bluuebunny/crossref_metadata_2025 huggingface dataset:
Variability in the Management of Childhood Constipation
Authors: Focht Dean R. , Baker Raymond C. , Heubi James E. , Moyer M. Susan
Published: June 2007

To assist primary care providers, the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) published clinical practice guidelines for management of childhood constipation. A cross-sectional survey of pediatricians from across the United States was conducted to assess pediatricians’ constipation management strategies, whether pediatricians are familiar with the NASPGHAN constipation guidelines, and reasons pediatricians refer constipated patients to a pediatric gastroenterologist. Overall, 75% of pediatricians used polyethylene glycol without electrolytes to treat childhood constipation, 8% of pediatricians were aware NASPGHAN had published constipation guidelines, and parental pressure was just one reason pediatricians referred constipated patients to a pediatric gastroenterologist.
Writing for Scientific Publication: Tips for Getting Started
Authors: Lin Angela E.
Published: June 2007

Pediatricians in training and clinical practice may be eager to submit their first scientific publication by writing a letter to the editor, case report, review article, or short clinical series. Unfortunately, the would-be author encounters a literary developmental delay when facing the blank page or computer screen. This article is dedicated to the novice author and offers practical tips on writing the first manuscript. Authors are encouraged to draw from their extensive experience writing other materials and to approach the task in a systematic way. Computer technology and software developments should facilitate the process.
Microbial Colonization of the Hands of Residents
Authors: Baker Kris , Katz Ben Z.
Published: June 2007

To determine whether carriage of resistant Gram-positive organisms by residents increases over time, the dominant hand of pediatric residents was cultured. Among first-year residents, 53 Gram-positive organisms were isolated; 12 were resistant to oxacillin, 13 to clindamycin. Six residents had organisms resistant to both; 14 carried at least one resistant to either. Among third-year residents, 46 Gram-positive organisms were cultured; 9 were resistant to oxacillin, 6 to clindamycin. Three residents carried organisms resistant to both; 10 carried at least one resistant to either. Colonization with resistant Gram-positive organisms did not increase with length of training.
Use of the Recto-Sigmoid Index to Diagnose Hirschsprung’s Disease
Authors: Garcia R. , Arcement C. , Hormaza L. , Haymon M. L. , Ward K. , Velasco C. , Correa H. , Congeni J. D. , Brown R. , Tyson P. , Udall J. , Schmidt-Sommerfeld E.
Published: June 2007

The recto-sigmoid index on barium enema may aid in the diagnosis of Hirschsprung’s disease. However, data on its reliability in different age groups are sparse. The recto-sigmoid index and transitional zone were evaluated blindly in 107 patients with diagnostic rectal suction biopsies. Patients were divided into 3 groups: neonates, infants older than 1 month, and children. The recto-sigmoid index and transitional zone agreed with the histopathologic diagnosis in 79% and 87% of the cases, respectively. Their negative predictive values reached clinical significance in infants and children but not in neonates. Their positive predictive values were not significant in any age group. The recto-sigmoid index identified 4 patients with recto-sigmoid Hirschsprung’s disease whose diagnosis was missed by evaluating the transitional zone alone.
Randomized Controlled Trial of Bottle Weaning Intervention: A Pilot Study
Authors: Kahn Richard , Bonuck Karen , Trombley Michelle
Published: June 2007

Inappropriate baby bottle use is associated with tooth decay, anemia, and overweight, and it may adversely affect dietary patterns. Parents often do not follow guidance to wean by 18 months of life. We piloted a brief, counseling-based weaning intervention in an urban WIC agency among primarily Hispanic parent/toddler dyads. At baseline (n = 48), toddlers consumed a mean 4.7 bottles/day. At follow-up (n = 39), the intervention group consumed fewer mean bottles/day than controls (0.09 vs 2.0 bottles/day, P < .045). Half the toddlers in the experimental group and one third of the control groups weaned completely. Parents of weaned children were satisfied with the outcome.
Throat Culture Is Necessary After Negative Rapid Antigen Detection Tests
Authors: Mirza Ayesha , Wludyka Peter , Chiu Thomas T. , Rathore Mobeen H.
Published: June 2007

This study was conducted to determine if culture confirmation is needed for a negative rapid antigen detection test. Data on 18 509 tests done in patients younger than 18 years old were reviewed. Of the 14 167 (76.5%) that were negative, 968 (6.8%) were associated with positive cultures. No significant seasonal variation was noted. Significant differences were found between hospital and pediatric practices in the percentage of patients with a negative rapid antigen detection test who actually had group A β-hemolytic streptococcus (3.5% to 9.8%). This study supports the recommendation of culture confirmation of a negative rapid antigen detection test and validation of results within an individual practice if confirmatory cultures are not being performed. This study showed a high false-negative rate of the negative rapid antigen detection test and variation among hospital and pediatric practices for rates of positive culture after a negative rapid antigen detection test.
Self-Efficacy for Smoking Cessation Counseling Parents in Primary Care: An Office-Based Intervention for Pediatricians and Family Physicians
Authors: Garg Arvin , Serwint Janet R. , Higman Susan , Kanof Ann , Schell Dottie , Colon Iris , Butz Arlene M.
Published: June 2007

