bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rheumatic Fever Prophylaxis Using Benzathine Penicillin G (BPG): Two-week Versus Four-week Regimens: Comparison of Two Brands of BPG
Authors: Kassem Ahmed Samir , Zaher Salah R. , Shleib Hamida Abou , El-Kholy Abdel Ghany , Madkour Ahmed A. , Kaplan Edward L. 
Published: December 2021

Objective. This prospective study was aimed at answering two important questions: 1) Is a biweekly schedule of 1.2 million U intramuscular benzathine penicillin G (BPG) superior to a 4-week one in the prevention of upper respiratory Group A beta-hemolytic streptococcal (GABHS) infections and rheumatic fever (RF) recurrences? 2) Is there a difference in the bioavailability of BPG obtained from different manufacturers?
Methodology. Three hundred sixty rheumatic patients aged 4 to 20 years were randomly assigned to either a biweekly (190 patients) or 4-week (160 patients) BPG prophylactic schedule and were followed-up monthly for 2 years by clinical examination, throat swab culture for GABHS and measurement of antistreptolysin O titer to detect GABHS infection and/or recurrences of RF (according to revised Jones' Criteria). Thereafter, 34 rheumatic subjects, aged 8 to 16 years were randomly assigned to receive a 4-week injection of 1.2 million U of either a locally manufactured BPG brand (22 patients) or an imported one (12 patients). Sera of all patients were tested for penicillin level by plate diffusion method on days 1, 2, 3, 4, 5, 6, 7, 14, 21, and 28 after the intramuscular injection of BPG.
Results. The GABHS infection rate was found to be 0.2% and 0.3% for patients on the biweekly and 4-week BPG schedules, respectively, with no significant differences between them. However, the RF recurrence rate/patient/year for the 4-week schedule patients (0.12) was double that for the biweekly schedule ones (0.06). Estimation of the bioavailability of the two different brands of BPG demonstrated a difference in their pharmacokinetics and a decrease in the serum penicillin concentration below the minimum inhibitory concentration 3 weeks after the injection of either brand.
Conclusion. Although a biweekly schedule may not be superior in preventing upper respiratory GABHS infection, it may play a role in preventing the sequelae of such infections. The short duration of penicillinemia explains the superiority of the 2-week schedule in RF prophylais. The difference in the pharmacokinetics of penicillin brands might contribute to the high recurrence rate of RF reported in Egypt.
The Evolution of Therapy for Dehydration: Should Deficit Therapy Still Be Taught?
Authors: Holliday Malcolm 
Published: December 2021

Objective. To describe the evolution of rehydration therapy for cholera and diarrhea! dehydration from its beginning in 1832 to the present. To reaffirm the central role for extracellular fluid (ECF) expansion and question the continued teaching of deficit therapy in many current pediatric texts.
Methodology. I reviewed the rationale underlying three treatment strategies: rapid parenteral infusions of saline solutions to restore ECF; deficit therapy to replace specific electrolyte and water losses; and oral rehydration therapy (ORT) to effect both. I used crude mortality rates as the measure of outcomes.
Results. (1) Beginning in 1832 for cholera and 1918 for infant diarrheal dehydration, parenteral saline infusions were infused to replace losses of salt and water; they were very effective in salvaging moribund dehydrated patients by quickly restoring ECF volume and renal perfusion. Mortality rates dropped from more than 60% to less than 30%. (2) Deficit therapy as it evolved in the 1950s defined potassium and other fluid and electrolyte defidts and replaced them using specific but complicated fluid and electrolyte replacement regimens. Mortality rates dropped to single digits. (3) ORT, with intravenous expansion of ECF volume when indicated, rapidly corrected specific fluid and electrolyte disorders with a very simple therapeutic regimen. Mortality rates dropped to less than 1%.
Conclusions. The simpler, more effective ORT regimen should be taught as standard therapy for diarrheal dehydration. Principles of body fluid physiology should be taught in their own right.
Serum Leptin in Children With Obesity: Relationship to Gender and Development
Authors: Hassink Sandra G. , Sheslow David V. , de Lancey Elizabeth , Opentanova Irina , Considine Robert V. , Caro Jose F. 
Published: December 2021

