bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of Nonhuman Milks in the Dietary Management of Young Children With Acute Diarrhea: A Meta-Analysis of Clinical Trials
Authors: Brown Kenneth H. , Peerson Janet M. , Fontaine Olivier 
Published: December 2021

Objective. To assess the effects of continued feeding of nonhuman milks or formulas to young children during acute diarrhea on their treatment failure rates, stool frequency and amount, diarrheal duration, and change in body weight.
Methods. A total of 29 randomized clinical trials of 2215 patients were identified by computerized bibliographic search and review of published articles. Data were abstracted and analyzed using standard meta-analytic procedures.
Results. Among studies that compared lactose-containing milk or formula diets with lactose-free regimens, those children who received the lactose-containing diets during acute diarrhea were twice as likely to have a treatment failure as those who received a lactose-free diet (22% vs 12%, respectively; P &lt; .001). However, the excess treatment failure rates occurred only in those studies that included patients whose initial degree of dehydration, as reported by authors, was severe, or that were conducted before 1985, when appropriate diarrhea treatment protocols were first widely accepted. Among studies of patients with mild diarrhea, all but one of which were completed after 1985, the overall treatment failure rates in the lactose groups were similar to the rates in the lactose-free groups (13% vs 15%). These results suggest that children with mild or no dehydration and those who are managed according to appropriate treatment protocols, such as that promoted by the World Health Organization, can be treated as successfully with lactose-containing diets as with lactose-free ones. The pooled information from studies that compared undiluted lactose-containing milks with the same milks offered at reduced concentration concluded that (1) children who received undiluted milks were marginally more likely to experience treatment failure than those who received diluted milk (16% vs 12%, P = .05), (2) the differences in stool output were small and of limited clinical importance, and (3) children who received the undiluted milk diets gained 0.25 SD more weight than those who received the diluted ones (P = .004). In addition, as with the previous set of studies, there were no differences in the pooled treatment failure rates between the respective groups in those studies of mildly dehydrated patients conducted after 1985 (14% vs 12%).
Conclusions. The vast majority of young children with acute diarrhea can be successfully managed with continued feeding of undiluted nonhuman milks. Routine dilution of milk and routine use of lactose-free milk formula are therefore not necessary, especially when oral rehydration therapy and early feeding (in addition to milk) form the basic approach to the clinical management of diarrhea in infants and children.
JUDGE LIFTS CALIFORNIA BAN ON IQ TESTS FOR BLACK CHILDREN
Authors: L. J. F. 
Published: December 2021

A federal judge in San Francisco ruled that any parent can arrange for the use of IQ testing in assessing students' learning disabilities, despite arguments that the tests discriminate against minorities.
Judge Robert F. Peckham issued a summary judgment ruling in favor of the families of nine black schoolchildren in California. The families were challenging the constitutionality of a statewide ban on the use of standardized intelligence tests for black children in California special-education classes.
The state Department of Education in 1986 banned the use of IQ tests for assessing black students, but the ban did not apply to students from other minority groups. Later, black students seeking access to programs for gifted students were exempted from the tests as well.
Cardiorespiratory Recordings From Infants Dying Suddenly And Unexpectedly at Home
Authors: Meny Robert G. , Carroll John L. , Carbone Mary Terese , Kelly Dorothy H. 
Published: December 2021

Objective. Little is known about the mechanism of death during sudden infant death. To study the mechanism, we obtained data on six infants who died while on a memory-equipped cardiorespiratory monitor.
Methods. Waveforms of respiration and heart rate trend were available for five infants; an alarm log only was available for the sixth. These printouts were reviewed with attention to mechanism and time to death.
Results. All infants were born prematurely; autopsies reported the cause of death as sudden infant death syndrome in three cases and bronchopulmonary dysplasia in the others. Bradycardia, which played a more prominent role than central apnea, was preceded by tachycardia in two deaths. Resuscitation occurred within 1 minute in four cases; no response to alarms occurred in the other two cases, apparently because the parents were desensitized by prior meaningless alarms. Five patients died within 20 minutes, whereas one death due to sudden infant death syndrome was prolonged.
Conclusion. Bradycardia is an important feature in all six of these infant deaths. Although its etiology is unknown, hypoxemia or obstructive apnea may precede bradycardia. Home monitors equipped to detect these possible antecedents will yield further insight into sudden infant death.
An Evaluation of Autonomic Nervous System Function in Patients With Prader-Willi Syndrome
Authors: DiMario Francis J. , Dunham Barbara , Burleson Joseph A. , Moskovitz Jay , Cassidy Suzanne B. 
Published: December 2021