Few pediatricians or family physicians routinely counsel parental smokers to quit smoking. Poor self-efficacy in smoking cessation counseling skills may be one barrier to counseling. Analysis of self-efficacy scores of physicians participating in the Clean Air for Healthy Children program demonstrates that pediatricians had higher self-efficacy scores for explaining the health risks of environmental tobacco smoke on children ( P < .05); family physicians had higher self-efficacy scores for smoking cessation counseling knowledge ( P < .05). Posttraining, both pediatricians and family physicians who participated in an office-based smoking cessation counseling program had significantly higher scores in all 4 self-efficacy domains ( P < .01).
Evaluation and Management of Shunt Infections in Children with Hydrocephalus
Authors: Duhaime Ann-Christine
Published: June 2007

Shunt infections constitute one of the main risks of shunt surgery for hydrocephalus, which is the single most common type of surgery performed by pediatric neurosurgeons. Infectious complications are responsible for increased morbidity and mortality, lengthy hospitalizations, and high cost. Most modern series report infection rates approaching 10% of all shunt procedures. Despite the high incidence of this complication, optimal management is still unknown, and research on prevention has been hampered by single-institution series and small numbers. This article will review the history, causes, presentation, management, and outcome from shunt infections in children. Pitfalls in diagnosis and management will be reviewed. Finally, prevention strategies and research questions still remaining in this area will be outlined.
Alternating Antipyretics for Fever Reduction in Children: An Unfounded Practice Passed Down to Parents from Pediatricians
Authors: Wright Ashley D. , Liebelt Erica L.
Published: June 2007

A convenience sample of parents/caregivers completed a 10-question survey on their patterns of antipyretic therapy administration to determine if antipyretics were alternated, how often, who advised them to do this, and how they learned to dose the antipyretic. Of the 256 caregivers (93%) who completed the survey, 67% responded that they alternated acetaminophen and/or ibuprofen. The frequency varied: every 2 hours (9%), every 3 hours (16%), every 4 hours (43%), every 6 hours (23%) and other (8%). Of these, 81% stated that their health care provider/pediatrician advised them to alternate acetaminophen and/or ibuprofen; 8% stated that nobody advised them. Only 61% received written instructions on how to dose antipyretics from their health care provider. Most caregivers of young children reported alternating acetaminophen and ibuprofen for fever reduction in their children. There was a wide variability of the dosing interval. Most learned this practice from their pediatrician/health care provider.
A Multimedia Program Helps Parents Manage Childhood Aggression
Authors: Scholer Seth J. , Cherry Rebecca , Garrard Henry G. , Gupta Anita O. , Mace Rachel , Greeley Nicci
Published: June 2007

Participants were 65 parents of 6- to 18-month-old children presenting for a well child checkup between September 2002 and February 2003 to one of two private pediatric offices. The intervention was a 30-minute multimedia program, Play Nicely, viewed at home, which teaches the basics in childhood aggression management. One year after intervention, parents were asked, “Do you feel that the CD program was helpful in managing aggressive behavior in your child?” Most (65%) parents who watched the program agreed that it helped them manage aggression with their own child (strongly agree, 31%; agree, 34%; uncertain, 28%; disagree, 7%; and strongly disagree, 0%). An inexpensive, brief, independently viewed, multimedia program helps parents manage aggression in their young children as long as 1 year after receiving it from their pediatrician. An easily implemented intervention may contribute to violence prevention efforts.
Parental Preferences on Addressing Weight-Related Issues in Children
Authors: Eneli Ihuoma U. , Kalogiros Ioanna D. , McDonald Kaitlin A. , Todem David
Published: June 2007

Little is known about parental preferences on how providers should approach or manage weight-related concerns. A cross-sectional survey was conducted of 292 parents in a pediatric primary care faculty group practice. Of the 292 respondents, 90% were women, 45% had a child on Medicaid, and 53% had a body mass index of 25 or more. Only 12.1% of parents reported they had an overweight child. The term “gaining too much weight” was preferred 2:1 to “overweight” (51.1% versus 25.9%, P < .001). Most respondents (62.3%) thought the physician's office was the best place to manage an overweight child. Parents who reported they had an overweight child were more likely to prefer individual than group sessions compared with those without an overweight child (odds ratio, 2.1; 95% confidence interval, 1.2-3.7). Further research is needed to investigate the reasons underlying these preferences and how they positively or negatively impact program satisfaction, attrition rates, and behavior change outcomes.
Review of Medical Reports on Pedophilia
Authors: Hughes John R.
Published: June 2007

The present report is a review of all 554 papers published on Medline on pedophilia. The first discussion is the history of the disorder from ancient Greece to the present time, especially the influence of the liberal country of the Netherlands, the North American Man-Boy Love Association, and the sexual crisis in the Catholic Church. One important question is the relationship between homosexual pedophilia and adult homosexuality. Evidence for and against this relationship is presented. Next discussed are the characteristics of the victim and the long lasting serious effects of sexual abuse. Laboratory correlations are included, especially phallometric tests in order to objectively measure the physical responses to sexual stimuli. Electrophysiological and radiographic tests are also mentioned, including electroencephalography, computed tomography, magnetic resonance imaging, and positron emission tomography scans. An important section is the characterization of pedophiles with emphasis on their frequent previous sexual abuse, their past, their present, and their anticipated future. The final topic is treatment of this disorder with surgery, medication, behavioral therapy and the combination of medication and behavioral therapy.
Pediatric Quality of Life in Transitioning to the Insulin Pump: Does Prior Regimen Make a Difference?
Authors: Cogen Fran R. , Henderson Celia , Hansen Jennifer A. , Streisand Randi
Published: June 2007

