, girls more often than boys. Relative bone age was retarded in prepubertal (-0.42 vs 0.32 SD) and accelerated in pubertal patients (0.54 vs -0.19 SD).

Conclusions. Children with hydrocephalus experience slow linear growth in prepuberty, but they have an earlier adolescent growth spurt. Together these factors result in a reduced final height. An increase in relative weight emerges in the preadolescent period, and this phenomenon is accentuated after puberty, leading to an increased prevalence of obesity.
Foreign Bodies of the Lower Airway: Sunflower Seed Alert!
Authors: Isaacson Glenn
Published: December 2021

Jackson and Jackson,1 in their landmark text, describe over 3000 foreign bodies of the air and food passages removed during their careers. Of these, 565 were vegetative and from the tracheobronchial tree. In their detailed list of foreign body types, sunflower seeds are not mentioned. A review of airway foreign bodies removed from children in the last 4 years at St. Christopher's Hospital for Children, the Jacksons' main operative hospital for children, showed a remarkable change.
Letters to the Editor
Authors: Kohl Steve
Published: December 2021

Dr DiNicola raises several important points concerning the new varicella vaccine. He questions the reliability of a positive history of chickenpox to be used to exclude an adolescent from receiving the vaccine. Several studies in adults (who usually do not have the benefit of parents' memories) have documented that a positive history of chickenpox is highly predictive of serologic immunity (97% to 99%).1-5 Only 10% of varicella occurs in individuals over 15 years of age.
QUANTIFICATION OF OCCUPATIONAL LATEX AEROALLERGENS IN A MEDICAL CENTER
Authors: Fischer Thomas
Published: December 2021

Measures to control exposure to latex can be monitored by area and personal air sampling with immunochemical approaches. Because of the increasing risk to health care professionals exposed to latex, the use of gloves with low allergen content or powder-free gloves appear to be most effective in reducing latex aeroallergen levels.
EXTRACTABLE LATEX ALLERGENS AND PROTEINS IN DISPOSABLE MEDICAL GLOVES AND OTHER RUBBER PRODUCTS
Authors: Sachs Martin I.
Published: December 2021

The allergen content of disposable rubber gloves varies widely and is higher in powdered gloves than powder-free gloves. It is also higher in examination gloves than in surgical gloves. Hypoallergenic gloves may contain significant amounts of immunoglobulin E (IgE)-binding latex proteins. Gloves and toy balloons appear to be more important sources of rubber allergens than condoms, rebreathing anesthesia devices, baby pacifiers, and various special infant nipple products.
ABOLITION OF ANAPHYLAXIS BY TARGETED DISRUPTION OF THE HIGH-AFFINITY IMMUNOGLOBULIN E (IgE) RECEPTOR α CHAIN
Authors: May Kathleen , Liu Andrew
Published: December 2021

Absence of the high-affinity IgE receptor in mice does not alter mast cell development or numbers, but completely protects these mice from IgE-mediated anaphylaxis. Therefore, it can be surmised that the high-affinity IgE receptor is necessary for allergic anaphylaxis (inmice).
FAMILY DYSFUNCTION IN ASTHMA—A PROSPECTIVE STUDY OF ILLNESS DEVELOPMENT
Authors: Randolph Christopher
Published: December 2021

Dysfunctional family interplay appears to be the result rather than the cause of wheezing in infancy.
Association Between Postpartum Substance Use and Depressive Symptoms, Stress, and Social Support in Adolescent Mothers
Authors: Barnet Beth , Duggan Anne K. , Wilson Michele D. , Joffe Alain
Published: December 2021

Objective. Substance use by pregnant teenagers is an important public health problem, but published data on alcohol and illicit drug use by parenting teenagers are virtually nonexistent. This study determined the prevalence of alcohol and drug use in adolescent mothers in the first 4 months postpartum and explored associated psychosocial characteristics.

Methods. Teenagers attending a comprehensive adolescent pregnancy and parenting program were enrolled consecutively during a routine third trimester prenatal visit. Alcohol use since delivery was determined by self-report at 4 months postpartum using an instrument developed for the 1984 Survey of Drug Abuse Among Maryland Adolescents. Illicit drug use was measured with anonymous quantitative urine drug screens at 2 and 4 months postpartum. Depressive symptoms, stress, and social support were assessed at 2 and 4 months postpartum using validated, self-administered instruments. Differences in demographic characteristics, peer group influences, and psychosocial variables between substance users and nonusers were evaluated.

