bluuebunny/crossref_metadata_2025_split huggingface dataset:
COST-EFFICIENCY MODEL
Authors: L. J. F. 
Published: December 2021

In an interview, Dr. Thier said he hopes to turn Massachusetts General into another kind of model: one that increases cost-efficiency without compromising basic research or patient care.
"A way of life is changing," Dr. Thier asserted. Academic medical centers are being forced to rein in costs quickly, he contended, because of growing price- pressure from insurers, as well as the movement in Washington to enact healthcare legislation.
Top teaching hospitals haven't conducted much cost-oriented research involving patients. Instead, the hospitals have concentrated on discovering fundamental medical techniques, often working at the molecular level. Research on treatment costs and effectiveness has been carried out mostly by schools of public health and by such think tanks as Rand Corp...
Other big teaching hospitals are starting research on treatment costs and effectiveness, said George Lundberg, editor of the Journal of the American Medical Association. "I expect such research to flourish with the pressures of health-system reform," he said.
"Now that it's so much in the best interests of the largest health-delivery groups to discover the best ways to deliver maximum services for minimum cost," Dr. Lundberg added, "it's not at all surprising that such institutions will enter health-services research in a big way."
Acetaminophen Analgesia in Neonatal Circumcision: The Effect on Pain
Authors: Howard Cynthia R. , Weitzman Michael L. , Howard Fred M. 
Published: December 2021

Objective. Recognizing the concerns about the use of local anesthesia in neonatal circumcision, a painful procedure usually performed without analgesia or anesthesia, we undertook a study of acetaminophen for pain management of this procedure.
Design. A prospective, randomized, double-blind, placebo-controlled, clinical trial of acetaminophen analgesia in 44 healthy full-term neonates undergoing circumcision was conducted. Beginning 2 hours before Gomco circumcision, neonates received either acetaminophen (15 mg/kg per dose, 0.15 mL/kg per dose) or placebo (0.15 mL/kg per dose) every 6 hours for 24 hours. Neonates were monitored intraoperatively for changes in heart rate, respiratory rate, and crying time. Postoperative pain was assessed at 30, 60, 90, 120, 360 minutes, and 24 hours using a standardized postoperative comfort scoring system. Feeding behavior was also assessed before and after circumcision by nursing observation.
Results. Neonates in both groups showed significant increases in heart rate, respiratory rate, and crying during circumcision with no clinically significant differences observed between the groups. Postoperative comfort scores showed no significant differences between the groups until the 360-minute postoperative assessment, at which time the acetaminophen group had significantly improved scores (P &lt; .05). Feeding behavior deteriorated in breast- and bottle-fed neonates in both groups, and acetaminophen did not seem to influence this deterioration.
Conclusions. This study confirms that circumcision of the newborn causes severe and persistent pain. Acetaminophen was not found to ameliorate either the intra-operative or the immediate postoperative pain of circumcision, although it seems that it may provide some benefit after the immediate postoperative period.
Carbamate Poisoning and Oxime Treatment in Children: A Clinical and Laboratory Study
Authors: Lifshitz Matitiahu , Sofer Shaul , Shahak Eliezer , Rotenberg Michal , Almog Shlomo , Tamiri Tsippy 
Published: December 2021

