bluuebunny/crossref_metadata_2025_split huggingface dataset:
Family History of Coronary Artery Disease and Cholesterol: Screening Children in a Disadvantaged Inner-City Population
Authors: Wadowski Stephen J. , Karp Robert J. , Murray-Bachmann Renee , Senft Carl 
Published: December 2021

Background and purpose. Little information relating to cholesterol levels and screening for hypercholesterolemia in inner-city children exists. For this study, given the disrupted family backgrounds of many of our patients and the unreliability of family histories, our hypothesis was that in comparison with other samples, family history of coronary heart disease would be a poor screening tool for the identification of children with elevations in total serum cholesterol (TSC).
Subjects and methods. During 15 months, more than 400 pediatric outpatients, 2 through 14 years old, were screened for a family history of atherosclerotic disease. These children were attending a clinic serving a disadvantaged black and Hispanic population at Kings County Hospital Center. Nonfasting TSC levels were measured in 300 children. Positive risk for coronary heart disease was determined by the presence of a family history of coronary heart disease (defined as angina, stroke, or myocardial infarction in any parent or grandparent) at less than 55 years age.
Results. The mean TSC level was 4.27 mmol/L (SD ± 0.85) (165.0 mg/dL [SD ± 32.81]). The 29.4% of this population with a history suggestive of high risk for hypercholesterolemia had a mean TSC of 4.48 mmol/L (SD ± 0.971) (173.2 mg/dL [SD ± 37.5]), and those with no risk history had a mean TSC of 4.18 mmol/L (SD ± 0.750) (161.4 mg/dL [SD ± 29.91) (P &lt; .005). Use of family history of coronary artery disease as a screening tool had a sensitivity of 39.3%, a specificity of 74.5%, and a positive predictive value of 39.8% for detection of moderate hypercholesterolemia (TSC ≥ 4.66 mmollL [180 mg/dL]).
Conclusions. This population's mean TSC level did not differ (P &gt; .10) from those obtained in multiple large studies of average North American populations, and the predictive value and sensitivity of family history as a screening tool was comparable, although the prevalence of a positive family history was greater. The findings may be due to a greater prevalence of coronary artery disease at a young age in these families. In this population, a positive risk history is an important indicator for further evaluation of these children.
Letter to the Editor
Authors: Bhushan Vidya , Paneth Nigel , Kiely John L. 
Published: December 2021

Drs Sola and Piecuch argue that the birth cohort prevalence is not the only way to express the frequency of cerebral palsy in the population and we agree.
Birth cohort prevalence is analogous to cumulative incidence, and is the most suitable measure for monitoring secular trends. Our focus on birth cohort prevalence derived from its dependence on changing patterns of newborn survival, which is a surrogate measure of newborn care, and its independence of the birth rate which is not related to medical factors which we purport to monitor in pennatal epidemiology. Besides, birth cohort prevalence is used in many population-based studies, which makes comparisons possible.
Clinical Comparison of Localized Intestinal Perforation and Necrotizing Enterocolitis in Neonates
Authors: Buchheit John Q. , Stewart Dan L. 
Published: December 2021

Objective. To better define the prognosis of neonates with gastrointestinal perforation and improve their management.
Methods. We reviewed the results of physical examinations, laboratory results, and radiographic tests of 42 patients in whom gastrointestinal perforation was diagnosed in our neonatal intensive care unit.
Results. Twenty-one patients had necrotizing enterocolitis and 21 had localized intestinal perforation. Perinatal history, gender, race, birth weight, and estimated gestational age were similar for both groups. Patients with localized perforation were more likely to have had an umbilical artery catheter in place within 48 hours of perforation, to have received higher doses of indomethacin, to have undergone primary surgical repair, and to have survived until discharge from the hospital. Patients with necrotizing enterocolitis were more likely to have received enteral feedings and to have had a metabolic acidosis and leukopenia at the time the perforation was diagnosed.
Conclusions. We conclude that localized intestinal perforation and necrotizing enterocolitis, although similax in the organ system they affect, are distinctly different in clinical correlates and outcome. The increased awareness of localized perforations may help those taking care of neonates to diagnose this condition more accurately and to discuss its implications with family members.
DO BIRDS GET HOOKED ON HAND-OUTS?
Authors: L. J. F. 
Published: December 2021

