bluuebunny/crossref_metadata_2025 huggingface dataset:
INTERLEUKIN (IL)-13 EXPRESSION AT THE SITES OF ALLERGEN CHALLENGE IN PATIENTS WITH ASTHMA
Authors: Hopp Russell
Published: December 2021

IL-13 is in the same gene cluster as IL-4, IL-5, and GM-CSF and is increased after allergen exposure. Other studies have shown IL-13 shares function with IL-4 inducing immunoglobulin E synthesis. A number of cytokines are relevant to the human allergic response.
RELATION OF THE COURSE OF BRONCHIAL RESPONSIVENESS FROM AGE 9 TO AGE 15 TO ALLERGY
Authors: Wood Robert A.
Published: December 2021

Allergy, as evidenced by both IgE level and skin tests, is of critical importance in predicting the course of lung function and BHR between the ages of 9 and 15 and the severity of symptoms at the end of follow-up.
ASSOCIATION OF ASTHMA WITH SERUM IMMUNOGLOBULIN E (IgE) AND SKIN TEST REACTIVITY TO ALLERGENS AMONG CHILDREN LIVING AT HIGH ALTITUDE
Authors: Wood Robert A.
Published: December 2021

Asthma was still a major cause of morbidity in schoolchildren even in an environment free of dust mites and outdoor air pollution. In this population, asthma was strongly associated with elevated IgE and sensitization to other indoor allergens, especially cats.
SENSITIZATION TO INHALANT ALLERGENS IN WHEEZING INFANTS IS PREDICTIVE OF THE DEVELOPMENT OF INFANTILE ASTHMA
Authors: Sicherer Scott H. , Wood Robert A.
Published: December 2021

Sensitization to inhalant allergens may distinguish wheezing infants who develop asthma from those who do not, and skin testing may assist in early diagnosis of asthma in wheezing infants.
SALMETEROL XINAFOATE IN CHILDREN ON HIGH-DOSE INHALED STEROIDS
Authors: Galant Stanley P.
Published: December 2021

The authors conclude that salmeterol 50 µg BID is a safe, convenient, and effective modality in children whose day and night symptoms are not well controlled by 400 µg of beclomethasone per day or an equivalent of another inhaled steroid. They feel the data justify the inclusion of long-acting β-2 agents in the guidelines for the management of childhood asthma.
REGULAR USE OF INHALED ALBUTEROL AND THE ALLERGEN-INDUCED LATE ASTHMATIC RESPONSES
Authors: Wood Robert A.
Published: December 2021

One week of albuterol treatment increased the late asthmatic response and allergen-induced increase in airway responsiveness. This suggests that the regular use of inhaled β-agonists may lead to increased airway inflammation after allergen exposure.
INDEPENDENT PARENTAL ADMINISTRATION OF PREDNISONE IN ACUTE ASTHMA: A DOUBLEBLIND, PLACEBO-CONTROLLED, CROSSOVER STUDY
Authors: Furukawa Clifton T.
Published: December 2021

A single dose of prednisone available for use at home for acute asthma did not improve asthma outcome. Instead, outpatient visits were increased. Therefore, such intervention is not recommended.
LOW COMPLICATION RATE OF CORTICOSTEROID-TREATED ASTHMATICS UNDERGOING SURGICAL PROCEDURES
Authors: Marino Joseph T.
Published: December 2021

Although this was a small retrospective study, it shows that careful preoperative evaluation and management of asthmatics with steroids lowers the pulmonary complication rate without causing other complications.
THEOPHYLLINE ATTENUATION OF AIRWAY RESPONSES TO ALLERGEN: COMPARISON WITH CROMOLYN METERED-DOSE INHALER
Authors: Wood Robert A.
Published: December 2021

Theophylline administered as a once daily slow-release formulation was as effective as cromolyn delivered by an MDI in attenuating airway responses to inhaled allergen.
MOLECULAR GENETIC ANALYSIS OF X-LINKED HYPOGAMMAGLOBULINEMIA AND ISOLATED GROWTH HORMONE DEFICIENCY
Authors: Sullivan Kathleen E.
Published: December 2021

XLA and X-linked hypogammaglobulinemia with isolated growth hormone deficiency are two distinct disorders. This suggests that there is another X-linked gene, which is important for the development of B cells.
NASOPHARYNGEAL ANTIBODIES TO PNEUMOCOCCAL CAPSULAR POLYSACCHARIDES IN CHILDREN WITH ACUTE OTITIS MEDIA
Authors: Greos Leon S.
Published: December 2021

Children with pneumococci in the ear more often developed a pneumococcus-specific nasopharyngeal IgA response than children with pneumococcus found only in the nasopharynx or not found in either MEF or NPA. Also, the findings support the hypothesis that mucosal immunity to bacterial polysaccharides matures at an age earlier than systemic immunity.
EARLY LOSS OF PASSIVE MEASLES ANTIBODY IN INFANTS OF MOTHERS WITH VACCINE-INDUCED IMMUNITY
Authors: Kobayashi Roger H. , Kobayashi AiLan D.
Published: December 2021

Persistence of passive measles antibody is unusual in infants at 12 months of age and then only in those whose mothers were born before 1958.
INTERCHANGEABILITY OF CONJUGATED HAEMOPHILUS INFLUENZAE TYPE B VACCINES IN INFANTS
Authors: Maguire Peter , Goldsobel Alan
Published: December 2021

