bluuebunny/crossref_metadata_2025 huggingface dataset:
Are Children at Risk for Sexual Abuse by Homosexuals?
Authors: Jenny Carole , Roesler Thomas A. , Poyer Kimberly L.
Published: December 2021

Objective. To determine if recognizably homosexual adults are frequently accused of the sexual molestation of children.

Design. Chart review of medical records of children evaluated for sexual abuse.

Setting. Child sexual abuse clinic at a regional children's hospital.

Patients. Patients were 352 children (276 girls and 76 boys) referred to a subspecialty clinic for the evaluation of suspected child sexual abuse. Mean age was 6.1 years (range, 7 months to 17 years).

Data collected. Charts were reviewed to determine the relationships of the children to the alleged offender, the sex of the offender, and whether or not the alleged offender was reported to be gay, lesbian, or bisexual.

Results. Abuse was ruled out in 35 cases. Seventy-four children were allegedly abused by other children and teenagers less than 18 years old. In 9 cases, an offender could not be identified. In the remaining 269 cases, two offenders were identified as being gay or lesbian. In 82% of cases (222/269), the alleged offender was a heterosexual partner of a close relative of the child. Using the data from our study, the 95% confidence limits, of the risk children would identify recognizably homosexual adults as the potential abuser, are from 0% to 3.1%. These limits are within current estimates of the prevalence of homosexuality in the general community.

Conclusions. The children in the group studied were unlikely to have been molested by identifiably gay or lesbian people.
Goat's Milk as a Substitute for Cow's Milk in Undernourished Children: A Randomized Double-Blind Clinical Trial
Authors: Razafindrakoto Odile , Ravelomanana Noéline , Rasolofo A. , Rakotoarimanana Roland D. , Gourgue Pierre , Coquin Pierre , Briend André , Desjeux Jehan-François
Published: December 2021

Objective. This paper compares the effects of goat's milk and cow's milk on weight gain and fat absorption, in children with overt malnutrition.

Methods. Thirty hospitalized malnourished children aged from 1 to 5 years were included in a randomized double-blind trial. The children were fed either goat or cow's milk with a randomized will defined composition, added with vegetable oil, sugar, vitamins and minerals o achieve 1 000 kcal/liter. Children were offered 100 kcal/kg on the first day, with a regular daily increase in energy intake thereafter that reached 200 kcal/kg per day on the tenth day.

Results. Both groups of children had the same degree of malnutrition on inclusion. The mean weight-for-height Z score was -1.7 in both groups. One death with candidiasis occurred in the goat's milk group. Weight gain was similar in both groups: 8.5 g/kg/day (SE = 137) with goat's milk and 7.8 (SE = 1.9) with cow's milk. There was no significant difference in HEM intake: 157 ml/kg/day (SE = 4), vs 162 (SE = 4) for goat and cow's milk, respectively. Fat absorption coefficients on the 15th day of treatment were also similar in both groups.

Conclusion. These results suggest that goat's milk has a nutritional value similar to that of cow's milk and could be used as an alternative to cow's milk for rehabilitating undernourished children.
INFANT DEATH RATE DROPS WHILE RACE GAP WORSENS
Authors: L. J. F.
Published: December 2021

ATLANTA—The U.S. infant mortality rate dropped to a record low, but black babies died at more than twice the rate of whites, and the gap is growing, health officials reported Thursday.

For every 1,000 births in 1990, 9.2 babies died before age 1, down from 9.8 in 1989, the Centers for Disease Control and Prevention said. It credited most of the drop to a new way of treating the underdeveloped lungs that kill thousands of premature and underweight babies.

The rate in 1990, the most recent year for which data are available, propelled the United States up two notches—to 20th place—in UNICEF's ranking of infant mortality in 23 developed countries. Japan has the world's best rate, 5 per 1,000.

Despite the new lung treatment, 38,351 babies died in 1990, down from 39,655 in 1989. The District of Columbia had by far the deadliest rate, 20.7. Vermont had the lowest rate, 5.4.

The mortality rate for black infants was 18, compared with 7.6 for whites, and the disparity is growing, the CDC said.

Low birthweight was the leading killer of black babies, while birth defects claimed more white babies.

Vt. is best

Infant mortality rates in 1990, from the Centers for Disease Control and Prevention. Numbers are per 1,000 live births:

• Connecticut, 7.9

• Maine, 6.2

• Massachusetts, 7.0

• New Hampshire, 7.1

• New York, 9.6

• Rhode Island, 8.1

• Vermont, 5.4, the nation's lowest rate

• United States, 9.2
EFFECTIVENESS OF ANTIBIOTIC NASAL SPRAYS IN THE TREATMENT OF SEVERE CHRONIC BACTERIAL SINUSITIS
Authors: Selcow Jay E.
Published: December 2021

The observations suggest that nasally inhaled antibiotics offer an alternative means of treating chronic bacterial sinusitis when used alone or in combination with oral antibiotics.
A 2- TO 3-YEAR OUTCOME AFTER BRONCHIOLITIS
Authors: Ostrom Nancy
Published: December 2021

Purpose of the Study. To evaluate risk factors and short term outcome for subsequent wheezing in children with early bronchiolitis or pneumonia.