A shift in conventional diabetes management has graduated to basal (glargine) and bolus (rapid-acting analogue) therapy via multiple daily injections or continuous subcutaneous insulin infusion (CSII). Continuous subcutaneous insulin infusion is considered the most intensive type of diabetes management, and before transitioning, consideration of regimen benefits should include lifestyle and quality-of-life issues in addition to medical benefits. Short-term and long-term changes in children's quality of life, as a function of their pre-CSII diabetes regimen, was assessed in 52 children before their transition to CSII from a conventional or multiple daily injection regimen. Results demonstrated significant improvement in quality of life only for those children transitioning to CSII from conventional vs multiple daily injection regimens; results were maintained at 6 months following pump initiation. Quality of life is an important consideration as children transition from more traditional to intensive regimens, and CSII devices may not necessarily improve satisfaction with diabetes control in all pediatric patients. Risks and benefits of both intensive regimens should be discussed before making the transition.
A Lamb-Meat-Based Formula for Infants Allergic to Casein Hydrolysate Formulas
Authors: Weisselberg Batia , Dayal Yogesh , Thompson John F. , Doyle Marcia S. , Senior Boris , Grand Richard J.
Published: June 2007

Ten infants with colitis due to milk protein allergy, presenting as hematochezia, whose symptoms did not resolve with the use of hydrolyzed cow-milk-based formulas, were treated with a modular lamb-meat-based formula (LOP). The patients were followed up for 3 months to 5 years. Prompt resolution of symptoms was achieved. In three patients, increased levels of creatinine and blood urea nitrogen and mild metabolic acidosis were noted, all returning to normal after the protein intake was lowered. All patients had normal growth. Seven patients were able to tolerate cow milk protein or soy at age 9-15 months. The LOP formula is well tolerated and is a safe alternative formula for infants allergic to cow milk hydrolysate formula.
Benign Transient Hyperphosphatasemia in Children with Leukemia and Lymphoma
Authors: Massey Gita V. , Dunn Nancy L. , Heckel Janice L. , Chan James C. M. , Russell E. Clifton
Published: June 2007

A temporary elevation of serum alkaline phosphatase has been described in young children who have no evidence of liver or bone disease. This phenomenon has been termed benign hyperphosphatasemia of infancy. Its occurrence is described in three children undergoing chemotherapy for acute lymphoblastic leukemia and lymphoma. All three children were in remission and in the consolidation or maintenance phase of their therapy when the hyperphosphatasemia occurred. All children were also receiving methotrexate (IM and IV), oral 6-mercaptopurine, and oral sulfamethoxazole/trimethoprim. Although these agents are associated with hepatotoxicity, other liver transaminases (ALT, AST) remained at normal concentrations, and there was an elevation only in the bone isoenzyme of alkaline phosphatase, thus making hepatic toxicity an unlikely etiology for the hyperphosphatasemia. No alteration in chemotherapy was necessary for resolution of the elevated alkaline phosphatase in these children.
You Won't Know Unless You Ask: The Biopsychosocial Interview for Adolescents
Authors: Perkins Kathaleen , Ferrari Norman , Rosas Angela , Bessette Roxanne , Williams Angela , Omar Hatim
Published: June 2007

In order to impact morbidity and mortality of adolescents, the health care provider must not only determine the risk status of the teenager but also take time to provide appropriate guidance and interventions. We have developed the West Virginia University Adolescent Risk Score, which is more inclusive than similar screening techniques and requires an 3-minute interview. This format facilitates specific guidance, provides documentation of risk status, and is readily accessible on future visits. Our data provide the basis for planning and research regarding the effectiveness of interventions.
Treatment of Patients wIth Niemann-Pick Type Is Using Repeated Amniotic Epithelial Cells Implantation: Correction of Aggregation and Coagulation Abnormalities
Authors: Cerneca Federico , Andolina Marino , Simeone Roberto , Boscolo Rita , Ciana Giovanni , Bembi Bruno
Published: June 2007

Variations of platelet aggregation and plasma levels of clotting factors V, IX, XI, and XII were studied in 5 patients with Niemann-Pick disease type Is in the course of a 3-year study of treatment with periodic subcutaneous infusions of amniotic epithelial cells. Before commencement of treatment, the concentrations of these factors were found to be abnormal in four of five patients. It was possible to complete the study protocol in only two patients. Platelet aggregation and plasma levels of V, IX, XI, and XII clotting factors had been determined before each epithelial amniotic cells implantation and after 24, 48, and 72 hours. In both patients the aggregation test and the plasma levels of coagulation factors V, IX, XI, and XII were below the normal values of reference. Results showed that the epithelial amniotic cells treatment normalized platelet aggregation after each implantation in the two studied patients, both in terms of intensity of response (increase in light transmission after addition of adenosine diphosphate up to 350%) and in terms of obtaining an irreversible aggregation with 3 and 8 pM of adenosine diphosphate. The data related to clotting factors showed an increase of these concentrations up to 60% and some of these concentrations normalized completely.
Once-Daily Cetirizine Effective in the Treatment of Seasonal Allergic Rhinitis in Children Aged 6 to 1 Years: A Randomized, Double-Blind, Placebo-Controlled Study
Authors: Pearlman David S. , Lumry William R. , Winder John A. , Noonan Michael J.
Published: June 2007