Background. The identification of the ob gene and its adipocyte-specific protein leptin has provided the first physiologic links to the regulatory system controlling body weight. In adults, elevations of serum leptin concentrations were closely correlated with the percentage of body fat. This study investigated whether leptin concentrations were elevated in obese children and the relationship between leptin concentrations and gender, pubertal stage, and race.
Methods. Seventy-seven children (44 girls and 33 boys), mean age, 11.3 years, with a body mass indices (BMIs) greater than 95% for age, race, and gender (mean BMI, 34.4) constituted the obese group. Thirty children (20 girls and 10 boys), mean age, 13.3 years, with BMIs less than 85% for age, race, and sex formed the control group. Radioimmunoassay for serum leptin was performed on a blood sample collected from each child after an overnight fast.
Results. The mean serum concentration of leptin in the obese group was 38.6 (SD, 21) ng/mL compared with 7.8 (SD, 6.5) ng/mL in the control group. Serum leptin concentrations were highly correlated with BMI (r = .88). Analysis of covariance revealed a main effect for Tanner stage and gender.
Conclusions. As in adults, obese children have high concentrations of serum leptin, which were highly correlated with arm fat and BMI. Increased adipose tissue in children is associated directly with serum leptin concentration. Leptin concentrations were found to vary with Tanner stage independent of adiposity. Compared with boys, girls had increased leptin concentrations independent of adiposity. It was hypothesized that children manifest a relative "leptin resistance" to support increased growth and development of reproductive capacity.
The Risk of Seizure Recurrence After a First Unprovoked Afebrile Seizure in Childhood: An Extended Follow-up
Authors: Shinnar Shlomo , Berg Anne T. , Moshe Solomon L. , O'Dell Christine , Alemany Marta , Newstein David , Kang Harriet , Goldensohn Eli S. , Hauser W. Allen 
Published: December 2021

Objective. To assess the long-term recurrence risks after a first unprovoked seizure in childhood.
Methods. In a prospective study, 407 children who presented with a first unprovoked seizure were then followed for a mean of 6.3 years from the time of first seizure.
Results. One hundred seventy-one children (42%) experienced subsequent seizures. The cumulative risk of seizure recurrence was 29%,37%,42%, and 44% at 1,2,5, and 8 years, respectively. The median time to recurrence was 5.7 months, with 53% of recurrences occurring within 6 months, 69% within 1 year, and 88% within 2 years. Only 5 recurrences (3%) occurred after 5 years. On multivariable analysis, risk factors for seizure recurrence included a remote symptomatic etiology, an abnormal electroencephalogram (EEG), a seizure occurring while asleep, a history of prior febrile seizures, and Todd's paresis. In cryptogenic cases, the risk factors were an abnormal EEG and an initial seizure during sleep. In remote symptomatic cases, risk factors were a history of prior febrile seizures and age of onset younger than 3 years. Risk factors for late recurrences (after 2 years) were etiology, an abnormal EEG, and prior febrile seizures in the overall group and an abnormal EEG in the cryptogenic group. These are similar to the risk factors for early recurrence.
Conclusions. The majority of children with a first unprovoked seizure will not have recurrences. Children with cryptogenic first seizures and a normal EEG whose initial seizure occurs while awake have a particularly favorable prognosis, with a 5-year recurrence risk of only 21%. Late recurrences do occur but are uncommon.
Parental Availability for the Care of Sick Children
Authors: Heymann S. Jody , Earle Alison , Egleston Brian 
Published: December 2021

