bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk Factors for Pneumonia Among Children in a Brazilian Metropolitan Area
Authors: Victora Cesar G. , Fuchs Sandra C. , Flores José Antonio C. , Fonseca Walter , Kirkwood Betty 
Published: December 2021

Objective. To investigate risk factors for pneumonia for infants &lt;2 years of age.
Design. Hospital-based, case-control study with neighborhood control subjects.
Setting. Urban area in southern Brazil.
Subjects. Five hundred ten infants with radiologically confirmed pneumonia who were admitted to a pediatric hospital. One age-matched neighborhood control subject was selected for each case.
Results. Multiple conditional regression modeling was used to control for confounding, taking into account the hierarchical relationships between risk factors. The incidence of radiologically confirmed pneumonia was associated with low paternal education, the number of persons in the household, young maternal age, attendance at day-care centers, low birth weight and weight-for-age, lack of breast-feeding and of non-milk supplements, and a history of previous pneumonia or wheezing. Day-care center attendance showed the highest risk, with an adjusted odds ratio of 11.75.
Conclusions. In addition to continued efforts toward appropriate case management, actions directed against the above risk factors may help prevent the major cause of deaths of children younger than 5 years.
The Incidence of Prenatal Syphilis at The Boston City Hospital: A Comparison Across Four Decades
Authors: Klass Perri E. , Brown Elizabeth R. , Pelton Stephen I. 
Published: December 2021

Objective. To examine the incidence and epidemiologic correlates of congenital syphilis at an inner-city Boston hospital, and draw comparisons with the situation at the same hospital 40 years ago.
Design. Chart review and comparison with data collected in 1951.
Setting. Maternity and pediatric services at Boston City Hospital.
Methods. A study conducted in 1951 on the maternity service of Boston City Hospital in which demographic data were collected on all women admitted in labor over a 5-month period was replicated. Serologic testing for syphilis was carried out on these women, and the demographic and medical correlates of positive maternal syphilis serology were examined. This study was repeated exactly 40 years later, using the cord blood screening for syphilis done routinely at delivery and a review of prenatal records.
Results. From a group made up largely of married white women in 1951, the study population shifted in 1991 to a group made up mostly of minority women, with 75% unmarried. In 1951, 24 patients were diagnosed with syphilis either before or during the pregnancy, giving a prevalence rate of 2.4%. In 1991, 25 of 647 women were diagnosed with syphilis, for a prevalence rate of 3.9%. The women with positive cord blood serologies had a higher rate of other sexually transmitted diseases and substance abuse. No symptomatic cases of congenital syphilis were seen in 1951 or in 1991, although at least 11 of the 26 infants born to mothers with positive serologies in 1991 received intravenous penicillin therapy.
Conclusions. The continued prevalence of diagnosed syphilis in women at delivery reflects an inner-city epidemic of congenital syphilis that is tied to substance abuse, human immunodeficiency virus, and changing social patterns, as well to older problems of serologic screening, prenatal care, treatment failures, and maternal reinfection. It is essential that screening programs be maintained and improved in this high-risk population, and that infants born to mothers with positive serologies receive full and adequate treatment if there is any doubt at all about their infection status.
Simethicone in the Treatment of Infant Colic: A Randomized, Placebo-Controlled, Multicenter Trial
Authors: Metcalf Thomas J. , Irons Thomas G. , Sher Lawrence D. , Young Paul C. 
Published: December 2021

Objective. To determine the efficacy of simethicone in the treatment of infant colic.
Design. Randomized, double blind, placebo-controlled.
Setting. Three general pediatric practices in distinct geographic regions.
Patients. Eighty-three infants between 2 and 8 weeks of age with infant colic.
Interventions. Treatment with simethicone and placebo in double blind crossover fashion.
Results. A total of 166 treatment periods, ranging from 3 to 10 days, were evaluated in the 83 infants. Compared to baseline, improvement in symptoms was reported for 54% of the treatment periods, worsening was reported for 22%, and, for 24%, there was no change. The likelihood of the treatment period being rated as showing improvement, worsening, or no change was the same whether the infant was receiving placebo or simethicone. Twenty-eight percent of he infants responded only to simethicone, 37% only to placebo, and 20% responded to both. No statistically significant differences were noted among these three groups of responders. No difference could be shown even when infants with "gas-related symptoms" (by parental report) were separated out as a group.
Conclusion. Although both produced perceived improvements in symptoms, simethicone is no more effective than placebo in the treatment of infantile colic.
RELATIONSHIP BETWEEN INDEBTEDNESS AND THE SPECIALTY CHOICES OF GRADUATING MEDICAL STUDENTS
Authors: L. J. F. 
Published: December 2021

