bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multiculturalism, Chronic Illness, and Disability
Authors: Groce Nora Ellen , Zola Irving Kenneth 
Published: December 2021

To gain at least an initial understanding of the underlying beliefs and attitudes in a cross-cultural situation, we believe that the three key points discussed in this paper should prove a significant point of departure:
1. Traditional beliefs about the cause of chronic illness or disability will play a significant role in determining family and community attitudes toward individuals with a disability and will influence when, how, and why medical input is sought.
2. The expectation of survival on the part of parents and community will have an effect on the amount of time, energy, and cooperation shown by family and community for the individual who has an impairment.16
3. The expectations by family and community for the social role(s) an individual with a chronic illness or disability will hold will affect a broad range of issues, including education, social integration, and independence.
Furthermore, although chronic illness and disability are often considered as issues distinct from the full range of problems encountered in society for immigrant and minority groups, in fact, these issues could not be more closely tied. The frequently discussed concerns within the ethnic and minority community about the role of the family, integration and acculturation, social articulation with the greater American society, stress, cross-cultural misunderstanding, and outright prejudice can all compound the problems encountered for the chronically ill or disabled individual in a multicultural society.
Cost-Effectiveness Analysis of Bicycle Helmet Subsidies in a Defined Population
Authors: Thompson Robert S. , Thompson Diane C. , Rivara Frederick P. , Salazar Angela A. 
Published: December 2021

Objective. To examine the potential effects of bicycle safety helmet cost subsidy on bicycle head injury rates and costs.
Design. Using empiric data on the incidence and costs of bicycle injuries to children, we examined the hypothetical effects of various bicycle helmet subsidies in a cost-effectiveness analysis. A hypothetical cohort of 100 000 5- through 9-year-olds was followed for 5 years after helmet cost subsidization. Sensitivity analyses were done of three different levels of safety helmet subsidy ($5, $10, $15), three discount rates (2%, 4%, 6%), 10 levels of safety helmet use ranging from 10% to 100%, and the occurrence or nonoccurrence of catastrophic head injuries.
Patients. Forty-three children 5 through 9 years of age and 27 children 10 through 14 years of age with head injuries due to bicycling were identified through emergency department surveillance of a population of 29 533.
Setting. Group Health Cooperative of Puget Sound, a large health maintenance organization.
Outcome measures. Bicycle head injuries prevented and the savings or costs associated with various subsidy, safety helmet use, and discount rates.
Results. Hypothetically, an increase in bicycle helmet use rates to 40% to 50% due to subsidies of $5 or $10 prevents 564 to 840 head injuries in a cohort of 100 000 5- through 9-year-olds over 5 years. Under these conditions and a 2% discount rate, cost savings ranging from $189 207 to $427 808 will result when catastrophic head injuries are included in the analysis.
Conclusion. Subsidization of bicycle safety helmets to achieve a cost of $14 to $20 per helmet and use rates of 40% to 50% will likely prove cost-effective. Empirical evidence from a Seattle campaign suggests that such helmet use rates are achievable.
Infants of Less Than 1250 Grams Birth Weight at Groote Schuur Hospital: Outcome at 1 and 2 Years of Age
Authors: Thompson Clare M. , Buccimazza Sandro S. , Webster Joanne , Malan Atties F. , Molteno Christopher D. 
Published: December 2021