Objective. Parents have always played a critical role in the care of sick children. Although parents' roles remain crucial to children's health, parental availability has declined during the past half century. The percentage of women with preschool children who work has risen almost fivefold in 45 years from 12% in 1947 to 58% in 1992. The percentage of women in the paid work force with school-aged children has almost tripled in the same period, from 27.3% to 75.9%. Research has examined the effects of a variety of parental work conditions on children. However, past research has not examined how working conditions affect the ability of parents to care for their sick children. In this article, we examine how often the children of working parents get sick and whether parents receive enough paid leave to care for their sick children.
Methodology. This analysis makes use of two national surveys, which provide complementary information regarding the care of sick children. The National Longitudinal Survey of Youth is a longitudinal survey of a nationally representative probability sample of 12 686 men and women; the National Medical Expenditure Survey is a panel survey of 34 459 people. First, we estimated the family illness burden. Second, we looked in detail at the number of days of sick leave mothers had. Third, we examined whether mothers who had sick leave had it consistently during a 5-year period. Finally, we conducted a logistic regression to determine what factors were significant predictors of both lacking sick leave.
Results. More than one in three families faced a family illness burden of 2 weeks or more each year. Yet, 28% of mothers had sick leave none of the time they were employed between 1985 and 1990. Employed mothers of children with chronic conditions had less sick leave than other employed mothers. Thirty-six percent of mothers whose children had chronic conditions had sick leave none of the time they were employed. Although 20% of working parents who did not live in poverty lacked sick leave, 38% of parents who did live in poverty lacked sick leave. The problem is also more marked for nonwhite parents. Although 23% of working white parents lacked paid sick leave, 31% of nonwhite parents lacked sick leave. One in six families that lacked sick leave had to cover for more than 4 weeks of family illness during the year.
Conclusion. In 1993, the US Congress passed the Family and Medical Leave Act (FMLA). However, by limiting the medical leave to the care of major illnesses, primarily those requiring hospitalization, the FMLA does not address the majority of children's sick care needs. For the common childhood illnesses that are not covered by the FMLA, employed parents often must rely on their sick leave if they are to care for their sick children themselves. Yet, we found that many employed parents lack sick leave. This is particularly true of parents of children with chronic conditions and poor and minority families.
Maternal Risks for Very Low Birth Weight Infant Mortality
Authors: Sumits Tracey , Bennett Robert , Gould Jeffrey 
Published: December 2021

Objective. To determine whether known maternal risk factors for low birth weight directly contribute to infant mortality among very low birth weight infants.
Design. Retrospective population-based, case-control study.
Setting. Four hospitals in the Oakland, California, area: one community, two private, one health maintenance organization.
Participants. All live-born singleton very low birth weight (&lt;1500 g) infants born to Oakland residents over a 3-year period. Cases were infants who died before their first birthday, identified by computerized linkage of birth and death certificates. For each case, a surviving control was selected to match for birth weight, sex, and race. Forty matched pairs were identified in total.
Outcome Measures. Prevalence of maternal risk factors among cases versus controls.
Results. After controlling for other factors known to influence either birth weight or infant mortality, maternal cocaine use (odds ratio [OR] = 5.43), prior infant death (OR = 27.14), and planned pregnancy (OR = 6.33) were significantly associated with the survival of very low birth weight infants.
Conclusions. Some maternal risk factors for low birth weight confer a survival advantage to very low birth weight infants. Our data reveal that maternal cocaine use is independently associated with survival among this subset of infants. Prior research supports the observed relationship as well as the scientific plausibility of a cocaine-mediated survival advantage among premature infants. Our study also showed both planned pregnancy and prior infant death to be independently associated with infant survival among this subset of infants, sugesting that maternal behaviors may play a role in determining birth weight-specific mortality. These data should be systematically evaluated to better define their relationship to infant mortality.
THE MAKING OF A PHYSICIAN
Authors: Darby C. P. 
Published: December 2021

