bluuebunny/crossref_metadata_2025 huggingface dataset:
Children's Household Exposure to Guns: A Pediatric Practice-Based Survey
Authors: Senturia Yvonne D. , Christoffel Katherine Kaufer , Donovan Mark
Published: December 2021

Guns in the home are a factor in pediatric unintentional and intentional firearm injuries, yet the patterns of ownership and use are unclear.

Objectives. To describe the prevalence of firearms in households containing children who go to pediatricians, the types of firearms owned, the purposes of such ownership, the conditions of firearm storage, and the social correlates of ownership.

Methods. Survey of parents attending 29 (urban, suburban, and rural) pediatric practices in Chicago, New Jersey, Houston, Utah, Georgia, Iowa, and South Carolina for well or sick child care during a 1-week study period. The main outcome measure was ownership of rifle/shotgun and/or handgun.

Results. Gun ownership was reported by 37% of 5233 respondent families: rifles (26%), handguns (17%), and powder firearm (32%). Ownership varied significantly across practices and geographical locations. Thirteen percent of 823 handguns and 1% of 1327 rifles were reported both unlocked and loaded. Recreation was the most common reason for both rifle (75%) and handgun (59%) ownership; 48% of handguns were kept for self-protection versus 21% of rifles. In logistic regression models, predictor variables for firearm ownership included rural area, single family dwelling, at least one adult male, and fewer preschool children (for handgun and rifle); mother with at least 12 years education (for handgun), and white mother (for rifle).

Conclusions. The data presented suggest that US pediatricians routinely see children in families that own firearms, including a worrisome number that keep loaded and unlocked handguns. Until more detailed information becomes available, it is reasonable for pediatricians to be guided by these data, and so to counsel routinely about gun exposure.
A Comparison of Diagnostic Methods in Adolescent Girls With and Without Symptoms of Chlamydia Urogenital Infection
Authors: Biro Frank M. , Reising Shirley F. , Doughman Jeff A. , Kollar Linda M. , Rosenthal Susan L.
Published: December 2021

Objective. To evaluate the clinical utility of various diagnostic tests, two enzyme immunoassays and a chemiluminescent DNA probe were compared with cell culture (with monoclonal antibody confirmation) for the diagnosis of endocervical Chlamydia trachomatis infection.

Design. The clinical performance of four diagnostic methods for Chlamydia trachomatis urogenital infections were compared, using specimens generated from consecutive pelvic examinations.

Setting. Subjects were recruited from an urban adolescent clinic that provides primary and referral care.

Participants. A total of 479 adolescent female subjects were enrolled. The order of sample collection was randomized. Subjects were stratified according to whether they were asymptomatic (n = 228) or symptomatic (n = 251).

Measurements and results. Discrepant analysis was performed when culture was negative and nonculture technique was positive. The subject was considered to have chlamydia if culture was positive, or if one or more nonculture techniques, with that test's confirmatory assay, were positive (consensus-positive). Prevalence of chlamydia was 11.0% in the asymptomatic, and 20.7% in the symptomatic, group. Overall, 32.5% of the infected subjects were asymptomatic. Sensitivity of diagnostic methods varied from 52% to 80% in the asymptomatic subjects, compared with 65% to 81% in symptomatic subjects. Culture sensitivity was 75% to 80%. The specificities of all tests were 96% or greater. Accuracy of nonculture methods varied from 89.5% (DNA probe, symptomatic subjects) to 96.9% (enzyme immunoassay asymptomatic subjects).

Conclusions. There are significant differences in symptomatic subjects when evaluating accuracy of test outcome, using a consensus-positive criterion. Asymptomatic infections account for nearly one third of adolescent females infected with chlamydia. The prevalence of chlamydia urogenital infections are underestimated by any single diagnostic test, particularly in the asymptomatic patient.
Financial Access to Care Does Not Guarantee Better Care for Children
Authors: Kohrman Arthur F.
Published: December 2021

The thoughtful and cautionary pieces by Newacheck et al1 and Perrin et al2 remind us of how much we have achieved in piecing together care for vulnerable children, how far there is yet to go, and how the transition to the long-overdue health care reform might worsen, rather than improve our present arrangements. In the absence of a rational, planned care system for children, especially for those who are poor or who require extensive services, pediatricians and child advocates in both the public and private sectors have managed to cobble together at least the possibility of decent services for large numbers of children, with some payment to those who provide those services.
Interferon-Associated Refractory Status Epilepticus
Authors: Miller Van S. , Zwiener R. Jeff , Fielman Barbara A.
Published: December 2021

Interferons have been used since the early 1980s for their antiviral, antiproliferative, and immunomodulatory actions to treat a variety of oncologic, infectious, and autoimmune disorders. Although many patients experience mild neurologic adverse effects with the administration of interferon, serious neurologic adverse effects are uncommon.1 We report on a child with severe postinfantile giant cell hepatitis in whom interferon α-2b seemed to induce status epilepticus with focal seizures and focal abnormalities on electroencephalogram (EEG).