Objective. (1) Retrospective evaluation of the clinical course of carbamate poisoning and the effect of oxime therapy in children. (2) In vitro study of the effect of oximes on the reactivation of carbamylated cholinesterase.
Design. (1) Clinical survey: The records of 26 children intoxicated with carbamates were examined retro-spectively. The poisoning agents in all cases were positively identified as methomyl or aldicarb by gas chromatography-mass spectrometry. (2) Laboratory study: The direct effect of obidoxime and of pralidoxime on acetylcholinesterase activity in vitro was investigated in normal human packed red blood cells pretreated with an organophosphate (paraoxon) or a carbamate (aldicarb or methomyl).
Clinical setting. Pediatric intensive care unit of a teaching hospital.
Patients. Twenty-six infants and young children (aged 1 to 8 years) admitted to the pediatric intensive care unit with severe carbamate intoxication.
Interventions. All cases had been treated with repeated doses of atropine sulfate (0.05 mg/kg) administered every 5 to 10 minutes until muscarinic symptoms disappeared. Obidoxime chloride (Toxogonin, 6 mg/kg) was administered on admission, and again after 4 to 5 hours.
Results. Predominant symptoms were related to central nervous system and nicotinic effects. All the patients showed marked improvement within several hours and recovered completely within 24 hours. None of the children deteriorated and none showed exacerbation of cholinergic symptoms after obidoxime treatment. In vitro, oximes reactivated acetylcholinesterase inhibited with paraoxon, whereas no significant effect of oximes on carbamylated enzyme activity was observed.
Conclusions. Based on the recovery of all cases, as compared with other reports of carbamate poisoning treated with atropine alone, it is concluded that, in the case of aldicarb or methomyl poisoning, oxime therapy apparently does not contribute to the recovery of poisoned patients. In cases of poisoning by an unknown pesticide or of mixed poisoning, oxime therapy can prove beneficial because no negative effects of the therapy can be discerned.
PREGNANT TEEN-AGERS ARE OUTCASTS NO LONGER
Authors: L. J. F. 
Published: December 2021

In the "old days" of the 1960's, 50's and 40's, pregnant teen-agers were pariahs, banished from schools, ostracized by their peers or scurried out of town to give birth in secret.
Today, pregnant teen-agers are even beginning to be viewed by some of their peers as role models. No longer are they shunned or ridiculed, but supported and embraced in their decisions to give birth, keep their babies, continue their educations and participate in school activities. Some adults, however, including many who in their youth considered the treatment of pregnant girls detestable, are never-the-less shocked by these attitudes.
When I was in high school, girls got pregnant and they disappeared," said Richard Schuldt of Eau Clair, Wis. "Now, my pregnant daughter goes on ‘The Montel Williams Show.’ " Mr. Schuldt's daughter April was elected homecoming queen at her high school last year when she was five months pregnant.
Assessing Physical Activity and Fitness in the Office Setting
Authors:   Committee on Sports Medicine and Fitness
Published: December 2021

The terms physical activity, exercise, and physical fitness are often confused and sometimes used interchangeably. Physical activity is defined as any body movement produced by skeletal muscle that results in energy expenditure.1 Exercise is physical activity that is planned and repetitive with a goal of improving physical fitness. Physical fitness is a set of attributes that are health-related, skill-related, or both. Physical fitness is difficult to address without discussing its components. The American Alliance of Health, Physical Education, Recreation, and Dance (AAHPERD) identifies the five components of health-related physical fitness as cardiorespiratory endurance, muscular strength, muscular endurance, flexibility, and body composition.2 There are no guidelines for pediatricians in regard to addressing physical activity and fitness in the office setting.
This statement will review fitness assessment options and recommend practical interventions.
BENEFITS OF EXERCISE
Cardiovascular fitness is important in the prevention of adult coronary artery disease, hypertension, and obesity. In adults, to produce an increase in cardiorespiratory fitness, an exercise must be performed for a minimum duration of 20 minutes, three times a week, at an intensity of at least 60% of maximum heart rate. This is the basis for the exercise recommendations of the American College of Sports Medicine,3 which were also adopted for the Health Objectives for 1990.4
More recent studies have suggested that less intense physical activity also benefits health. An increasing number of scientists are promoting moderate to vigorous activity,5 because maximizing cardiovascular fitness may not be necessary to elicit changes in lifelong health. The greatest benefits of physical activity in adults are achieved when the least active individuals become moderately active.6
A Short-Term Study of Nitrofurantoin Prophylaxis in Children Managed With Clean Intermittent Catheterization
Authors: Johnson Hjalman W. , Anderson John D. , Chambers G. Keith , Arnold William J.D. , Irwin Beverly J. , Brinton Jocelyne R. 
Published: December 2021

