bluuebunny/crossref_metadata_2025 huggingface dataset:
New York's Experience
Authors: Diaz-Barrios Vivien
Published: December 2021

In 1964, the New York State Public Health Law, §2500a, set the stage for mandatory newborn screening. By 1978, testing was already under way when the last of the total of eight diseases was added. Screening for homozygous sickle cell disease was included in 1975. Specimens submitted from 1975 to 1984 totaled nearly 2.5 million, and these specimens were sent to four different laboratories in New York state. New York City, with the largest population of newborns, sent the largest proportion of specimens (1.1 million).

Although testing was occurring, it was not until 1979 that citywide follow-up was established. Follow-up efforts were coordinated through the New York City Department of Health in cooperation with 52 hospitals. Of these hospitals, 25 received New York state funding for the provision of genetic services, which included testing and counseling for parents of children whose test results were positive for trait or disease. A cooperative effort was set up between the New York City Department of Health and health providers, who agreed to provide follow-up for newborns with all hemoglobinopathies at their respective hospitals. In cases of sickle cell disease, efforts were made to obtain second specimens from affected infants. In cases in which this was difficult, New York City Department of Health aids visited the home and obtained the specimen, counseled the parents, and arranged for further follow-up.

Other cooperative efforts occurred when various genetic or sickle cell centers came together and organized committees. Two major committees, the Sickle Cell Advisory Committee, and its executive arm, the Implementation Committee, in which all providers of genetic services throughout the state are represented, met to discuss statewide problems, to identify needs, and to formulate policy.
Follow-up of Children With Trait in a Rural Setting
Authors: Harris Herman
Published: December 2021

The Comprehensive Sickle Cell Centers were established in 1972 to test, educate, counsel, and research sickle cell anemia and related hemoglobinopathies. Standards and protocols for testing, education, and research were readily established because similar procedures and methods were already in operation at the institutions where the centers were located.

The most difficult and still the most controversial program to provide is counseling. It became evident, early, that there is no universally accepted method for informing carriers of abnormal Hb S about their results.

Centers located in large urban areas with a limited testing radius do not face the same problems as centers located in rural areas where the testing radius may cover an entire state or several states.

Individual, or one-on-one, counseling of persons with trait results appears to be successful for urban centers where the individual may be called to the center and given information. But, in a rural setting, it is not feasible for the center to ask a person to travel 350 miles to be told he or she has nothing to worry about. And it is not cost-effective to send a caseworker 350 miles to say the same thing. It must, therefore, be concluded that each agency or center must adopt counseling methods that meet its specific needs. Each program must be flexible, imaginative, and creative and must successfully and accurately deliver information about being a carrier for the sickle gene or other hemoglobinopathy and its implication and significance for patients and their future offspring.

To do this, we must first look at the problems facing us.
Screening of the Mother During Early Pregnancy
Authors: Rooks Yolanda
Published: December 2021

Screening for the early diagnosis of sickle cell disease has been advocated as essential for reducing infant mortality and morbidity. The provision of comprehensive and preventive care optimizes the chance for a longer and more healthy life by minimizing the detrimental complications that often occur in early life. Accordingly, the goals of early identification and intervention include preventing complications through the anticipation of medical problems, educating the family so that they become knowledgeable about sickle cell disease and how it may affect their child, and assisting the family in identifying specialized medical centers where appropriate care and follow-up will occur.

MATERIALS AND METHODS

The target population in New Haven, CT, was defined as black and Puerto Rican gravida women giving birth at Yale Medical Center. Screening these at-risk pregnant women and the fathers permitted prior identification of the newborn at risk. This was perceived to be a method of decreasing the number of cord blood specimens to be screened as well as increasing the yield.

Screening guidelines mandated education, informed consent, and appropriate follow-up for parents whose infants were identified to be heterozygous or homozygous for a sickle variant. The protocols for sample collection and sample testing were established. Hemoglobin electrophoresis was performed by the following two techniques: (1) cellulose acetate at pH 8.4 and (2) citrate agar gel at pH 6.2. The latter technique facilitates the identification of Hb S and Hb C in the presence of large amounts of Hb F3.

The screening program was introduced to the medical community and support staff.
LESSONS FROM THE THIRD WORLD
Authors: Sissman Norman J.
Published: December 2021

American pediatricians are often unaware of significant developments in international health, especially when they are reported in non-pediatric journals. A case in point is summarized by this abstract of a study from Java:

In a controlled trial, fortification of commercially marketed monosodium glutamate (MSG) with vitamin A improved serum vitamin A levels of young children and the vitamin A content of breast milk of lactating women. These improvements in vitamin A indices were accompanied by dramatic changes in health and anthropometric status. During the course of the study, the prevalence of Bitot's spots among children in program villages fell progressively from 1.2% at base line to 0.2% 11 mo after introduction of the fortified product (p<0.001) xerophthalmia rates in control villages remained essentially unchanged. Linear growth was greater among program than among control children at every age. Hemoglobin levels among program children rose by ∼10 g, from 113 ± 16 g/L at base line to 123 ± 16 by 5 mo (p<0.0001); they remained essentially unchanged among children of control villages. Preschool children in control villages died at 1.8 times the rate of children in program villages. Am J Clin Nutr 1988;48:1271-6

