bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hepatitis B Immunization in Infants of Hepatitis B Surface Antigen-Negative Mothers
Authors: CHIRICO GAETANO , BELLONI CESARE , GASPARONI ANTONELLA , CERBO ROSA MARIA , RONDINI GIORGIO , KLERSY CATHERINE , ORSOLINI PAOLO , FILICE GAETANO 
Published: December 2021

The American Academy of Pediatrics (AAP) Committee on Infectious Diseases and the Immunization Practices Advisory Committee of the Centers for Disease Control have recently pointed out that the selective strategy of immunization against hepatitis B virus (HBV) of high-risk populations has not resulted in the limitation of the diffusion of the disease. In fact, in spite of vaccine availability for more than 10 years, about 200 000 to 300 000 new cases of infection occur in the United States each year. Therefore, the AAP recommended the "universal hepatitis B immunization" strategy as a means to control the disease.1,2
In Italy, where about 400 000 new cases of infection are expected each year, the vaccination has been extended to all newborns, regardless of mother's serologic status (and, for the first 12 years, to all 12-year-old adolescents), with a law promulgated in May 1991.
Clinical Features of Infants With Primary Human Herpesvirus 6 Infection (Exanthem Subitum, Roseola Infantum)
Authors: Asano Yoshizo , Yoshikawa Tetsushi , Suga Sadao , Kobayashi Ikuko , Nakashima Toshihiko , Yazaki Takehiko , Kajita Yuji , Ozaki Takao 
Published: December 2021

Objective. To clarify clinical features of patients with primary human herpesvirus 6 (HHV-6) infection (roseola infantum, exanthem subitum) in a large-scale study.
Subjects and methods. Clinical signs and symptoms were analyzed in 176 infants in whom exanthem subitum was initially suspected and primary HHV-6 infection was later confirmed. The infection was proved by isolation of the virus from blood, a significant increase in the neutralizing antibody titers to the virus, or both.
Results. The primary HHV-6 infection, which occurred throughout the year, was observed in 94 boys and 82 girls (mean age, 7.3 months). Fever developed in 98% (mean maximum fever, 39.4°C) and lasted for 4.1 days. Macular or papular rashes appeared in 98%, on face, trunk, or both, mostly at the time of subsidence of the fever, and lasted for 3.8 days. Other clinical manifestations occurred as follows: mild diarrhea in 68%, edematous eyelids in 30%, erythematous papules in the pharynx in 65%, cough in 50%, and mild cervical lymph node swelling in 31%. Twenty-six percent had bulging of the anterior fontanelle and 8% had convulsions.
Conclusions. Clinical features of patients with virologically confirmed exanthem subitum were comparable with those described before discovery of HHV-6.
CALPERS TELLS 18 HEALTH-CARE PROVIDERS IT EXPECTS A 5% ROLLBACK IN PREMIUMS
Authors: L. J. F. 
Published: December 2021

In it most aggressive swipe at health-care costs to date, the huge California Public Employees' Retirement System served notice that it expects health-care providers to agree to a 5% rollback in health-care premiums for 900,000 public employee families ...
Calpers, which manages one of the country's largest groups of insured individuals and is often cited as a model of health-care reform, told 18 managed-care companies that it expects the 5% rollback to be effective in the 1994-95 contract year, which begins August 1 ...
Providers expressed surprise and muted alarm at the depth of the cutback proposed ...
The 5% target was based on numerous studies, not only of individual HMO fiscal data, but also on Rand Corp. studies showing the persistence of waste and overutilization in health care which documented excessive Caesarean deliveries, overuse of magnetic resonance imaging scans, overprescribing of drugs, and performance of unnecessary surgery when less invasive procedures would suffice.
Smoking and Health in Substance-Abusing Adolescents: A Two-Year Follow-up
Authors: Myers Mark G. , Brown Sandra A. 
Published: December 2021