Objective. Because there is no evidence for the effectiveness of antibiotic prophylaxis in children with neurogenic bladder, the value of once-daily nitrofurantoin macrocrystals was assessed in a selected population with neurogenic bladder due to meningomyelocele.
Methods and trial population. Children with significant urinary tract abnormalities other than neurogenic bladder were excluded. A urinary tract "infection" was defined as ≥108 colony forming units of bacteria/L of urine together with pyuria of ≥50 x 106 leukocytes/L, and/or symptoms consistent with an urinary tract infection. Fifty-six children participated in a 24-week double-blinded, placebo-controlled cross-over study. The infeclion status was assessed at two weekly intervals or if relevant clinical manifestations occurred.
Results. For the whole trial the average percentage of "infections" per urine sample for each patient was reduced from 39% on placebo to 19% on single daily dose prophylaxis (P &lt; .0003). For the first 12 weeks of the trial corresponding figures were 45% on placebo and 22% on prophylaxis (P &lt; .0018). There was evidence for a marked carryover protective effect of nitrofurantoin into the placebo arm of the trial.
Conclusion. Nitrofurantoin is an effective prophylactic agent during a 3-month period. Long-term studies are needed to confirm the reasonable expectation of a beneficial effect on urinary tract damage.
Are Infants With Bronchopulmonary Dysplasia at Risk for Sudden Infant Death Syndrome?
Authors: Gray Peter H. , Rogers Yvonne 
Published: December 2021

Objective. To compare the incidence of sudden infant death syndrome (SIDS) and apparent life-threatening event (ALTE) in infants with bronchopulmonary dysplasia (BPD) and birth weight-matched control infants in view of the changing pattern of chronic lung disease of prematurity.
Methods. The study population consisted of 78 preterm infants of 26 to 33 weeks gestation who were diagnosed as having BPD and discharged. The 78 control infants were matched with the study infants for birth weight categories. Infants unable to maintain adequate oxygenation without supplemental oxygen when they were feeding well and thriving were discharged on home oxygen. All infants were at least 8 months of age at follow-up and information concerning the occurrence of any ALTE was obtained by direct parent interview.
Results. No infant died during the period of follow-up. Seven (8.9%) of the study group compared with eight (10.5%) of the control infants had an ALTE. Three infants (one study, two control infants) were hospitalized for further investigation. No infant discharged on the home oxygen program had an ALTE.
Conclusions. The data from this study suggest that preterm infants with BPD are not at increased risk from SIDS compared with preterm infants without this condition. This may be related to close monitoring of the infants' oxygenation status and the provision of home oxygen when appropriate, which should eliminate episodes of unrecognized and untreated hypoxemia. Home monitoring for infants with BPD may not be warranted.
Prenatal Exposure to Cigarettes in Infants With Obstructive Sleep Apneas
Authors: Kahn André , Groswasser José , Sottiaux Martin , Kelmanson Igor , Franco Patricia , Rebuffat Elizabeth , Dramaix Michèle , Wayenberg Jean Louis 
Published: December 2021

Objective. To investigate the effect of prenatal smoking on infant respiratory behavior during sleep.
Methods. A questionnaire concerning family habits and infants' history was completed for 550 healthy infants before a 9-hour night polysomnographic study. Because the data for 41 infants were not available for analysis, 509 subjects were studied: 115 were newborns evaluated within 1 week after birth, and 394 were healthy infants admitted at 11 weeks of life (range 5 to 29 weeks) after various research protocols.
Results. According to the smoking frequency of the mothers during pregnancy, the subjects were defined as "nonsmokers" (no cigarette smoked during pregnancy; n = 400), "light smokers" (1 to 9 cigarettes per day; n = 37), or "smokers" (10 or more cigarettes per day; n = 72). Compared with nonsmokers and light smokers, "smoking" mothers had a significant increase in the number of episodes of uterine bleeding during the pregnancy. Their infants had lower birth weights and more frequent episodes of profuse sweating during sleep. Infants of smokers also had more frequent and longer obstructive sleep apneas than those of the two other groups. For infants of smokers the relative risk for obstructive apneas was 2.76 (95% confidence interval: 1.63 to 4.69; P = .001) The relation between prenatal smoking and postnatal manifestation of obstructive sleep apneas demonstrated a dose-response pattern. Paternal smoking during pregnancy increased the risk of obstructive apneas only in the infants of smoking mothers, but not in those of the two other groups. Maternal smoking after birth did not add significantly to the risk of obstructive apneas. The effect of smoking was seen in older infants, as well as in the newborns not yet exposed to ambient cigarette smoke. A stepwise logistic regression, using obstructive sleep apneas as the dependent variable identified three significant independent variables: smoking during pregnancy (P = .001), profuse sweating during sleep (P = .001), and birth weight (P = .010). No explanation was found for the effect of prenatal smoking on obstructive sleep apneas.
Conclusion. Prenatal smoking by mothers correlated with an increase in frequency and length of obstructive apneas and a decrease in birth weight of their infants. The infants were under greater risk for obstructive apnea if both parents smoked. Explanations for our results are unknown to us, but these findings may be of interest in the study of infant breathing behavior and epidemiological characteristics of sudden infant death syndrome.
Postoperative Respiratory Compromise in Children With Obstructive Sleep Apnea Syndrome: Can It Be Anticipated?
Authors: Rosen Gerald M. , Muckle Robert P. , Goding George S. , Mahowald Mark W. , Ullevig Connie 
Published: December 2021