These results are similar to those independently obtained in Sumatra, where Vitamin A capsules were given to preschool children at 6 month intervals (A. Sommer, et al: Impact of vitamin A supplementation on childhood mortality. Lancet 1986;1:1169) The data should stimulate inquiries into the mechanisms of the effect of Vitamin A on general health and mortality (in addition to its preventing xerophthalmia) and their relevance for nutritionally marginal children in the United States.
Risks From Circumcision During the First Month of Life Compared With Those for Uncircumcised Boys
Authors: Wiswell Thomas E. , Geschke Dietrich W.
Published: December 2021

The records of 136,086 boys born in US Army hospitals from 1980 to 1985 were reviewed for indexed complications related to circumcision status during the first month of life. For 100,157 circumcised boys, there were 193 complications (0.19%). These included 62 local infections, eight cases of bacteremia, 83 incidences of hemorrhage (31 requiring ligature and three requiring transfusion), 25 instances of surgical trauma, and 20 urinary tract infections. There were no deaths or reported losses of the glans or entire penis. By contrast, the complications in the 35,929 uncircumcised infants were all related to urinary tract infections. Of the 88 boys with such infections (0.24%), 32 had concomitant bacteremia, three had meningitis, two had renal failure, and two died. The frequencies of urinary tract infection (P < .0001) and bacteremia (P < .0002) were significantly higher in the uncircumcised boys. Serious complications from routine prepuce removal are rare and relatively minor. Circumcision may be beneficial in reducing the occurrence of urinary tract infections and their associated sequelae.
DR CHARLES WEST ON THE PROPER APPROACH TO THE ILL CHILD (1850)
Authors: C. T. E.
Published: December 2021

Charles West (1816-1898), founder of the Children's Hospital, Great Ormond Street, London, has been described by Fielding H. Garrison, America's leading medical historian, as: "The greatest English pediatrist of his time, and perhaps the most genial practitioner of the art who ever lived." West's pediatric treatise, first published in 1848, opens with this admirable advice on the approach to the ill child.

The quiet manner and the gentle voice which all who have been ill know how to value in their attendants, are especially needed when the patient is a child. Your first object must be not to alarm it; if you suceed in avoiding this danger, it will not be long before you acquire its confidence; do not therefore, on entering the room, go at once close up to the child, but, sitting down sufficiently near to watch it, and yet so far off as to attract its attention, put a few questions to its attendant. While doing this, you may, without seeming to notice it, acquire a great deal of important information; you may observe the expression of the face, the character of the respiration, whether slow or frequent, regular or unequal, and if the child utter any sound, you may attend to the character of the cry. All your observations must be made without staring the child in the face, little children, especially if ill, seem always disturbed by this, and would be almost sure to cry. If the child be asleep at the time of your visit, your observations may be more minute; the kind of sleep should be noticed, whether quiet or disturbed, whether the eyes be perfectly closed during it, or partly open as they are in many cases where the nervous system is disordered: you may, too, if the sleep seem sound, venture to count the frequency of the respiration, and the beat of the pulse, but in doing this you should be careful not to arouse the child. It should be awoke gently by the nurse or mother, and a strange face should not be the first to meet its eye on awakening. If it were awake when you entered the room, it will probably in a few minutes have grown accustomed to your presence, and will allow you to touch its hand, and feel its pulse.
Follow-up or Weaning Formulas
Authors:   COMMITTEE ON NUTRITION
Published: December 2021

A high level of success in infant nutrition has been achieved in the United States by breast-feeding as preferred, or by feeding with iron-fortified infant formulas. Minor controversies about feeding choices occur when infants are weaned from an all liquid diet to one containing a variety of solid foods.

Weaning is not a single event but a process that takes place throughout a number of months, beginning optimally between 4 and 6 months of age. The nutritional objective is to achieve a varied diet with approximately 35% to 50% of energy coming from sources other than breast milk or infant formula. Variety remains the key to the diet, particularly for infants older than 6 months of age. Solid food must provide an adequate source of iron, trace minerals, and vitamins to replace and supplement those in that portion of breast milk or formula removed from the diet.

Breast milk and fortified infant formula continue to be optimal for the milk segment of the diet during the second 6 months of life. The mother may choose to stop breast-feeding for a variety of reasons, however. The Committee on Nutrition has indicated that cow's milk could be substituted in the second 6 months of age provided that (1) the amount of milk calories consumed does not exceed 65% of total calories and (2) the solid food portion of the diet replace the iron and vitamins deficient in cow's milk.

Recently "follow-up" feedings (formulas) have been marketed in the United States as they have been in Europe for many years.
Proposed Treatment for Infants With Wolman Disease
Authors: WOLMAN MOSHE
Published: December 2021

Presently available information indicates that Wolman disease is due to a defect in a single lysosomal enzyme molecule, called acid lipase, esterase, or cholesterol ester hydrolase (EC3.1.1.13). Cells of the reticuloendothelial system, hepatocytes, adrenocortical, and presumably many other cells normally, contain a neutral esterase associated with their microsomes, which is not deficient in Wolman disease.