CASE REPORT

Our patient was healthy until 11 months of age when she developed fever, jaundice, vomiting, and elevated liver function tests. The results of liver biopsy at 14 months of age showed severe giant cell hepatitis with bridging fibrosis, but an extensive anatomic, metabolic and infectious evaluation failed to reveal a specific etiology, and electron microscopy did not reveal viral particles.
Hemothorax in a Child as a Result of Costal Exostosis
Authors: Tomares Stuart M. , Conrad Carol K. , Phoon Colin K. , Carroll John L. , Jabra Amal A. , Beauchamp Norman
Published: December 2021

Chest pain in pediatric patients is uncommon. Chest pain due to hemothorax is rare. Although hemothorax is usually a result of trauma, it has been reported as a complication of costal exostoses.1-6 The youngest such patient reported, to our knowledge, was 7 years old. We report a case of hemothorax in a 3½-year-old boy with hereditary multiple exostoses.

CASE HISTORY

A 3½-year-old boy was referred for evaluation of an asymptomatic, right-sided pleural effusion. The child, who was adopted from Romania at 1 year of age, was a known chronic hepatitis B carrier. He had been malnourished when he was first adopted, but he was currently thriving, with height and weight at the 50th percentile for age.
Burn From Hairdryer: Accident or Abuse?
Authors: Sudikoff Stephanie , Young Richard S.K.
Published: December 2021

We believe the following experience should be shared with your readers.

A child was born to a 16-year-old primigravida. At the age of 2 years, she was brought to the emergency department by her grandmother for evaluation of a burn mark on the back. The grandmother had witnessed multiple episodes of abuse during the past 2 years, including seeing the child being beaten, stepped on, and locked in a bathroom, but had never reported any of these incidents.
WHERE HAVE ALL THE PRIMARY CARE APPLICANTS GONE?
Authors: Colwill Jack M.
Published: December 2021

TABLE 1. U.S. Medical School Graduates Matched with Positions by the National Residency Matching Program in 1986 and 1991, According to Primary Care Specialty.

See table in the PDF file
Low-Dose Indomethacin and Prevention of Intraventricular Hemorrhage: A Multicenter Randomized Trial
Authors: Ment Laura R. , Ehrenkranz Richard A. , Duncan Charles C. , Scott David T. , Taylor Kenneth J.W. , Katz Karol H. , Schneider Karen C. , Makuch Robert W. , Oh William , Vohr Betty , Philip Alistair G.S. , Allan Walter
Published: December 2021

Objectives. Parenchymal involvement of intraventricular hemorrhage (IVH) is a major risk factor for neurodevelopmental handicap in very low birth weight neonates. Previous trials have suggested that indomethacin would lower the incidence and severity of IVH in very low birth weight neonates.

Methods. We enrolled 431 neonates of 600- to 1250-g birth weight with no evidence for IVH at 6 to 11 hours of age in a prospective, randomized, placebo-controlled trial to test the hypothesis that low-dose indomethacin (0.1 mg/kg intravenously at 6 to 12 postnatal hours and every 24 hours for two more doses) would lower the incidence and severity of IVH. Serial cranial ultrasound examinations and echocardiographs were performed.

Results. There were no differences in the birth weight, gestational age, sex, Apgar scores, and percent of neonates treated with surfactant between the indomethacin and placebo groups. Within the first 5 days, 25 (12%) indomethacin-treated and 40 (18%) placebo-treated neonates developed IVH (P = .03, trend test). Only one indomethacin-treated patient experienced grade 4 IVH compared with 10 placebo-treated neonates (P = .01). Sixteen indomethacin-treated neonates and 29 control neonates died (P = .08); there was a difference favoring indomethacin with respect to survival time (P = .06).

Eighty-six percent of all neonates had a patent ductus arteriosus on the first postnatal day; indomethacin was associated with significant ductal closure by the fifth day of life (P < .001). There were no differences in adverse events attributed to indomethacin between the two treatment groups.

Conclusions. Low-dose prophylactic indomethacin significantly lowers the incidence and severity of IVH, particularly the severe form (grade 4 IVH). In addition,indomethacin closes the patent ductus arteriosus and is not associated with significant adverse drug events in very low birth weight neonates.
Assessing the Health Status of Children Entering Foster Care
Authors: Chernoff Robin , Combs-Orme Terri , Risley-Curtiss Christina , Heisler Alice
Published: December 2021

Objective. Most research on health problems of children in foster care has been cross-sectional, resulting in overselection of children who have been in care long-term and underrepresentation of children who are in care for a short time.

Methodology. This paper reports on the health of a large cohort of children who had complete health examinations at the time of entry into foster care in a middle-size city during a 2-year period.

Results. Results indicate that >90% of the children had an abnormality in atleast one body system, 25% failed the vision screen, and 15% failed the hearing screen. The children were also lighter and shorter than the norm. Mental health screening revealed that 75% had a family history of mental illness or drug or alcohol abuse. Of children older than 3 years of age, 15% admitted to or were suspect for suicidal ideation and 7% for homicidal ideation. Of the children younger than 5 years of age, 23% had abnormal or suspect results on developmental screening examinations. At the time of entry into foster care, 12% of the children required an antibiotic. More than half needed urgent or nonurgent referrals for medical services and, for children >3 years of age, more than half needed urgent or nonurgent referrals for dental and mental health services. Just 12% of the children required only routine follow-up care.