Objective. Prader-Willi syndrome (PWS) is a complex multisystem genetic disorder in which many cardinal features may have a neurologically based patho-physiology involving both the central and peripheral components of the autonomic nervous system. Autonomic nervous system function was studied noninvasively in a group of subjects with PWS and control subjects to determine whether autonomic nervous system dysfunction exists as part of the PWS.
Design/setting. This cross-sectional study was performed in the neurophysiology laboratory at a tertiary care facility.
Methods. Evaluation included anthropometric measurements and calculation of a body mass index (BMI). Simultaneous electrocardiography and serial recordings of pulse rate and systolic/diastolic mean arterial blood pressures during orthostatic maneuvers were taken. Pupillary response to the instillation of dilute pilocarpine and measurements of plasma norepinephrine at rest and after standing were also obtained. Results were analyzed using two-tailed t tests, Fisher exact test, analysis of variance, and analysis of covariance adjusting for age, gender, and BMI.
Patients. There were 14 subjects with PWS (8 female, 6 male; aged 4 to 40 years, mean age 16 years) and 8 control subjects (4 female, 4 male; aged 5 to 37 years, mean age 19 years).
Results. Abnormal findings were obtained only in subjects with PWS. Analysis of covariance adjusting for age, gender, and BMI revealed a trend for subjects with PWS to have lower resting diastolic blood pressure (P &lt; .09) and significantly less change in diastolic blood pressure after standing (P &lt; .02). Subjects with PWS had significantly greater BMI than did control subjects (P &lt; .001), which correlated significantly with all pulse rate measurements where the greater the BMI the higher the pulse rate at rest (r = .25, P &lt; .04) and the lower the pulse rate after arising from lying to standing at both 15 and 30 seconds (r = .17, P &lt; .1; r = .55, P &lt; .08 respectively). Pupillary constriction of 2 mm or more was seen in 7 of 14 subjects with PWS and in no control subjects (P &lt; .004). The 30:15 R-R interval ratio was abnormal in 6 of 14 subjects with PWS and in no control subjects (P &lt; .03).
Conclusions. These results suggest that patients with PWS have a detectable underlying autonomic dysfunction characterized principally by diminished parasympathetic nervous system activity.
Simultaneous Technique for Acuity and Readiness Testing (START): Further Concurrent Validation of an Aid for Developmental Surveillance
Authors: Sturner Raymond A. , Funk Sandra G. , Green James A. 
Published: December 2021

Study objective. A brief (8-minute) procedure, now called Simultaneous Technique for Acuity and Readiness Testing or START, has been shown to be efficacious for predicting developmental outcomes and a cost-effective screen for visual acuity. The objective of the two studies reported here was to examine the ability of this procedure to predict concurrent developmental outcome by using a new simplified scoring system.
Design. A prospective design was used. Subjects were screened using START, and then samples were stratified on the basis of developmental screening results (START in study 1 and the revised Denver Developmental Screening Test and a shortened version of the Minnesota Child Development Inventory in study 2) into subsamples (n = 118 and 120) which were administered the standard criterion test (McCarthy Scales of Children's Abilities in one cohort and the Stanford-Binet in the other).
Setting. Prekindergarten registration for a rural school system in North Carolina.
Subjects. Two county-wide cohorts of preschool children (n = 352 and 362).
Measurements and main results. Results for prediction of the McCarthy outcomes were as follows: sensitivity, 0.76; specificity, 0.99; predictive value, 0.81; underreferral, 1.3%; overreferral, 1.0%; and percent agreement, 98%. Prediction of Stanford-Binet results was as follows: sensitivity, 0.94; specificity, 0.83; predictive value, 0.22; underreferral, 0.3%; overreferral, 16%; and percent agreement, 84%. Most of the overreferrals for the Stanford-Binet were in the clinically important borderline category.
Conclusion. These results provide further support for the concurrent validity of START. The results illustrate how routine health procedures can be restructured to obtain clinically useful data on specific child developmental functioning.
Parents' Responses to Vaccine Information Pamphlets
Authors: Clayton Ellen Wright , Hickson Gerald B. , Miller Cynthia S. 
Published: December 2021

