bluuebunny/crossref_metadata_2025 huggingface dataset:
The Pediatrician's Role in Family Support Programs
Authors:   Committee on Early Childhood, Adoption and Dependent Care
Published: December 2021

The health and welfare of children depend on the ability of families, alone or with the assistance of others, to meet their needs. This task has become increasingly difficult for many families. Pediatricians need to be able to recognize situations in which families may have difficulty fulfilling parental obligations and assist the family in finding available additional support.

CHANGES IN FAMILIES

The structure of families and patterns of family life in the United States have undergone some profound changes during the past quarter century. The proportion of births to unmarried women increased between 1960 to 1985 from 5.3% to 22% and has continued in the same direction.1-3 Since 1960 the divorce rate has more than doubled,1-3 and it is estimated that 25% of children growing up in this decade will experience a divorce.4 Although remarriage rates are high, over a third again end in divorce.5 As a consequence, 8% fewer children are living with two parents (74.8% in 1989 versus 83.1% in 1971),6,7 and only 61% live with both biologic parents.8 Further evidence of change in family life is that almost 60% of all mothers with preschool-aged children are in the labor force, reflecting a twofold increase since 1970.9 A decline in the purchasing power of family income, the lack of comparable wages for women, and significant rates of homelessness have all stressed families and contributed to the continuing escalation of the percentage of children who live in poverty. Finally, internal migration within the country has separated many families from the natural support systems provided by their extended families, leaving parents socially isolated and interrupting the intergenerational transmission of advice and support.
Letters to the Editor
Authors: Silber Tomas J.
Published: December 2021

I was moved, but not surprised, by Dr Kaplan's report of a colleague who took his own life after the ordeal of false accusation of sexual misconduct. The three professionals described in my original article1 reported intense anxiety and distress as well as sleep and mood disturbances for several weeks (until resolution of the issue took place). One of them, a very talented Fellow in adolescent medicine, even reached the point of considering abandoning the field!
Letters to the Editor
Authors: Stevenson David K.
Published: December 2021

Dr Moneit makes two points, which we would endorse and re-emphasize. First, if infants are being discharged at or before 24 hours, then ensuring that they are seen again between 48 and 96 hours, would be prudent practice. What should be avoided is the temptation to count the discharge physical examination as the first follow-up visit of a well newborn and schedule the infant to be seen again in 2 weeks for routine care, leaving the parents with the assignment of monitoring for transitional jaundice.
No So Sunny
Authors: Mangrem Carole L. , Leggiadro Robert J.
Published: December 2021

We recently cared for a young patient who we believe represents a serious example of egg-associated salmonellosis in a member of a high-risk group because of his young age. His case serves to remind pediatricians to discuss infant feeding practices with parents and to warn them of the potential hazards of eggs related to salmonellosis.

This previously healthy 5-month-old white male was brought to the emergency department of a Mississippi regional medical center with a 1-day history of fever and irritability.
DOCTORS PLANNING BATTLE AGAINST HEALTH-CARE PLAN
Authors: L. J. F.
Published: December 2021

CHICAGO, June 14—Leaders of the American Medical Association laid the groundwork today for an aggressive legal and political campaign against two important elements of the health plan being developed by President Clinton: limits on national health-care spending and on doctors' charges.

The association's board warned that there would be significant constitutional problems if the Government tried to impose price controls or an overall limit on health spending, both of which have been advocated by the White House ...

Doctors across the country plan to distribute a list of questions to be used by patients in evaluating President Clinton's health-care plan. Among the questions, drafted by the medical association, are these:

"Will I still be able to see my own doctor? Will I have to pay extra?

"I have a group insurance policy through my employer. Will that change? Will my premiums, deductibles and copayments go up?

"Will I be able to choose my own type of health insurance? And can I buy extra insurance if I want it?

"Will the quality of care my family receives be maintained under a new system?

"I'm retired and on a fixed income. Will my Medicare coverage be affected?

"Will everybody in America have health insurance? And if so, how will we pay for this?"
MEDICAL STUDIES' CLAIMS IRK PROFESSION'S SKEPTICS
Authors: L. J. F.
Published: December 2021

According to the canons of truth in statistics, cigarette smoking increases the risk of suicide and being murdered. But does it really?

Three medical researchers took ... note recently of the proliferating number of population studies finding unexpected connections between behavior and disease. Studies have found 280 "risk factors" for coronary heart disease alone, including low birth weight, abstinence from alcohol and poor dental health, they report in the Lancet.

The three then applied the statistical methods used in many such epidemiological studies to an analysis of a 12-year study of 361,000 middle-aged American men for heart-disease risk factors.

The analysis showed that among nonsmokers, there were 1.09 suicides per 100,000 person years. The suicide rate increased steadily with the number of cigarettes smoked, reaching 3.78 suicides per 100,000 person years for people who smoke three packs of cigarettes a day. Researchers often put heavy emphasis on such a "dose-response relation."

The "relative risk" of being murdered also rose with smoking: Two-pack-a-day smokers were twice as likely to be murdered as nonsmokers were.