Objective. To examine the prevalence and persistence of cigarette smoking along with health outcomes in a clinical sample of substance-abusing adolescents.
Design. This is a 2-year prospective case series study.
Setting. Subjects were recruited from two private, hospital-based inpatient adolescent substance abuse treatment facilities.
Participants. A consecutive sample of 166 adolescents, ages 12 to 18, meeting Diagnostic and Statistical Manual of Mental Disorders (3rd ed, revised) criteria for substance abuse participated in the present investigation. Of the original sample, 154 and 144 were interviewed 12 and 24 months after discharge, respectively.
Measurement and results. Information regarding cigarette smoking, drug and alcohol use, and respiratory problems was based on self-report by the adolescents and was corroborated by parent interview. The prevalence of smoking in this sample of teens immediately before treatment was 85%. Sixty-one percent of the sample smoked ½ pack or more/day and 75% were daily smokers. Although prevalence (74 and 77%) and average daily cigarette consumption (11.1 and 10.7 cigarettes daily) decreased at 12 and 24 months after treatment, rates remained very high. Teens reporting posttreatment respiratory problems smoked more, and heavier smokers at the time of treatment were more likely to report respiratory problems at follow-up than lighter smokers.
Conclusions. Substance-abusing teens smoke at rates far and above those of the general adolescent population. Further, these teens appear at increased risk for negative health consequences regardless of posttreatment drug and alcohol use. These findings highlight the importance of preventing adolescent cigarette smoking by substance abuse treatment programs.
Letter to the Editor
Authors: Harrison Helen 
Published: December 2021

We appreciate Dr Cunningham's candor in describing a situation some of us have experienced first-hand.
A disinclination to be the bearer (or recipient) of bad news lies behind many communication failures in the neonatal intensive care unit and beyond. It is no excuse for withholding the truth from families.
Some parents do react with anger to bad news about their child, at least initially. Others, however, are relieved to have their own perceptions confirmed and to have a diagnosis that can serve as the basis for action to help their child.
Measles Vaccine Immunogenicity in 6- Versus 15-Month-Old Infants Born to Mothers in the Measles Vaccine Era
Authors: Johnson Candice E. , Whitwell Judy , Kumar Mary L. , Nalin David R. , Chui Linda W. , Marusyk Raymond G. 
Published: December 2021

Hypothesis. The low titer of measles antibody in infants of mothers with vaccine-induced immunity may allow immunization against measles before 15 months of age.
Methods. Six- and 15-month-old infants born to mothers ≤ 30 years of age with no history of measles were recruited. Infants enrolled at 6 months of age were immunized with monovalent measles vaccine (Attenuvax), and maternal serum and infant pre- and postvaccination sera were obtained. Those enrolled for primary vaccination at 15 months of age received either Attenuvax (N = 12) or M-M-RII (N = 3). Six-month-old infants were revaccinated with M-M-RII at 15 months of age; pre- and postrevaccination sera were again obtained. Three antibody assays were used: a measles neutralizing assay (NT) and two enzyme immunoassays (EIA) for measles IgG and measles IgM.
Results. Among primary vaccinees, 14 of 19 infants aged 6 months (74%) developed NT antibody, as did 15 of 15 infants aged 15 months (100%). The reciprocal geometric mean titer of 6-month-old seroresponders was 23.3, significantly lower than that of the 15-month-old primary vaccinees (87.7, P &lt; .001). Primary seroconversion rates by EIA were 53% for 6-month-old infants and 100% for those aged 15 months. Revaccination of infants who had received Attenuvax at 6 months of age resulted in 100% NT positivity; the geometric mean titer rose to equal that of the group given primary immunization at 15 months of age. Measles IgM antibody was detected in 10 of 14 infants tested 1 month after primary vaccination at 15 months, but was not detected in any of the revaccinated infants after the second dose at 15 months of age (P &lt; .001).
Conclusions. 1) Immunization with measles vaccine in infants born to vaccine-immune mothers at 6 months of age induced NT antibody in 74% of infants. 2) Revaccination of prior 6-month-old vaccinees at 15 months resulted in antibody titers equivalent to 15-month-old vaccinees. 3) Lack of an IgM response following revaccination suggests that even seronegative infants may be primed to respond on re-exposure to measles.
Senior-Loken Syndrome: Revisited
Authors: Warady Bradley A. , Cibis Gerhard , Alon Uri , Blowey Douglas , Hellerstein Stanley 
Published: December 2021

