bluuebunny/crossref_metadata_2025_split huggingface dataset:
Culture, Ethnicity, and Bicultural Competence: Implications for Children With Chronic Illness and Disability
Authors: Brookins Geraldine Kearse 
Published: December 2021

The examination of culture and child and human development is not a new venture. There has been a fascination with how culture shapes human behavior over decades.1-4 Generally, whenever the terms "culture" and "child development" were invoked, they referred to work that was conducted in faraway places and compared to middle-class European-American children and families as the standard or norm.
For so long, studies of development focused on the generic human child—white and middle class. LeVine5 noted that many psychologists seemed to have a deep-seated metaphysical conviction that humans everywhere, all those that counted, at least, were the same in all respects. Cultural variations were merely external details not unlike malnutrition. Importantly, to the discipline's credit, views of child development have changed from the examination of development via a perspective that implied that the human organism existed in a vacuum without context, to the recognition that our understanding of the complexity of individual development is greatly enhanced by focusing on the child in context. Among developmental psychologists, there is a general consensus that a broad spectrum of maturational factors undergirds human development. Even so, human behavior manifests itself in differentiated arrays across cultural settings.
Rogoff6 suggests that variability is intrinsic to the developmental process and this variability is structured by those events and conditions within the ecological environs that serve to promote and constrain human endeavor. She notes that ". . . the inherent variations in development that occur with different groups and circumstances are ordered in their own terms, with progress toward developmental goals across the course of life."6(p30)
The Need for More Accurate and Timely Diagnosis in Fanconi Anemia: A Report From the International Fanconi Anemia Registry
Authors: Giampietro Philip F. , Davis Jessica G. , Adler-Brecher Barbara , Verlander Peter C. , Auerbach Arleen D. , Pavlakis Steven G. 
Published: December 2021

Objective. The objective of this study was to address the need for early diagnosis of Fanconi anemia (FA), an autosomal recessive chromosomal instability syndrome characterized by a unique cellular hypersensitivity to DNA cross-linking agents, such as diepoxybutane, and by a high risk of malignancies.
Methods. We analyzed data from 370 FA patients enrolled in the American Registry of the International FA Registry. Of these individuals, 220 had congenital malformations; the rest were ascertained based on hematologic abnormalities only or on clinical evaluation and screening following the diagnosis of an affected family member. The probands noted to have congenital malformations at the time of diagnosis were classified into two groups on the basis of their clinical presentation: (1) patients manifesting both congenital malformations and hematologic abnormalities (159 individuals); (2) patients manifesting congenital malformations only (61 individuals).
Results. The mean age of diagnosis was 6.6 years and 1.1 years for Groups 1 and 2, respectively. Thus, the majority of FA patients with congenital malformations were not diagnosed until after the onset of hematologic abnormalities. We also report central nervous system, gastrointestinal, and skeletal malformations which previously have not been included as part of the FA phenotype. Our review of the patients enrolled in the International FA Registry indicates that the FA phenotype is more variable than recognized previously.
Conclusions. Testing for sensitivity to diepoxybutane to rule out a diagnosis of FA needs to be applied more widely in patients with congenital malformations. All siblings of affected probands also should have testing, because a lack of concordance of phenotype in affected siblings makes clinical diagnosis unreliable even within sibships. A more timely diagnosis of FA in the preanemic phase is needed to implement appropriate therapy and to enable parents to make informed reproductive decisions.
Long-term Effect of Inhaled Corticosteroids on Growth Rate in Adolescents With Asthma
Authors: Merkus Peter J.F.M. , Quanjer Philip H. , van Essen-Zandvliet Elisabeth E.M. , Kerrebijn Karel F. , Duiverman Eric J. , van Houwelingen Hans C. 
Published: December 2021