Conclusions. The high prevalence and broad range of health needs of children at the time they enter foster care necessitate the design and implementation of better models of health care delivery for children in foster care.
Comparison of a Three-Component Acellular Pertussis Vaccine With a Whole-Cell Pertussis Vaccine in 15- Through 20-Month-Old Infants
Authors: Bernstein Henry H. , Rothstein Edward P. ,   Pennridge Pediatric Associates, Long Sarah S. , Reisinger Keith S. , Blatter Mark M. , Arbeter Allan M. , Fontana Mary E. , Jacobs Jeanine M. , Rathfon Hal , Crayne Olivia , Krause David S.
Published: December 2021

Objective. To compare the immunogenicity and reactogenicity of a diphtheria and tetanus toxoids and three-component acellular pertussis vaccine (DTaP) with a diphtheria and tetanus toxoids and whole-cell pertussis vaccine (DTwP) when administered as a booster dose to infants 15 through 20 months of age.

Design. Randomized, double-blind, comparative study.

Setting. Three pediatric practices (two private; one hospital-based).

Participants. One hundred and sixty-five healthy 15-through 20-month old infants.

Selection procedures and interventions. Infants were randomly assigned in a 2:1 ratio to receive vaccine from a single lot of DTaP or from commercially available DTwP. DTaP contained 25 µg of pertussis toxoid, 25 µg of filamentous hemagglutinin, 8 µg of pertactin (69-kilodalton outer membrane protein), 25 flocculating units of diphtheria toxoid, and 10 flocculating units of tetanus toxoid per 0.5-mL dose. DTwP contained one half the concentrations of diphtheria and tetanus toxoids compared with DTaP and a pertussis component with a potency of 4 U/0.5-mL dose. Serum samples were obtained on the day of immunization and 4 weeks later. Adverse reactions were recorded by parents for 7 days after immunization. An interval history was obtained 4 weeks after immunization.

Measurements and results. IgG antibody to pertussis toxoid, filamentous hemagglutinin, pertactin, diphtheria toxoid, and tetanus toxoid was measured by an indirect enzyme-linked immunosorbent assay (ELISA) method. One month after immunization, the geometric mean antibody levels after DTaP compared with DTwP were: pertussis toxoid, 70.6 vs 28 ELISA U/mL (P = .003); filamentous hemagglutinin, 183.4 vs 43 ELISA U/mL (P < .001); pertactin, 216 vs 49.9 ELISA U/mL (P < .001); diphtheria, 14.1 vs 14.9 IU/mL (P = .74); and tetanus, 11.9 vs 14.8 IU/mL (P = .089). After immunization with DTaP, most local and systemic adverse experiences were significantly fewer compared with DTwP (P < .05).

Conclusions. This three-component DTaP vaccine demonstrates significantly greater immune responses to pertussis toxoid, filamentous hemagglutinin, and pertactin, equivalent immune responses to diphtheria and tetanus toxoids, and significantly less reactogenicity compared with a licensed DTwP.
Physical Activity, Fitness, and Health in Children: A Close Look
Authors: Rowland Thomas W. , Freedson Patty S.
Published: December 2021

The available research information suggests, then, that the best primary strategy for improving the longterm health of children and adolescents through exercise may be creating a lifestyle pattern of regular physical activity that will carry over to the adult years rather than promoting childhood physical fitness.26 This implies that it is of primary importance to discover behavioral approaches that will be effective in increasing activity levels of children. It is an approach that raises critical questions in future research efforts: What are the factors that make exercise enjoyable for children? What settings (family, school physical education, physicians, community programs) are most effective in "turning children on" to physical activity? How can interest in exercise be sustained as children grow into adulthood? Furthermore, this conclusion bears implications for the design of physical education curricula, the role of families in the early molding of exercise habits, and the important function of physicians in identifying sedentary patients and introducing them to the fun of physical activity.

This viewpoint does not assume the importance for children of a critical threshold of activity or fitness. Instead, it emphasizes the significance of establishing a physically active lifestyle during the pediatric years; this is best achieved by exposing children to the enjoyment of physical exercise early. This strategy is based on the concept that health outcomes may relate more to the persistence of exercise throughout life rather than its quantity during the pediatric years.
A Unique Complication of Nonsteroidal Anti-inflammatory Drug Use
Authors: Wattad Ahmad , Feehan Tammy , Shepard Frank M. , Youngberg George
Published: December 2021

We read with great interest the two case reports by McIntire et al 1 on "Acute Flank Pain and Reversible Renal Dysfunction Associated with Nonsteroidal Anti-Inflammatory Drug Use."

We also treated a 14-year-old healthy girl who had acute severe bilateral flank pain and nonoliguric acute renal failure. The patient's flank pain and vomiting started 4 days before admission. A diagnosis of possible urinary tract infection was made and amoxicillin therapy was instituted. Her past medical history was unremarkable except for an uncomplicated urinary tract infection 6 years earlier.
Letter to the Editor
Authors: Pourcyrous Massroor , Bada Henrietta S. , Korones Sheldon B. , Baselski Vickie , Wong Seok P.
Published: December 2021

We appreciate Dr Philip's sharing his experience on the use of serial C-reactive protein (CRP) for monitoring neonates with sepsis or pneumonia due to group B streptococcus. In his letter, Dr Philip alluded to the use of normal serial CRP within 24 to 48 hours of life as a guide to discontinuing antibiotic therapy when cultures are negative. Our current practice is carried further. Based on our published data and our continuing experience, we discontinue antibiotic therapy in asymptomatic infants, even in those with positive blood cultures.
Letter to the Editor
Authors: Seashore Margretta R.
Published: December 2021

The American Academy of Pediatrics Committee on Genetics thanks Dr Herbert for his comments, and would like to address his concerns as follows.