Theoretically, catabolism of intracellular hydrophobic cholesterol (esters and triglycerides) should proceed normally in Wolman disease cells whenever the metabolic chain does not depend on lysosomal hydrolysis.
Oral Suction in the Delivery Room
Authors: BALLARD JEANNE L.
Published: December 2021

Dr Kempen's point that the practice of orally suctioning neonates for meconium aspiration is no longer acceptable and should be abandoned is well taken. This is true not only because of the potential danger to the physician of acquiring human immunodeficiency virus but other sexually transmitted agents as well.

It is true that secretions obtained by oral suction are frequently ingested by the resuscitating physician. In a survey of pediatric residents, 74% reported having accidentally ingested secretions suctioned orally from neonates during 1 year of training.
Dangers of Captopril Therapy in Newborns
Authors: REZNIK VIVIAN , GRISWOLD WILLIAM , MENDOZA STANLEY
Published: December 2021

Angiotensin-converting enzyme inhibitors are effective at lowering blood pressure in the neonate and the child. However, these drugs, when used for the treatment of hypertension in the premature infant, must be used with caution to avoid the complications that are well documented in the literature. All of the infants described in the article by Perlman and Volpe had extreme hypotension and oligunia. A group of nine infants with renal failure complicating captopril therapy were recently reported from the same institution.
Breed or Meadow?—Munchausen or Münchhausen?
Authors: SNEED R. C.
Published: December 2021

Salmon et al indicated that only three cases of factitious hematuria in children have been reported to date. However, there is at least a fourth report of factitious hematunia associated with factitious renal stones which was reported in Pediatrics, in 1976 by us which is not listed in the article's references. Also not listed was the review of Paperny et al of factitious hematuria in their report of Munchausen's syndrome in 1980. Another article in Pediatrics in 1983 reported that only four cases of Munchausen syndrome, all in adolescents, had been reported but did not include our earlier report of a 10-year-old child with this condition.
Breed or Meadow?—Munchausen or Münchhausen?
Authors: M R. J.
Published: December 2021

To pick another nit, the name Munchausen is an anglicization apparently coined by R. E. Raspe and his English publisher in 1786 and since perpetuated.

Freiherr von Münchhausen, after whose tall tales the syndrome was named, not only spelled his name with two hs, as noted by Meadow and Lennert (Pediatrics 1984;74:554-556), but also with an umlaut over the first u. Interestingly, Meadow and Lennert's article carried a picture of a book printed in Germany with the name correctly spelled on the cover but they, this editor and the copy editor all missed the discrepancy!
Anabolic Steroid Use by Male Adolescents
Authors: Johnson Mimi D. , Jay M. Susan , Shoup Brad , Rickert Vaughn I.
Published: December 2021

Anabolic steroids have recently been used by professional and college athletes to improve athletic ability by increasing muscle size and strength. A study was done to determine the extent of steroid use and knowledge about these drugs in a population of high school male adolescents in a southern state. A self-report questionnaire, which allowed multiple answers for each question, was administered to 853 male students in six high schools. Results indicated that an average of 11% had used or were using anabolic steroids. The following were assessed: the reasons for steroid use, the sources from which the students received information about steroids, their familiarity with the physiologic effects and complications of steroid use, and the extent of their involvement in sports. The results suggest that a segment of male adolescents are using anabolic steroids without fully understanding the risks of such behavior. Health care providers need to become knowledgeable about steroids so that they may better educate adolescents about the potential deleterious effects of these agents.
Pediatric Emergencies in Office Practices: Prevalence and Office Preparedness
Authors: Fuchs Susan , Jaffe David M. , Christoffel Katherine K.
Published: December 2021

Because of a nationally apparent increased interest in emergency medical services for children and the need for a greater understanding of the relationship between office pediatric and emergency department care of children, a questionnaire was mailed to practitioners to (1) describe office physician involvement with emergent conditions, and (2) evaluate physician office preparedness for pediatric emergencies. Responses were received from 280 pediatricians and family practitioners, including information regarding the availability of equipment and medication, physician training, and practice characteristics. Of the responding physicians, 62% reported that they assessed in their offices more than one child each week who required hospitalization or urgent treatment. A preparedness score was developed and multiple regression analysis was used to investigate the relationship between this score and physician and practice characteristics. The mean overall preparedness score was 53.7 of a possible 156 (range 5 to 136, SD = 31.3). Characteristics related to this score were type of practice and advanced cardiac life support certification. Large multispecialty practices and practices with physicians trained in advanced cardiac life support tended to have better preparedness scores. Family practitioners tended to have more complete stock of medications than pediatricians. The data presented suggested that critically ill children who enter the medical system via the office setting may have a better than even chance of finding the office unprepared to treat the emergency: in fewer than one third of the offices in which it was reported that at least one patient was seen weekly with asthma, anaphylaxis, sickle cell vasoocclusive crisis, status epilepticus, and sepsis were they fully equipped to treat emergencies related to these conditions. This finding suggests a need for further study of office-based care of life-threatening conditions and for the development of guidelines for office emergency preparedness.
REVIEWS OF LAY LITERATURE ON CHILD CARE: WHAT PARENTS ARE READING
Authors: Glascoe Frances P. , Moore William R. , Henderson James , Martin Elaine D.
Published: December 2021