Background. Growth in stature in asthmatic adolescents may be delayed compared to normals as a result of treatment with inhaled corticosteroids (CS) or because of a delay in puberty. However, growth rates in asthmatic children have never been studied when treatment with CS was randomized and when growth was compared with that of matched healthy control subjects.
Objective. To assess the long-term effect of CS treatment on growth rates in asthmatic adolescents.
Methods. Participants were 40 asthmatic teenagers (mean age 12.8 years) who received randomized treatment with 0.2 mg of albuterol (salbutamol) with either placebo three times a day (BA + PL) or 0.2 mg of budesonide three times a day (BA + CS) for a median period of 22 months in a double-blind controlled study. Growth rates were compared with those of 80 control subjects who were matched for sex, age, height, and duration of follow-up.
Results. Growth rates in male patients, but not in female patients, were significantly less than in control subjects (P &lt; .05), a finding consistent with a delay of puberty due to asthma. The mean difference (95% confidence interval) in growth rates between patients treated with BA + PL and their controls was -0.70 (–1.62, 0.22) cm/y; that between patients treated with BA + CS and their controls was -0.44 (–1.25, 0.37) cm/y. The observed mean (SEM) case-control difference between treatment groups was + 0.27 (0.58) cm/y in favor of BA + CS.
Conclusion. Growth retardation observed in adolescents with asthma may be due to a delay in puberty but not to the prescription of 0.6 mg of budesonide daily.
Attitudes of Mothers, Doctors, and Nurses Toward Neonatal Intensive Care in a Developing Society
Authors: Wainer Stephen , Khuzwayo Harriet 
Published: December 2021

Background. The ethical allocation of scarce resources is a major challenge for physicians working in the developing world. Guidelines currently employed by health care workers in the developed world may be considered impractical or inappropriate in the "Third World."
Objective. To gain insight into the attitudes of doctors, nurses, and mothers of recent neonatal intensive care unit (NICU) survivors toward the utilization and withdrawal of life support in the context of a developing society.
Design. Descriptive cohort study.
Participants. Thirty-three doctors, 20 nurses, and 70 mothers of recent NICU survivors. The cohort of mothers surveyed were predominantly unmarried, poorly educated, and either unemployed or still at school.
Results. In response to hypothetical scenarios, mothers exhibited very conservative attitudes toward withdrawal of life support compared to caregivers. Only 2.9% (2/70) of mothers would contemplate any degree of life support withdrawal for infants with probable "moderate" handicap compared with 51.0% (26/51) of the medical staff. One mother (1.4%, 1/70) accepted the concept of withdrawal of life support where extremely poor outcome was anticipated, compared with 85% (45/53) of the caregivers. Doctors and nurses exhibited very utilitarian attitudes toward NICU resource allocation, with emphasis directed toward avoidance of significant handicap. The majority of these caregivers considered the anticipated burden of the handicapped child in the society to be a major factor in the justification of their decision.
Conclusion. The nonideal conditions under which doctors and nurses work in developing nations mandate resource allocation to be an integral component of NICU care.
Which Is the Most Appropriate Dosage of Liposomal Amphotericin-B (AmBisome) for the Treatment of Fungal Infections in Infants of Very Low Birth Weight?
Authors: DA SILVA L. PEREIRA , AMARAL J. M. VIDEIRA , FERREIRA N. CORDEIRO 
Published: December 2021

To the Editor.—
Lackner et al1 report on the excellent efficacy and lack of toxicity of 1 to 5 mg/kg per day of liposomal Amphotericin-B (AmBisome) administered to two infants of very low birth weight with disseminated fungal infection.
We agree with the authors when they say that success in the treatment of two cases does not allow extrapolation of the same therapeutic schedule to an infants with identical multisystemic immaturity.
We would like to report two cases from our own clinical experience with distinct characteristics.
Hepatitis B Virus Infection in Honolulu Students
Authors: Pon Eugene W. , Ren Hexuan , Margolis Harold , Zhao Zixian , Schatz Gary C. , Diwan Arwin 
Published: December 2021