The studied sequential combinations of Hib vaccines were safe and at least as immunogenic as either vaccine alone.
A CYSTIC FIBROSIS MUTATION ASSOCIATED WITH MILD LUNG DISEASE
Authors: Chipps Bradley E.
Published: December 2021

The second most common mutation for cystic fibrosis in the Netherlands, A455E, is associated with preservation of pancreatic function, absence of diabetes mellitus, and mild to moderate obstructive lung disease suggesting that this group of patients has a better prognosis than the deltaF508 mutation.
Blood Lead Screening Practices Among US Pediatricians
Authors: Campbell James R. , Schaffer Stanley J. , Szilagyi Peter G. , O'Connor Karen G. , Briss Peter , Weitzman Michael
Published: December 2021

Objectives. In 1991, the Centers for Disease Control and Prevention (CDC) decreased the blood lead level of concern to 10 µg/dL (0.48 µmol/L) and recommended universal screening. Because these guidelines continue to provoke controversy, we conducted a study to:1) estimate the proportion of pediatricians who are members of the American Academy of Pediatrics (AAP) who report screening for elevated blood lead levels; 2) describe their clinical practices regarding screening for elevated blood lead levels; 3) compare attitudes of universal screeners, selective screeners, and nonscreeners; and 4) identify characteristics of pediatricians who universally screen.

Design. Confidential, cross-sectional survey of a nationally representative random sample of 1610 pediatricians conducted through the AAP Periodic Survey.

Subjects. The study included 1035 responders (64% response rate). Analysis was limited to the 734 pediatricians who provide well-child care (ie, primary-care pediatricians).

Results. Fifty-three percent of pediatricians reported screening all their patients aged 9 to 36 months, 39% reported screening some, and 8% reported screening none. Among those who screen, 96% use a blood lead assay. The primary risk factors for which selective screeners screen are: history of pica (94%); living in an older home with recent renovations (92%); living in an older home with peeling paint (93%); and having a sibling who had an elevated blood lead level (88%). Among primary-care pediatricians, 73% agree that blood lead levels ≥10 µg/dL should be considered elevated, and 16% disagree. However, 89% of primary-care pediatricians believe that epidemiologic studies should be performed to determine which communities have high proportions of children with elevated blood lead levels, and 34% of primary-care pediatricians believe that the costs of screening exceed the benefits.

Conclusions. Three years after the Centers for Disease Control and Prevention issued new guidelines for the management of elevated blood lead levels, a slight majority of primary-care pediatricians in the United States who are members of the AAP report that they universally screen their appropriately aged patients, while most of the remaining pediatricians report screening high-risk patients. Many pediatricians may want additional guidance about circumstances under which selective screening should be considered.
Failure of Current Guidelines for Cholesterol Screening in Urban African-American Adolescents
Authors: Rifai Nader , Neufeld Ellis , Ahlstrom Promise , Rimm Eric , D'Angelo Lawrence , Hicks Jocelyn M.
Published: December 2021

Objective. The National Cholesterol Education Program (NCEP) and the American Academy of Pediatrics recommend selective screening to detect children and adolescents with hypercholesterolemia. We compared the effectiveness of these guidelines with other potential screening strategies in urban African-American adolescents.

Subjects and Methods. Two hundred sixty African-American adolescents and young adults (192 females and 68 males; age range, 12 to 20 years) who were free from illnesses or medications that disrupt lipid metabolism were included in the study. Participants completed a questionnaire regarding their smoking habits, blood pressure, contraceptive pill use, and family history of early heart disease and high cholesterol and had their blood lipids, lipoproteins, and apolipoproteins measured (152 fasting and 108 nonfasting).

Results. Nineteen percent of participants reported family histories of hypercholesterolemia; 26% reported family histories of premature heart disease; and 8% had family histories of both hypercholesterolemia and premature heart disease. Therefore, 37% of these participants would have been targeted for cholesterol screening, compared with the 25% predicted by the NCEP. Less than 50% of the participants with low-density lipoprotein cholesterol (LDL-C) levels greater thane 110 or 130 mg/dL would have been detected by selective screening. Total cholesterol was superior as a screening test to apolipoprotein B in predicting LDL-C levels greater than 110 mg/dL (sensitivity, 92% vs 59%). However, total cholesterol minus high-density lipoprotein cholesterol showed better positive predictive value (100%) at LDL-C levels greater than 110 mg/dL than total cholesterol in the fasting (80%) and total groups (90%).

Conclusions. In this population, selective screening with total cholesterol, as recommended by the NCEP, has such poor sensitivity and positive predictive value that other options may be superior. As an alternative, we recommend the measurement of high-density lipoprotein cholesterol together with total cholesterol at the initial screening step in adolescents and universal screening for those older than 16 years to capture a greater proportion of young adults with increased LDL-C. Furthermore, we recommend using the less stringent treatment guidelines established by the Adult Treatment Panel II for premenopausal women and men younger than 35 years for older adolescents and young adults.
Breastfeeding Practices Among Resident Physicians
Authors: Miller Nancy H. , Miller David J. , Chism Melissa
Published: December 2021

Objective. To determine how employment as a resident physician (resident) affects breastfeeding practices and experiences.

