bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Trial of Glucose-Oral Rehydration Solution (ORS), Rice Dextrin-ORS, and Rice Flour-ORS for the Management of Children With Acute Diarrhea and Mild or Moderate Dehydration
Authors: Molina Susana , Vettorazzi Carolina , Peerson Janet M. , Solomons Noel W. , Brown Kenneth H. 
Published: December 2021

Objective. To assess the effects of glucose (G)-oral rehydration solution (ORS), rice dextrin (RD)-ORS, and rice flour (RF)-ORS on fluid intake, rapidity of rehydration, and stool output of children with acute diarrhea and mild or moderate dehydration.
Methods. The study was a randomized, double-masked clinical trial. One hundred forty-six male infants, ages 3 to 36 months, were randomly assigned to one of three treatment groups. Clinical evaluations and fluid balances were conducted every 2 to 4 hours for 48 hours. Principal outcome variables were ORS consumption, recovery of hydration status, and fecal output.
Results. The groups were similar at admission with regard to age, nutritional status, history of the current episode, and clinical status. There were no differences in ORS consumption by treatment group during any period of study. During the first 6-hour period, patients in group RF had less stool output (16 ± 14 g/kg/body weight) than those in group G (22 ± 20 g/kg) or RD (21 ± 19 g/kg; P &lt; .05). After 12 hours of hospitalization, there were no differences by treatment group. Recovery of hydration status, changes in serum sodium and potassium, and duration of diarrhea in the hospital were similar in all three groups.
Conclusion. There was a 24% to 27% reduction in stool output during the first 6 hours of treatment among children who received RF-ORS compared with those who received G-ORS or RD-ORS, but this effect did not persist after the first 12 hours of therapy. Because this difference was of small magnitude and limited duration, it has minor clinical importance. Thus, we conclude that the three solutions had similar efficacy for children with acute, watery diarrhea and mild or moderate dehydration.
Condom Availability for Youth
Authors:   Committee on Adolescence
Published: December 2021

The medical consequences of adolescent sexual activity are a national health concern, highlighted by unintended pregnancy and sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS). Health promotion goals for teenagers include postponement of sexual activity until psychosocial maturity and consistent use of condoms by those who do engage in sexual intercourse.
Although designing effective strategies to accomplish these goals remains a challenge, increased condom use is a realistic, achievable objective. The national public health agenda to reduce HIV transmission emphasizes the need to facilitate condom use as a method of disease prevention. Condom availability programs in schools are receiving widespread attention as a potential strategy to increase condom use by sexually active adolescents. Pediatricians are being asked for advice by school boards and community groups. This statement reviews the pertinent issues related to condom availability in schools and provides recommendations for use in responding to requests for advice.
Background
Sexual behavior of American adolescents has been studied for the past generation. Trend analysis shows increasing rates of sexual intercourse among young people over the past 20 years.1-3 Middle to late adolescence is now the average time for initiation of sexual intercourse. The 1992 Centers for Disease Control and Prevention national school-based Youth Risk Behavior Survey (YRBS) of 11 631 students in grades 6 through 12 reported that 54% of all high school students were coitally experienced, with 39% having had coitus in the 3 months before the survey. 4,5 Forty percent of 9th graders reported having sexual intercourse, a percentage that increased to 72% in 12th graders.
The Use of Cranial CT Scans in the Triage of Pediatric Patients With Mild Head Injury
Authors: Davis Robert L. , Hughes Michael , Gubler K. Dean , Waller Patti L. , Rivara Frederick P. 
Published: December 2021

