bluuebunny/crossref_metadata_2025 huggingface dataset:
THE CD40 LIGAND gp39, IS DEFECTIVE IN ACTIVATED T CELLS FROM PATIENTS WITH X-LINKED HYPER-IgM SYNDROME
Authors: Levy Arden , Liu Andrew
Published: December 2021

Purpose of the Studies. Hyper-IgM immunodeficiency is characterized by recurrent bacterial infections, normal or elevated IgM, and markedly decreased IgG, IgA, and IgE. Previous research suggested that the T cells of these patients are defective in their ability to help B cells make functional antibody. CD40 ligand (CD4OL) is a membrane glycoprotein on activated T helper cells and binds the CD40 molecule expressed on B cells, and induces proliferation and immunoglobulin class switching (in conjunction with IL-4). The gene for the CD4OL has been mapped to position q26.3-q27.1 on chromosome X (same as the Hyper-IgM gene and the area of isotype switching). Several research groups sought to determine if the immunodeficiency in Hyper-IgM patients is due to defective CD4OL.

Findings. The five papers listed above document the work of different research groups that simultaneously found abnormalities in the CD4OL gene in a total of 16 patients with X-linked Hyper-IgM syndrome. Different mutations of the CD4OL gene have been discovered, including point mutations, deletions, and nonsense sequences. Mutant version of CD4OL taken from Hyper IgM patients were unable to "help" B cells in vitro. Thus, deficient CD40/CD40L interactions between B and T cells results in severely impaired immunity. Restricted CD40L gene expression to T cells may ultimately allow gene therapy as treatment.

Reviewers' Comments. A concise editorial by Jean Marx entitled "Cell Communication Failure Leads to Immune Disorder" describes this landmark research and accompanies the Spriggs article in the February 12th issue of Science (pp. 896-897). This discovery may not only lead to treatment of this disorder, but also modification of other less favorable immune responses.
The Role of the Primary Care Physician in the Care of Children with Serious Heart Disease
Authors: Young Paul C. , Shyr Yu , Schork M. Anthony
Published: December 2021

Objective. To determine the roles of primary care physicians and specialists in the medical care of children with serious heart disease.

Setting. Pediatric Cardiology Division; Tertiary Care Children's Hospital.

Subjects. Convenience sample of parents, primary care physicians, and pediatric cardiologists of 92 children with serious heart disease.

Design. Questionnaire study; questionnaires based on 16 medical care needs, encompassing basic primary care services, care specific to the child's heart disease and general issues related to chronic illness.

Results. All children had a primary care physician (PCP), and both they and the parents (P) reported high utilization of PCP for basic primary care services. However, there was little involvement of PCP in providing care for virtually any aspect of the child's heart disease. Parents expressed a low level of confidence in the ability of PCP in general or their child's own PCP to meet many of their child's medical care needs. Both PCP and pediatric cardiologists (PC) were significantly more likely than parents to see a role for PCP in providing for care specific to the heart disease as well as more general issues related to chronic illness. PC and PCP generally agreed about the role PCP should play, although PC saw a bigger role for PCP in providing advice about the child's activity than PCP themselves did. PC were less likely to see the PCP as able to follow the child for long term complications than PCP did. PC were more likely than PCP to believe that PCP were too busy or were inadequately reimbursed to care for children with serious heart disease. Only about one-third of parents reported discussing psychosocial, family, economic, or genetic issues with any provider, and PCP were rarely involved in these aspects of chronic illness.

Conclusions. Primary care physicians do not take an active role in managing either the condition-specific or the more general aspects of this serious chronic childhood illness. With appropriate information and support from their specialist colleagues primary care physicians could provide much of the care for this group of children. Generalists and specialists are both responsible for educating and influencing parents about the role primary care physicians can play in caring for children with serious chronic illness.
Reference Values for Respiratory Rate in the First 3 Years of Life
Authors: Rusconi Franca , Castagneto Manuela , Porta Norberto , Gagliardi Luigi , Leo Gualtiero , Pellegatta Antonio , Razon Sultana , Braga Mario
Published: December 2021

Background. Raised respiratory rate is a useful sign to diagnose lower respiratory infections in childhood. However, the normal range for respiratory rate has not been defined in a proper, large sample.

Objective. To assess the respiratory rate in a large number of infants and young children in order to construct percentile curves by age; to determine the repeatability of the assessment using a stethoscope and compare it with observation.

Methods. Respiratory rate was recorded for 1 minute with a stethoscope in 618 infants and children, aged 15 days to 3 years old, without respiratory infections or any other severe disease when awake and calm and when asleep. In 50 subjects we compared respiratory rate taken 30 to 60 minutes apart to assess repeatability, and in 50 others we compared simultaneous counts obtained by stethoscope versus observation.

Results. Repeatability was good as the standard deviation of differences was 2.5 breaths/minute in awake and 1.7 breaths/minute in asleep children. Respiratory rate obtained with a stethoscope was systematically higher than that obtained by observation (mean difference 2.6 breaths/minute in awake and 1.8 breaths/minute in asleep children; P = .015 and P < .001, respectively). A decrease in respiratory rate with age was seen for both states, and it was faster in the first few months of life when also a greater dispersion of values was observed. A second degree polynomial curve accurately fitted the data. Reference percentile values were developed from these data.