We must be aware that freedom from organic disease alone can not be our goal. The optimal functioning of the individual must be our aim, and that it occur in an environment conducive to a fuller life. We must be aware that man does not live by bread alone, nor by his antihypertensive pill alone. We must be citizens of the community, helping to make it a better place for the raising of our children, for a fuller educational opportunity, for the development of the arts and other cultural aspects which help raise man above the level of animal life.
Thus, the making of a doctor almost begins at his mother's knee. Nurtured further by society and its educational and Cultural institutions, he is finally given a privilege by society, to act in a responsible way in furthering the health, both physical and mental, of those he calls his patients. (Delivered to medical students and faculty, School of Medicine, University of South Dakota, May 1976 by Mitchell I. Rubin, MD, Emeritus Professor of Pediatrics, State University of New York at Buffalo, and Consultant in Pediatrics, Medical University of South Carolina).
Pain in Pediatric Human Immunodeficiency Virus Infection: Incidence and Characteristics in a Single-institution Pilot Study
Authors: Hirschfeld Steven , Moss Howard , Dragisic Katherine , Smith Wendy , Pizzo Philip A. 
Published: December 2021

Objective. Children with human immunodeficiency virus (HIV) infection have multiple complications associated with the disease process. Many of these complications are potentially painful and could affect the patient's quality of life. We examined the incidence and characteristics of the perception of pain in a cohort of families with children with HIV infection.
Methodology. A questionnaire was developed and validated with a cohort of families with children with cancer. In a survey of families at the Pediatric Branch of the National Cancer Institute, 61 children with HIV infection and their care givers, along with 19 children with cancer and their care givers, were interviewed to determine the incidence and impact of pain.
Results. Fifty-nine percent of the HIV-infected children and 55% of their care givers described pain as a component of their illness that impacted on their lives. Younger children and girls tended to report more pain. There was also a tendency for biological parents to expect and to treat more pain than foster parents, although there was no difference in the incidence of pain that biological and foster parents reported for their children. No differences were found between parents who were HIV posifive and those who were not. In addition, no correlations were noted in incidence, expectation, or impact of pain with disease progression or surrogate markers such as CD4 counts. Pain in HIV-infected patients tended to be either in the gastrointestinal tract or limbs and usually responded to nonsteroidal anti-inflammatory therapy. The patients with cancer reported an incidence (47%) and impact of pain similar to those of previously reported studies on pediatric patients with cancer.
Conclusion. Pain is common among children infected with HIV and can adversely impact on their lives, and its management should be a component of the general care of these patients.
Hypoglycemia and Cortisol Deficiency Associated With Low-dose Corticosteroid Therapy for Asthma
Authors: Carrel Aaron L. , Somers Stephanie , Lemansne Robert F. , Allen David B. 
Published: December 2021

In the article by Carrel et al entitled "Hypoglycemia and Cortisol Deficiency Associated With Low-dose Corticosteroid Therapy for Asthma," reference #18 was incomplete. The correct citation is (boldface type indicates the correction):
18. Lemanske RF, Allen DB. The safety of chronic asthma treatments: continuous beta agonist therapy and prolonged inhaled corticosteroids in childhood asthma. In: Middleton E, Reed CE, Ellis EF, Adkinson NF, Yuninger JW, Busse WW, eds. Allergy: Principles and Practice. 4th ed. (Update #15). St Louis: Mosby; 1993
Paternity After Unilateral Cryptorchidism: A Controlled Study
Authors: Lee Peter A. , O'Leary Leslie A. , Songer Nancy J. , Coughlin Michael T. , Bellinger Mark F. , LaPorte Ronald E. 
Published: December 2021