A prospective 2-year follow-up study of infants with birth weights of less than 1250 g was undertaken at Groote Schuur Hospital Neonatal Intensive Care Unit. For a 12-month period beginning July 1988, all live infants born at Groote Schuur Hospital or referred to the Neonatal Intensive Care Unit were included in the study cohort. The aim of the study was to document the morbidity, mortality, and neurodevelopmental outcome of these infants to 2 years of age.
Of 235 liveborn infants, 143 (61%) survived to discharge. One hundred twenty-six infants were born weighing less than 1000 g; 42% survived to discharge. One hundred nine infants weighed 1000 g or more at birth, and 83% survived to discharge. Better survival was documented for infants whose mothers attended antenatal care, who weighed more than 900 g, and who were of greater than 30 weeks' gestation. Eleven infants died in the first 6 months after discharge. One hundred six infants (83% of survivors) underwent Griffiths developmental testing and clinical assessment at 1 year of age. Ninety-six (91%) of these survivors were seen and tested at 2 years of age. Of the 106 infants assessed at 1 year of age, 6 infants had cerebral palsy, 6 were globally developmentally delayed without signs of cerebral palsy, and 1 infant showed significant motor delay with a normal developmental quotient. At 2 years of age 1 additional infant had cerebral palsy and 9 more infants are likely to be mentally retarded. At 2 years of age the major handicap rate was, therefore, 22% . Sixty-nine percent of surviving infants, and all but 1 of the infants with cerebral palsy, were underweight for gestational age at birth. There was a tendency for these underweight-for-gestational-age infants to score less well at 2 years of age. Infants who received ventilation and infants with a birth weight of less than 1000 g were not found to score less well than other infants in the cohort.
Birth Weight and Illness Severity: Independent Predictors of Neonatal Mortality
Authors: Richardson Dougbas K. , Phibbs Ciaran S. , Gray James E. , McCormick Marie C. , Workman-Daniels Kathryn , Goldmann Donald A. 
Published: December 2021

Background. Low birth weight is a major determinant of neonatal mortality. Yet birth weight, even in conjunction with other demographic markers, is inadequate to explain the large variations in neonatal mortality between intensive care units. This variation probably reflects differences in admission severity. The authors have recently developed the Score for Neonatal Acute Physiology (SNAP), an illness severity index specific for neonatal intensive care, and demonstrated illness severity to be a major determinant of neonatal mortality.
Objective. To define the relative contributions of birth weight and illness severity to the risk of neonatal mortality and to identify other significant independent risk factors.
Methods. Logistic regression was used to analyze data from a cohort of 1621 consecutive admissions to three neonatal intensive care units (92 deaths), to test six alternative predictive models. The best logistic model was then used to develop a simple additive clinical score, the SNAP Perinatal Extension (SNAP-PE).
Results. These analyses demonstrated that birth weight and illness severity are powerful independent predictors across a broad range of birth weights and that their effects are additive. Below 750 g, there is an interaction between birth weight and SNAP. Other factors that showed independent predictive power were low Apgar score at 5 minutes and small size for gestational age. Separate derivation and test samples were used to demonstrate that the SNAP-PE is comparable to the best logistic model and has a sensitivity and specificity superior to either birth weight or SNAP alone (receiver-operator characteristic area .92 ± .02) as well as excellent goodness of fit.
Conclusion. This simplified clinical score provides accurate mortality risk estimates for application in a broad array of clinical and research settings.
Bone Mineral Content in Infants and Children With Chronic Cholestatic Liver Disease
Authors: Argao Eric A. , Specker Bonny L. , Heubi James E. 
Published: December 2021

Objective. To assess bone mineral content (BMC) status and serum vitamin D metabolite levels of infants and children with chronic cholestatic liver disease. To determine if severity of bone disease in these patients correlates with serum vitamin D metabolite levels.
Methodology. We measured radial BMC with the use of a single-beam photon absorptiometer and serum vitamin D metabolite levels in 56 patients with chronic cholestasis seen at our institution from 1985 through 1991. Patients were divided into two groups according to age.
Results. In group 1 (n = 37; age 2 to 22 months), decreased levels of BMC were seen as early as the first few months of life, with sharp decline observed with increasing age (approaching 3 to 5 standard deviations [SD] below the mean, P &lt; .0003). Older patients (group 2, n = 19; age 2 to 20 years) had BMC values which clustered between 2 and 4 SD below the mean throughout the age range. Although a downward trend also was noted with increasing age, this was not statistically significant. Despite correction for weight-age or height-age, BMC was decreased in most of these patients. No correlation between severity of osteopenia and serum levels of 25(OH)-vitamin D and 1,25(OH)2-vitamin D was observed in either infants or older children.
Conclusions. Decreased bone mineralization, as a complication of chronic cholestatic conditions, is a disease process that begins early in infancy, rapidly worsens with increasing age and hepatic dysfunction, and remains relatively stable in children with more stable liver disease.
Ambient Air Pollution: Respiratory Hazards to Children
Authors:   Committee on Environmental Health
Published: December 2021