Analysis of data from the 1992 GQ has shown that educational debt was not a factor significantly influencing most graduates' specialty choices . . . As a strong or major influence, debt affected the specialty choices of only 6.2% of the 1992 graduates who had decided on a specialty. However, for students with debts of $75,000 or more, debt became more important, having a strong or major influence on the choices of surgical (13.9%) and support (20.3%) specialties. Although the effects of debt on specialty choice were found to be small . . . it is disturbing to note that over 20% of medical school graduates have such levels of indebtedness.
Length of residency training, as a factor affecting specialty choice, generally was a strong or major influence for only 9.0% of respondents. However, this number increased to 20.5% for respondents with debts of $75,000 or more who planned generalist specialty certification, suggesting that high debt turned students toward, as well as away from, the generalist specialties.
Pediatric Defibrillation: Current Flow Is Improved by Using "Adult" Electrode Paddles
Authors: Atkins Dianne L. , Kerber Richard E. 
Published: December 2021

Objective. Current flow, the major determinant of defibrillation success, depends on delivered energy and transthoracic impedance. Previous experimental data suggest that transthoracic impedance is higher using "pediatric" electrode paddles compared to the larger "adult" electrode paddles. There are few data from actual shocks to support the experimental studies. The purpose of this study was to measure transthoracic impedance during actual shock delivery and to determine the optimal electrode paddle size for pediatric defibrillation and cardioversion.
Methods. We prospectively evaluated all shocks of ≤ 20 joules given to pediatric patients at the University of Iowa from 1988 to 1992. Data collected included energy selected by the operator, energy delivered by the defibrillator, peak current flow and transthoracic impedance. Data were analyzed by unpaired t test and linear regression.
Results. Fifty-five shocks were delivered to 20 patients, age newborn to 8 years. Thirty-seven shocks were given with "pediatric" electrode paddles (surface area 21 cm2) and 18 with "adult" electrode paddles (surface area 83 cm2). Selected energy correlated well with delivered energy (r = .98, P &lt; .0001). Delivered energy using "pediatric" electrodes did not differ from that delivered with "adult" electrodes (8.0±0.9 joules vs 10.5 ± 1.2 joules P &gt; .1). However transthoracic impedance was significantly higher with "pediatric" electrodes (78.1±4.4 ohms vs 54.6 ± 2.7 ohms P &lt; .0008), resulting in lower peak current flow through "pediatric" electrode paddles (6.2±0.5 amps vs 8.7 ± 0.5 amps P &lt; .002). There was no correlation between joules/kg and peak current flow (r = .26, P &gt; .05).
Conclusion. Use of "pediatric" electrode paddies results in higher transthoracic impedance and thus lower peak current flow. In pediatric defibrillation, larger "adult" electrode paddies should be used as soon as chest size permits (approximateiy 10 kg). Lower transthoracic impedance results in higher current flow that facilitates cardioversion and defibrillation.
BLUE CROSS FREEZES TOP EXECUTIVES' PAY
Authors: L. J. F. 
Published: December 2021

ALBANY, Jan. 27 (AP)—The financially troubled Empire Blue Cross and Blue Shield, under fire for its top executives' pay, has frozen the salary of its chief executive at $600,000, officials said today.
Empire, New York State's largest insurer, has also frozen the base pay of other top executives, although these officials can get raises if they are promoted or if they significantly exceed performance goals
The company has been criticized for Albert Cardone's $600,000 salary.
[The vice president of government operations] said the criticism was unfounded because Mr. Cardone is underpaid by industry standards.
ALLERGENS IN SCHOOL DUST: I. THE AMOUNT OF THE MAJOR CAT (Fel d I) AND DOG (Can f I). ALLERGENS IN DUST FROM SWEDISH SCHOOLS IS HIGH ENOUGH TO PROBABLY CAUSE PERENNIAL SYMPTOMS IN MOST CHILDREN WITH ASTHMA WHO ARE SENSITIZED TO CAT AND DOG
Authors: Graft David F. 
Published: December 2021