The flaw, the researchers say, is the implausibility of such links. Although smoking could reflect some mental state that predisposes a person to suicide, there's no plausible way that smoking, in and of itself, could cause suicide. And there's no plausible mechanism to explain how smoking could cause people to be murdered.

"If epidemiology can throw up a spurious independent dose-response relation for smoking/suicide, how many more such relations, for other exposures and other diseases, are equally spurious, protected only by their lack of obvious implausibility?" the trio asks rhetorically.
THE EFFECT OF PERMETHRIN IMPREGNATED BEDNETS ON THE INCIDENCE OF PLASMODIUM FALCIPARUM IN CHILDREN OF NORTH GUADALCANAL, SOLOMON ISLANDS
Authors: Kere N. K. , Parkinson A. D. , Samrawickerema W. A.
Published: December 2021

Kere and colleagues were able to demonstrate significant reductions in the incidence of malaria (Plasmodium falciparum) in children under the age of 10 years with the use of permethrin impregnated bednets. Eight hundred and sixty (860) people in 23 villages were given impregnated bednets and were compared with 520 people in 20 villages from a contiguous area who served as a control population. Incidences were based on mass blood screenings with thick and thin blood films examined conventionally.

Greater nighttime outdoor exposure of adults resulted in less impressive improvements than in children, who were more likely to be under the bednet during peak mosquito biting time.

In addition to reductions in malarial incidence in children, febrile episodes in children were reduced in frequency as well as the number of Anopheles farauti mosquitoes themselves. Survival of trapped mosquitoes was shown to be significantly reduced in the bednet homes compared with the control area, leading to the authors' conclusions that the nets not only protect people, but kill mosquitoes as well. Protection by the nets continued to be satisfactory for up to 1 year after permethrin treatment.
A PROSPECTIVE STUDY OF THE INFLUENCE OF α-THALASSAEMIA ON MORBIDITY FROM MARLARIA AND IMMUNE RESPONSES TO DEFINED PLASMODIUM FALCIPARUM ANTIGENS IN GAMBIAN CHILDREN
Authors: Allen S. J. , Rowe P. , Allsop C. E. M.
Published: December 2021

α-Thalassaemia is the most common haemoglobinopathy in Africa and is due to a defect in α-globin chain synthesis. Earlier studies have indicated that α-Thalassaemia may provide a selective advantage against Plasmodium falciparum malaria and account for the increased prevalence of α-Thalassaemia in malarial endemic areas. The mechanism by which α-Thalassaemia is protective against malaria is not clear. One hypothesis is that there is a greater binding of immunoglobulin molecules to the surface of thalassaemic red cells resulting in better clearance of parasitized erythrocytes. The present authors conducted a study on children living in two groups of villages in Gambia to test this hypothesis. These studies were conducted once at the beginning of May and once at the end of October, which is the end of the rainy season and a period of intense malaria transmission. In addition to definition of active and asymptomatic malarial infection, the authors conducted a number of studies including genotyping for haemoglobinopathies (specifically α-Thalassaemia and sickle cell), measurement of antibody to a variety of antigens related to malarial parasite, and in vitro cellular immune response to specific malarial antigens. They included a control group of 30 Swedish children who had never been exposed to malaria. They also used PHA, candida, and PPD as control antigens for in vitro stimulation of lymphocytes. They looked at the lymphocyte stimulation index and IFNγ production in vitro in response to various mitogens.

The authors did not find an increased parasite rate in children with α-Thalassaemia. A similar proportion of normal and heterozygotes thalassaemia children acquired malaria. This was different from earlier studies conducted in Papua, New Guinea. They also noted a higher rate of infection among children with hemoglobin AS and heterozygote for \g=a\-Thalassaemia than in those with normal hemoglobin and heterozygote for \g=a\-Thalassaemia. There was no difference between children with \g=a\-Thalassaemia and those with normal genes in the prevalence of antibodies to any of the malarial antigens. However, in the in vitro assay they noted greater lymphoproliferative responses to some of the soluble antigens and lower IFN\g=g\ production response to two of the recombinant antigens for merozoite protein in \g=a\-Thalassaemic children compared with normal children. However, considering the number of antigens that were tested, these abnormalities may have been by chance.

Although there was no difference in the frequency of malaria among children with \g=a\-Thalassaemia and those with normal haemoglobin genotype, there were few children who had both \g=a\-Thalassaemia and sickle cell trait with fewer clinical episodes of malaria than children with sickle cell trait alone. This is an unexpected finding. This finding may be more important to follow than the original question with which the authors started the study.
INTRALESIONAL TREATMENT OF CUTANEOUS LEISHMANIASIS WITH SODIUM STIBOGLUCONATE ANTIMONY
Authors: Faris R. M. , Jarallah J. S. , Khoja T. A. , Al-Yamani M. J.
Published: December 2021

Cutaneous leishmaniasis is endemic in Saudi Arabia and is a worldwide problem. In an attempt to reduce the side effects of parental drugs and keep costs low, this study evaluated intralesional sodium stibogluconate.

