bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Randomized, Controlled Trial of a School-based, Multi-faceted AIDS Education Program in the Elementary Grades: the Impact on Comprehension, Knowledge and Fears
Authors: Schonfeld David J. , O'Hare Linda L. , Perrin Ellen C. , Quackenbush Marcia , Showalter Donald R. , Cicchetti Domenic V. 
Published: December 2021

Objective. Several educational theorists have suggested that young children are unlikely to benefit from detailed instruction regarding AIDS prevention because of inherent developmental cognitive limitations. This study aims to determine whether AIDS education in the elementary grades can advance young children's understanding of this illness.
Methods. A randomized, controlled trial was used to measure the impact of a 3-week, multifaceted AIDS education program on conceptual understanding, factual knowledge, and fears about AIDS in 189 students in grades kindergarten through 6th. The ASK (AIDS Survey for Kids), a standardized, semistructured interview that measures conceptual understanding, factual information, and fears about AIDS, was administered before and after the intervention.
Results. Children in the intervention group, as compared to those in the control group, showed significant (P &lt; .0001) gains in their level of understanding of the concepts of causality and prevention of AIDS. These results were unaffected by controlling for grade, gender, race, socioeconomic status, and verbal fluency. The gains in children's understanding of causality of AIDS represented at least 2 years' growth in the level of conceptual sophistication and persisted at a follow-up evaluation several months later. After the intervention, more children (P &lt; .001) in the intervention group than in the control group accurately identified causes of AIDS in response to open-ended questions: germ/germ theory (41% vs 13%), mother-to-infant transmission (54% vs 15%), blood transmission (83% vs 40%), and sexual transmission (56% vs 30%). Fewer than half as many children in the intervention group responded incorrectly to each of five direct questions about transmission of HIV through casual contact. The intervention did not increase children's fears about the illness.
Conclusions. A short, developmentally based, multifaceted AIDS education program in the elementary grades can advance children's conceptual understanding and factual knowledge about AIDS and decrease their misconceptions about casual contact as a means of acquiring the illness, without increasing their fears. Significant advances in conceptual understanding about AIDS can be achieved through direct educational interventions.
The Contribution of Level of Cognitive Complexity and Pubertal Timing to Behavioral Risk in Young Adolescents
Authors: Orr Donald P. , Ingersoll Gary M. 
Published: December 2021

Purpose. To determine the unique contributions of cognitive complexity and pubertal timing to participation in behavioral risk (substance use, sexual activity, school and legal problems) among young adolescents.
Design. Cross-sectional with cohort replication.
Methods. Two cohorts of middle school students in grades eight and nine in a midwestern school district completed a self-report questionnaire in 1987 and 1989. Measures of behavioral and emotional risk, cognitive complexity and pubertal timing relative to peers were included.
Results. Complete data were available for 817 and 796 students in each cohort year. Gender, race, level of cognitive complexity and pubertal timing each contributed significantly to the variance in behavioral risk independent of chronological age (P &lt; .0001). Boys, whites, those at lower levels of cognitive complexity and those who began pubertal maturation earlier than peers, were at significantly greater risk. Adolescents who demonstrated higher levels of cognitive complexity and those who began puberty later compared to peers participated in a smaller array of risk behaviors, independent of chronological age.
Implications. Pediatricians should consider adolescents at lower levels of cognitive complexity (concrete thinking) and those who begin puberty earlier at greater risk for participation in health risk behaviors. Preventive health counseling tailored to the needs of this group may be most beneficial.
Cerebral Oxygenation and Hemodynamics During Induction of Extracorporeal Membrane Oxygenation as Investigated by Near Infrared Spectrophotometry
Authors: Liem K. D. , Hopman J. C. W. , Oeseburg B. , de Haan A. F. J. , Festen C. , Kollée L. A. A. 
Published: December 2021

