bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effects of Health Promotion Literacy Program on Knowledge and Health Behaviors of National Health Recommendations among Middle School Students
Authors: Khamwichai Kanyarat , Yurahan Natchapat , Srisiri Sununta , Moungsirithum Pimpa
Published: December 2021

This study was examined the effect of health promotion literacy program on knowledge and health behaviors of Ten National Health Recommendations among middle school students. Classroom action research was implemented among grade 8 students at middle school students selected purposively. Two comparable schools were assigned to the online Health Promotion Literacy Program for 3 weeks. The instruments employed in the study consisted of Health Promotion Literacy Program, questionnaire on knowledge and health behaviors, and user satisfaction survey. It revealed there was a significant difference in the learning achievement of health literacy and health behaviors of each school those who were participated in Health Promotion Literacy Program who performed posttest better than pretest the programme (t1=24.26, P1=0.000, t2=26.33, P2=0.000). It revealed there was an insignificant difference in the learning achievement of health literacy and health behaviors of both affiliations that it is shown that students who come from different schools totally have similar knowledge, perceptions, and behaviors (t=1.22, P=0.848). The students who participated in health promotion literacy program had satisfaction at good level (x ̅=4.39). From the study, health literacy promotion program on health behaviors according to the National Health Recommendations can positively affects student learning outcomes.
Validity of the 20 Meter Multi-Stage Shuttle Run Test (MSSRT) In Predicting VO2 Max
Authors: Kumar A. Shasi
Published: December 2021

The purpose of this study was to investigate the validity of the 20 meter multi-stage shuttle run test (MST) in predicting VO2max compared to the directly measured reading from the laboratory. 4 male participants, who were diverse in terms of their ages and who were active physically, performed the MST and an incremental treadmill tests. Predicted VO2max values were obtained for the MST based on their stages and shuttles and actual VO2max values were obtained from the laboratory treadmill test. Results showed that all predicted VO2max values for the MST over-predicted that of the actual VO2max values from the laboratory test. This study seems to suggest that there is no validity in the MST in predicting VO2max of an individual as compared to the actual VO2max values from the laboratory.
Injury Causes and Recovery Management Strategies among Singapore CrossFitters
Authors: Tan Kun Lan , Chung Ho Jin
Published: December 2021

CrossFit is a combination of movements from various sport disciplines such as Olympic Weightlifting, Powerlifting and Gymnastics executed at high intensity. It has shown to bring about physiological and psycho-social benefits to members, increasing exercise adherence. Established in 2005, CrossFit has seen an exponential growth since, with 13,991 CrossFit affiliates worldwide. The popularity of the program despite its disposition to injury requires greater attention to its safety. This research aims to understand (1) reasons of injury among CrossFitters; (2) Injury management techniques among CrossFitters. In-depth interviews were conducted with nine CrossFitters from five Singapore CrossFit affiliates. Data was transcribed and thematically analyzed. Findings revealed that causes of injury include poor workout program designs, insufficient physiological knowledge passed down from coaches to athletes, athlete’s impatience when learning new skills as well as athletes conforming to performance and peer pressures. Further, Crossfitters manage their injuries through self-care physiological means and with professional guidance. The study concludes that coaches play a vital role in both the prevention and management of injuries. Therefore, they should design their programs with the athlete’s safety in mind and foster an environment that values patience, strength building discipline and safety. Athletes should also pay extra attention to their movement technique and be self-reflective in their physical capabilities. All athletes should regularly practice conservative physiological recovery methods and seek treatment or diagnosis from medical practitioners when necessary.
Modifications of microfiber synthetic leather base (MSLB) to enhance the sanitary performances: a review
Authors: Rahman Khan Md Khalilur , Hassan Mohammad Naim , Siddique Abu Bakr , Begum Hosne Ara
Published: December 2021

Microfiber leather is a type of synthetic leather made up of a high-grade polyurethane resin and microfiber bundles that resemble the microscopic characteristics of natural leather. Microfiber has benefited from its smaller diameter, which is similar to that of real leather fibrils. Microfibers have received a lot of focus and are frequently employed in the synthetic leather basis, which is an important factor in regulating synthetic leather functionality. Microfiber synthetic leather has advantages over natural leather in terms of mechanical behavior, for example. However, there is a significant difference between natural leather and microfiber synthetic leather in terms of other aspects, such as hygiene issues. Microfiber synthetic leather, unlike natural leather, has inferior transmission and absorption qualities, making it feel hotter. As a result, there is a pressing need to improve the sanitary performance of superfine synthetic leather. Several studies have endeavored to improve the hygienic qualities of MSLB by modifying it in various ways. It is attempted to make a review on the different types of modifications in brief.
Two modified natural in vitro fertilisation (IVF) protocols compared to conventional IVF treatment: Retrospective data from one Danish Fertility Centre
Authors: Almind Gitte Juul , Abraham-Zadeh A , Faerch E , Lindenberg F , Smidt-Jensen S , Lindenberg S
Published: December 2021