The combination of familial juvenile nephronophthisis (FJN) and congenital amaurosis of Leber, the so called Senior-Loken Syndrome, was first described by Senior et al in 1961.1 Despite recognition of the syndrome for &gt; 30 years, its occurrence is relatively rare and the basis for the oculorenal association remains unresolved. Our recent experience with two patients who had end-stage renal disease (ESRD) as a manifestation of the syndrome prompted this review.
CASE HISTORIES
A.M. is an 11-year-old girl who complained of generalized fatigue over the previous 3 weeks. The patient had been diagnosed with Leber's amaurosis at 3 months of age.
WHAT DO HEALTH CARE PROFESSIONALS KNOW ABOUT CHILDHOOD ASTHMA?
Authors: Joos Than H. 
Published: December 2021

Purpose of the Study. Salbutamol (albuterol) metered dose inhalers are a nonprescription, over-the-counter medication in Australia. In some instances, therefore, the only health care professional to advise asthmatics is the pharmacist. The present study was performed to assess the asthma knowledge base of pharmacists, general practitioners, and pediatric nurses in a given geographic area.
Methods. A questionnaire that was developed and tested with medical students and parents of asthmatics was mailed to the above groups of health care professionals in the New Castle region of New South Wales, Australia.
Results. An overall return rate of 50% was obtained. The following areas of significant knowledge deficiencies were noted:
1) Pharmacists—Fifty-six percent were unaware of the three cardinal symptoms of asthma: cough, wheeze, and breathlessness, 52% were unaware that asthma often worsens at night, and 57% did not know that viral infections were common triggers of asthma.
2) General Practitioners—Thirty-four percent believed childhood asthma damages the heart, 28% were unable to name three treatments useful in an acute attack, and 18% could not name two asthma preventative drugs.
3) Pediatric nurses—Fifty percent were uninformed regarding the need to seek medical care if nebulizer treatments were required more frequently than every two hours, 40% said inhaled medicines caused more side effects than their oral counter parts, and 40% thought auscultation was the best way to assess asthma.
Reviewer's Comments. How would we in America compare, if asked to participate in such an exercise? I would let the reader decide, but in general we need to enlarge our educational programs.
THE $4.3 BILLION MISTAKE
Authors: L. J. F. 
Published: December 2021

Three recent epidemiological studies of purported links between breast implants and a variety of ailments, notably the skin hardening disease scleroderma, have concluded that the linkage simply cannot be established.
Gee, that's nice to know. Better late than never. Too bad, though, that in our era the scientific method can't compete anymore with lawyers marauding after some $1 billion in contingency fees, politically correct mind-sets in the media, or Dr. Kessler's Food and Drug Administration.
It's too bad, because as a result of the atmosphere of fright created by this triumvirate, nearly all companies withdrew from the silicone breast-implant market. Mastectomy patients, past and future, now face a destroyed market for silicone implants.
It has to be understood that these plaintiffs' lawyers have a huge economic incentive in the outcome of such cases because they get an enormous percentage cut of any settlement. It is in their economic interest to make the stories of diseases related to silicone implants as lurid and horrible as possible, because it drives deep-pockets defendants toward settlements like the $4.3 billion pot set up by Dow Corning, Bristol-Myers, Baxter Labs, 3M, and others in this case. Only about 22 lawyers will be divvying up most of the $1 billion in contingency fees.
Depressive Symptoms and Work Role Satisfaction in Mothers of Toddlers
Authors: Olson Ardis L. , DiBrigida Lisa A. 
Published: December 2021

Objective. To determine the incidence of depressive symptoms in mothers of toddlers in community pediatric practice. The interaction of employment and work role satisfaction with depressive symptoms was also investigated.
Subjects and methods. Depression screening measures were completed by 233 mothers of toddlers (aged 12 to 24 months) at health supervision visits in two community pediatric practices in New Hampshire. Depression was evaluated with a depressive symptom screening inventory modified by Barrett, Oxman, and Gerber from the Hopkins Symptom Checklist for use in primary care population. Data were obtained on parents' socioeconomic variables, hours worked, and whether the mother was satisfied with her current role of being employed or not employed.
Results. Depressive symptoms were present in 42% of mothers. Rates of depressive symptoms were similar in employment groups but varied significantly with work role satisfaction. When both employment and satisfaction were considered, mothers who were dissatisfied were 3.7 times more likely to be depressed. After controlling for work role satisfaction, mothers working part time were half as likely to be depressed as mothers working full time and not employed.
Conclusion. Depressive symptoms are a major problem for mothers of toddlers in middle class pediatric practice. Work role satisfaction and employment status together are related to depressive symptoms.
Boilerbaisse: An Outbreak of Methemoglobinemia in New Jersey in 1992
Authors: Askew George L. , Sosin Daniel M. , Finelli Lyn , Genese Carol A. , Sorhage Faye E. , Spitalny Kenneth C. 
Published: December 2021