Levels of many outdoor air pollutants decreased substantially after the passage of the Clean Air Act of 1970; however, levels of ozone, carbon monoxide, and particulate matter are still high enough to present hazards to children. Failure to meet the federal standards for these pollutants was a major force driving the adoption of the revised Clean Air Act of 1990. In addition, recent research indicates that acidic aerosols, for which there are no health-based standards, may be associated with adverse respiratory effects.
As an ambient air pollutant, ozone is formed by the action of sunlight on nitrogen oxides and reactive hydrocarbons (both of which are emitted by motor vehicles and industrial sources). Ozone levels therefore tend to be highest on warm, sunny days, which are conducive to outdoor activities. In many areas ozone concentrations peak in the midafternoon, when children are likely to be playing outside. It is important to distinguish ground-level ozone air pollution from stratospheric ozone depletion by chlorofluorocarbons. These issues are unrelated. Carbon monoxide, a product of incomplete combustion, is emitted mainly from cars and other mobile sources. Airborne particulate matter is a variable and complex mixture of natural materials and substances released from numerous industries, motor vehicles, residential wood burning, construction and demolition, and other sources. Acidic aerosols are traceable mainly to combustion of sulfur-containing fossil fuels and to reactions of photochemical free radicals with nitrogen dioxide.
Exposure to ambient air pollution in North America has been clearly associated with acute and subacute effects in epidemiologic investigations and in controlled exposure studies in environmental chambers.
Self-regulation of Energy Intake in Children, Questioned
Authors: SHEA STEVEN , BASCH CHARLES E. , CONTENTO ISOBEL , STEIN ARYEH D. 
Published: December 2021

In Reply.—
Birch et al found a threefold difference in the magnitude of the coefficient of variation for energy intake at eating occasions compared to daily energy intake in a controlled setting,1 and we observed a similar threefold difference among children in their everyday environment.2 Dr Goldman points out that averaging individual measurements reduces the variability of the mean. It was for this reason that we used a statistical test to compare the observed coefficient of variation for the day's energy intake to the expected coefficient of variation for the day.
Practice Guideline for the Management of Infants and Children 0 to 36 Months of Age With Fever Without Source
Authors: Baraff Larry J. , Schriger David L. , Bass James W. , Fleisher Gary R. , Klein Jerome O. , McCracken George H. , Powell Keith R. 
Published: December 2021

Study objective. To develop guidelines for the care of infants and children from birth to 36 months of age with fever without source.
Participants and setting. An expert panel of senior academic faculty with expertise in pediatrics and infectious diseases or emergency medicine.
Design and intervention. A comprehensive literature search was used to identify all publications pertinent to the management of the febrile child. When appropriate, meta-analysis was used to combine the results of multiple studies. One or more specific management strategies was proposed for each of decision nodes in draft management algorithms. The draft algorithms, selected publications, and the meta-analyses were provided to the panel, which determined the final guidelines using the modified Delphi technique.
Results. All toxic-appearing infants and children and all febrile infants less than 28 days of age should be hospitalized for parenteral antibiotic therapy. Febrile infants 28 to 90 days of age defined at low risk by specific clinical and laboratory criteria may be managed as outpatients if close follow-up is assured. Older children with fever less than 39.0°C without source need no laboratory tests or antibiotics. Children 3 to 36 months of age with fever of 39.0°C or more and whose white blood cell count is 15 000/mm3 or more should have a blood culture and be treated with antibiotics pending culture results. Urine cultures should be obtained from all boys 6 months of age or less and all girls 2 years of age or less who are treated with antibiotics.
Conclusion. These guidelines do not eliminate all risk or strictly confine antibiotic treatment to children likely to have occult bacteremia. Physicians may individualize therapy based on clinical circumstances or adopt a variation of these guidelines based on a different interpretation of the evidence.
Effect of Antibiotic Therapy and Etiologic Microorganism on the Risk of Bacterial Meningitis in Children with Occult Bacteremia
Authors: Baraff Larry J. , Oslund Scott , Prather Mark 
Published: December 2021

