bluuebunny/crossref_metadata_2025 huggingface dataset:
EFFORT TO RESCUE OTTERS AFTER SPILL IS IN DISPUTE
Authors: L. J. F.
Published: December 2021

ANCHORAGE, April 20—Sea otters rescued from waters fouled by the Exxon Valdez oil spill fared poorly after their return to the wild last fall, and scientists working under Government contract say at least half may have perished over the winter.

Nearly 900 dead otters were found after the tanker spilled almost 11 million gallons of crude oil in March 1989. An additional 360 were netted alive and brought to rehabilitation centers at Valdez, Seward, Homer and Kodiak. About 200 were later returned to Prince William Sound but some scientists say that as many as half may have perished and that the rehabilitation effort has been largely futile...

The withholding of scientific information on the spill for legal reasons by all the parties is becoming a major source of controversy as research projects begin to generate at least preliminary data.
Hepatitis C Infection in a Pediatric Dialysis Population
Authors: Jonas Maureen M. , Zilleruelo Gaston E. , LaRue Silvia I. , Abitbol Carolyn , Strauss Jose , Lu Ying
Published: December 2021

A variable prevalence of hepatitis C (HCV) infection has been reported in adult patients on hemodialysis. We have studied HCV infection and associated risk factors in a pediatric dialysis unit. Sera from all 27 patients undergoing either hemodialysis or peritoneal dialysis in our unit were tested for antibody to HCV by enzyme-linked immunosorbent assay, and seropositives were confirmed by recombinant immunoblot assay. Records were reviewed for demographic, biochemical, and risk factor data. From the total of 27 patients (12 male, mean age 20.9 years, range 7.3 to 28.1 years), five were anti-HCV(+) (18.5%). All the anti-HCV(+) patients had been on hemodialysis (69 to 194 months, mean 105 months), while of the 22 anti-HCV(–) patients, only 14 had been on hemodialysis (5 to 209 months, mean 41.4 months), P < .005. All the anti-HCV(+) patients had received blood transfusions (10 to 124 units, mean 61.4 units) as had 12 of the anti-HCV(–) patients (1 to 54 units, mean 14 units), P < .02. Of the 5 anti-HCV(+) patients, only one had prior hepatitis B infection of the 22 anti-HCV(–) patients, three had hepatitis B surface antigen, and no others had evidence of hepatitis B infection. The most predictive risk factor for HCV infection was length of time on hemodialysis. Eleven of the 27 patients (40.7%) had abnormal alanine aminotransferase values, of whom four were anti-HCV(+), three were hepatitis B surface antigen(+), and one was seropositive for antibody to human immunodeficiency virus. Pediatric dialysis patients are at risk for HCV infection; the most predictive risk factor in this population is length of time on hemodialysis. Approximately one third of abnormal alanine aminotransferase values in pediatric dialysis patients may be caused by HCV.
The "Companion Bottle": A Useful Predictor of Children at Risk for the Development of Nursing Bottle Caries
Authors: KOVESI THOMAS , LEVISON HENRY
Published: December 2021

To the Editor.—

Bottle caries result from prolonged contact between sugar-containing fluids and the teeth of children put to bed with a nursing bottle,2 and can lead to serious dental morbidity. Although inquiry into children's nighttime use of bottles should be included in preventive health surveys,3 it may be omitted in the busy pediatric office or ward. We tested the hypothesis that children carrying a bottle in a clinic setting were also more likely to receive a bottle in the crib or bed at home.
Andrew Stinson Recalled
Authors: BACHRACH STEVEN
Published: December 2021

To the Editor.—

It now has been nearly 15 years since Andrew Stinson was first admitted to the Intensive Care Nursery where I was working as a second year resident. Andrew was an 800-g premie, whose subsequent complicated course and eventual demise would not sound unfamiliar to anyone who has worked in an intensive care nursery. What made Andrew different was his family. While not medically sophisticated, they were well-educated people with very definite ideas about what they did or did not want done for their infant.
Diarrhea Care in Private Practice
Authors: TOCHEN MARK L. , TSUKAMAKI DON
Published: December 2021

To the Editor.—

The article by Dr Snyder, "Use and Misuse of Oral Rehydration Therapy for Diarrhea,"1 led us to review our treatment of gastroenteritis, revise our telephone protocols, and seek out rehydration solutions. Our difficulty in obtaining adequate supplies mirrored that of Dr O'Banion.2 Expense to the patient is also an important factor: commercial premixed solutions sell for $4 to $6 per quart in our area, which many families cannot pay. Our solution was to obtain from the World Health Organization the name of the US supplier of oral rehydration solution (ORS) packets and order direct from the supplier (Jianas Bros Packaging Co, 2533 SW Blvd, Kansas City, MO 64108).
Talented Students
Authors: KIM DONTE , KWASMAN ALAN
Published: December 2021

To the Editor.—

We read with great interest the commentary by Carol J. Mills, PhD.1 We have several concerns about her commentary.

