bluuebunny/crossref_metadata_2025_split huggingface dataset:
A 2- TO 3-YEAR OUTCOME AFTER BRONCHIOLITIS
Authors: Ostrom Nancy 
Published: December 2021

Purpose of the Study. To evaluate risk factors and short term outcome for subsequent wheezing in children with early bronchiolitis or pneumonia.
Study Population. One hundred twenty-seven children (0 to 2 years old) hospitalized for wheezing (83) or pneumonia in a 1-year period in two hospitals in Finland.
Methods. Patients with a history of hospitalization for wheezing with respiratory infection (including bronchiolitis) versus pneumonia were examined, and their parents were interviewed at 1 month, 1.5 to 2 years, and 2.5 to 3 years. Family history of atopy, environmental factors, breast feeding history, and other atopy (eczema, elevated IgE) were noted using a standardized questionnaire and physician-documented wheezing episodes were quantified. Statistical χ2 tests were analyzed comparing the wheezing group to the control group of patients with pneumonia not associated with wheezing.
Findings. There was no significant difference between the groups in bacterial versus viral etiology of their lower respiratory symptoms. Subsequent wheezing after bronchiolitis occurred in 76% of children 1-2 years of age and 58% of children at 2-3 years of age. This compares with 9% and 16% (respectively by age) of the group with "non-wheezing" pneumonia. Atopic diathesis, particularly a positive family history of asthma was the host factor best associated with initial wheezing. Parenthetically, parental smoking was found in 61% of the wheezing group and 45% of the pneumonia group.
Reviewer's Comments. This is a sound study, perhaps limited, in its comparability to our clinical populations with wider racial and socioeconomic diversity. Of note is the finding of no differences between the wheezing and nonwheezing groups in bacterial and viral etiologies.
Glutamate in Pyridoxine-Dependent Epilepsy: Neurotoxic Glutamate Concentration in the Cerebrospinal Fluid and Its Normalization by Pyridoxine
Authors: Baumeister Friedrich A. M. , Shin Yoon S. , Egger Joseph , Gsell Wieland 
Published: December 2021

Background. Pyridoxine-dependent epilepsy is a rare autosomal recessive disorder. Untreated patients suffer from a progressive encephalopathy with mental retardation, intractable epilepsy, and progressive neurological signs and symptoms. Lifelong supplementation with vitamin B6 is the treatment of choice. However, despite early treatment, many patients develop mental retardation.
Objectives. To assess the role of glutamate as an excitatory neurotransmitter and neurotoxin in pyridoxine-dependent epilepsy.
Methods. We examined cerebrospinal fluid (CSF) levels of glutamate, γ-aminobutyric acid, and pyridoxal-5'-phosphate in a patient with pyridoxine dependency while on and off vitamin B6 treatment.
Results. Off vitamin B6 the glutamate level was two hundred times normal. An intermediate dose of vitamin B6 (5 mg/kg BW/day) caused normalization of the EEG and remission of the seizures, but the CSF glutamate concentration was still ten times normal. With a higher dose of pyridoxine (10 mg/kg BW/day) the CSF glutamic acid normalized.
Conclusions. The results indicate that control of epilepsy might not suffice as the therapeutic aim in treating of pyridoxine dependency. In view of the evidence for the role of excitatory amino acids in destruction of CNS nerve cells, the optimal treatment must counteract the raised levels of CSF glutamate and the dosage of vitamin B6 must be adjusted accordingly. The development of mental retardation might theoretically be prevented by adjusting the dose of vitamin B6 to achieve not only remission of epilepsy but also normalization of CSF glutamate.
DATA SHOW PITFALLS IN CHILD TESTIMONY
Authors: L. J. F. 
Published: December 2021

