bluuebunny/crossref_metadata_2025_split huggingface dataset:
Day-Care Standards: Need and Impact
Authors: Bredekamp Sue 
Published: December 2021

Any discussion of standards, no matter how brief, must first acknowledge that there are different types of standards established for different purposes. As the director of the national voluntary accreditation system for child care centers and schools established by the National Association for the Education of Young Children (NAEYC), I am most familiar with the need and impact of accreditation standards, which are, by definition, standards for distinguishing high-quality programs established by a professional organization. In any case the implementation of a national accreditation system is heavily influenced by local and state licensing standards, which are mandatory government regulations that establish a baseline of protection. Accreditation and licensing standards are both influenced by model standards such as the health and safety standards of the American Academy of Pediatrics and the American Public Health Association.1 These standards establish a model, based on the best professional evidence, that serves as a reference for the other two systems but does not carry an enforcement system of its own.
This paper will discuss the need for and impact of all three types of standards from the point of view of my experience in operating NAEYC's accreditation system.2 Because our accreditation process is nationally administered, we have the opportunity to observe the impact of diverse licensing standards on quality. In order to maintain accessibility we have relatively few eligibility requirements, and because we do not require 100% compliance with our criteria, we also have the opportunity to observe the interrelationships among standards and other effects.
One caveat must be offered at the outset.
From the Bedside to the Public Policy Arena: The Role of General Pediatric Research
Authors: Rivara Frederick P. 
Published: December 2021

The Ambulatory Pediatric Association is an organization dedicated to improving teaching, patient care, and research in general pediatrics. This paper addresses the task of conducting successful research in general pediatrics, often a challenging task for fellows and junior faculty beginning their careers. However, I believe general academic pediatrics has almost a unique opportunity to translate what is seen at the bedside into a research question and from there to try to use the results to affect the health of children. There are three steps in this process: finding a good idea, conducting rigorous research, and doing something with the results.
PATIENT CARE AS A SOURCE OF RESEARCH IDEAS
How does one come up with the "right" research idea? Fellows and graduate students find this a difficult process. I believe the best way to select a research topic is from one's patient care experience. By listening to and learning from our patients, the most important research questions become obvious. Nearly all of us started our careers as pediatricians and most of us remain practicing physicians. This means seeing patients each week, listening to the concerns of their parents, dealing with the thorny issues that arise, and scratching our heads about the unknowns and the uncertainties we face as clinicians. From this constant experience, we learn what is important. We learn which are the problems most in need of prevention, which problems need further study of their etiology and which problems are the most vexing to manage because of our inadequate knowledge.
School-Based Crisis Intervention Services for Adolescents: Position Paper of the Committees on Adolescence and School Health, Connecticut Chapter of the American Academy of Pediatrics
Authors: SCHONFELD DAVID J. 
Published: December 2021

The Connecticut State Chapter of the American Academy of Pediatrics, through its Committees on Adolescence and School Health, acknowledges that the need to respond effectively to crises involving adolescents within a school setting is confronting pediatricians and school systems with increasing frequency; although this paper will focus on the needs of adolescents, crises affect younger children as well. Concerted efforts between pediatricians and school personnel may serve as a first step in addressing this problem; this position paper is intended to stimulate both interest and action in this regard.
Schools provide a constant environment that can contribute positively to adolescents' psychological development.
Developmentally Disabled Children Recycle Car Seats: A Win-Win Program
Authors: BERGER LAWRENCE R. , BENALLY LORRAINE M. , ROBSON WILLIAM , OLSON LENORA M. 
Published: December 2021

Injuries are the leading cause of death for Native Americans from age 1 to 44 years, accounting for 63% of all deaths in that age range.1 Motor vehicles are responsible for 55% of all Native American injury deaths.2 Among Native American children 1 to 14 years of age, the death rate from motor-vehicle occupant injuries (6.9/100 000 per year) is more than double that of white children in the United States (3.3/100 000 per year).3
To help reduce this toll, both the Indian Health Service (IHS) and individual tribes have initiated car seat loaner programs. Because of widespread poverty—the unemployment rate is as high as 80% in some Native American communities—no fees or deposits are collected in many of these programs.
Group Health Supervision Visits More Effective Than Individual Visits in Delivering Health Care Information
Authors: DODDS MARGARET , NICHOLSON LAURA , MUSE BRETT , OSBORN LUCY M. 
Published: December 2021

