bluuebunny/crossref_metadata_2025_split huggingface dataset:
MEDICAL STUDIES' CLAIMS IRK PROFESSION'S SKEPTICS
Authors: L. J. F. 
Published: December 2021

According to the canons of truth in statistics, cigarette smoking increases the risk of suicide and being murdered. But does it really?
Three medical researchers took ... note recently of the proliferating number of population studies finding unexpected connections between behavior and disease. Studies have found 280 "risk factors" for coronary heart disease alone, including low birth weight, abstinence from alcohol and poor dental health, they report in the Lancet.
The three then applied the statistical methods used in many such epidemiological studies to an analysis of a 12-year study of 361,000 middle-aged American men for heart-disease risk factors.
The analysis showed that among nonsmokers, there were 1.09 suicides per 100,000 person years. The suicide rate increased steadily with the number of cigarettes smoked, reaching 3.78 suicides per 100,000 person years for people who smoke three packs of cigarettes a day. Researchers often put heavy emphasis on such a "dose-response relation."
The "relative risk" of being murdered also rose with smoking: Two-pack-a-day smokers were twice as likely to be murdered as nonsmokers were.
The flaw, the researchers say, is the implausibility of such links. Although smoking could reflect some mental state that predisposes a person to suicide, there's no plausible way that smoking, in and of itself, could cause suicide. And there's no plausible mechanism to explain how smoking could cause people to be murdered.
"If epidemiology can throw up a spurious independent dose-response relation for smoking/suicide, how many more such relations, for other exposures and other diseases, are equally spurious, protected only by their lack of obvious implausibility?" the trio asks rhetorically.
THE EFFECT OF PERMETHRIN IMPREGNATED BEDNETS ON THE INCIDENCE OF PLASMODIUM FALCIPARUM IN CHILDREN OF NORTH GUADALCANAL, SOLOMON ISLANDS
Authors: Kere N. K. , Parkinson A. D. , Samrawickerema W. A. 
Published: December 2021

Kere and colleagues were able to demonstrate significant reductions in the incidence of malaria (Plasmodium falciparum) in children under the age of 10 years with the use of permethrin impregnated bednets. Eight hundred and sixty (860) people in 23 villages were given impregnated bednets and were compared with 520 people in 20 villages from a contiguous area who served as a control population. Incidences were based on mass blood screenings with thick and thin blood films examined conventionally.
Greater nighttime outdoor exposure of adults resulted in less impressive improvements than in children, who were more likely to be under the bednet during peak mosquito biting time.
In addition to reductions in malarial incidence in children, febrile episodes in children were reduced in frequency as well as the number of Anopheles farauti mosquitoes themselves. Survival of trapped mosquitoes was shown to be significantly reduced in the bednet homes compared with the control area, leading to the authors' conclusions that the nets not only protect people, but kill mosquitoes as well. Protection by the nets continued to be satisfactory for up to 1 year after permethrin treatment.
A PROSPECTIVE STUDY OF THE INFLUENCE OF α-THALASSAEMIA ON MORBIDITY FROM MARLARIA AND IMMUNE RESPONSES TO DEFINED PLASMODIUM FALCIPARUM ANTIGENS IN GAMBIAN CHILDREN
Authors: Allen S. J. , Rowe P. , Allsop C. E. M. 
Published: December 2021