Bird lovers opposed to the welfare state can rest easy. American ecologists have found that if you feed birds in the winter, they will not, as most people believe, end up dependent on hand-outs and unable to fend for themselves.
Margaret Brittingham and Stanley Temple, of the University of Wisconsin at Madison observed birds visiting a feeder one winter. They found that regular visitors coped with finding food just as well as birds that had never used a feeder (Journal of Field Ornithology, vol 63, p 190).
Interleukin-6: A Sensitive Parameter for the Early Diagnosis of Neonatal Bacterial Infection
Authors: Buck Christian , Bundschu Julia , Bartmann Peter , Pohlandt Frank , Gallati Harald 
Published: December 2021

Objective. Early recognition is important for the successful treatment and outcome of neonatal infections. As interleukin-6 (Il-6) plays a critical role in the induction of C-reactive protein (CRP) synthesis in the liver, it was hypothesized that this cytokine could be detected earlier in blood than the CRP during the course of bacterial infection.
Design. In a prospective study of 298 newborns who were admitted to the nursery unit, CRP levels, blood cell count with differential, and Il-6 levels were determined at the time of admission and 24 hours after admission. Seventy-six newborns were excluded from the study because of incomplete or incorrect blood sampling.
Results. The remaining 222 newborns were assigned to one of five groups: 11 newborns with blood culture-positive sepsis (sensitivity of Il-6 on admission 73%), 15 newborns with clinical sepsis (sensitivity of Il-6 on admission 87%), 41 newborns with infection (sensitivity of Il-6 on admission 68%), and 54 newborns without clinical and laboratory evidence of infection (specificity 78%). The remaining 101 newborns were defined as a mixed group because the diagnosis of neonatal infection could not clearly be made. Seventy-five percent of infected newborns had negative Il-6 levels 24 hours after admission. Of the 18 infected newborns with negative Il-6 levels on admission, 10 newborns had elevated CRP levels, suggesting that Il-6 was already negative because of the short half-life of Il-6. Sensitivity of Il-6 in CRP-negative newborns on admission was 100% in newborns with blood culture-positive and clinical sepsis. Il-6 was more sensitive than CRP in infected newborns on admission (73% vs 58%).
Conclusion. Il-6 is a sensitive parameter for diagnosing neonatal bacterial infection. The combination of CRP and Il-6 seems to be the ideal tool for the early diagnosis of neonatal infection.
SCREENING FOR ALL NEWBORNS URGED FOR SICKLE-CELL DISEASE
Authors: L. J. F. 
Published: December 2021

WASHINGTON, April 27—Issuing new guidelines for diagnosing and treating sickle-cell disease, a Federal panel recommended today that all newborns be screened for the blood condition, regardless of race.
The expert panel, which spent two years studying what is known about sickle-cell disease, said that although the disorder was most prevalent in African-Americans, looking for it only in blacks would miss too many other children who should be treated.
"Even though the rate of sickle-cell disease is lower in some populations than in others, sickle-cell disease can and does occur in almost all racial and ethnic groups," said Dr. Jeanne A. Smith of Harlem Hospital Center in New York, cochairman of the 13-member panel that drafted the guidelines...
The new guidelines were endorsed by several medical groups, including the American Academy of Pediatrics, the American Nurses Association, the National Medical Association and the National Association for Sickle Cell Disease...
Copies of the sickle-cell treatment guidelines for newborns and infants, in versions for doctors and health workers, as well as for parents, can be obtained by writing to Sickle Cell Disease, A.H.C.P.R. Publications Clearinghouse, PO Box 8517, Silver Spring, MD 20907, or calling (800) 358-9295.
HEALTH CARE CONTRAPTION
Authors: L. J. F. 
Published: December 2021