Results. Participants (125/129 eligible) were predominantly African-American, mean age 16.3 years. Completed assessments were obtained from 110 at 2 months and 105 at 4 months postpartum. Forty-two percent screened positive for illicit drugs at a postpartum visit or reported using alcohol since delivering their baby and were classified as substance users. Thirty-one percent of subjects reported alcohol use since delivery. Marijuana was the most prevalent illicit drug (14%), followed by opiates (5%), and cocaine (4%). When substance users were compared with nonusers, 44% versus 24% scored depressed (P = .02), 62% versus 43% had high stress (P = .04), and 62% versus 44% reported a high need for social support (P = .07). Results of logistic regression, after controlling for age, indicated that illicit substance and/or alcohol use was 3.3 times greater for those who were depressed, 2.8 times greater if they reported friends' using illicit drugs, and 6.7 times greater if the adolescent reported smoking cigarettes since delivery.

Conclusions. This study indicates that alcohol and drug use are common among this sample of postpartum teenage mothers and that depression, stress, high support need, and peer group drug use are associated factors. Although this study cannot determine whether depression and stress precede or result from use of substances, attention to these factors appears warranted in the care of adolescent mothers.
Response to Dr Stone
Authors: Pearson Howard A.
Published: December 2021

Dr Elsa Stone, in her usual organized and lucid fashion, has presented the case for inclusion of pediatric nurse practitioners (PNPs) in private pediatric practices. She bases her conclusions on her nearly 10 years of positive experience with a PNP in her own practice in Connecticut. Dr Stone describes the PNP population and demography, describes the training curriculum of PNPs, and discusses the scope of work of these individuals. She concludes that "there is substantial evidence that PNPs provide quality health care and that collaborative teams of pediatricians and PNPs can provide high-quality, cost-effective care to a broader spectrum of children than can be served by either profession alone."

The American Academy of Pediatrics (AAP) has insisted for several years that there is a shortage of pediatricians to meet the expanding needs of the children of the United States. Furthermore, pediatricians—because of system changes—will be expected increasingly to provide a variety of time-intensive services. Dr Stone believes that many of these services can be well provided by PNPs.

Within the AAP, there have been some concerns about the role of PNPs. Of particular worry seems to be the possibility that PNPs might decide to practice independently, leading to a lower quality of care for their patients. Less often stated, but clearly an issue, is that PNPs are viewed by some pediatricians as potential competitors. Dr Stone's demographic analysis of what PNPs are currently doing is relevant to these concerns. One third of PNPs work in private pediatric practices or health maintenance organizations.
Dietary Fiber Intake of Children: The Bogalusa Heart Study
Authors: Nicklas Theresa A. , Myers Leann , Berenson Gerald S.
Published: December 2021

Age and secular trends in dietary fiber intake of children were examined using the 24-hour dietary recall method. Dietary fiber intake of five cohorts of 1O-year-olds (n = 1254); two cohorts of 13-year-olds (n = 360); and children ages 10 (n = 767), 13 (n = 249), 15 (n = 108), and 17 (n = 89) years was examined from 1976 to 1988. Total dietary fiber intake remained unchanged from 1976 to 1988, even after adjusting for energy intake; averaging 12 or 5 g/1000 calories (kcal). Black children had higher fiber intakes per 1000 kcal than white children from ages 10 to 17 years. Consumption of vegetables and/or soups and breads and/or cereals accounted for 53% (10 years) to 70% (13 years) of the total fiber consumed. When children were stratified into quartiles based on fiber intake per 1000 kcal, the percent of energy from total fat and saturated fat was lower, and the percent of energy from carbohydrates was higher in children with higher fiber intakes per 1000 kcal. Additional studies are needed to document dietary fiber intakes of children and their impact on overall diet composition and cardiovascular risk factors.
An Investigation Into Why Adolescents May Reject Norplant
Authors: Wiemann Constance M. , Berenson Abbey B.
Published: December 2021

Objectives. To identify characteristics of patients 18 years of age and younger who would and would not consider using levonorgestrel implants (Norplant) for contraception and to isolate potential barriers to its use.

