bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identification of Potentially Avoidable Pediatric Hospital Use: Admitting Physician Judgment as a Complement to Utilization Review
Authors: Soulen Jeffrey L. , Duggan Anne K. , DeAngelis Catherine D. 
Published: December 2021

Objective. To determine, for acute general pediatric admissions, 1) the proportion of admissions that the admitting physician would identify as potentially avoidable; 2) services that might help reduce avoidable admissions; 3) potential savings in hospital days through eliminating avoidable admissions; 4) the role that social factors play in admission decisions; and 5) if admitting physician judgment provides a valuable complement to Utilization Review (UR) in identifying avoidable admissions.
Methods. A questionnaire was used to determine the proportion of 600 acute general pediatric admissions considered potentially avoidable by the admitting physician and to identify services required to prevent such admissions. Savings through eliminating potentially avoidable admissions and social factors influencing admission decisions were examined. Physicians' and UR assessments of necessity of inpatient care were compared.
Results. Admitting physicians judged 28% of admissions as potentially avoidable, citing alternative services for each avoidable admission. Eliminating all avoidable admissions would have reduced hospital days by 7.7%. Physicians identified 6% of admissions as social admissions, most commonly due to an overwhelmed family. UR identified 1% of potentially avoidable admissions as unnecessary.
Conclusion. Incorporating admitting physician judgment may significantly improve current efforts to identify and reduce avoidable hospital use.
Low Density Lipoprotein Cholesterol/Apolipoprotein B-100 Ratio: Interaction of Family History of Premature Atherosclerotic Coronary Artery Disease With Race and Gender in 7 to 11 Year Olds
Authors: Islam Syed , Gutin Bernard , Manos Tina , Smith Clayton , Treiber Frank 
Published: December 2021

Background. In adults, a low density lipoprotein cholesterol (LDL-C)/apolipoprotein B-100 (ApoB) ratio is an indicator of ApoB-enriched small dense LDL, which is associated with premature coronary artery disease (CAD). Since this LDL subclass may be inherited, we investigated whether a low LDL-C/ApoB ratio was associated with a positive family history of premature CAD in young children.
Methods. Subjects were 66 children aged 7 to 11 years who were recruited through a school-based family history survey, flyers, and hospital newspaper advertisements. They were divided according to family history and assessed for fatness, blood pressure, lipids, lipoproteins, and apoproteins.
Results. Family history interacted with gender such that girls with a positive family history had a lower LDL-C/ApoB ratio than girls with a negative family history, while the opposite was true in boys; ie, family history-positive boys had a higher ratio than family history-negative boys. The association of a low ratio with a positive family history was seen most clearly in white girls. Family history-positive whites had higher ApoB than family history-negative whites, whereas the pattern was reversed in the blacks. The LDL-C/ApoB ratio and ApoB were not related to other CAD risk factors such as fatness, blood pressure, or other lipids and lipoproteins.
Conclusion. In young children, a low LDL-C/ApoB ratio and high ApoB levels were associated with a positive family history of CAD only in the white girls, suggesting that this group is at increased risk of genetically mediated CAD.
Seroconversion Rates to Combined Measles-Mumps-Rubella-Varicella Vaccine of Children With Upper Respiratory Tract Infection
Authors: Dennehy Penelope H. , Peter Georges , Saracen Cheryl L. 
Published: December 2021