Objective. To investigate cerebral oxygenation and hemodynamics in relation to changes in some relevant physiologic variables during induction of extracorporeal membrane oxygenation (ECMO) in newborn infants.
Methods. Twenty-four newborn infants requiring ECMO were studied from cannulation until 60 minutes after starting ECMO. Concentration changes of oxyhemoglobin (cO2Hb), deoxyhemoglobin (cHHb), total hemoglobin (ctHb), and (oxidized-reduced) cytochrome aa3 (cCyt.aa3) in cerebral tissue were measured continuously by near infrared spectrophotometry. Heart rate (HR), transcutaneous partial pressures of oxygen and carbon dioxide (tcPo2 and tcPco2), arterial O2 saturation (saO2), and mean arterial blood pressure (MABP) were measured simultaneously. Intravascular hemoglobin concentration (cHb) was measured before and after starting ECMO. In 18 of the 24 infants, mean blood flow velocity (MBFV) and pulsatility index (PI) in the internal carotid and middle cerebral arteries were also measured before and after starting ECMO using pulsed Doppler ultrasound.
Results. After carotid ligation, cO2Hb decreased whereas cHHb increased. After jugular ligation, no changes in cerebral oxygenation were found. At 60 minutes after starting ECMO, the values of cO2Hb, saO2, tcPo2, and MABP were significantly higher than the precannulation values, whereas the value of cHHb was lower. There were no changes in cCyt.aa3, tcPco2, and HR, whereas cHb, decreased. The MBFV was significantly increased in the major cerebral arteries except the right middle cerebral artery, whereas PI was decreased in all measured arteries. Cerebral blood volume, calculated from changes in ctHb and cHb, was increased in 20 of 24 infants after starting ECMO. Using multivariate regression models, a positive correlation of ΔctHb (representative of changes in cerebral blood volume) with ΔMABP and a negative correlation with ΔtcPo2 were found.
Conclusions. The alterations in cerebral oxygenation after carotid artery ligation might reflect increased O2 extraction. Despite increase of the cerebral O2 supply after starting ECMO, no changes in intracellular O2 availability were found, probably because of sufficient preservation of intracellular cerebral oxygenation in the pre-ECMO period despite prolonged hypoxemia. The increase in cerebral blood volume and cerebral MBFV may result from the following: (1) reactive hyperperfusion, (2) loss of autoregulation because of prolonged hypoxemia before ECMO and/or decreased arterial pulsatility, or (3) compensation for hemodilution related to the ECMO procedure.
Evaluation of Airway Complications in High-Risk Preterm Infants: Application of Flexible Fiberoptic Airway Endoscopy
Authors: Downing Gregory J. , Kilbride Howard W. 
Published: December 2021

Objectives. We sought to determine factors that would predict the development of subglottic stenosis (SGS) and tracheomalacia (TM) in preterm infants. The utility of a semiquantitative measurement of airway dimensions was assessed in relation to signs of airway complications. We also sought to determine from a high-risk population of infants those likely to have abnormal findings identified by bronchoscopic examination.
Methods. Prospective airway endoscopy was performed for preterm infants who were intubated for 7 days or more or who demonstrated chronic oxygen needs beyond 28 days after birth and 36 weeks postconceptional age. Subjects were 117 preterm (less than 36 weeks' gestation) infants from two level III intensive care nurseries. Endoscopy was used to classify the type and degree of airway injury. Subglottic stenosis was defined subjectively and compared with an objective measurement using subglottic spatial relations described as a trans- subglottic/vocal cord ratio (TSG/VC). Clinical signs and symptoms and other risk factors were evaluated as significant predictors of SGS and TM, identified by bronchoscopy.
Results. Moderate or severe airway abnormalities were identified in 32 patients (27.3%); 13 with SGS, 17 with TM, and 2 with both. All but one infant with TSG/VC less than 0.83 had signs and symptoms of airway dysfunction. Variables more commonly found in patients with SGS included greater number of intubations, use of inappropriately large endotracheal tubes, and longer duration of intubation. Higher averaged mean airway pressure during the first week after birth and lower gestational age were clinical features associated with TM.
Conclusions. Flexible bronchoscopic evaluation of a high-risk population demonstrated a higher incidence of moderate or severe SGS or TM than previously suspected. Subglottic stenosis and TM appear to have different etiologies based on different factors associated with their development. The TSG/VC ratio correlated well with obstructive symptoms and may represent a means to quantitate clinically subglottic narrowing. Infants with chronic lung disease who have persistently elevated partial pressure of carbon dioxide, apnea, or phonation abnormalities are most likely to have airway abnormalities identifiable by bronchoscopy.
CLARIFICATION:

CHANGE IN RECOMMENDED DOSE OF ENGERIX-B FOR ADOLESCENTS
Authors: Gindler Jacqueline 
Published: December 2021

The commentary entitled "The Recommended Childhood Immunization Schedule of the United States"1 that appeared in the January 1995 issue of Pediatrics stated that infants born to hepatitis B surface antigen (HBsAg)-positive mothers should receive immunoprophylaxis with 0.5 mL of hepatitis B immune globulin (HBIG) and 0.5 mL of hepatitis B vaccine administered at separate sites. Hepatitis B vaccines licensed in the United States are produced by Merck & Co and SmithKline Beecham Pharmaceuticals, and are available in various concentrations. The recommended infant dose of hepatitis B vaccine varies by manufacturer and HBsAg status of the mother (see Table). Merck & Co recommends 2.5 µg of Recombivax HB for infants of HBsAg-negative mothers and 5.0 µg for infants of HBsAg-positive mothers; SmithKline Beecham recommends 10 µg of Engerix-B regardless of the mother's HBsAg status. Providers should know the HBsAg status of an infant's mother and consult the product package insert for the recommended vaccine dose.
Providers should also be aware that the Food and Drug Administration has recently lowered the age-appropriate dose of Engerix B from 20 µg to 10 µg for adolescents 11 to 19 years of age (see Table).
REPORTS TELL PARENTS HOW SCHOOLS PERFORM
Authors: L. J. F. 
Published: December 2021

School children throughout New York City are taking home report cards this month—not their own, but those of their schools. The reports were ordered by Schools Chancellor Ramon C. Cortines, who has said that schools can be improved through more involvement by parents.
The three-page annual reports, similar to those issued in New Jersey and other states, compare various aspects of a school's performance against the school system's.
Report cards like these have been gaining in popularity throughout the country as a means of making schools more accountable to parents and other groups.
"It's getting to be a pretty wide-spread practice," said Kathy Christy, a spokes-woman for the Education Commission of the States, a national clearinghouse for school statistics. "What parents want to know is, even though my child got straight As, how is my school or my district doing compared to other schools?"
About forty-two states require that schools report to one central office about their performance or student achievement, she said, although not all require that they make such information available to parents.
Contribution of Heritable Disorders to Mortality in the Pediatric Intensive Care Unit
Authors: Cunniff Christopher , Carmack Janet L. , Kirby Russell S. , Fiser Debra H. 
Published: December 2021

Objectives. To determine the percentage of patients dying in the pediatric intensive care unit (PICU) who have heritable disorders and to compare vital statistics classification of underlying cause of death with underlying heritable disorder identified from medical record review.
Design. Retrospective medical record review.
Setting. The PICU of a university-affiliated hospital.
Methods. Medical records were reviewed for all deaths occurring in the PICA over a 5-year period. Further review, including hospital course, clinical findings, and the presence or absence of a genetic evaluation, was accomplished for those patients found to have a chromosome abnormality, recognized syndrome, single major malformation, or unrecognized syndrome. Underlying cause of death classification obtained from the Center for Health Statistics, Arkansas Department of Health was reviewed to determine the frequency with which the underlying heritable disorder was recorded.
Results. Fifty-one of 268 (19%) deaths during the study period were in patients with heritable disorders. Of these 51 patients, eight (16%) had chromosome abnormalities, 17 (33%) had a recognized syndrome, 15 (29%) had a single primary defect in development, and 11 (22%) had an unrecognized syndrome. Genetic evaluation was carried out on 45% of patients, with the frequency of evaluation differing between categories of patients with heritable conditions. When underlying cause of death from vital statistics classification was reviewed, 21 of 51 (41%) records did not include the underlying heritable disorder.
Conclusions. Heritable disorders are a frequent cause of mortality in the PICU. Vital statistics classification of underlying cause of death in this population often fails to identify heritable disorders, leading to an underascertainment of these conditions in mortality statistics. Improved cause of death classification procedures will be necessary to target public health interventions to etiology-specific populations.
Children, Adolescents, and Advertising
Authors:   Committee on Communications
Published: December 2021