Objectives. To determine hepatitis B virus (HBV) carrier and infection rates and HBV epidemiology in Honolulu students.
Design. Cross-sectional survey.
Setting. Honolulu public elementary, intermediate, and high schools.
Patients. A volunteer sample of 4936 students from 43 Honolulu schools.
Main outcome measures. HBV carrier rate (presence of hepatitis B surface antigen) and infection rate (presence of either hepatitis B surface antigen, antibody to hepatitis B surface antigen, antibody to hepatitis B core antigen, or any combinations of these) by school grade, ethnicity, and place of birth.
Results. Eighty-three (1.68%) students were identified as HBV carriers, and a total of 353 (7.15%) students had serologic evidence of infection. Infection rates increased from elementary school age to high school age, more so in Asian/Pacific Island-born students. The prevalence of infection was higher in Asian/Pacific Island-born students than in those born in the United States. The majority of infected Hawaiian-born students were first-generation Asian/Pacific Island Americans.
Conclusions. Horizontal transmission of HBV occurs in Honolulu school-age children. HBV immunization of all infants in Hawaii, not just those born to carrier mothers, is necessary to reduce HBV transmission in Hawaii.
MAKING MONEY BY MAKING BABIES
Authors: L. J. F. 
Published: December 2021

The State of New York may be eager to attract new business, but there's one kind of inflow it would do well to avoid. According to state health officials, New York is fast becoming "the surrogate-parenting capital of the nation."
New York accounts for some 40 percent of the several thousand surrogate parenting contracts signed so far in the nation, and the number is rising ...
At least 17 state legislatures have decided it's harmful commerce, and forbidden it. So have Germany, France, Britain and a slew of other countries. But not New York . . . That's why advertisements like this one appear in New York newspapers:
Married or single women with children needed as surrogate mothers for couples unable to have children. Conception to be by artificial insemination. Please state your fee. Contact ...
For those who want children, infertility can be a tragedy. Allowing this kind of commerce, however, would be a greater one.
Addressing Concerns of Pediatric Trainees Caring for Patients With Human Immunodeficiency Virus Infection
Authors:   TASK FORCE ON PEDIATRIC AIDS
Published: December 2021

Since the recognition of the human immunodeficiency virus (HIV) as the cause of HIV infection and the acquired immunodeficiency syndrome (AIDS), studies have determined that the risk of infection to the health care worker through occupational exposure is extremely low. However, the perception of risk can have potential psychologic consequences for health care workers providing medical care to HIV-infected patients. What is it that makes caring for HIV-infected patients an unsettling emotional experience? While occupational risks accompany all work, physicians have in the recent past perceived themselves with little vulnerability to a devastating disease. Medical professionals at the turn of the century had alarmingly high rates of mortality from tuberculosis, and today, if not immunized, they are at increased risk for hepatitis B. HIV infection carries formidable biologic and social consequences that contribute to the psychologic stress that may accompany caring for infected patients.
Because H1V-infected patients are dealt with extensively in tertiary centers, there are significant implications for resident and medical student training, especially in urban locales where the rate of HIV infection is high.
The emotional risks of caring for patients with HIV infection have had scant documentation, but there is growing evidence for concern. A study of 250 residents in New York City documented that 19% of pediatric residents and 36% of medical residents had needle-stick exposure to HIV in 1986. A 1988 study of 294 pediatric residents in 11 New York City programs revealed that 205 of the residents (69.7%) had been stuck with a blood-contaminated needle on 588 separate occasions. While there was considerable concern expressed by residents over acquiring HIV, more than half did not want to know whether they were HIV seropositive.
Complication of Intranasal Midazolum
Authors: LUGO RALPH A. , FISHBEIN MARK , NAHATA MILAP C. , LININGER BARBARA 
Published: December 2021

The recent article by Theroux et al on the use of intranasal midazolam was interesting. The purpose of this letter is to share our experience regarding a complication associated with the use of this drug.
The need for an ideal sedative for pediatric patients undergoing diagnostic and short surgical procedures is well established. In the past 5 years, the literature is replete with reports on the efficacy, ease of administration, and tolerance of intranasal midazolam. Currently, our group is also evaluating the efficacy of intranasal midazolam in pediatric patients (aged 2 to 12 years) undergoing upper endoscopy. Soon after beginning enrollment, however, it became apparent that intranasal midazolam causes intense burning, irritation, and lacrimation on instillation into the nares.
ROUTINE DISCHARGE EXAMINATION OF BABIES: IS IT NECESSARY?
Authors: L. J. F. 
Published: December 2021