Background. On October 20, 1992, &gt; 40 children from one elementary school visited the school nurse due to the acute onset of blue lips and hands, vomiting, and headache during and after the school lunch periods. Forty-nine children were seen by physicians that day and 14 were hospitalized. Laboratory analysis revealed methemoglobinemia in many of the children. All recovered in 36 hours.
Objective. A case-control study was supplemented by environmental and laboratory investigations to determine the outbreak source.
Methods. Cases were selected based on the laboratory diagnosis of methemoglobinemia (methemoglobin level &gt; 2%). Children whose methemoglobin levels were missing or &lt; 2% were excluded from analysis. Controls were obtained by selecting every third name from a school roster. The parents of 29 students who met the case definition and 52 controls were interviewed.
Results. All 29 cases and 33% (17/52) of the controls ate soup during the school lunch (odds ratio undefined, lower 95% confidence limit 16.1). Two pots of soup were prepared from ready-to-serve cans, which were diluted with water and enriched with a commercially prepared flavor enhancer. The school's boiler, dormant during the previous 5 months, was restarted on the morning of the outbreak. The boiler also served as a tankless hot water heater. Laboratory analysis of the soup identified abnormally high quantities of nitrite (459 ppm) and sodium metaborate, major components of the boiler water treatment solution. Undiluted soup from the same lot had 2.0 ppm nitrites; the flavor enhancer had 2.2 ppm nitrites. Nitrites were present in the hot potable water system (4 to 10 ppm) and absent in the cold potable water system.
Conclusions. This outbreak of methemoglobinemia due to nitrite poisoning was traced to soup contaminated by nitrites in a boiler additive. Nitrites are ubiquitous and potentially hazardous inorganic ions. Extreme caution should be used when the possibility for toxic human exposure to nitrites exists.
Letter to the Editor
Authors: Harvey Birt 
Published: December 2021

Needleman and other distinguished investigators of lead toxicity raise three issues.
1. Whether lead is a neurotoxin. Here there is full agreement. As I stated in my editorial, "Lead is a poison, and the less of it in the bodies of growing children the better."1 Adverse effects in young children possibly may occur at blood lead (BPb) levels &lt;10 µg/dL However, neither the epidemiologic studies cited by Needleman and colleagues nor any references I could find demonstrate that BPb &lt;20 µg/dL at age I year causes a clinically important decrease in intelligence or an increase in neurobehavioral problems by the time a child enters school.
MORE SKATERS, MORE INJURIES
Authors: L. J. F. 
Published: December 2021

The Product Safety Commission forecasts 83 000 emergency room cases this year from skating injuries, more than double last year's figure. Sixty percent will be children under age 15. Wrist injuries are the most common, followed by lower arm, leg, and head injuries. What makes in-line skating (or Rollerblading, from the name of a popular brand) dangerous is failure to wear protective gear, lack of instruction and possibly what the commission calls "high-risk behavior," or what daredevils call hot-dogging.
Most people are being injured because the sport has become so popular—l2 million participants last year compared with 3.5 million participants in 1990. There are also a huge number of beginners.
Caring for Gravely Ill Children
Authors: Fleischman Alan R. , Nolan Kathleen , Dubler Nancy N. , Epstein Michael F. , Gerben Mary Ann , Jellinek Michael S. , Litt Iris F. , Miles Margaret Shandor , Oppenheimer Sonya , Shaw Anthony , van Eys Jan , Vaughan Victor C. 
Published: December 2021