Contending that nurture determines development, Briggs contends that parents are responsible for building children's self-esteem; felt to be a critical element for children's success in all endeavors. Aimed at all developmental levels from infancy through adolescence, management methods involve clear directions for communicating with children at different ages and use of social reinforcement (praise and verbal redirection). Practical suggestions are provided for managing the behavioral conflicts likely to occur at each developmental stage. Parents' roles as nurturers are not idealized excessively; mistakes can be rectified and parents are taught to deal with such likely feelings as anger. In its advocacy of tolerance for verbal misbehavior, some parents may find a conflict between realistic appraisal of a child and unconditional valuing, as well as with parenting by democracy. There are no apparent presumptions of family structure or material resources. The reading level is moderately easy and the text sufficiently well-organized.
Functional Blinking in Childhood
Authors: Vrabec Tamara R. , Levin Alex V. , Nelson Leonard B.
Published: December 2021

At the Department of Pediatric Ophthalmology, Wills Eye Hospital, 17 children, 18 months to 10 years of age, were seen with a chief complaint of intermittent excessive blinking. Eight (47%) of the patients had been referred for ophthalmologic examination by their pediatrician for evaluation of this symptom. All were in excellent health with no associated symptoms or signs of systemic or ocular disease. None of the children were taking topical ocular or systemic medications. The parents of seven (41%) of these children were able to identify a temporally related stressful event that coincided with the onset of blinking. Durations of the symptom prior to examination ranged from 1 week to 4 months. Spontaneous resolution occurred from one day to 5 months after the first ophthalmologic examination. Recurrence occurred in only one child, but resolution was still completed within 5 months. Excessive eye blinking unassociated with other systemic or ocular findings appears to be a medically benign, self-limited functional disorder.
Adult Respiratory Distress Syndrome in Full-Term Newborns
Authors: Faix Roger G. , Viscardi Rose M. , DiPietro Michael A. , Nicks Joanne J.
Published: December 2021

Since 1984, 11 newborns with severe respiratory distress have been treated whose clinical characteristics appear distinctive. Characteristics of these neonates were as follows: (1) they were full term by obstetric and neonatal criteria, (2) they had diffuse bilateral alveolar opacification on chest radiographs during the acute illness, (3) each had an acute perinatal triggering insult, (4) the neonates required continuous positive pressure ventilation for at least 48 hours with Fio2 > 0.50 for at least 12 hours, (5) they needed positive end-expiratory pressure of 6 cm of H2O or greater within three days of the triggering event, (6) there were no other known causes of these clinical conditions. Ten (91%) neonates had evidence of other organ dysfunction in addition to the lungs. Trials of hyperventilation in nine and tolazoline in five failed to improve oxygenation. Ten infants who underwent trials of increased positive end-expiratory pressure ≥6 cm of H2O without other concurrent changes in ventilator settings responded with prompt increases in PaO2 (median increase 84 mm Hg, range 22 to 196 mm Hg). All 11 babies survived but required prolonged mechanical ventilation and supplemental oxygen. We suggest that adult respiratory distress syndrome can and does occur in newborns. A trial of positive end-expiratory pressure ≥6 cm of H2O should be considered in full-term infants with severe respiratory distress in whom other causes can be excluded.
Lumbar Cutaneous Hemangiomas as Indicators of Tethered Spinal Cords
Authors: Albright A. Leland , Gartner J. Carlton , Wiener Eugene S.
Published: December 2021

Children with cutaneous hemangiomas in the lumbar region often also have tethered spinal cords. This diagnosis can be overlooked, because children with cutaneous hemangiomas may be otherwise asymptomatic and neurologically normal. From 1983 to 1987, six consecutive children with lumbar cutaneous hemangiomas underwent magnetic resonance imaging, and a seventh had a myelogram. In all seven children, despite their normal neurologic status, tethered spinal cords were diagnosed. All children had operations, which confirmed this finding. None had postoperative neurologic deficits. Infants and children with similar lumbar cutaneous hemangiomas should have magnetic resonance scans to detect the presence of tethered spinal cords.
Occluded Fourth Ventricle After Multiple Shunt Revisions for Hydrocephalus
Authors: Coker Steven B. , Anderson Craig L.
Published: December 2021

Trapped occluded fourth ventricle has been considered a rare occurrence. Intraventricular hemorrhage followed by repeated shunt revisions may increase the risk (8/47 cases). Because premature infants with intraventricular hemorrhage and shunted hydrocephalus often have preexisting neurologic abnormalities, dilation may produce clinically undetected further neurologic damage. Shunting improved function in both currently treated as well as 13 of 14 previously treated patients. In light of this observation, the importance of recognition is stressed.
Behcet Disease: Long-term Follow-up of Three Children and Review of the Literature
Authors: Rakover Yardena , Adar Hanna , Tal Itamar , Lang Yaron , Kedar Amos
Published: December 2021