Objective. To determine if upper respiratory tract infection (URI) affects the seroconversion rate or quantitative response to each component of a combined measles-mumps-rubella-varicella vaccine.
Subjects and methods. One hundred forty-nine children between 15 and 18 months of age were prospectively divided into two groups according to the presence of URI or recent history of URI symptoms within the 4 weeks before vaccination. Once stratified, 74 children in the healthy group and 75 children in the URI group were randomly assigned to receive one of three lots of measles-mumps-rubella varicella vaccine by subcutaneous injection into the deltoid area. Serum was obtained from each child just before vaccination and 4 to 6 weeks later for measuring antibody levels against each virus.
Results. Prevaccination antibody levels against each virus in the URI and healthy groups did not differ. Nine children had pre-existing antibodies to varicella and six to mumps; no child had positive serologies for measles or rubella before vaccination. Children with pre-existing antibody were excluded from analysis of seroconversion for that virus. Seroconversion to measles, mumps, and rubella occurred in 100% of children in both groups. Mean antibody levels did not differ between the healthy and URI groups for measles (111 vs 122), mumps (97 vs 108), or rubella (96 vs 102). Three (4%) of 70 children with URIs in whom varicella serologies were available failed to seroconvert to varicella vaccine although none of the 69 healthy children had vaccine failure (P = .24). The mean varicella antibody level was 11.3 ± 1.4 in the healthy children, which did not differ significantly from the level of 9.5 ± 0.9 in the URI group.
Conclusions. Seroconversion to measles, mumps, rubella, and varicella was not significantly affected by the presence of a concurrent or recent URI in 15-to 18-month-old children.
Immunization Practices of Pediatricians and Family Physicians in the United States
Authors: Szilagyi Peter G. , Hager Jonathan , Roghmann Klaus J. , Doane Cindy , Cove Lisa , Rodewald Lance E. , Humiston Sharon G. , Fleming Gretchen V. , Hall Caroline B. 
Published: December 2021

Objective. To assess current practices and attitudes among pediatricians and family physicians across the United States regarding Immunizations.
Design. Survey of a random sample of pediatricians and family physicians.
Subjects. Fellows of the American Academy of Pediatrics (N = 746) and American Academy of Family Medicine (N = 429).
Survey topics. General Immunization practices (eg, types of visits during which vaccinations are provided, mechanisms to identify undervaccinated children); and opinions about perceived barriers to immunizations, acceptance of alternative sites for immunizations, and possible immunization requirements for Medicaid and The Special Supplemental Food Program for Women, Infants, and Children (WIC).
Results. Pediatricians and family physicians (combined) reported the following Immunizing children during acute illness visits (28%), follow-up visits (90%), and chronic illness visits (77%); using computer or reminder files to identify undervaccinated children (13%); and simultaneously administering four vaccines (diphtheria-tetanus-pertussis, oral poliovaccine, measles, mumps, and rubella and Haemophilus influenzae type b) to an eligible 18-month-old child (66%). Physicians perceived the following as barriers to immunizations missed preventive visits (40%), vaccine costs (24%), lack of insurance coverage (24%), inability to track undervaccinated patients (22%), incomplete immunization records (12%), and missed vaccination opportunities (12%). Physicians agreed with offering vaccinations during hospitalizations (51%) or emergency department visits (30%), and with immunization requirements for continued eligibility for Medicaid (66%) or WIC (64%). Pediatricians were more likely to vaccinate during chronic illness and follow-up visits, and were more likely to use systems to track undervaccinated children (P &lt; .05); however, most immunization practices and attitudes of pediatricians and family physicians were similar. Physicians who graduated from medical school more recently and those in high-risk urban practices were more likely to vaccinate during acute illness visits, provide simultaneous vaccinations, and favor vaccinations in hospital settings.
Conclusions. Vaccination rates might be Improved by closer adherence to current immunization guidelines regarding vaccinations during all encounters and simultaneous vaccinations, by developing systems to identify undervaccinated children, and by reducing patient costs for vaccinations. Current immunization practices fall short of the immunization guidelines; changes in individual practice styles will be required to conform with these standards.
Neonatal Bilirubin Workshop
Authors: Gartner Lawrence M. , Catz Charlotte S. , Yaffe Sumner J. 
Published: December 2021