Our first concern is that the phenomenon of frustration and disillusionment, which she describes, may not be isolated to "gifted" children. In her commentary, she states that there is, "a good deal of evidence to show that many gifted students . . . whose needs are not met adequately at an early age become frustrated and disillusioned with school."
The Normal Variation of Skin Creases
Authors: SLADEN ELSPETH M.
Published: December 2021

To the Editor.—

I don't usually pay too much attention to the advertisements in Pediatrics, however, I was intrigued to see, in the October 1991 issue, the fine array of infant backsides in the ad for Genius Thermometers on pages A14 to A15. It is a good demonstration of the normal variation of skin creases. It should put to rest the myth that asymmetrical skin creases are a sign of congenital dislocation of the hips.
BLOOD SUGAR AND CITRIC ACID LEVELS IN NEWBORN INFANTS
Authors: GITTLEMAN ISAAC F. , PINCUS JOSEPH B.
Published: December 2021

Citric acid levels were determined in 161 newborn infants varying in age from 2 hours to 8 days. The highest levels were found in the youngest individuals. The citric acid values varied between 0.5 and 5.5 mg./100 cc.

Glucose levels were also determined in 151 of the same infants and the authors found a tendency for the sugar levels to rise as the infants advanced in age.

A relationship between citric acid and glucose metabolism is again suggested by this study.

In the instances of neuromuscular hyperirritability which was studied, the citric acid levels cannot account for the convulsive state.
FDA Varicella Warning
Authors: TINKELMAN DAVID G.
Published: December 2021

To the Editor.—

In a recent Food and Drug Administration (FDA) medical bulletin, letin,1 the FDA issued a warning that severe varicella infection may follow in individuals for whom corticosteroid therapy has been prescribed. Included in their warning was the use of all formulations of corticosteroids, without reference to dosage or demonstration of immunosuppression. In view of the fact that there are thousands of children receiving inhaled corticosteroids for the treatment of their asthma, and that this form of therapy recently has been not only condoned but recommended by the National Asthma Education Program Expert Panel Report,2 we feel that more research and education are required prior to issuing such a warning.
Presurgical Routine Screening
Authors: COHEN ALAN , BURK CAROL
Published: December 2021

In Reply.—

Doctors Lackmann and Töllner provide additional data supporting our finding that the discovery of clinically important coagulation disorders during routine preoperative laboratory screening is infrequent. However, these investigators are troubled, as are we, by the problem of determining the appropriate use of screening tests when the disorder is rare and the tests are imperfect, but the consequence of failing to recognize the disorder may be grave. Even the most elaborate cost-benefit analysis may be of little comfort in approaching the individual patient and concerned parents.
Health Consequences of Behaviors: Injury as a Model
Authors: Irwin Charles E. , Cataldo Michael F. , Matheny Adam P. , Peterson Lizette
Published: December 2021

I always like to make things as simple as possible, but no simpler.

—Einstein

As a model for behavioral pediatric research, injury prevention presents a relatively clear example of how behavior can dramatically and directly impact health status. Approaches to injury prevention range from passive, environmental control to the modification of behavior so thát the consequence is safety not injury. Regardless of the level of intervention, behavioral changes of some form are essential for interventions to reduce injuries. Approaches addressing injury prevention exemplify both challenges and models for the interface of behavior and biology wherein the focus is behavior that produces serious biological outcome.

This article will specifically focus on a developmental-psychosoical approach to children's injuries because it incorporates more than one scientific discipline and knowledge base. Increasingly, behavioral pediatric endeavors involve combining research findings and intervention technologies from a number of disciplines. After briefly reviewing the magnitude of the childhood injury problem, we will use four ongoing research programs to exemplify differing levels of analysis within a developmental-psychosocial approach. Further, these programs and this multidisciplinary approach can have generality to other areas of pediatrics that concern a health-behavior interaction.

THE PROBLEM

Injuries are the most common cause of death and hospitalization in the pediatric population.1 Injuries rank as the third leading cause of death (39.0/100 000) for the total US population. The distribution is U-shaped, with the rates of deaths due to injuries ranging from 25.2/100 000 in the younger than 1-year-old age category to a low of 11.7/100 000 in the 5- through 9-year-old age category, and then rising to a high of 51.4/100 000 in the 20- through 24-year-old age category.
Chronic Fatigue in Children: Illness or Disease?
Authors: VAN AERDE J.
Published: December 2021

In Reply.—

Carter et al address an important problem in the practice of today's high-technology-driven medicine: the treatment of a diseased organ or system without taking the psychological, social, environmental, and spiritual context of the patient into consideration. In that regard, as suggested by Dr Smith et al,1 different diagnostic criteria may be needed for children than for adults with chronic fatigue syndrome (CFS).2 Unfortunately, Dr Smith's paper does not bring us any closer to that objective.
The Missouri Child Fatality Study: Underreporting of Maltreatment Fatalities Among Children Younger Than Five Years of Age, 1983 Through 1986
Authors: Ewigman Bernard , Kivlahan Coleen , Land Garland
Published: December 2021