Design. Cross-sectional questionnaire survey.

Setting. US resident physicians in the second half of their postgraduate year three (PGY3).

Participants. 1500 questionnaires were mailed at random to female 1990 graduates of American medical schools. After eliminating unusable surveys, an adjusted response rate of 45% produced 450 surveys; 60 delivered a child during residency.

Interventions. None.

Measurement/Main Results. Forty-eight (80%) of 60 residents who delivered initiated breastfeeding, and continued for the duration of their maternity leave (mean, 7 weeks). With a return to residency half (24) of those who had initiated breastfeeding discontinued breastfeeding. The breastfeeding rate dropped to 15% (9/60) at 6 months. Residency work schedule was the most common reason (80%) for discontinuing breastfeeding. Of the 24 residents who continued breastfeeding while working, 83% pumped breast milk during their work shifts; 79% felt there was insufficient time during work, and 42% reported no appropriate place at work to express milk. Only 54% who continued felt supported by their attending physicians for their efforts to breastfeed; 67% felt colleagues were supportive.

Conclusions. The breastfeeding initiation rate for resident mothers was in compliance with the Healthy People 2000 guidelines, but the rate at infant age 6 months fell well below the goal of 50%. Modifiable factors in residents' work sites include both physical and emotional accommodations to encourage resident mothers to breastfeed.
Baseball Injuries: A Little League Survey
Authors: Pasternack Joel S. , Veenema Kenneth R. , Callahan Charles M.
Published: December 2021

Objectives. To determine the patterns of injury in youth baseball and apply the data to estimate the value of proposed safety equipment.

Design. Prospective population-based injury survey.

Participants. 2861 Little League baseball players (ages 7 to 18) for 140 932 player-hours.

Measurements. An injury was included in the data only if it was serious enough to require medical/dental care, caused missing a game, or disallowed playing a certain position. The injuries were subdivided into acute or overuse. The acute injuries were classified as either catastrophic, severe, or minor. Injuries were categorized according to mechanism, area injured, and whether the player was on offense or defense.

Results. There were 81 total injuries, of which 66 (81%) were acute and 15 (19%) were overuse. Of the acute injuries, 11 were severe and 55 were minor. The overall injury rate was .057 injuries per 100 player-hours. The severe injury rate was .008 injuries per 100 player-hours, of which 46% were ball-related injuries and 27% were collisions. The most frequent mechanism of injury was being hit by the ball, which represented 62% of the acute injuries. Of the 41 ball-related injuries, 28 (68%) occurred to players on defense. Of the 18 ball-related facial injuries, 16 occurred to players on defense.

Conclusions. 1) Little League baseball is a safe activity with a low injury rate and a particularly low rate of severe injury;

2) impact by the ball causes more than half the acute injuries, thus safety interventions should be directed towards decreasing these injuries, especially on defense;

3) facemasks on batters can safely eliminate facial injuries to offensive players, but would only moderately reduce the incidence of ball-related facial injuries as most of these injuries are sustained by defensive players.
Papillary Thyroid Cancer: A Pediatric Perspective
Authors: Flannery Timothy K. , Kirkland John L. , Copeland Kenneth C. , Bertuch Alison A. , Karaviti Lefkothea P. , Brandt Mary L.
Published: December 2021

A less-invasive approach to the evaluation of papillary carcinoma in children and adolescents recently has been proposed, based on reports of the accuracy and reliability of fine-needle aspiration biopsy (FNAB) in this population.1-4 Such confidence may be ill-founded, as the following clinical histories will illustrate. Functioning nodules, Hashimoto's thyroiditis (HT), and goiter-associated lymphadenopathy are unusual but significant presentations of papillary carcinoma in children and young adults, likely to be missed by the standard diagnostic approach in adults, which is reliant on FNAB, 123I scintiscans, or clinical response to suppressive doses of L-thyroxine (T4).

CASE REPORTS

Case 1

A thyroid nodule developed in a 12-year-old girl, first observed 1 month before evaluation in an endocrine clinic.
Residency Maternity Leave
Authors: Walter Robert S.
Published: December 2021

This letter is in strong support of the principles outlined in the American Academy of Pediatrics (AAP) statement on parental leave for pediatric residents and pediatric training programs.1 While family illness, paternity, and other personal leave issues must be appropriately handled, maternity leave situations are by far the most common reason for schedule adjustments for our residency each year. Although these adjustments can take much effort (especially by the resident involved and the chiefs) to ensure fairness to all, they can be successful with careful planning of call schedules and rotation changes.
DNR CRAZINESS
Authors: Gillon Raanam
Published: December 2021

CPR is the only treatment we must get permission not to give, when it is not indicated.
HOW TO RELIEVE ANXIETY
Authors: Fisher R. A.
Published: December 2021

Randomization relieves the experimenter from the anxiety of considering and estimating the magnitude of the innumerable causes by which his data may be disturbed.
Letter To The Editor
Authors: Schneider Sanford
Published: December 2021