Conclusions. The repeatability of respiratory rate measured with a stethoscope was good. Percentile curves would be particularly helpful in the first months of life when the decline in respiratory rate is very rapid and prevents to use cut off values for defining "normality."
DOCTORS CUSTOMERS
Authors: L. J. F.
Published: December 2021

Dr. Stephen Jones of Rockville, MD, calls me his patient. I like that word; it make me feel secure. Dr. Richard Selzer, the surgeon and writer, once told a Mayo Medical School graduating class that the word patient comes from the Latin pati, "to suffer," adding: "Doctors have patients. This is, above all, what distinguishes us from lawyers, who have clients . . . We have patients, and they suffer."

Clients suffer, too, at the hands of some lawyers, but the distinction is valid. In recent years, however, a dehumanizing note has crept into the medical language: patients have become health care consumers. Victor Cohen, the former Washington Post health columnist, was among the first to deride the trend toward calling doctors caregivers and healthcare [one word] producers; the new terms lump the MDs among less well-trained professionals.

The big word now is provider, which has taken care of caregiver.

Thanks to the info explosion, it's spreading. I used to be a writer. Now I'm a content provider. Don't laugh; it could happen to you.
Febrile Infants at Low Risk for Serious Bacterial Infection—An Appraisal of the Rochester Criteria and Implications for Management
Authors: Jaskiewicz Julie A. , McCarthy Carol A. , Richardson Amy C. , White Kathleen C. , Fisher Donna J. , Powell Keith R. , Dagan Ron ,   Febrile Infant Collaborative Study Groups
Published: December 2021

Objective. Prospective studies were conducted to test the hypothesis that infants unlikely to have serious bacterial infections (SBI) can be accurately identified by low risk criteria.

Methods. Febrile infants (rectal T ≥ 38°C) ≤60 days of age were considered at low risk for SBI if they met the following criteria: 1) appear well; 2) were previously healthy; 3) have no focal infection; 4) have WBC count 5.0-15.0 x 109 cells/L (5000-15 000/mm3), band form count≤ 1.5 x 109 cells/L (≤1500/mm3), ≤10 WBC per high power field on microscopic examination of spun urine sediment, and ≤5 WBC per high power field on microscopic examination of a stool smear (if diarrhea). The recommended evaluation included the culture of specimens of blood, cerebrospinal fluid, and urine for bacteria. Outcomes were determined. The negative predictive values of the low risk criteria for SBI and bacteremia were calculated.

Results. Of 1057 eligible infants, 931 were well appearing, and, of these, 437 met the remaining low risk criteria. Five low risk infants had SBI including two infants with bacteremia.

The negative predictive value of the low risk criteria was 98.9% (95% confidence interval, 97.2% to 99.6%) for SBI, and 99.5% (95% confidence interval, 98.2% to 99.9%) for bacteremia.

Conclusions. These data confirm the ability of the low risk criteria to identify infants unlikely to have SBI. Infants who meet the low risk criteria can be carefully observed without administering antimicrobial agents.
Circumcision Questions
Authors: Anderson Peter A. , Schwarz Robert D.
Published: December 2021

The article by Wiswell et al (Pediatrics 1993;92:791-793) on the circumcision rate of boys beyond the neonatal period reports findings that we do not find surprising: if less circumcisions are done on neonates, more will be done at a later age. One would presume that a similar study on the tonsifiectomy rate would show that because young children no longer undergo routine removal of this organ, the operation is now more commonly done in older children.
LIFETIME COST OF TREATING AIDS PATIENTS GOING DOWN
Authors: L. J. F.
Published: December 2021

The estimated cost of treating a person with the human immunodeficiency virus (HIV) from the time of infection until death is $119,000, but the cost is declining, according to a new study by the Agency for Health Care Policy and Research. Study author Fred J. Hellinger, Ph.D., director of AHCPR's Division of Cost and Financing, Center for General Health Services Extramural Research, used data from the AIDS Cost and Service Utilization Survey (ACSUS) to estimate the monthly cost of treatment for persons in various disease stages ...

The study projects that the average survival time of a person with AIDS (PWA) diagnosed in 1993 would be 25 months.
HEALTH REFORM CAN'T CURE HIGH COSTS
Authors: L. J. F.
Published: December 2021

These facts prove that, contrary to widespread belief, no health care system offers a magic cure for rising costs. Something else is going on.

The "something else" is that health care, like education and police work, is a "handicraft service." Characteristically, these activities can't be automated or sped up and made more productive. Doctors, for instance, simply cannot work much faster than they do without cutting into quality. True, technological advances can and do add some productivity to these fields, but not that much ...