Preventive health care consumes a substantial amount of pediatricians' time and has been promoted as one of the most important medical functions physicians perform.1-4 The American Academy of Pediatrics (AAP) has emphasized the need for preventive health care. To assist in the delivery of child health supervision, the AAP Committee on Psychosocial Aspects of Child and Family Health has recently published guidelines recommending specific topics to be covered at each of the routine health maintenance visits.5
Despite the acceptance of recommendations for preventive child health care, the efficacy of office-based prevention strategies has not yet been proven.6 However, assessment of the literature addressing the effectiveness and costs of strategies for promoting and maintaining child health has been noted to be "more remarkable for its limitations than its findings."6
Child Life Programs
Authors:   Committee on Hospital Care
Published: December 2021

Child life programs have become the standard in pediatric settings to address the psychosocial concerns that accompany hospitalization and medical care. Child life specialists facilitate coping and the adjustment of children and families by providing play experiences, presenting information about events and procedures, and establishing supportive relationships with children and parents to encourage family involvement in each child's medical care.
These activities are shared by other members of the health care team. The role of the child life specialist, however, is unique because it combines each of these services as the primary duty. The child life specialist focuses on the strengths and health of children.1 Most major hospitals for children have child life programs, and the number of these has doubled since 1965.
The patient-to-staff ratio should not exceed 15 patients to 1 child life specialist. Child life or similar services should be offered by all hospitals. Most child life specialists work in inpatient settings, but they are increasingly serving outpatient populations. Certification of child life specialists is available through the Child Life Certifying Commission, which was established in 1986.
PLAY
Play is the core of the child life program. Play activities are offered both in group settings and individual sessions. Play opportunities in health care settings communicate a respect for and understanding of children. Play helps eliminate the distinction between the comfortable and familiar setting outside the hospital and the foreign and intimidating hospital environment.
Play contributes to the child's adjustment in several important ways. By providing age-appropriate activities, the possibility that hospitalization may disrupt normal development is minimized.
Saving Young Arms and Batters' Heads
Authors: DORSEY J. KEVIN , BENTON RON 
Published: December 2021

To the Editor.—
The local baseball commission of the boys' 8- to 10-year-old league recently implemented several changes in an attempt to increase safety and improve instruction. One of these was the use of a pitching machine for the first three innings of every six-inning game. A neutral adult served as a "pitching coach" for both teams and adjusted the height of the pitched ball to correspond to the strike zone of the batter. Pitch speed was regulated to approximate the speed of a ball thrown by an average to good pitcher in that age group.
Hepatitis B Immunization: Premonitions and Perceptions of Pediatricians
Authors: HALL CAROLINE BREESE , MARGOLIS HAROLD S. 
Published: December 2021

In this issue of Pediatrics, the article by Freed and colleagues1 emphasizes important issues in ensuring the implementation of our immunization programs. The effector arm of the program, those who administer the immunizations, must have not only the capability, but also the will. This comes only from understanding the need and rationale of the recommendations.
Freed et al surveyed pediatricians about their awareness and receptivity of the new recommendations for universal infant hepatitis B immunization; the survey was conducted during the 2- to 3-month period between publication of these recommendations from the Centers for Diseases Control and Prevention (CDC)2 and those of the American Academy of Pediatrics (AAP).3
It's Not Henoch-Schönlein Purpura (HSP)
Authors: MORGENSTERN BRUCE Z. , MILLINER DAWN S. 
Published: December 2021