Objective. Recent evidence suggests that patients with a normal cranial CT scan after head injury can be safely discharged home from the emergency department. However, supporting data from previous studies has relied on incomplete patient follow-up. We utilized a statewide comprehensive hospital abstract reporting system (CHARS) to assess whether children with normal CT scans after head injury subsequently developed intracranial sequelae in the month following their initial injury.
Design. Retrospective case-series study, with comprehensive statewide follow-up for 1 month.
Setting. The emergency department of a Level 1 Trauma Center in Seattle, Washington.
Participants. All children (n = 400) with head injury, Glasgow Coma Score of 13 to 15, and initial normal CT scan seen over a 4.5-year time period. All were matched against CHARS to evaluate admissions within 30 days after emergency department disposition. For readmissions, International Classification of Diseases (9th revision) discharge and procedure information was collected. All children were also matched against the state death files.
Results. Four children were readmitted for neurologic reasons within 1 month following injury. One child on coumadin for heart disease developed a symptomatic subdural hematoma 5 days after head injury, requiring neurosurgical drainage. One child developed a symptomatic hemorrhagic contusion 3 days after injury, requiring observation only. Two children were readmitted 1 day after injury for concussive symptoms; both were discharged home after observation only. There were no deaths among the study population.
Conclusions. Among children with a normal cranial CT scan after mild head injury, delayed intracranial sequelae requiring intervention are extremely uncommon. In otherwise stable patients, a normal cranial CT scan can identify patients to be safely discharged from the emergency department, and would be more cost-effective than 1 to 2 days of hospital observation.
JUNK SCIENCE JUNKED
Authors: L. J. F. 
Published: December 2021

It took a decade, but in a California courtroom this month science finally beat the plaintiffs' lawyers. The Ninth Circuit Court of Appeals dismissed the notorious Bendectin case.
This was the lawsuit brought by the parents of two children who said their sons' birth defects were caused by the anti-morning sickness drug that the mothers took during their pregnancies. The dismissal is a giant step toward returning sanity to our out-of-control tort liability system.
In a unanimous opinion filed on January 4, a three-judge panel ruled that the science offered up by the plaintiffs' experts was inadequate. The court pointed out that none of their findings had been published in scientific journals or offered up for peer review.
The court didn't mince words. "Bendectin litigation has been pending in the courts for over a decade," Judge Alex Kozinski's scathing opinion reads, "yet the only review the plaintiffs' experts' work has received has been by judges and juries, and the only place their theories and studies have been published is in the pages of federal and state reporters."
Or as we would put it, the aim of this case wasn't a search for truth and justice but a search for deep pockets.
"Topical Steroid Holiday"
Authors: Hepburn David , Morelli Joseph , Weston William L. 
Published: December 2021

Daily use of low-potency topical steroids is a frequently observed pediatric prescribing pattern.1 Many clinicians believe such a strategy is safe because low-potency topical steroids usually do not suppress levels of plasma cortisol or produce systemic side effects. However, daily use of low-potency steroids may result in suppression of plasma cortisol levels.1-4
Suppression of plasma cortisol levels after use of topical steroids has been observed in a biphasic pattern. There is suppression within 2 weeks of starting daily therapy, then recovery to normal despite continued use, then suppression again after 4 to 6 weeks of daily therapy.2,3
AMERICAN HOSPITAL ASSOCIATION FAULTS PERFORMANCE OF JCAH
Authors: L. J. F. 
Published: December 2021

The American Hospital Association (AHA) declared a "crisis of confidence" in the Joint Commission on Accreditation of Health-care Organizations, which accredits most of the nation's hospitals.
The AHA said its 5,000 member hospitals are so frustrated by the Commission's performance that more than ten of its state chapters are considering alternatives. Defections could lead to the Commission's collapse, said Richard Davidson, president of the AHA.
The AHA's unusual public criticism comes as the Joint Commission scrambles to revamp its procedures to respond to vast changes under way in the US health-care system. It also comes amid growing demands by consumers and employers for accountability among health-care providers.
The Commission inspects most of the nation's hospitals every three years as part of its accrediation process. Hospitals must be accredited to receive Medicare reimbursements for treating the elderly.
At a press conference in Chicago, officials of the AHA said its members have expressed broad concerns about the quality of the agency's inspections and the costs of the services. In addition, they said a "relentless marketing of education programs" and other products aimed at helping hospitals prepare for the surveys has clouded the Joint Commission's mission with conflicts.
INTERNATIONAL LACTATION CONSULTANT ASSOCIATION ANNOUNCES 1996 MANUSCRIPT COMPETITION
Authors: Auerbach K. G. 
Published: December 2021