Seven hundred and ten (710) patients with the parasite demonstrated in smears from the lesion were enrolled. Sixty-four percent (64%) were less than 15 years of age. Seventy-three percent (73%) of the patients had one lesion and the mean number of lesions was 1.5. Sixty-eight percent (68%) of the lesions were on the face. Treatment consisted of injection with a fine insulin needle with 0.5-1 mL of the agent and repeated on alternate days for a total of eight injections. In those lesions complicated by infection or previous cautery or cryotherapy up to 24 injections were done. Secondarily infected lesions were first treated with systemic rifampin and/or topical antibiotic or ketoconazole.

Seventy-two percent (72%) of the treated lesions healed completely. Twenty-three and nine-tenths percent (23.9%) showed some improvement after 1 month of treatment. Resolution took 2 to 8 weeks depending on site. Of the 4.1% showing deterioration, all had been treated previously. Other than injection site pain there were no side effects except hyperpigmentation in 17%, all of whom received previous local treatment. This usually disappeared spontaneously.

The rapid response may be due to the direct application of the agent directly to the affected tissues.

Recently, this method of treatment has been recommended by the World Health Organization.

Conclusion: Intralesional sodium stibogluconate is safe and therapeutically effective.
WEIGHT GAIN OF KENYAN SCHOOL CHILDREN INFECTED WITH HOOKWORM, TRICHURIS TRICHIURA AND ASCARIS LUMBRICOIDES IS IMPROVED FOLLOWING ONCE- AND TWICE-YEARLY TREATMENT WITH ALBENDAZOLE
Authors: Stephenson L. S. , Latham M. D. , Adams E. J.
Published: December 2021

Hookworm, Ascaris lumbricoides, and Trichuris trichiura each are estimated to infect ⅙ to ¼ of the world's population. Many studies show the association between infestation with these parasites and poor growth in children. Although the long-term solutions to malnutrition lie in eradicating poverty and in community-based programs to improve health care, living conditions, sanitation, water supplies, and health education, the enormous financial and logistic difficulties of implementing such improvements led these investigators to study the effectiveness of the pharmacology approach for short-term impact.

Previous studies demonstrated that nearly all primary school children in the area in Kenya in which they worked had hookworm and Trichuris trichiura and half had Ascaris lumbricoides. A population-based randomly controlled trial of a once a year, twice a year, and placebo treatment with Albendazole 600 mg follow-up after 8 months demonstrated, in the two treatment groups compared with the placebo, significant decreases in the parasite burden and significant increases in weight for age, weight for height, and arm circumference with little difference between the two treatment groups.

The mechanism by which such improvement in gravity occurred presumably involved altering host nutritional intake, metabolism, and excretion. These children did not have chronic diarrhea; therefore, the mechanism appears to be either increased by intake, metabolism, or both.

This community chemotherapeutic approach to control these parasites and improve growth and nutrition is a practical, short-term method to improve child health in areas with a high prevalence of these parasites.
Pediatric Home Health: The Need for Physician Education
Authors: Goldberg Allen I.
Published: December 2021

Home health represents a spectrum of exciting practice possibilities for the pediatrician. Care in the home can be provided for acute, intermediate, or long-term health conditions. An acute infection can be treated at home with physician or nurse visits; a relapse of leukemia or chronic infection (osteomyelitis) can be managed at home with intermittent drug therapy. Home care can involve high technology (mechanical ventilators), low technology (assistive mobility aids), or no technology. Home care can be provided only by family members or with supplemental support from neighbors, friends, personal attendants, or professionals on an intermittent or continuous care basis. For the physician, home care may involve discharge planning, postdischarge care oversight (telephone, documentation), or just "an old-fashioned house call."
First Case of Human Infection Caused by Pasteurella gallinarum Causing Infective Endocarditis in an Adolescent 10 Years After Surgical Correction for Truncus Arteriosus
Authors: Al Fadel Saleh Mohammad , Al-Madan Mohammad S. , Erwa Hashim H. , Defonseka Ivy , Sohel Saira Z. , Sanyal Shyamal Kumar
Published: December 2021

Objective. To report the first case of human infection (infective endocarditis [IEI]) caused by Pasteurella gallinarum and to review the literature regarding IE caused by the genus Pasteurella.

Setting. University hospital based.

Patient. An adolescent boy who underwent successful correction for truncus arteriosus 10 years before the present illness.

Results. Persistent fever, pallor, and a palpable spleen suggested IE clinically. Echocardiography documented vegetation in the conduit that was used for surgical correction. Blood cultures grew P. gallinarum and confirmed its role as the causative organism for IE in the patient.

Conclusion. This case illustrates that IE may develop in a child with congenital heart disease several years after surgical intervention using material that is foreign to the body (conduit), and that such a complication may involve unusual pathogens. These observations emphasize the need for careful long-term follow-up of children with congenital heart disease even after successful surgical correction.
Drugs and Breast Milk
Authors: Eidelman Arthur I. , Schimmel Michael S.
Published: December 2021

The recent publication of the Committee on Drugs of the American Academy of Pediatrics1 of an updated list of drugs and their potential effect on the infant or lactation is most welcome, given the increase both in the practice of breast-feeding and the awareness of the medical and lay public as to the adverse effect of drugs ingested by the nursing mother. In particular, the availability of newer antihypertensive and psychoactive agents for the treatment of common postpartum conditions inevitably leads to therapeutic dilemmas for the perinatal team concerned about the maternal-infant dyad.
Letters to the Editor
Authors: Hausser Dominique , Michaud Pierre-André
Published: December 2021