Study Population. One hundred twenty-seven children (0 to 2 years old) hospitalized for wheezing (83) or pneumonia in a 1-year period in two hospitals in Finland.

Methods. Patients with a history of hospitalization for wheezing with respiratory infection (including bronchiolitis) versus pneumonia were examined, and their parents were interviewed at 1 month, 1.5 to 2 years, and 2.5 to 3 years. Family history of atopy, environmental factors, breast feeding history, and other atopy (eczema, elevated IgE) were noted using a standardized questionnaire and physician-documented wheezing episodes were quantified. Statistical χ2 tests were analyzed comparing the wheezing group to the control group of patients with pneumonia not associated with wheezing.

Findings. There was no significant difference between the groups in bacterial versus viral etiology of their lower respiratory symptoms. Subsequent wheezing after bronchiolitis occurred in 76% of children 1-2 years of age and 58% of children at 2-3 years of age. This compares with 9% and 16% (respectively by age) of the group with "non-wheezing" pneumonia. Atopic diathesis, particularly a positive family history of asthma was the host factor best associated with initial wheezing. Parenthetically, parental smoking was found in 61% of the wheezing group and 45% of the pneumonia group.

Reviewer's Comments. This is a sound study, perhaps limited, in its comparability to our clinical populations with wider racial and socioeconomic diversity. Of note is the finding of no differences between the wheezing and nonwheezing groups in bacterial and viral etiologies.
Glutamate in Pyridoxine-Dependent Epilepsy: Neurotoxic Glutamate Concentration in the Cerebrospinal Fluid and Its Normalization by Pyridoxine
Authors: Baumeister Friedrich A. M. , Shin Yoon S. , Egger Joseph , Gsell Wieland
Published: December 2021

Background. Pyridoxine-dependent epilepsy is a rare autosomal recessive disorder. Untreated patients suffer from a progressive encephalopathy with mental retardation, intractable epilepsy, and progressive neurological signs and symptoms. Lifelong supplementation with vitamin B6 is the treatment of choice. However, despite early treatment, many patients develop mental retardation.

Objectives. To assess the role of glutamate as an excitatory neurotransmitter and neurotoxin in pyridoxine-dependent epilepsy.

Methods. We examined cerebrospinal fluid (CSF) levels of glutamate, γ-aminobutyric acid, and pyridoxal-5'-phosphate in a patient with pyridoxine dependency while on and off vitamin B6 treatment.

Results. Off vitamin B6 the glutamate level was two hundred times normal. An intermediate dose of vitamin B6 (5 mg/kg BW/day) caused normalization of the EEG and remission of the seizures, but the CSF glutamate concentration was still ten times normal. With a higher dose of pyridoxine (10 mg/kg BW/day) the CSF glutamic acid normalized.

Conclusions. The results indicate that control of epilepsy might not suffice as the therapeutic aim in treating of pyridoxine dependency. In view of the evidence for the role of excitatory amino acids in destruction of CNS nerve cells, the optimal treatment must counteract the raised levels of CSF glutamate and the dosage of vitamin B6 must be adjusted accordingly. The development of mental retardation might theoretically be prevented by adjusting the dose of vitamin B6 to achieve not only remission of epilepsy but also normalization of CSF glutamate.
PEDIATRIC NEUROLOGISTS E-MAIL/INTERNET
Authors: KJ Mack
Published: December 2021

An electronic mail mailing list has been created to aid communication between pediatric neurologists. Any child neurologist or neurologist with connections to the Internet, or a private on-line service can subscribe. The mailserver serves as a forum for discussion of topics in child neurology. Topics include problem patients, therapeutic approaches to clinical problems, and discussions of recent journal articles. In addition, we hope that individual case reports may evolve into series of patients by pooling similar patients from separate institutions. Cases, questions, comments, etc. e-mailed to the mailserver are automatically forwarded to everyone on the list. Responses can either be private (to the initial sender or any other member) or public (to everyone on the list). The CHILD-NEURO mailserver is run out of the University of Wisconsin, and the service is free-of-charge. To sign up, send an e-mail message from the address you will be using to: MAILSERV@WAISMAN.WISC.EDU with no subject and SUBSCRIBE CHILDNEURO as the entire message. A welcoming message with instructions on the use of the mailserver will be sent to new subscribers. Please e-mail or phone Dr. Ken Mack (Mack@waisman.wisc.edu; 608-263-9086) or Dr. Steve Leber (Leber@umich.edu) for more information, or if difficulties arise in subscribing to the list.
DATA SHOW PITFALLS IN CHILD TESTIMONY
Authors: L. J. F.
Published: December 2021

Use of Dolls Criticized

"The experts are correct about whether the child's account is accurate about one-third of the time," Dr. Ceci said. "That's worse than chance."

Anatomically detailed dolls, which are often used in investigations of child abuse, have also been called into question by recent research findings. At the University of Chicago meeting, Dr. Ceci and his colleagues reported preliminary results from a study in which they questioned 3-year-olds who had just been given a physical examination. Half the exams included a standard inspection of the child's genitals, half did not. Of those children who received no genital exam, 38 percent answered, "yes," when a researcher pointed to the doll's genitals and asked, "Did he touch you here?"