Pernicious anemia. There are few data in the literature that address the issue of folic acid and vitamin B12 deficiency. Estimates suggest that the masking of pernicious anemia by folate rarely takes place with an intake of folate < 5 mg per day. On the other hand, there is evidence that a number of individuals with vitamin B12 deficiency have neurological symptoms without any anemia.
Universal Hepatitis B Immunization of Infants: Reactions of Pediatricians and Family Physicians Over Time
Authors: Freed Gary L. , Bordley W. Clayton , Clark Sarah J. , Konrad Thomas R.
Published: December 2021

Objective. In November 1991 the Advisory Committee on Immunization Practice (ACIP) recommended universal hepatitis B immunization of infants. In February 1992 the American Academy of Pediatrics (AAP) and in August 1992 the American Academy of Family Physicians (AAFP) issued similar recommendations. The purpose of this study was to assess over time the effectiveness and impact of the dissemination efforts of the ACIP, AAP, and AAFP regarding this new recommendation and to determine the factors affecting its adoption.

Design. Cohort survey over time.

Setting. North Carolina.

Participants. All 778 pediatricians and a random sample of 300 family physicians in North Carolina were surveyed by mail 3 months after publication of the ACIP recommendation (January/February 1992), but before the AAP and AAFP recommendations. Response rate was 78%. Of these, 83% responded to a follow-up survey 8 months later (October 1992).

Main outcome measures. Rates of agreement and adoption of the recommendation for universal infant immunization with hepatitis B vaccine; factors affecting agreement and adoption of the recommendation.

Results. In the first survey (3 months after the ACIP recommendation) more pediatricians than family physicians were aware of the new recommendation (82% vs 48%), yet only 37% of pediatricians and 23% of family physicians agreed that immunization of all newborns in their practice was warranted. Eight months later, after the AAP and AAFP recommendation, 66% of pediatricians and 32% of family physicians agreed universal immunization was warranted, but still only 53% of pediatricians and 23% of family physicians had adopted it into practice. Factors associated with these low rates of adoption include physician and practice characteristics, cost, perceived need for the vaccine, and aversion to multiple injections.

Conclusions. Federal, AAP, and AAFP efforts have not been effective thus far in fostering widespread agreement and adoption of this recommendation. If this and future vaccine programs are to succeed, research is needed to determine influences on implementation of new recommendations and to address the economic and noneconomic concerns of physicians and parents.
Effect of Dietary Fat on Cardiovascular Risk Factors in Infancy
Authors: Fuchs George J. , Farris Rosanne P. , DeWier Marianne , Hutchinson Sharon , Strada Russell , Suskind Robert M.
Published: December 2021

Objective. To determine the effects of feeding regimens of varying fat composition on dietary intake and serum lipid and lipoprotein concentrations in older infants.

Design, setting, and participants. One hundred four healthy infants aged 4 to 6 months were enrolled from private pediatric practices or public health clinics and were randomly assigned to one of four feeding groups until 12 months of age.

Interventions. Infants received whole cow milk or a standard infant formula (48% to 49% of energy as fat from butterfat or a soy-coconut oil blend, respectively) or one of two nearly identical investigational lower fat follow-up formulas (36% kcal from a fat blend of palm olein, corn, and safflower oils) as their primary food source in addition to table foods.

Main outcome measures. Nutrient intakes during the study period were characterized qualitatively and quantitatively. Serum lipids, lipoprotein concentrations, and anthropometrics were determined at baseline and at 12 months of age (study completion).

Results. Total energy intake was equivalent among feeding groups. Infants fed cow milk had higher mean daily intakes of total fat, saturated fat, monounsaturated fat, and cholesterol. Linoleic acid intake by infants fed cow milk, including that from table foods, was insufficient to meet current recommendations. Mean serum total cholesterol was significantly higher in the infants fed cow milk at age 12 months, whereas mean low density lipoprotein and apolipoprotein B were lower in the infants fed the follow-up formulas. Infants consuming the infant formula or whole cow milk demonstrated greater increases in mean serum total cholesterol, low density lipoprotein, and apolipoprotein B by 12 months of age compared with infants ingesting follow-up formula. Ponderal, linear, and head circumference growth was equivalent among feeding groups.

Conclusions. (1) Older infants fed lower fat formula have adequate total energy intake and normal growth. (2) The fat composition of the diets fed to the infants influenced serum lipid and lipoprotein profiles. (3) The fat composition of cow milk is inferior compared with commercial formulas. (4) The optimal fat blend for older infants including the consequences of the standard practice of adding high percentage of coconut oil to infant formulas should be defined further.
The Clinical Usefulness of Breast Milk Sodium in the Assessment of Lactogenesis
Authors: Morton Jane A.
Published: December 2021

Objective. A study was undertaken to assess the value of breast milk sodium concentration (BM [Na+) during early lactogenesis in predicting nursing outcome.