Background. Much has been written about the care of the hopelessly ill adult, but there is little guidance for pediatric health care professionals in the management of children who are critically or terminally ill.
Methods. Through a 3-day meeting in Tarrytown, NY, attended by a group of pediatricians and others directly involved in these issues, a principled approach was developed for the treatment of, and health care decision-making for, children who are gravely ill.
Results. The group agreed that the needs and interests of the child must be the central focus of any treatment plan and that the child should be involved to as great extent possible, consistent with developmental maturity, in the decision-making process. Quality of future life should be viewed as being relevant in all decisions. Parents are believed to be the natural guardians of children and ought to have great latitude in making decisions for them. However, parental discretion is not absolute and professionals must maintain an independent obligation to protect the child's interests.
Conclusions. Decision-making should be collaborative among patient, parents, and professionals. When conflict arises, consultation and ethics committees may assist in resolution. When cure or restoration of function is no longer possible, or reasonable, promotion of comfort becomes the primary goal of management. Optimal use of pain medication and compassionate concern for the physical, psychological, and spiritual well-being of the child and family should be the primary focus of the professionals caring for the dying child.
Pulmonary Hemorrhage Risk in Infants With a Clinically Diagnosed Patent Ductus Arteriosus: A Retrospective Cohort Study
Authors: Garland Jeffery , Buck Rosanne , Weinberg Michelle 
Published: December 2021

Objective. To determine if an early, dinically detectable patent ductus arteriosus (FDA) was associated with pulmonary hemorrhage (PH) in infants who received rescue artificial surfactant therapy.
Methods. This retrospective cohort study of 233 low birth weight infants (≤ 1700 g) who received artificial surfactant therapy for respiratory distress syndrome compared antenatal and postnatal characteristics of infants with PH and without PH. Pulmonary hemorrhage was defined by an onset of bright red blood from the endotracheal tube in quantities that resulted in increased ventilatory support and a new infiltrate on a chest radiograph.
Results. Pulmonary hemorrhage occurred in 6% (15/233) of the infants. Thirty-three percent (5/15) of the infants with PH died within 14 days of the hemorrhage. Of the 15 PH, 73% occurred within 48 hours of the first surfactant dose. Pulmonary hemorrhage was more common in male infants and infants of mothers who received antibiotic therapy during labor (P ≤ .04). Infants with PH received surfactant earlier than those without PH (P = .04). Nursery events or therapies occurring following surfactant therapy that were associated with PH included: little improvement in ventilatory efficiency index (P = .01), dopamine infusion (P = .04), and the presence of a clinically detectable PDA before, or at the time of, the PH [60% (9/15) vs 33% (71/217), P = .03]. After adjusting for severity of illness before surfactant therapy, risk of PH remained greater in infants who developed symptoms of a PDA. Dopamine support appeared to modify the association between PDA and PH.
Conclusions. In this retrospective cohort study, pulmonary hemorrhage was associated with the presence of a clinically detectable patent ductus arteriosus before, or at the time of, pulmonary hemorrhage.
Administration of the Third Dose of Oral Poliomyelitis Vaccine at 6 to 18 Months of Age
Authors:   Committee on Infectious Diseases
Published: December 2021

This statement describes a modification of the recommended routine schedule for administering trivalent oral poliomyelitis vaccine (OPV). The American Academy of Pediatrics previously has recommended that healthy children receive a three-dose primary series of OPV at 2, 4, and 15 to 18 months of age and a fourth dose at the time of school entry (4 to 6 years of age).1 Available data indicate that the response rates to the third dose of OPV administered at 6 months of age are as good as the rates following administration of this dose at 15 to 18 months of age. Completion of the three-dose primary series at an earlier age will help health care providers induce immunity against poliomyelitis at an early age.
Although wild type poliomyelitis has not caused disease in the United States for many years, the virus remains prevalent in many countries. Continued introduction of the virus into the United States by travelers could result in transmission and disease if high levels of immunity are not maintained in preschool age children. For example, wild type poliovirus type 3 was recently introduced into Canada by a religious sect that did not believe in immunization.2 The virus was probably imported from the Netherlands, where a small epidemic of poliomyelitis occurred in members of the same sect in 1992 and 1993.3
SERUM ANTIBODY RESPONSE FOLLOWING OPV ADMINISTRATION
After two doses of OPV are administered at 2 and 4 months of age, 89 to 100% of children vaccinated in the United States have evidence of humoral immunity to poliomyelitis types 1 and 3, and 99 to 100% have immunity to type 2 (Table).