When the question was posed in a leading fashion, using the child's own word for genitals, 70 percent of children who had received no genital exam indicated incorrectly that the doctor had touched their genitals ...

Dr. Ceci and Dr. Bruck, in an article to appear in the fall in a report by the Society for Research in Child Development, recommend that people investigating possible cases of child abuse change their procedures, for example, by avoiding repeated suggestions or putting much emphasis on evidence from anatomical dolls.
In Reply: Omphalocele in Down Syndrome
Authors: AUGHTON DAVID J. , REDDY VINAY N. , DEWITTE DAVID B. , HARPER CHERYL E. , LORENZ ROBERT P.
Published: December 2021

We thank Dr Karamanoukian and Dr Glick for their thoughtful comments concerning our report. We could not more earnestly support Dr Karamanoukian's and Dr Glick's call for a multidisciplinary approach to the management of a pregnancy in which a fetal anomaly has been identified; indeed, our institution has followed the multidisciplinary team counseling model for many years, and we are absolutely convinced of the value of this approach. Had our patient's omphalocele been detected prenatally, the parents would most certainly have been counseled in precisely the manner advocated by Dr Karamanoukian and Dr Glick; we have found the multidisciplinary approach to be remarkably effective and beneficial.
Urinary Oxalate Excretion in Premature Infants: Effect of Human Milk Versus Formula Feeding
Authors: Campfield Thomas , Braden Gregory , Flynn-Valone Patrecia , Clark Nathaniel
Published: December 2021

Objective. To study urinary oxalate excretion in infants fed human milk versus formula, and to compare urinary calcium oxalate and calcium phosphate saturation in premature infants with term infants and adults.

Methodology. We measured urinary oxalate-to-creatinine ratio and urinary oxalate concentration in 15 premature infants fed human milk compared to 16 formula-fed premature infants, and in eight human milk-fed term infants compared to 17 formula-fed term infants. We then studied urinary calcium oxalate and calcium phosphate saturations based on our observations of elevated urinary oxalate excretion in premature infants. Urinary calcium oxalate and calcium phosphate saturations were calculated from urinary concentrations of oxalate, calcium, sodium, potassium, chloride, uric acid, magnesium, phosphorus, and urinary pH. We calculated urinary calcium oxalate and calcium phosphate saturations in nine healthy adults and nine formula-fed term infants to establish control values for urinary saturation. Urinary calcium oxalate and calcium phosphate saturations were determined in nine premature infants receiving a glucose and electrolyte solution, 11 premature infants receiving parenteral nutrition, nine formula-fed premature infants, and 11 human milk-fed premature infants.

Results. Urinary oxalate excretion was higher in formula-fed compared to human milk-fed premature infants whether expressed as oxalate-to-creatinine ratio (0.32 ± 0.04 versus 0.18 ± 0.03, P < .01) or urinary oxalate concentration (0.047 ± 0.007 versus 0.022 ± 0.002 mg/mL, P < .01). Urinary oxalate excretion was higher in formula-fed term infants than in human milk-fed term infants whether expressed as oxalate-to-creatinine ratio (0.14 ± 0.01 versus 0.07 ± 0.01, P < .01) or urinary oxalate concentration (0.022 ± 0.002 versus 0.012 ± 0.002 mg/mL, P < .01). The urinary calcium oxalate saturation in healthy adults was 2.84 ± 0.79; the value in formula-fed term infants was 2.12 ± 0.31. The urinary calcium oxalate saturation was significantly higher in premature infants receiving formula (15.68 ± 3.15), human milk (15.02 ± 2.27), or parenteral nutrition (11.38 ± 2.56) compared to adults or term infants (P < .01). Urinary calcium oxalate saturation in premature infants receiving a glucose and electrolyte solution (2.45 ± 0.36) was not significantly different from that in adults or term infants. In contrast, urinary calcium phosphate saturation in premature infants as well as term infants and adults was less than 1; precipitation of calcium phosphate is not likely to occur under these conditions.

Conclusion. Formula-fed infants have higher urinary oxalate excretion than human milk-fed infants. Premature infants receiving standard nutritional regimens may have urinary calcium oxalate saturation levels at which dissolved calcium oxalate may form nuclei of its solid phase.
Cost and Quality in Child Care
Authors: Taylor William R. , Galinsky Ellen , Helburne Suzanne , Culkin Mary
Published: December 2021

Over the last 20 to 30 years, an increased proportion of mothers are participating in the labor force and an increased number of preschool children are placed in nonfamilial care, primarily because less care is given now by relatives.1 In 1990, 43% of children age 3 years and over were enrolled in child-care centers and 17% in family child care, while 16% were cared for by relatives.

Responding to this demand, the supply of child care has increased. By 1990, 80 000 unregulated child-care centers served between 4 million and 5.1 million children; 118 000 regulated child-care centers served 700 000 children; and 685 000 to 1.2 million nonregulated homes cared for 3.4 million children.2,3 However, access to child-care services is still limited. Fewer than 10% of centers have vacancies for infants, and parents spend 5 weeks on average to locate child-care services for their children.