A neonatal bilirubin workshop took place at The Rockefeller University on June 20 through 22, 1993 to consider controversial issues in the field of neonatal jaundice and bilirubin neurotoxicity, particularly as they relate to management. The conference was sponsored by the National Institute of Child Health and Human Development (Pregnancy and Perinatology Branch, Center for Mothers and Children), The Rockefeller University, and the Consiglio Nazionale delle Richerche (Italy).
tk;4Presentations and discussion emphasized diagnosis, biochemistry, and mechanisms of bilirubin toxicity, the definition and consequences of kernicterus, and the appropriateness and safety of the various therapies currently in use. Identification of future research needs was an important agenda item.
The conferees agreed that conventional management of jaundice in the newborn with phototherapy and exchange transfusion, as well as with phenobarbital in certain situations, had significantly reduced the occurrence of "traditional" kernicterus. However, the conferees acknowledged that the classical definition of kernicterus was in need of re-examination in view of the potential of bilirubin as a CNS toxin.
Early discharge of newborns from the hospital has significantly altered diagnostic and therapeutic management of neonatal jaundice, transforming it into an outpatient problem. This transformation raises new questions regarding the best time to ascertain the cause(s) of jaundice and to identify risk factors to insure optimal management of the infant.
Review of the current state of knowledge of bilirubin metabolism focused on new methods for measurement of unconjugated and conjugated bilirubin, measurement of bilirubin synthesis rates, the molecular biology of bilirubin conjugation and the developmental role of the family of enzymes known as glucuronyl transferase(s), and the role of genetic and other host factors in determining the safety or toxicity of bilirubin in the newborn.
Toward Immunizing Every Child On Time
Authors: ORENSTEIN WALTER A. , BERNIER ROGER H. 
Published: December 2021

Few procedures pediatricians undertake can compare with the impact of immunizations on their patients. A recent cost-benefit analysis by Battelle Medical Technology documented that approximately $29, $21, and $6 in total costs were saved for every dollar spent on diphtheria, tetanus, pertussis vaccines (DTP), measles, mumps, rubella vaccines (MMR), and oral poliovaccines (OPV), respectively (Hatziandreu et al, manuscript in preparation).
Immunization is also important because of its relationship to other aspects of primary care. Children who are underimmunized at 24 months of age are 3 to 12 times less likely to have been screened for anemia, tuberculosis, or lead.
BOY HARMED BY LEAD TO GET $1.5 MILLION IN COURT SETTLEMENT
Authors: L. J. F. 
Published: December 2021

A 5-year old boy who was poisoned by lead during his landlord's attempts to clear his apartment of lead-based paint will receive up to $1.5 million over his lifetime from the landlord's insurance company.
The boy has attention deficit disorder with hyperactivity. In reports filed with the Milwaukee County Circuit Court, doctors said the disorder had either been caused by the lead poisoning or had been made worse by it.
...In the summer of 1991, the city health department discovered that the boy's blood contained lead levels that were three times the Federal health standard.
In June 1992, the city ordered the owners of the apartment building, a converted 65-year-old frame house, to begin removing the lead-based paint. But instead of alleviating the victim's problem, their scraping of the paint spread lead dust throughout the home. As a result, lead levels increased to eight times the Federal standard. The family sued, contending negligence.
Media, Children, and Violence: A Public Policy Perspective
Authors: Charren Peggy , Gelber Andrew , Arnold Milton 
Published: December 2021

Pediatrician advocacy concerning the impact of television violence on children should be clearly grounded in the holistic concern of pediatricians with children's health and well-being.
Pediatricians should not promote legislative or regulatory efforts to reduce children's exposure to television violence by proscribing certain kinds of program content. Instead, priority should be given to strategies that improve the content and quality of television programming viewed by children and that enhance the viewing choices made by children and their families. Such strategies include providing parent education and pressing for strong implementation of the Children's Television Act.
Pediatricians should dedicate their efforts to increasing the awareness of broadcasters and the general public, acting as educators and persuaders. In order to advocate and educate effectively, pediatricians need to amplify their own knowledge and understanding of television-related issues and their significance.
Finally, because children's exposure to television violence is but one part of a larger social context, pediatricians concerned with this issue should devote significant attention to related problems that diminish the health and well-being of children.
An Approach to Ventilator-Dependent Neonates with Arthrogryposis
Authors: Bianchi Diana W. , Van Marter Linda J. 
Published: December 2021