The following is a correction to the AAP Policy Statement entitled "Childen, Adolescents, and Advertising" that appeared in the February 1995 issue of Pediatrics (1995:95:295-297).
Under the heading entitled Beer and Wine on page 296, the statistic should have read "In 1993, 3137 young people who were 16 to 24 years of age died in alcohol-related motor vehicle crashes."
Also, on page 297, Reference 19 should be changed to the following: National Center for Statistics and Analysis. National Highway Traffic Safety Administration. Traffic Safety Facts 1993: A Compilation of Motor Vehicle Crash Data From the Fatal Accident Reporting System and the General Estimates System. Washington, DC: National Center for Statistics and Analysis; 1993. US Department of Transportation publication DOT HS 808 169.
Adolescents' Misinterpretation of Health Risk Probability Expressions
Authors: Cohn Lawrence D. , Schydlower Manuel , Foley John , Copeland Randolph L. 
Published: December 2021

Objective. To determine if differences exist between adolescents and physicians in their numerical translation of 13 commonly used probability expressions (eg, possibly, might).
Design. Cross-sectional.
Setting. Adolescent medicine and pediatric orthopedic outpatient units.
Participants. 150 adolescents and 51 pediatricians, pediatric orthopedic surgeons, and nurses.
Measurement. Numerical ratings of the degree of certainty implied by 13 probability expressions (eg, possibly, probably).
Results. Adolescents were significantly more likely than physicians to display comprehension errors, reversing or equating the meaning of terms such as probably/possibly and likely/possibly. Numerical expressions of uncertainty (eg, 30% chance) elicited less variability in ratings than lexical expressions of uncertainty (eg, possibly).
Conclusion. Physicians should avoid using probability expressions such as probably, possibly, and likely when communicating health risks to children and adolescents. Numerical expressions of uncertainty may be more effective for conveying the likelihood of an illness than lexical expressions of uncertainty (eg, probably).
Prenatal Tobacco and Marijuana Use Among Adolescents: Effects on Offspring Gestational Age, Growth, and Morphology
Authors: Cornelius Marie D. , Taylor Paul M. , Geva Diklah , Day Nancy L. 
Published: December 2021

Objective. This longitudinal study examined the effects of tobacco and marijuana use during pregnancy on the gestational age, growth, and morphology of 310 offspring of adolescents. Data were collected during 1990 through 1993.
Methodology. The adolescents were drawn from a prenatal clinic in Pittsburgh, PA. They were interviewed at mid-pregnancy and at delivery to obtain information on tobacco, marijuana, and other substance use before and during pregnancy. Infants were examined 24 to 36 hours after birth.
Results. The average maternal age was 16.1 (range 12 to 18 years); 70% were African-American. Prenatal tobacco use was associated with reduced birth weight, length, head and chest circumferences, and ponderal index, but not gestational age or the number of morphological abnormalities. Prenatal marijuana exposure was associated with reduced gestational age. Among whites, first trimester marijuana exposure was associated with an increased rate of minor physical anomalies. Prenatal marijuana exposure was not associated with any growth outcomes.
Conclusions. These effects of prenatal tobacco and marijuana use were prominent despite lower levels of prenatal exposure in the offspring of adolescent mothers as compared with the offspring of adult mothers from the same clinic. Young maternal age may increase the offspring's risk of negative effects from prenatal tobacco and marijuana exposure.
Specification of the Neurobehavioral Phenotype in Males with Fragile X Syndrome
Authors: Baumgardner Thomas L. , Reiss Allan L. , Freund Lisa S. , Abrams Michael T. 
Published: December 2021