We thank Dr Tankersley for his comments and offer the following answers:

1. Dr Tankersley rightly points out the mistake in Table 4. Seventy -seven percent of boys in 1987 and 87% of boys in 1990 answered the question: "have you ever used a condom?" The 22% of boys in 1987 and the 34% of boys in 1990 who said they have used a condom on a regular basis are thus included in these figures.
Letters to the Editor
Authors: Resnick Michael D. , Blum Robert Wm.
Published: December 2021

We appreciate and share the legitimate, heartfelt concern of our colleagues over the damaging effect of sexual abuse, sexual coercion, and early onset of sexual intercourse among adolescents. We strongly concur that sexual abuse in any form has profound effects on the health and well-being of young people, and very early onset of sexual intercourse–whether or not it is defined or divulged as sexual abuse–places young people at risk for a variety of adverse outcomes.
Emergency Medical Services for Chi and Pediatric Subspecialty Practice: A Call to Action
Authors: Fiser Debra H.
Published: December 2021

For many pediatric subspecialists, their role in the emergency medical services for chi system is unclear. However, subspecialists have an affirmative responsibility to contribute to development of a system that integrates consumers and providers from each subsystem. Avoiding fragmentation with an integrated system will yield the best outcome for patients while minimizing resource utilization. Additional roles for the subspecialist include responsibilities for advocacy, for guiding policy decisions and implementation, and for education, quality assurance, and research.
The Institute of Medicine Report on Emergency Medical Services for Chi: Thoughts for Emergency Medical Technicians, Paramedics, and Emergency Physicians
Authors: Cook Richard T.
Published: December 2021

The emergency medical technician, the paramedic, and the emergency physician, as well as emergency physicians who have additional expertise in emergency medical service (EMS) prehospital care or pediatric emergency medicine (through experience or formal fellowship training), will all find the Institute of Medicine's report, Emergency Medical Services for Chi (EMS-C), to be an invaluable background resource as well as a guide for EMS system and EMS-C-related planning. With both breadth and depth, it reviews many of the issues in EMS-C today from many perspectives and provides practical information to enable these care givers to understand better the "big picture" of EMS-C as well as to assist them in continuing to make a difference in the day-to-day emergency care for children. It is well referenced, engenders respect for all members of the team within the broad continuum of EMS-C, and provides encouragement to them to work together to identify and address issues and solve problems to improve the quality of care for our nation's children.
PROBLEMS AHEAD
Authors: L. J. F.
Published: December 2021

Are you a victim of HMO medicine?

You thought there was something wrong, but the doctor said you did not need a test. Now you have cancer which should have been found earlier.

Angry?

You should be. HMOs are reporting billions of dollars of profits—money saved by "gatekeeper" doctors who shortchange their patients.

Our office specializes in representing the victims of HMO medicine. For a free consultation call ...
Prevalence of Lead Poisoning Among Two-Year-Old Children in Vermont
Authors: Paulozzi Leonard J. , Shapp Joanne , Drawbaugh Robert E. , Carney Jan K.
Published: December 2021

Objectives. The recent redefinition of childhood lead poisoning by the Centers for Disease Control and Prevention means that many more children are considered lead poisoned than previously. The primary purpose of this study was to determine how many 2-year-old children had lead levels of 10 µg/dL or more in a rural state.

Methods. Random samples of 334 children drawn from the birth certificate file and 350 children from Vermont Medicaid rosters submitted capillary blood specimens that were confirmed by venous tests if lead levels were 10 µg/dL or more.

Results. Participation rates were 63.9% in the birth certificate group and 66.4% in the Medicaid group. In the birth certificate sample, the percentages of children with confirmed lead levels 10 µg/dL or more, 15 µg/dL or more, and 20 µg/dL or more were 9.0 (95% confidence interval [CI], 6.2-12.6), 2.7 (95% CI, 1.2-5.0), and 1.5 (95% CI, 0.5-3.4), respectively. In the Medicaid sample, the corresponding percentages were 14.9 (95% CI, 11.4-19.2), 5.1 (95% CI, 3.1-8.0), and 2.0 (95% CI, 0.8-4.1), respectively. The percentage of children in the state's most urban county with lead levels of 10 µg/dL or more was significantly less than that in the rest of the state in both samples.

Conclusions. The prevalence of elevated lead levels in 2-year-old children may be significant in rural states with old housing stock. Medicaid-enrolled children represent a readily identifiable high-risk group.
Physicians and the Communication of "Bad News": Parent Experiences of Being Informed of Their Child's Cleft Lip and/or Palate
Authors: Strauss Ronald P. , Sharp Michael C. , Lorch S. Claire , Kachalia Beejal
Published: December 2021

Objective. Physicians often are called on to deliver "bad news" in the form of a diagnosis with unhappy implications. Few guidelines exist for practitioners who wish to meet patient and family expectations for clear and caring communication. To develop recommendations for physicians, this study was undertaken to document how biologic parents of children born with a specific, non-life-threatening birth defect perceive the encounter with a physician during which they were informed of their children's diagnosis. The study also examines parental preferences for how this communication might best be managed and compares those with parent reports of their actual experiences.

