bluuebunny/crossref_metadata_2025_split huggingface dataset:
Alternative Child Care in France: Advances in the Study of Motor, Interactive, and Social Behaviors of Young Children in Settings Allowing Them to Move Freely in a Group of Peers
Authors: Montagner Hubert , Gauffier Gérard , Epoulet Bernard , Restoin Albert , Goulevitch Robert , Taule Marguerite , Wiaux Bernard 
Published: December 2021

This paper reports new data on the emergence and development from the 9th to 19th month of age of motor, interactive, and social behaviors of 17 children with peers in a milieu that allows the "conquest" of the third dimension of space without limitation of their motor activity. Their motor skills and social behaviors appear more precocious and complex than previously indicated by scientific publications, clinical observations, and developmental scales.
1. The motor skills that allow the "conquest" of climbing structures (ascents of a spiral staircase and a ramp) are already observed before the age of 12 months in some children (ascents of the ramp) or nearly half of them (ascents of the staircase). Complex social behaviors (multimodal interactions from here and there along a holed partition, imitations, cooperations, anticipation of the behavior of the partner) also emerge before 12 months.
2. The age range from 12 to 14 to 15 months is characterized by consolidation of the motor skills that allow the "conquest" of the third dimension of the space and a rapid increase of the imitations and interactions around the holed partition.
3. The age range from 14 to 18 months is characterized by diversification of the posturomotor patterns during ascents and descents of staircase and ramp and the growing predominance of the standing position. This is also a phase of significant increase in frequency of imitations and cooperations and of emergence of complex forms of cooperation.
4. Aggression is infrequent at all ages.
Fatal Child Abuse and Sudden Infant Death Syndrome: A Critical Diagnostic Decision
Authors: Reece Robert M. 
Published: December 2021

Distinguishing between an unexpected infant death due to sudden infant death syndrome (SIDS) and one due to fatal child abuse challenges pediatricians, family physicians, pathologists, and child protection agencies. If child abuse is suspected, the physician must fuffill mandated legal obligations to report the case to the appropriate authorities. Coroners, medical examiners, and pathologists have the added responsibility of rendering a medicolegal opinion as to the cause and manner of death. Child protection agencies need to ensure that other children in the home are not at risk. Law enforcement personnel and prosecutors need to proceed if the law has been broken. All agree that the state of our knowledge in this area is incomplete and ambiguity exists in some cases. For everyone concerned, it is necessary and desirable, within the limits of our capability, to know the cause and manner of an infant death. This process requires application of current knowledge, a desire to know the reasons for the deaths, the resources necessary to conduct essential procedures, and the sensitivity and wisdom to perform the task without causing distress to innocent family members.
The history relevant to this decision is a relatively short one. In the first half of this century, searching for the reasons infants die was the lonely province of a few clinicians, researchers, and pathologists who examined the retrospective traces of infant deaths. Bergman1 recounts the slow progression of knowledge about sudden unexpected infant death in the pathologists' laboratories and morgues where Werne and Garrow2 and then Adelson and Kinney3 proposed etiologies for "crib death" other than suffocation.
SIDS and Sleeping Position
Authors: SHANNON DANIEL C. , HUNT CARL E. 
Published: December 2021

In Reply.—
Guntheroth and Spiers,1 displeased with our commentary in Pediatrics,2 have raised many issues. However, the key question is whether the scientific data incriminating the prone position as a contributor to SIDS warrant a recommendation to change sleeping position at this time. Based on our critical review of the literature, we conclude that this recommendation was premature and unwarranted.
Accepting the current definition of SIDS as the sudden death of an infant that remains unexplained even after a thorough postmortem examination, death scene investigation, and review of the clinical history, one can decide which of the 15 published studies in which a statistical association is described between prone sleeping and SIDS is acceptable.
The Changing Role and Responsibilities of a Chairman—Letters
Authors: STRASBURGER VICTOR C. 
Published: December 2021