The International Lactation Consultant Association is sponsoring a competition designed to identify outstanding manuscripts relating to human lactation or breast-feeding in 1996. Authors may enter one of two categories: a Literature Review competition or a Research Paper competition. The winner in each category will receive $500 (US currency); winning manuscripts will be published in the Journal of Human Lactation. Entrants need not be members of the International Lactation Consultant Association. Students are encouraged to enter.
Competition in the Research Paper competition is open to published or unpublished authors; the Literature Review competition is limited to currently unpublished authors. The postmark deadline for entry in the 1996 competition is January 5, 1996.
To obtain guidelines for submitting a manuscript for consideration in the competition, send a self-addressed (and stamped if US) envelope to:
Developmental Outcome as a Function of the Goodness of Fit Between the Infant's Cry Characteristics and the Mother's Perception of Her Infant's Cry
Authors: Lester Barry M. , Boukydis C. F. Zachariah , Garcia-Coll Cynthia T. , Peucker Mark , McGrath Margaret M. , Vohr Betty R. , Brem Francine , Oh William 
Published: December 2021

Objective. To determine whether the "goodness of fit" between infant cry characteristics and the mother's perception of the cry is related to developmental outcome at 18 months of age.
Design. This was a prospective, longitudinal study from birth to 18 months performed in a blinded manner.
Setting. The study was conducted in a maternity hospital, including normal and special care nurseries and a laboratory for developmental follow-up.
Patients. The 121 term and preterm infants and their mothers were selected to meet medical criteria.
Measurement. Acoustic analysis of 1-month infant cry and the mother's perception of the same cry was used to divide subjects into four groups representing matches and mismatches between infant cry characteristics and maternal cry perception. Primary outcome measures of cognitive, language, motor, and neurologic outcome were administered at 18 months. Caretaking environment measures were also recorded.
Results. Statistically significant (P &lt; .05) findings showed that matched groups scored higher on measures of language and cognitive performance than infants in the mismatch groups, with a particular advantage for infants in the matched group in which mothers accurately perceived the higher-pitched cries of their infants. There were no differences between the groups in biologic or sociodemographic factors. Group differences were observed in social support and maternal self-esteem.
Conclusions. Matches and mismatches between infant cry characteristics at 1 month and the mother's perception of the cry are related to cognitive and language outcome at 18 months in term and preterm infants. This relation is probably due to transactional processes in which developmental outcome is affected by the clarity of the infants' signals and by the ability of the mother to accurately perceive her infant's signals. The mother's ability to read her infant's cues may be affected by factors such as social support and self-esteem.
Skateboard Injuries
Authors:   Committee on Injury and Poison Prevention
Published: December 2021

Skateboarding has resurged and so have its associated hazards and injuries. There are an estimated 8 million skateboarders now in the United States.1 Pediatricians informed about skateboard activities in their areas can help prevent needless injuries to children and adolescents.
During the last skateboard injury epidemic, the annual incidence of injuries peaked at 150 000 in 1977 and subsequently decreased to 16 000 in 1983. It is likely that this decrease in injuries was primarily related to decreased skateboard activity and not to improved safety conditions. With increased popularity the number has risen, with an estimated 56 435 injuries being treated in emergency departments in 1992.1 In addition, an estimated 1900 hospitalizations occurred due to skateboard-related injuries during this period. The vast proportion of admissions were from head injuries.2
Analysis of Consumer Product Safety Commission data from 1991 indicates the following salient features of the current outbreak of skateboard injuries during this period3:
• 95% involved skateboarders younger than 25 years; 61% involved 5- to 14-year-olds;
• 87% of victims were male;
• 74% of injuries involved the extremities—usually fractures of radius and ulna, 21% to the head and neck, and 5% to the trunk;
• severe injuries (intracranial, internal) were uncommon, moderate injuries (long bone fractures) were most common, and deaths occurred almost always from collisions with motor vehicles;
• younger victims incurred a higher proportion of head and neck injuries than older victims—head injury occurred in 75% of the victims in the 0- to 4-year-old age group, 50% in the 5- to 9-year-old group, and 15% in the 10- to 19-year-old category;
• head injuries in the older age groups were more severe because of collisions with motor vehicles; and
• helmets designed for skateboarding are seldom worn but will protect skateboarders from serious head injury; data on the protective value of elbow pads, knee pads, and wrist guards are inconclusive; they may reduce injury severity. The use of bicycle or hockey helmets has not been evaluated.4,5
The Management of Febrile Infants by Primary-Care Pediatricians in Utah: Comparison With Published Practice Guidelines
Authors: Young Paul C. 
Published: December 2021