With these striking changes in demand and supply and with continued shortages, it is remarkable that the cost of child care and the salaries of teachers have remained constant during the last 15 years. The average yearly salary for teachers was $11 500 in 1990.2 Although low teacher salaries subsidize the cost of child care, the average annual cost of child care is $3150, or 10% of average family income.1 For lower-income families (incomes under $15 000), this expense represents as much as 23% of their family income.

These low salaries for child-care-center teachers surely influence the quality of services. Annually, 25% of child-care-teachers turn over, and the rate of turnover is 50% in half the centers in the country.2
A Comparison of Child Day-Care Settings in Four Countries
Authors: Malkki Rita M. , Chen Jianhua , Honegger Danielle , Simonnet Catharine , Kushnir Talma , Soto Julio
Published: December 2021

A surprisingly wide variety of child day-care systems exist throughout the world, and each system has its own particular purposes, benefits, and drawbacks. In some countries, child day care is viewed as an integral part of the public education process; in others it serves primarily to provide working parents a safe haven for their children during work hours. The issue of health and health care in the day-care setting is also viewed in a number of ways, from the Chinese view that health care should be built into the daily routine of child day care to the American approach of placing that responsibility primarily on the parent. This paper explores the day-care settings found in four countries.

Both child care and health services are determined by a number of different influences in the cultural, social, and historical background of a given country. The economic situation and overall societal values combine to produce a child day-care system that at least attempts to respond to the needs of the majority of that society. Furthermore, the economic trends of the last two decades have had an even greater impact on day care than could have been imagined at the outset. Even in countries where the extended family is still a strong force in the care and rearing of children, the need for additional assistance has increased. A look at the systems in China, Israel, France, and Canada will identify a range of approaches to dealing with this issue.

Child day care is largely a public undertaking in most countries, often with a smaller, private system operating independently under government regulations.
Desmopressin Tablets in the Treatment of Severe Nocturnal Enuresis in Adolescents
Authors: Stenberg Arne , Läckgren Göran
Published: December 2021

Background. In recent years the treatment of primary nocturnal enuresis (PNE) with desmopressin (DDAVP) has been promising. The route of administration until now had been intranasal, but because the tablets were introduced for the treatment of diabetes insipidus they have also become available for the treatment of PNE.

Objectives. To find the optimal dosage of desmopressin tablets and to compare desmopressin's efficacy with placebo in a group of adolescents with severe monosymptomatic enuresis. The long-term safety of desmopressin was also studied in the same group of patients.

Methods. The effect of oral desmopressin (1-deamino-8-D-arginine-vasopressin) (DDAVP® tablets, Minirin®) was investigated in 25 adolescents (ages 11 to 21 years) with severe monosymptomatic nocturnal enuresis. The first part of the dose-ranging study comprised a single-blind dose titration period, followed by a double-blind, crossover efficacy period comparing desmopressin with placebo. The final part was an open long-term study consisting of two 12-week treatment periods. The efficacy of the drug was measured in reductions of the number of wet nights per week.

Results. During the first dose-titration period, the majority of the patients were given desmopressin 400 µg, and the number of wet nights decreased from a mean of 4.9 to 2.8. During the double-blind period, a significant reduction of wet nights was observed (1.8 vs 4.1 for placebo). During the two long-term periods, 48% and 53% of the patients could be classified as responders (0 to 1 wet night per week) and 22% and 23.5% as intermediate responders (2 to 3 wet nights per week). No weight gain was observed due to water retention. After cessation of the drug, 44% of the patients had a significant decrease in the number of wet nights.

Conclusions. Oral desmopressin has a clinically significant effect on patients with PNE, and therapy is safe when administered as long-term treatment.
Evidence in Infants With Cleft Palate That Breast Milk Protects Against Otitis Media
Authors: Paradise Jack L. , Elster Barbara A. , Tan Lingshi
Published: December 2021

Objective. Most infants with cleft palate suckle unproductively and require feeding by artificial means. Most also have unremitting otitis media accompanied by (usually) nonpurulent middle-ear effusion, a complication generally attributed to impaired eustachian tube ventilatory function. We observed two infants with cleft palate in whom one or both ears appeared effusionfree on more than one occasion, and who also were receiving or previously had received breast milk feedings. This prompted us to analyze the relation between middle-ear status and feeding mode in a large series of infants with cleft palate. Our objective was to determine whether in these infants the receipt of breast milk mitigated the otherwise virtually invariable development and continued presence of otitis media.

Methods. We reviewed and analyzed data concerning both feeding mode and the presence or absence of middle-ear effusion in 315 infants with cleft palate, as recorded systematically in the course of prospective studies at our Cleft Palate-Craniofacial Center. Analysis was limited to periods preceding the infants' receipt of tympanostomy-tube placement or palate repair, or their second birthday, whichever occurred first.

Results. Freedom from effusion in one or both ears was found at one or more visits in only seven (2.7%) of 261 infants fed cow's milk or soy formula exclusively, but in 17 (32%) of 54 infants fed breast milk exclusively or in part for varying periods (P < .0001). In virtually all instances, the breast milk had been harvested by the mother and fed to the infant via an artificial feeder. Baseline clinical and sociodemographic characteristics and surveillance in the two groups of infants were comparable.