The pro and con commentaries by Drs Judelsohn and Katz (Pediatrics 1996;98:115-117) do not mention projected costs. In these days of limited resources, the greatest bang for the buck is important and perhaps is becoming the most important factor of delivery of medical services to large populations. Developing a single product multi-vaccine containing inactivated polio virus, to be followed by oral live virus vaccine, will unquestionably add to the cost of protection. Also, Dr Katz does not seem to address the problem of compliance.
Letter To The Editor
Authors: Knöbel Harald H. , Chen Chien-Jen , Liang Kung-Yee
Published: December 2021

We are grateful to Steven Koehler for his comments on our study on sudden infant death syndrome (SIDS) and air pollution in Taiwan.1 The criticism focuses on the autopsy rate and the new, but well-referenced finding, that in Taiwan, and probably other Asian countries, the majority of classic SIDS is coded as suffocation. Following is an itemized reply to the issues raised. SIDS has been assumed to be a phenomenon of western countries. In China and Hong Kong it is thought to be virtually nonexistent2,3 Japan and Taiwan have officially published rates that are extremely low.4,5
Letter To The Editor
Authors: Furukawa Clifton T.
Published: December 2021

Asthma is "inflammatory airway disease." However, additional characteristics are necessary to distinguish asthma from other inflammatory airway diseases, such as infectious bronchitis and pneumonia (infectious and toxic). These additional characteristics are at least partial reversibility of airway obstruction and increased airway responsiveness to a variety of stimuli. Thus, "infectious bronchitis" and "allergic bronchitis" are specific for those children who do not have reversible obstruction and hyperresponsiveness to other factors that can trigger obstruction. Wheezing is not necessarily a symptom shared in common among these airway diseases.
"It Takes a Whole Village": Working With Community Coalitions to Promote Positive Parenting and Strengthen Families
Authors: Chamberlin Robert W.
Published: December 2021

RATIONALE FOR AN ECOLOGIC APPROACH

This conference brings me back full circle to where I started my academic career in the mid-1960s studying the effects of different child-rearing styles on the behavior and development of children. At that time I was interested in the studies of Lewin et al1 that demonstrated how different leadership styles affect child behavior in groups. I used that model to develop an interview method for identifying different approaches to child rearing by having mothers describe how they handled many common rearing situations with young children.2 Those mothers who made frequent use of unmodified directives and physical and/or psychological punishment for noncompliance were identified as authoritarian and those who responded with reasoning and more flexible approaches to discipline, such as using distraction and time out, were identified as accommodative.3 I was interested to see whether pediatricians could identify high-risk styles that would be harmful to children and then work with the parents to change those styles. This led me to develop a longitudinal study that followed a group of 135 2-year-olds experiencing different parenting styles into first grade.4 The parents of these children were recruited from two suburban pediatric group practices. The first observation we made was that even with this middle class population it was difficult to find an adequate sample of parents of 2-year-olds who did not use a lot of unmodified directives and spanking. We did, after considerable effort, find a suitable contrast group in a highly educated subsample of the population. As for corporal punishment, the parents using an authoritarian style generally reported using physical punishment once a day or more to control behavior and those with an accommodative style once a week or less.
Spanking and the Making of a Violent Society
Authors: Straus Murray A.
Published: December 2021

Most of the world's societies are violent in the sense that they have high rates of physical assault, homicide, and war. The United States (US) is the most violent of the advanced industrial societies. The current US homicide rate of 8.5 per 100 000 is three times the Canadian rate of 2.3 per 100 000, and about eight times the rate of Western European countries. Nevertheless, many societies are even more violent. The Mexican homicide rate of 19.4 is more than double that of the US, and the rate for the cities of Columbia (110.4 per 100 000) is more than ten times higher.

Most of the world's societies also bring up children violently through the use of corporal punishment. Perhaps the correspondence between the preponderance of violence and that of corporal punishment is just a coincidence. Obviously, corporal punishment and assaults and murders differ in severity, and also in the cultural definition that makes one legitimate and the other criminal. However, there is also a correspondence between the behavior involved in corporal punishment and the behavior involved in criminal assaults and homicides that is seldom perceived. Everyone understands that corporal punishment is carried out to correct or control misbehavior. What is not understood is that almost all assaults by adults and about two thirds of homicides are also carried out to correct what the offender perceives as misbehavior. Typical examples include a confrontation between two men over a loan of $50 that is to be paid back in 1 week.
Iatrogenic Scald Burn: A Consequence of Institutional Infection Control Measures
Authors: Mirowski Ginat W. , Frieden Ilona J. , Miller Carol
Published: December 2021

Accidental burns are common, causing signficant morbidity and mortality in all age groups, but they occur most frequently in young children. Each year, tap water burns result in approximately 2600 visits to emergency rooms in the United States1 and cause approximately 200 deaths,2 but these burns are rare in the hospital setting. We describe a case of scald injury in a newborn during routine postnatal bathing that occurred shortly after an increase in the temperature of the hospital water supply due to a Legionella outbreak and discuss precautions that should be used by hospitals to avoid scald injuries.

CASE REPORT
Increased Methylphenidate Usage for Attention Deficit Disorder in the 1990s
Authors: Safer Daniel J. , Zito Julie M. , Fine Eric M.
Published: December 2021

Objective. To estimate the increased use and the prevalence of methylphenidate (Ritalin) treatment of youth with attention deficit disorder (ADD) during the 1990s.