Use of Dolls Criticized
"The experts are correct about whether the child's account is accurate about one-third of the time," Dr. Ceci said. "That's worse than chance."
Anatomically detailed dolls, which are often used in investigations of child abuse, have also been called into question by recent research findings. At the University of Chicago meeting, Dr. Ceci and his colleagues reported preliminary results from a study in which they questioned 3-year-olds who had just been given a physical examination. Half the exams included a standard inspection of the child's genitals, half did not. Of those children who received no genital exam, 38 percent answered, "yes," when a researcher pointed to the doll's genitals and asked, "Did he touch you here?"
When the question was posed in a leading fashion, using the child's own word for genitals, 70 percent of children who had received no genital exam indicated incorrectly that the doctor had touched their genitals ...
Dr. Ceci and Dr. Bruck, in an article to appear in the fall in a report by the Society for Research in Child Development, recommend that people investigating possible cases of child abuse change their procedures, for example, by avoiding repeated suggestions or putting much emphasis on evidence from anatomical dolls.
Urinary Oxalate Excretion in Premature Infants: Effect of Human Milk Versus Formula Feeding
Authors: Campfield Thomas , Braden Gregory , Flynn-Valone Patrecia , Clark Nathaniel 
Published: December 2021

Objective. To study urinary oxalate excretion in infants fed human milk versus formula, and to compare urinary calcium oxalate and calcium phosphate saturation in premature infants with term infants and adults.
Methodology. We measured urinary oxalate-to-creatinine ratio and urinary oxalate concentration in 15 premature infants fed human milk compared to 16 formula-fed premature infants, and in eight human milk-fed term infants compared to 17 formula-fed term infants. We then studied urinary calcium oxalate and calcium phosphate saturations based on our observations of elevated urinary oxalate excretion in premature infants. Urinary calcium oxalate and calcium phosphate saturations were calculated from urinary concentrations of oxalate, calcium, sodium, potassium, chloride, uric acid, magnesium, phosphorus, and urinary pH. We calculated urinary calcium oxalate and calcium phosphate saturations in nine healthy adults and nine formula-fed term infants to establish control values for urinary saturation. Urinary calcium oxalate and calcium phosphate saturations were determined in nine premature infants receiving a glucose and electrolyte solution, 11 premature infants receiving parenteral nutrition, nine formula-fed premature infants, and 11 human milk-fed premature infants.
Results. Urinary oxalate excretion was higher in formula-fed compared to human milk-fed premature infants whether expressed as oxalate-to-creatinine ratio (0.32 ± 0.04 versus 0.18 ± 0.03, P &lt; .01) or urinary oxalate concentration (0.047 ± 0.007 versus 0.022 ± 0.002 mg/mL, P &lt; .01). Urinary oxalate excretion was higher in formula-fed term infants than in human milk-fed term infants whether expressed as oxalate-to-creatinine ratio (0.14 ± 0.01 versus 0.07 ± 0.01, P &lt; .01) or urinary oxalate concentration (0.022 ± 0.002 versus 0.012 ± 0.002 mg/mL, P &lt; .01). The urinary calcium oxalate saturation in healthy adults was 2.84 ± 0.79; the value in formula-fed term infants was 2.12 ± 0.31. The urinary calcium oxalate saturation was significantly higher in premature infants receiving formula (15.68 ± 3.15), human milk (15.02 ± 2.27), or parenteral nutrition (11.38 ± 2.56) compared to adults or term infants (P &lt; .01). Urinary calcium oxalate saturation in premature infants receiving a glucose and electrolyte solution (2.45 ± 0.36) was not significantly different from that in adults or term infants. In contrast, urinary calcium phosphate saturation in premature infants as well as term infants and adults was less than 1; precipitation of calcium phosphate is not likely to occur under these conditions.
Conclusion. Formula-fed infants have higher urinary oxalate excretion than human milk-fed infants. Premature infants receiving standard nutritional regimens may have urinary calcium oxalate saturation levels at which dissolved calcium oxalate may form nuclei of its solid phase.
Cost and Quality in Child Care
Authors: Taylor William R. , Galinsky Ellen , Helburne Suzanne , Culkin Mary 
Published: December 2021