Aim of study: Over the last decade, laboratory procedures in in vitro fertilisation (IVF) have improved. Hyperstimulated ovaries cause an overload of surplus embryos. The present study was designed to evaluate the efficiency of two different modified IVF cycle protocols trying to reduce the load of medication used for IVF: simple IVF (S-IVF), Tamoxifen 40 mg daily from day 2 in the cycle to ovulation induction) and mild IVF (M-IVF), Tamoxifen 40 mg daily and every secondary 150 IU Gonal F until ovulation induction. The study aims to evaluate their efficiency compared with our conventional IVF (C-IVF) using a short antagonist protocol. Methods: A retrospective cohort study including all patients admitted to IVF for unexplained infertility, tubal factor, and male factor. In all stimulated cycles patients aimed at having fresh embryos transferred and surplus good embryos cryopreserved. All patients were recruited in the same period and allocated to the different treatments on their own request. The study was conducted between June 2019 and February 2021. Results: In total the study included 976 IVF cycles. 651 cycles from C-IVF, 145 cycles from S-IVF and 180 cycles from M-IVF. Mean age in the groups were comparable. Mean number of eggs retrieved was 6.1 (C-IVF), 1.2 (S-IVF) and 3.0 (M-IVF). Pregnancy rate per fresh transfer was found to be 29% for C-IVF, 26% in the S-IVF group and for the M-IVF 20%. Conclusion: Modified IVF stimulation protocols may be an important step towards a simpler assisted reproductive technology (ART) approach. More tolerable for women, easier and cheaper for patients and society they maintain acceptable clinical pregnancy rates. Large prospective studies need to be performed in the future.
THE PRESIDENT'S PAGE
Authors: BLACK WM. C.
Published: December 2021

I am in receipt of your form letter to all members of the Academy dated March 2, 1948 with the appended report of the American Academy of Pediatrics' "Committee for the Improvement of Child Health." I note with despair that this report was approved by the Academy's Executive Board, Chicago, February 8, 1948.

I cannot tell you how stunned and staggered I was as I read this vicious document which has received official approval by our Executive Board. I could not believe my eyes. Now that I have recovered from the initial shock somewhat, I wish to inform you of my complete, total, uncompromising disgust with this stupid and visionary report, and the clear implication that control of Academy affairs and of the pediatric survey have fallen into the hands of persons committed to the collectivist social philosophy.

No one is more desirous of the "good life" than I am. No one is more anxious than I for every child in America to have the best of pediatric care and guidance, and an ample share of all the other attributes of a full and abundant life. But only an impractical dreamer could write a report such as this or believe for one instant that adoption of any part of its recommendations could lead to anything but compulsion, coercion, bureaucracy, stateism, and despotism. The report clearly, baldly, and unequivocally cleaves to the communist social philosophy. I don't!

Therefore, please be advised that through my own personal sense of responsibility to the young men and women who choose medicine as a profession, to our honored profession itself, to the American children under my care now and in the future, to the concept of the dignity and worth of the individual, to my conviction that mankind can attain its future high destiny and maintain progress in that direction only through personal liberty under law, I am compelled to proffer my resignation from the American Academy of Pediatrics to become effective immediately, when and if this disastrous report or any part thereof is adopted by the Academy.
GROWTH OF THIOCYANATE SPACE IN INFANCY AND CHILDHOOD
Authors: ELY ROBERT S. , SUTOW WATARU W.
Published: December 2021

Thiocyanate space was determined in 108 normal subjects and blood volume in 50 of these. These values are presented with relationship to physical indices of growth. The decrease in SCN-space as per cent of body weight is shown to be primarily in the first year of life. The significance of this change is discussed with relation to total water and per cent of body fat.
PROGNOSIS OF PALSIES FROM CRANIAL NERVE INVOLVEMENT IN POLIOMYELITIS
Authors: ZELLWEGER HANS U. , GABATHULER E.
Published: December 2021

Seven-hundred thirteen cases of poliomyelitis with spinal paralysis, encephalitic or bulbar symptoms are reviewed. The mortality rate in bulbar cases was four times that in spinal cases, whereas early recovery after bulbar symptoms was twice that of spinal paralysis.

A follow-up study of 59 patients with 69 palsies from cranial nerve injury performed 2 to 18 years after the acute stage showed that 39 patients with 48 palsies were cured; 18 patients had together 19 palsies of minor degree. Two patients, one with involvement of the sixth and one with involvement of the seventh cranial nerve had more severe sequelae. None of the palsies affected the life of the patients.

Thus if patients with cranial nerve involvement stay alive the late prognosis is much better; the majority of the palsies disappear, the remaining ones have no crippling effect for the patient.
REACTIVITY OF THE SKIN OF THE NEWBORN INFANT
Authors: MATHESON ABE , NIERENBERG MARVIN , GREENGARD JOSEPH
Published: December 2021

The skin of the full term newborn infant reacts to various dilutions of histamine phosphate with erythema but no wheal formation, as contrasted to the skin of older children where, with the same technic (scratch), whealing was frequent.

The skin of the full term newborn infant is capable of fixing reagin locally.

Similar fixation of antibody (and skin reactions with tendency to smaller wheals) was shown in prematurely born infants of varying ages and weight.