Cetirizine (once daily), a highly selective HI-antagonist, is efficacious for treating seasonal allergic rhinitis (SAR), perennial allergic rhinitis, and chronic idiopathic urticaria. A 4-week, randomized, double-blind, placebo-controlled trial investigated the safety and efficacy of cetirizine syrup (5 or 10 mg daily) in 209 children ages 6 to 11 years with SAR. Parents assisted patients in recording symptom severity (sneezing, nasal discharge, itchy eyes, itchy nose or mouth, conjunctivitis, nasal congestion) daily. A total symptom severity (TSS) score was derived from all symptoms, excluding nasal congestion. At baseline, TSS was comparable for all groups (range 6.8-7.0). Cetirizine 10 mg produced a significantly greater mean TSS reduction (3.2) than placebo (P<0.05) over the treatment period. Cetirizine 5 mg once daily produced mean reductions in weekly symptom scores of 2.4; this did not differ statistically from placebo. Furthermore, cetirizine 10 mg significantly improved symptoms of itchy eyes, nose, or mouth. The most commonly reported adverse reactions to both cetirizine and placebo were headache, pharyngitis, and abdominal pain, which did not occur with an incidence statistically different from that of placebo. Once-daily cetirizine is safe for treating SAR in children ages 6-11 years. Once-daily cetirizine 10 mg provides effective improvement in symptoms and is well tolerated.
Sedation wlth Intravenous Midazolam in the Pediatric Intensive Care Unit
Authors: Notterman Daniel A.
Published: June 2007

Physical and emotional distress can have important effects on patients in the pediatric intensive care unit (ICU). Intravenous (IV) infusion of benzodiazepines is an important adjunct to assisted ventilation and other potentially distressing ICU procedures. Combined with intermittent or continuous infusion of opioids, the benzodiazepines provide smooth control of anxiety, pain, and agitation. Intravenous midazolam (Versed® Roche Laboratories) is distinguished from diazepam (Valium® Roche Products) by its water solubility, short elimination half-life, and generally short duration of action. These pharmacological properties, which are also shared, in part, with the more slowly eliminated drug lorazepam (Ativan® Wyeth-Ayerst), facilitate titration of the rate of infusion against patient response and permit regulation of the depth of sedation. The major adverse effects of long-term benzodiazepine infusion are withdrawal symptoms and, occasionally, delayed awakening. The dosage needed to initiate and maintain sedation must be adjusted to body weight, degree of sedation desired, and concomitant medications, as well as to underlying health and cardiovascular status. Benzodiazepines, such as midazolam and lorazepam, represent important choices among drugs used for sedation in the pediatric ICU.
The Information Highway for the Pediatrician: An Understanding of the Internet for the Clinician
Authors: Saneto Russell P.
Published: June 2007

The author details the information highway available to the computer-literate pediatrician: the Internet, Electronic mail (E-mail), the World Wide Web, and explains how to access the information.
Management of Asymptomatic Term Neonates Whose Mothers Received Intrapartum Antibiotics—Part 2: Diagnostic Tests and Management Strategies
Authors: Allen Steven R.
Published: June 2007

The evaluation of the potentially septic newborn is often a source of frustration for practitioners. In the past, it has often been standard practice to evaluate and treat empirically all neonates whose mothers received antibiotics during labor, regardless of whether the infant had any signs or symptoms suggestive of infection. With the advent of recommendations for intrapartum antibiotic therapy to prevent early-onset neonatal group B streptococcal infections, this strategy is no longer practicable because too many infants would thus be evaluated and treated needlessly. This two-part review addresses the issues involved in managing asymptomatic newborns whose mothers received intrapartum antibiotics. Part 1, published separately, reviewed the rationale behind strategies for preventing intrapartum transmission of bacterial infection. This final part addresses the evaluation and management of the newborn. A number of diagnostic tests are often used in looking for bacterial infections in the neonate. Unfortunately, none of these is both rapid and reliable. A clinical pathway provided here can serve as a useful guide for the clinician, but uncertainty will always remain. Ultimately, each practitioner must determine the degree of risk or uncertainty that he or she can accept on the basis of clinical experience.
Respiratory Health, Lung Function, and Airway Responsiveness in School-Age Survivors of Very-Low-Birt-Weight
Authors: Schraeder Barbara D. , Czajka Carol , Kalman Denise D. , McGeady Stephen J.
Published: June 2007