Purpose of the Study. To measure the levels of cat and dog allergens in schools.
Methods. Dust samples from four Swedish schools were taken from floors and the horizontal surfaces of chairs and tables. The levels of cat allergen (Fel d I) and dog allergen (Can f I) in these dust samples were measured.
Results. Higher amounts of cat allergen were found on chairs than on tables or floors. The concentration of dog allergen was 2 to 20 times higher than cat allergen.
Reviewer's Comments. Children and teachers who have close contact with cats and dogs bring these allergens into the school environment. Concentrations of these allergens were high enough to cause symptoms in sensitized children.
IMPACT OF CHILDHOOD ASTHMA ON HEALTH
Authors: Randolph Christopher 
Published: December 2021

Purpose of the Study. To determine the disease burden resulting from asthma and to determine the functional status of asthmatics versus those without.
Study Population. A multi-state probability sample of civilian U.S. residents for the National Health Interview Survey (NHIS); 17 110 households of individuals residing in the U.S.
Findings. The prevalence of asthma in children under 18 years of age in the U.S. was 4.3% in 1988 and 3.2% in 1981 . The difference between the prevalence of asthma was statistically significant with an estimated 2.7 million children &lt;18 years of age reported to have asthma over the past year. The added burden experienced by children with asthma was an additional 10.1 million days missed from school, 12.9 million contacts with medical doctors and 200 000 hospitalizations. 30% of children had limitation of activity compared to 5% without asthma. Black children had more severe functional disability and hospitalizations than whites with asthma. 35% of hospitalizations for asthma and 77% of all days in the hospital were accounted for by 10% of children with asthma or severe disease.
Reviewer's Comments. These statistics are largely preventable with preventive asthma management reiterated to the patients and frequent follow up visits.
ALLERGIST INFLUENCE IN ASTHMA CARE
Authors: Galant Stanley P. 
Published: December 2021

Purpose of the Study. To determine whether care by an allergist reduces the morbidity for asthma specifically by decreasing the need for hospitalizations and emergency room visits.
Methods. This was a retrospective chart review of patients first seen between June 1985 and June 1986 and followed the second year either in an allergy clinic or in a general pediatric clinic. Charts were analyzed for demographic information; information regarding hospitalizalions, emergency room visits, and intensive care unit admissions; medications, including bronchodilators, systemic steroids and inhaled steroids, and home nebulizer; and home peak flow meters. There were 209 charts reviewed initially. Of these, 83 patients were then followed by allergists, 40 by non-allergists, and 86 were lost to followup.
Findings. There was no statistically significant difference in patient characteristics of asthma at baseline, except that those followed by allergists had a significant increase in the use of oral steroids. There was a significant difference in favor of the allergy followup group for decrease in hospitalization rate and emergency room visits. In terms of medication, there was no significant difference in the use of theophylline, beta2-agonists, or home nebulizers, but there was a statistically significant increase in the use of cromolyn sodium and inhaled steroids, the use of spacers for the metered-dose inhalers, use of home peak flow monitoring, and a decreased incidence of intensive care admissions. Interestingly, there was no change in pets or smoking in the children's environment.
Reviewer's Comments. This study suggests that the followup of asthmatics by an allergist is superior to the non-allergist.
INPATIENT MANAGEMENT OF STATUS ASTHMATICUS
Authors: Bell Thomas 
Published: December 2021