Behcet disease is rare in children. There are only two reports of Behcet disease in childhood, describing seven patients. Three pediatric patients are described, in whom the age of onset ranged from 6 to 11 years. Aphthous stomatitis and arthritis were present in all of the patients; genital ulcers, iridocylitis, erythema nodosum, and CNS involvement were present in two patients. Other manifestations included Stevens-Johnson-like eruption, fever of unknown origin, and testicular involvement. All of the patients responded to glucocorticoids; two were also treated with colchicine and one was treated with chlorambucil. In two patients, follow-up of more than 10 years was done, with complete cure in one patient and benign course of illness in the other. Because of the rarity of the disease in childhood and the difficulty in making the diagnosis, there is not enough awareness by pediatricians concerning this disease.
Acromegaly in an Infant
Authors: Blumberg Denise L. , Sklar Charles A. , David Raphael , Rothenberg Saul , Bell Jennifer
Published: December 2021

Serial hormonal studies were carried out in a girl with a growth hormone-secreting pituitary adenoma and hyperprolactinemia diagnosed at 21 months of age, the youngest verified case of acromegaly. The child had progressive macrocephaly, noted at 6 months of age, which preceded the rapid acceleration of linear growth by nearly 1 year. At 21 months of age, the girl's head circumference measured 55 cm (+5.5 SD) and her height was 97.6 cm (+4.4 SD). Preoperative serum growth hormone level was 135 ng/mL, somatomedin C was 1,540 ng/mL (normal for bone age 18 to 97 ng/mL), and prolactin was 370 ng/mL (normal < 20 ng/mL). Following total resection of a large adenoma, immunohistochemical staining of the tumor showed growth hormone but not prolactin. With longitudinal monitoring of the child for 2 years postoperatively, persistently low growth hormone levels were demonstrated and normal growth velocity (6 cm/yr). Peak serum growth hormone levels ranged from 2.8 to 4.1 ng/mL after stimulation tests with insulin, arginine, and L-dopa. Maximum sleep-entrained growth hormone level was 3.4 ng/mL. At the same time, serum somatomedin C levels measured serially were normal (29 to 111 ng/mL), whereas simultaneous prolactin levels were moderately increased (30 to 147 ng/mL). The data support the hypothesis that hyperprolactinemia may have contributed to stimulating somatomedin C and sustaining the normal growth rate in this child.
REVIEWS OF LAY LITERATURE ON CHILD CARE: WHAT PARENTS ARE READING
Authors: Glascoe Frances P. , Moore William R. , Henderson James , Martin Elaine D.
Published: December 2021

Frankel A: Once Upon a Potty: His (Hers). New York, NY: Barron's: 1980; list price $4.95. (#3 on the 1988 bestseller list of books on child care of the Ingram Book Co, distributors of trade books).

It is hard to tell why this book is categorized with books on child-rearing. It is essentially a children's book without much information and virtually no guidance, except perhaps to emphasize that toilet training often takes a long time. Using the euphemisms, "poo-poo" and "wee-wee," the book colorfully and graphically depicts the story of Joshua, his new potty, and his first successful experience with it. The pictures show only a mother and not a father having a role. Young children may not recognize the potty as such because the example is atypical. The companion book is identical except that the leading character is named Prudence. The book is certainly easy to read and at an early elementary level.
Traumatic Monocular Blindness and Associated Carotid Injuries
Authors: KING MICHAEL A. , BARKOVICH ANTHONY J. , HALBACH VAN V. , HIESHIMA GRANT B. , EDWARDS MICHAEL S. B.
Published: December 2021

Cases of traumatic carotid injuries have been described sporatically in the literature since the early 19th century. The general availability of angiography in the 1930s caused a significant increase in the number of articles published concerning this subject, but reports of carotid artery injuries remain uncommon. In one series of 2000 head injury patients, carotid injuries were recognized in only 0.5% of patients.

Of the various types of injury the carotid artery can sustain, the development of intracavernous false aneurysm is potentially the most devastating. The syndrome of traumatic monocular blindness and severe delayed epistaxis in association with carotid injuries and basilar skull fractures was first reported by Barth and more recently by Chambers et al. Mortality rates of 20% to 40% have been attributed to a delay in diagnosis.
Home Visiting of Varying Frequency and Child Development
Authors: Powell Christine , Grantham-McGregor Sally
Published: December 2021