The purpose of this study was to determine the respiratory symptoms, pulmonary function, and airway reactivity in school-age survivors of very-low-birth-weight and to describe the influence of birth weight and perinatal illness on their pulmonary function. Thirty (of 39) 10- to 11-year-old survivors of very-low-birth-weight (VLBW) recruited at birth into a prospective longitudinal study of development; 30 (of 32) normal-birth-weight peers recruited from the same school or census tract as the VLBW group at age 5; and 15 normal-birth-weight siblings of the VLBW group participated in the study. Outcome measures were mother's reports of respiratory health; forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1); FEV1/FVC; forced expiratory flow, midexpiratory phase (FEF25 75); peak expiratory flow rate (PEFR); and tolerance to methacholine. There were no differences between groups in mothers' reports of current respiratory health. Pulmonary function values were lower for the VLBW survivors but significant only for FEF25-75 (F=4.13; P=0.02). Number of days in the intensive care nursery correlated significantly with decreased FEV1 (r=-.40, df=28, P-0.03), FEV1/FVC (r=-.37, df=28, P=0.04, and FEF25-75 (r=-.39, df=28, P=0.03). Only the relationship between length of nursery stay and FEV1/FVC was independent of birth weight. Number of days on mechanical ventilation was significantly correlated with decreased FEV1 (-.44, df=28, P=0.01), FEV1/FVC (r=-.38, df=28, P=0.04), FEF25-75 (r=-.44, df=28, P=0.01, and PEFR (r=-.40, df=28, P=0.03). All of these relationships were independent of birth weight. There were no significant associations between perinatal risk factors and methacholine responsiveness. Differences between VLBW children and normal-birth-weight children in pulmonary function are modest even when statistically significant. Severity of perinatal illness influences pulmonary function parameters into late childhood.
The Web, Communication Trends, and Children's Health Part 5: Encouraging Positive and Safe Internet Use
Authors: Izenberg Neil , Lieberman Debra A.
Published: June 2007

The previous four articles in this series on the Web, Communication Trends, and Children's Health (Clinical Pediatrics, March-June, 1998) have shown that the Internet is a rich interactive window on the world, with health-related resources not readily available elsewhere. While the Internet brings great benefits, there are also some significant potential drawbacks. In this final article of the series, we focus on the precautions parents, teachers, and caregivers can take to help children and their families use the Internet wisely and safely.
Rabies Prophylaxis Following the Feeding of a Rabid Pony
Authors: Feder Henry M. , Nelson Randall S. , Cartter Matthew L. , Sadre Irene
Published: June 2007

A survey was performed to identify people who were exposed to a rabid pony and determine whether or not they received rabies postexposure prophylaxis (PEP). Sixty-one visitors who came in contact with the rabid pony were identified. These visitors heard about the rabid pony via the news media. Forty-five visitors were exposed during the 2 weeks before the pony died. Thirtytwo of these 45 visitors received PEP. Thirty-one visitors had or may have had saliva contact to an open wound or mucosa and all 31 received PEP. Fourteen visitors had no saliva contact to a wound or mucosa and one received PEP. Sixteen visitors were exposed before the pony was potentially shedding rabies virus and one received PEP. No visitor was bitten by the pony. Most of the persons 31/33 (94%) who received PEP had an exposure for which PEP was indicated. Nonbite transmission of rabies is discussed.
Airway Responsiveness to Inhaled Albuterol in Patients wit Pulmonary Hypertension
Authors: O'Hagan Adrian R. , Stillwell Paul C. , Arroliga Alejandro
Published: June 2007

We studied patients with pulmonary hypertension who had evidence of bronchial respon-siveness to inhaled albuterol. The records of all patients evaluated for lung transplantation were reviewed: the charts of patients with pulmonary hypertension, either primary (PPH, n=46) or Eisen-menger's syndrome (n=12), were abstracted. Measurements of lung function revealed equal numbers of patients with normal, restrictive, obstructive, and mixed abnormalities. None were more than moderate. Airway responsiveness was defined as an increase of forced expiratory volume in 1 second (FEV1) >15% or forced expiratory flow between 25% and 75% of the vital capacity (FEF25-75) >25%. Of the 24 PPH and nine Eisenmenger's patients, 14 and four, respectively, had reversible airflow obstruction. These patients were more likely to have a history of atopic disease and to have responded to calcium channels blockers during hemodynamic monitoring. They did not have more severe pulmonary hypertension, as measured by hemodynamic monitoring. Four patients had a history of asthma, which required hospitalization in three. Reversible airflow obstruction occurred in half of the patients with pulmonary hypertension and was clinically important in at least three.
Rectal Prolapse in Pediatrics
Authors: Sialakas Constantinos , Vottler Theodore P. , Andersen John M.
Published: June 2007

Rectal prolapse in pediatrics has its highest incidence in infancy and is uncommonly seen in industrialized countries. The prolapse may involve only the mucosa (mucosal prolapse) or all layers of the rectum (complete prolapse or procidentia). It is usually detected by the child's parents and is brought urgently to medical attention; however, it is usually spontaneously reduced by the time they reach the practitioner's office. Rectal prolapse should be viewed as a symptom of an underlying condition rather than a discrete disease entity. Potential causes are increased intra-abdominal pressure, diarrheal and neoplastic diseases, malnutrition, and conditions predisposing to pelvic floor weakness. Its strong association with cystic fibrosis makes the sweat test mandatory for infants and children with recurrent rectal prolapse. Of particular importance are three entities related to rectal prolapse that may easily escape diagnosis by practitioner: occult rectal prolapse, solitary ulcer of the rectum syndrome, and inflammatory cloacogenic polyps. The treatment of rectal prolapse is mainly conservative and is directed at the underlying conditions. Surgical intervention may be required for recurrent rectal prolapse refractory to conservative measures. The simplest, less invasive, yet highly effective approach, appears to be perirectal injection with a sclerosing agent. While the majority of children experience spontaneous resolution of the prolapse, the prognosis is worse when presentation occurs after the age of 4 years.
Managed Care of Children with Special Health Care Needs: The ABC Program
Authors: Grossman Lindsey K. , Rich Leslie N. , Michelson Suzanne , Hagerty Genevieve
Published: June 2007