This important phenomenon is called "the cost disease of the handicraft services" and it undermines a basic assumption of some health reforms. If, by its craft nature, health care is condemned to low productivity growth and rapidly rising costs, then these inherent limits will simply not be correctable by price controls or other reforms of the system. In other words, cost increases are in the nature of the health care beast. Efforts to alter this nature will be fruitless or harmful.
BRITAIN ESTABLISHES AN INFRASTRUCTURE FOR R&D IN HEALTH
Authors: Student
Published: December 2021

Britain's National Health Research & Development is a new departure; the first attempt by any country to establish a coherent R&D infrastructure to support the promotion of health and the provision of health care... [The program] will be able to ensure that practice reflects research-based knowledge and that new technologies in need of assessment do not find their way prematurely into routine use.
The Increased Rate of Stimulant Treatment for Hyperactive/Inattentive Students in Secondary Schools
Authors: Safer Daniel J. , Krager John M.
Published: December 2021

Objective. To describe trends in medication use for hyperactive/inattentive (HA/I) secondary school students from 1975 through 1993 and to present differences in the treatment of HA/I relative to school grade.

Design. A comprehensive survey of the HA/I treatment of public elementary and secondary school students has been conducted biennially by school nurses in Baltimore County, MD since 1975.

Results. Although only 11% of all public school students on medication for HA/I were in secondary schools in 1975, the proportion gradually rose such that in the 1990s, 30% of all medicated students were attending secondary schools. Also in secondary schools, the gender ratio for students on medication for HA/I narrowed from a 1:12 female/male ratio in 1981 to a 1:6 female/male ratio in 1993.

Conclusions. Many more elementary school students are now remaining on stimulant medication for HA/I into their teens. Compared with a decade ago, relatively more girls are on stimulant treatment for HA/I during their secondary school years.
Biological Rhythmicity in Normal infants During the First 3 Months of Life
Authors: Glotzbach Steven F. , Edgar Dale M. , Boeddiker Margaret , Ariagno Ronald L.
Published: December 2021

Objective. The mammalian "biological clock," which resides in the hypothalamic suprachiasmatic nucleus, has an important role in both the timing and organization of sleep and in the coordination of sleep with other physiological rhythms such as temperature regulation and respiratory control. We wished to describe the development of the circadian system in normal infants during the first 3 months of life.

Methods. Ten healthy full term infants were studied in the infant's home for three consecutive days at 1 month and 3 months postnatal age. Rectal temperature, abdominal skin temperature, heart rate, and activity were recorded at 2-minute intervals during each study using a small microcomputer.

Results. Circadian periodicity for most variables was seen at 1 month of age and significantly increased at 3 months. Differences in the pattern of rhythmicity during these two developmental periods were highlighted by an increase in activity during the subjective day and a decrease in Trecduring the subjective night at 3 months compared to 1 month. Correlational analysis revealed that all pairs of variables, exclusive of Tsk, showed a significantly higher association at 3 months relative to 1 month. The lengthening of the interfeeding interval at 3 months of age corresponded with an increased consolidation of sleep during the night and a relatively lower nocturnal body temperature minima compared to 1 month of age.

Conclusion. The results of this study underscore the subtle changes in the nature and interaction of several infant variables during this critical developmental period, which may reflect maturation of the circadian system and its coupling with homeostatic effector systems that are developing in parallel.
BRITAIN TO PROBE CLINIC THAT ALLOWS COUPLES TO CHOOSE INFANT'S GENDER
Authors: Hawthorne Stephanie
Published: December 2021

LONDON—The Health Department said yesterday it would investigate a private clinic that allows would-be parents to determine their baby's sex.

The London Gender Clinic, which opened on Thursday, charges couples $980 to use a technique that isolates the sperm that produce the desired sex so it can then be implanted into the woman.
LONGITUDINAL RELATIONS BETWEEN TEMPERAMENT TRAITS AND BEHAVIORAL SYNDROMES IN MIDDLE CHILDHOOD
Authors: Rende Richard D.
Published: December 2021

Objective: This study tested Graham and Stevenson's 1987 hypothesis specifying links between EAS (emotionality-activity-sociability) temperament traits and behavioral syndromes of depression, hyperactivity, and delinquency in an unselected sample of 164 children in infancy and early childhood. Method: Mothers completed the Colorado Child Temperament Inventory. Each mother also used the Child Behavior Checklist (CBCL) to report on her child's behavior problems after the child's completion of first grade. Scores on three CBCL scales, anxiety/depression and attention problems, and delinquent behavior, were examined in relation to the EAS traits. Results: For boys, high emotionality in infancy and early childhood was associated with high scores on both the anxiety/depression and attention problem scales. For girls, both high emotionality and low sociability predicted high scores on the anxiety/depression scale. There were no associations between EAS traits and attention problems for girls. There was little evidence for links between EAS traits and delinquent behavior for either boys or girls. Conclusions: The results are discussed with respect to temperamental traits as risk factors for the emergence of behavior problems in childhood.
Women and the Invention of Well Child Care
Authors: Baker Jeffrey P.
Published: December 2021

Few rituals better capture the preventive ethos of pediatrics than does the well child examination. In the United States, 25 to 50% of all general pediatric office visits involve the supervision of routine health care. Yet the same cannot be said for many European countries. In Britain, pediatricians function primarily as hospital-based specialists, with general practitioners and public health nurses providing most preventive care and immunizations. Indeed, an American Academy of Pediatrics (AAP) study of several European countries and Canada in 1990 noted that only a minority of the nations surveyed relied principally on pediatricians for primary care. In the European paradigm, preventive and therapeutic services are frequently administered in separate spheres.
APGAR STAMP
Authors: Butterfield L. J.
Published: December 2021

On Monday, October 24, 1994 at 2:00 PM, a definitive stamp will be dedicated to Dr Virginia Apgar at the American Academy of Pediatrics (AAP) annual meeting in Dallas. A definitive stamp lasts for years while the commemorative stamp is printed just one year.