Study Design. Survey of 323 adolescents attending family planning or obstetrics clinics between April 29 and October 27,1992. For purposes of analyses, patients were stratified by their willingness to consider using Norplant. Statements about Norplant that differentiated between groups were considered significant barriers. Additional analyses were conducted for the sample, stratified by pregnancy status, race and ethnicity, parity, and Norplant class attendance.

Results. Sixty-four percent of participants stated that they would be willing to consider using Norplant. These adolescents were significantly older, were more likely to already have given birth or have had abortions, planned to delay (additional) childbearing for 5 or more years, aspired to receive college educations, and reported lower annual household incomes than did adolescents unwilling to consider using the device. Identified barriers to Norplant use included misinformation, perceived advantages, physical aversions, perceived efficacy, fertility concerns, social influences, and concerns about safety and side effects.

Conclusions. Misperceptions and concerns about safety and side effects will prevent many adolescents from using Norplant. Recent negative publicity surrounding its use will intensify this problem. Health care providers must work to remove these barriers so that sexually active adolescents can make informed decisions about contraceptives.
Defect in the X-Lipoyl-Containing Component of the Pyruvate Dehydrogenase Complex in a Patient With a Neonatal Lactic Acidemia
Authors: GEOFFROY V. , FOUQUE F. , BENELLI C. , POGGI F. , SAUDUBRAY J. M. , LISSENS W. , MEIRLEIR L. D. , MARSAC C. , LINDSAY J. G. , SANDERSON S. J.
Published: December 2021

Studies of human pyruvate dehydrogenase (PDH) deficiency have shown that defects in the E1 component are not common, with only a small number of defects associated specifically with the E3, E2, and component X subunits. We report here clinical, enzymatic, and immune studies of the PDH complex (PDHc) in a girl presenting with a primary defect in the component X. The patient, born from nonconsanguineous parents, presented with severe neonatal lactic acidosis, minor facial dysmorphia, and complete corpus callosum agenesis. The metabolic profile revealed marked hyperlactatemia and hyperpyruvic acidemia, with a normal lactate/pyruvate ratio and no detectable ketosis or hyperammonemia. The activity of total PDHc in cultured skin fibroblasts and in fresh mononuclear cells was markedly decreased by about 80% as compared with the controls and with the parents.
Comparison of Topical Anesthetics Without Cocaine to Tetracaine-Adrenaline-Cocaine and Lidocaine Infiltration During Repair of Lacerations: Bupivacaine-Norepinephrine Is an Effective New Topical Anesthetic Agent
Authors: Smith Gary A. , Strausbaugh Steven D. , Harbeck-Weber Cynthia , Shields Brenda J. , Powers Jean D. , Hackenberg Douglas
Published: December 2021

Objective. To compare the effectiveness of four topical anesthetics that do not contain cocaine with that of topical tetracaine-adrenaline-cocaine (TAC) and lidocaine infiltration during laceration repair in children.

Design. This was a randomized, blinded trial.

Setting. The study was conducted in the emergency department of a large children's hospital.

Participants. Subjects were children 2 years of age or older with a laceration 5 cm or less in length that required suturing.

Interventions. Patients were randomly assigned to receive one of four noncocaine-containing topical anesthetics, topical TAC, or lidocaine infiltration anesthesia before laceration repair.

Outcome Measures. Outcome measures assessed pain perceptions using a Visual Analogue Scale, Likert scale, and Anesthetic Effectiveness scale. Distress behaviors of patients were measured with the Restrained Infants and Children Distress Rating Scale.

Results. Two hundred forty patients were enrolled in the study. Using α = 0.05 and β = 0.2, there was statistical power to detect differences of 0.3 to 1.3 U for the outcome measures used. The bupivacaine-norepinephrine topical solution (Bupivanor) performed better than the other three new topical preparations. It provided effective wound anesthesia during laceration repair, especially for lacerations of the face and scalp, where it was consistently rated as effective as TAC and 1% lidocaine infiltration by all observer groups for all outcome measures. There was a 4% overall wound complication rate, including one wound infection.