Methods. Samples of breast milk from 130 nursing mothers were obtained between the 3rd and 8th postpartum day for analysis of BM [Na+]. Approximately half the mothers were referred for nursing problems, although no problems were anticipated in the other primiparous mothers. A BM [Na+] of ≤16 mmol/L was considered normal. For women with normal BM [Na+], follow-up was scheduled at 1 month, whereas those with high [Na+] were evaluated more frequently with repeated [Na+] determinations.

Results. Of the 65 women with normal BM [Na+] (excluding five mothers who had experienced breast surgery), 95.4% were exclusively and successfully breast-feeding at 1 month without intervention. Of 60 women with high BM [Na+], all of whom received intervention, 55% were ultimately successful. In general, those who failed tended to have higher initial [Na+] determinations; additionally, the longer the [Na+] remained elevated, the lower the success rate. Infant weight gain was greater if the initial BM [Na+] was normal. Infants of mothers with normal BM [Na+] gained an average of 994 g above birth weight by 1 month in contrast to the average weight gain of 818 g in infants of mothers with initially elevated [Na+].

Conclusion. This study suggests that a normal drop in [Na+] is highly predictive of successful lactation, although a prolonged elevation of [Na+] signifies impaired lactogenesis with a high risk of failure. The clinical usefulness and limitations of this determination are discussed.
Infant Sleep Position and Sudden Infant Death Syndrome (SIDS) in the United States: Joint Commentary from the American Academy of Pediatrics and Selected Agencies of the Federal Government
Authors:   American Academy of Pediatrics, Task Force on Infant Sleeping Position and SIDS, Kattwinkel John , Brooks John , Keenan Maurice E. , Malloy Michael ,   National Institute of Child Health and Human Development,   National Institute on Deafness and Other Communication Disorders,   National Center on Sleep Disorders Research of the National Heart, Lung and Blood Institute,   Indian Health Service,   Consumer Product Safety Commission,   Division of Reproductive Health, National Center for Chronic Diseases Prevention and Health Promotion, Centers for Disease Control,   Health Resources and Services Administration,   Maternal and Child Health,   Health Resources Development,   Health Care Delivery and Assistance,   Health Professions
Published: December 2021

The preceding report describes new evidence from around the world linking infant prone sleeping position and sudden infant death syndrome (SIDS). Other than in this report, much of the recent information has not yet been published, except in official governmental statistics reports from the various countries. Nevertheless, it seems clear that SIDS rates do decrease significantly after public campaigns aimed at reducing the incidence of prone sleeping. The initial concern, that a shift away from prone sleeping might result in an increase in undesirable complications, has not materialized. There have been no increases in disorders such as aspiration, acute life-threatening events, and vomiting, after infant sleeping position has changed almost exclusively to non-prone in several countries.
A Practical Application of Fluorescent in Situ Hybridization to the Wolf-Hirschhorn Syndrome
Authors: Bagric K. Fagan , Colley P. , Partington M.
Published: December 2021

We have confirmed the practical utility of this relatively inexpensive method in the investigation of a patient with the clinical diagnosis of the Wolf- Hirschhorn syndrome. Not only was the diagnosis confirmed, but there is also the possibility of future reliable prenatal diagnosis in this family. The method of choice for prenatal diagnosis in future pregnancies is FISH, because this enables identification of carrier status as well as all unbalanced forms of the translocation.
Endemic "Lime" Disease: Phytophotodermatitis in San Diego County
Authors: Goskowicz Maki Okamura , Friedlander Sheila Fallon , Eichenfield Lawrence F.
Published: December 2021

Phytophotodermatitis is an acute phototoxic skin eruption which often occurs after contact with certain fruits or plants in association with sun exposure. Due to the bizarre configurations of lesions induced by phytophotodermatitis, it can be confused with many other diseases. We present 10 cases with illustrative histories of children with misdiagnosed phytophotodermatitis seen during a 15-month period. All patients were referred for pediatric dermatology evaluation with incorrect diagnoses, and a history was elicited of contact with limes or lemons and sun exposure. The dermatitis mimicked a variety of different diseases. We discuss the peculiar findings of this entity and illustrate its various manifestations.
Successful Medical Therapy of Aspergillus Osteomyelitis of the Spine in an 11-Year-Old Boy With Chronic Granulomatous Disease
Authors: Kline Mark W. , Paul Mary E. , Rosenblatt Howard M. , Shearer William T. , Bocobo Florante C.
Published: December 2021

Aspergillus is one of the most common causes of serious infection and death in individuals with chronic granulomatous disease (CGD).1 Clinically evident infection often begins in the lung with pneumonia; contiguous spread or dissemination of infection may occur. Vertebral osteomyelitis in individuals with CGD usually is caused by Aspergillus.2 Unfortunately, despite aggressive medical and surgical therapy of this condition, reported cases have been associated with treatment failure, recurrence, severe disabling orthopedic or neurologic complications and death.2-5

In this report we describe a unique case in which therapy with intravenous amphotericin B lipid complex (AmBLC), oral itraconazole, and granulocyte transfusions resulted in complete clinical and radiographic resolution of Aspergillus fumigatus osteomyelitis of the spine.
Mycobacterium bovis Spinal Epidural Abscess in a 6-Year-Old Boy With Leukemia
Authors: Shope Timothy R. , Garrett Amy L. , Waecker Norman J.
Published: December 2021