Objective. To assess parents' knowledge and opinions about immunizations and immunization practices before and after introduction of vaccine information pamphlets.
Research design. Telephone questionnaire administered to parents whose children received immunizations in the preceding week.
Setting. Six private pediatric practices in Nashville area and resident continuity clinic at Vanderbilt University Medical Center.
Participants. Parents whose children were scheduled to receive immunizations were asked to participate. Interviews were completed with 177 parents whose children received immunizations before and 156 parents after pamphlets were introduced. These two groups of parents had similar demographic characteristics.
Results. Parents who received vaccine information pamphlets learned more about vaccines (2.38 facts/parent after vs 1.18/parent before vaccine information pamphlets, z = -6.28, P &lt; .0001) and were more eager to obtain immunizations for their children (76% vs 38%, χ2 = 47.24, P &lt; .001). Receipt of pamphlets did not make parents significantly more likely to report side effects from vaccines (63% after vs 55% before, NS) but tended to make them less likely to turn to non health care providers for information (58% after vs 69% before, χ2 = 3.73, P = .06). Parents who received pamphlets, however, said more often that they received too much information (20% vs 4%, χ2 = 14.9, P &lt; .001).
Conclusions. Vaccine information pamphlets enhanced parents' knowledge and acceptance of immunizations. There is room for further improvement.
Blowing Away Shot Pain: A Technique for Pain Management During Immunization During Immunization
Authors: French Gina M. , Painter Eileen C. , Coury Daniel L. 
Published: December 2021

Objective. To study the effect of an active distraction technique on pain in preschool children receiving diphtheria, pertussis, and tetanus immunization.
Design. Randomized, unblinded controlled study.
Setting. Columbus Public Health Department Immunization Clinics.
Participants. One hundred forty-nine 4- to 7-year-old children.
Intervention. Children were taught to blow out air repeatedly during the injection, as if they were blowing bubbles.
Results. Children who were taught to blow out air during their shots had significantly fewer pain behaviors (P &lt; .04) and demonstrated a trend toward lower subjectively reported pain (P = .06). There was no significant difference in the nurse or parent visual analog scale scores.
Conclusions. A simple distraction technique can be effective in helping children cope with the pain of immunization. The use of such a technique to relieve the pain and distress associated with even a brief painful procedure should be encouraged.
ALL-GIRL CLASSES TO HELP GIRLS KEEP UP WITH BOYS
Authors: L. J. F. 
Published: December 2021

A wealth of research shows that girls are largely shortchanged in traditional classrooms, particularly in math and science, where boys tend to dominate discussion, receive more of their teachers' time and wring the self-confidence from girls who enter school equal in achievement and attitude but leave with lower test scores and diminished dreams.
In response to that research, which shows girls scoring generally lower on standardized tests—there is a 50-point gap on the math S.A.T.—and avoiding advanced math and science classes, three California schools are segregating girls in some classes ...
The pilot was so popular that the program was expanded this year to include two math and two science classes for both freshman and sophomore girls.
It is the public schools, however, that could face legal challenges and the loss of state or federal money by offering segregated instruction.
Health Care Reform and the Special Needs of Children
Authors: Perrin James M. , Bloom Sheila R. , Kahn Robert S. , Davidson Stephen , Guyer Bernard , Hollinshead William , Richmond Julius B. , Wise Paul H. , Walker Deborah Klein 
Published: December 2021