Over the last 20 to 30 years, an increased proportion of mothers are participating in the labor force and an increased number of preschool children are placed in nonfamilial care, primarily because less care is given now by relatives.1 In 1990, 43% of children age 3 years and over were enrolled in child-care centers and 17% in family child care, while 16% were cared for by relatives.
Responding to this demand, the supply of child care has increased. By 1990, 80 000 unregulated child-care centers served between 4 million and 5.1 million children; 118 000 regulated child-care centers served 700 000 children; and 685 000 to 1.2 million nonregulated homes cared for 3.4 million children.2,3 However, access to child-care services is still limited. Fewer than 10% of centers have vacancies for infants, and parents spend 5 weeks on average to locate child-care services for their children.
With these striking changes in demand and supply and with continued shortages, it is remarkable that the cost of child care and the salaries of teachers have remained constant during the last 15 years. The average yearly salary for teachers was $11 500 in 1990.2 Although low teacher salaries subsidize the cost of child care, the average annual cost of child care is $3150, or 10% of average family income.1 For lower-income families (incomes under $15 000), this expense represents as much as 23% of their family income.
These low salaries for child-care-center teachers surely influence the quality of services. Annually, 25% of child-care-teachers turn over, and the rate of turnover is 50% in half the centers in the country.2
A Comparison of Child Day-Care Settings in Four Countries
Authors: Malkki Rita M. , Chen Jianhua , Honegger Danielle , Simonnet Catharine , Kushnir Talma , Soto Julio 
Published: December 2021

A surprisingly wide variety of child day-care systems exist throughout the world, and each system has its own particular purposes, benefits, and drawbacks. In some countries, child day care is viewed as an integral part of the public education process; in others it serves primarily to provide working parents a safe haven for their children during work hours. The issue of health and health care in the day-care setting is also viewed in a number of ways, from the Chinese view that health care should be built into the daily routine of child day care to the American approach of placing that responsibility primarily on the parent. This paper explores the day-care settings found in four countries.
Both child care and health services are determined by a number of different influences in the cultural, social, and historical background of a given country. The economic situation and overall societal values combine to produce a child day-care system that at least attempts to respond to the needs of the majority of that society. Furthermore, the economic trends of the last two decades have had an even greater impact on day care than could have been imagined at the outset. Even in countries where the extended family is still a strong force in the care and rearing of children, the need for additional assistance has increased. A look at the systems in China, Israel, France, and Canada will identify a range of approaches to dealing with this issue.
Child day care is largely a public undertaking in most countries, often with a smaller, private system operating independently under government regulations.
Desmopressin Tablets in the Treatment of Severe Nocturnal Enuresis in Adolescents
Authors: Stenberg Arne , Läckgren Göran 
Published: December 2021

Background. In recent years the treatment of primary nocturnal enuresis (PNE) with desmopressin (DDAVP) has been promising. The route of administration until now had been intranasal, but because the tablets were introduced for the treatment of diabetes insipidus they have also become available for the treatment of PNE.
Objectives. To find the optimal dosage of desmopressin tablets and to compare desmopressin's efficacy with placebo in a group of adolescents with severe monosymptomatic enuresis. The long-term safety of desmopressin was also studied in the same group of patients.
Methods. The effect of oral desmopressin (1-deamino-8-D-arginine-vasopressin) (DDAVP® tablets, Minirin®) was investigated in 25 adolescents (ages 11 to 21 years) with severe monosymptomatic nocturnal enuresis. The first part of the dose-ranging study comprised a single-blind dose titration period, followed by a double-blind, crossover efficacy period comparing desmopressin with placebo. The final part was an open long-term study consisting of two 12-week treatment periods. The efficacy of the drug was measured in reductions of the number of wet nights per week.
Results. During the first dose-titration period, the majority of the patients were given desmopressin 400 µg, and the number of wet nights decreased from a mean of 4.9 to 2.8. During the double-blind period, a significant reduction of wet nights was observed (1.8 vs 4.1 for placebo). During the two long-term periods, 48% and 53% of the patients could be classified as responders (0 to 1 wet night per week) and 22% and 23.5% as intermediate responders (2 to 3 wet nights per week). No weight gain was observed due to water retention. After cessation of the drug, 44% of the patients had a significant decrease in the number of wet nights.
Conclusions. Oral desmopressin has a clinically significant effect on patients with PNE, and therapy is safe when administered as long-term treatment.
Evidence in Infants With Cleft Palate That Breast Milk Protects Against Otitis Media
Authors: Paradise Jack L. , Elster Barbara A. , Tan Lingshi 
Published: December 2021