Methodology. Biologic parents of children born with cleft lip and/or palate (n = 100) were studied with a self-administered questionnaire about the diagnostic encounter in which they rated theoretically derived dimensions of physician communication. Their experiences, as well as their preferences for communication in a hypothetical case, were compared through the use of ratings and open-ended qualitative narratives.

Results. Parents learned the diagnosis at birth (90%) from a physician (96%). Many report positive experiences, but there are significant differences between what parents experienced and what they desire in the informative interview. Parents wanted more opportunity to talk and to show their feelings and wanted the physician to try harder to make them feel better. As compared with their experiences, parents indicated a desire to have more information and more of a discussion about the possibility of mental retardation. They wanted the physician to show more caring and confidence, and wanted more referral to other parents, than they had experienced. Dimensions of physician behavior were more positively perceived by parents who were informed by a physician whom they felt they knew well.

Conclusions. It is possible for physicians to effectively deliver bad news, such as the diagnosis of a birth defect, to parents. This study suggests specific communicative and educational approaches that are likely to improve parental satisfaction with such physician communications.
Familial Hypercholesterolemia: Molecular, Biochemical, and Clinical Characterization of a French-Canadian Pediatric Population
Authors: Assouline Linda , Levy Emile , Feoli-Fonseca Juan Carlos , Godbout Caroline , Lambert Marie
Published: December 2021

Background. Familial hypercholesterolemia (FH) is a dominantly-inherited disorder attributable to a defect in the low-density lipoprotein (LDL) receptor gene. Five mutations at this locus have been identified in French-Canadians. In children, it may be difficult to clinically distinguish FH from other forms of polygenic or monogenic hyperlipidemia. Therefore, our objectives were to define the molecular basis of our subjects' hypercholesterolemia, to characterize their biochemical phenotype in relation to the underlying molecular defect, and to assess their response to chronic dietary therapy.

Methods. We studied 88 unrelated French-Canadian children with a persistent increase in LDL cholesterol and a parental history of hyperlipidemia. Baseline and end-of-diet lipid and apolipoprotein levels were measured. Mutational analysis at the LDL receptor gene locus was performed.

Results. Heterozygosity for the common French-Canadian LDL receptor gene >10-kb deletion was found in 57% of subjects (group 1), 14% carried one of the other four previously characterized LDL receptor gene mutations (group 2), and none of the five molecular defects tested was detected in 29% (group 3). Total cholesterol, LDL cholesterol, and apolipoprotein B baseline levels were similar among these three groups but significantly higher than in control subjects. However, there was wide interindividual variability even among those carrying the same mutation. Significantly lower baseline levels of high-density lipoprotein cholesterol and apolipoprotein A1 were found in group 1 compared with group 3 and the controls. The response to diet was similar among the three groups with an average reduction in the mean level of total cholesterol of 4.4%.

Conclusions. The frequency of proven FH heterozygotes (71%) was remarkable in the pediatric population studied. Our data suggest that, in children, a persistent primary increase in LDL cholesterol associated with a parental history of hyperlipidemia is a good predictor of an underlying monogenic disorder as opposed to a polygenic disorder, at least in French-Canadians. Only molecular analysis allowed us to unequivocally define the cause of our patients' hypercholesterolemia. Most children with familial hyperlipidemia did not reach desirable plasma lipid levels solely under diet therapy.
High-Risk Behaviors Among High School Students in Massachusetts Who Use Anabolic Steroids
Authors: Middleman Amy B. , Faulkner Annie H. , Woods Elizabeth R. , Emans S. Jean , DuRant Robert H.
Published: December 2021

Objective. To assess the association between the frequency of anabolic steroid use and the frequency of other health risk and problem behaviors among high school students in Massachusetts.

Methods. The 1993 Massachusetts Youth Risk Behavior Survey was conducted on a random sample of 3054 high school students (49% male; mean age, 16 ± 1.2 years). The frequency of lifetime anabolic steroid use was measured on an ordinal scale from 1 to 6, representing "0" to "40 or more times." Other health risk and problem behaviors measured were sexual behaviors, suicidal behaviors, frequency of not wearing a passenger seat belt, riding a motorcycle, not wearing a helmet while riding a motorcycle, driving after drinking alcohol, riding with a driver who had been drinking alcohol, fighting, and carrying a weapon. The associations between the frequency of anabolic steroid use and other high-risk behaviors were determined using the Spearman correlation coefficient for ordinal data and the Kruskall-Wallis analysis of variance for categorical data. Representative indicators of each risk behavior significantly associated with anabolic steroid use were then analyzed using a stepwise multiple-regression analysis.

Results. The frequency of anabolic steroid use was associated with all of the other high-risk behaviors analyzed. Using multiple-regression analysis, driving after drinking alcohol accounted for 12.5% of the variance of the model. Carrying a gun, the number of sexual partners within the past 3 months, not using a condom during last intercourse, injury in a physical fight requiring medical attention, history of a sexually transmitted disease, not wearing a helmet on a motorcycle, not wearing a passenger seatbelt, and a suicide attempt requiring medical attention accounted for an additional 9.0% of the variance. The full model accounted for greater than 21% of the variation.