Estimates of the incidence of child maltreatment fatalities vary widely; most experts believe they are underreported. To investigate the suspicion that fatal maltreatment was underreported in Missouri preschool children, a statewide, population-based study was conducted using nine data sources. The study cases included the 384 children younger than age 5 who died from 1983 through 1986 and whose death certificates were coded with an external cause (injury) or whose deaths were substantiated as abuse or neglect fatalities by the Missouri Division of Family Services. Each fatality was categorized as one of the following: definite maltreatment, probable maltreatment, possible maltreatment, non-maltreatment, or inadequate information. Of the 121 cases classified as definite maltreatment, only 47.9% had codes consistent with maltreatment on their death certificates. The Division of Family Services had substantiated 79.3% of definite maltreatment cases as abuse or neglect fatalities. The Federal Bureau of Investigation Uniform Crime Reports database reported only 38.8% of these cases as homicides. In 37.2% of the cases, there was at least one criminal conviction. Child maltreatment fatalities are drastically underreported as such in Missouri because of inadequate investigations, lack of information-sharing between investigators and agencies, and reporting systems that fail to capture the contribution of maltreatment as a cause of death. Missouri has created a statewide system of child fatality review panels and a child fatality surveillance system to address the problems documented in this study.
The Changing Role and Responsibilities of a Chairman—Letters
Authors: DIGEORGE ANGELO M.
Published: December 2021

To the Editor.—

I enjoyed Dr Brent's article on the role and responsibilities of chairmen in the july issue of Pediatrics (1992;90:50-57). I can't think of a better person to write such a thoughtful essay.

Although the paper was not written primarily for chairmen, I hope that ours will read it.
The Changing Role and Responsibilities of a Chairman—Letters
Authors: HANSON JAMES W.
Published: December 2021

To the Editor.—

I want to report the pleasure that the recent essay by Robert L. Brent on being a department chairman gave me. I overheard a discussion of this article between some of our other faculty members which was extremely complimentary. As an aside, let me mention that the participants in that discussion felt that article should be read by all department chairmen (and debated whether they should all send copies to relevant individuals at the University of Iowa!).
How Much Resuscitation Is Enough Resuscitation?
Authors: QUAN LINDA
Published: December 2021

To the Editor.—

In his commentary, "How Much Resuscitation Is Enough Resuscitation?" Dr Orlowski identifies most of the arguments against stopping resuscitations in the field.1 Unfortunately, most of these arguments are assumptions, not supported by data.

As Dr Orlowski states, a possible one victim in eleven could survive a prolonged resuscitation (>25 minutes) with a good outcome. That likelihood, however, is the absolute upper limit of survival. It is much more likely that the outcomes would be closer to the lower limit of survival, the 100% bad outcome where the relative risk was ascertained.
Which Is the Most Appropriate Dosage of Liposomal Amphotericin-B (AmBisome) for the Treatment of Fungal Infections in Infants of Very Low Birth Weight?
Authors: LACKNER H. , URBAN CH.
Published: December 2021

In Reply.—

We read with great interest the results of Pereira da Silva and co-workers, who successfully treated two premature newborns with disseminated fungal infection using lower doses of liposomal Amphotericin-B (AmBisome) than we have reported in our paper.1 We agree with the authors that the most appropriate dosage of liposomal Amphotericin-B for the treatment of very low birth weight infants is still to be established, and that the main goal of treatment should be to use AmBisome in a dose with maximal effect but minimal toxicity.
Crying an Motor Behavior of Six-Week-Old Infants and Postpartum Maternal Mood
Authors: Miller Anton R. , Barr Ronald G. , Eaton Warren O.
Published: December 2021

Objective. To determine whether prepartum and postpartum emotional distress in first-time mothers is associated with crying and fussing behavior and activity level in 6-week-old infants, after eliminating potential biases.

Design. Observational study examining predictive and concurrent associations between maternal emotions and infant behaviors.

Setting. General community.

Participants. Expectant primiparas attending obstetricians' offices for routine prenatal care were recruited in the third trimester. Mothers and babies were required to be free of medical complications to complete the study. Of 113 mothers who enrolled, complete crying/fussing data were obtained in 88 dyads. Activity data were obtained in a designated subgroup of 50 infants.

Measurements. Mothers completed a self-report scale of emotional distress, the 28-item General Health Questionnaire, at 34 weeks of gestation and at 6 weeks postpartum. Crying/fussing data were obtained using a previously validated parent diary of infant behavior during the sixth week of life. Motor activity was measured objectively in the home setting with actometers.

Results. Third-trimester distress was not related to either infant crying/fussing or activity. Postpartum distress was significantly related to crying/fussing duration and bout frequency (r[88] = .45 and .28, respectively; both P < .01). These relations were not diminished after controlling statistically for background and/or potential mediating variables, nor could they be accounted for by different diary-recording styles in the mothers. Postpartum distress was not, however, related to activity level (r[50] = -.09; not significant). Furthermore, the pattern of maternal distress was associated differentially with crying levels. Distress levels increased from prepartum to postpartum among mothers of infants who met predefined clinical criteria for "colic," while decreasing in the others ("colic" status x period interaction: F(1,86) = 8.2; P < .01). Also, infant crying varied among four groups of mothers who differed according to presence and timing of clinically significant emotional disturbance (one-way analysis of variance, F (3,86) = 9.4; P < .001). Infants of mothers who became significantly distressed postpartum ("reactive") cried more than those in the other groups, even mothers who had been distressed both prepartum and postpartum ("depressed") (3.7 vs 2.7 h/d; P = .05, post hoc Tukey).