Objective. To determine if paternity is decreased among formerly unilateral cryptorchid men compared with a control group of men.
Subjects and Methods. Formerly unilateral cryptorchid men who had orchiopexy between 1955 and 1971 at the Children's Hospital of Pittsburgh and a group of control men have had their medical records reviewed and have been surveyed by questionnaire.
Results. Among the men who had ever married and had attempted paternity, significantly more of the unilateral cryptorchid men had been unable to father children (10.5%) than among the control group (5.4%). No difference was found when the groups were compared for the duration of regular intercourse without contraception to conception of their first child. There was no relationship between the age of orchiopexy or lifestyle factors and paternity or between the age of orchiopexy and months of regular unprotected intercourse to conception. Paternity among both groups was related to femalerelated infertility factors and to the presence of vericoceles.
Conclusion. When compared with a control group, paternity was compromised after unilateral cryptorchidism. Infertility is about twice as frequent among the unilateral group. There was no evidence of subfertility requiring a longer exposure of regular intercourse without contraception among the fertile subgroup. No correlation was found between age of orchiopexy and paternity.
Neonatal Cranial Ultrasound Abnormalities in Low Birth Weight Infants: Relation to Cognitive Outcomes at Six Years of Age
Authors: Whitaker Agnes H. , Feldman Judith F. , Van Rossem Ronan , Schonfeld Irvin Sam , Pinto-Martin Jennifer A. , Torre Carolyn , Blumenthal Suzannah R. , Paneth Nigel S. 
Published: December 2021

Objective. To assess the independent relation of neonatal cranial ultrasound (US) abnormalities in low birth weight (LBW) infants to cognitive outcomes at 6 years of age.
Design. Prospective cohort study.
Sample and Methods. Six-year follow-up data were obtained on a regional birth cohort of LBW infants (&lt;2 kg) systematically screened as neonates with serial US. US abnormalities were dichotomized into isolated germinal matrix/intraventricular hemorrhage (GM/IVH) and parenchymal lesions/ventricular enlargement (PL/VE). Global cognitive outcomes (mental retardation, borderline intelligence, and normal intelligence) and selected specific cognitive abilities were assessed at 6 years of age with standardized instruments. Multivariate techniques were used to assess the effects of US independent of maternal social disadvantage at birth and other perinatal and neonatal risk factors.
Results. The sample as a whole had a significantly elevated rate of mental retardation (MR; 5%), almost all moderate to profound in severity. PL/VE was independently related to MR (odds ratio [OR], 65.8; confidence interval [CI], 19.1 to 22.4) and borderline intelligence (OR, 3.7;CI, 1.3 to 10.8); isolated GM/IVH was more modestly related to MR (OR, 4.6; CI, 1.2 to 18.6) but not related to borderline intelligence. Approximately half of the cases of MR were attributable to PL/VE independent of other factors. Of non-US factors, the number of days receiving mechanical ventilation increased the risk for MR. Maternal social disadvantage increased the risk for borderline intelligence but not MR. Among children of normal intelligence, those with PL/VE, but not isolated GM/IVH, performed more poorly than those without US abnormalities on tests of visual perceptual organization but not on tests of language, memory, or quantitative skills.
Conclusion. Prevention of white matter injury would substantially improve cognitive outcomes for LBW infants.
Using Research to Change Public Policy: Reflections on 20 Years of Effort to Eliminate Corporal Punishment in Schools
Authors: Hyman Irwin A. 
Published: December 2021

In the past 20 years, over half of the states have abolished corporal punishment in schools. Without the use of ethically questionable, experimental studies in which students were randomly assigned to paddlings, advocacy researchers were able to integrate the literature and experimental research on reward, punishment, and motivation, and conduct enough studies to provide sufficient data for policy changes. Further, every popular school discipline training program promotes well-proven positive and preventive techniques and punishments that do not inflict physical pain24. Research on alternatives, naturalistic evidence from schools that eliminated corporal punishment, and survey research prove that schools do not need to use corporal punishment.2
The movement to eliminate parental spanking is at a stage similar to the beginning of the school corporal punishment debate in 1976. Even though some studies may show that moderate parental spanking may do no short-term harm, there is little scientific evidence that it is necessary.30 There are no data to indicate that schools which eliminated corporal punishment became any worse.18
The same demographic factors and political polarizations that have kept about half of American school children from the protections against paddling afforded students in almost all other Western democracies also impede the movement to eliminate parental spanking. Since we know that corporal punishment too often leads to excesses, and since we have a multitude of effective positive approaches, what is the worst thing that would happen if all Americans stopped hitting children in any setting?
The same children who are hit for misbehavior would continue that misbehavior and other ineffective punishments would be used.