Health care reform may well address many of the needs of children and adolescents, offering greater emphasis on prevention and providing insurance to the large number of US children currently uninsured. Yet key public health and community health service programs essential to the well being of children and adolescents have gained little attention in the current national health care reform debates. Most discussions focus on insurance and cost containment and fail to address other systemic barriers to health care. Insurance alone will not solve the health problems faced by children and adolescents.
SPECIAL NEEDS OF CHILDREN AND ADOLESCENTS
Addressing the health risks that children and adolescents face requires combining public and private efforts and community-oriented and personal care services.
Childhood Lead Poisoning in the '90s
Authors: Piomelli Sergio 
Published: December 2021

Lead is an extremely toxic metal: even a single atom of lead, once in the human body, binds to a protein and induces some damage; the greater the exposure, the more serious the effects. Lead has no physiological function; any amount of body lead reflects environmental pollution.1
In the 1990s, in the United States, is lead poisoning a devastating environmental threat to our children or is childhood lead poisoning a threat of the past? Probably neither of these statements is correct. It may be worthwhile to look at the current situation in detail.
In the 1970s, before efforts were made to reduce environmental lead, common effects in children of the widespread environmental contamination with lead were encephalopathy and even death.
Letter to the Editor
Authors: Holberg Catharine J , Duncan Burris , Ey John 
Published: December 2021

We would like to thank Dr Heery for his comments on our paper "Exclusive Breast-Feeding for at Least 4 Months Protects Against Otitis Media."1 The first finding he mentions refers to a decrease in the mean number of otitis media (OM) episodes with increasing duration and exclusivity of breast-feeding. Dr Heery is correct that this part of the analysis did not control for other potential risk factors. We had preferred to give the actual mean number of otitis media episodes by breast-feeding status (Table 2), which most clearly expresses the data in its raw form, rather than deriving predicted or adjusted means, which are more removed from the data.
See table in the PDF file
Letter to the Editor
Authors: Snellman Leonard W. , Stang Howard J. , Johnson Dwight R. , Kaplan Edward L. 
Published: December 2021

We appreciate Dr Wald's interest in our article1 and the opportunity to respond to some of her comments.
Patients in our study were not treated with a varying number of doses before the performance of a repeat throat culture, but had a throat culture performed before each of the first four doses of oral antibiotic if treated with oral penicillin or erythromycin. The initial and three subsequent throat cultures were performed at intervals similar to those patients treated orally if patients were treated with intramuscular benzathine penicillin G.
ACADEME GETS LESSONS FROM BIG BUSINESS
Authors: L. J. F. 
Published: December 2021

PITTSBURGH—Like many other academics, Richard Florida used to stand before his public-policy classes at Carnegie Mellon University here and lecture students who silently copied every word.
But after a weeklong seminar in "Total Quality Management" at Xerox Corp. this past summer, Prof. Florida has a new style: He sits with his legs crossed in the corner of the classroom, listening and doodling. While he draws, the students, whom Prof. Florida considers his "customers," plan the course, design the syllabus, run the classes and even suggest their own grades.
Prof. Florida is practicing a controversial new brand of education. He says he believes that by treating students as customers and allowing them to choose what they want to learn, he is making them better thinkers, superior problem-solvers and more employable graduates.
"We're setting up an educational system here that's totally geared to meeting customer requirements," he says. "We've got to serve these customers if we're going to survive."
MINNESOTA TAKES CONTROVERSIAL STEPS TO REFORM HEALTH CARE
Authors: L. J. F. 
Published: December 2021