Conclusions. The frequency of anabolic steroid use among adolescents is associated with other high-risk behaviors, thus supporting the hypothesis that anabolic steroid use is part of a "risk behavior syndrome" rather than an isolated behavior. This finding emphasizes the need for comprehensive high-risk behavior screening and counseling among teens who use anabolic steroids.
Psychosocial Adaptation of 39 Adolescents With Sex Chromosome Abnormalities
Authors: Bender Bruce G. , Harmon Robert J. , Linden Mary G. , Robinson Arthur
Published: December 2021

Objectives. Children with sex chromosome abnormalities (SCA) are known to be at increased risk for neuromotor, language, learning, and behavioral problems, but little is known of psychosocial adaptation of SCA adolescents. This study was conducted to evaluate psychologic characteristics of unselected SCA adolescents, including socialization, educational progress, seperation from family, and incidence and severity of psychiatric disturbance.

Methods. Thirty-nine propositi identified through the screening of 40 000 consecutive Denver newborns, including boys with 47,XXY karyotypes and girls with 47,XXX, 45,X, and partial X monosomy, or SCA mosaic karyotypes, have been followed longitudinally into adolescence. Twenty-seven siblings served as controls. Between 12 and 19 years of age, all participated in blind psychiatric interviews and were administered standardized intelligence and achievement tests.

Results. SCA propositi demonstrated a mean IQ score 21 points lower than that of control subjects. In addition, lower mean scores were seen on achievement test results as well as lower overall psychosocial adaptation scores and increased incidence of psychiatric disturbance. Depression was the most frequent psychiatric diagnosis. Propositi were more likely to receive special education assistance in high school and were less likely to graduate from high school than were controls. Of the three nonmosaic propositi groups, the 47,XXX girls demonstrated the poorest overall psychosocial adaptation and highest degree of psychiatric disturbance. Mosaic girls were indistinguishable from control subjects. Marked variability was found among all three nonmosaic groups, with some individuals in each group demonstrating relatively strong psychosocial adaptation.

Conclusions. The presence of nonmosaic sex chromosome abnormality increases the risk for impeded cognitive skills, learning abilities, and psychosocial adaptation in adolescence. The factors that allow for stronger adaptation in some of these adolescents include the presence of a stable and supportive family environment. The outlook for adaptation in unselected SCA adults remains uncertain.
BUREAUCRATS TAKING OVER!
Authors: L. J. F.
Published: December 2021

Academic medicine seemed to offer the best of both worlds: plenty of time for research, some teaching, and limited practice responsibilities.

Today, it all seems somehow lost: the independence, the time, the easily acquired grants, the lifestyle, and the security. Control has been wrested from medicine and is in the hands of bureaucrats, politicians, and CEOs. Patients—or consumers as they are now known—are distrustful and litigious. Lawyers are ever present and increasingly skilled at pitting one doctor against another. Academic health centers are locked in fierce battles for survival, and all physicians worry about the future.

Why has this happened?

The usual response to this questions mentions four major factors that have precipitated a health care "crisis," largely by driving up the costs of medical care: 1) the spectacular (and expensive) advances in medical technology and treatment; 2) changes in society, including epidemics of violence, drug abuse, economic disenfranchisement, and AIDS, which have added considerably to the nation's health care needs; 3) the shifting demographics of American society, particularly the growing numbers of elderly, who consume a disproportionate share of health care; and 4) the economic realities of global competition, in which American products lose a competitive edge because of the escalating health insurance costs of large employers.

To this list may be added two other factors: the unrealistic expectations of consumers, and the unchecked growth of physician specialists.
Surfactant Replacement in Neonates With Early Chronic Lung Disease
Authors: Pandit Paresh B. , Dunn Michael S. , Kelly Edmond N. , Perlman Max
Published: December 2021

In the article entitled "Surfactant Replacement in Neonates With Early Chronic Lung Disease" by Pandit et al that appeared in the June issue of Pediatrics (pages 851-854), there was an error in the Results section (page 852). The third sentence in this section should read:

"Of note, the birth weights of seven patients were less than 750 g; two were between 750 and 1000 g; and one weighed 1100 g."
The Initiation or Withdrawal of Treatment for High-Risk Newborns
Authors:   Committee on Fetus and Newborn, 1994 to 1995
Published: December 2021

As medical technology has advanced, outcomes for high-risk newborns have greatly improved. With advanced technology such as assisted ventilation, it is now possible to keep some terminal, severely ill, or extremely premature infants alive for long periods of time. The result of such treatment is that dying may be prolonged or that the infant will survive with profound neurologic or other debilitating problems.1 The medical treatment of infants should be based on what is in their best interest. However, because the infant's "best interest" is not always clear, parents and health care givers are often faced with difficult treatment decisions when faced with the situation of a severely ill, extremely premature, or terminally ill infant.