Two studies were made of home visiting and psychosocial stimulation with deprived urban children in Jamaica. The aim was to determine the relative effectiveness of different frequencies of visiting on the children's developmental levels and the feasibility of integrating the model into government primary health care services. Health paraprofessionals supervised by a nurse from a local health center conducted the intervention. In the first study, 152 children aged 6 to 30 months were assigned to groups visited biweekly, monthly, or not at all by area of residence. The biweekly group showed small but significant increases in scores on the Griffiths Mental Development Scales (developmental quotient) and performance subscale compared with the monthly and control groups, whereas no benefit was shown in the Griffiths scores of the monthly group. In the second study, 58 children aged 16 to 30 months from the same neighborhoods were randomly assigned to weekly visited and control groups. The group visited weekly showed marked improvements in the performance and hearing and speech subscales as well as the developmental quotient scores. The results indicate that as the frequency of visiting increases from none through monthly and biweekly to weekly, the benefits increase as well.
CALAMITIES VS CYCLES
Authors: Student
Published: December 2021

AIDS quickly became a global event—discussed not only in New York, Paris, Rio, Kinshasa but also in Helsinki, Buenos Aires, Beijing, and Singapore—when it was far from the leading cause of death in Africa, much less in the world. There are famous diseases, as there are famous countries, and these are not necessarily the ones with the biggest populations. AIDS did not become so famous just because it afflicts whites too, as some Africans bitterly assert. But it is certainly true that were AIDS only an African disease, however many millions were dying, few outside of Africa would be concerned with it. It would be one of those "natural" events, like famines, which periodically ravage poor, overpopulated countries and about which people in rich countries feel quite helpless. Because it is a world event—that is, because it affects the West—it is regarded as not just a natural disaster. It is filled with historical meaning. (Part of the self-definition of Europe and the neo-European countries is that it, the First World, is where major calamities are history-making, transformative, while in poor, African or Asian countries they are part of a cycle, and therefore something like an aspect of nature.)
In-training Examinations as Predictors of Resident Clinical Performance
Authors: Quattlebaum Thomas G. , Darden Paul M. , Sperry John B.
Published: December 2021

Previous attempts to predict resident clinical performance based solely on measures of cognitive skills have been uniformly unsuccessful. For the past 8 years, a formative residency evaluation system has been used that includes yearly comprehensive oral in-training examinations (OITEs) assessing each resident's performance in the three areas of professional competence: cognitive, psychomotor, and affective. The results of these examinations and scores received on the written in-training examination (WITE) given by the American Board of Pediatrics were compared with faculty ratings received during the subsequent year of residency. No significant correlation was found at any level of training between WITE scores and clinical performance. Analysis based on clinical setting did not improve these results. Oral intraining examination scores, however, were highly correlated with clinical performance ratings. In addition, with oral in-training examination scores, the "problem" interns—those whose clinical performance rating placed them in the lower 10% of interns—were predicted with a high degree of significance, sensitivity, and specificity. Predictions based on WITEs were not significant. Simultaneous evaluation of all three areas of professional competence should be done when predictions of resident performance are attempted. The OITE is a powerful formative evaluation tool, providing valuable learning experiences as residents are objectively assessed while they perform patient-centered tasks that represent critical skills in the practice of medicine. It allows early detection and possible amelioration of future problems in the clinical performance of a resident.
Home Visiting: A Necessary but not in Itself Sufficient Program Component for Promoting the Health and Development of Families and Children
Authors: CHAMBERLIN ROBERT W.
Published: December 2021

The importance of home visiting in the overall strategy for promoting the health and development of children and families is still being debated. In a 1980 conference in which the role of home visiting in delivering preventive services to families with young children was explored, a number of rather heterogeneous programs were examined. There was little agreement concerning why one program appeared to be effective and another did not. Some of the variables thought to be related to positive outcomes were the timing of the intervention (prenatal vs postnatal); intensity (weekly or more vs monthly or less); duration (a year or more vs less than a year); how careful was the selection, training and supervision, and continuing education of the home visitors; content of the intervention (specific educational content and/or emotional support); the overall framework of the intervention (child centered, family centered, ecologic); and the research design and sample size.
Professional Liability Coverage for Residents
Authors: COHN BRAD
Published: December 2021

As a member of the American Academy of Pediatrics' Committee on Liability, I have been asked to comment further on professional liability coverage for residents (Pediatrics 1989;83:311). The positions stated are satisfactory. However, the problems encountered by residents who "moonlight" under a professional liability coverage written on a "claims made" form were not addressed.

Most medical professional liability individual policies in the United States are now written on a "claims made" form. This classification means that the insured is covered only for claims arising and reported during the policy year for which a premium has been paid.
"Hip-Pocket" Sign in the Diagnosis of Nicotine Poisoning
Authors: HARUDA FRED
Published: December 2021

A 14-year-old adolescent boy was referred to me for neurologic evaluation of headaches and dilated pupils. He had complained of headaches for several weeks. When examined by his pediatrician, the only abnormality noted was dilated and fixed pupils. When seen in neurologic consultation, he complained only of diffuse, constant headache. The only positive neurologic findings were that his pupils dilated to 6 mm and were only slightly reactive to light. He was alert, fluent, and oriented. Results of funduscopic examination and computed tomographic scan of the brain were normal.
Tuberculosis in the Pediatric Population of Houston, Texas
Authors: Starke Jeffrey R. , Taylor-Watts Kym T.
Published: December 2021