Conclusions. Maternal emotional distress and infant crying behavior are associated in the postpartum period independent of reporting or referral biases. Clinically significant levels of crying (or "colic") are differentially associated with different patterns of clinically significant maternal distress. Reported concern about either maternal mood or infant crying behavior should be taken seriously as a possible indicator of a stressed mother-infant relationship.
Treatment of Congenital Telangiectatic Vascular Malformations With the Pulsed-Dye Laser (585 nm)
Authors: MORELLI JOSEPH C. , HUFF J. CLARK , WESTON WILLIAM L.
Published: December 2021

The two most common vascular abnormalities of childhood are port-wine stains and hemangiomas. Port-wine stains are congenital capillary malformations, whereas hemangiomas are benign tumors of vascular endothelium. The natural history of each of these lesions is distinct. Port-wine stains begin as discrete pink/red macules and grow proportionately with the child. As they mature they darken, and vascular ectasia and blebbing, as well as soft tissue and bony overgrowth of the affected area, can develop. Hemangiomas undergo a very predictable natural history, progressing through a rapid growth phase out of proportion to the child's growth, followed by a regressive phase and eventual involution in 90% of cases.
International Statistics—Incomparable
Authors: SEPKOWITZ SAMUEL
Published: December 2021

Howell and Vert are hard-put to compare the incomparable: United States perinatal mortality rates from Michigan and French rates from Lorraine. How can you compare perinatal mortality rates meaningfully between two countries when the definitions of fetal deaths are dissimilar, when there are markedly different registration systems for vital events, and when the United States natality registration system has been in place since 1950 and a French system had to be set up just for this study?

To make the data comparable, 34% of all Michigan deaths were eliminated, that is, all infants weighing <500 g. These deaths were concentrated in 0.47% of all births. How comparable the remaining birth and death events >500 g would be remains open to question.
In Reply: Complication of Intranasal Midazolum
Authors: THEROUC MARY C.
Published: December 2021

We appreciate the remarks by Lugo et al. When designing the study, we used information from previous studies and our own practice of using intranasal midazolam for reducing anxiety in children undergoing surgery and anesthesia. The age group of the children selected for the use of midazolam was less than 5 years of age in both situations. Taking the oldest boy in our study who is just under 5 years and assuming an average weight (50th percentile for boys) of 19 kg, the dose of intranasal midazolam would be 7.6 mg, the volume of which is 1.52 mL. The oldest boy of the patients of Lugos et al is just under 12 years of age. With the 50th percentile weight being 40 kg, this patient would receive 3.2 mL of midazolam intranasally.
Safety and Efficacy of a Topical Anesthetic for Neonatal Circumcision
Authors: Weatherstone Kathleen B. , Rasmussen Lynn B. , Erenberg Allen , Jackson Emily M. , Claflin Katherine S. , Leff Richard D.
Published: December 2021

Objective. Circumcision is a common neonatal surgical procedure routinely performed without the use of anesthesia. The purpose of this study was to evaluate the safety and efficacy of topical lidocaine cream as an anesthetic for circumcision.

Methods. Thirty newborns were studied in a randomized, double-blind, placebo-controlled study; 15 received a topical 30% lidocaine cream and 15 received the cream base alone. Vital signs were recorded, and preoperative and postoperative serum β-endorphin and lidocaine concentrations were measured. A videotape of the newborn was used to score behavioral changes.

Results. Comparisions of the vital signs precircumcision and postcircumcision showed no differences between the placebo and treatment groups, with the exception of mean systolic blood pressure, which significantly increased in the placebo-treated newborns (P < .05). Serum β-endorphin concentrations increased postoperatively in 11 of 15 subjects receiving placebo, but decreased or remained unchanged in 10 of 15 subjects receiving lidocaine (P = .03, Fisher's exact test). When stress-related behaviors in the precircumcision and post-circumcision periods were compared, the mean increase in their occurrence was greater in the placebo than in the treatment group. There was no significant absorption of lidocaine as measured in the serum.

Conclusion. Topical application of a 30% lidocaine cream as used in this study may be a safe and efficacious anesthetic for circumcision.
Prevention of Fetal Alcohol Syndrome
Authors: ALPERT JOEL J. , ZUCKERMAN BARRY S.
Published: December 2021

To the Editor.—

The recent Academy statement on fetal alcohol syndrome and fetal alcohol effects recommends abstinence from alcohol for women who are pregnant or planning a pregnancy.1 Our position was incompletely quoted in the statement. We have stated that there is no scientific evidence to support abstinence from alcohol during pregnancy in well-nourished women.2

Mills, who is also referred to in the committee statement as finding a substantial risk with the consumption of one to two drinks daily, was also referenced incompletely.
AMERICAN ACADEMY OF PEDIATRICS E. H. CHRISTOPHERSON LECTURESHIP ON INTERNATIONAL CHILD HEALTH—1994
Authors:   Johnson & Johnson Consumer Products, Inc.
Published: December 2021

The American Academy of Pediatrics is requesting nominations for the 1994 E. H. Christopherson Lectureship on International Child Health. Nominees must be internationally recognized individuals (not necessarily physicians) who have made significant contributions to international child health. The nomination deadline is January 31, 1994.