Families of children voluntarily enrolled in a managed care program for children with special health care needs receiving SSI and Medicaid benefits and their case managers were surveyed regarding care satisfaction, quality, and access. Claims data were used to compare the cost and utilization of health care before and during program enrollment. Families rated health care quality improved in 43%, unchanged as “excellent” in 50% of cases. The care received was seen as more nearly complete and of higher quality when the provider was based in the hospital or the hospital's community clinics as compared with “private” community pediatricians. Hospitalization decreased, but no decrease in cost was demonstrated. A carefully planned and implemented managed care program can improve patient perception of quality among chronically ill children.
Adolescents' Views Regarding Sexual History Taking
Authors: Rosenthal Susan L. , Lewis Lisa M. , Succop Paul A. , Burklow Kathleen A. , Nelson Patrick R. , Shedd Kimberly D. , Heyman Richard B. , Biro Frank M.
Published: June 2007

To address the health needs of adolescents, health care providers need to understand adolescent perceptions of the sexual history taking process. Adolescents (n=1 13) were recruited from two sources of health care to complete a questionnaire regarding sexual history taking issues. The results revealed that there were differences in demographics, practice characteristics, and communication strategies between the private office and the hospital clinic. Attitudes and beliefs related to the discussion of sensitive issues were similar. Most adolescents would like health care providers to discuss sensitive topics directly. It is important for health care providers to feel comfortable initiating discussion of sensitive issues directly.
Pediatric Hospitals' and Physician Strategies for the 21st Century
Authors: Thompson Jerome W. , Chesney Russell W. , Stocks Rose Mary , Shmerling James , Herron Paul
Published: June 2007

Changes in market-driven health care economics are rapid and of great magnitude. This report describes a study of some of these changes in regard to children's health issues. We used a survey tool to assess long-range plans (next 10 years) and marketing strategies for major freestanding children's hospitals in different regions of the United States. We then used these assessments to draw conclusions about the impact of the plans and strategies on the practice of pediatric physicians and their workforce requirements. This may allow pediatric specialists and their programs to develop strategic plans and to take actions to contend with these market-driven economic changes. The tool was a questionnaire mailed to chief executive officers of 30 randomly chosen but geographically well-distributed children's hospitals. Seventeen children's hospitals responded (57%), providing information concerning each hospital and its current medical economic environment. The data were analyzed and trends were then identified from their responses. All institutions in this study expected to have fewer physicians on staff in the future. These institutions plan: (1) to improve quality and (2) to reduce costs. Quality will be improved by utilizing Continuous Quality Improvement (CQJ) and/or Benchmarking to Best Practices, both of which encourage physicians to follow standardized treatment protocols. Costs will be reduced by decreasing hospital staff size. Some children's hospitals have merged or will merge with larger, fullservice adult hospitals, but most plan to remain autonomous. Many expect a continued decrease in revenues, and almost all expect to downsize both bed number and staff. Restructuring will reduce the number of specialists, particularly in the fields of hematology-oncology, psychiatry, endocrinology, nephrology, and cardiology, and will also reduce the number of surgical specialists. The administrators predicted that more nurse practitioners will be employed at these hospitals in the 21st century, serving the role of physician extenders, if not physician substitutes. To ensure their own survival, physicians must develop their own strategic plans as have the hospitals in which they practice. Optimally they should embrace those activities that parallel their hospital's efforts such as Quality Improvement (CQI, Benchmarking), cost containment, and practice mergers.
Treatment of Acute Sinusitis in Childhood with Ceftibuten
Authors: Simon Michael W.
Published: June 2007

Acute sinusitis is a common childhood illness. If it is overlooked or undertreated, suppurative and intracranial complications may develop. Amoxicillin has traditionally been the antibiotic of choice for treatment of acute sinusitis. However, the efficacy of amoxicillin has been reduced because of the emergence of bacteria producing b-lactamase and altered penicillin-binding proteins. This study compares the effectiveness of 10, 15, and 20 days of ceftibuten therapy with 14 days of erythromycin-sulfisoxazole therapy in treating acute sinusitis. The results indicate that both treatment regimens are effective in treating acute sinusitis (96% clinical response for erythromycin-sulfisoxazole vs 92% for a 10-or 15-day course of ceftibuten vs 100% for a 20-day course of ceftibuten). Longer treatment periods may be more effective in resolving the acute illness.
Maternal Fever and Neonatal Depression: Preliminary Observations
Authors: Perlman Jeffrey M.
Published: June 2007

The objectives of this study were to determine in term infants: (1) the importance of maternal fever (maternal temperature >38° C) as a risk factor for neonatal depression and (2) the clinical course of infants admitted to the Neonatal Intensive Care Unit (NICU) born to mothers with fever. For 2 years, 59 (0.24%) of 25,000 term infants had a 5-minute Apgar score ≤5 and 22 (0.08%) infants were administered chest compressions with or without epinephrine as part of cardiopulmonary resuscitation (CPR) in the delivery room. The perinatal event most commonly associated with a 5-minute Apgar score ≤5 was maternal fever in 19 infants (32%), with meconium + fetal heart rate (FTHR) abnormalities in 15 (25%), and FTHR abnormalities only in 13 (22%), additional associations (n=13). By stepwise linear regression analysis, a 5-minute Apgar ≤5 was related only to the initial infant temperature (p=0.009, r=0.33).