α-Thalassaemia is the most common haemoglobinopathy in Africa and is due to a defect in α-globin chain synthesis. Earlier studies have indicated that α-Thalassaemia may provide a selective advantage against Plasmodium falciparum malaria and account for the increased prevalence of α-Thalassaemia in malarial endemic areas. The mechanism by which α-Thalassaemia is protective against malaria is not clear. One hypothesis is that there is a greater binding of immunoglobulin molecules to the surface of thalassaemic red cells resulting in better clearance of parasitized erythrocytes. The present authors conducted a study on children living in two groups of villages in Gambia to test this hypothesis. These studies were conducted once at the beginning of May and once at the end of October, which is the end of the rainy season and a period of intense malaria transmission. In addition to definition of active and asymptomatic malarial infection, the authors conducted a number of studies including genotyping for haemoglobinopathies (specifically α-Thalassaemia and sickle cell), measurement of antibody to a variety of antigens related to malarial parasite, and in vitro cellular immune response to specific malarial antigens. They included a control group of 30 Swedish children who had never been exposed to malaria. They also used PHA, candida, and PPD as control antigens for in vitro stimulation of lymphocytes. They looked at the lymphocyte stimulation index and IFNγ production in vitro in response to various mitogens.
The authors did not find an increased parasite rate in children with α-Thalassaemia. A similar proportion of normal and heterozygotes thalassaemia children acquired malaria. This was different from earlier studies conducted in Papua, New Guinea. They also noted a higher rate of infection among children with hemoglobin AS and heterozygote for \g=a\-Thalassaemia than in those with normal hemoglobin and heterozygote for \g=a\-Thalassaemia. There was no difference between children with \g=a\-Thalassaemia and those with normal genes in the prevalence of antibodies to any of the malarial antigens. However, in the in vitro assay they noted greater lymphoproliferative responses to some of the soluble antigens and lower IFN\g=g\ production response to two of the recombinant antigens for merozoite protein in \g=a\-Thalassaemic children compared with normal children. However, considering the number of antigens that were tested, these abnormalities may have been by chance.
Although there was no difference in the frequency of malaria among children with \g=a\-Thalassaemia and those with normal haemoglobin genotype, there were few children who had both \g=a\-Thalassaemia and sickle cell trait with fewer clinical episodes of malaria than children with sickle cell trait alone. This is an unexpected finding. This finding may be more important to follow than the original question with which the authors started the study.
INTRALESIONAL TREATMENT OF CUTANEOUS LEISHMANIASIS WITH SODIUM STIBOGLUCONATE ANTIMONY
Authors: Faris R. M. , Jarallah J. S. , Khoja T. A. , Al-Yamani M. J. 
Published: December 2021

Cutaneous leishmaniasis is endemic in Saudi Arabia and is a worldwide problem. In an attempt to reduce the side effects of parental drugs and keep costs low, this study evaluated intralesional sodium stibogluconate.
Seven hundred and ten (710) patients with the parasite demonstrated in smears from the lesion were enrolled. Sixty-four percent (64%) were less than 15 years of age. Seventy-three percent (73%) of the patients had one lesion and the mean number of lesions was 1.5. Sixty-eight percent (68%) of the lesions were on the face. Treatment consisted of injection with a fine insulin needle with 0.5-1 mL of the agent and repeated on alternate days for a total of eight injections. In those lesions complicated by infection or previous cautery or cryotherapy up to 24 injections were done. Secondarily infected lesions were first treated with systemic rifampin and/or topical antibiotic or ketoconazole.
Seventy-two percent (72%) of the treated lesions healed completely. Twenty-three and nine-tenths percent (23.9%) showed some improvement after 1 month of treatment. Resolution took 2 to 8 weeks depending on site. Of the 4.1% showing deterioration, all had been treated previously. Other than injection site pain there were no side effects except hyperpigmentation in 17%, all of whom received previous local treatment. This usually disappeared spontaneously.
The rapid response may be due to the direct application of the agent directly to the affected tissues.
Recently, this method of treatment has been recommended by the World Health Organization.
Conclusion: Intralesional sodium stibogluconate is safe and therapeutically effective.
WEIGHT GAIN OF KENYAN SCHOOL CHILDREN INFECTED WITH HOOKWORM, TRICHURIS TRICHIURA AND ASCARIS LUMBRICOIDES IS IMPROVED FOLLOWING ONCE- AND TWICE-YEARLY TREATMENT WITH ALBENDAZOLE
Authors: Stephenson L. S. , Latham M. D. , Adams E. J. 
Published: December 2021