The United States Postal Service announced the 1994 stamp program on December 7, 1993 during a press conference at the National Postal Museum.

Dr Apgar was nominated for a stamp in 1987 by the AAP. The initiative was spawned by the Perinatal Section at the 1985 annual meeting of the AAP in San Antonio.
Aspartame and Attention Deficit Disorder (ADD)
Authors: SHAYWITZ BENNETT A.
Published: December 2021

Dr Krohn sets up a straw man by criticizing our study for not being a screening study to detect individual "responders" to aspartame. This argument rests on Bernard Weiss' (Dr Krohn's reference 5) conclusion that statistical analysis of means failed to identify "responders" in studies designed to test the Feingold hypothesis. The generally accepted sequel to that story is that Weiss' conclusion (that there is an identifiable group of responders to color additives) is a Type I error (ie, a false positive)! In any event, Dr Weiss' conclusion is not supported by the data cited. The only way to avoid such an error is a blinded clinical evaluation of each child using all available data.
Violence Prevention: A Call to Action
Authors: Spivak Howard
Published: December 2021

The Landscape Of Children's Health Issues Is Changing. While This Is Obvious To Most Pediatricians, Few Would Have Predicted, Even A Decade Ago, The Prominence Of Violence And Violent Injuries In The Present Landscape Facing Children And Youth. What Was Once Seen And Addressed As A Problem Confined To Certain Populations, Particularly Poor And Minority Youth, Is Now Increasingly Visible Throughout The Nation, Crossing All Socioeconomic Boundaries, Affecting Rural, Suburban, And Urban Communities. In Just A Few Years, If Current Trends Continue, Guns Will Kill More Us Children And Youth Than Automobiles.1 Pediatricians And Other Health Professionals Concerned About Children Must Face This Issue Head-On And Must Participate In Efforts To Turn The Tide On Violence And Its Effects On Children. The Key Is To Better Understand The Underlying Risks And Contributing Factors Surrounding This Growing Epidemic And To Clearly Define Our Role, As Individual Pediatricians And At The Professional Organizational Level, In Working To Reduce Those Risks.

The Papers Contained In This Supplement Present A Broad Overview Of Some Of The Key Factors Related To Violence As Well As An Overview Of What Is Known About The Responses To These Factors. Four Of The Papers Specifically Focus On How Violent Behavior Is Learned By And Reinforced In Children At Home,2,3 In The Community,4 And Through The Media.5 One Paper Takes A Look At The Role Of Firearms, Particular Hand-Guns, In This Epidemic.6 The Last Three Papers Describe And Review Strategies For Reduction Of Violence In The Community,7 In The Media,8 And Through Advocacy At The State And National Levels.9
WHOA! WAIT A MINUTE..
Authors: Student
Published: December 2021

A Massachusetts task force on organ transplantation...believes that such costly procedures should be made available only after the clinical, social, and economic consequences of introducing the procedure, including the cost-effectiveness, ethical implications, and long term effects on society, are studied and reviewed by a publicly accountable body.
FISH SWIM WHERE THE FOOD IS
Authors: Student
Published: December 2021

A scientist who is really exploring the unknown has no idea where the research is going. That makes it difficult to predict. . .But, on the other hand scientists who are actually exploring the unknown are very rare. Most prefer to take whatever mission the NIH proposes and write their grants accordingly.

Dr. Ponzy Lu, Biochemist. Quoted in: Kolata G. Scientists fluff the answer to a billion-dollar question. The New York Times. November 1, 1992.
ARE YOU BETTER OFF NOW THAN YOU WERE IN 1983?
Authors: Student
Published: December 2021

Three groups whose incomes rose most in the years 1983-1991 were physicians (+43.6%), child care workers (+ 34.3%) and lawyers (+ 18.1%). Three groups whose income fell most were travel agents (-21.8%), economists(-11.0%) and machinists (-8.7%).
HEY! I UNDERSTAND PROBABILITY
Authors: Student
Published: December 2021

Everyone has an intuitive grasp of probability. Sometimes it's as primitive as that of the barber who revealed his lottery strategy to me: "The way I figure it, I can either win or lose, so I've got a 50-50 shot at it."
INTRODUCTION
Authors: Harvey Birt
Published: December 2021

One of the ongoing objectives of the Johnson & Johnson Pediatric Institute is to provide pediatricians with practical information on issues whose importance is just becoming clear, issues that may not yet be adequately addressed in the usual pediatric reference sources. The prevention of violent behavior in children is one such issue. Recognizing that violent behavior has become part of the "new morbidity," that violence in adulthood may have its genesis in childhood, and that pediatricians can play an important role in preventing children from using violence, the Institute's board of trustees elected to explore the possibility of a conference on this topic. A group of experts—Jerome Hirschfeld, Howard Spivak, Don Schwarz, and Modena Wilson—was asked to advise the board of trustees on what general and specific content should be included in such a conference, which experts to invite for each subject, and how best to format a conference. Pleased with the suggestions of this group, who became a planning committee, the board agreed to support a conference that would offer recommendations for physician actions on both an individual and an organizational level.