Conclusions. Artificially fed breast milk provides variable protection against the development of otitis media in infants with cleft palate. This finding supports the likelihood of a similarly protective effect of breast milk in noncleft infants. The finding also suggests strongly that in infants with cleft palate, impaired eustachian tube function is not the only pathogenetic factor in the infants' initial development of middle-ear effusion.
Letter to the Editor
Authors: Raffin Michael J. M. , Matz Gregory J.
Published: December 2021

We thank Bess and Paradise, (1994)1 for bringing attention to some relevant issues related to universal newborn hearing screening. We note that their assertion that the effects of mild or moderate temporary hearing loss are "entirely speculative and perhaps nonexistent" may be somewhat overstated (see, for example, Teele, Klein, Chase, Menyuk, Rosner and associates, 1990).2

The assertion that click-evoked auditory brainstem response (ABR) may be used "... primarily to detect high-frequency hearing loss" is not warranted and misleading.
Letter to the Editor
Authors: Hayes Deborah
Published: December 2021

In March 1993, the Consensus Panel of the National Institutes of Health (NIH) Consensus Development Conference on Early Identification of Hearing Impairment in Infants and Young Children recommended universal infant hearing screening and reinforced the goal of early intervention for infants with hearing loss. In an editorial commentary, Bess and Paradise opposed the recommendation for universal infant hearing screening and disparaged the benefit and effectiveness of early intervention.1 I am concerned that pediatricians will underestimate the importance of childhood hearing loss and the effectiveness of early intervention.
Letter to the Editor
Authors: Richmond Virginia L.
Published: December 2021

The article by Jacobs et al1 regarding treatment of acute childhood diarrhea with homeopathic medicine as an adjunct to the World Health Organization Oral Rehydration Solution (ORS) omits some essential measurements needed for comparison with previous literature reports and pertinent references from the last 15 years.

The authors ignored the whole body of literature on rice- or cereal-based ORS (CB-ORS) that dealt with much larger patient samples and more precise measurements.2 These reports empha-sized the variability of results depending on the previous nutritional status of the child and whether adequate, nutritious diets were actually given the child on early refeeding.3
Disability and Perinatal Care
Authors: Johnson Ann
Published: December 2021

The declining infant mortality is carefully documented year by year in the Annual Summary of Vital Statistics in this journal.1 Although socioeconomic factors play an important role in this decline, the falling death rate among neonates weighing <1500 g at birth is widely attributed to changing patterns of neonatal intensive care. For neonates weighing 1000 g at birth, this assumption is probably correct. Thirty years ago, almost all these neonates died; now, over half survive to leave the neonatal unit and this proportion is as high as 70% in large tertiary centers.2 In terms of "rescue from death," neonatal intensive care can be described as a remarkably successful medical technology.
Fatal Hantavirus Pulmonary Syndrome in an Adolescent
Authors: Khan Ali S. , Ksiazek Thomas G. , Zaki Sherif R. , Nichol Stuart T. , Rollin Pierre E. , Peters Cj , Khabbaz Rima F. , Cheek James E. , Shireley Larry A. , McDonough Stephen L. , Welty Thomas K. , Kuklinski Diana
Published: December 2021

Hantavirus pulmonary syndrome (HPS) is a recently recognized viral zoonosis characterized by a febrile prodrome progressing to severe noncardiogenic pulmonary edema.1-4 This syndrome is caused by at least three newly described hantaviruses: the first, Sin Nombre virus, is the Southwestern hantavirus that caused an outbreak of respiratory failure during the summer of 1993; the second, Black Creek Canal virus, caused a case of HPS in Florida; and the third hantavirus was identified in lung tissue from a patient in Louisiana. Diagnosis is by enzyme-linked immunosorbent assay (ELISA) serology with elevated immunoglobulin M (IgM) titers against heterologous and homologous hantaviral antigens, positive immunohistochemistry on formalin-fixed tissue, or reverse transcriptase-polymerase chain reaction (RT-PCR) amplification of hantaviral nucleotide sequence from frozen tissue.
Sexuality, Contraception, and the Media
Authors:   Committee on Communications
Published: December 2021

The age at which American adolescents first experience sexual intercourse continues to decline. Approximately half of all American females and two-thirds of all males have experienced coitus by 17 years of age.1,2 For those who begin having intercourse before age 18, 45% of females report having had four or more partners,3 and males report having had an average of five partners.2 Most adolescent females report that their first experience was unplanned.4 More than 85% have first coitus before seeking professional advice about preventing pregnancy or sexually transmitted diseases (STDs). The earlier the first coitus, the longer the interval until such advice is sought.

There are a number of consequences of unprotected coitus including pregnancy, often unwanted, and exposure to STDs that may adversely affect pregnancy outcome, damage the reproductive system, or even threaten life.5,6 An estimated 4% of students in grades nine through 12 have a history of a STD.3 The number of adolescents with acquired immunodeficiency syndrome (AIDS) has increased 77% since 1989.7 The 10-year latency period between infection with the human immunodeficiency virus (HIV) and development of symptoms suggests that many AIDS patients were probably infected as teenagers.5 For females, early intercourse, repeated infections, and multiple partners greatly increase the risk of cervical cancer and infertility.5 Although the use of contraception, especially condoms, can prevent many of these conditions, teenagers do not use contraceptives effectively.3

The 1985 Guttmacher Report found that despite levels of sexual activity comparable to their European counterparts, the teenage pregnancy rate in the United States was two to five times higher than in other developed countries.8
The Hazards of Child Labor
Authors:   Committee on Environmental Health
Published: December 2021

This Policy Statement was retired January 2005.