Spinal epidural abscess (SEA) is an uncommon and often serious infection in childhood. Rapid diagnosis with early surgical and medical treatment is extremely important to prevent permanent neurologic sequelae. Diagnosing SEA in pediatric patients can be difficult due to the infrequent occurrence, inadequate verbalization of symptoms, and variability of presentation.1-3 The most common cause of SEA is Staphylococcus aureus but other Gram-positive cocci, Gram-negative rods, and anaerobes have been reported.1 Tuberculous SEA has been described in adults and children, but it almost invariably occurs with osteomyelitis of the surrounding bony structures (Pott's disease).4,5 The only known pediatric case of SEA caused by Mycobacterium bovis (presented in brief as part of a large series of M bovis infections in San Diego)6 is presented here.
Health Supervision for Children With Down Syndrome
Authors:   Committee on Genetics
Published: December 2021

These guidelines are designed to assist the pediatrician in caring for the child in whom the diagnosis of Down syndrome has been confirmed by karyotype. Although the pediatrician's initial contact with the child is usually during infancy, occasionally the pregnant woman who has been given the prenatal diagnosis of Down syndrome will be referred for advice. Therefore, these guidelines offer advice for this situation as well.

Children with Down syndrome have multiple malformations and mental retardation due to the presence of extra genetic material from chromosome 21. Although the phenotype is variable, usually there is enough consistency to enable the experienced clinician to suspect the diagnosis. Among the more common physical features are hypotonia, small brachycephalic head, epicanthic folds, flat nasal bridge, upward slanting palpebral fissures, Brushfield spots, small mouth, small ears, excess skin at the nape of the neck, single transverse palmar crease, and short fifth finger with clinodactyly. A wide space, often with a deep fissure, between the first and second toes is also common. The degree of mental retardation is variable, ranging from mild (IQ, 50 to 70) to moderate (IQ, 35 to 50), and only occasionally to severe (IQ, 20 to 35). There is an increased risk of congenital heart disease (50%); leukemia (<1%); deafness (75%); serous otitis media (50% to 70%); Hirschsprung disease (<1%); gastrointestinal atresias (12%); eye disease (60%), including cataracts (15%) and severe refractive errors (50%); acquired hip dislocation (6%); and thyroid disease (15%). Social quotient may be improved with early intervention techniques.
Request for Ideas to Humanize Physicians
Authors: Shulman Neil , Appelrouth Daniel
Published: December 2021

As the author of the book Doc Hollywood, I tried to make some impact on an important health care issue relating to the shortage of doctors in rural areas. By developing a story about a doctor who gets stuck in a small rural town during a cross-country automobile trip to Hollywood, I attempted to show the benefits of family practice in an area of need. Now I am joining a colleague in an effort to develop a nonfiction book on another medical topic that is close to my heart.
How Aggressive Should Delivery Room Cardiopulmonary Resuscitation Be for Extremely Low Birth Weight Neonates?
Authors: Clark Frank I.
Published: December 2021

The article by Dr Davis1 regarding cardiopulmonary resuscitation for extremely low birth weight neonates provides a useful example of easily collected and thoughtfully analyzed data. I agree that birth weights would be helpful. However, I have a question and two critical observations:

1. The text states "resuscitation was attempted" for 62 infants weighing 501 to 750 g. In Fig 1, under the heading ACTIVE INTERVENTION? this cohort is split into NO, N = 4 and YES, N = 58.
Graduate Medical Education and Pediatric Workforce Issues and Principles
Authors:   Task Force on Graduate Medical Education Reform
Published: December 2021

The Federation of Pediatric Organizations supports designing a program to ensure quality health care to all children by developing appropriate guidelines and funding for GME.
Letter to the Editor
Authors: Wiswell Thomas E.
Published: December 2021

I agree with Dr Setzer's thought that the number of boys with malignant hyperthermia (2/476) was greater than the expected frequency (1/15 000).1 Nonetheless, both boys had received succinylcholine and halothane and had the classical symptoms of malignant hyperthermia (tachycardia, hyperthermia, combined metabolic and respiratory acidosis, elevated creatine phosphokinase levels, and myoglobinuria) and responded to dantrolene therapy. I believe the diagnosis of malignant hyperthermia is accurate.

The dorsal penile nerve block appears to be a safe and effective method of anesthesia among neonates.
Letter to the Editor
Authors: Rappaport Leonard
Published: December 2021

Dr Fefferman's letter seriously questions the basis upon which the Food and Drug Administration approved DDAVP for the treatment of enuresis, and points out some potentially serious side effects of DDAVP. I agree with Dr Fefferman's concern about the questionable research on the etiology of enuresis that has been used to support the use of DDAVP as well as his concerns about potential side effects, but do not feel at this time that the data support his level of concern.
Letter to the Editor
Authors: Moffatt Michael E. K.
Published: December 2021

Dr Fefferman points out one of the unanswered questions regarding vasopressin and nocturnal enuresis—the issue of whether the low morning urine osmolalities and flat ADH secretion pattern that have been reported1-3 can somehow be related to excessive water intake. As a clinician, I have always had the impression that many children with nocturnal enuresis do drink a lot, but it is exceedingly difficult to get accurate measurements. I have always wondered whether the patterns reported could be due to some sort of washout of the osmoregulating system due to a chronically excessive intake of water.
The "Hustle": Socioeconomic Deprivation, Urban Drug Trafficking, and Low-Income, African-American Male Gender Identity
Authors: Whitehead Tony Larry , Peterson James , Kaljee Linda
Published: December 2021

Objective. Drug trafficking seems to be both prevalent and associated with considerable morbidity and mortality among inner-city African-American males. Survey data has indicated the possible importance of economic need in the rapid emergence of drug trafficking in this population. In the present study, an historical-cultural approach is used to examine this economic relationship further and to explore the role that drug trafficking plays in a society that has permitted its successful and rapid growth.