Design. Using time-trend findings from two large population-based data sources, three pharmaceutical databases, and one physician audit, a best-fit estimate of the usage and the usage trends for methylphenidate treatment over the half decade from 1990 through 1995 was sought.

Setting. Five regions in the United States (US) and the nation as a whole.

Patients. Youths on record as receiving methylphenidate for ADD.

Results. The findings from regional and national databases indicate that on average, there has been a 2.5-fold increase in the prevalence of methylphenidate treatment of youths with ADD between 1990 and 1995. In all, approximately 2.8% (or 1.5 million) of US youths aged 5 to 18 were receiving this medication in mid-1995. The increase in methylphenidate treatment for ADD appears largely related to an increased duration of treatment; more girls, adolescents, and inattentive youths on the medication; and a recently improved public image of this medication treatment.

Conclusion. The database findings presented serve to correct exaggerated media claims of a 6-fold expansion of methylphenidate treatment, although they do not clarify the issue of the appropriateness of this treatment.
Motor Vehicle Driving Competencies and Risks in Teens and Young Adults with Attention Deficit Hyperactivity Disorder
Authors: Barkley Russell A. , Murphy Kevin R. , Kwasnik Denise
Published: December 2021

Purpose. To evaluate the motor vehicle driving knowledge, skills, and negative driving outcomes of older teens and young adults with attention deficit hyperactivity disorder (ADHD).

Location. A university medical center clinic for adult ADHD.

Subjects. A total of 25 young adults with ADHD and 23 young adults without ADHD 17 to 30 years old drawn from the community and equated for age, gender, and educational level.

Measures. Structured interview, behavior ratings by self and others, video test of driving knowledge, computer simulated driving test, and official motor vehicle records.

Results. ADHD young adults were cited more often for speeding, were more likely to have had their licenses suspended, were involved in more crashes, were more likely to have had crashes causing bodily injury, and were rated by themselves and others as using poorer driving habits. Official driving records corroborated these negative outcomes. Although no group differences in driving knowledge were evident, young adults with ADHD had more crashes, scrapes, and erratic steering during the computer-simulated driving test than did the control subjects.

Conclusions. Findings supported previous research suggesting that greater driving risks are associated with ADHD and suggested that ADHD does not interfere with driving knowledge so much as with actual performance (motor control) during vehicle operation.
WHICH COUNTS MORE: ABILITY OR CLASS?
Authors: L. J. F.
Published: December 2021

There is plenty of evidence about social mobility in Britain. The best is the National Child Development Survey, which has analyzed all the children born in a single week in 1958 at various points in their lives. In "Two Nations? The Inheritance of Poverty and Affluence," the Institute for Fiscal Studies, an independent research group, analyzed this data. It found that by 1991, 34% of those in the highest income quintile had fathers who were also in the top income group; 11%, however, had fathers in the poorest quintile. In a society with full equality of opportunity, and ability distributed equally across the population, 20% of the richest quintile would have had fathers from the richest quintile, and 20% from the poorest. This suggests that opportunity is dispersed in Britain, but not fully equalized.

But what if ability is not in fact distributed equally amongst the population? This question is explored, using the same data as the Institute for Fiscal Studies, in "Unequal but Fair?", a pamphlet by Peters Saunders, a sociologist at Sussex University, published last month by the Institute of Economic Affairs. He concludes that ability is greater at the top of the class/income pile than at the bottom, and that individual ability plays a crucial part in deciding where an individual will end up. Ability alone is well over twice as important as their class origins, three times more powerful than the degree of interest their parents showed in their schooling, and five times more powerful than their parents' level of education or the aspirations which their parents harbored for them while they were growing up.
Intentions to Use Violence Among Young Adolescents
Authors: DuRant Robert H. , Treiber Frank , Goodman Elizabeth , Woods Elizabeth R.
Published: December 2021

Objective. Frequent violent behavior among adolescents has been found to be associated with previous exposure to violence, personal victimization, depression, hopelessness, and older age. Although young adolescents engage in less severe violent behavior than older adolescents, their perceived normative expectations to use violence to resolve conflicts may already be established by early adolescence. This study examined the influence of exposure to violence, depression, church attendance, multiple drug use, and demographic variables on young adolescents' intentions to use violence to resolve conflict.

Methods. Young adolescents (N = 225, males = 49.4%, black = 88.7%, mean age = 12.9 ± 1 years) in two middle schools serving low-income and working-class communities were administered a previously tested anonymous questionnaire. They were also asked how they would resolve conflict in 15 different hypothetical situations. Each situation had 10 possible responses ranging from humor or avoidance to severe violence (eg, use of a gun). The Intentions to Use Violence in Hypothetical Situations Scale had a high internal reliability (α = .88) and was correlated (r = .46) at the expected level for this age group with a standardized use of violence and weapon-carrying scale.

Results. The Intentions to Use Violence in Hypothetical Situations Scale was significantly correlated with age (r = .17), school grade (r = .14), lower church attendance (r = -.23), frequency of smoking (r = .24), alcohol use (r = .37), marijuana use (r = .36), crack cocaine use (r = .14), smokeless tobacco use (r = .20), injecting drug use (r = .16), depression (r = .12), and exposure to violence (r = .48). Based on multiple regression analysis, exposure to violence, marijuana use, frequency of church attendance, alcohol use, cocaine use, and tobacco use accounted for 36.6% of the variation in the Intentions to Use Violence in Hypothetical Situations Scale.