From September 1984 to December 1987, the children's tuberculosis clinic in Houston, TX, cared for 110 children with active tuberculosis. The median age was 24 months. Approximately one half of the cases were in Hispanic children, but one third were in black children. Only 11% were foreign-born. Diagnosis resulted from case contact investigation in 50% of cases, routine tuberculin screening in 6%, and evaluation of an ill child in 44%. Intrathoracic disease alone was present in 77% of cases, and extrathoracic disease in 23%, including involvement of the cervical and supraclavicular lymph nodes, meninges, brain, liver, and skin. Gastric aspirates yielded Mycobacterium tuberculosis from 39% of the children with pulmonary disease. Of six children infected with drug-resistant tuberculosis, two became critically ill before referral because the probability of resistance was not recognized by the referring physician. Presently, 94% of patients have successfully completed therapy, which has been shortened from 12 to 18 months to 6 to 9 months. However, 39% were noncompliant with treatment and required twice-weekly supervised therapy to complete treatment. Tuberculosis remains a serious cause of morbidity in children; specific expertise in obtaining cultures, selecting drugs, and assuring compliance is crucial for adequate results.
Revising Diagnosis-Related Groups for Neonates
Authors: Lichtig Leo K. , Knauf Robert A , Bartoletti Albert , Wozniak Lynn-Marie , Gregg Robert H. , Muldoon John , Ellis William C.
Published: December 2021

Groups of neonates who are usually treated at hospitals that provide specialized pediatric care are not adequately classified by the use of diagnosis-related groups (DRGs). Therefore, a set of revised DRGs, pediatric modified DRGs (PM-DRGs), have been developed. Use of PM-DRGs substantially improves the classification of neonates in the following ways: a single pediatric modified major diagnostic category has been defined to include only and all neonates (patients younger than 29 days of age when admitted to the hospital); deaths and transfers of newborns are no longer combined into a single group; birth weight (rather than diagnosis) is used as the primary variable to differentiate categories of neonates; and duration of mechanical ventilation, presence of major problems, and surgery are used to define specific PM-DRGs. A total of 46 PM-DRGs have been developed to replace the 7 DRGs for neonates. Based on a sample of discharged patients from 13 children's hospitals, the overall variance reduction in duration of stay for neonates using PM-DRGs was 38.7% compared with 20.4% for DRGs. Variance reduction for PM-DRGs was 45.9% compared with 16.3% for DRGs when operating cost per case was used instead of duration of stay. After removing outliers at 150 days, the duration of stay variance reduction was 53.3% vs 23.6%, respectively, and the operating cost variance reduction was 58.8% vs 17.8%, respectively.
ON CORPORAL PUNISHMENT OF CHILDREN IN ENGLAND (1880)
Authors: C. T. E.
Published: December 2021

The annotation cited below concerning corporal punishment may strike modern readers as excessively cruel. In the mid-nineteenth century, however, few would have been offended by the use of a birch-rod in disciplining children.

No one who has had much to do with children can doubt that punishment is necessary to their proper discipline, or that sometimes it needs to be administered with considerable severity. The sentimental theory that children can be trained and taught "wholly by kindness" generally issues in a practice which is the converse of the principle laid down by Hamlet—"I must be cruel to be kind." There are, however, certain forms of punishment which compare most unfavourably with the old-fashioned birch, and ought to be discouraged, if not interdicted. We have repeatedly pointed out the evils and injuries likely to result from the boxing of ears and the smacking of faces. These "methods" should be summarily repressed by those who are the masters of school-masters and school-mistresses. Cases which have recently occurred have too forcibly illustrated the truth and need of our many warnings, Nevertheless, punishments of this class are still daily inflicted, and until some hard lessons have been taught the pedagogues who resort to this stupid mode of stimulating the dull intellect, there will be consequences of which the few that come to public knowledge are probably a small percentage. The practice of keeping children without their proper food, of locking them in dark closets, or even of placing them in solitary confinement in light rooms, cannot be defended, because they are injurious to body or mind. The imposition of tasks is a shortsighted policy, seeing that it makes learning a terror, whereas it ought to be a delight. Can no disciplinarian devise a suitable discipline for youth"? Until that discovery is made, it would be better to fall back on the old birch, properly and moderately applied. It made the flesh smart, but it broke no bones; and few, if any, of its so-called victims failed to profit by its occasional administration.
Clean, Intermittent Catheterization of Infants With Neurogenic Bladder
Authors: Joseph David B. , Bauer Stuart B. , Colodny Arnold H. , Mandell James , Retik Alan B.
Published: December 2021

Clean, intermittent catheterization was instituted in 38 babies with myelodysplasia who were thought to be at risk for upper urinary tract deterioration because of neurogenic bladder dysfunction. There were 19 patients 2 weeks to 12 months of age, 11 were 1 to 2 years of age, and 8 were older than 2 years. Effectiveness of clean, intermittent catheterization was determined by maintenance of upper urinary tract stability. Upper urinary tracts improved or remained stable in 13 of 16 infants (81%) with reflux and 16 of 18 infants (89%) with detrusor-sphincter dyssynergia. Bacteriuria was present in 16 (42%), with only 2 infants (5%) having a febrile episode; no infant required hospitalization because of urinary tract infections. No further complications were identified in infants who were cleanly and intermittently catheterized. Most families found clean, intermittent catheterization of their infants easy to master and not stressful, and their children adjusted to it at an early age.
MEDICARE'S MONEY PIT
Authors: M. R. J.
Published: December 2021

Medicare, which was advertised in 1965 as a modest program to protect senior citizens from bankruptcy, has become the federal budget's $100 billion money pit . . .