To the Editor.—
Dr Brent's article on academic chairmen (Pediatrics. 1992;90:50-57) was terrific—insightful, helpful, and much needed. If I may be so bold as to add one further insight and suggestion: When chairmen of academic departments are selected, invariably it seems to be done by the "weight of the c.v." approach. An outstanding researcher does not necessarily make an outstanding chairman. (In fact, one could argue that there are skills needed for bench or clinical research that are antithetical to those needed to chair an academic department.)
The Use of Cow's Milk in Infancy
Authors: KLEINMAN RONALD E. 
Published: December 2021

In Reply.—
The Committee on Nutrition of the American Academy of Pediatrics recently recommended that the introduction of whole cow's milk into an infant's diet should be delayed until 1 year of age.1 The relationship between insulin-dependent diabetes mellitus (IDDM) and bovine albumin is well established in rat and mouse models of IDDM. However, the relationship between the ingestion of dairy products and diabetes in humans is still at a very preliminary stage. The recent report of 146 Finnish children with antibodies to a fraction of bovine albumin certainly will stimulate further investigation but, as MacLaren and Atkinson point out, this single observation does not prove that cow milk protein is either the cause or promotor of diabetes mellitus in humans.
Effects of Time-in-Clinic, Clinic Setting, and Faculty Supervision on the Continuity Clinic Experience
Authors: Osborn Lucy M. , Sargent Janice R. , Williams Scott D. 
Published: December 2021

Study objective. To evaluate the effects of setting, type of supervision, and time in clinic on the resident continuity clinic experience.
Design. Prospective cohort with preintervention and postintervention measures.
Settings. Pediatric residents selected one of three clinic settings for their continuity clinic experience. These included a traditional, university-based clinic, private practice offices, and publicly funded community-based clinics.
Subjects. All pediatric residents at the University of Utah Health Sciences Center, July 1985 through June 1991.
Interventions. Using varied clinic sites, matching residents one or two to one with preceptors for their continuity clinic, increasing continuity clinic from 1 to 2 half-days per week.
Measurements and main results. Residents in private offices had the most varied experience, seeing more patients, more acute care, and a broader age range of patients than residents at other sites. They were more likely both to be observed by their preceptors during patient visits and to observe their preceptors delivering care. Because the number of patients seen per session rose, increasing continuity clinic time from one to two half-days per week more than doubled the number of patients seen per week. Increased time away from hospital did not affect scores on the Pediatric In-Training Examination. While test scores were similar for incoming residents, those in private offices scored higher on the final Behavioral Pediatrics Examination (P &lt; .05).
Conclusions. Clinic setting, time in clinic, and faculty supervision affect the quality of the continuity clinic experience. Increased time in clinic resulted in a broader exposure to patients. Residents placed in private offices had a more varied patient mix, were more closely supervised, and seemed to gain primary care skills more rapidly than residents at other sites.
Increased Leukocyte Elastase of the Tracheal Aspirate at Birth and Neonatal Pulmonary Emphysema
Authors: Fujimura Masanori , Kitajima Hiroyuki , Nakayama Masahiro 
Published: December 2021

Objective. The authors have previously shown the association of elevated neonatal serum IgM and chorioamnionitis in infants in whom pulmonary emphysema characteristic of Wilson-Mikity syndrome subsequently developed. This paper extends the observation to the measurement of polymorphonuclear leukocyte elastase-α1-proteinase inhibitor complex (PMN elastase-α1-PI) in tracheal aspirates of infants with chronic lung disease.
Patients. Tracheal aspirates were obtained from 90 very low birth weight neonates within 24 hours of birth. Serum also was collected within 72 hours of birth, and placentas were examined for signs of inflammation.
Results. The mean PMN elastase-α1-PI was significantly elevated (21.8 µg/mg albumin) in infants with a pulmonary emphysema syndrome like that designated by Wilson-Mikity compared either with those with bronchopulmonary dysplasia (1.5 µg/mg albumin, P &lt; .01) or those with respiratory distress syndrome in whom bronchopulmonary dysplasia did not develop (2.3 µg/mg albumin, P &lt; .01). Infants with pulmonary emphysema had a significantly elevated mean serum IgM and a high incidence of chorioamnionitis.
Conclusions. The level of PMN elastase-α1-PI was increased in the tracheal aspirates of newborns in whom pulmonary emphysema developed. Intrauterine inflammation may increase the level of PMN elastase in the fetal respiratory tract. This increase in PMN elastase-α1-PI in fetal lung tissue may cause lung injury in utero, resulting in postnatal pulmonary emphysema consistent with the Wilson-Mikity syndrome following ventilation.
Shunts in Patients With Respiratory Distress Syndrome
Authors: EVANS NICK 
Published: December 2021