Conclusion. Although the intention to use violence was associated with previous exposure to violence and current drug use, adolescents who attended religious services more often were less likely to report that they would use violence to resolve interpersonal conflict.
Continuous Negative Extrathoracic Pressure in Neonatal Respiratory Failure
Authors: Samuels Martin P. , Raine Joseph , Wright Theresa , Alexander John A. , Lockyer Kate , Spencer S. Andrew , Brookfield David S. K. , Modi Neena , Harvey David , Bose Carl , Southall David P.
Published: December 2021

Objective. In uncontrolled clinical trials, negative extrathoracic pressure has been shown to be an effective respiratory support. We aimed to assess its role in the context of current neonatal intensive care.

Design. A randomized controlled trial, with sequential analysis of matched pairs of infants. Matching was undertaken by stratified randomization from 15 groups divided according to gestational age, oxygen requirement, and whether patients were intubated at 4 hours of age.

Setting. Two neonatal intensive care units.

Patients. Two hundred forty-four patients (birth weight 1.53 ± 0.69 kg (mean ± SD); gestational age 30.4 ± 3.5 weeks) with respiratory failure.

Interventions. Patients were randomized at 4 hours of age to receive either standard neonatal intensive care, or standard care plus continuous negative extrathoracic pressure (CNEP, -4 to -6 cmH2O) applied within a purpose-designed neonatal incubator.

Outcome Scores. Clinical scores were calculated for each infant at 56 days of age, or death if earlier. Scores included measures for mortality, respiratory outcome, the presence of cerebral ultrasound abnormalities, patent arterial duct, necrotizing enterocolitis, and retinopathy. The treatment given for the higher score for each pair was recorded and the cumulative net number of pairs favoring CNEP plotted in the sequential analysis to provide an ethical early termination strategy. Individual components of the outcome score and other secondary measurements were analyzed on completion of the trial.

Results. The sequential analysis reached a decision boundary after 122 out of a possible maximum of 124 pairs were completed. The overall outcome score showed an overall significant benefit for CNEP. Secondary analysis showed that the use of CNEP was associated with an increase in mortality, cranial ultrasound abnormalities, and pneumothoraces, which were not statistically significant. However, 5% fewer patients were intubated (95% confidence interval [CI], 0-10), and the total duration of oxygen therapy among surviving infants at 56 days was lower (20.5 days, compared with 38.9 in controls; difference 18.4 days, 95% CI 3.8 to 33.0). Among all infants, the mean total duration of oxygen therapy was 18.3 days among CNEP-treated infants compared with 33.6 days among the controls (difference -15.3 days, 95% CI -0.2 to -30.4). This reduction in mean levels is entirely attributable to substantially fewer patients requiring prolonged oxygen therapy, the median duration of treatment being very similar in the two groups. As a result, commensurately fewer surviving infants showed chronic lung disease of prematurity.

Conclusions. The use of continuous negative pressure improves the respiratory outcome for neonates with respiratory failure.
PLACEBO VS NONTREATMENT
Authors: Student
Published: December 2021

We often and wrongly equate the response seen in the placebo arm of a clinical trial with the placebo effect. In order to obtain the true placebo effect, other nonspecific effects can be identified by including an untreated control group in clinical trials.
National Childhood Vaccine Injury Act: Revision of the Vaccine Injury Table
Authors: Evans Geoffrey
Published: December 2021

The National Childhood Vaccine Injury Act of 1986 (the Act) established the National Vaccine Injury Compensation Program (VICP) as a federal "no-fault" compensation system for individuals who may have been injured by specific covered vaccines. Entering its ninth year of operation, the VICP has ensured childhood vaccine supplies by dramatically reducing vaccine companies' and providers' liability that threatened the production of vaccines during the 1980s. The VICP has received 5057 petitions filed for possible injury from vaccines covered under the VICP, including 4240 filed for vaccines administered before October 1988, and 817 for vaccines administered between October 1988 and August 1996. Over 3700 claims have been adjudicated, 985 of which have been found to be compensable, and the remainder have been dismissed.

The Vaccine Injury Table (the Table) lists specific injuries or conditions and timeframes after vaccination that may be compensated under the VICP. The Table establishes legal presumptions about causation, which are used by the US Court of Federal Claims (the Court) to adjudicate petitions. The VICP covers seven "childhood" vaccines: diphtheria, pertussis, tetanus, measles, mumps, rubella, and polio.