The skin sites passively sensitized with serum containing reagin to egg showed erythema and whealing following the feeding of whole raw egg to both newborn infants and older children. This suggests that proteins or products of protein digestion, of sufficient complexity to be antigenic, are absorbed from the gastrointestinal tract of both newborn infants and older children.

The above experiments support the view that the skin of the newborn infant is capable of demonstrating an antigen antibody reaction and that such reaction may be in the nature of erythema or whealing.
Round Table Discussion
Authors: YANNET HERMAN , PERLSTEIN M. A. , SHELDON ALBERT J.
Published: December 2021

Chairman Yannet: Mental deficiency may be defined as an interference with the development of intellectual capacity resulting in social inadequacy. This may be so severe as to necessitate complete custodial care indefinitely; it may be so slight, that a simple change in environment or program may allow for relatively normal community activity with minimal to no supervision. For these different degrees of disability a wide variety of terms have been used. In decreasing order of disability, the terms most frequently employed including their definitions in terms of intelligence quotients are as follows:

1. Borderline: I.Q. 70-80

2. Moron or high grade: I.Q. 50-70

3. Imbecile or middle grade: I.Q. 20-49

4. Idiot or low grade: I.Q. 0-19

Such terms as feeblemindedness and mental retardation are generally used interchangeably for mental deficiency.

Obviously, not all children failing to adjust socially or follow normal paths of development are so because of basic mental deficiency. Certain other conditions, either superficially or strikingly resembling mental deficiency states, must be differentiated. These latter conditions require a different and sometimes highly specialized therapeutic approach and any considerable delay in their recognition may adversely affect subsequent adjustment. The most common of these conditions include the following which are briefly described:

1. Delay in Educational Maturation: There is considerable variation in the time at which children of normal intellectual capacity reach the stage at which they properly react to the usual educational procedures, normally introduced at about 6 years of age. This so-called period of "educational readiness", for want of a better term, includes many aspects such as attention span, personal relations and socialization status, and may occasionally be delayed 2 or 3 years.
STUDIES IN PANCREATIC FIBROSIS
Authors: NADAS ALEXANDER S. , COGAN GILBERT , LANDING BENJAMIN H. , SHWACHMAN HARRY
Published: December 2021

1. The cardiac complications of pancreatic fibrosis were studied by clinical examination and autopsy.

2. Of 45 patients with severe pancreatic fibrosis studied clinically, 8 showed cor pulmonale. One of these eight died in right-heart failure, the others showed only electrocardiographic changes characteristic of right ventricular hypertrophy.

3. A comparison of the autopsy findings of 35 patients with pancreatic fibrosis with those of a control series showed no diagnostic differences in cardiac weight or absolute right ventricular thickness. The ratio of right to left ventricular thickness, however, was higher in the group with pancreatic fibrosis, as was the ratio of cardiac weight to body weight. Only 2 out of 35 autopsies showed visceral edema and congestion of significant degree, suggestive of frank right ventricular failure.

4. Physiologic and pathologic considerations are presented concerning the development of pure pulmonary hypertension and its relationship to cor pulmonale, compensated or decompensated.

5. The data presented here suggest that the pulmonary involvement associated with infection is still the principal threat to life in patients with pancreatic fibrosis and the one towards which major therapeutic efforts should be directed.
PUBLIC HEALTH, NURSING AND MEDICAL SOCIAL WORK
Authors: HELMHOLZ HENRY F.
Published: December 2021

TODAY there are about 60,000 more people in the world to feed, clothe and house than there were yesterday; and tomorrow there will be 60,000 more than there are today. This continuous excess of births over deaths is more marked now than ever before in history, an excess of approximately 20,000,000 in a year. It is hardly necessary to point out here that a claim for great accuracy cannot be made for the figures given in this paper. Such as they are, however, they can support the main contention of this communication.

It is estimated that there are about 2,500,000,000 people in the world today. The population in 5000 B.C. has been reckoned at from 5 to 10 million; in 3500 B.C., from 20 to 40 million; between 1000-500 B.C. 100 million; between 100-500 A.D. 200 million; in 1825, 1 billion (1,000,000,000) and in 1930, 2 billion (2,000,000,000). The percentage increase in the years B.C. was 0.05%, from 1650-1750 A.D., 0.29% and from 1900 to 1950 A.D., 0.75%. It is estimated that at present the increase in population is about 1% a year, which figures out to an increase of 2 persons every 3 seconds, and 200,000,000 in a decade. In spite of World War II, Europe increased 20,000,000 in population from 1940 to 1950.
Neonatal Drug Withdrawal
Authors:   Committee on Drugs
Published: December 2021

Maternal drug use during pregnancy may result in neonatal withdrawal. This statement presents current information about the clinical presentation, differential diagnosis, therapeutic options, and outcome for the offspring associated with intrauterine drug exposure.
Organizational Responses to Managed Care: Issues for Academic Health Centers and Implications for Pediatric Programs, by Norlin and Osborn
Authors: Norlin Chuck , Osborn Lucy M. , Rivara Frederick P.
Published: December 2021