Maternal fever noted in six infants (27%) was also commonly associated with CPR, as was the presence of meconium + FTHR abnormalities in seven (32%), and FTHR abnormalities only in four (18%). One hundred thirteen (7.5%) of the approximately 1,500 term infants born to mothers with maternal fever were admitted to the NICU. In addition to fever, the labor was complicated by meconium (in 16 infants), meconium + FTHR abnormalities (in 19 infants), and FTHR abnormalities only (in 11 infants). Resuscitative interventions in the delivery room included oxygen only in 43 infants, bag and mask ventilation in 38, continuous positive airway pressure in 10, intubation in 16, and CPR in six infants. Forty-nine infants (43%) had an initial temperature >38°C including 13 (11I%) with an initial temperature >39°C. Twelve (10%) infants remained intubated on admission and five required ventilator support >24 hours. One blood culture was positive although all mothers were pretreated with antibiotics. One infant developed hypoxic ischemic encephalopathy including seizures.
Children with Moderately Elevated Lead Levels: Is Chelation with DMSA Helpful?
Authors: O'Connor Mary E. , Rich Deborah
Published: June 2007

This study evaluates the effectiveness (use under routine circumstances) of DMSA (2,3 dimercaptosuccinic acid) and environmental remediation as compared with placebo and environmental remediation on children with blood lead (BPb) levels of 30-45 pg/dL (1.45-2.17 pmol/L). The endpoints were BPb at 1 month and 6 months after study entry. This double-blind placebo-controlled trial involved 39 children aged 2-5 years, who were randomized to one course of DMSA or placebo. The mean BPb levels of the two groups at study entry were similar, placebo group 33.0 pg/dL (1.59 pmol/L) and the DMSA group 34.9 pg/dL (1.68 pmol/L). At 1 month (the end of treatment) the mean BPb levels of the two groups were: placebo group 33.2 pg/dL (1.60 pmol/L) and the DMSA group 27.4 pg/dL (1.32 pmol/L), p=0.16. At 6 months, the mean BPb levels were 25.1 pg/dL (1.21 pmol/L) for the placebo group and 28.8 pg/dL (1.39 pmol/L) for the DMSA-treated group, p=0.06. Neither of these differences is statistically significant. All children with BPb, in the range studied here, should receive environmental evaluation and remediation; DMSA does not improve long-term blood lead levels.
Parent-Child Relationship Disorders: What Do the Child Vulnerability Scale and the Parent Protection Scale Measure?
Authors: Thomasgard Michael , Metz W. Peter
Published: June 2007

While scales exist to aid clinicians in the assessment of parent-child relationship disorders, there are minimal data regarding their clinical usefulness. This study examined the ability of parent responses to questions regarding the child's health, behavior, and development to predict total scores on the Child Vulnerability Scale and the Parent Protection Scale. Of 120 potential participants, 103 parents (92% mothers, 69% white, 54% married, 44% lower socioeconomic status) with children aged 2-5 years completed the Child Health and Family Functioning Questionnaire. Logistic regression yielded a correct prediction rate of 77% for perceived child vulnerability and 76% for parental overprotection. Our data provide support for the independence of parental perceptions of increased child vulnerability and parental overprotection as well as for the content validity of the Child Vulnerability Scale and the Parent Protection Scale.
A Multicenter Randomized Controlled Trial of a Liquid Loperamide Product Versus Placebo in the Treatment of Acute Diarrhea in Children
Authors: Kaplan Michael A. , Prior Mary Jane , McKonly Kimberly I. , DuPont Herbert L. , Temple Anthony R. , Nelson Edward B.
Published: June 2007

This randomized, double-blind, placebo-controlled trial of 48 hours' duration conducted in 13 primary care ambulatory practices in the United States and Mexico was used to compare the efficacy and safety of loperamide with placebo for the treatment of acute diarrhea in children aged 2 through 11 years. Two hundred fifty-eight children with acute nonspecific diarrhea were enrolled. Children were randomly assigned to treatment with loperamide HCO 0.5 mg/5 mL (n= 130) or placebo (n=1 28). The first dose of loperamide consisted of either 1.0 mg (children 2 through 5 years of age) or 2.0 mg (children 6 through 11 years of age) of study medication under the observation of study personnel. This was followed by 1 mg after each unformed stool, with a total daily dose of up to 3.0 mg in the children 2-5 years of age, 4.0 mg in the children 6-8 years of age, and 6.0 mg in the children 9-11 years of age. The primary outcome measures were time to last unformed stool, time to first unformed stool, number of unformed stools during six consecutive 8-hour periods, and overall rating of efficacy/acceptability. Secondary outcomes included abdominal pain/cramping, vomiting, and fever. Children who received loperamide had significantly shorter time to last unformed stool (p=0.0017) and fewer numbers of unformed stools (p=0.0237) than children who received placebo. The end-of-study overall efficacy/acceptability rating of loperamide was significantly better than for placebo (p=0.0107). All other clinically important outcome measures related to diarrhea relief favored loperamide. There was no significant difference in the incidence of drug-related adverse events between treatment groups, although total adverse events were reported more frequently (p=O.048) by the loperamide group (15%) compared with the placebo group (7%). In conclusion, this controlled study provides data demonstrating that at recommend doses, loperamide is well tolerated and significantly shortens the duration and severity of symptoms of acute nonspecific diarrhea in children 2 through 11 years of age.
Analysis of the Costs of Surgery for Hirschsprung's Disease: One-Stage Laparoscopic Pull-Through Versus Two-Stage Duh.amel Procedure
Authors: Bufo Anthony J. , Chen Mike K. , Shah Rasik , Gross Eitan , Cyr Nancy , Lobe Thom E
Published: June 2007