Methodology. Data were obtained from interviews of approximately 600 African-Americans residing in inner-city neighborhoods in Washington, DC and Baltimore during nine drug- and acquired immunodeficiency syndrome-related studies conducted over 4 years.

Results and conclusions. From the perspective of the study participants, the need to provide economic support for one's family as well as to achieve some sense of status, respect, and reputation among one's peers are two core constructs of masculine identity in the United States. The historical and worsening inequities in access to economic resources and power by African-American males are viewed as significantly reducing the opportunity for economic success through more social or legal enterprises. Pursuit of nonmainstream activities (such as drug trafficking) is perceived as offering an opportunity for economic advancement and for establishing a power base for individuals who have been denied access to mainstream opportunities.
Drug Use, Drug Trafficking, and Weapon Carrying Among Low-Income, African-American, Early Adolescent Boys
Authors: Black Maureen M. , Ricardo Izabel B.
Published: December 2021

Objective. To examine relationships involving three extremely high-risk behaviors (drug use, drug trafficking, and weapon carrying) among low-income, urban, African-American early adolescent boys using both quantitative and qualitative methods.

Method. The quantitative phase included 192 African-American boys from 9 through 15 years of age recruited from recreation centers located in low-income communities. Youth completed a survey addressing personal risk practices; intentions to engage in risk practices; risk taking among family, friends and community; and values toward risk practices. They also completed standardized assessments of sensation seeking, perceived peer pressure, and parent-child communication. All questionnaires were self-administered through MacIntosh computers programmed to present questions aurally and visually. The qualitative phase included 12 African-American youth from low-income, urban families. The youth participated in 60- to 90-minute interviews regarding drug activities and violence.

Results. Most boys (73%) were not involved in either drug activities or weapon carrying. Boys who were involved in drug activities or weapon carrying were often involved in other high-risk activities (cigarette and alcohol use, school failure and expulsion) and had low rates of adaptive communication with their parents. The boys reported high rates of drug involvement by their family, friends, and community. However, psychological and interpersonal factors were better predictors of individual risk activities than community or family variables. Personal values regarding economics predicted drug trafficking. More than 56% of the boys who reported past involvement in drug activities did not anticipate future involvement.

Conclusions. Multilevel strategies are necessary to prevent involvement in drug activities and weapon carrying. Intervention programs should begin early and should promote communication between parents and children, adaptive behavior in school, and avoidance of cigarette and alcohol use. Community-level interventions are needed to alter the myth that drug involvement and weapon carrying are normative and to promote images that are less materialistic and more supportive of education and future-oriented activities.
TOP INVESTIGATOR AT GOVERNMENT HEALTH AGENCY ACCUSED OF SEX HARASSMENT
Authors: L. J. F.
Published: December 2021

WASHINGTON, Aug. 7—The man in charge of investigating misconduct in science for the Federal Government has been accused of misconduct of another sort: sexually harassing an office manager by seeking sexual favors from her in return for good employee ratings.
AIDS AND FALSE INNOCENCE II
Authors: L. J. F.
Published: December 2021

... Any pointed reference to the relation of sexual promiscuity to AIDS is not to be found in the media or among our educators. It is repressed because it might seem to be "judgmental"—i.e., having a moral connotation. When Newsweek recently had a cover story on AIDS among teen-agers, it recounted the sad tale of an 18-year-old girl, a high school graduate, who aimed at a career in the military. Tests however, revealed that she was HIV positive. Further inquiries by the doctors revealed that, in the previous twelve months, she had had sexual encounters with 24 different men! This is a seemingly average, cheerful, ambitious girl. And what did Newsweek have to say about such promiscuity? Nothing, absolutely nothing. It reported the facts but strenuously avoided any suggestion that she had been wrong in her behavior. The tone of the story was such as to imply that her mistake was in not insisting that those men practice "safe sex."
Sudden Infant Death Syndrome and Child Abuse
Authors: Hick J. F.
Published: December 2021

In reporting two siblings who succumbed to "sudden infant death syndrome," Steinschneider exposes an unparalleled family chronicle of infant death.1 Of five children, four died in early infancy and the other died without explanation at age 28 months. Prolonged apnea is proposed as the common denominator in the deaths, yet the author leaves many questions relevant to the fate of these children unanswered.
Sexual Practices and Intentions Among Preadolescent and Early Adolescent Low-Income Urban African-Americans
Authors: Stanton Bonita , Li Xiaoming , Black Maureen , Ricardo Izabel , Galbraith Jennifer , Kaljee Linda , Feigelman Susan
Published: December 2021

Objective. To assess the sexual practices and the social and intrapersonal influences on sexual practices and intentions which have an impact on the risk for acquired immunodeficiency syndrome among pre- and early adolescent, low-income African-American youths.