To the Editor.—
The cases reported by Olson et al1 of pulmonary hemorrhage in children with systemic vasculitis clearly highlight the fact that children are not "immune" to these conditions. We must take issue, however, with the diagnosis of Henoch-Schönlein purpura in the patients described. Because Henoch-Schönlein purpura is a subset of systemic vasculitis, the clinical manifestations may mimic or be mimicked by other vasculitis syndromes such as polyarteritis nodosa, Wegener's granulomatosis, and systemic lupus erythematosus.2
It's Not Henoch-Schönlein Purpura (HSP)
Authors: OLSON JUDYANN C. , KELLY KEVIN J. , PAN CYNTHIA G. , WORTMANN DOROTHY W. 
Published: December 2021

In Reply.—
Classification criteria have been established by the American College of Rheumatology (ACR) for the diagnosis of Henoch-Schöenlein purpura (HSP). These criteria include palpable purpura, age ≤20 years, bowel angina, and wall granulocytes on biopsy. The presence of two of four criteria is required for classification with a reported 87.1 % sensitivity and 87.7% specificity. The authors of the criteria recognized that the diagnosis of HSP is primarily clinical and that biopsies are rarely necessary to diagnose HSP in children.1
Guidelines vs the Legal Standard of Care and Screening for Polycythemia
Authors: MERENSTEIN GERALD B. 
Published: December 2021

To the Editor.—
Dr David Reynolds1 appropriately applauds policy of the American Academy of Pediatrics to accompany committee statements with a paragraph recognizing that alternative strategies may be appropriate and that the opinions expressed do not constitute standards of medical care. He states that he was unable to find a similar statement in the second edition of Guidelines for Perinatal Care.2 Both the second and third editions1 contain such a statement which says, in part, on page ii:
Screening for Treatable Disorders
Authors: CLAYTON ELLEN WRIGHT 
Published: December 2021

In Reply.—
I appreciate the opportunity to respond to Dr Arnold's thoughtful letter because she raises a frequently made argument that failure to consent to newborn screening constitutes actionable neglect.1-3 The problem with this argument, however, is that it tends to combine inappropriately the risks of failing to screen with the risks of failing to treat a child with the disease being sought.4 For example, the actual risk that any particular child who is not screened will develop mental retardation that could have been avoided is very low simply because the incidence of phenylketouria (PKU), congenital hypothyroidism, and the other metabolic disorders sought is very low, even in the aggregate.
Lead and IQ
Authors: BELLINGER DAVID 
Published: December 2021

In Reply.—
Dr Needles raises several important points about our study. He questions the presence of a dose-effect relationship between blood lead level at age 24 months and intellectual functioning at age 10, as well as our assertion that a threshold for this relationship was not apparent. His skepticism is understandable. Our conclusions were based on three observations, not all of which we were able to include in our paper. 1) Examination of the partial regression residual plot (IQ adjusted for all covariates and blood lead level adjusted for all covariates) indicated symmetrical distribution of residuals about the regression line and similarity in the residual variances over the blood lead range.
Stewart Smiled
Authors: KIBELBEK MICHAEL J. , SCHWARTZ JAN A. , TENEDIOS GEORGE 
Published: December 2021

To the Editor.—
Dr Tobias' study dramatically demonstrates the efficacy of orally administered ketamine.1 When given in a controlled manner to properly prepared oncology patients, ketamine can be a very useful drug. Tobias suggests that although many institutions restrict the use of ketamine to anesthesiologists, "...we believe that other physicians should be allowed to use this valuable agent as an oral premedicant." We believe he is wrong. Except for scheduled oncologic procedures, there are relatively few areas where profound central nervous system depression is desirable.
A Conference on Culture and Chronic Illness in Childhood: Conference Summary
Authors: Patterson Joan M. , Blum Robert Wm 
Published: December 2021