Objective. To determine primary-care pediatricians' management of febrile infants and compare them with published practice guidelines.
Design. Case scenarios were sent to 194 primary-care pediatricians in Utah, describing three febrile infants, ages 21 days, 60 days, and 20 months, corresponding to the three age groups: 0 to 28 days; 29 to 90 days, and 91 days to 36 months for which the guidelines suggest different strategies.
Results. Ninety-four pediatricians responded (response rate, 48%). Compliance with the guidelines was 39% for the 21 day old, 9.6% for the 60 day old, and 75% for the 20 month old. No respondent followed the guidelines for all three infants. Performance of tests to determine if an infant was low risk varied from 3%, for a stool white cell examination in a febrile 2 month old with diarrhea, to 75% for a complete blood count in a 20 month old with a temperature of 40°C. Compliance did not differ between private and academic practitioners. Those in practice less than 5 years (n = 22) were more likely than those with more experience to follow the guidelines for the 21 day old but not the other two infants.
Conclusion. Primary-care pediatricians in Utah manage febrile infants with fewer laboratory tests and less hospitalization than recent practice guidelines developed by an expert panel of academic specialists suggest.
Unintentional Perineal Injury in Prepubescent Girls: A Multicenter, Prospective Report of 56 Girls
Authors: Bond G. Randall , Dowd M. Denise , Landsman Ira , Rimsza Mary 
Published: December 2021

Objective. To determine the pattern of perineal injuries and frequency of hymenal involvement resulting from unintentional trauma in prepubescent girls.
Design. Prospective, multicenter. Observation by skilled observers. Determination of the circumstance and physical pattern of injury, with specific attention to the hymen.
Setting. Children's emergency department or acute care clinic.
Patients. Tanner stage 1 girls presenting with acute perineal injury. Criteria for unintentional injury: observation of the event or knowledge of the girl's engagement in a risky activity (eg, biking or climbing monkey bars) immediately before the injury.
Results. Fifty-six girls were evaluated. Age range: 1 to 12 years (median, 6 years; mean, 6.2 years). Associations: bicycle, 39%; other outdoor injuries, 25% (climbing apparatus, straddling an object, and falls); indoor injuries, 36% (straddling furniture and falls). Most injuries were minor. In each group the labia minora was the most frequent structure involved. The majority of injuries were anterior or lateral to the hymen. However, in 34% some or all of the injuries were posterior to the hymen. Thigh injuries were observed only in older children engaged in bicycle riding or outdoor play. In only one patient was the hymen involved. That patient was a 2 year old who fell outdoors, at a park, abducting her legs in a splits-type mechanism. She had a pinpoint abraded area on the hymenal surface at three o'clock. Otherwise, no unique pattern of injury was associated with age or circumstance of injury.
Conclusions. Hymenal injuries are rarely the result of unintentional injury. The presence of a hymenal injury should suggest sexual abuse. Involvement of other perineal structures was commonly associated with unintended injury. Given the limited resources for prevention, the relative infrequency of perineal injuries and the minor nature of most of these injuries, significant preventive efforts are not justified.
CONGRESSIONAL STUDY QUESTIONS VALUE OF OUTCOMES RESEARCH
Authors: L. J. F. 
Published: December 2021

The 320-page report, "Identifying Health Technologies that Work: Searching for Evidence," by the Office of Technology Assessment, has significant implications for both researchers and health policy makers ...
The Office of Technology Assessment found that the hopes for effectiveness research are not misplaced, but they have been overly optimistic and often misdirected, the report concludes. It will not necessarily reduce health care costs significantly ... The analysis of large databases ... has proved not to be a particularly useful tool in providing valid, believable answers about comparative effectiveness. The report suggests that experimental research based on randomized, controlled trials might provide more valid results.
Clinical practice guidelines themselves came under fire in the Office of Technology Assessment report because of how they are developed and disseminated. Simply issuing them to physicians often has no effect, and unless they promote "extremely compelling" practices or are issued by credible organizations, they may have the unintended effects as clinicians try to circumvent them ...
The report is available for $20 from the US Government Printing Office. S/N 052-003-01389-4. Call 202/512-1800.
Invasive Fungal Dermatitis in the ≤1000-Gram Neonate
Authors: Rowen Judith L. , Atkins Jane T. , Levy Moise L. , Baer Susan C. , Baker Carol J. 
Published: December 2021