The health care market dynamics that supported and directed the growth and development of Academic Health Centers (AHCs) have changed dramatically in the last 10 years. AHCs are struggling to adapt to new reimbursement mechanisms and to compete effectively for limited dollars, but are constrained by administrative and governance structures that are slow to evolve. Their multiple missions, including education, research, and care for complex patients and underserved populations, are at risk. Although most recognize the need for substantive reorganization, available resources and market specifics vary dramatically from one AHC to another. The current approaches to adaptation by four AHCs are described, along with some of the unique challenges confronted by academic pediatric programs.
Pediatrician-led Community Child Health Initiatives: Case Summaries from the Evaluation of the Community Access to Child Health Program
Authors: Grason Holly , Aliza Barbara , Hutchins Vince L. , Guyer Bernard , Minkovitz Cynthia
Published: December 2021

Objectives.

Case study investigations of projects identified with the Community Access to Child Health (CATCH) Program were conducted to illustrate the range of achievements of CATCH and to identify those elements related to successful or unsuccessful implementation.

Methods.

We developed a purposive sample of 12 projects, selected based on time of initiation (1989–1995), level of intensity of involvement in CATCH, project locus (statewide or local), nature of program service(s), project setting, and target population(s). Two investigators spent approximately 1.5 days at each site using a preestablished case study guide that included document review and multiple in-person interviews. A total of 171 interviews were conducted with project leadership and staff, community and institutional partners, and public health officials. In seven communities, we also met with individuals receiving project services (consumers).

Results and Conclusions.

The premise of CATCH that with information, support, and tools, pediatricians can be agents of change in their communities was confirmed. The CATCH pediatricians with whom we met capitalize on their status in the community as physicians, their expertise, and their programmatic and political connections to create opportunities to expand and improve health and social services for children. The specific leadership of these pediatricians is often key in overcoming political and cultural barriers to implement system changes. CATCH was and continues to be an effective program strategy for stimulating and enhancing community-based child health initiatives.
Growth Hormone and Craniofacial Changes: Preliminary Data From Studies in Turner's Syndrome
Authors: Simmons Kirt E.
Published: December 2021

Normal craniofacial and dental growth and development is dependent on growth hormone (GH) and insulin-like growth factor I (IGF-I). Deficiencies of either during childhood cause diminished growth of the maxilla and (to a greater degree) the mandible. Dental development/eruption also is compromised. Conversely, excessive GH/insulin-like growth factor I causes overgrowth, with the mandible again more affected than the maxilla. Replacement therapy in deficiency conditions generally normalizes craniofacial growth. Systemic GH also has been used in other disorders for which overt deficiency of GH has not been demonstrated. One such condition, Turner's syndrome, is now widely treated with GH. Although systemic GH in Turner's syndrome has been shown to positively affect stature, the effects on craniofacial growth and dental development/eruption are largely unknown. To explore these issues, standardized lateral radiographs of seven untreated patients with Turner's syndrome were analyzed and revealed hypoplasias of the cranial base, maxilla, and mandible. Dental development/eruption of patients with Turner's syndrome was found to be significantly advanced (by 0.63 years), relative to control subjects, in a separate study. Annual radiocephalometric measurements of 19 patients with Turner's syndrome treated with GH were compared with nonaffected control subjects over 1 year of treatment. Compared with age-matched historic control subjects, all maxillary—and most mandibular—growth measures were within 2 standard deviations of control. However, in our patients with Turner's syndrome, we found two measures of mandibular growth that deviated by more than 3 standard deviations from control. These data, although preliminary and only encompassing a short period, indicate that mandibular growth may be more affected than is maxillary growth by GH treatment and should be monitored over long-term-therapy.
Regular Monitoring of Bone Age Is Not Useful in Children Treated With Growth Hormone
Authors: Wilson Darrell M.
Published: December 2021

Although bone age estimates are traditionally used to monitor children receiving growth hormone therapy, few data support this practice. Bone age determination is fraught with technical difficulties, resulting in high interobserver differences. Longitudinal studies show that an individual's bone age can change erratically over time. The resulting errors in predicted adult heights based on these bone age determinations are large. Moreover, growth hormone therapy appears to accelerate bone maturation. The radiographic evidence of this acceleration can be delayed. In this setting, improvements in predicted adult heights can be artifactually large. Routine monitoring of bone age during GH therapy is unnecessary. Bayley and Pinneau, bone age determination, Greulich and Pyle, predicted height, radiography, Tanner and Whitehouse.
Regular Monitoring of Bone Age Is Useful in Children Treated With Growth Hormone
Authors: Kaufman Francine Ratner , Sy Judy P.
Published: December 2021

Objective.

This study was undertaken to determine whether serial bone age (BA) radiographs were obtained in patients with growth hormone deficiency and to assess whether there were differences in outcome between subjects with and without monitoring of BA radiographs.

Research Design and Methods.

Data were collected from the National Cooperative Growth Study database on growth hormone-deficient subjects who were treated for at least 3 years. Comparisons were made among three groups of subjects: 1) those with BAs at entry versus those without; 2) those with BA values in the first year of follow-up if an entry radiograph had not been done versus those with no first-year examination; and 3) those with a BA at entry and yearly for 3 years versus those with no radiographs during the same period. Differences in the change in height standard deviation score (SDS); change in height age, age, pubertal progression, number of visits, growth hormone dosage; and number of growth hormone injections per week were compared.