Conclusion. Bupivanor is an effective alternative to TAC and lidocaine infiltration for local anesthesia during laceration repair, especially on the face and scalp. The effectiveness of Bupivanor on the face is important, because it is here where TAC is most likely inadvertently to come into contact with mucous membranes and result in systemic toxicity. Because pain and distress scores did not take into consideration the pain associated with the initial injection of lidocaine, the findings of this study conservatively estimate Bupivanor's effectiveness compared with lidocaine infiltration.
Racial (Black-White) Differences in Insulin Secretion and Clearance in Adolescents: The Bogalusa Heart Study
Authors: Jiang Xiaozhang , Srinivasan Sathanur R. , Radhakrishnamurthy Bhandaru , Dalferes Edward R. , Berenson Gerald S.
Published: December 2021

Objective. Earlier we found black-white contrast in insulin levels in adolescents. The purpose of this study is to assess whether this difference is attributable to alterations in insulin secretion and/or clearance.

Methods. Fasting circulating insulin and C-peptide concentrations were examined in 1157 adolescents aged 11 to 18 years from a biracial community. Fasting plasma C-peptide, C-peptide to insulin ratio, and glucose to insulin ratio were used as indices of insulin secretion, hepatic insulin clearance, and insulin sensitivity, respectively.

Results. After adjusting several covariates (age, sexual maturation, and obesity), black adolescents had higher insulin levels (14.99 vs 12.66 µU/mL in girls). However, they had lower C-peptide levels than their white counterparts, indicating lower insulin secretion by pancreatic beta cells in black adolescents. Moreover, black adolescents had lower levels of C-peptide to insulin ratio than white adolescents (0.14 vs 0.17), suggesting reduced hepatic insulin clearance in black adolescents. In addition, significantly lower levels of glucose to insulin ratio in black girls suggest a reduced insulin sensitivity in this group. Further, differences in insulin levels between white and black girls disappeared after adjusting for differences in C-peptide to insulin ratio.

Conclusion. These data suggest that elevated insulin levels observed in black adolescents, especially in black girls, may be attributed to their decreased hepatic insulin clearance, not hypersecretion of insulin.
Inhalant Abuse
Authors:   COMMITTEE ON SUBSTANCE ABUSE,   COMMITTEE ON NATIVE AMERICAN CHILD
Published: December 2021

This Policy Statement was retired May 2017.

Inhalant abuse is the intentional inhalation of a volatile substance for the purpose of achieving a euphoric state. It is also known as solvent abuse, volatile substance abuse, glue sniffing, sniffing, and huffing. Beginning with children as young as 6 years of age, it is an underrecognized form of substance abuse with a significant morbidity and mortality. This statement reviews important aspects of inhalant abuse and makes several recommendations involving prevention and education strategies to address this problem.

EPIDEMIOLOGY

As with other types of substance abuse, precise epidemiologic data on inhalant abuse are not available. The peak age of inhalant abuse is 14 to 15 years, with onset occurring in those as young as 6 to 8 years. Use declines typically by 17 to 19 years of age; however, some users may continue into adulthood.

Since 1975, the National Institute on Drug Abuse annual survey of high school seniors (Monitoring the Future) has documented a lifetime incidence of inhalant abuse of 15% to 20%, with 5% to 10% of seniors using inhalants during the previous year. This survey underestimates the true prevalence, because school dropouts, who have a relatively higher incidence of substance abuse, are not included. Although there has been a general decline in the use of most other mind-altering substances, the relative incidence of inhalant abuse has increased. Since 1988, eighth graders also have been surveyed, disclosing that inhalant abuse has increased recently and has surpassed marijuana use within this group. Nationwide mortality data are not collected; however, the United Kingdom (with a population approximately one fifth of that of the United States and the only major country in the western world that tracks deaths caused by inhalants) has documented two deaths pen week.
In Reply: "Mild" Varicella—Does It Protect?
Authors: KOHL STEVE
Published: December 2021

Dr Joseph raises the interesting question whether children with mild cases of varicella are more likely to develop second cases of varicella in the future. I am not aware of studies correlating levels of varicella antibody with the severity of varicella. Baba et al did show that infants with low levels of transplacental antibody developed mild varicella and robust antibody responses. In a study of adults, Gershon et al demonstrated that a small proportion of adults with no history of varicella and with positive but low levels of antibody were still susceptible to varicella.