Hookworm, Ascaris lumbricoides, and Trichuris trichiura each are estimated to infect ⅙ to ¼ of the world's population. Many studies show the association between infestation with these parasites and poor growth in children. Although the long-term solutions to malnutrition lie in eradicating poverty and in community-based programs to improve health care, living conditions, sanitation, water supplies, and health education, the enormous financial and logistic difficulties of implementing such improvements led these investigators to study the effectiveness of the pharmacology approach for short-term impact.
Previous studies demonstrated that nearly all primary school children in the area in Kenya in which they worked had hookworm and Trichuris trichiura and half had Ascaris lumbricoides. A population-based randomly controlled trial of a once a year, twice a year, and placebo treatment with Albendazole 600 mg follow-up after 8 months demonstrated, in the two treatment groups compared with the placebo, significant decreases in the parasite burden and significant increases in weight for age, weight for height, and arm circumference with little difference between the two treatment groups.
The mechanism by which such improvement in gravity occurred presumably involved altering host nutritional intake, metabolism, and excretion. These children did not have chronic diarrhea; therefore, the mechanism appears to be either increased by intake, metabolism, or both.
This community chemotherapeutic approach to control these parasites and improve growth and nutrition is a practical, short-term method to improve child health in areas with a high prevalence of these parasites.
First Case of Human Infection Caused by Pasteurella gallinarum Causing Infective Endocarditis in an Adolescent 10 Years After Surgical Correction for Truncus Arteriosus
Authors: Al Fadel Saleh Mohammad , Al-Madan Mohammad S. , Erwa Hashim H. , Defonseka Ivy , Sohel Saira Z. , Sanyal Shyamal Kumar 
Published: December 2021

Objective. To report the first case of human infection (infective endocarditis [IEI]) caused by Pasteurella gallinarum and to review the literature regarding IE caused by the genus Pasteurella.
Setting. University hospital based.
Patient. An adolescent boy who underwent successful correction for truncus arteriosus 10 years before the present illness.
Results. Persistent fever, pallor, and a palpable spleen suggested IE clinically. Echocardiography documented vegetation in the conduit that was used for surgical correction. Blood cultures grew P. gallinarum and confirmed its role as the causative organism for IE in the patient.
Conclusion. This case illustrates that IE may develop in a child with congenital heart disease several years after surgical intervention using material that is foreign to the body (conduit), and that such a complication may involve unusual pathogens. These observations emphasize the need for careful long-term follow-up of children with congenital heart disease even after successful surgical correction.
Letters to the Editor
Authors: Hausser Dominique , Michaud Pierre-André 
Published: December 2021

We thank Dr Tankersley for his comments and offer the following answers:
1. Dr Tankersley rightly points out the mistake in Table 4. Seventy -seven percent of boys in 1987 and 87% of boys in 1990 answered the question: "have you ever used a condom?" The 22% of boys in 1987 and the 34% of boys in 1990 who said they have used a condom on a regular basis are thus included in these figures.
PROBLEMS AHEAD
Authors: L. J. F. 
Published: December 2021

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Prevalence of Lead Poisoning Among Two-Year-Old Children in Vermont
Authors: Paulozzi Leonard J. , Shapp Joanne , Drawbaugh Robert E. , Carney Jan K. 
Published: December 2021

Objectives. The recent redefinition of childhood lead poisoning by the Centers for Disease Control and Prevention means that many more children are considered lead poisoned than previously. The primary purpose of this study was to determine how many 2-year-old children had lead levels of 10 µg/dL or more in a rural state.
Methods. Random samples of 334 children drawn from the birth certificate file and 350 children from Vermont Medicaid rosters submitted capillary blood specimens that were confirmed by venous tests if lead levels were 10 µg/dL or more.
Results. Participation rates were 63.9% in the birth certificate group and 66.4% in the Medicaid group. In the birth certificate sample, the percentages of children with confirmed lead levels 10 µg/dL or more, 15 µg/dL or more, and 20 µg/dL or more were 9.0 (95% confidence interval [CI], 6.2-12.6), 2.7 (95% CI, 1.2-5.0), and 1.5 (95% CI, 0.5-3.4), respectively. In the Medicaid sample, the corresponding percentages were 14.9 (95% CI, 11.4-19.2), 5.1 (95% CI, 3.1-8.0), and 2.0 (95% CI, 0.8-4.1), respectively. The percentage of children in the state's most urban county with lead levels of 10 µg/dL or more was significantly less than that in the rest of the state in both samples.
Conclusions. The prevalence of elevated lead levels in 2-year-old children may be significant in rural states with old housing stock. Medicaid-enrolled children represent a readily identifiable high-risk group.
Physicians and the Communication of "Bad News": Parent Experiences of Being Informed of Their Child's Cleft Lip and/or Palate
Authors: Strauss Ronald P. , Sharp Michael C. , Lorch S. Claire , Kachalia Beejal 
Published: December 2021