Results.

Of the 6191 subjects assessed, 93% had at least one BA radiograph obtained; there was a mean of 3.6 ± 2.6 total number of BA radiographs per patient during the 5.2 ± 1.9 years of follow-up. Subjects with BA values at entry were older and had slightly higher cumulative height SDS and height age change compared with those without BA values at entry. Subjects with BA assessment during the first year were older and had shorter growth hormone treatment time and slightly better cumulative change in height SDS and height age than did those without BA in the first year. Comparing those with serial BA determination for the first 3 years of treatment versus those with no BA values, those with BA were older, more pubertal, seen more often, had more growth hormone injections per week of a comparable growth hormone dosage, and had slightly larger cumulative change in height SDS and height age than those without x-rays.

Conclusions.

These data suggest that National Cooperative Growth Study investigators find it of benefit to obtain baseline and follow-up measurements of BA in most subjects treated with growth hormone. Subjects with BA monitoring do slightly better than do those whose skeletal maturation is not measured. BA assessment should be considered part of the follow-up of patients treated with growth hormone therapy.
HEMATOLOGIC ADJUSTMENTS TO CYANOTIC CONGENITAL HEART DISEASE
Authors: RUDOLPH ABRAHAM M. , NADAS ALEXANDER S. , BORGES WAYNE H.
Published: December 2021

Several infants and children with cyanotic congenital heart disease and polycythemia, but without a corresponding increase in hemoglobin, have been encountered.

The presence of a normal hemoglobin level in cyanotic children is not sufficient evidence of absence of anemia.

These children responded well to iron therapy; they showed a rise of hematocrit and developed normal red cells in excessive amounts. Clinical improvement paralleled the rise of hematocrit.

A rise of hematocrit above 75% resulted in return of symptoms, possibly due to marked increase of blood viscosity.

Studies on newborn infants with congenital heart disease show an absence of the usual postnatal erythrocyte decrease in very cyanotic infants but revealed a tendency to the development of "relative anemia" after the third or fourth month of life.
MEASLES ENCEPHALITIS
Authors: SOLOMONS GERALD , MARKMAN CHARLES A. , WEST EDWARD J.
Published: December 2021

Thirty-five cases of measles encephalitis over a 15 year period are reviewed. The rising incidence of this complication is suggested. The older average age and the mortality rate occurring in females is noted, and a concept based on previous central nervous system involvement to account for this is presented. The use of gamma globulin is discussed.
SPECIAL REVIEWS
Authors: ROGERS KENNETH D. , WISHIK SAMUEL M.
Published: December 2021

Over the last decade or more, pediatricians have become increasingly aware that operative procedures can carry with them psychologic trauma for the child. While it is not to be implied that every operation is a life-shaking experience upon which hinges the future happiness and security of the child, we do know that operations and their attendant events are well remembered by all of us, that they are found to be part of the "meaningful content" of psychiatric exploration, and that the onset of night terrors, disobedience, enuresis, excessive dependence reactions and similar disorders often follow operations. Unquestionably, the exact effect of these experiences on children varies both with the type of experience and with the basic security of the child. Although neurotic symptoms may have their origin in traumatic hospital experience, it is more likely that unfavorable reactions to hospitalization are caused by an activation or reinforcement of anxieties or neurotic trends already present.

Unfortunately, there has been a wide discrepancy between the acceptance of these ideas and the modification of present presurgical and surgical managment of the child to conform with them. The reasons are not hard to find, for the child patient has paid the price of specialization in medicine by having his pediatrician discover a condition, the surgeon elect to operate, the hospital nurse and physician manage the preoperating room experience, the anesthetist perform the potentially most upsetting procedure of the whole experience, and all these persons and others manage his postoperative hospital course.
FUNNEL CHEST
Authors: BILL ALEXANDER H.
Published: December 2021

Funnel chest as seen in childhood seldom produces disability.

A review of the literature reveals a growing number of cases of funnel chest in adult patients in whom varying degrees of cardiac disability have been described.

In a questionnaire answered by 25 American physicians, the majority feel that among adult patients with severe funnel chest there are some who suffer from cardiac or respiratory disability. There was a feeling that many of these patients undergo psychologic trauma.

Twenty-three of the 25 feel that operative correction of a severe degree of funnel chest should be undertaken in childhood.

A series of eight cases operated upon by the author is reviewed. Of these cases the outcome has been the most successful in children operated upon by radical surgery between 2 and 6 years of age.

The author believes that, for children with a severe grade of funnel chest, surgery should be recommended when they are between 2 and 6 years of age.
A HEARING TEST FOR NEWBORN INFANTS
Authors: RICHMOND JULIUS B. , GROSSMAN HERBERT J. , LUSTMAN SEYMOUR L.
Published: December 2021

A simple, readily reproducible test of gross hearing in the newborn infant is presented. Although the test is particularly applicable to adoption problems, it is suggested that this examination be adopted as standard procedure in all nurseries as a part of the routine evaluation of the neonate.
COMMITTEE ON ACCIDENT PREVENTION
Authors:   COMMITTEE ON TUMOR REGISTRY,   COMMITTEE ON ACCIDENT PREVENTION
Published: December 2021

The Committee on Accident Prevention has submitted the following statement:

Precautions in the Use of Fluoroscopy

General

No unnecessary examination should be made.