The planning committee believed that the conference should focus on one of the things that pediatricians do best—prevention—and that it should be limited to primary prevention because of time considerations. Thus, the focus was on providing information that would help pediatricians in preventing violent behavior among all the children they care for, not only those children in families that may be at risk. These efforts would be in contrast to the secondary prevention efforts that would occur after a child has already been involved in violent activity or the tertiary efforts that might include special school or community programs or rehabilitative efforts for chronic violent offenders.
THE VIABILITY LIMIT OF GESTATION FOR THE FETUS AND PREMATURE NEONATES—THE EFFECT OF THE RECENT AMENDMENT OF EUGENIC PROTECTION ACT IN JAPAN
Authors: L. J. F.
Published: December 2021

The Eugenic Protection Act in Japan was amended in respect of the viability limit of gestation from 24 weeks to 22 weeks in 1991, because of the rapid progress of survival rate of extremely low birth weight infants in recent years. At Tokyo Women's Medical College, 112 out of 134 (84%) infants whose birth weight were less than 1,000 grams survived in the past 6 years. The effect of this amendment on perinatal and neonatal health care is discussed from medical, ethical and socioeconomic aspects. Viability is defined as not only "the ability to live" but also "the ability to grow and develop normally." The fundamental thought underlying ethics on viability of extremely premature infants are "recognition of continuity and discontinuity" and "human principle and life principle."
GROUP B STREP ASSOCIATION
Authors:   GROUP B STREP ASSOCIATION
Published: December 2021

Group B Strep Association is a nonprofit organization formed by a handful of parents whose babies were victims of GBS infections. Having experienced the pain and devastation of this illness, these parents sought the help of prominent researchers and physicians from all over the country. These doctors responded with great support and have joined together to act as the Medical Advisory Board for the organization. Together we hope to create public awareness of GBS disease, to bring about guidelines for testing and treatment of GBS, and to generate continuing support for vaccine research ...
PARENTAL REPORTS OF SEASONAL MOOD AND BEHAVIOR CHANGES IN CHILDREN
Authors: Carskadon Mary A. , Acebo Christine
Published: December 2021

Objective: The chief purpose of this study was to investigate the nature and prevalence of children's seasonal symptoms. Method: Parental reports of seasonal changes in six mood or behavioral symptoms (sleeping, eating, irritability, energy, withdrawal, and sadness) were surveyed for children living across the United States. The sample included 892 girls (mean age = 10.5 ± 1.0 years) and 788 boys (mean age = 10.6 ± 0.9 years), with a response rate of 46% for girls' parents and 39% for boys' parents. Results: At least one winter recurring symptom was reported in 48.5% of children, as compared with 91% in fall and 10.8% in spring. Winter symptoms were reported equally in girls and boys with one exception ("is tired"); age effects were found for three symptoms only in girls ("sleeps more," "is tired," and "withdraws"). Regional effects showed more winter symptoms reports in northern zones than in southern zones. Conclusions: Given the potential therapeutic benefit of light therapy in children with seasonal patterns, careful assessment of seasonality is merited for children with winter mood and behavior problems.
Patterns of Haemophilus influenzae type b Invasive Disease in New York State, 1987 to 1991: The Role of Vaccination Requirements for Day-Care Attendance
Authors: Schulte Elaine E. , Birkhead Guthrie S. , Kondracki Stan F. , Morse Dale L.
Published: December 2021

Haemophilus influenzae type b (Hib) is the most common cause of bacterial meningitis in young children and is a major cause of other invasive bacterial disease.1 The case fatality rate for Hib meningitis is 1.0% to 3.4%.2,3 Also, 14% of meningitis cases result in persisting neurologic sequelae and 10% to 11% result in sensorineural hearing loss.4,5 With the introduction of Hib vaccines in 1985, what was once a potentially devastating disease is now preventable by vaccination.6

The risk of Hib in day-care centers (DCCs) is highest for younger children (≤23 months of age), during the first month of enrollment in day care, and for those children who attend larger day-care centers as opposed to home day-care settings.7 The incidence of Hib disease is higher for blacks, Hispanics, native Alaskans, American Indians, and children of lower socioeconomic status.8 Increasing enrollment in licensed DCCs throughout the country has provided an opportunity, through entrance requirements, to ensure that these children receive public health preventive measures such as vaccinations. Most states have laws requiring certain vaccinations before entry into DCCs; however, many states do not have a specific DCC entry requirement for Hib vaccination.9

The purposes of this article are to examine patterns of Hib incidence in New York State by gender, race, and age and to evaluate Hib disease within the DCC setting in New York State in relation to changing Hib vaccine requirements for DCCs.