Child labor is the paid employment of children under 18 years of age. Today, more than 4 million children and adolescents in the United States are legally employed.1

Illegal child labor is also widespread and apparently has increased in frequency over the past decade. An estimated 1 to 2 million American children and adolescents are employed under unlawful, often exploitative conditions—working under age, for long hours, at less than minimum wage, on dangerous, prohibited machinery. Widespread employment of children in sweatshops—establishments that repeatedly violate fair labor as well as occupational health and safety standards—has been documented.2,3 Tens of thousands of children are employed in illegal farm labor. Detected violations of child labor laws increased fourfold from 1983 to 1989.4

LEGAL CONTEXT

Since 1938, child labor in the United States has been regulated under the federal Fair Labor Standards Act (FLSA).5 Under this Act, employment in any hazardous nonagricultural occupation is prohibited for all children less than 18 years old. No child under 18 may work in mining, logging, construction, on a motor vehicle, or with power-driven machinery. The Act imposes additional restrictions on the employment of children under age 16 and sets limits on the number of hours a child may work on school days (no more than 3 hours per day for 14- and 15-year-olds). In agriculture, where legal restrictions are much less stringent, work with power-driven equipment and hazardous pesticides is prohibited only until age 16, and all work on family farms is exempt from legal protection. Work permits are a central aspect of the administration of FLSA.
Death in the Emergency Department
Authors: Greenberg Larrie W.
Published: December 2021

The American Academy of Pediatrics Committee on Pediatric Emergency Medicine's position on the death of a child in the emergency department that appeared in the May 1994 issue of Pediatrics omitted a critical issue, in my opinion.1 The paper did not address what pediatric residency programs are or should be doing to train physicians to be more effective in crisis counseling. Unfortunately, the most inexperienced physicians are often expected to inform parents that their child has died and then counsel them.
NOISY HEART
Authors: L. J. F.
Published: December 2021

A New York federal judge dismissed a $10 million lawsuit by Aaron Bravman of Kingston, Pa., who complained his artificial heart valve made "inordinately loud" clicking that can be heard 30 feet away. He said it keeps him awake and destroys concentration.
Surfactant Replacement in Neonates With Early Chronic Lung Disease
Authors: Pandit Paresh B. , Dunn Michael S. , Kelly Edmond N. , Perlman Max
Published: December 2021

Objective. To study the effect of a single dose of exogenous bovine surfactant on oxygen and ventilatory requirements of neonates with early chronic lung disease.

Study design. Prospective pilot study.

Setting. Three regional neonatal intensive care units.

Methods. Infants 7 to 30 days old with birth weights less than 1500 g were eligible if they required a fraction of inspired oxygen (FIO2) of more than 0.4, had stable ventilatory requirements for 24 hours before study entry, and showed diffuse haziness on chest radiographs. Those with patent ductus arteriosus or active infection or those receiving steroid therapy were excluded. After treatment with the surfactant, differences in FIO2 and the ventilator efficiency index were analyzed using the Wilcoxon signed rank test.

Results. Ten patients were recruited. Median values (range): birth weight, 693 g (530 to 1100 g); gestation, 25 weeks (24 to 27 weeks); and postnatal age at study entry, 13 days (9 to 30 days). The FIO2 decreased significantly between 0 and 1 hour after surfactant administration, from a median (range) of 0.67 (0.47 to 0.88) to 0.39 (0.28 to 0.63). This effect was sustained for 24 hours (median FIO2, 0.36). Although the FIO2 subsequently increased to 0.49 (range, 0.35 to 0.88) at 72 hours, it was significantly lower than that entry before the study. There was a trend toward an increase in the ventilator efficiency index at 24 and 48 hours.

Conclusions. A single dose of surfactant is effective in reducing oxygen requirements in neonates with early chronic lung disease. Surfactant replacement may be useful adjunctive therapy in these neonates.
Good Nutrition is the Issue
Authors: Kretchmer Norman
Published: December 2021

House Resolution (HR) 999 is the stimulus for this commentary. HR 999 would give block grants to states to provide nutritional assistance to economically disadvantaged individuals and families. As a result of this proposal, fifty different nutritional programs will emerge. It is stated within the bill that each state will be permitted maximum flexibility. Chaos will ensue if each state makes its own criteria for nutrition, and each state will probably re-invent the wheel.