To the Editor.—
Although I agree with many of the echocardiographic findings of Walther et al1 they have not given us sufficient data to draw their main conclusion: that large right-to-left (R-L) shunts are common in preterm neonates with severe respiratory distress syndrome (RDS).
They base this conclusion on two observations. First, they believe that aortopulmonary pressure differences are small in these neonates. Pulmonary arterial pressures in RDS are high2 but, as previously published data have shown,3 they are predominantly subsystemic and therefore not likely to be conducive to a large R-L shunt.
Down Syndrome and Omphalocele: An Underrecognized Association
Authors: Reddy Vinay N. , Aughton David J. , DeWitte David B. , Harper Cheryl E. 
Published: December 2021

Omphalocele is associated with Down syndrome,1 and the concurrence of omphalocele and Down syndrome has been reported several times.1-8 However, these observations are not noted in standard genetic reference books (such as references 9 through 15), genetic databases (such as POSSUM), or pediatric textbooks (such as references 16 through 18). We report a further case of omphalocele associated with Down syndrome, in which the presence of this "atypical" major anomaly, combined with initially good muscle tone and marked but transient facial edema, led to a brief delay in recognizing the clinical diagnosis of Down syndrome.
CASE REPORT
The propositus was born to a 33-year-old, gravida 2, para 1 woman via primary cesarean section for face presentation after a 41-week pregnancy that was complicated by maternal hypertension and by premature onset of labor early in the third trimester, controlled by bed rest.
Acrodermatitis-Like Syndrome in Organic Aciduria
Authors: Blecker U. , Vandenplas Y. , De Meirleir L. , De Raeve L. , Ramet J. 
Published: December 2021

Methylmalonic aciduria (MMA) is an autosomal recessive in-born error of metabolism with a variation in the severity of the clinical manifestations, ranging from asymptomatic patients to fulminating neonatal forms causing severe ketosis, acidosis, hyperammonemia, pancytopenia, coma, and death. Severe cases can be treated with high doses of vitamin B12 and a diet low in proteins.
We describe an exceptional manifestation of MMA. A 14-month-old boy with a neonatal manifestation of MMA was admitted during an intercurrent infection with ketoacidosis and hypoglycemia.
Sex Difference in Disability and Handicap at Five Years of Age in Children Born at Very Short Gestation
Authors: Verloove-Vanhorick S. P. , Veen S. , Ruys J. H. , Ens-Dokkum M. H. , Schreuder A. M. , Brand R. 
Published: December 2021

Objective. The objective of this study was to examine the relationship between sex and disabilities or handicaps at 5 years of age in infants born at less than 32 weeks gestation.
Design. From the nationwide collaborative survey starting in 1983, including perinatal data obtained during routine perinatal care and follow-up assessments by the attending pediatricians, data from 1008 infants fulfilling the criteria were used. At age 5 years, a detailed assessment was performed by three specially trained pediatricians in 96% surviving infants (n = 648), of which 345 were boys. Each child was categorized as disabled or handicapped, using World Health Organization definitions.
Results. The prevalence of handicaps was three times greater in boys than in girls (21% vs 7%, odds ratio 3.2). Adjustment for gestational age and birth weight (logistic regression analysis) did not change this (odds ratio 3.5). Further adjustment by including perinatal variables such as idiopathic respiratory distress syndrome did not alter the odds ratios. The male excess in handicaps was not related to lower mortality, and therefore was not a mere consequence of a higher survival rate. The excess in handicaps was found in all assessed areas.
Conclusions. Infants' sex seems to be an important determinant of handicaps. The perinatal variables used in the present study do not explain the difference in handicaps. These findings emphasize the need to include the sex distribution of a study population more systematically in analyses in future studies concerning long-term outcome of very preterm birth or low birth weight.
Folate Supplements Should Be Appropriately Labeled to Protect Consumers
Authors: Herbert Victor 
Published: December 2021