A focus on disability and chronic illness within the disciplines of health, education, and social services has usually assumed a dominant cultural ethos grounded in European-American values. Indicators of social and psychological competence, normative behavior, response to stress and to illness, and even adaptation to life have been assumed to comprise a relatively homogeneous pattern. "Abnormal" has usually been defined as deviation from this pattern. For the most part, there has been a failure to take into account the reality that there may be many different processes of adaptation utilized by different cultural and ethnic groups. Such adaptation patterns should not be viewed as deviant, but rather as different and comprising strengths, resources, and advantages, as well as potential problems and disadvantages. Unfortunately, the continuing prevalence of racism in our society has contributed to equating different with deviant.
Just as children from different cultural, ethnic, and racial groups are too often marginalized by society and experience restricted access or denial to important resources needed for optimal physical, psychological, and social development, so too, children who experience disability and chronic illness are too often marginalized by the attitudes and behaviors of others. The parallels between these two sources of exclusion—minority status and disability status—as well as the interaction of the two factors has received very little attention in research, service delivery, or policy formation.
Even though pluralism is inherent in the history of the United States, our orientation has been homogenization—"the great melting pot." This is changing. With awareness of the growing proportion of ethnic minorities comprising tht US population and with a new positive value and emphasis being placed on ethnic diversity, there is renewed interest in cultural variation.
Prevention of Progression to Severe Obesity in a Group of Obese Schoolchildren Treated With Family Therapy
Authors: Flodmark Carl-Erik , Ohlsson Torsten , Rydén Olof , Sveger Tomas 
Published: December 2021

Study objective. To evaluate the effect of family therapy on childhood obesity.
Design. Clinical trial. One year follow-up.
Setting. Referral from school after screening.
Participants. Of 1774 children (aged 10 to 11), screened for obesity, 44 obese children were divided into two treatment groups. In an untreated control group of 50 obese children, screened in the same manner, body mass index (BMI) values were recorded twice, at 10 to 11 and at 14 years of age.
Intervention. Both treatment groups received comparable dietary counseling and medical checkups for a period of 14 to 18 months, while one of the groups also received family therapy.
Results. At the 1-year follow-up, when the children were 14 years of age, intention-to-treat analyses were made of the weight and height data for 39 of 44 children in the two treatment groups and for 48 of the 50 control children. The increase of BMI in the family therapy group was less than in the conventional treatment group at the end of treatment, and less than in the control group (P = .04 and P = .02, respectively). Moreover, mean BMI was significantly lower in the family therapy group than in the control group (P &lt; .05), and the family therapy group also had fewer children with BMI &gt; 30 than the control group (P = .02). The reduction of triceps, subscapular, and suprailiac skinfold thicknesses, expressed as percentages of the initial values, was significantly greater in the family therapy group than in the conventional treatment group (P = .03, P = .005 and P = .002, respectively), and their physical fitness was significantly better (P &lt; .05).
Conclusions. Family therapy seems to be effective in preventing progression to severe obesity during adolescence if the treatment starts at 10 to 11 years of age.
Smoking and the Sudden Infant Death Syndrome
Authors: Mitchell E. A. , Ford R. P. K. , Stewart A. W. , Taylor B. J. , Becroft D. M. O. , Thompson J. M. D. , Scragg R. , Hassall I. B. , Barry D. M. J. , Allen E. M. , Roberts A. P. 
Published: December 2021

Objective. Maternal smoking has been shown to be a risk factor for sudden infant death syndrome (SIDS). The effect of smoking by the father and other household members has not previously been examined.
Methods. A large nationwide case-control study. Four hundred eighty-five SIDS deaths in the postneonatal age group were compared with 1800 control infants.
Results. Infants of mothers who smoked during pregnancy had a 4.09 (95% confidence interval [CI] = 3.28, 5.11) greater risk of death than infants of mothers who did not smoke. Infants of mothers who smoked postnatally also had an increased risk of SIDS compared with infants of nonsmokers and, furthermore, the risk increased with increasing levels of maternal smoking. Smoking by the father and other household members increased the risk (odds ratio [OR] = 2.41, 95% CI = 1.92, 3.02 and OR = 1.54, 95% CI = 1.20, 1.99, respectively). Smoking by the father increased the risk of SIDS if the mother smoked, but had no effect if she did not smoke. In analyses controlled for a wide range of potential confounders, smoking by the mother and father was still significantly associated with an increased risk of SIDS.
Conclusion. Passive tobacco smoking is causally related to SIDS.
Increases in Crash Involvement and Fatalities Among Motor Vehicle Occupants Younger Than 5 Years Old
Authors: Chorba Terence L. , Klein Terry M. 
Published: December 2021