Objective. To identify the clinical factors and/or test results necessary to determine the diagnosis and prognosis for a group of neonates who presented with respiratory insufficiency and multiple contractures.
Methods. We performed a retrospective review of medical records and identified 15 newborns over a 10-year period (1980 through 1990) who had arthrogryposis multiplex congenita and required ventilator support at birth. We designed a 104 item data base to record clinical information; this was subsequently analyzed using the Clinfo data base program for statistical analysis.
Results. Fourteen of the 15 patients died. Of the fourteen, 13 were electively extubated after a variable time course (2 hours to 64 days). Autopsies performed on all 14 revealed an approximately equal distribution of central nervous system (CNS) malformations, peripheral neuropathies, and peripheral myopathies as the etiology. The single survivor had myasthenia gravis.
Conclusion. In neonates with arthrogryposis, ventilator dependence at birth carries a poor prognosis. Prenatal factors that potentially predict respiratory insufficiency for the fetus with arthrogryposis include decreased fetal movements, polyhydramnios, micrognathia, and thin ribs. The combination of a thorough physical examination and radiographic and neuromuscular studies may not result in a specific diagnosis, but it can indicate whether the abnormality is in the CNS, peripheral nerves or muscles. Before elective withdrawal of ventilatory support, an edrophonium chloride challenge test should be performed to rule out myasthenia gravis.
SURVEY SAYS MOST NONPROFIT GROUPS PAID CHIEF EXECUTIVES OVER $100,000 YEARLY
Authors: L. J. F. 
Published: December 2021

NEW YORK—A survey of executive pay at 122 nonprofit organizations found that at least 99 of the groups paid their executives more than $100,000 a year. But in some cases, the survey found, other employees received far more. For instance, a professor of surgery at Cornell, earned $1.7 million in the fiscal year ended June 1991; the president of the university earned $111,131, less than 10% of that, although his benefits exceeded his salary that year. The survey didn't give details of the professor's pay.
At Lincoln Center in New York, the five highest-paid employees who aren't officers are stagehands, earning $110,467 to $146,820, the survey found. Only the president, with a salary of $315,000 in the fiscal year ended June 1992, earned more.
Anaphylaxis to Natural Rubber Latex in a Girl with Food Allergy
Authors: Llátser Rafael , Zambrano Concepción , Guillaumet Baltasar 
Published: December 2021

Over the past few years, an increase in intraoperative and obstetric anaphylactic episodes has been related to rubber exposure. Individuals at high-risk for sensitization to latex include health care workers,1,2 rubber industry professionals,3 and children with spina bifida or congenital urogenital abnormalities who undergo frequent medical procedures.4,5 However, severe reactions have been observed in other subjects.6,7 Therefore, identifying patients at risk for anaphylaxis is essential before performing medical procedures involving rubber exposure.
Recently,8 similarities in the protein content between natural rubber and several fruits have been found. Those proteins are cross-reactive and may cause severe allergic reactions if the patient comes in contact with rubber products and eats fruit.
Intrathoracic Disease Associated With Mycobacterium avium-intracellulare Complex in Otherwise Healthy Children: Diagnostic and Therapeutic Considerations
Authors: Gupta Sandeep K. , Katz Ben Z. 
Published: December 2021

Mycobacterium tuberculosis (MTB) is a well described human pathogen.1 Less commonly, atypical or nontuberculous mycobacteria (NTM) can cause disease in humans. Recent studies report that NTM account for one-third of all pathogenic mycobacterial isolates in the United States.2
Mycobacterium avium-intracellulare complex (MAI) is the most common NTM causing human disease.2 It is also the most common mycobacterial cause of cervical lymphadenitis in children in areas with low endemic rates of MTB infection.3 MAI/NTM infection other than cervical adenitis is unusual in children, except in those that are immunosuppressed.4 Rarely, MAI presents as mediastinal or endobronchial disease in otherwise healthy children.
Medical Conditions Affecting Sports Participation
Authors:   Committee on Sports Medicine and Fitness
Published: December 2021