METHODS

We conducted a retrospective study of invasive Hib disease in New York State outside New York City.
A Community-Health Approach for Infection Control in Day-Care Centers
Authors: Soto Julio C. , Guy Micheline , Deshaies Doris , Durand Louise , Gratton Jean , Belanger Lise
Published: December 2021

The incidence of infectious diseases can be significantly reduced in day-care centers through health education and public health interventions. Active participation of a center's staff and children are the key element of the success.
Molecular Epidemiology of Enteric Adenovirus Outbreaks in Houston Day-Care Centers
Authors: Van Rory , Pickering Larry K. , Matson David O. , Estes Mary K.
Published: December 2021

EAd is an important cause of outbreaks of diarrhea among young children attending DCCs. EAd 41 was the serotype identified. DNA restriction analysis of cultivated EAds proved to be an effective way of differentiating EAd serotypes.
Group A Streptococcus Carriage in an Alabama Child-Care Center Following a Fatal Invasive Case
Authors: Engelgau Michael M. , Horan John M. , Woernle Charles H. , Schwartz Banjamin , Facklam Richard R. , Vance Norma J.
Published: December 2021

Carriage of the GAS strain was common and widespread following a single fatal case of invasive GAS disease at the child-care center. Risk factors for GAS T-1 carriage did not identify all carriers. Our findings suggest that widespread culturing is needed to identify all potential carriers. The role of prophylactic antibiotic administration in preventing secondary cases could not be determined.
Injuries in Swedish Day-Care Centers
Authors: Sellström Eva , Bremberg Sven , Chang Albert
Published: December 2021

In the developed countries, an increasing number of children are enrolled in day-care centers. When parents leave their child in a day-care center they expect high standards of health and safety. Accidental injuries are a major threat in this age group. In a comparable institution that serves children, the school, the risk of injury is higher than in the home environment.1-2 Thus, safety in day-care centers cannot be taken for granted. A few studies of injuries in day-care centers have been reported, from the Nordic countries2,3-5 and from the US.6-10 Most of these studies, however, have been small and most lack information on time of exposure.

Information about the risk of injury in Swedish day-care centers might be of interest as enrollment has been high for a long time. In Sweden, within the frame of a national injury program,11 a number of local hospital- and health center-based injury report systems have been set up. All have a basic common coding. These systems enable compilation of injuries in day-care centers on a national basis.

The aim of our study was to analyze child injuries in day-care centers as reported in 10 local injury registry systems in Sweden regarding incidence, type, and mechanism of injury.

METHOD

Data were compiled from 10 local injury registry systems, covering 1- to 2-year periods. The earliest registers were from the years 1983 to 1984 and the latest from 1991. These systems were set up in all medical institutions at a predefined level, covering all individuals in a total or a part of a county.
Child Care for Children With Special Needs
Authors: Cohen Herbert J.
Published: December 2021

During the 1990s, requirements for child care for children with special needs will increase substantially. Parents of children with special needs face particular challenges in finding suitable child care for their children.

A major factor influencing future directions in child care for children with special needs is PL 99-457, the Early Intervention Amendments to the Education for All Handicapped Children Act.1 The component for 0- to 3-year-olds is Part H of the Individuals with Disabilities Education Act (IDEA).2 Almost all states have indicated their intent to provide early intervention services for children with disabilities and developmental delays. As each state moves toward implementation of its plan for 0- to 3-year-olds, federal fiscal incentives to expand such services will grow. The IDEA encourages integrated or inclusionary services for children with disabilities, as does the Americans with Disabilities Act (ADA).3 As a result of this stream of legislation, there will be growing pressure to serve children with special needs in generic child-care settings. Less certain is whether children with identifiable biological or social risks will have a similar entitlement under Part H, because only 10 states have, thus far, included an "at risk" group in their legislative mandate for early intervention.

WHO ARE CHILDREN WITH SPECIAL NEEDS AND HOW MANY ARE THERE?

The Technical Panel on Children with Special Needs of the American Public Health Association's and American Academy of Pediatrics' (APHA/AAP) National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs4 defined the population with special needs as those children with developmental disabilities, mental retardation, emotional disturbance, and chronic illness, as well as those with sensory or motor impairments.
Interagency Coordination: The Key to Mainstreaming Children With Special Needs into Day Care
Authors: Riley Ann L.
Published: December 2021

While the need for mainstreamed day-care services continues to increase, many barriers remain that prevent or delay providers from enrolling children with special needs. The suggestions in this article to coordinate local resources will help programs begin to provide initial necessary services to children with special needs. The use of volunteers will help supplement the staffing needs of a day-care center and allow for more individualized care of the children. Unfortunately, the absence of public funds for child day care continues to be a major barrier to creating appropriate programs for children with special needs. State and federal policies need to be expanded to support day care in general and children with special needs specifically. Part H of PL 99-457 (now Part H of IDEA PL102-119) is a national impetus to promote interagency collaboration at state and local levels. This is a beginning, but more state and federal funding is needed. In addition, regulations need to be developed that will make it easier rather than more difficult for local agencies to participate. Day-care providers and professionals in every community must work together to provide appropriate services to children with special needs. The most effective services use interdisciplinary teams to work together to plan and implement the care. Let us pick up the challenge of this mandate and develop programs that will help future generations recognize and accept the differences between individuals as well as see the similarities.
Effects of Child Care on Psychological Development: Issues and Future Directions for Research
Authors: Friedman Sarah L. , Brooks-Gunn Jeanne , Vandell Deborah , Weinraub Marsha
Published: December 2021