The purpose of this report is to evaluate the cost-effectiveness of a single-stage laparoscopic pull-through for Hirschsprung's disease compared to the traditional two-stage Duhamel procedure. In this series of 33 children, the length of hospitalization (2.5 ± 3.5 vs 10.6 ± 3.9, p<0.0 1), cost (19,088 ± 13,075 vs 34,110 ± 19,443, p<0.05), and complications were all significantly less with the laparoscopic assisted pull-through compared to the more traditional open approach.
Some Basic Factors in Food Service Planning
Authors: Kotschevar Lendal
Published: June 2007

This is the second of two articles based on recent addresses given by Professor Kotschevar to seminar groups meeting at the School of Hotel Administration, Cornell University. The first article appeared in the February 1968 issue ( Vol. 8, No. 4) of this magazine.
Presenting... 3 Selected Chapters from MARKETING for a FULL HOUSE
Authors: Coffman C. Dewitt
Published: June 2007

This new book will be off the press in May 1972 and sell for $10 plus postage. Advance orders are now being accepted at $9, postage free. Address your order and make checks payable to: The Cornell H.R.A. Quarterly, 336 Statler Hall, Cornell University, Ithaca New York 14850. U.S.A.
Advertising Research for the Food Service Industry
Authors: Ramond Charles
Published: June 2007

We do know a good deal about how advertising works — the hard part is to use that knowledge. Most of us are like the farmer who was told of new techniques by the county agricultural agent. "No thanks, young man," he said, "I already know how to farm better than I do."
A Concise Guide to Coffee from seedling to Cup
Authors: Durocher Joseph F.
Published: June 2007

The coffee break has become an integral part of the American work day; for many individuals, the aroma of a specific variety of coffee evokes memories of student life and late nights studying for exams; when we wish to visit with friends, we invite them over—or out—for a cup of coffee.

In short, coffee has become a firmly entrenched part of our daily lives. But how much do you know about this common beverage —where it comes from, how it is processed, the factors that affect the price you pay? Offered here are an overview of the coffee industry and some useful guidelines for preparing better coffee in your own operation.
Public Speaking for Hospitality Managers
Authors: Ference Eugene A.
Published: June 2007

There is an unprecedented industry-wide need for managers with well-honed communication skills-including expertise in speaking to groups
Call-Accounting Decision
Authors: Engel Douglas S. , Ives Thomas P.
Published: June 2007

New laws that permit hotels to resell telephone calls to guests, and new call-accounting systems capable of recording and billing such calls, may make the hotel telephone department —historically run in the red-profitable. This article shows you how to steer through a sea of competing systems to select the one most appropriate for your operation
The Trials of a Poor Middle School Trying to Catch Up in Mathematics: Teachers' Multiple Communities of Practice and the Boundary Encounters
Authors: Cwikla Julie
Published: June 2007

This article details a 5-year evolution of a middle school mathematics faculty serving predominantly economically at-risk students. Faculty members worked to improve students' mathematics test scores, used a scripted curriculum, and integrated National Council of Teachers of Mathematics (NCTM) standards-based activities. Schools nationwide are transforming with the No Child Left Behind legislation, accountability mandates, and the NCTM standards. The demands on these teachers are typical of high-stakes systems. Drawing on Lave and Wenger's “community of practice” and Cobb, McClain, Lamberg, and Chrystal's extension, this article describes how teachers accommodate to the process of change and the group dynamics encountered within a school structure.
The Purpose in Life Scale: Psychometric Properties for Social Drinkers and Drinkers in Alcohol Treatment
Authors: Marsh Ali , Smith Leigh , Piek Jan , Saunders Bill
Published: June 2007

The aim of the present research was to further investigate (a) the structure of the Purpose in Life test (PIL) using confirmatory factor analytic techniques,(b) the reliability of PIL scores, and (c) the validity of the PIL. Participants were 357 social drinkers (not in alcohol treatment) and 137 treatment drinkers (in alcohol treatment). With the exclusion of 3 items, a unidimensional measurement model for the PIL provided an adequate fit for social and treatment drinkers. Model invariance analysis indicated that 6 of 17 PIL items had different pattern coefficients for the two groups of drinkers. The 17 items of the PIL demonstrated good measurement reliability for both groups of drinkers and good criterion-related validity