Finances aside for the moment, the issue is good nutrition for the country's children, regardless of the economic status of the individual. Nutritional requirements for children cannot be influenced by the individual preferences or prejudices of each state.
Media Violence
Authors:   Committee on Communications
Published: December 2021

American children and adolescents are being exposed to increasing amounts of media violence, especially in television, movies, video games, and youth-oriented music. By age 18, the average young person will have viewed an estimated 200 000 acts of violence on television alone.1 Video game violence, children's cartoons, and music lyrics have become increasingly graphic. In movies, action films depict anatomically precise murders, rapes, and assaults; with each sequel, the number of deaths increase dramatically.2 Although media violence is not the only cause of violence in American society, it is the single most easily remediable contributing factor.3

According to recent Nielsen data, the average American child views 21 to 23 hours of television per week.4 By the time today's children reach age 70, they will have spent 7 to 10 years of their lives watching television.5 Although movies and video games are more graphic in depictions of violence, television is the single most important medium in the lives of young people (98% of all American house-holds have at least one television set).4 Despite public concern about television violence, the amount of television violence has not changed appreciably in the past two decades: the level of prime-time violence has remained at three to five violent acts per hour, and violence in Saturday morning children's programming ranges between 20 to 25 violent acts per hour.6-8 American media are the most violent in the world, and American society is now paying a high price in terms of real-life violence.9,10

Some people in the entertainment industry maintain that: 1) violent programming is harmless because no studies exist that prove a connection between violence in the media and aggressive behavior in children and 2) young people know that television, movies, and video games are simply fantasy.11
Health Care for Children of Farmworker Families
Authors:   Committee on Community Health Services
Published: December 2021

Migrant and seasonal farmworkers constitute a major portion of the labor force in the American agricultural industry. By harvesting and processing farm crops, they contribute positively to farm communities and the American economy.

In 1988, the Office of Migrant Health estimated that nationwide migrant and seasonal farmworkers and their dependents numbered between 3 and 5 million.1 The majority of farmworkers are married and/or have children. Only 10% to 25% of farmworkers are estimated to be unauthorized workers. The average annual income for migrant and seasonal farmworkers is well below the poverty level despite the prevalence of families with two wage earners. Although most farmworker families qualify for some type of public assistance, only 18% actually receive it.2 Because health care insurance is invariably beyond the reach of farmworker family budgets, and employers of farmworkers rarely provide health care benefits for their employees, these families are usually uninsured. In some cases, these families lack US citizenship or are in this country illegally, further limiting access to health care for their children. Medicaid eligibility is complicated by migration, because different eligibility requirements must be met in each state.

Because of their income level, lack of insurance, and mobile lifestyle, families of farmworkers often find that comprehensive child health care (health maintenance, anticipatory guidance, and preventive medicine) is essentially unavailable. Additionally, recent changes in immigration policy and economic developments have resulted in a rapid growth of population that is not parallelled by the growth of health care facilities. Other problems that delay or prevent access to health care for the children of farmworker families include language barriers and differences in culture.
Factors Related to Immunization Status Among Inner-City Latino and African-American Preschoolers
Authors: Wood David , Donald-Sherbourne Cathy , Halfon Neal , Tucker M. Belinda , Ortiz Vilma , Hamlin Julie Shea , Duan Naihua , Mazel Rebecca M. , Grabowsky Mark , Brunell Philip , Freeman Howard
Published: December 2021

Objective. To identify factors associated with undervaccination at 3 months and 24 months among low-income, inner-city Latino and African-American preschool children.

Design. Interviews with a representative sample of inner-city families using a cross-sectional, multi-stage, cluster-sample design combined with a replicated quota sampling approach.

Setting. South Central and East Los Angeles areas in inner-city Los Angeles.

Population. Eight hundred seventeen Latino and 387 African-American families with children between 12 and 36 months of age.

Main Outcome Variables. Being fully immunized or up-to-date (UTD) at 3 months (1 diphtheria-tetanus-pertussis vaccine and 1 oral polio vaccine) and 24 months of age (4 diphtheria-tetanus-pertussis vaccines, 3 oral polio vaccines, and 1 measles-mumps-rubella vaccine).

Methods. Logistic regressions of UTD immunization status at 3 and 24 months by population and health care system factors.

Results. Seventy percent of Latino children and 53% of African-American children were UTD at 3 months of age. At 24 months of age, 42% of Latino children and 26% of African-American children were UTD on their immunizations. Receipt of the first immunizations by 3 months was associated with smaller family size, and evidence of connection to prenatal care. Latino children were less likely to be UTD at 24 months if they obtained well child care from private providers versus public clinics (odds ratio [OR] = 0.45, 95% confidence interval [CI] = 0.26, 0.79). There was also a trend for Latino children to be less well immunized if they were in health maintenance organizations versus public clinics (0.31, .0.05 < P < .1). African-American children were more likely to be UTD at 24 months if they were UTD at 3 months (OR = 5.56, 95% CI = 1.43, 21.6), had more health visits (OR = 1.13, 95% CI = 1.01, 1.27), and were less likely to be UTD at 24 months if they were on Medicaid versus private insurance (OR = 0.26, 95% CI = 0.08, 0.90).