Objective. In 1991, we noted the emergence amongst our extremely low birth weight neonates of a new clinical entity, invasive fungal dermatitis, characterized by erosive, crusting lesions and a high rate of subsequent systemic fungal infection. We sought to define this condition and examine potential risk factors.
Methods. Sixteen neonates with invasive fungal dermatitis were seen during a 2-year period in three Baylor College of Medicine affiliated intensive care nurseries. Seven were confirmed cases, with skin biopsy evidence of invasion beyond the stratum corneum. Nine had a consistent clinical course and a positive potassium hydroxide examination of skin scrapings or isolation of fungi from skin or systemic cultures. Three controls were matched to each case by hospital, date of admission, and birth weight Data was collected by retrospective chart review.
Results. Invasive fungal dermatitis occurred in 5.9% of at-risk infants. Case patients had a mean birth weight of 635 g and developed skin lesions at a mean age of 9 days (range, 6 to 14). Candida albicans was the most commonly implicated pathogen, but other Candida species, Aspergillus, Trichosporon beigelii, and Curoularia were also seen. Disseminated infection occurred in 69%, all due to Candida sp. Case patients were significantly more premature than controls (mean gestation, 24.4 vs 25.9 weeks) and were more likely to be delivered vaginally (81% vs 50%). Postnatal steroids were administered to cases (81%) more often than controls (46%). Case patients had more prolonged hyperglycemia (as assessed by insulin administration) than controls (mean 4.3 vs 2.0 days).
Conclusions. Invasive fungal dermatitis is a disease of the smallest, most immature neonates and is associated with vaginal birth, steroid administration, and hyperglycemia. We speculate that the skin serves as a portal of entry for colonizing fungal species and may thus lead to disseminated infection. Methods to improve skin barrier function may be useful in preventing this disorder.
Neonatal Pulmonary Mechanics and Oxygenation After Prophylactic Amnioinfusion in Labor: A Randomized Clinical Trial
Authors: McEvoy Cindy , Sardesai Smeeta , Macri Charles , Paul Richard , Durand Manuel 
Published: December 2021

Objective. Amnioinfusion has been reported to improve the perinatal outcome of pregnancies complicated by decreased amniotic fluid volume, but detailed information on its possible adverse effects on neonatal pulmonary mechanics and oxygenation is not available.
Study design. We evaluated 42 infants with birth weights of 2600 to 4320 g and gestational ages of 36 to 44 weeks, who were born to mothers enrolled in a prospective, randomized trial of amnioinfusion for oligohydramnios in labor. Maternal entry criteria were gestational age 36 weeks or older, estimated fetal weight more than 2500 g, oligohydramnios defined as an amniotic fluid index of 5 cm or less, and a normal fetal heart rate pattern. Evaluation of pulmonary mechanics and oxygen saturation (SaO2) was done with the infants breathing room air between birth and day 3 of life. Transpulmonary pressure, flow, and tidal volume were recorded simultaneously, and pulmonary resistance and lung compliance were calculated. SaO2 was measured for 30 minutes with the Nellcor N-200 oximeter and IBM computer oximetry software.
Results. Evaluation of the data revealed no significant difference between the two groups for tidal volume, lung compliance, pulmonary resistance, or work of breathing. There were no differences between the two groups in the number of desaturation episodes or in percent of desaturations to less than 90%, 85%, or 80% SaO2.
Conclusion. Prior studies have shown amnioinfusion to improve perinatal outcome. Our findings demonstrate that amnioinfusion for oligohydramnios in labor does not adversely affect neonatal pulmonary mechanics or oxygenation.