Effective March 10, 1995, the Table was revised to better reflect current scientific knowledge about vaccine injuries (Table 1). As part of the Act, Congress mandated a review of the scientific literature and other information on specific adverse consequences of pertussis and rubella vaccines. The Institute of Medicine (IOM) performed and published a report of this review in 1991, and a review of a follow-up study of the National Childhood Encephalopathy Study in 1994.
The Pediatric Prenatal Visit: A Time for Change?
Authors: DERSHEWITZ ROBERT A.
Published: December 2021

Why shouldn't a pediatric prenatal visit be recommended? After all, it initiates a relationship between the pediatrician and family, and from there, establishes a foundation for health education and anticipatory counseling so central to primary care. Serwint et al are to be commended for performing a much-needed study to determine if there is value in a prenatal pediatric visit. The relatively few published studies have largely been descriptive, survey data, or of a case-control design in which the focus has been narrow, eg, effect on breastfeeding only. By reporting on their randomized, controlled trial, Serwint and colleagues advance objective evidence on the effect of the prenatal pediatric visit to its next level.
J'accuse!-M. LeComte de LaPlace a Prohibé le Recrutement des Alvéoles du Poumon
Authors: NELSON NICHOLAS M.
Published: December 2021

A recurrent concept throughout all the natural sciences is that of capacitance—"the extension or displacement of a loaded structure per unit load." The electrical engineer knows capacitance as the ratio of charge/voltage. Physicists (since Hooke, who first enunciated the concept) recognize strain/stress as compressibility (the inverse of the modulus). Pulmonary physiologists look at volume/pressure and call it compliance, while biochemists view the volume of molecules that can be liganded to a carrier and call it a binding curve. Clinicians recognize this form as the oxygen-dissociation curve, instantly identified by its sigmoid shape.

This shape also describes the inflation curve of the gasless lung—in the following sequence of increasing transpulmonary pressure: (1) a flat portion with only a small increase in volume—this segment describes the discontinuous openings of the smaller airways and alveoli, once their interfacial tensions have been overcome;
Transition of Care Provided for Adolescents With Special Health Care Needs
Authors:   COMMITTEE ON CHILDREN WITH DISABILITIES,   COMMITTEE ON ADOLESCENCE
Published: December 2021

This policy statement describes how the pediatrician can work closely with patients with special health care needs and their families as an advocate and educator to help them adapt positively to an adult-focused system of health care. Issues in health care transitions including independence and dependence, education and vocational issues, insurance issues and limitations, Social Security, and hospitalization are outlined.
Encouraging Teens to Use Norplant Is Bad Advice
Authors: GRIFFIN GLEN C.
Published: December 2021

An American Academy of Pediatrics (AAP) news release trumpeted misinformation to the world from the seriously flawed conclusions of an article in the February 1996 issue of Pediatrics. This press release and seemingly scientific article conclude that "Health care workers must work to remove barriers . . . so young patients who wish to avoid pregnancy will view Norplant as a contraceptive alternative." This is just plain bad advice. Why "work" for an objective that causes more problems? Although Norplant may protect a teen from pregnancy, it certainly does not protect a teen from acquired immunodeficiency syndrome (AIDS), which is 100% fatal, or any other sexually transmitted disease (SID).
In Reply: Encouraging Teens to Use Norplant Is Bad Advice
Authors: WIEMANN CONSTANCE M. , BERENSON ABBEY
Published: December 2021

We agree with Dr Griffin that abstinence is the only fail-safe method of contraception that prevents both sexually transmitted diseases and unintended pregnancies. However, adolescents who are denied access to contraception do not necessarily abstain from having sexual intercourse. Seventy-five percent of today's female adolescents are sexually active by age 19. More than 800 000 of these teenagers experience unplanned pregnancies each year, largely due to poor access to or inconsistent use of contraceptives. One of our responsibilities as adolescent health care providers is to facilitate responsible sexual behavior by promoting abstinence among those adolescents willing to wait until marriage.
In Reply: The Pediatrician's Role—Shrinking and Shrinking!
Authors: MELZER SANFORD M. , GROSSMAN DAVID C. , RIVARA FREDERICK P.
Published: December 2021

Dr Burke raises important concerns about the changing role of the primary care physician, especially in light of our findings that most pediatricians in Washington State take care of a limited number of pediatric inpatients. However, our conclusions may have been misinterpreted. This study does not suggest that pediatricians should not be trained in inpatient care, but that the proportion of residency training dedicated to inpatient care be more commensurate with the needs of the typical practitioner.
In Reply: Does Adenosine Infusion Improve Oxygenation in Term Infants With Respiratory Failure?
Authors: KONDURI G. GANESH , KAZZI NADYA J. , SHANKARAN SEETHA
Published: December 2021

Dr Leblanc brings up an important issue regarding the safe use of purines, such as adenosine infusion, used in our study over a prolonged period of time. We did not measure uric acid levels in serum or urine in our study. Therefore, we are unable to comment on potential nephrotoxicity of this drug. However, previous studies published in adult humans and adult rats show that the dose of adenosine used in our study should not affect the uric acid excretion or lead to nephrotoxicity.
Questions About Varicella Vaccine
Authors: LAVIN ARTHUR
Published: December 2021

The promotion of the varicella vaccine has been based on habit and profit rather than science, and has exposed the premise of immunization to doubtful legitimacy. Dr Plotkin's commentary (Pediatrics. 1996;97:251-253) nicely illustrates these problems with the varicella vaccine program, and helps explain why pediatricians who care for children are hesitant to participate.