For additional information contact: Jean Dow, MEd, Director of the Division of Medical Journals, or Kyle Ostler, Division Secretary, American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, IL 60007. Tel.:800-433-9016.
SELF-INFLICTED RATIONING
Authors: H. B.
Published: December 2021

Who said the health service could not resolve its funding crisis? Britain's cardiac surgeons have come up with a solution that will solve the government's problems at a stroke: the withdrawal of treatment for self-inflicted sickness. Surgeons at two separate medical centers were reported last week to have withdrawn non-urgent coronary bypass operations from patients who were refusing to give up smoking. The potential for savings seems unlimited if the same principle is applied to other medical cases: drinkers in need of liver transplantation, HIV patients who acquired the infection through drug addiction or promiscuous sex, heart patients who are overweight, accident victims who had been driving carelessly or under the influence of drink, and those with sports injuries, not to mention smokers with lung cancer...

The debate raises complex philosophical issues that need to be pursued—eg, the right to use statistics that apply to a category of people to deny treatment to an individual. Yet in an age rightly requiring individuals to take more responsibility for the consequences of their behavior, self-inflicted injuries cannot be totally ignored. Doctors themselves may well revolt when they see politicians shifting responsibility for what are basic rationing decisions on to doctors' shoulders. The issues raised are not primarily medical, but political: what criteria should be used for rationing resources?
ADVANCED NURSING PRACTICES ARE INVADING DOCTORS' TURF
Authors: L. J. F.
Published: December 2021

When Margaret Manchester was training to be a nurse, she was taught to stand up whenever a doctor entered the room and to offer him her chair.

But nurses are no longer handmaidens to the medical profession...

Pat Moccia, chief executive of National League for Nursing, said: "What I think we're going to see in the future is that the family doctor is going to be a nurse practitioner. That's where we're headed, as doctors get more specialized, and advanced-practice nurses take over more routine care...

But what the nursing groups see as the natural evolution of health care the American Medical Association sees as a growing danger...

A 1986 report by the Office of Technology Assessment, an investigative arm of Congress, estimated that 60 to 80 percent of the basic health care performed by doctors could be done by nurses with the same results, at a lower cost.

And earlier this year the American Nurse Association released a study comparing care by doctors and nurse practitioners, finding that nurse-practitioners offered better-quality care, as assessed by the accuracy of diagnoses and the completion of comprehensive medical histories, and at a lower cost.

Not surprisingly, the A.M.A. challenged those findings.
MERCY ON US ALL
Authors: H. B.
Published: December 2021

Here's a country with 90 million grown-ups who can't write a coherent letter or do simple arithmetic. It's a country where "Everything I Need to Know I learned in Kindergarten" inevitably becomes a huge best seller ...

The President's people last week started serious leaking about what kind of program they would like to install.

The immediate impulse is to smite the forehead with flat of hand and cry, "What country do these dreamers think they live in?" ...

The 37 million now with health insurance obviously include a good percentage of the 90 million who can't read much or figure shrewdly, and some of whom can't read or figure at all ...

They are designing another nightmare as complicated as the tax law, with the same kind of opportunities for finagling and corruption.
Province-Based Study of Neurologic Disability Among Survivors Weighing 500 Through 1249 Grams at Birth
Authors: Robertson Charlene , Sauve Reginald S. , Christianson Heather E.
Published: December 2021

Background. As the mortality of children weighing 500 through 1249 g at birth decreases, the published rates of neurologic disability among survivors have caused concern. Outcome information from a province-based study in which perinatal/neonatal regional care is well developed and includes high-risk identification, early referral, organized transport, and outreach education, provides data from a Canadian source for comparison with epidemiologic reports.

Methods. Neurologic disability rates among 2- to 3-year-old survivors weighing 500 through 1249 g at birth is provided based on all live births/neonatal survivors/1-year survivors born in Alberta, Canada to Alberta residents in 1990.

Results. Corrected survival to 1-year was 163 of 229 or 71% of live births of the total group weighing 500 through 1249 g. Of 168 live births, 143 or 85% weighing 750 through 1249 g, free from lethal anomalies, survived. Based on 1-year survival, disability rates were: cerebral palsy, 67/1000; vision loss (acuity in the best seeing eye after correction, <20/60), 12/1000; neurosensory hearing loss (loss of ≥30 dB binaurally), 12/1000; and trainable/profound mental retardation, 18/1000. No survivor had a convulsive disorder. No vision loss or mental retardation as defined by this study occurred in survivors of ≥750 g. All children with cerebral palsy were or were projected to become ambulatory.

Conclusions. Neurologic disability among small preterm surviving infants can occur less frequently than suggested by published reports. We believe this provincial study supports the value of well developed regional perinatal programs.
Objections to AAP Statement on Homosexuality and Adolescence
Authors: Nicolosi Joseph
Published: December 2021

I would like to point out some objectionable assumptions in "Homosexuality and Adolescence,"1 by the American Academy of Pediatrics Committee on Adolescence.

The Statement advises pediatricians that "therapy directed specifically at changing sexual orientation is contraindicated, because it can provoke guilt and anxiety while having little or no potential for achieving change in orientation." This advice ignores the vast body of literature on successful treatment for unwanted homosexuality.