A history of any previous x-ray exposures—by fluoroscopy or roentgenography—should be obtained.

Carry out at no more than 3, but preferably 2 milliamperes.

Record the durations of each examination and the site examined on the child's history.

Equipment

Filters 2-3 mm. aluminum are to be used.

The longest possible target—table top distance—preferably 18" should be used.

Calibration of output (r) of machine should be made not less than once a year unless the tube has been changed or other repairs made.

Machines should have a timing switch which cuts off automatically after 5 minutes.

The machine and controls should be of shockproof type.

Method

Accommodate before fluoroscopy (use red glasses—10 minutes before entering fluoroscopy room).

Wear protective apron and gloves.

Use the minimal field compatible with the requirements of the examination.

Never increase milliampere settings to "see better."
PUBLIC HEALTH, NURSING AND MEDICAL SOCIAL WORK
Authors: WALLACE HELEN M. , LOSTY MARGARET A. , HEARSEY MILDRED E.
Published: December 2021

Long standing problems of over-hospitalization and inappropriate hospital discharge of newborn infants have been brought to attention by the concentration of premature infants in centers, through the interest of pediatricians, nurses and social service staffs at these centers. A plan for improved after-care was made and put into effect through joint community effort of health, welfare, and social agencies concerned. This plan consisted of: (1) strengthening of the existing home follow-up program; (2) promoting fuller use of other services available from the Health and Welfare Departments; (3) developing a special program for placement in foster homes.
GROWTH IN HEAD WIDTH DURING THE FIRST TWELVE YEARS OF LIFE
Authors: MEREDITH HOWARD V.
Published: December 2021

This paper brings together the research findings on biparietal diameter from more than 50 investigations. It constitutes a synthesis of present knowledge pertaining to the head breadth of physically normal, North American infants and children.

There are sections on the following topics: methodologic considerations, means for head width, variability in head width, findings from longitudinal data, and the relation of head width to other variables. Included in the section on variability is a table of norms and comments on its clinical use.

Representative generalizations are:

1. The average North American white child attains 30% of adult head width by the middle of prenatal life, 60% by birth, 80% by 6 postnatal months, 90% by 3 years and 95% by 9 years.

2. Throughout the period from birth to 12 years, the 2 sexes differ systematically: head width distributions for North American white girls have slightly lower means and smaller standard deviations than comparable distributions for boys.

3. At 1 year of age, the limits of normal variation in head width are 11.4 cm. and 14.8 cm. for North American white boys, 11.1 cm. and 14.3 cm. for North American white girls. The normal limits at age 10 years are 12.9 cm. and 16.3 cm. for boys, 12.7 cm. and 15.9 cm. for girls.

4. North American Negro school children have narrower heads than North American white school children, and North American Japanese school children wider heads than North American white school children. The mean biparietal diameter of children of Mexican descent approximates that of American Negro children.

5. The association between width of head and length of head is low—of the order r = .25. A similarly low relationship exists between width of head and width of hips, but the relationship between width of head and width of face is appreciably higher.
PEDIGREE DEMONSTRATING A SEX-LINKED RECESSIVE CONDITION CHARACTERIZED BY DRAINING EARS, ECZEMATOID DERMATITIS AND BLOODY DIARRHEA
Authors: ALDRICH ROBERT A. , STEINEBERG ARTHUR G. , CAMPBELL DONALD C.
Published: December 2021

Genetic analysis of the family of an individual suffering from what appeared to be secondary thrombocytopenic purpura indictated that:

1. Sixteen of 40 male infants died.

2. Ten of these, including the proband, were known to have suffered from draining ears, eczematoid dermatitis and bloody diarrhea.

3. The pattern of deaths agrees with the assumption that a sex-linked recessive gene is responsible for the primary deviation which leads to the death of these infants.
ANOMALIES OF THE LARYNX ASSOCIATED WITH TRACHEO-OESOPHAGEAL FISTULA
Authors: SAYRE J. W. , HALL E. G.
Published: December 2021

Two cases of unusual congenital laryngeal abnormalities occurring in association with tracheo-oesophageal fistula are described. In one there was a subglottic cartilaginous stenosis, in the other, a subglottic cartilaginous atresia. An embryologic explanation for the occurrence of these anomalies is presented.
PULMONARY FUNCTION IN CYSTIC FIBROSIS OF THE PANCREAS
Authors: WEST JOHN R. , LEVIN SHELDON M. , SANT'AGNESE PAUL A.
Published: December 2021

Studies of pulmonary function in patients with chronic pulmonary disease associated with cystic fibrosis of the pancreas have revealed a pattern of dysfunction which may be said to be characteristic of this disease, but which is subject to great variation in severity.