The Maternity Services Advisory Committee recommended a routine neonatal discharge examination in 1985. However, this has not been generally accepted and the 1989 report of the joint Working Party on Child Health Surveillance recommended only a repeat examination of hip stability on discharge or within 10 days after birth. This altered recommendation was partly a response to the welcome trend towards early discharge which makes it increasingly difficult to ensure that a second examination is carried out. Moss et al addressed this problem with an audit assessing the value of the second neonatal examination. The examination, performed on 97.3% of 1795 newborn infants, was done on the day of discharge on 1428 infants (79.6%). Because of early discharge, 38.5% of babies were examined on or before day 2, the median time of the discharge examination being 4 days of age. The second examination uncovered previously undetected problems in 63 infants (3.6%). However, 49 abnormalities were minor, such as superficial infection and jaundice not requiring phototherapy; in seven babies the abnormality was not new and should have been detected by the first examination. Only seven infants had a new or potentially important abnormality: jaundice, a transient heart murmur, a distended abdomen which resolved spontaneously, and—most significantly—dislocatable hips in four infants. An important finding was therefore detected in only 0.5% of second examinations. The study concluded that a full second examination cannot be justified, but a test for hip stability should be performed.
The Hall report discusses the key role of parents in the detection of defects but stresses that some defects are unlikely to be recognised even by the most astute parents and require a special search by health professionals. In this category congenital dislocation of the hip and congenital heart disease require special consideration.
Factors Affecting Left Ventricular Mass in Childhood: The Muscatine Study
Authors: Malcolm Donald D. , Burns Trudy L. , Mahoney Larry T. , Lauer Ronald M. 
Published: December 2021

Objective. To examine the contribution of age, body size, and blood pressure to left ventricular mass (LVM) in childhood and develop a population-based reference of normative LVM data.
Methods. Age, sex, height, weight, and auscultatory systolic and diastolic blood pressures were measured and an echocardiogram was performed to estimate LVM in 904 normal children, aged 6 to 16 years, in Muscatine, IA. Pearson product-moment correlation coefficients were determined to describe the degree of linear association between LVM and age, body size, and blood pressure. Age-sex-, weight-sex-, and height-sex-spedfic Z scores were determined for LVM, age, weight, height, and blood pressure. Sex-specific LVM prediction equations were derived using weighted-least-squares regression analysis.
Results. A strong positive linear association of LVM with age, weight, height, Quetelet index, and systolic and diastolic blood pressure was demonstrated. Z scores for eight different LVM quintile patterns revealed that age, height, weight, and blood pressure each exert an independent influence on LVM in children. Sex-specific predicted M-mode LVM and upper limits of the 90% prediction intervals based on age and height are presented.
Conclusion. Since age, height, weight, and blood pressure may each exert an independent influence on LVM in children, each factor must be considered when interpreting LVM in childhood. While age, sex, and height are unalterable, both weight and blood pressure can be modified. Thus the pathologic contribution of excess weight and blood pressure ought not be masked by statistical adjustments in reference values for LVM. Sexspecific values of LVM and the 90% and 95% prediction intervals of LVM that do not factor out the effects of obesity or blood pressure are presented. These provide the upper-limit reference values of LVM for the evaluation of children in whom increased LVM is suspected.
Pediatric Workforce Statement
Authors:   Committee on Careers and Opportunities
Published: December 2021