There can be tragic consequences when an uninformed physician assists in prematurely identifying an adolescent as "gay," especially if the youth expresses dissatisfaction with his/her homosexual feelings.
Job Lewis Smith and the Germ Theory of Disease
Authors: Yankauer Alfred
Published: December 2021

"If these doctrines (evolution and germ theory of disease with its concomitant disproof of spontaneous generation) are true, all talk of creation or methods of creation becomes absurdity; for just as certainly as they are true, God Himself is impossible. . . . No, if this after all is the best that science can give me, give me then, I pray, no more science."1

These are not the words of a modern-day creationist, but those of the President of Columbia College, F.A.P. Barnard, speaking at the first meeting of the American Public Health Association in 1873. Barnard was no religious fanatic but a sophisticated scientist who had summarized the work of Pasteur and Lister earlier in his talk.
PROLONGED APNEA AND THE SUDDEN INFANT DEATH SYNDROME: CLINICAL AND LABORATORY OBSERVATIONS
Authors: Steinschneider Alfred
Published: December 2021

A 25-Year Trail to Murder Charges—... The first suspicions were raised in 1985 by Dr. Linda Norton, a former medical examiner for Dallas County, Texas, and an expert on pediatric pathology, who had been a consultant in the VanDerSluys case.

"You may have a serial killer in Syracuse," she told the prosecutor in giving him a copy of an October 1972 article in Pediatrics (1972;50(4)) called "Prolonged Apnea and the Sudden Infant Death Syndrome: Clinical and Laboratory Observations." In the report Dr. Steinschneider described his work with the syndrome and how two children in a family plagued with the affliction had died within hours of their release from his Syracuse research project.

In his paper, Dr. Steinschneider concluded that the family, which he still identifies only as "H," showed that victims suffered from real if almost undetectable physical abnormalities. In a proposal that was radical then but is now accepted, he suggested that the syndrome had a genetic component and was therefore inherited. He suggested that scientists could identify the abnormalities and thereby devise a warning system.

"But the paper indicated a more sinister possibility to Dr. John F. Hick of Minnesota. In a letter to the journal, he wrote that the case offered "circumstantial evidence suggesting a critical role for the mother in the death of her children." (See below.)

But his warning was dismissed, until Mr. Fitzpatrick read the paper 15 years later.

"The medical records described two happy, healthy, perfectly normal kids," he said. "It convinced me that these children were murdered."
Letter to the Editor
Authors: Kinsella John P. , Abman Steven H.
Published: December 2021

We appreciate the thoughtful comments of Drs Gaston and Keith, and share their concerns about potential toxicity associated with new therapies, including nitric oxide (NO). As we have emphasized in several publications, the potential for NO-related toxicity should be of foremost concern to investigators using this experimental drug.1-4 Moreover, the use of inhalational NO therapy must currently be limited to the most critically ill patients, for whom complications associated with conventional therapy are well recognized.
BABIES' EARS SOUND EARLY WARNING OF DEAFNESS
Authors: L. J. F.
Published: December 2021

Under a law being prepared in the US, all newborn babies will have to be screened for defective hearing with a device that picks up sounds that emanate from their ears. Brenda Lonsbury-Martin, director of research at the University of Miami Ear Institute, told the AAAS meeting that the test could ensure that children with serious hearing difficulties do not miss out on the first vital years of education

The new screening test is quick and simple to perform, and can identify the degree of impairment at all audible frequencies. The device needed to carry it out is relatively cheap at about $10 000, said Lonsbury-Martin.

The test is based on an effect known as "otoacoustic emission," which was first detected by a British physicist, Dave Kemp. In 1979, Kemp found that a few microseconds after sound enters a healthy ear, the same sound—amplified up to 10 times—can be detected emanating from the ear. If the ear is defective, the signal is not as strong.

The device used for the test looks like a hearing aid. As well as generating sounds, it picks up and records the emissions from the inner ear that are produced in response.
Letter to the Editor
Authors: Bailey Robert , McGill Leigh , Bergeson Paul S. , Piatt Janice P. , Hopkin Robert
Published: December 2021

The inconspicuous penis encompasses a number of different entities. Over the years, this problem has engendered much controversy and endless discussion by urologists but has remained surprisingly unknown among other medical practitioners. Dr Little raises some of the issues that have led to the controversy concerning the buried penis. (The buried penis is but one of the entities comprising the inconspicuous penis).