Objective. To quantify the effect of antibiotic therapy on the probability of subsequent bacterial meningitis in children with fever without source treated as outpatients.
Design. Bayesian meta-analyses.
Reports included. All reports of the organism-specific prevalence of occult bacteremia in children with fever without source treated as outpatients, and the organism-specific prevalence of subsequent meningitis in children with occult bacteremia initially treated as outpatients stratified by type of antibiotic therapy.
Results. The mean probabilities of subsequent meningitis in children with occult bacteremia were 9.8%, 8.2%, and 0.3% in the no antibiotic, oral antibiotic, and parenteral antibiotic therapy groups, respectively. All cases of bacterial meningitis in children with occult bacteremia treated with oral antibiotics were due to Haemophilus influenzae. There were no cases of culture-positive bacterial meningitis in 139 bacteremic children treated with ceftriaxone (mean probability, 0.3%; 95% confidence interval, 0.0% to 1.5%). The mean probabilities of bacterial meningitis in a child with fever without source treated as an outpatient without antibiotics were: Streptococcus pneumoniae, 0.21%; and H influenzae, 0.06%.
Conclusions. Antibiotic therapy is effective in preventing meningitis in children at risk of occult bacteremia.
More to Be Learned From Crigler-Najjar Patients
Authors: HANSEN THOR WILLY RUUD 
Published: December 2021

To the Editor.—
In a recent study by Galbraith et al,1 the use of tin-mesoporphyrin in two patients with the Crigler-Najjar type I syndrome is described. The feasibility of this kind of treatment is documented, and the authors' comments on the size of the total-body bilirubin pool as well as their calculations on bilirubin production and clearance in these patients are illuminating.
Personally, I am intrigued as much by aspects of the case reports, about which the authors do not comment, probably because these aspects are outside the focus of their paper.
Superiority of Oral Agar and Phototherapy Combination in the Treatment of Neonatal Hyperbilirubinemia
Authors: Caglayan Suat , Candemir Halil , Aksit Sadik , Kansoy Savas , Asik Sezin , Yaprak Isin 
Published: December 2021

Objective. To determine the value of oral agar in the treatment of neonatal hyperbilirubinemia and to compare it with two other treatment modalities: phototherapy alone and phototherapy plus oral agar.
Methods. Two hundred eight jaundiced full-term newborns were divided into four groups. They were given either phototherapy alone, phototherapy plus oral agar, oral agar alone, or no treatment (control group). The changes in the serum bilirubin values were determined and the results were compared statistically, mainly using analysis of variance.
Results. In all three therapy groups, the time required to reduce the bilirubin level to either 15 mg/dL or to 10 mg/dL was significantly shorter than that required by the control group. Although oral agar was found to be as effective as phototherapy, the most significant decrease in bilirubin level was in the combination group.
Conclusions. The efficacy of phototherapy in decreasing the serum bilirubin level in neonatal hyperbilirubinemia can be augmented with the use of oral agar. Oral agar can also be used as a single agent for the treatment of neonatal hyperbilirubinemia, since it is as effective as phototherapy.
Randomized Controlled Trial of Three Interventions in the Management of Persistent Crying of Infancy
Authors: Parkin Patricia C. , Schwartz Clive J. , Manuel Betty Ann 
Published: December 2021

Objectives. The objective of this study was to evaluate the effectiveness of three methods in the management of infantile colic.
Methods. Healthy infants with persistent crying were randomly assigned to one of three groups for a 2-week period. All groups received an assessment and reassurance from a pediatrician and support from a public health nurse. Group 1 also received counseling regarding specific management techniques. Group 2 also received a car-ride simulation device. Group 3 acted as a control. Mothers completed crying diaries and preintervention and postintervention anxiety questionnaires.
Results. Thirty-eight mother-infant pairs were enrolled. Combining all three groups, there was a 24% reduction in daily hours of crying (P = .01) and a 18% improvement in maternal anxiety (P &lt; .001), but no significant difference among groups.
Conclusions. The natural history of persistent crying of infancy is improvement over time. These specific interventions proved no better than reassurance and support alone in decreasing daily hours of crying and maternal anxiety.
Severe Varicella Associated With Steroid Use
Authors: Dowell Scott F. , Bresee Joseph S. 
Published: December 2021