You could almost hear the jaws dropping when Ira Magaziner, the White House's guru at guruing, said over the weekend, "The government is going to set standards, guarantee high-quality, affordable care, and then get out of the way."
As any of the health care reformers who used to gather at Jackson Hole could tell you, a lot of what's already wrong with the medical economy arises from Washington's habit of creating entitlements while trying to conceal from taxpayers how much they really cost...
The whole Clinton health care scheme advances behind a phalanx of euphemism aimed at muddying up what's really going on here. It would spawn huge new bureaucracies, but these will travel under the alias "purchasing alliance." Price controls are subsumed under the MBAish-sounding "global budgets," and the taxes that would finance the thing are called "premiums"...
It's odd to see people who are so obviously far behind the rest of the world's learning curve. In Sweden, Germany and most other serious places they're pulling U-turns and beginning to dismantle their expensive welfare bureaucracies...
Experience With the Illuminated Endotracheal Tube in the Prevention of Unsafe Intubations in the Premature and Full-Term Newborn
Authors: Heller Richard M. , Heller Toni W. 
Published: December 2021

Objective. To determine whether an endotracheal tube modified by incorporation of a fiberoptic strand in the wall and connected to a light source could be safely and reliably positioned in premature and full-term newborns using transdermal siting of a bright spot on the skin at the suprastemal notch of the chest wall.
Methods. All newborns in the Vanderbilt Neonatal Intensive Care Unit who were candidates for intubation by established clinical criteria, who were not already intubated, were candidates for the study. We defined optimal placement of the endotracheal tube to be one with the tip of the tube below the first thoracic vertebral body and no less than 0.5 cm above the carina or at T-4 (if the carina could not be seen on the radiograph). A light source was connected to the fiberoptic strand and the endotracheal tube positioned so that a circle of light was visible on the skin of the chest wall at the suprasternal notch.
Results. In all 22 placements, the tube tip was below the larynx and above the canina. In 20 of the placements, the position was optimal between T-1 and T-4, whereas in the other 2 the tube tip was high between the larynx and the thoracic inlet.
This system required that an endotracheal tube 0.5 mm smaller than usually used be utilized because of the slight increase in outer diameter due to the fiberoptic strand. Conventional suction catheters were used in this study.
Conclusions. This study has shown that the illuminated endotracheal tube is a reliable device for accurate positioning in premature and full-term newborns using transdermal siting of a bright spot on the skin at the suprasternal notch.
Outcome and Cost of Open- and Closed-Chest Cardiopulmonary Resuscitation in Pediatric Cardiac Arrests
Authors: Sheikh Azad , Brogan Thomas 
Published: December 2021

Objective. The dismal survival rates of cardiac arrest in children managed with conventional closed-chest cardiopulmonary resuscitation (CC-CPR) have renewed interest in the use of open-chest CPR (OC-CPR). We determined the efficacy of the early use of OC-CPR in children after cardiac arrest.
Methods. A retrospective review of emergency medical services (EMS) and hospital records revealed 27 children who were brought to the emergency department under CPR after blunt trauma.
Results. Twelve children had CC-CPR and 15 children underwent OC-CPR. Prehospital resuscitation and transport of both groups of children was excellent by current standards, and OC-CPR was performed within 5 minutes of arrival in the emergency department. CPR was successful with restoration of spontaneous circulation in 17% of children after CC-CPR, whereas 20% of children had restoration of spontaneous circulation after OC-CPR. This difference was not statistically significant. None of the children regained consciousness or survived to discharge. The hospital charges for patients who underwent OC-CPR were significantly higher (P = .005). Less than 30% of the hospital charges were reimbursed in both groups.
Conclusions. OC-CPR does not improve survival in children who sustain cardiac arrest and receive CPR for more than 20 minutes in the field. Under these circumstances OC-CPR is an expensive and futile procedure to undertake.
THE OLD SHELL GAME
Authors: L. J. F. 
Published: December 2021