Developing accurate forecasts for physician workforce needs is an extraordinarily difficult task. In 1980 the Graduate Medical Education National Advisory Committee (GMENAC) completed a comprehensive workforce study. Based on estimates of growth of the number of pediatricians, GMENAC predicted a potential excess of 4950 pediatricians by 1990.1 The American Academy of Pediatrics (AAP) studied the report and issued a response in 1981 that questioned many elements in the model.2 However, the Academy was concerned that an excess number of pediatricians would be produced by the 1990s, and a statement published in 1985 and revised in 1987 recommended government and academic policies ensuring the production of pediatricians of the highest quality, but in fewer numbers.3
Subsequent to the 1987 statement, consistent evidence has pointed to shortages of pediatricians rather than the projected surplus in all regions of the country. A 1990 survey of residency program directors provided the strongest empirical evidence to date that the supply of new pediatricians is not meeting the demand.4
In 1990, the Council on Graduate Medical Education (COGME) contracted with the consulting firm of Abt Associates, Inc to reexamine the adequacy of physician workforce supply. The resulting report, commonly referred to as the Abt report, contends there would be an even greater oversupply of peditricians than projected in the 1980 GMENAC report.5 The AAP concerns with this report's methodology and conclusions were strongly voiced to the COGME and in the literature.6,7 Subsequent to the Abt Report, the COGME published a report which emphasizes a growing shortage of practicing generalists (ie, general pediatricians, general internists, and family physicians) and calls for an increase in the percentage of residents who complete a 3-year training program in the generalist specialties.8
Questions About Electrographic Seizures in Newborns
Authors: SCHELLER JOSEPH M. 
Published: December 2021

To the Editor.—
The study by Scher et al in the January issue of Pediatrics1 on electrographic neonatal seizures is an important addition to the neonatal seizure database. However, there are some aspects of the study that I find problematic. First, the study calculates the incidence (prevalence) of electrographic seizures for that patient population without providing details about which patients were included and excluded. Did any newborns who were suspected of having seizures not have electroencephalograms (EEGs)? Were any newborns suspected of having seizures treated with anticonvulsants before the EEG was performed? If the answer to either of these questions is yes, the reported incidence may not be accurate.
Prevention of Fetal Alcohol Syndrome
Authors: SHOEMAKER F. WELLS 
Published: December 2021

To the Editor.—
The American Academy of Pediatrics (AAP) policy statement on fetal alcohol syndrome (FAS) in the May issue Pediatrics1 makes several errors of omission and, I believe, of naivete. The report cites an incidence figure of 1.9 per 1000 live births and a corresponding annual cost estimate of $320 million from a 1987 report by Abel and Sokol. 2 The report ignores, however, the 1991 reports3 by the same two distinguished authors in which they revised their estimates downward sixfold to 0.3 per 1000, and the cost estimate to $70 million.
Acellular and Whole-Cell Pertussis Vaccines as Booster Doses: A Multicenter Study
Authors: Englund Janet A. , Decker Michael D. , Edwards Kathryn M. , Pichichero Michael E. , Steinhoff Mark C. , Anderson Edwin L. 
Published: December 2021

Objective. To compare the safety and immunogenicity of a variety of acellular (AC) and whole-cell (WC) pertussis vaccines combined with diphtheria and tetanus toxoids.
Methods. Standard enrollment and reaction forms were used at five sites, and serologic evaluation was performed at a single site. Nine AC (Massachusetts Public Health Laboratories, Biocine Sclavo recombinant pertussis toxoid [PT], Connaught/BIKEN, Lederle three-component, Biocine Sclavo recombinant three-component, SmithKline Beecham three-component, Porton three-component, Takeda-Wyeth, and Connaught multicomponent), and three WC (Connaught Laboratoties, Lederle Laboratories, and Massachusetts Public Health Laboratories) were studied. All AC contained varying concentrations of PT; some vaccines also contamed filamentous hemagglutinin (FHA), pertactin, and/or agglutinogens.
Results. Two hundred forty children, aged 16 to 21 months and 4 to 6 years, were enrolled at five sites. Significantly less fever, redness, swelling, pain, limp, and use of pain medication were noted following AC compared with WC. Significant increases in antibody to PT were seen following all vaccines. Significant rises in FHA antibody were seen following all WC and the seven AC that contained FHA. Postbooster PT antibody levels were similar among the AC groups, regardless of the amount of PT administered (between 3.5 and 25 µg per dose). The dose of FHA did not affect PT antibody response. Infants primed with WC who were boosted with a monocomponent PT vaccine did not manifest a significant antibody response to FHA.
Conclusion. The rate of adverse reactions was not a function of the number of antigens or the antigen quantity in the acellular vaccines, and antibody responses following AC were similar or better than antibody responses following WC. These results support the further evaluation of these vaccines in a larger National Institute of Allergy and Infectious Diseases-sponsored study in infants.