Objective. To evaluate whether corticosteroid use is associated with severe varicella.
Design. The odds of corticosteroid exposure were compared among 35 children with severe varicella and 10 000 control subjects.
Results. Five (26.3%) of 19 case patients without known immunosuppression had received steroids within 30 days prior to the onset of their rash compared with 20 of the 10 000 control subjects (0.2%), giving an odds ratio of 178 (95% confidence interval 59 to 541). If 16 case patients with leukemia or other known immunosuppressive conditions were included, the odds ratio was larger (odds ratio 420, 95% confidence interval 189 to 935). Of the 13 case patients whose dosage was recorded, 7 received less than the equivalent of 2 mg/kg per day of prednisone. The timing of the steroid use in those who had severe varicella clustered within the incubation period for the virus.
Conclusions. Systemic corticosteroid use appears to increase substantially the risk of severe or fatal varicella. The timing of corticosteroid exposure, in addition to dose and duration, may be an important factor in determining vulnerability. Further studies are needed to determine whether short-course, low-dose, or inhaled steroids are associated with similarly increased risk. Physicians should be aware that varicella-susceptible patients receiving corticosteroids are at considerably increased risk for severe varicella and should consider how to counsel their patients.
Child-Rearing Practices and Nursing Caries
Authors: Serwint J. R. , Mungo R. , Negrete V. F. , Duggan A. K. , Korsch B. M. 
Published: December 2021

Objective. To determine which child-rearing practices are associated with nursing caries.
Design. Cross-sectional study.
Setting. Hospital-based general pediatric clinic.
Participants. Sequential sample of 110 healthy children aged 18 to 36 months.
Outcome measures. Feeding practices of children, limit-setting issues, and familial dental health were determined by maternal interview. Nursing caries were diagnosed by dental examination.
Results. Nursing caries were found in 22 (20%) of the children. Ninety percent of children with and without caries were bottle-feeding at 12 and 18 months of age. Ninety-one percent of children with caries and 84% without were still drinking a nighttime bottle at 18 months (P = .33). The mothers of children with caries were found to have fewer years of education, 8.9 vs 10.8 years (P = .02), and were more likely to have eight or more cavities, 55% vs 19% (P = .002). More infants in the caries group had been breast-fed, 72% vs 46% (P = .02), although length of breast-feeding was similar, 5.4 vs 6.7 months. Fewer children with caries drank fluoridated tap water 27% vs 54% (P = .05), but there were no differences in topical fluoride use, dental hygiene practices, or visits to the dentist.
Conclusions. These findings fail to substantiate a straightforward relationship between child-rearing practices and nursing caries and suggest that well-designed prospective studies are need to clarify the etiology of early caries.
Effect of Bundling and High Environmental Temperature on Neonatal Body Temperature
Authors: Cheng Tina L. , Partridge J. Colin 
Published: December 2021

Objective. The effect of bundling and ambient heat on newborn body temperature has not been systematically studied. It was hypothesized that bundling and warm environments can elevate the newborn's temperatures to the range that would prompt clinical concern of neonatal sepsis.
Methods. Twenty well, term newborns more than 1 day old were assigned to the control group (one blanket; 24.0°C room) or the experimental group (five blankets and hat; 26.6°C room). Continuous rectal probe temperatures were monitored over a 2½hour period.
Results. There were 8 control and 12 experimental newborns. The mean change in rectal temperature after 2½ hours was -0.04°C (SD ± 0.23) in control newborns and + 0.56°C (SD ± 0.12) in the treatment group (P &lt; .0001, t test). Temperatures in the treatment group rose, after an initial half-hour lag, at a linear rate of 0.27°C per hour without a plateau. Two newborns reached 38.0°C, a rectal temperature that may raise concern of infection.
Conclusions. Bundling and warm environments can elevate newborn body temperature to the "febrile" range in this age group. Physicians treating neonates with elevated temperature should ask about bundling and environmental conditions to differentiate endogenous from exogenous "fevers."