The Treatment Dilemma

If intensive treatment uniformly resulted in saving infants at risk, it would be the obvious choice for all severely ill infants. This outcome, of course, does not always occur. If intensive treatment is not provided to very ill infants, most of them will die, but some may survive with significant neurodevelopmental disability, in part because specific treatments were withheld. The following dilemma therefore exists: intensive treatment of all severely ill infants sometimes results in prolongation of dying or occasionally iatrogenic illness; nonintensive treatment results in increased mortality and unnecessary morbidity. The overall outcomes of either approach are disappointing.

Strategy for Care

A reasonably acceptable approach to this dilemma is an individualized prognostic strategy.2,3 In this setting, care is provided for the individual infant at the appropriate level based on the expected outcome at the time care is initiated.
Letters to the Editor
Authors: Shira James E.
Published: December 2021

The Committee on Hospital Care (COHC) was indeed remiss in failing to include the hospital pharmacist in the list and description of essential unit personnel in its statement "Staffing Patterns for Patient Care and Support Personnel in a General Pediatric Unit."1 The omission was truly unintentional and unfortunate.

We sincerely appreciate Dr Oddis' valuable comments and wholeheartedly concur with his message that pharmacists provide many essential services both to patients and the other members of the health care team on the pediatric unit.
HIV/Age of First Sexual Encounter
Authors: Adams Joyce , Friedman Lawrence S. , Mason Vincent , Rice Lynn
Published: December 2021

We congratulate Hein et al1 on their study comparing teenagers who are HIV-infected with those who are not. Although this study was quite detailed in its investigation of infection risk factors, we would like to know whether they considered two other potentially important risk factors in their investigation. The first is the age of the sexual partner. There is reason to believe that teenagers who have older sexual partners are at substantially greater risk of HIV infection than teenagers who have age-equivalent partners.
Taste Counts!
Authors: Lallier Chuck
Published: December 2021

I've read a number of articles on oral rehydration, including Cohen et al in the May 1995 issue of Pediatrics. The question "Why don't general pediatricians accept the use of oral rehydration?" comes up repeatedly.

There's a simple answer. We do. The problem is kids don't. They don't like the taste of the oral rehydration solutions and I don't blame them. I've tried it, in sickness and in health. The stuff tastes like lightly sugared sea water.
Letters to the Editor
Authors: Cohen Mitchell B.
Published: December 2021

Dr Lallier writes that the taste of oral rehydration solutions (ORS) is an impediment to their use. I concur that ORS commonly in use in the United States are not tasty to my palate either. Exceptions are the CeraLyte rice-based oral electrolyte solutions (Cera Products, Columbia, MD), which are not readily available and have not yet been adequately studied in children. Some advocate the addition of powders or flavored sugarless solutions to enhance the palatability of ORS.
SERUM SICKNESS-LIKE REACTIONS TO CEFACLOR: ROLE OF HEPATIC METABOLISM AND INDIVIDUAL SUSCEPTIBILITY
Authors: Randolph Christopher , Kaplan Michael
Published: December 2021

The findings indicate that cefaclor-associated serum sickness-like reaction may be a unique adverse drug reaction that requires biotransformation of the parent drug and may be associated with inherited defects in the metabolism of reactive intermediates. The condition can be retrospectively confirmed with an in vitro lymphocyte-based cytotoxicity assay. This assay is specific for cefaclor and does not cross-react with cephalexin.
EPIDEMIOLOGY OF PHYSICIAN-DIAGNOSED ALLERGIC RHINITIS IN CHILDHOOD
Authors: Randolph Christopher
Published: December 2021

Allergic rhinitis incidence in the first years of life is an early indication of an atopic predisposition that may be triggered by early environmental exposures.
BRONCHIAL BIOPSY EVIDENCE FOR LEUKOCYTE INFILTRATION AND UPREGULATION OF LEUKOCYTE-ENDOTHELIAL CELL ADHESION MOLECULES 6 HOURS AFTER LOCAL ALLERGEN CHALLENGE OF SENSITIZED ASTHMATIC AIRWAYS
Authors: Raub Jeff , Spahn Joseph
Published: December 2021

Endobronchial allergen challenge in allergic asthmatics leads to a decrease in pulmonary function, and an increase in bronchial hyperresponsiveness within 24 hours, and an influx of inflammatory cells (neutrophils, eosinophils, mast cells, and lymphocytes) within 6 hours. In addition, 6 hours postallergen challenge, an increase was detected in the expression of several endothelial cell adhesion molecules (ICAM, E-selectin), which are essential for inflammatory cell migration.
EFFECTIVENESS OF ROUTINE SELF MONITORING OF PEAK-FLOW IN PATIENTS WITH ASTHMA
Authors: Bell Thomas
Published: December 2021

The authors felt that individual data suggested the possession of the peak-flow meter led to some improvement in the management of more severe asthmatics. They conclude the benefits of peak-flow self-management are questionable.
INFLUENCE OF SPACER DEVICE ON DRUG DELIVERY TO YOUNG CHILDREN WITH ASTHMA
Authors: Joos Thad H.
Published: December 2021

Purpose of the Study. To evaluate the effectiveness of three different spacer devices for the delivery of an inhaled corticosteroid in asthmatic children 10 to 25 months of age.