Research about the effects of child care on the psychological development of children has been stimulated by social reality. Industrialized societies, including the US, have witnessed two simultaneous social trends: an increase in the number of mothers in the work force and a decrease in the age at which children enter child-care arrangements.1-3 These trends, in conjunction with cultural beliefs, psychological theories, and research findings emphasizing the important role of mothers in early child development,4-6 have motivated researchers to investigate the effects of maternal employment and of child care on the development of infants and older children.

Issues facing developmental psychologists who study child care and its effect on children's development are theoretical, methodological, and budgetary. The waves of psychological research about child care1 reflect changes in conceptual emphasis: Originally, it seemed sufficient to compare children reared in any child-care context with those reared by the mother as the primary care provider. As the results from these investigations were accumulating, investigators recognized a need to focus on variations in the quality of child-care arrangements and to relate these to children's psychological development. Because of issues of access to child-care arrangements, much of the research on quality of care that was generated pertained to center-based care. Most recently, investigators have turned their attention to the relationship between demographic characteristics of families and their choices of child-care arrangements for their children. Even though the research appeared in waves, they all continue to coexist and they all elaborate and enrich our knowledge. Investigators are now interested in weaving the earlier lines of research into a more comprehensive framework.
Occupational Health and Safety Issues in Child-Care Work
Authors: Swanson Naomi G. , Piotrkowski Chaya S. , Curbow Barbara , Graville Stacey , Kushnir Talma , Owen Bernice D.
Published: December 2021

Child-care work obviously contains a range of health and safety hazards for the care providers. We are only beginning to delineate these hazards, and determine their prevalence and seriousness in different types of child-care work. Only with the development of systematic information on health and safety hazards in child-care work can we formulate the most effective types of interventions to reduce on prevent these hazards. The need for such information may be crucial because of the potential link between the health of child-care workers and the health of the children in their care.
Child Day-Care Health: Themes, Issues, and Future Directions
Authors: Goodman Richard A. , Sacks Jeffrey J. , Aronson Susan S. , Addiss David G. , Kendrick Abbie Sharpiro , Osterholm Michael
Published: December 2021

The issues addressed in the concurrent sessions of the conference were worldwide in scope and importance. The knowledge base on infectious disease and injury in the child-care setting is increasing, but investigative work in these areas must continue to further define and reduce these risks. Current knowledge offers tools for both risk reduction and health promotion in group care. Effective implementation of this knowledge requires collaboration among disciplines and sectors of our society. We need intensified scientific study, creative development of pragmatic solutions, and a societal commitment to improving the quality of child care. The conference surfaced many interconnected issues and recommendations for how child care can help society "transmit civilization." The future health of our societies may depend on how well we use our opportunities to nurture children in child care.
AMERICAN ACADEMY OF PEDIATRICS
Authors:   Johnson & Johnson Consumer Products, Inc.
Published: December 2021

The American Academy of Pediatrics is requesting nominations for the 1995 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 dead-line is January 31, 1995.

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; 800/433-9016.
Comparison of Cefpodoxime Proxetil and Cefixime in the Treatment of Acute Otitis Media in Infants and Children
Authors: Asmar Basim I. , Dajani Adnan S. , Del Beccaro Mark A. , Mendelman Paul M. ,   Otitis Study Group
Published: December 2021

Objective. To compare the use of once-a-day cefpodoxime proxetil to once-a-day cefixime in the treatment of acute suppurative otitis media.

Design. Randomized, multicenter, investigator-blinded.

Setting. Outpatient.

Patients. A total of 368 patients (age 2 months to 17 years) were randomized to receive either cefpodoxime or cefixime in a 2:1 ratio (245 cefpodoxime, 123 cefixime); 236 patients (155 cefpodoxime, 81 cefixime) were evaluable for drug efficacy.

Interventions. Patients received either cefpodoxime proxetil oral suspension (10 mg/kg/day, once daily for 10 days) or cefixime oral suspension (8 mg/kg/day, once daily for 10 days).

Main outcome measures. Clinical evaluations were performed before treatment (study day 1), at an interim visit (study day 3 through 6), at the end of therapy (study day 12 through 15), and at final follow-up (study day 25 through 38). Microbiologic evaluations were performed at enrollment and whenever appropriate thereafter.

Results. End-of-therapy clinical cure rates in evaluable patients were 56% for the cefpodoxime group and 54% for the cefixime group. Clinical improvement rates were 27% for both groups. Clinical response rates were not significantly different between treatment groups (P = .541; 95% confidence interval = -8.1%, 15.2%). At long-term follow-up, 17% of patients in the cefpodoxime group and 20% in the cefixime group had a recurrence of infection. Drug-related adverse events (eg, diarrhea, diaper rash, vomiting, rash) occurred in 23.3% of cefpodoxime-treated patients and 17.9% of cefixime-treated patients (P = .282).