Objective. To determine whether increased exposure as car occupants could be a major contributor to increases observed in deaths of young children in car crashes.
Design and setting. Crash data from police reports for Maryland, Michigan, Pennsylvania, and Washington for various years from 1982 through 1990 were examined to compare annual age mix of injured and uninjured occupants in crashes involving at least two passenger vehicls. Aggregate national data from the Fatal Accident Reporting System were also examined over the same time period and compared to population estimates for children younger than 5 years old to assess temporal trends in number of occupants in this age group who were involved in motor vehicle crashes in which a fatality occurred in fatal crashes and the number of them killed in passenger vehicles.
Results. In regression analyses for each state, the number of car occupants younger than 5 involved in crashes increased during the years studied; their percentage among nondriver occupants involved also increased. At a national level, similar analyses showed increases in the number of occupants younger than 5 involved in crashes in which a fatality occurred.
Conclusions. Despite overall increases in the use of restraint devices (ie, both child safety seats and adult restraints), fatalities among restrained children have increased. Given that exposures to crash environments are increasing, clinicians need be aware of the importance of child restraints as a means of reducing the likelihood of injury.
Clinical and Biochemical Phenotype in 11 Patients With Mevalonic Aciduria
Authors: Hoffmann Georg F. , Charpentier Christiane , Mayatepek Ertan , Mancini Josette , Leichsenring Michael , Gibson K. Michael , Divry Priscille , Hrebicek Martin , Lehnert Willy , Sartor Klaus , Trefz Friedrich K. , Rating Dietz , Bremer Hans J. , Nyhan William L. 
Published: December 2021

Objective. Mevalonic aciduria is a consequence of the deficiency of mevalonate kinase, the first enzyme after 3-hydroxy-3-methylglutaryl-coenzyme A reductase in the biosynthesis of cholesterol and nonsterol isoprenes. To establish the clinical and biochemical phenotype of mevalonic aciduria, the authors assembled their experience with 11 patients including attempts at therapeutic interventions.
Methods. Mevalonic acid in body fluids was determined by stable isotope dilution gas chromatography/mass spectroscopy with selected ion monitoring, ubiquinone-10 concentrations by reversed-phase high-pressure liquid chromatography.
Results. Varying degrees of severity of clinical illness were observed despite uniform, virtual absence of residual activity of the enzyme. The most severely affected patients have had profound developmental delay, dysmorphic features, cataracts, hepatosplenomegaly, lymphadenopathy, and anemia, as well as diarrhea and malabsorption, and have died in infancy. Less severely affected patients have had psychomotor retardation, hypotonia, myopathy, and ataxia. All patients have had recurrent crises in which there was fever, lymphadenopathy, increase in size of liver and spleen, arthralgia, edema, and a morbilliform rash. Neuroimaging studies revealed selective and progressive atrophy of the cerebellum. Mevalonic acid concentrations were found to be grossly elevated in body fluids of all patients. Concentrations of plasma cholesterol were normal or only slightly reduced. Concentrations of ubiquinone-10 in plasma were found to be decreased in most patients. Abnormalities such as hypoglycemia, metabolic acidosis, or lactic acidemia, the usual concomitants of disorders of organic acid metabolism, were conspicuously absent.
Conclusions. These observations establish the broad range of clinical symptoms and biochemical findings in mevalonic aciduria. It is concluded that although patients with mevalonic aciduria have a recognizable phenotype of serious clinical manifestations, some patients are likely to remain undiagnosed and may be found in a variety of subspeciality clinics, including neurology, troenterology, cardiology, and genetics.