Objective. The aim of this research was to describe the postoperative respiratory complications after tonsillectomy and/or adenoidectomy (T and/or A) in children with obstructive sleep apnea syndrome (OSAS), to define which children are at risk for these complications, and to determine whether continuous positive airway pressure (CPAP) is an effective strategy for dealing with these complications.
Methods. The data for this study were gathered through a retrospective chart review of all children 15 years of age or younger with polysomnographically (PSG) proven OSAS who had a T and/or A at Hennepin County Medical Center between January 1985 and September 1992. Particular attention was paid to factors that contributed to the OSAS, postoperative respiratory complications, and intervention strategies for dealing with these complications.
Results. The charts of 37 children with OSAS documented by preoperative PSG who later had a T and/or A were reviewed retrospectively. Ten of these children had significant postoperative respiratory compromise secondary to OSAS that prolonged their hospital stay from 1 to 30 days and caused symptoms ranging from O2 desaturation &lt;80% to respiratory failure. These children were younger and had significant associated medical problems that contributed to or resulted from their OSAS in addition to large tonsils and adenoids. The associated medical problems included craniofacial anomalies, hypotonia, morbid obesity, previous upper airway trauma, cor pulmonale, and failure to thrive. The children with postoperative respiratory complications also had more severe apnea on their preoperative PSG. One child had a uvulopalatopharyngoplasty (UPPP) in addition to the T & A. Taken together, the history, physical and neurological examination, and the PSG were able to identify successfully the children who subsequently developed respiratory compromise secondary to OSAS after a T and/or A. Nasal continuous positive airway pressure (CPAP) and bilevel CPAP was used successfully to manage the preoperative and/or postoperative upper airway obstruction in five of these children.
Conclusions. Based on these findings, overnight observation is recommended with an apnea monitor and oximeter for patients undergoing a T and/or A who have OSAS and meet any of the following high-risk clinical criteria: (1) &lt;2 years of age, (2) craniofacial anomalies affecting the pharyngeal airway particularly midfacial hypoplasia or micro/retrognathia, (3) failure to thrive, (4) hypotonia, (5) cor pulmonale, (6) morbid obesity, and (7) previous upper airway trauma; or high-risk PSG criteria: (1) respiratory distressindiex (RDI) &gt;40 and (2) SaO2 nadir &lt;70%; or undergoing a UPPP in addition to the T and/or A. Nasal CPAP/bilevel CPAP can be used to manage the preoperative and/or postoperative upper airway obstruction in patients with OSAS undergoing a T and/or A.
Age-Related Response to Lidocaine-Prilocaine (EMLA) Emulsion and Effect of Music Distraction on the Pain of Intravenous Cannulation
Authors: Arts S. E. , Abu-Saad H. H. , Champion G. D. , Crawford M. R. , Juniper K. H. , Ziegler J. B. , Fisher R. J. 
Published: December 2021