Conclusions. These findings suggest that cefpo-doxime proxetil administered once daily is as effective and safe as cefixime given once daily in the treatment of acute suppurative otitis media in pediatric patients.
A Classic Study of Infant Mortality—1911-1915
Authors: Yankauer Alfred
Published: December 2021

A New York Times editorial in 1925 began with these words: "The human cost of poverty might have been the title of a report recently issued by the Children's Bureau of the United States Department of Labor." The editorial concluded with the words: "It is unfortunate that reports of this sort receive so little distribution. "A thorough knowledge of the causes of infant mortality', it is well stated in the introduction, "is the first step toward their complete control.' "2

The editorial was referring to the remarkably thorough investigations of infant mortality in eight cities, the combined results of which were analyzed by Robert Morse Woodbury.3
NATIONAL MEDICAL AGREES TO SETTLEMENT OF FRAUD CHARGES TOTALING $380 MILLION
Authors: L. J. F.
Published: December 2021

"National Medical Enterprises, Inc detailed a broad settlement of fraud charges with the United States and 28 states involving payments of a record $380 million and federal guilty pleas on eight criminal counts by two of its units."

"The settlement total is more than three times the previous largest health-care-fraud payment, $111.4 million by National Health Laboratories, Inc in 1992. It is higher even than the nearly $300 million the government has recovered from ten defense contractors in its Ill Wind probe, the huge Pentagon fraud investigation that ended early this year."
The Future of Clinical Experimentation in Neonatal Medicine
Authors: Silverman William A.
Published: December 2021

In an address to the British Neonatal Society, in 1993,1 Ola Saugstad spoke about the future of neonatal research; and he referred to Karl Popper's views concerning the limitations of inductive reasoning when trying to prove cause and effect in medicine. Saugstad's words remind me how hard it has been to give up the conventional notion about the nature of scientific proof. Even at this late date many in our profession still believe that a statement is scientific, if it can be verified by objective observation, and that the truth of statements about natural events can be proven by repeated verifications.
Acquired Rectovaginal Fistula in Human Immunodeficiency Virus-Positive Children
Authors: Hyde George A. , Sarbah Steedman
Published: December 2021

In 1990, at Harare Central Hospital, an unusual finding of acute acquired rectovaginal fistula, principally in young infants, was noted. These infants had a normal anorectal canal and most had a history of passing stool through the vagina for 1 to 2 months.

PRESENTATION

The first infant was seen in 1990 and both mother and child had evidence of acquired immunodeficiency syndrome (AIDS). Since then 17 girls have been admitted to the Pediatric Surgical Service with the same complaint, but no other mother has had obvious AIDS. All but one infant, who died of clinical AIDS before a test was obtained, were human immunodeficiency virus (HIV)-positive as determined by an enzyme-linked immunosorbent assay (ELISA) test.
Unilateral Choanal Atresia Masquerading as Chronic Sinusitis
Authors: Rothman Glenn , Wood Robert A. , Naclerio Robert M.
Published: December 2021

Choanal atresia is a congenital anomaly usually diagnosed at birth. This case involves bilateral choanal atresia in a newborn with respiratory difficulties in whom there is an inability to pass a #8 French catheter through the nose. In contrast, unilateral choanal atresia causes a variable degree of nasal obstruction that may delay the diagnosis. We report a case of unilateral choanal atresia in a 9-year-old boy diagnosed as having chronic sinusitis with allergic rhinitus. Initial interpretation of a computerized, tomographic (CT) examination confirmed the diagnosis of chronic sinusitis. The definitive diagnosis, however, was made by endoscopic evaluation. A review is presented of the epidemiology, clinical presentation, differential diagnosis, and contemporary surgical management for unilateral choanal atresia.
Universal Screening for Infant Hearing Impairment
Authors: Nierenberg David
Published: December 2021

In their article in the February issue of Pediatrics, Bess and Paradise perform a useful public service by highlighting the problems inherent in using otoacoustic emissions (OAE) technology to screen infants before hospital discharge.

The problem I have with the authors' analysis, however, is that their disappointments with a specific modality should not lead them to dismiss screening altogether. They apparently have not tested other competing modalities that do not suffer from the problems that make OAE inaccurate and noneconomic.
Letter to the Editor
Authors: Northern Jerry L.
Published: December 2021

In their recent commentary Bess and Paradise1 impugn the recommendations of the National Institutes of Health (NIH) Consensus Development Conference on Early Identification of Hearing Impairment in Infants and Young Children (March 1-3, 1993) for universal infant hearing screening. Bess and Paradise challenge the validity and predictive value of the recommended two-sequence screening procedure, evoked otoacoustic emissions (EOAE), and auditory brainstem response (ABR). Although they confirm that EOAE and ABR testing is highly sensitive, they contend that the specificity and positive predictive value of these procedures are problematic.