Purpose of the Study. To find causes of increasing asthma mortality by assessing patterns of physician management in a university hospital setting.
Study Population. The charts reviewed represented 130 admissions for 98 patients, some admitted more than once, ranging in age from 19 to 67. Seventy-four were women.
Methods. 130 charts, representing 13 months status asthmaticus admissions were reviewed in detail for numerous parameters. These data were then utilized to answer two questions applied to each day of hospitalization: Did physicians document the severity of the attack and its response to therapy using findings on physical exam and objective indices of airflow obstruction? What treatments were used?
Findings. Despite its university setting where high standards of practice would be expected, several striking findings emerge. Peak flows or spirometry were measured in only a minority of patients. On day one 55% of patients had peak flows recorded, on day two an additional 13%. In 41 cases peak flow was never recorded. Spirometry was never recorded on the first day, and only 22% of patients ever had this measured. Since oximetry is not mentioned I assume this was rarely, if ever, measured. Most objective measures found on physical examination are likewise rarely recorded except for wheezing and use of accessory muscles on the first day (the mean length of stay was 5.5 days). Examination of treatments used is much as would be expected: Only 74% received intravenous theophylline, and 9% had no steroids during their entire stay. On discharge 17% had no stated follow-up plan.
EXTRACORPOREAL LIFE SUPPORT FOR STATUS ASTHMATICUS
Authors: Bell Thomas 
Published: December 2021

Purpose of the Study. This report presents the experience with one case of status asthmaticus who failed to respond to mechanical ventilation and was successfully managed with extracorporeal life support (ECLS) using venovenous bypass. The purpose is to inform the practitioner of an additional therapy, potentially of benefit, in management of asthma complicated by treatment-resistant respiratory failure.
Methods. Low volume venovenous bypass with extracorporeal life support resolved severe respiratory failure in a 23-year-old female asthmatic over a 22-hour period after failure of 5 hours of mechanical ventilation. Bypass was initiated remotely by an ECLS team using a portable ECLS circuit before the 180-mile transport to the "nearby" center. Details of the technique are presented.
Conclusion and Reviewer's Comments. This may be the first instance where asthma was the primary indication for ECLS; other asthmatics have been so treated, but for other complicating conditions like pneumonia and adult respiratory distress syndrome. This report provides a further alternative therapy, even in somewhat remote areas, for asthma-caused respiratory failure.
DOES ASTHMA OR TREATMENT WITH THEOPHYLLINE LIMIT CHILDREN'S ACADEMIC PERFORMANCE?
Authors: Chipps Bradley E. , Ostrom Nancy 
Published: December 2021

Purpose of the Study. To determine the effect of theophylline and asthma on academic performance as measured by scores on standardized achievement tests.
Study Population. One hundred children with asthma who had siblings within 4 years of age who did not require any regular medications. All subjects had taken standardized achievement tests within 4 years. All were patients in health care facilities staffed by the authors.
Methods. Parents were interviewed regarding any perceived effect of asthma or asthma medication on their child's learning. Medical records were reviewed regarding medication prescribed at the time of the testing session. Results of the Iowa Tests of Basic Skills (ITBS) for grades 1 through 8 and Iowa Tests of Educational Development (ITED) for grades 9 through 12 were obtained from the testing agency.
Findings. The mean scores for reading, mathematics, and composite for both groups were 0.6 to 0.8 standard deviations above the national averages. The asthma and control groups did not significantly differ on scores of the ITBS or ITED. The number of children with scores below the 10th percentile was similar (3% asthma and 5% siblings). Of the asthmatic children, 72% were taking maintenance theophylline, and this group did not significantly differ from the whole. Parental interviews revealed that 23% attribute behavioral problems to the disease itself. The parents ascribe learning problems to asthma in 23% of the patients and 18% of the parents believed asthma medications produced learning difficulties.
Reviewers' Comments. The study supports lack of demonstrable effect of asthma or maintenance theophylline therapy on standardized test performances.
HUMAN IMMUNODEFICIENCY VIRUS-INFECTED ADOLESCENTS: THE FIRST 50 PATIENTS IN A NEW YORK CITY PROGRAM
Authors: McAnelly George , Shearer William T. 
Published: December 2021