In 1988 the American Academy of Pediatrics (AAP) published an analysis of medical conditions affecting sports participation.1 This statement was endorsed by the American Medical Association, replacing their own recommendations.2 A further modification of this analysis is presented here, with additions and changes that attempt to increase its accuracy and completeness and to include current information.
In Table 1, sports are categorized by their probability for collision or contact. In "collision" sports (eg, boxing, ice hockey, football, or rodeo), athletes purposely hit or collide with each other or inanimate objects, including the ground, with great force. In "contact" sports (eg, basketball and soccer), athletes routinely make contact with each other or inanimate objects, but usually with less force than in collision sports. Table 1 does not separate collision and contact sports because there is no clear dividing line between them. In "limited contact" sports such as softball and squash, contact with other athletes or inanimate objects is either occasional or inadvertent.
Sports with limited contact, for example downhill skiing and gymnastics, can be as dangerous as the contact or collision activities. Even in noncontact sports serious injuries can occur, such as in power lifting. Overuse injuries are not related to contact or collision. For all these reasons, the categorization of sports in Table 1 reflects imperfectly their relative risk of causing injury. The categorization does, however, give an idea of the comparative likelihood that participation in different sports results in acute traumatic injuries from blows to the body.
We assessed the medical conditions listed in Table 2 to determine whether participation would create an increased risk of injury or adversely affect the medical condition.
Letter to the Editor
Authors: Senturia Yvonne D. , Christoffel Katherine Kaufer , Donovan Mark 
Published: December 2021

In response to Dr Blackman:
Dr Blackman's letter confuses several distinct issues: 1) gun exposure of children seen in pediatric practices, 2) teen gun use, 3) the root causes of violence (eg, poverty), and 4) his model of "a stable and moral family environment." Our paper addresses only the first issue. Guns in the homes of pediatric practice attenders are not the cause of all of society's ills, nor of all gun violence. On the other hand, guns in the home are a proven hazard,1-4 which pediatric counseling may help to reduce.
A Virtually Routine Procedure—Why!?
Authors: Ríos Enrique , Martinez Homero , Neuhauser Linda 
Published: December 2021

We would like to bring to your attention the widespread practice of routine gastric lavage for newborns in Mexican hospitals.
We recently completed a study of newborn feeding in health institutions in Mexico.1 A stratified random sample was selected from three regions in Mexico (Mexico City, Sonora, and Chiapas). Health facilities were stratified by type of provider (government or private), size (number of deliveries per month), specialties (gynecology-obstetrics, general, maternity, rural clinic), and geographical location (north, central, and south).
Letter to the Editor
Authors: Friedman Deborah M. 
Published: December 2021

I was surprised to find the editorial comments by Steven Lipshultz1 published in the "article" section of Pediatrics without even a rebuttal by the Children's Cancer Study Group (CCSG).
This apparent attack on the "Steinherz recommendations"2 is really only mere opinion aimed against the expert panel of the CCSG, which had concluded that the anthracycline dose in a child should be modified if there were noninvasive evidence of cardiac toxicity even before the onset of clinical congestive heart failure.
Letter to the Editor
Authors: Silber Jeffrey H. 
Published: December 2021

Lipshultz et al1 level some strong criticism at the Children's Cancer Study Group (CCSG) algorithm for screening anthracycline cardiotoxicity in pediatric oncology patients.2 However, their economic analyses suffer from significant errors in both the application and interpretation of well-described economic theory.
The key insight of the Lipshultz et al paper is one based on what they called "incremental" changes in dosage. Although the concept is correct, the methodology was not applied appropriately to their problem.
Letter to the Editor
Authors: Finlay Jonathan , Meadows Anna T. 
Published: December 2021

We have read the paper by Lipshultz et al,1 that objects to the published recommendations for monitoring anthracycline cardiotoxicity,2 and we find no data to substantiate their opinion. In addition, they ignore their own data and instead make unjustified assumptions to reach unwarranted and dangerous conclusions.
The authors contend that if patients who receive anthracyclines are monitored, and if the therapy is modified on the basis of cardiac toxicity without overt failure, this will result in a net loss instead of benefit to the patients.
Letter to the Editor
Authors: Lipshultz Steven E. , Sanders Stephen P. , Colan Steven D. , Goorin Allen M. , Sallan Stephen E. , Krischer Jeffrey P. 
Published: December 2021

The above letters confirm our belief that monitoring for anthracycline cardiotoxicity is not only an important and emotional issue, but a highly complex one. We wish to respond to several of the points raised therein.
First, our several references to "authors," "Steinherz and her colleagues," and "Steinherz et al," as well as using the full name of the committee in the abstract and concluding paragraph, should have made the multiple authorship of the Children's Cancer Study Group (CCSG) paper clear.