Caveats are needed regarding the Academy of Pediatrics policy statement1 (in the September issue of Pediatrics) advising all women capable of becoming pregnant to take a daily over-the-counter multivitamin containing 0.4 mg of folic acid to reduce the frequency of neural tube defect (NTD) babies.
I provided similar advice in my 1992 paper, "Folate and Neural Tube Defects".2 However, in that paper I discussed important caveats. I repeated and extended those caveats at the August 12, 1993, Centers for Disease Control and Prevention (CDC) meeting on monitoring the effects of folate supplementation.
Metered-Dose Inhalers for Young Athletes With Exercise-Induced Asthma
Authors:   Committee on Sports Medicine and Fitness
Published: December 2021

Bronchoconstriction can occur in association with exercise in up to 15% of the general population, including nearly 100% of people with asthma, 35% to 40% of those with allergic rhinitis, and some who have no other evidence of allergy.1 This phenomenon, termed exercise-induced asthma (EIA), is manifested by coughing, choking, chest pain, easy fatigability, shortness of breath, wheezing, chest tightness, or any combination of these symptoms during, or especially after, exercise. In a child known to have asthma or nasal allergies, the diagnosis of EIA can usually be made on the basis of history alone. Repeated episodes of increased difficulty breathing or cough in association with physical exertion should be assumed to be EIA until proved otherwise.
Sophisticated pulmonary function testing is not necessary in the majority of cases. In the atypical case, pulmonary function testing, often in conjunction with an exercise challenge, can confirm the diagnosis.
Exercise-induced asthma is less likely to occur in a child whose asthma is well controlled,1 a goal accomplished best with attention to the role of airway inflammation as well as bronchoconstriction.2 Fortunately, EIA can be controlled in most athletes by the inhalation of a β2-agonist bronchodilator (eg, albuterol), cromolyn sodium, or both 15 to 30 minutes before exercise. These safe medications come in several different forms, but the most convenient for patients older than 2 or 3 years is the pressurized metered-dose inhaler (MDI), which is especially easy to use with the addition of a spacing device.
Cromolyn has never been thought to be effective as an ergogenic (performance-enhancing) aid,3 and only two studies have suggested the possibility that albuterol is ergogenic.4,5
THE HEALTH POLICE ARE COMING
Authors: L. J. F. 
Published: December 2021

Despite all the controversy surrounding the president's proposed Health Security Act, nary a word has been heard about the significant new civil and criminal penalties included in the act. These new crimes and penalties both raise significant issues in their own right and belie the administration's claims that its plan relies on market incentives and choice.
The Health Security Act federalizes a broad range of routine crimes and torts previously dealt with by the states. Most notably, the act creates two broad new categories of federal crime, dubbed "federal health care offense" and "Health care fraud" (Sec. 5402[d]; 5401). "Health care fraud" includes, among other things, any effort to defraud a "health plan" (i.e., a private insurer, health maintenance organization or self-insured employer) or "any . . . other person" in connection with the delivery or payment of health care benefits, supplies or services. Thus the act federalizes mundane fraud cases merely because they are perpetrated on an organization that provides health care.
There will undoubtedly be shortages and waiting lists for procedures, and bribes might provide patients with a life-saving short cut. On the other side of the table, medical students, their options to enter the specialty of their choice limited by the act's quota on specialists, might seek to ensure their desired career through a well-placed gift. In a plan that ignores markets, bribery and influence peddling will be the natural result. The criminal and civil penalties in the act roll on and on. A health Insurer, HMO or self-insured employer that fails to pay daims "promptly" may be fined up to $1 million for repeat "offenses" (Sec. 5206).
SLOWING THE DETERIORATION OF ASTHMA AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE OBSERVED DURING BRONCHODILATOR THERAPY BY ADDING INHALED CORTICOSTEROIDS: A 4-YEAR PROSPECTIVE STUDY
Authors: Cvietusa Peter , Spahn Joseph , Otto William R. 
Published: December 2021