Our paper describes the different types of inconspicuous penis so that pediatricians can recognize the physical manifestation and make the appropriate referral to specialty care.
Letter to the Editor
Authors: Newman Thomas B. , Klebanoff Mark A.
Published: December 2021

Dr Rhine and colleagues' first concern is that we may have missed some cases of kernicterus by excluding patients who died. This is an important possibility, and applies not just to deaths in the first year, but for the entire 7-year followup period. There was, in fact, a higher death rate among infants with bilirubin levels of 20 or more compared with infants with lower bilirubin levels. The death rates up to age 7 were 3.6% versus 1.4%, a 2.2% excess in the high bilirubin group (P = .004).
THE DECREASE IN SEVERITY OF ASTHMA IN CHILDREN OF PARENTS WHO SMOKE SINCE THE PARENTS HAVE BEEN EXPOSING THEM TO LESS CIGARETTE SMOKE
Authors: Sachs Martin I.
Published: December 2021

Since 1986 an increasing awareness of the harmful effects of secondhand smoke has caused parents to smoke fewer cigarettes in the presence of their asthmatic children. This has been associated with a marked reduction in asthma severity of the smokers' children.
CONTROLLED STUDY OF LINEAR GROWTH IN ASTHMATIC CHILDREN DURING TREATMENT WITH INHALED GLUCOCORTICOSTEROIDS
Authors: Randolph Christopher
Published: December 2021

Purpose of the Study. To determine the impact of short term inhaled budesonide on linear growth in school children with mild asthma.

Study Population. Forty-three school children with mild asthma.

Methods. A randomized double blind parallel group study with three dose groups of 200, 400, and 800 µg of budesonide per day administered with a 750-mL spacer (Nebuhaler). Each group received budesonide for 8 consecutive weeks. Placebo was given 4 weeks before or after budesonide.

Findings. Compared with placebo, children treated with 800 µg of budesonide had a statistically significant lower leg growth velocity by 0.26 mm/week (P < .0012; t = 5.0; df = 11; 95% confidence interval, 0.14 to 0.37 mm/week). There was no statistically significant difference in the growth velocity between 200 or 400 µg of budesonide treatments and placebo.

Reviewer's Comments. This study was conducted with knemometry, a method utilized in measuring the length of the lower leg with apparent high reproducibility and accuracy. Unfortunately, the correlation between growth of the lower leg and chronic growth is undear. Several steroid studies in the past have indicated that budesonide up to levels of 800 µg does not interfere with long term growth. Thus, the impact of the study is unclear at present. Clearly, a longer term study is necessary to determine the outcome of these children. Additionally, it would be important to see the impact of budesonide in chronic asthma with greater severity, which itself may interfere with growth.
YOUR DOCTOR IS NOT IN, BY JANE M. ORIENT
Authors: L. J. F.
Published: December 2021

The government has signed a contract to pay $850,000 for development of "practice guidelines" and "protocols" to tell doctors how to treat an ear infection, a $20 problem. If the Clinton administration has its way, there will be protocols for the treatment of virtually every ailment. Yet there is no evidence that protocols save money or improve quality. Nurses, for instance, outperform protocols in deciding how to treat abdominal pain.

So why aren't doctors raising a cry of alarm? Many have been browbeaten into submission, or have discovered that it's easier to play the game than to buck the system. But also, a different type of person is entering medical practice these days. Although the evidence is largely anecdotal, Dr. Orient says that the best students are avoiding medical schools and the schools are lowering their standards. (In 1990, 16% of medical graduates flunked the national boards, compared with 9% in 1984.)
HOW THE CLINTON HEALTH PROPOSAL WAS CONCEIVED AND PROPAGATED
Authors: L. J. F.
Published: December 2021

... The working groups contained more than 1000 participants, not 511, as claimed by the Task Force. Nearly half of the members were private citizens.

Large numbers worked for managed-care interests, most notably the Robert Wood Johnson Foundation and the Henry J. Kaiser Family Foundation. Both foundations have supported managed-care reform in several states. In addition, six members the White House passed off as Congressional staffers turned out to be Robert Wood Johnson fellows assigned to the staffs of four Democratic Senators; all were on the foundation's payroll.

Dozens of other private interests were represented in the working groups—Aetna, Prudential, Kaiser-Permanente, health czar Ira Magaziner's former consulting company Telesis, to name a few. Conspicuously absent were physicians in private practice.

The Task Force spent at least $4 million and possibly as much as $16 million on expenses, salaries, and consulting fees. In the charter it filed with the GSA in March 1993, the Task Force said expenses would total $100 000.
A Different View of Guns
Authors: Suter Edgar A.
Published: December 2021

To their credit, Sentunia et al (Pediatrics 1994;93:469-475) did not use tax dollars to finance their poll. Such hard-earned praise aside, their "tortured data," except for finding the typical innercity high-crime/low gun ownership pattern, is at variance with most other research on gun ownership and usage patterns.1 Familiar contrivances about children and guns are noted—the ominous-sounding imagery of "... firearms are the third or fourth leading cause of unintentional death in childhood" overlooks that the average of 200 to 250 annual children's accidental gun deaths is not nearly as horrific as the first cause, automobile accidents that claim the lives of about 3300 children annually.2
Scalding Water Temperatures
Authors: LUKEFAHR JAMES L. , EZEKIEL KALAVALLI
Published: December 2021

Tap water scald burns are the most frequent cause of nonfatal burn injuries in United States children. Most of these burns occur in the home, and hot water heater thermostat settings below 60°C (140°F) significantly decrease the risk of such burns in young children. The American Academy of Pediatrics and other safety-promotion organizations recommend that thermostats be set at 49 to 53°C (120 to 130°F), and ordinances encouraging lower hot water temperatures exist in some localities.