The recent development of hepatitis B and varicella universal vaccination recommendations broke new ground in the history of immunizations. For the first time, universal immunizations were recommended for a problem that the community and its physicians did not agree presented a danger sufficient to justify such an intervention.
Educational Principles of Community-based Education
Authors: Roberts Kenneth B.
Published: December 2021

Much of medical education remains teacher centered, as exemplified by the continued emphasis on lectures. Increasingly, however, the importance of the learner is being recognized and acknowledged in medical school curricula. The distinction between teaching and learning is also an issue for graduate medical education; accreditation bodies focus on programs and teaching, and credentialing bodies determine whether individuals have accomplished sufficient learning. The true mission of teaching is to facilitate learning, and adult learning is enhanced by four elements: respect, building on previous experiences, immediacy of application, and the opportunity to practice. These elements should be considered when designing educational experiences in the community.

Educational planning includes five steps, represented by the mnemonic GNOME: goals, needs assessment, objectives, methods, and evaluation. Goals are broad aspirations, which are refined by the learners' needs to specific, measurable objectives. Methods are selected to match the objective, and evaluation determines whether the objectives were achieved. The results of the evaluation serve as another needs assessment, and the process continues until the goals are achieved. Throughout the process, the primary focus should be on the resident, with the program in a supporting role.
Implementing Community-based Education: Essential Elements and Recommendations
Authors: Osborn Lucy M.
Published: December 2021

Two elements are essential for implementing community-based educational programs: a vision of how community experiences fit into the training of the health professionals of the future and a local environment that will support innovation, change, and growth. Change cannot occur unless very basic assumptions regarding medical education are challenged. What is "quality education"? Can programs oriented toward tertiary and specialty care adequately provide the training that should be the core of a 3-year general training program? Do schools and programs select and train physicians to function within the microcosm of the academic center, or do they prepare physicians to manage the country's health care needs? National consensus has had little influence over local environments. Each medical school, training program, and teaching facility must reexamine its values and its culture. Each must have a vision of the physicians of the future and a commitment to train them appropriately.

The role of vision and culture in creating successful programs has been clearly described. Several key elements have been found to be consistent with success, the first being vision. Four basic principles will bring the vision to fruition: (1) preserving core values while still stimulating progress; (2) emphasizing the process by which programs are created, implemented, and changed rather than the product; (3) avoiding the "tyranny of the or," learning to be inclusive with a broad vision rather than limited to an "either-or" approach; and (4) aligning the process, management, and values in working toward envisioned progress for the future. Effective leadership is essential for a group or organization to accomplish its mission, as is an organizational structure that aligns responsibility, authority, resources, and accountability.
AN ESKIMO CHILD'S VIEW OF LIFE AND DEATH
Authors: Student
Published: December 2021

The worst thing about white people is that they make you think the way they do, and you get greedy for every minute of life, and forget your ancestors: you won't let anyone else's spirit come into the world, because you're here, and you won't leave, and no one can take your place until you do!
Anemia in Infancy: Iron Deficiency and Vitamin E Deficiency
Authors: Oski Frank A.
Published: December 2021

It is now established that vitamin E is an essential nutrient for all animals including man. It is now established that a deficiency of this vitamin, particularly in the infant, will result in a shortening of red cell life-span. The magnitude of the anemia appears related to the presence of associated factors such as the lipid composition of the red cell membrane and the nature of associated oxidant stresses.

Healthy term infants who are fed either human milk or proprietary formulas in quantities sufficient to meet their caloric requirements will receive adequate amounts of vitamin E. The same appears to be true for small preterm infants even when the formulas are fortified with iron. Infants who are receiving inadequate volumes of formula should receive vitamin E supplementation of approximately 15 mg/day.
Alcohol Use during Pregnancy: What Is the Risk?
Authors: Alpert Joel J. , Zuckerman Barry
Published: December 2021

Alcohol use during pregnancy now is believed generally to be a serious risk to the health of the fetus. As a result, women of childbearing age are urged to avoid, if not to eliminate, alcoholic beverages from their diet. This increasingly common view states that, because there is no known safe threshold for alcohol use, abstinence is the safest road to travel. Clearly, this important recommendation, symbolized by the labeling of alcoholic beverages as dangerous during pregnancy, should be based upon the best available scientific data. The report that women metabolize alcohol differently than men and that a smaller amount (compared with men) produces a higher blood level only emphasizes the need to quantify the risk of drinking during pregnancy.1 Scientific information is needed to make the best possible clinical, public health, and public policy decisions. This paper reviews what is known about the risk of alcohol for the well nourished woman who drinks two or less alcoholic beverages (drinks) per day while pregnant. Our conclusion is that there is no measurable or documented risk from this level of drinking during pregnancy. Therefore, by urging well nourished pregnant women to abstain from alcoholic beverages, we may be turning our attention away from negative health behaviors of far greater danger than consuming a glass of wine or its alcoholic equivalent.
FETAL ALCOHOL SYNDROME
Authors: Jones Kenneth L. , Alpert Joel J. , Zuckerman Barry
Published: December 2021

In the wake of recent government legislation mandating warning labels and of Michael Dorris' fine book, The Broken Cord,1 in which the pain and frustration experienced by the father of a child who has the fetal alcohol syndrome is documented, the American public is gaining much needed information regarding the deleterious effects of alcohol on the unborn baby. A review of the scientific evidence regarding this issue is, therefore, timely. Unfortunately, the review published in this issue of Pediatrics in Review is rather one-sided. A response to each of the points made by Alpert and Zuckerman is beyond the scope of this critique.