Pressure to ration will be greatest in alliances that indude cities. Inside an alliance, everyone pays the same rate—"community rating"—for health care (page 227), and the premiums collected have to cover everyone's needs, including the AIDS patient, the assault victim, and the $158,000 low-birth-weight baby. People will figure out that you pay the highest premiums and get the least health care in affiances that include inner cities.
Moreover, the bill shifts medical costs now paid by the federal government, including a large part of Medicaid, onto the alliances. The brunt will be borne by urban alliances. For example, the bill halts Medicaid payments to the chronically ill and subsidies to urban hospitals that treat the poor (pages 802, 812).
Reductions in federal spending are called "savings" by the Clinton administration, but the costs are just shifted from the federal budget to the regional alliances, which must pay for everyone's health needs out of local premiums. For example, the $4.9 billion annual cost of caring for 387,450 chronically ill New York City residents will be shifted from Medicaid to local premiums.
Parents With Human Immunodeficiency Virus Infection: Perceptions of Their Children's Emotional Needs
Authors: Niebuhr Virginia N. , Hughes Janice R. , Pollard Richard B. 
Published: December 2021

Objective. To investigate the likelihood of patients who have human immunodeficiency virus/acquired immunodefidency syndrome (HIV/AIDS) being parents and to identify concerns of these parents about their children.
Design. A survey was conducted of parental status, demographics, perceptions of social/emotional needs of self and one's children. Responses were analyzed for demographic differences.
Participants. A total of 242 patients from the university HIV/AIDS clinics completed the survey.
Main outcome measures. Parental status, number, and ages of children, parental concerns about their children related to their own HIV/AIDS.
Results. Nearly one third (31.8%) of the sample of HIV/AIDS patients were parents, and three fourths (76%) of the female patients were mothers. Slightly more than one third of these were married, and these were not predominantly families who also had infected children. The percentage of women in the parent subsample (40.8%) was higher than the percentage of women in the overall patient sample (16.7%). Only half of the parents reported that their children &gt;4 years of age knew of their diagnosis. Two thirds of the parents reported they believed their children did not need to talk to someone about their parent's health, and nearly half of the parents reported that they did not need help dealing with their children concerning issues related to AIDS.
Conclusion. The percentage of HIV/AIDS patients who are parents is high, and parental status and emotional needs of parents and their children will likely become an increasingly important issue. Many questions are raised by our findings. Should we be concerned that many parents have been unable to talk to their children about their own health? Should we help parents acknowledge that their children may need some outside help to cope?
Criteria for Exchange Transfusion in Jaundiced Newborns
Authors: Ahlfors Charles E. 
Published: December 2021

Objective. A widely published set of exchange transfusion criteria lowers critical bilirubin concentrations when the serum albumin falls to &lt;2.5 g/dL. Although acknowledging the role of bilirubin-albumin binding in bilirubin neurotoxidty, this approach may inadvertently produce two critical bilirubin concentrations. This study investigates using the bilirubin/albumin ratio instead of the single albumin concentration to eliminate this potential ambiguity in the criteria.
Design and participants. The bilirubin/albumin ratio was defined as a reliable indicator of bilirubin-albumin binding if the frequency curves of specific unbound bilirubin concentrations are normally distributed functions of the ratio. Therefore the bilirubin/albumin ratios at which the unbound bilirubin reached 10, 15, and 20 nmol/L were determined by the peroxidase method in 35 well full-term, 10 ill full-term, and 19 ill preterm neonates. The frequency curves for each unbound bilirubin concentration plotted against the bilirubin/albumin ratio were tested for normality.
Results. The frequency of each unbound bilirubin concentration was a normally distributed function of the bilirubin/albumin ratio. Furthermore, the mean ratio at which each unbound bilirubin occurred did not differ significantly among the groups of neonates.
Conclusion. The bilirubin/albumin ratio is a simple, nonambiguous way of incorporating the serum albumin concentration into exchange transfusion criteria.
HMOS—ANOTHER ROADBLOCK FOR ALZHEIMER'S DRUG
Authors: L. J. F. 
Published: December 2021