This study identifies a large cohort of HIV-infected adolescents cared for in a multidisciplinary program. Since the subjects were selected because of their risk of HIV-infection, differences between the HIV-positive and -negative groups were minimized. Rates of STDs, drug use, and prior sexual abuse were much higher in both groups than those reported in population-based studies of adolescents; thus, behavior profiles can play a role in identifying high-risk adolescents.
In adolescents, sexual behavior and sexual identity are often not the same, and thus AIDS prevention programs designed for the homosexual community are often not recognized as relevant by adolescents engaging in same-sex encounters. Virtually all HIV-positive females in this study apparently contracted HIV through heterosexual intercourse. None of the females were able to consistently convince their partners to use a condom. The majority of the HIV-positive adolescents reported more than 10 life-time sexual partners. There was a strong association between crack/cocaine use and increased numbers of sexual partners, termed "survival-sex." Traditional safer-sex messages are unlikely to reach teens attempting to survive on the street. Comprehensive drug treatment programs must be developed as a component of HIV prevention in adolescents. Medically, 80% of seropositive adolescents were asymptomatic by history and physical, yet by CD4 counts, nearly half were eligible for antiretroviral treatment. Adequate referral sources for comprehensive medical care should be linked to HIV counseling and testing programs for youth.
After being informed of their seropositivity, most adolescents assumed they were going to die within a year. With a realistic message of hope, many of the adolescents were able to make positive changes in their lives, and the HIV infection became an organizing force in their lives.
TRANSIENT SEROREVERSION IN CHILDREN BORN TO HUMAN IMMUNODEFICIENCY VIRUS 1-INFECTED MOTHERS
Authors: Pacheco Susan E. , Shearer William T. 
Published: December 2021

Purpose of the Study. To review the clinical and laboratory data of three infants born to HIV-1-infected mothers, who became HIV-1 seronegative after 6 months of age, but subsequently became HIV-infected and seropositive.
Study Population. Three infants are described from a cohort of 218 born to HIV seropositive mothers at the Maternity Ward of the Centre Hospitalier de Kigali, Rwanda, enrolled from November 1988 to June 1989. Of these, 140 infants (64.2%) became HIV-1 seronegative (based on a minimum of two negative serum samples). Three (2.1 %) of these 140 infants were subsequently found to be seropositive for HIV-1 antibodies after 6 to 9 months of seronegativity. The infants had no history of blood transfusion or exposure to contaminated needles. They were breast-fed during at least 18 months of their lives.
Methods. Sera were screened for anti-HIV-1 antibodies by ELISA, and those positive were confirmed by Western Blot (WB). Serum immunoglobulins were measured by radial immunodiffusion. Mononuclear cell subpopulations were analyzed using indirect immunofluorescence and monoclonal antibodies. A double PCR was performed with three pairs of HIV-1-specific oligonucleotide primers with amplified sequences located in the gag, pol, and env region of the HIV-1 genome. A positive PCR was defined as a detectable signal for at least two of the three primer pairs.
Results. The infants were HIV-1 seropositive until 6 months of age and were seronegative on the following examination at 9 months of age. They remained seronegative for 6-9 months when HIV seropositivity was again noted. Case 1 had a normal physical examination until seroconversion at 15 months (hepatosplenomegaly was noted once at 3 months of age).
THE GENE INVOLVED IN X-LINKED AGAMMAGLOBULINEMIA IS A MEMBER OF THE SRC FAMILY OF PROTEIN-TYROSINE KINASES
Authors: Abernathy-Carver Katherine J. , Liu Andrew 
Published: December 2021

Purpose of the Studies. X-linked agammaglobulinemia (XLA) is a humoral immunodeficiency characterized by recurrent bacterial infections. Affected males lack mature B cells and serum immunoglobulins of all isotypes. They have a normal number of pre-B cells in the bone marrow, which suggests a defect in the pathway of B cell development. These two research groups sought to identify the gene and protein product responsible for this disorder.
Findings. Both groups, using different methodologies, successfully identified the mutant gene on the X chromosome, and characterized the defective protein product in a total of 10 XLA patients. The protein is a cytoplasmic tyrosine kinase. Other tyrosine kinases are known to play a critical role in signal transduction pathways that stimulate cell growth and differentiation.
Reviewers' Comments. These papers represent a major breakthrough in the understanding of XLA. More research is needed to explain how this defective protein results in this disorder. However, this opens the door for prenatal diagnosis and possible gene therapy in the future.