Both ventilatory insufficiency (leading to dyspnea) and disturbances in gas exchange (leading to arterial hypoxia and carbon dioxide retention) may occur. The former would seem to be largely the result of factors which bring about a diminished ventilatory capacity, among which an increased resistance to air flow within the tracheobronchial tree, due to obstruction of the larger and smaller bronchi by accumulated secretions and purulent exudate, is probably most important. Defective gas exchange seems to stem largely from disturbances in the normal relationships of alveolar ventilation to perfusion. This seems in large part due to uneven distribution of tidal air to the alveoli as a result of bronchial obstruction, although concomitant variation in the distribution of blood probably occurs also.

In general, the severity of the impairment of pulmonary function closely parallels the chronicity and severity of the characteristic secondary bronchial and pulmonary infections. The treatment of these constitutes, logically, the major effort in therapy.
CONGENITAL BOWING AND ANGULATION OF LONG BONES
Authors: ANGLE CAROL R.
Published: December 2021

The clinical picture of congenital angulation and bowing of long bones is presented and 37 roentgenographically proved cases are reviewed from the English literature. A case of bilateral femoral angulation is presented. The pathogenesis of the condition is discussed and correlated with mechanical principles and with the published results of experimental investigations. It is concluded that although the etiology is still uncertain, the mechanical theory is most acceptable. Some modifications of this theory are offered.
GROUP DISCUSSIONS WITH PARENTS OF ILL CHILDREN
Authors: LUZZATTI LUIGI , DITTMANN BARBARA
Published: December 2021

Group discussions with parents of diabetic children were started as part of the services offered in the Metabolic Clinic of the Children's Hospital of the East Bay, followed later by similar groups of parents of children with cerebral palsy. This approach to some of the delicate problems confronting parents of children with chronic disease and the children themselves was utilized in an attempt to solve some of the aspects of care that cannot be dealt with entirely in a one-to-one approach in a clinic or doctor's office. The technical aspects of such groups are presented and some of the significant points are discussed.
STUDIES OF THE IMMUNOLOGY OF THE NEWBORN INFANT
Authors: DANCIS JOSEPH , KUNZ HANS W.
Published: December 2021

The bacteriostatic activity of the serum of infants was compared by an in vitro test with that of older children and adults in an attempt to explain the increased susceptibility to septicemia of the former.

The serum of newborn infants at birth has a bacteriostatic activity against E. coli comparable to that of older individuals. This property is lost during the first weeks of life. It reappears in some infants in a few months and is usually present after one year of age.

The bacteriostatic activity of premature infant serum follows closely that of the full term infant.

The complement activity of 9 of 11 sera from premature infants fell within the range found in normal adult sera. Experiments using guinea pig serum as a source of complement also indicate that the poor bacteriostatic activity of premature infant serum is not the result of deficient complement ent activity. This is probably also true of the full term infant.

Experiments with gamma globulin indicate that a deficiency in this serum fraction is at least partly responsible for the poor bacteriostatic performance of premature infant serum.

Concurrent bacteriostatic tests with E. coli, Neisseria catarrhalis and Salmonella derby suggest that the ability to inhibit one organism is usually paralleled by the ability to inhibit the others.

The possible nature of the bacteriostatic substances is discussed.
RETROPERITONEAL MYXOLIPOMA
Authors: PINTO V. CARVALHO , MATTOS A. GOMES , PIMENTA E. , MORAES R. VILHENA , ALTENFELDER P.
Published: December 2021

A case of a fatty tumor of the retroperitoneal space, with the histologic diagnosis of myxolipoma, is presented. The boy was 7 years old and weighed 24.2 kg.; the tumor weighed 12.8 kg., or more than half the child's weight.

The clinical history suggests that the tumor appeared at the age of 1½ years and developed without any complications of the renal and intestinal functions. There was predominance of the myxomatous tissue and the removal of the whole tumor was possible. It was located between the mesenteric leaves and for its removal, 50 cm. of the ileum had to be resected. The complete extirpation was performed and the child is in good physical condition six months after the operation.
AN EVALUATION OF CHLORAMPHENICOL THERAPY IN TYPHOID FEVER IN CHILDREN
Authors: FRIEDMAN ABRAHAM
Published: December 2021

In the light of the author's experience with chloramphenicol therapy of typhoid fever in 122 children, the following conclusions appear to be valid:

I. Prolonged chloramphenicol therapy is unnecessary, undesirable and sometimes even harmful. The course of therapy should be limited to the period of fever and continued for just one or two days after the temperature has become normal. This view is based upon the following considerations:

A. The finding that relapses were just as frequent on longer courses as on shorter ones.

B. Prolonged courses of chloramphenicol expose the patient more intensely to the hazard of severe and sometimes fatal gastrointestinal disturbances.

C. Prolonged courses may expose the patient more seriously to severe and sometimes fatal bone marrow depressions.

D. This conclusion is of special importance where the availability of the drug and the expense involved are factors to be taken carefully into consideration.

II. Except in hypertoxic forms of typhoid, chloramphenicol therapy should be instituted as early as possible and should not be delayed for any reason. This view is based upon the following considerations:

A. On the one hand, when chloramphenicol is started early, during the first week of illness, the relapse rate is higher in comparison to the relapse rate when therapy is started later.