Objective. To compare the efficacy of a local anesthetic cream and music distraction in reducing or preventing pain from needle puncture (intravenous cannulation) in children. A secondary aim was to examine the influence of age on the pain report and behavior and on the therapeutic outcome.
Methodology. Children aged 4 to 16 years (N = 180) who were to undergo surgery under general anesthesia via intravenous cannulation were randomly allocated to one of three interventions. The comparison of lidocaine-prilocaine emulsion (EMLA, Astra) and a placebo emulsion was double-blind. Stratification by age group (4 to 6, 7 to 11, 12 to 16) ensured an equal number of children (20) in each intervention/age group category. A global assessment of the behavioral reaction to the procedure was made by the principal investigator, taking into account vocal, verbal, facial, and motor responses. The child was asked to assess pain severity on the Faces Pain Scale (FPS) and a visual analogue toy (VAT). The scales were applied conservatively as ordinal scales: FPS 0 to 6; VAT 0 to 10.
Results. Children who received lidocaine-prilocaine emulsion reported less pain (mean FF5 score = 1.42) compared with placebo emulsion (mean FPS score = 2.58) and with music distraction (mean FPS = 2.62). There was a highly significant therapeutic effect (P &lt; .001) on the self-report and behavioral scores. Younger children, regardless of intervention, reported significantly more pain than the older children (mean FPS scores: 2.85, 2.33, 1.43 for age groups 4 to 6, 7 to 11, and 12 to 16 respectively; P &lt; .001). The superiority of the local anesthetic emulsion was maximal in the youngest age group (4 to 6) almost eliminating pain-related behavior, and multiple regression analysis confirmed significant age and treatment effects and revealed interaction between therapeutic effect and age. Although a trend favoring the active emulsion was evident in the older children (7 to 11, 12 to 16) the differences were not significant. The pain scores were influenced by the type (gauge) of cannula, but this did not affect the conclusion regarding therapeutic and age effects. There was no influence of sex, experience with venipuncture, or whether the child was anxious on arrival in the operating room.
Conclusions. The results show that lidocaine-prilocaine emulsion is highly effective in preventing pain from venipunctures in young children the group in most need of prevention.
Infant Sleep Position and Risk for Sudden Infant Death Syndrome: Report of Meeting Held January 13 and 14, 1994, National Institutes of Health, Bethesda, MD
Authors: Willinger Marian , Hoffman Howard J. , Hartford Robert B. 
Published: December 2021

Objective. To evaluate the current knowledge on the relationship between infant sleep position and sudden infant death syndrome (SIDS), and to determine how the information can be used to guide further activities in the United States.
Methods. Data from international vital statistics, epidemiologic studies of SIDS risk factors, and studies of outcomes of public health interventions that advocated nonprone sleeping to reduce the risk for SIDS were discussed at a meeting held by the National Institute of Child Health and Human Development (NICHD) with cosponsorship from the National Institute on Deafness and Other Communication Disorders (NIDCD), and the National Center for Health Statistics (NCHS) on January 13, and 14, 1994.
Results. Trends in postneonatal mortality and SIDS rates from 1980 through 1992 were evaluated for Australia, Britain, New Zealand, the Netherlands, Norway, Sweden, and the United States. All of the countries that experienced a rapid decline in prone sleeping also had reductions of approximately 50% in their SIDS rates. Postneonatal mortality rates dropped as well, with the reduction in SIDS being the primary contributor to the reported declines. The major behavioral change in all targeted populations was in sleep position. No significant changes were observed in the proportion of parents who smoked cigarettes, or in breast-feeding. Preliminary data from population-based studies showed there were no reported adverse outcomes associated with a change to side or back sleep position, such as an increase in deaths due to aspiration or in apparent life-threatening events.
Conclusion. The overwhelming opinion of the assembled experts was that the evidence justified greater effort to reach parents with the American Academy of Pediatrics' recommendation that healthy infants, when being put down to sleep, be positioned on their side or back.
Hereditary Sensory Neuropathy Manifesting as Possible Child Abuse
Authors: Makari George S. H. , Carroll James E. , Burton Edward M. 
Published: December 2021

Because child abuse occurs frequently and leads to repeated trauma if unrecognized, pediatricians are acutely aware of nonaccidental injury. On occasion, an uncommon disease is manifested in a way that suggests child abuse as a possible explanation of trauma. We report on two siblings with hereditary sensory neuropathy. One of these two children was removed from the home because of suspected child abuse. It is important to recognize hereditary sensory and autonomic neuropathies (HSAN) as a cause of repeated trauma to prevent unnecessary family intervention for suspected child abuse.
CASE REPORTS
PATIENT 1
A 5-year-old Hispanic girl was removed from her home after hospitalization for second degree burns over 15% of her body.