Objective. Physicians often are called on to deliver "bad news" in the form of a diagnosis with unhappy implications. Few guidelines exist for practitioners who wish to meet patient and family expectations for clear and caring communication. To develop recommendations for physicians, this study was undertaken to document how biologic parents of children born with a specific, non-life-threatening birth defect perceive the encounter with a physician during which they were informed of their children's diagnosis. The study also examines parental preferences for how this communication might best be managed and compares those with parent reports of their actual experiences.
Methodology. Biologic parents of children born with cleft lip and/or palate (n = 100) were studied with a self-administered questionnaire about the diagnostic encounter in which they rated theoretically derived dimensions of physician communication. Their experiences, as well as their preferences for communication in a hypothetical case, were compared through the use of ratings and open-ended qualitative narratives.
Results. Parents learned the diagnosis at birth (90%) from a physician (96%). Many report positive experiences, but there are significant differences between what parents experienced and what they desire in the informative interview. Parents wanted more opportunity to talk and to show their feelings and wanted the physician to try harder to make them feel better. As compared with their experiences, parents indicated a desire to have more information and more of a discussion about the possibility of mental retardation. They wanted the physician to show more caring and confidence, and wanted more referral to other parents, than they had experienced. Dimensions of physician behavior were more positively perceived by parents who were informed by a physician whom they felt they knew well.
Conclusions. It is possible for physicians to effectively deliver bad news, such as the diagnosis of a birth defect, to parents. This study suggests specific communicative and educational approaches that are likely to improve parental satisfaction with such physician communications.
Familial Hypercholesterolemia: Molecular, Biochemical, and Clinical Characterization of a French-Canadian Pediatric Population
Authors: Assouline Linda , Levy Emile , Feoli-Fonseca Juan Carlos , Godbout Caroline , Lambert Marie 
Published: December 2021

Background. Familial hypercholesterolemia (FH) is a dominantly-inherited disorder attributable to a defect in the low-density lipoprotein (LDL) receptor gene. Five mutations at this locus have been identified in French-Canadians. In children, it may be difficult to clinically distinguish FH from other forms of polygenic or monogenic hyperlipidemia. Therefore, our objectives were to define the molecular basis of our subjects' hypercholesterolemia, to characterize their biochemical phenotype in relation to the underlying molecular defect, and to assess their response to chronic dietary therapy.
Methods. We studied 88 unrelated French-Canadian children with a persistent increase in LDL cholesterol and a parental history of hyperlipidemia. Baseline and end-of-diet lipid and apolipoprotein levels were measured. Mutational analysis at the LDL receptor gene locus was performed.
Results. Heterozygosity for the common French-Canadian LDL receptor gene &gt;10-kb deletion was found in 57% of subjects (group 1), 14% carried one of the other four previously characterized LDL receptor gene mutations (group 2), and none of the five molecular defects tested was detected in 29% (group 3). Total cholesterol, LDL cholesterol, and apolipoprotein B baseline levels were similar among these three groups but significantly higher than in control subjects. However, there was wide interindividual variability even among those carrying the same mutation. Significantly lower baseline levels of high-density lipoprotein cholesterol and apolipoprotein A1 were found in group 1 compared with group 3 and the controls. The response to diet was similar among the three groups with an average reduction in the mean level of total cholesterol of 4.4%.
Conclusions. The frequency of proven FH heterozygotes (71%) was remarkable in the pediatric population studied. Our data suggest that, in children, a persistent primary increase in LDL cholesterol associated with a parental history of hyperlipidemia is a good predictor of an underlying monogenic disorder as opposed to a polygenic disorder, at least in French-Canadians. Only molecular analysis allowed us to unequivocally define the cause of our patients' hypercholesterolemia. Most children with familial hyperlipidemia did not reach desirable plasma lipid levels solely under diet therapy.
High-Risk Behaviors Among High School Students in Massachusetts Who Use Anabolic Steroids
Authors: Middleman Amy B. , Faulkner Annie H. , Woods Elizabeth R. , Emans S. Jean , DuRant Robert H. 
Published: December 2021