The first Cognex auguries are not promising. These signs of resistance come from two of the nation's largest HMOs, Northern California Kaiser Permanente and the Group Health Cooperative of Puget Sound. Northern California Kaiser has already decided to ban Cognex from its formulary...
Cognex is expected to cost about $1,300 to $1,500 annually per patient, and this does not include the costs of blood tests and physician visits required to guard against side effects. Against this Kaiser argues that Cognex helps only some victims of Alzheimer's Disease; the gain is not very great in many patients; and some who take Cognex suffer liver toxicity that the HMOs would have to treat. So from an HMO's point of view, Cognex is not "cost-effective," the magic mantra of HMO health care. But for anyone who's aware of the living hell in which many Alzheimer's patients and their families live, this argument does not wash...
Americans still expect their doctors to put patients' interests first. As the Cognex incident at the two major HMOs shows, that expectation need not be satisfied in HMO health care. Mr. Clinton, his health reform, and the American people can only benefit if the president takes specific measures to ensure that patients' expectations and HMO reality are congruent.
Video Game-Related Seizures: A Report on 10 Patients and a Review of the Literature
Authors: Graf William D. , Chatrian Gian-Emilio , Glass Stephen T. , Knauss Thomas A. 
Published: December 2021

Objective. To further describe the features, postulated pathophysiology, treatment, and outcome of seizures occurring while playing or watching video games (video game-related seizures (VGRS)).
Design. We evaluated retrospectively 10 patients with VGRS seen by us and reviewed 25 reported cases.
Results. The 35 patients ranged in age from 1 to 36 years (mean: 13.2); and 26 subjects (74%) were male. Eight individuals (29%) had prior infrequent nonfebrile seizures, 4 (11%) had febrile convulsions, and 2 (6%) had a family history of epilepsy. VGRS consisted of generalized tonic-clonic seizures in 22 of 35 individuals (63%); absences in 2 (6%); simple partial seizures in 6 (19%); complex partial seizures in 4 (11%); and other manifestations in 4. Neurologic examination and computed tomographic and magnetic resonance imaging scans were normal. Electroencephalograms demonstrated generalized or focal, interictal or ictal epileptic patterns in 11 of 21 patients (52%) and photoparoxysmal responses in 17 of 32 (53%). Eleven of 15 individuals (73%) treated with video game (VG) abstinence alone, 3 of 6 who received anticonvulsants but played VGs, and 7 of 12 treated with combined VG abstinence and anticonvulsants had no further seizures.
Conclusions. We postulate that a special convulsive susceptibility of selected neurons in striate, peristriate, infratemporal, and posterior parietal cortices to particular visual stimuli plays a major role in VGRS. VG abstinence is the treatment of choice of VGRS. Anticonvulsant medication is suggested only for those individuals who continue to play VGs or suffer from seizures triggered by other, unavoidable visual stimuli, or from unprovoked attacks.
Does a Condom-Promoting Strategy (the Swiss STOP-AIDS Campaign) Modify Sexual Behavior Among Adolescents?
Authors: Hausser Dominique , Michaud Pierre André 
Published: December 2021

Objective. To measure sexual behavior changes (especially the use of condoms) among adolescents after 5 years of a population-based acquired immunodeficiency syndrome prevention strategy at the national and regional level.
Design. Two comparative cross-sectional surveys by self-administered questionnaires were conducted in 1987 and 1990.
Setting. Two similar samples of 16- to 19-year-old apprentices. The two samples, 1987 (n = 1359) and 1990 (n = 817), are comparable in terms of sex, age, profession, and location.
Results. The percentage of boys who say they are sexually active has remained the same (75%) and has slightly increased among younger girls (65% to 75%, NS). The average number of partners has remained steady for boys and girls. Regular use of any contraceptive device has remained steady among girls (75%) and increased among boys (1987, 38%; 1990, 54%; P &lt; .001). In 1987 as well as in 1990, the condom was the most widely used method (&gt;90%), followed by the pill (50%), withdrawal (20%), and chemicals (5%). Rates were about the same for both sexes. Rates of irregular use of condoms increased among boys and girls (P &lt; .01); regular use of condoms increased among boys (22% to 34%, P &lt; .01) and girls (10% to 27%, P &lt; .001); use of the pill has slightly decreased.
Conclusions. During a 5-year period, the Swiss "STOP-AIDS" campaign and local interventions had had no real effect on the rate of sexual activity of apprentices but had had a positive effect on the use of contraception and condoms. The prevention strategy should (and will) be maintained in the future.