Methods. The three spacers used were: Nebuhaler, Babyspacer, and Aerochamber (only the Aerochamber is available in the United States). Twenty children received in a crossover pattern 200 µg, in a single dose, of budesonide via a spacer and tightly-fitting face mask. A special filter was interposed between the face mask and the infant to catch the inhaled budesonide, which was then measured. In addition, the flow rates generated by the infants were determined as well as the budesonide remaining in the spacers.

Results. Both the Nebuhalen and Babyspacen were convincingly better than the Aenochamben in the amount of active drug as measured in the filter. The investigators felt that the amount deposited on the filter was an indicator of how much would reach the lungs.

Discussion. The Aerochamber had been the spacer of choice of the authors' before the study was completed, so the results were unexpected.

Reviewer's Comments. We have all used spacers to some degree and truly wonder how much medicine the patient really does receive. I feel Drs Agertoft and Pedersen have come up with an excellent way to resolve this dilemma.
ORAL VERSUS NEBULIZED ALBUTEROL IN MANAGEMENT OF RHINOVIRUS BRONCHIOLITIS IN EGYPT
Authors: Randolph Christopher
Published: December 2021

Nebulized albuterol significantly improves clinical outcome and reduces respiratory rate of recurrently wheezing, individuals compared with those in randomized groups.
EFFICACY OF ALBUTEROL IN THE MANAGEMENT OF BRONCHIOLITIS
Authors: Lee Napoleon , Kettelhut Brett , Kobayashi Roger H.
Published: December 2021

Purpose of the Study. To determine the efficacy and safety of albuterol (0.15 mg/kg per dose) in the management of bronchiolitis.

Study Population. Eighty-eight infants (mean age, 5.5 months old) with their first episode of wheezing due to bronchiolitis were enrolled. Exclusionary criteria included previous treatment with bronchodilators, mechanical ventilation, or a history of cardiorespiratory diseases.

Methods. This was a double-blind, placebo-controlled study with infants randomly assigned into four treatment groups: 1) those who received nebulized albuterol (0.15 mg/kg) 2) those who received oral albuterol, 3) those who received nebulized placebo, and 4) those who received oral placebo.

Patients were assessed at baseline, 30 minutes, and 60 minutes after treatment for respiratory rate (RR), symptom score (SC), heart rate (HR), and pulse oximeter (SPO2). Seventy-five had nasopharyngeal aspirate cultures perfomed.

Results. Thirty-six (48%) of nasopharyngeal aspirates were positive for respiratory syncytial virus (RSV) and were equally distributed among the four groups. Four others had cultures positive for other viruses. HR, RR, SC, and SPO2 did not differ after 30 minutes and 60 minutes from initial treatment for groups 1, 3, and 4. Results were similar for group 2 except for an increase in heart rate (+15 beats/min) at 60 minutes (P = .006). Hospital admission rates were similar for all four groups.

Reviewer's Comments. Albuterol in either form did not alter the course of bronchiolitis in infants. Care in selection of study infants was taken to identify those infants with wheezing due to a viral bronchiolitis and exclude other causes of wheezing.
HIV-1 INFECTION OF SUBCORTICAL ASTROCYTES IN THE PEDIATRIC CENTRAL NERVOUS SYSTEM
Authors: Church Joseph A.
Published: December 2021

Subcortical astrocytes appear to be an unrecognized reservoir for HIV in the developing nervous system of some children with HIV encephalopathy.
HIV-Infected Adolescents With Hemophilia: Adaptation and Coping
Authors: Brown Larry K. , Schultz Janet R. , Gragg Rod A. ,   Hemophilia Behavioral Intervention Evaluation Project
Published: December 2021

Objective. It is estimated that 70% of individuals with factor VIII deficiency hemophilia who received blood products before 1985 are infected with human immunodeficiency virus (HIV). The goal of the current study was to assess how adolescents with hemophilia cope with reminders of their HIV status, because adaptation is likely to have implications for these individuals' quality of life and adherence to safer sex recommendations.

Methods. Participants included 297 HIV-positive adolescents with hemophilia who were recruited from 11 sites across the United States. Adolescents reported on the use and effectiveness of strategies for coping with reminders of their HIV status.

Results. A significant degree of distress was reported in response to such reminders, with anger being the most commonly reported emotion. Although a wide variety of coping strategies had been tried, participants reported using resignation (80.9%), self-calming (78.8%), and distraction (76.4%) most frequently in their attempts to cope with reminders of HIV. Self-blame (3.6%), engaging in risky behaviors (22.2%), thinking about sex (25.4%), and drug/alcohol use (29.1%) were used least. These adolescents tended to rate more active cognitive and behavioral coping strategies (eg, cognitive restructuring, seeking social support, physical activity) as most effective, whereas passive strategies (eg, wishful thinking, blaming others) were reported to be least helpful. Those individuals who reported being distressed by reminders of HIV endorsed most of the coping strategies significantly more often than the nondistressed group, although ineffective strategies were commonly chosen. Sexually active adolescents were more likely than their abstinent peers to cope by thinking about sex, engaging in risky behaviors, or using alcohol and drugs.

Conclusion. In this population of adolescents who have known their serostatus for several years, distress about everyday reminders of HIV appears to be associated with ineffective coping strategies.