Purpose of the Study. To determine if the deterioration in lung function, seen in adults with asthma or chronic obstructive pulmonary disease (COPD), could be reversed or slowed by the addition of inhaled beclomethasone. Many short-term studies have shown the benefits of inhaled steroids in asthma; in particular, their ability to improve pulmonary function, decrease bronchial hyperreactivity, and reduce symptoms. Few studies have evaluated the long-term effects of inhaled steroids on the clinical course of either asthma or COPD.
Methods. This report is an extension of a 2-year study that followed 160 patients with asthma or COPD on bronchodilator therapy alone. From this group, 56 patients who displayed a rapid decline in pulmonary function (FEV1 ≥ 80 ml/year) and a high exacerbation rate (≥1/year) were selected to receive additional treatment with beclomethasone dipropionate 400 µg two times daily over 4 years. FEV1 and airways responsiveness to histamine were measured every 6 months and at 1 and 13 months upon completion of the study. Peak flows and symptom scores were recorded weekly, and compliance, inhaler technique, and adverse affects were monitored every 3 months.
Findings. During the first 6 months of beclomethasone treatment, both groups showed a significant improvement in pre- and postbronchodilator FEV1 with the most significant change noted in the asthma group. Thereafter, the FEV1 began to decline again, as it had in the first 2 years of the study, but at a rate that was 33% slower. In addition to slowing the decline in FEV1, inhaled beclomethasone resulted in a substantial decrease in the degree of bronchial hyperreactivity, and peak flow rates improved.
Examination Findings in Legally Confirmed Child Sexual Abuse: It's Normal to be Normal
Authors: Adams Joyce A. , Harper Katherine , Knudson Sandra , Revilla Juliette 
Published: December 2021

Background. Studies of alleged victims of child sexual abuse vary greatly in the reported frequency of physical findings based on differences in definition of abuse and of "findings." This study was designed to determine the frequency of abnormal findings in a population of children with legal confirmation of sexual abuse, using a standardized classification system for colposcopic photographic findings.
Methods. Case files and colposcopic photographs of 236 children with perpetrator conviction for sexual abuse, were reviewed. The photos were reviewed blindly by a team member other than the examiner, and specific anatomical findings were noted and classified as normal to abnormal on a scale of 1 to 5. Historical and behavioral information, as well as legal outcome was recorded, and all data entered into a dBase III program. Correlations were sought between abnormal findings and other variables.
Results. The mean age of the patients was 9.0 years (range 8 months to 17 years, 11 months), with 63% reporting penile-genital contact. Genital examination findings in girls were normal in 28%, nonspecific in 49%, suspicious in 9%, and abnormal in 14% of cases. Abnormal anal findings were found in only 1% of patients. Using discriminant analysis, the two factors which significantly correlated with the presence of abnormal genital findings in girls were the time since the last incident, and a history of blood being reported at the time of the molest.
Conclusions. Abnormal genital findings are not common in sexually abused girls, based on a standardized classification system. More emphasis should be placed on documenting the child's description of the molestation, and educating prosecutors that, for children alleging abuse: "It's normal to be normal."
Parenting Behaviors and the Onset of Smoking and Alcohol Use: A Longitudinal Study
Authors: Cohen Deborah A. , Richardson Jean , LaBree Laurie 
Published: December 2021

Objective. To identify which specific parenting behaviors are associated with the onset of alcohol and tobacco use and how they are associated.
Design. Prospective cohort study of two groups of preadolescents surveyed annually, the first group for 4 years, the second for 3 years.
Setting. Two public school districts in Southern California.
Subjects. 1034 fifth graders and 1266 seventh graders began the study after obtaining parental consent to complete surveys in a classroom setting. By the last measurement, attrition was 37 and 38% for the two cohorts, respectively.
Main outcome measures. The onset of tobacco or alcohol use in the last month.
Results. Children who reported that parents spent more time with them and communicated with them more frequently had lower onset rates of using alcohol and tobacco in the last month. These parental interactions lead to more positive relationships with their children. Parental monitoring and positive relations were protective factors for disruptive behavior and the selection of substance-using friends. Disruptive behavior increased the odds of adolescents drinking in the last month approximately twofold and of smoking in the last month two to fourfold.
Conclusions. This study provides further evidence that parenting behaviors are significant precursors to adolescent disruptive behavior, vulnerability to peer pressure, and subsequent substance use. Parents should be targeted in future substance use prevention programs, before their children reach adolescence.