Objective. To assess the association between the frequency of anabolic steroid use and the frequency of other health risk and problem behaviors among high school students in Massachusetts.
Methods. The 1993 Massachusetts Youth Risk Behavior Survey was conducted on a random sample of 3054 high school students (49% male; mean age, 16 ± 1.2 years). The frequency of lifetime anabolic steroid use was measured on an ordinal scale from 1 to 6, representing "0" to "40 or more times." Other health risk and problem behaviors measured were sexual behaviors, suicidal behaviors, frequency of not wearing a passenger seat belt, riding a motorcycle, not wearing a helmet while riding a motorcycle, driving after drinking alcohol, riding with a driver who had been drinking alcohol, fighting, and carrying a weapon. The associations between the frequency of anabolic steroid use and other high-risk behaviors were determined using the Spearman correlation coefficient for ordinal data and the Kruskall-Wallis analysis of variance for categorical data. Representative indicators of each risk behavior significantly associated with anabolic steroid use were then analyzed using a stepwise multiple-regression analysis.
Results. The frequency of anabolic steroid use was associated with all of the other high-risk behaviors analyzed. Using multiple-regression analysis, driving after drinking alcohol accounted for 12.5% of the variance of the model. Carrying a gun, the number of sexual partners within the past 3 months, not using a condom during last intercourse, injury in a physical fight requiring medical attention, history of a sexually transmitted disease, not wearing a helmet on a motorcycle, not wearing a passenger seatbelt, and a suicide attempt requiring medical attention accounted for an additional 9.0% of the variance. The full model accounted for greater than 21% of the variation.
Conclusions. The frequency of anabolic steroid use among adolescents is associated with other high-risk behaviors, thus supporting the hypothesis that anabolic steroid use is part of a "risk behavior syndrome" rather than an isolated behavior. This finding emphasizes the need for comprehensive high-risk behavior screening and counseling among teens who use anabolic steroids.
Psychosocial Adaptation of 39 Adolescents With Sex Chromosome Abnormalities
Authors: Bender Bruce G. , Harmon Robert J. , Linden Mary G. , Robinson Arthur 
Published: December 2021

Objectives. Children with sex chromosome abnormalities (SCA) are known to be at increased risk for neuromotor, language, learning, and behavioral problems, but little is known of psychosocial adaptation of SCA adolescents. This study was conducted to evaluate psychologic characteristics of unselected SCA adolescents, including socialization, educational progress, seperation from family, and incidence and severity of psychiatric disturbance.
Methods. Thirty-nine propositi identified through the screening of 40 000 consecutive Denver newborns, including boys with 47,XXY karyotypes and girls with 47,XXX, 45,X, and partial X monosomy, or SCA mosaic karyotypes, have been followed longitudinally into adolescence. Twenty-seven siblings served as controls. Between 12 and 19 years of age, all participated in blind psychiatric interviews and were administered standardized intelligence and achievement tests.
Results. SCA propositi demonstrated a mean IQ score 21 points lower than that of control subjects. In addition, lower mean scores were seen on achievement test results as well as lower overall psychosocial adaptation scores and increased incidence of psychiatric disturbance. Depression was the most frequent psychiatric diagnosis. Propositi were more likely to receive special education assistance in high school and were less likely to graduate from high school than were controls. Of the three nonmosaic propositi groups, the 47,XXX girls demonstrated the poorest overall psychosocial adaptation and highest degree of psychiatric disturbance. Mosaic girls were indistinguishable from control subjects. Marked variability was found among all three nonmosaic groups, with some individuals in each group demonstrating relatively strong psychosocial adaptation.
Conclusions. The presence of nonmosaic sex chromosome abnormality increases the risk for impeded cognitive skills, learning abilities, and psychosocial adaptation in adolescence. The factors that allow for stronger adaptation in some of these adolescents include the presence of a stable and supportive family environment. The outlook for adaptation in unselected SCA adults remains uncertain.