We advise our pediatric colleagues that consumer products manufacturers do not always follow these recommendations in their published guidelines for product use. Specifically, we have found that four of five major manufacturers of automatic dishwasher detergent recommend hot water thermostat settings of 60°C or higher. (See Table.)
DOING WHAT COMES UNNATURALLY
Authors: Student
Published: December 2021

"The problem is fundamental. Put twenty or more children of roughly the same age in a little room, confine them to desks, make them wait in lines, make them behave. It is as if a secret committee, now lost to history, had made a study of children and, having figured out what the greatest number were least disposed to do, declared that all of them should do it."
The Effects of Bundling on Infant Temperature
Authors: Grover Geeta , Berkowitz Carol D. , Thompson Marita , Berry Lynne , Seidel James , Lewis Roger J.
Published: December 2021

Objective. To determine whether bundling elevates rectal and/or skin temperature of young infants.

Design. Randomized, prospective study stratified by age.

Setting. Clinical Studies Center at a teaching hospital in Los Angeles.

Patients. Sixty-four well, full-term infants (ages 11 to 95 days).

Interventions. Control infants (n = 28) were dressed in a disposable diaper and terry coveralls. Bundled infants (n = 36) were dressed as control infants, plus a cap, a receiving blanket, and a thermal blanket. All infants were monitored in an open crib (room temperature 72° to 75°F). Rectal and skin (anterior mid-lower leg) temperatures and infant states were measured at 5-minute intervals from time 0 to 60 minutes and at 62 and 65 minutes.

Results. The mean skin temperature of bundled infants increased by 2.67°C/hr; mean rectal temperature increased by 0.06°C/hr. The mean skin temperature of nonbundled infants increased by 1.5°C/hr; mean rectal temperature decreased by less than 0.01°C/hr. Comparing bundled infants to nonbundled controls, there was a significant rise in skin temperature (P = .0001) but not in rectal temperature (P > .05, Wilcoxon rank sum test). The study had a power > 98% to detect a rise of .5°C in rectal temperature over 60 minutes. The 95% confidence interval for the change in rectal temperature in bundled infants was -0.03 to + 0.15°C.

Conclusions. Bundling a healthy infant in a temperate external environment causes an increase in skin temperature, but not in rectal temperature. Elevated rectal temperatures should therefore, rarely if ever be attributed to bundling.
"HOW THE BRITISH VIEW US"
Authors: L. J. F.
Published: December 2021

"American citizens are not protected by a law akin to the British firearms Act 1920. These regulations, along with the laws passed in 1936, 1968, and 1988, have protected British citizens for nearly three generations. Quite apart from America, "where buying a handgun is as easy as buying a tooth brush," British society is far more circumspect about private weaponry. To obtain a gun license, potential owners must satisfy local police that they have "good reason" for possessing a gun and that they are "fit to be entrusted with it." One of the guiding philosophies behind British gun restrictions—that personal protection is not a good reason for having a firearm—may seem untenable (possibly quaint) to some Americans. Yet defenseless Britons remain comparatively safe in their homes with a murder rate one tenth of that in the USA.
The Continuing Gun Debate-Puzzling; Byzantine and Drug Abuse?
Authors: Cowan David N.
Published: December 2021

In their zealous pursuit of finding something printworthy about gun ownership, Senturia et al1 have conducted Byzantine analyses to identify groups with increased likelihood of gun ownership (eg, crosstabulation of area by adult males for rifles, but not for handguns). Apparently the authors had not seen the article on data abuse recently published in another journal.2 In their anti-gun crusade, the authors have left evidence of both opportunistic and Procrustean data torturing. At the very least, the authors should have made it clear that this was a descriptive, hypothesis-generating exercise, and should not attempt to go beyond their data.
Surveillance for Transmission of Hepatitis B in Child Day Care
Authors: Foy Hjordis M. , Swenson Paul D. , Freitag-Koontz M. Jayne , Boase Janice , Tianji-Yu  , Alexander E. Russell
Published: December 2021

Relatively little is known about the risk of transmission of hepatitis B virus (HBV) in day-care centers; the virus is primarily spread by blood and other body secretions. Gradual horizontal transmission of hepatitis B has been observed in homes for the mentally retarded.1-3 Horizontal spread in children appears to be of equal importance with vertical transmission in countries where hepatitis B is endemic.4 These infections, which usually are asymptomatic, may result in chronic carriage and may go undetected unless children are tested for hepatitis B markers. Studies in day-care centers in Okinawa, where HBV carriage is relatively common, suggest that transmission may occur in day-care centers.5 Case reports of HBV transmission in school or day-care settings in the US6 and Italy7 have been published.

Our study was undertaken to determine whether there is evidence of horizontal transmission of HBV infections in US day-care facilities. To evaluate this, we screened for the antibody to hepatitis B core antigen (anti-HBc), a marker which is seen both in those who have recovered from hepatitis B and those who are carriers.8 Capillary blood specimens, obtained by finger prick, were used. Children who tested positive had venous blood specimens drawn and their families were approached for consent to draw venous specimens also from the household members to evaluate if the infection may have originated in the family. The venous specimens were tested also for additional markers, especially for hepatitis B surface antigen (HBsAg), which is found during acute infection and in carriers, and antibody to HBsAg (anti-HBs) which develops after infection and immunization.