When Minnesota legislators last spring passed health legislation that included a tax on health care providers, many physicians thought the state had gone too far. As the state begins to implement the law, however (physicians will begin paying the tax in 1994), those same physicians are realizing that their troubles may have just begun.
The tax is only one part of a larger health reform package that promises to change the way Minnesota physicians practice. Under the law, for example, the state will assign physicians to some patients. The law also requires the state to develop practice parameters and controls on technology...
Beginning in 1994, physicians will pay a 2% income tax on their gross revenues. The tax, which will not be levied on Medicare or Medicaid services or on physicians employed by managed care providers, will help pay for health insurance for the state's approximately 400,000 uninsured.
Many physicians opposed the legislation because it will cut into their pay...
And to achieve its goal of reducing health care costs by 10% a year for five years, the state will develop and implement practice parameters in an attempt to avoid ineffective treatment.
THE VA IS THE LARGEST HEALTH CARE SYSTEM IN THE USA
Authors: L. J. F. 
Published: December 2021

What would the chances for congressional approval of President Clinton's health care plan be if Americans peered into the future and discovered that:
Over half of the patients (55%) in the plan with routine medical problems wait three hours or longer, sometimes all day, to be seen for a few minutes by an over-worked doctor struggling with increasing numbers of patients and piles of government forms, regulations, controls and policy directives...
The VA is the largest health care system, public or private, in the U.S. and one of the largest in the world. It operates 171 medical centers with 80,000 beds; 362 out-patient and community clinics with 23 million patient visits annually...
VA is the quintessential government bureaucracy: administratively officious and laden with red tape and regulatory minutiae destructive to both quality patient care and staff conduct. Three volumes of the U.S. Code (title 38) and a full volume of the Code of Federal Regulations, plus scores of volumes of federal personnel and other policy restrictions, govern each VA employee's every move. Thousands of pages provide detailed descriptions of medical conditions, degrees of disability and potential eligibility for pension benefits and free health care.
Providing Comprehensive Health Care to Children With Chronic Illness
Authors: Jessop Dorothy Jones , Stein Ruth E. K. 
Published: December 2021

Objectives. To test whether a program of outreach and comprehensive health care for children with chronic disorders provides more complete care and reduces unmet health needs compared with traditional care.
Design. A pretest-posttest randomized control trial.
Setting. An inner-city municipal teaching hospital.
Sample. Two hundred nineteen systematically enrolled mothers of children with diverse chronic physical health conditions.
Interventions. A comprehensive outreach program, Pediatric Home Care (PHC), contrasted with Standard Care.
Measurements and Results. Nine elements of comprehensive care established in the literature as components of a basic package of care for those with chronic conditions. The PHC intervention addressed gaps in services and improved both the acquisition and maintenance of elements of comprehensive care.
Conclusions. These data suggest mechanisms through which comprehensive care programs may contribute to the improvement in psychological and social outcomes previously reported for those in the PHC intervention.
Outcome of Very Low Birth Weight Infants: Multiple Gestation Versus Singletons
Authors: Leonard Carol H. , Piecuch Robert E. , Ballard Roberta A. , Cooper Bruce A. B. 
Published: December 2021

Objective. Multiple gestation infants are overrepresented in intensive care nurseries, and have been reported to have greater morbidity than singletons. A cohort of very low birth weight infants was examined to determine outcome of premature infants based on gestation type (multiple or single) and hypothesized that at this low birth weight, the outcome of the groups would be similar.
Method. The sample was composed of all infants with birth weights ≤1250 g born in a 10-year period (September 1977 through September 1987). Ninety-two percent (n = 364) of the infants discharged were seen at 1 year of age, and 73% (n = 249) were observed to school age. Morbidity was assessed by neurodevelopmental examinalions and standard developmental tests.
Results. At 1 year of age and at school age, there were no differences in neurologic or neurosensory outcome between multiple gestation and single gestation infants. Logistic regression analyses were performed on the school age data, using cognitive outcome as the dependent variable and gestation type, birth weight, gestational age, intracranial hemorrhage, chronic lung disease, and a social risk factor as predictor variables. Gestation type was not associated with cognitive outcome at school age. Social risk factors and chronic lung disease showed an association with cognitive outcome at school age.
Conclusions. Multiple gestation was not related to increased morbidity in this very low birth weight group. The developmental outcome of all infants with birth weights ≤1250 g in this study was related to medical and social risk factors. These findings were consistent for a large group of infants over a 10-year period.