Objective. A controlled clinical study was designed to identify the neurobehavioral profile that is specific to males with fragile X syndrome.
Design. Thirty-one males with fragile X syndrome and 30 age and IQ-matched male controls were evaluated with instruments that assess multiple domains of adaptive functioning and problem behaviors. The Vineland Adaptive Behavior Scales and the Aberrant Behavior Checklist were selected for their dimensional scaling of behavioral ratings.
Results. Parent and Teacher versions of the Aberrant Behavior Checklist demonstrated a profile of behaviors specific to males with fragile X syndrome characterized by significantly higher levels of hyperactivity, stereotypic movements, and unusual speech. The Vineland Adaptive Behavior Scales revealed no fragile X-specific profile of adaptive skills development.
Conclusions. The distinct pattern of aberrant behaviors observed among males with fragile X emphasizes the importance of drawing subtype distinctions within the classification of individuals with mental retardation on the basis of underlying etiology. For clinical research, specifying the fragile X phenotype is a vital part in the effort to elucidate the neurodevelopmental pathways of normal behavior and psychopathology. Understanding the fragile X symptom pattern is essential for designing symptom-specific treatment interventions, as well as for research into the efficacy of interventions strategies.
The Pediatrician's Role in Family Support Programs
Authors:   Committee on Early Childhood, Adoption and Dependent Care
Published: December 2021

The health and welfare of children depend on the ability of families, alone or with the assistance of others, to meet their needs. This task has become increasingly difficult for many families. Pediatricians need to be able to recognize situations in which families may have difficulty fulfilling parental obligations and assist the family in finding available additional support.
CHANGES IN FAMILIES
The structure of families and patterns of family life in the United States have undergone some profound changes during the past quarter century. The proportion of births to unmarried women increased between 1960 to 1985 from 5.3% to 22% and has continued in the same direction.1-3 Since 1960 the divorce rate has more than doubled,1-3 and it is estimated that 25% of children growing up in this decade will experience a divorce.4 Although remarriage rates are high, over a third again end in divorce.5 As a consequence, 8% fewer children are living with two parents (74.8% in 1989 versus 83.1% in 1971),6,7 and only 61% live with both biologic parents.8 Further evidence of change in family life is that almost 60% of all mothers with preschool-aged children are in the labor force, reflecting a twofold increase since 1970.9 A decline in the purchasing power of family income, the lack of comparable wages for women, and significant rates of homelessness have all stressed families and contributed to the continuing escalation of the percentage of children who live in poverty. Finally, internal migration within the country has separated many families from the natural support systems provided by their extended families, leaving parents socially isolated and interrupting the intergenerational transmission of advice and support.
No So Sunny
Authors: Mangrem Carole L. , Leggiadro Robert J. 
Published: December 2021

We recently cared for a young patient who we believe represents a serious example of egg-associated salmonellosis in a member of a high-risk group because of his young age. His case serves to remind pediatricians to discuss infant feeding practices with parents and to warn them of the potential hazards of eggs related to salmonellosis.
This previously healthy 5-month-old white male was brought to the emergency department of a Mississippi regional medical center with a 1-day history of fever and irritability.
DOCTORS PLANNING BATTLE AGAINST HEALTH-CARE PLAN
Authors: L. J. F. 
Published: December 2021

CHICAGO, June 14—Leaders of the American Medical Association laid the groundwork today for an aggressive legal and political campaign against two important elements of the health plan being developed by President Clinton: limits on national health-care spending and on doctors' charges.
The association's board warned that there would be significant constitutional problems if the Government tried to impose price controls or an overall limit on health spending, both of which have been advocated by the White House ...
Doctors across the country plan to distribute a list of questions to be used by patients in evaluating President Clinton's health-care plan. Among the questions, drafted by the medical association, are these:
"Will I still be able to see my own doctor? Will I have to pay extra?
"I have a group insurance policy through my employer. Will that change? Will my premiums, deductibles and copayments go up?
"Will I be able to choose my own type of health insurance? And can I buy extra insurance if I want it?
"Will the quality of care my family receives be maintained under a new system?
"I'm retired and on a fixed income. Will my Medicare coverage be affected?
"Will everybody in America have health insurance? And if so, how will we pay for this?"