Design. Cross-sectional cohort study conducted in nine recreation centers serving three public housing developments in an eastern city.

Participants. Three hundred fifty-one African-American youths 9 to 15 years of age.

Outcome measures. Past and intended sexual intercourse, and past and intended condom use determined by a risk assessment instrument delivered aurally and visually via a "talking" MacIntosh computer.

Results. The median age was 11 years; 35% of youths had had sexual intercourse and 20% of virgins thought it likely that they would become sexually active in the next six months. Age and male gender were correlated with sexual activity. Of sexually active youths 62% had used a condom during their last episode of coitus and 60% expected to do so at the next episode. Among sexually active youths, 24% of boys and 35% of girls had had anal intercourse. Rates of foreplay (nonpenetrative sex) were low even among sexually active youths. The median number of sexual partners in the past six months was two. Social influences from parents, peers, and partners in an intimate relationship were important for all four sexual outcomes both by univariate analysis and after logistic regression.

Implications. A high percentage of the low-income, urban African-American pre- and early adolescents in this study are engaging or intending to engage in high-risk sexual behaviors. Acquired immunodeficiency syndrome reduction interventions for early adolescents should incorporate the importance of social influences from multiple sources.
Prevention of Intellectual Impairment in Children of Women Who Smoke Cigarettes During Pregnancy
Authors: Olds David L. , Henderson Charles R. , Tatelbaum Robert
Published: December 2021

The acknowledgement section of the following two articles should have included the statement listed below:

Prevention of Intellectual Impairment in Children of Women Who Smoke Cigarettes During Pregnancy. Pediatrics. 1994;93:228-233.

We thank Robert Chamberlin for serving as co-investigator on the original trial; John Shannon for his administrative support of the work; and Elizabeth Chilson, Diane Farr, Georgianna McGrady, Jacqueline Roberts, and Lyn Scazafabo for their work with the families enrolled in the program.
WHEN DEATH SQUADS MEET STREET CHILDREN
Authors: L. J. F.
Published: December 2021

Four children are murdered every day in Brazil. While the general murder rate has decreased in Rio de Janeiro since 1990, more children are being murdered: 306 died in 1991, 424 last year, and in the first six months of this year the number leapt to 298. Sao Paulo and Recife are not far behind.

The grim statistics usually get tucked away in the crime pages of the tabloids. Last week, however, when eight street children were shot dead in the centre of Rio the news shocked even Brazil.

The circumstances were especially macabre. The children, aged between 11 and 17, all poor and most of them black, were shot around midnight as they huddled by an elegant fountain in a prominent square named after Pope Pius χ. The five gunmen carried out their assault in the shadows of the Nossa Senhora da Candelaria, a floodlit 18th-century Catholic church which serves as one of Rio's prettiest postcards and a favoured spot for society weddings.
Management Errors Leading to Unnecessary Hospitalization for Kerion
Authors: Pomeranz Albert J. , Fairley Janet A.
Published: December 2021

Objective. Tinea capitis is a common problem in the inner city, outpatient population. It is known that some children were being admitted for treat- ment of the kerion type of tinea capitis. The purpose of this study was to determine why these children were being admitted and whether hospitalization was justified.

Design. A retrospective study of all children hospitalized at Children's Hospital of Wisconsin between January 1990 and December 1992 with the diagnosis of tinea capitis was performed.

Results. Twenty-nine children who were hospitalized with tinea capitis were identified. In 10 cases, tinea capitis was the primary reason for admission, in 19 patients it was a secondary diagnosis. All of the patients with a primary diagnosis of tinea capitis were presumed to have a secondary bacterial infection of the kerion; however, this was not verified by the workup of any patient. Numerous deviations from optimal treatment were noted in both groups of patients. Although tinea capitis had been correctly diagnosed before admission in seven primary tinea capitis patients, only two of these patients received oral griseofulvin. The patients in whom tinea capitis was a secondary diagnosis also had a number of therapeutic deficiencies including failure to prescribe griseofulvin (16%), failure to administer griseofulvin with a fatty food or meal (58%), and failure to prescribe a sporicidal shampoo (63%).

Conclusions. Although all patients were assumed to have a secondary bacterial infection, this could not be documented. With the possible exception of one patient all the symptoms described by the patients could be explained by the highly inflammatory nature of a kerion. A better understanding of the degree of inflammation that may accompany a kerion, as well as its proper treatment, may prevent unnecessary hospitalization of children.
ATTITUDES TO RANDOMIZED TRIALS (1970S)
Authors: L. J. F.
Published: December 2021

Medical education in the Protestant North West has for some time been more scientific than elsewhere. There are, however, still problems. There is resistance to the idea of randomised controlled trials in West Germany. An attempt was made to have them declared illegal. After lecturing in Germany on the value of randomised controlled trials in cardiovascular medicine, and after a rather violent discussion, I was taken aside by the chairman, who said, "Dr. Cochrane, you don't seem to understand. Controlled trials are done by the pharmaceutical industry. Gentlemen don't do them." It is difficult to interpret this particular remark, but I suspect that the feeling of shame about the Nazi medical pseudo-experimentation may be a factor.