Within 15 years Medicare outlays will equal those for defense or Social Security. Only seven years after that, Medicare spending will equal that for Social Security and defense combined . . .

. . . as Senator Ellender understood, who won't take a check when someone else is writing it? Medicare taxes the young to care for the old, but it offers the old no incentive to think about, much less restrain, the cost of their care. The elderly we know hardly want to burden their grandchildren, yet Medicare's socialist incentives are encouraging them to do just that.
Maternal Cocaine Use During Pregnancy: Effect on the Newborn Infant
Authors: Hadeed Anthony J. , Siegel Sharon R.
Published: December 2021

The newborn infants of 56 mothers who used cocaine were prospectively studied in to determine the effects of cocaine. There were no differences with respect to maternal preeclampsia or cesarean section rate. Meconium-stained amniotic fluid was increased (10 of 56 cases [17.8%]) compared with the control group (3 of 56 cases [5.3%]) (x2 = 4.2, P < .05). Fetal distress recorded with fetal monitoring and Apgar scores at 1 and 5 minutes were similar. The weight, length, and head circumference growth curves of the infants born to cocaine-using mothers were shifted below the 25th percentile. Microcephaly was present in 12 of 56 (21.4%) infants whose mothers used cocaine during pregnancy (x2 = 5.96, P < .01), and 15 of 56 (26.7%) had intrauterine growth retardation (x2 = 9.53, P < .01) compared with the control infants (2 of 5 [3.5%] and 3 of 56 [5.3%], respectively). There was no increase in teratogenicity. Neither narcotic withdrawal symptoms nor illness could distinguish the infants born of cocaine-using mothers from the control infants. In conclusion, cocaine use during pregnancy results in newborn infants with growth retardation and microcephaly.
Needle Injuries Among Pediatric Housestaff Physicians in New York City
Authors: Melzer Sanford M. , Vermund Sten H. , Shelov Steven P.
Published: December 2021

Concerns regarding accidental needle puncture wounds, needle injuries among house officers have increased following reports of human immunodeficiency virus (HIV) transmission via this route. Pediatric house officers training in areas with large numbers of children infected with HIV may face a significant risk of occupational HIV infection via needle injury. The cumulative incidence of needle injury among pediatric house officers in New York who completed at least 1 year of training was ascertained. A questionnaire designed to elicit retrospective information regarding needle injuries was completed by 294 house officers in medical school-affiliated pediatric training programs. A total of 205 (69.7%) had stuck themselves or been stuck with a needle contaminated with a patient's blood, and 48 (17%) reported a needle injury involving a needle contaminated with the blood of a patient with suspected HIV infection. Only 11 of the 48 had received counselling or HIV testing following their possible HIV exposure. These data indicate that needle injury among pediatric house officers in New York is common. Reducing occupational risk is an especially compelling policy issue for pediatric training programs in areas where HIV is endemic.
Enteric Adenovirus Infection and Childhood Diarrhea: An Epidemiologic Study in Three Clinical Settings
Authors: Kotloff Karen L. , Losonsky Genevieve A. , Morris J. Glenn , Wasserman Steven S. , Singh-Naz Nalini , Levine Myron M.
Published: December 2021

During a 2-year prospective study of gastroenteritis in children less than 2 years of age, the role of enteric adenovirus as a cause of infantile diarrhea was examined in three clinical settings in a case-control fashion. Using a monoclonal antibody-based enzyme-linked immunosorbent assay with specificity for adenovirus serotypes 40 and 41, enteric adenovirus was identified in 10 of 246 episodes of diarrhea in outpatients (4.1%), 13 of 211 children admitted to the hospital with diarrhea (6.2%), and 5 of 8l children in whom nosocomial diarrhea developed (6.2%), making this agent the third most commonly identified etiologic agent of diarrheal disease. Asymptomatic infections were uncommon (5 of 372 control subjects, or 1.3%) and were seen most frequently in the nosocomial setting. Cases occurred in every calendar month except March and April of each year. A syndrome of watery diarrhea of longer duration compared with other patients with diarrhea (mean 5.4 vs 3.8 days, P = .01), associated with vomiting and dehydration, was present in most cases. Compared with patients with rotavirus, patients were as likely to experience fever and dehydration and more likely to vomit. Household contact with gastroenteritis, often with a child 2 to 5 years of age, was a predisposing factor. It was concluded that enteric adenovirus is an important cause of infantile diarrhea in Baltimore children. Although far less common than rotavirus, this agent was associated with diarrheal illnesses that were at least as severe as those seen with rotavirus.