Implications. Both African-American and Latino children in inner-city Los Angeles have low immunization rates at 3 and 24 months. Prenatal care and family size are strongly associated with being UTD by 3 months; however, family and child characteristics are relatively unimportant predictors of being UTD at 24 months of age. Important risk factors for underimmunization at 2 years of age in the inner-city, low-income communities studied include type of health insurance and source of well child care, with the public sector having higher rates than private doctors' offices or health maintenance organization/managed care plans.
The Relationship of Selenium Status to Respiratory Outcome in the Very Low Birth Weight Infant
Authors: Darlow Brian A. , Inder Terrie E. , Graham Patrick J. , Sluis Karl B. , Malpas Tim J. , Taylor Barry J. , Winterbourn Christine C.
Published: December 2021

Objective. To examine the relationship between plasma and erythrocyte selenium and glutathione peroxidase (GPx) levels in premature infants and outcome measures.

Design. Prospective observational longitudinal study.

Setting. Two regional neonatal intensive care units in the South Island of New Zealand, an area with low soil selenium.

Patients. Seventy-nine infants with birth weights less than 1500 g or gestation less than 32 weeks admitted within 48 hours of birth from November 1992 through November 1993.

Main Outcome Measures. Oxygen requirement at 28 days (chronic lung disease), or 36 weeks postmenstrual age and for all or most of the time from birth (bronchopulmonary dysplasia), total days in oxygen, retinopathy of prematurity, periventricular hemorrhage, or ventricular dilatation.

Results. Initial infant plasma selenium and GPx levels were about two thirds of maternal levels and fell a further 30% in 28 days. In contrast to adults, there was a poor correlation in infant plasma between selenium and GPx at birth and 28 days. Plasma selenium at 28 days was significantly lower in infants with chronic lung disease and bronchopulmonary dysplasia. After controlling for gestational age and age when fully fed orally, 28-day plasma selenium was significantly associated with the log of total days of oxygen requirement, each drop of 0.1 µmol/L in 28-day selenium being associated with a 58% increase in days of oxygen dependency. No significant associations of other parameters of selenium status and respiratory outcome were found, and there were no significant associations of any parameters of selenium status with other outcome measures.

Conclusions. This study demonstrates for the first time in human infants that low plasma selenium levels are significantly associated with an increased respiratory morbidity. Whether selenium deficiency is etiologically important in determining the respiratory outcome or the result of sickness in the infant should be investigated in a randomized, controlled trial.
THE ASSOCIATION BETWEEN β-AGONIST USE AND DEATH FROM ASTHMA. A META-ANALYTIC INTEGRATION OF CASE-CONTROL STUDIES
Authors: Goldsobel Alan B.
Published: December 2021

These results document the extremely small magnitude of the relation between β-agonist use and death from asthma. These results specify that the relatioship between β-agonist use and death from asthma may be restricted to the delivery of β-agonists via the nebulizer. One article included in the meta-analytic integration was the Spitzer article published in 1992 which has caused great controversy in both the medical community and the popular press. This was the only one of the case-control studies included in this analysis to find an association between MDI-delivered β-agonists and death. The other studies included were based on a total sample of 1433 patients compared with the Spitzer study sample of 277 patients. The association of β-agonist use and death with nebulizer administration was felt to be related to nebulizer use marking the more severe asthmatic patients. Age was a significant predictor among all of the studies, even significant when the Spitzen data were eliminated. That study had the oldest mean age patients, possibly explaining why their study may have maximized the likelihood of observing a significant association between β-agonist use and death.
Enzyme Replacement Therapy for Gaucher Disease: Skeletal Responses to Macrophage-targeted Glucocerebrosidase
Authors: Rosenthal Daniel I. , Doppelt Samuel H. , Mankin Henry J. , Dambrosia James M. , Xavier Ramnik J. , McKusick Kenneth A. , Rosen Bruce R. , Baker John , Niklason Loren T. , Hill Suvimol C. , Miller Stephen P. F. , Brady Roscoe O. , Barton Norman W.
Published: December 2021

Objectives. Reversal of the hematologic and visceral abnormalities characteristic of Gaucher disease, the most common lipid storage disorder, with biweekly infusions of macrophage-targeted glucocerebrosidase (glucosylceramidase) is well documented. The extent to which the skeleton responds to enzyme replacement therapy has not been systematically investigated.

Methods. To assess the skeletal response to enzyme replacement therapy, we treated 12 patients with type 1 Gaucher disease, who had intact spleens, with macrophage-targeted glucocerebrosidase. The initial dose of enzyme was 60 U/kg body weight every 2 weeks for 24 months, followed by reduction in dosage to 30 and then 15 U/kg body weight every 2 weeks, each for 9 months.

Results. The lipid composition of bone marrow, determined by direct chemical analysis, began to improve after 6 months of treatment at a time when noninvasive imaging studies showed no significant changes. By 42 months, improvement in marrow composition was demonstrable on all noninvasive, quantitative imaging modalities (magnetic resonance score, quantitative xenon scintigraphy, and quantitative chemical shift imaging) used in this study. Quantitative chemical shift imaging, the most sensitive technique, demonstrated a dramatic normalization of the marrow fat content in all patients. Net increases in either cortical or trabecular bone mass, as assessed by combined cortical thickness measurements and dual-energy quantitative computed tomography, respectively, occurred in 10 patients.

Conclusions. Prolonged treatment over 3½ years with macrophage-targeted glucocerebrosidase produces objective reversal of disease in both the axial and appendicular skeleton in patients with Gaucher disease. Marked improvement occurs in marrow composition and bone mass in both children and adults.