B. On the other hand, complications and mortality rates are considerably higher when therapy is postponed to the second week or later.

C. Weighing these two hazards against each other, it appears that the latter outweighs the former and that it would certainly be wiser to take the risk of a relapse than of a severe complication or a fatality and therefore therapy should be started in every case as early as diagnostic considerations permit.

III. In hypertoxic forms of typhoid, chloramphenicol therapy should be withheld at the beginning, trying supportive therapy, including blood transfusions. Later chloramphenicol may be started but with small doses only, perhaps 12.5 mg./kg./day. If no deterioration in the general condition takes place it may then be increased, say 3 to 4 days later, to 25 mg./kg./day and 3 to 4 days later again, to 50 mg./kg./day, provided the general condition of the patient does not deteriorate.

IV. If in spite of special care in instituting chloramphenicol therapy in hypertoxic forms of typhoid an intestinal perforation-like syndrome develops, chloramphenicol therapy should be stopped immediately and general supportive measures instituted as soon as possible. The same applies when the intestinal perforation-like syndrome develops suddenly in a patient not previously severely toxic.

V. Gastrointestinal disturbances during chloramphenicol therapy should be taken seriously, and any degree of severity in such disturbances warrants the immediate cessation of chloramphenicol with the immediate institution of corrective measures to combat the electrolyte disturbances which might have resulted.
JUVENILE THYROTOXICOSIS
Authors: ALLEN RICHARD F. , ROSE EDWARD , ROSE ELIZABETH KIRK
Published: December 2021

Results of treatment are presented in 30 thyrotoxic children whose symptoms appeared prior to age 15 years.

Fifteen patients received thyroid irradiation with or without stable iodine and 15 received prolonged treatment with antithyroid compounds, with or without stable iodine.

Among the 24 patients in whom the final results of treatment could be fairly assessed, satisfactory remissions were obtained in 17 (70.8%). Approximately similar results were obtained in those who were irradiated and in those who received antithyroid compounds.

Satisfactory remissions were obtained in 5 of the 6 patients subjected to thyroidectomy.

Two cases of unusual interest are described. Reasons for the present conservative policy in the treatment of juvenile thyrotoxicosis are stated.
THE PEDIATRICIAN AND THE PUBLIC
Authors: PARK EDWARDS A.
Published: December 2021

The British National Health Service is a highly original system. Its organization is as democratic as our public school system and free from political control. It is the most interesting and exciting social experiment of my life which means a great many years. It is time that we give up one-sided consideration and turn to study it fairly, for whatever direction medical care takes in this country it is possible to learn enormously from the experiences of the British system. I believe that it has some serious defects but that in spite of them it has been a prodigious success in supplying the needs of the people.

I think that in assessing the value of the British National Health Service we Americans fall into two errors. In the first place we compare the best which we have in this country with what we happen to run across and in some instances with the selected worst in Great Britain. The second error, which is the more important, is that we think primarily in terms of the physicians, i.e., ourselves. We involuntarily put ourselves in the place of the British physician and ask how we would like to be restricted as they are. The primary aim of medical service is the patient and, in the aggregate, the preservation of the health and welfare of the nation. In developing any system of medical care, it is necessary to consider first the welfare of the people, but it is a fundamental mistake not to consider adequately the welfare of the physician.

I think that the error in the organization of the National Health Service was in considering almost exclusively the needs of the people and giving very little attention to the needs of the physician, who have been moved about and their activities limited and defined too much as if they were chess men on the board. From this error, it is the people who will ultimately suffer.
THE EFFECTS OF HYPOXIA ON THE RESPIRATION OF NEWBORN INFANTS
Authors: MILLER HERBERT C. , BEHRLE FRANKLIN C.
Published: December 2021

The effects of administering atmospheres containing 10 and 12% oxygen to healthy newborn infants of different ages have been studied.

Infants under 24 hours of age tended to hypoventilate throughout the period of hypoxia. Infants six to 11 days of age hyperventilated for the first two or three minutes and then showed a decrease, although not so marked as observed in the infants under 24 hours of age. Infants 16 to 48 days of age showed the most marked increase in ventilation, but even in these infants it was poorly maintained as compared to responses seen in adults.

Hypoxia produced a slowing of the respiratory rate in all infants except the very oldest. Tidal air was increased at first and then decreased. The increases in tidal air accounted for most of the increase in minute volume seen in the older infants.

Hypoxia increased the incidence of periodic breathing in the two older groups of infants, but had very little effect on infants under 24 hours of age.

Respiratory patterns did not appear to be altered by the hypoxic conditions employed in this study.

It has been postulated that the comparatively weak response to hypoxia made by infants immediately after birth possibly is dependent on relatively poor chemoreceptor reflexes and that the latter increase in strength during the first weeks of postnatal life.

It has also been suggested that the relative inability to induce periodic breathing in infants under 24 hours of age as compared to those several weeks old is further evidence indicating that metabolism of the medullary respiratory centers is to a larger extent anerobic than at the later periods of postnatal life.