Objective. Most infants with cleft palate suckle unproductively and require feeding by artificial means. Most also have unremitting otitis media accompanied by (usually) nonpurulent middle-ear effusion, a complication generally attributed to impaired eustachian tube ventilatory function. We observed two infants with cleft palate in whom one or both ears appeared effusionfree on more than one occasion, and who also were receiving or previously had received breast milk feedings. This prompted us to analyze the relation between middle-ear status and feeding mode in a large series of infants with cleft palate. Our objective was to determine whether in these infants the receipt of breast milk mitigated the otherwise virtually invariable development and continued presence of otitis media.
Methods. We reviewed and analyzed data concerning both feeding mode and the presence or absence of middle-ear effusion in 315 infants with cleft palate, as recorded systematically in the course of prospective studies at our Cleft Palate-Craniofacial Center. Analysis was limited to periods preceding the infants' receipt of tympanostomy-tube placement or palate repair, or their second birthday, whichever occurred first.
Results. Freedom from effusion in one or both ears was found at one or more visits in only seven (2.7%) of 261 infants fed cow's milk or soy formula exclusively, but in 17 (32%) of 54 infants fed breast milk exclusively or in part for varying periods (P &lt; .0001). In virtually all instances, the breast milk had been harvested by the mother and fed to the infant via an artificial feeder. Baseline clinical and sociodemographic characteristics and surveillance in the two groups of infants were comparable.
Conclusions. Artificially fed breast milk provides variable protection against the development of otitis media in infants with cleft palate. This finding supports the likelihood of a similarly protective effect of breast milk in noncleft infants. The finding also suggests strongly that in infants with cleft palate, impaired eustachian tube function is not the only pathogenetic factor in the infants' initial development of middle-ear effusion.
Letter to the Editor
Authors: Raffin Michael J. M. , Matz Gregory J. 
Published: December 2021

We thank Bess and Paradise, (1994)1 for bringing attention to some relevant issues related to universal newborn hearing screening. We note that their assertion that the effects of mild or moderate temporary hearing loss are "entirely speculative and perhaps nonexistent" may be somewhat overstated (see, for example, Teele, Klein, Chase, Menyuk, Rosner and associates, 1990).2
The assertion that click-evoked auditory brainstem response (ABR) may be used "... primarily to detect high-frequency hearing loss" is not warranted and misleading.
Letter to the Editor
Authors: Richmond Virginia L. 
Published: December 2021

The article by Jacobs et al1 regarding treatment of acute childhood diarrhea with homeopathic medicine as an adjunct to the World Health Organization Oral Rehydration Solution (ORS) omits some essential measurements needed for comparison with previous literature reports and pertinent references from the last 15 years.
The authors ignored the whole body of literature on rice- or cereal-based ORS (CB-ORS) that dealt with much larger patient samples and more precise measurements.2 These reports empha-sized the variability of results depending on the previous nutritional status of the child and whether adequate, nutritious diets were actually given the child on early refeeding.3
Sexuality, Contraception, and the Media
Authors:   Committee on Communications
Published: December 2021

The age at which American adolescents first experience sexual intercourse continues to decline. Approximately half of all American females and two-thirds of all males have experienced coitus by 17 years of age.1,2 For those who begin having intercourse before age 18, 45% of females report having had four or more partners,3 and males report having had an average of five partners.2 Most adolescent females report that their first experience was unplanned.4 More than 85% have first coitus before seeking professional advice about preventing pregnancy or sexually transmitted diseases (STDs). The earlier the first coitus, the longer the interval until such advice is sought.
There are a number of consequences of unprotected coitus including pregnancy, often unwanted, and exposure to STDs that may adversely affect pregnancy outcome, damage the reproductive system, or even threaten life.5,6 An estimated 4% of students in grades nine through 12 have a history of a STD.3 The number of adolescents with acquired immunodeficiency syndrome (AIDS) has increased 77% since 1989.7 The 10-year latency period between infection with the human immunodeficiency virus (HIV) and development of symptoms suggests that many AIDS patients were probably infected as teenagers.5 For females, early intercourse, repeated infections, and multiple partners greatly increase the risk of cervical cancer and infertility.5 Although the use of contraception, especially condoms, can prevent many of these conditions, teenagers do not use contraceptives effectively.3
The 1985 Guttmacher Report found that despite levels of sexual activity comparable to their European counterparts, the teenage pregnancy rate in the United States was two to five times higher than in other developed countries.8
The Hazards of Child Labor
Authors:   Committee on Environmental Health
Published: December 2021

This Policy Statement was retired January 2005.
Child labor is the paid employment of children under 18 years of age. Today, more than 4 million children and adolescents in the United States are legally employed.1
Illegal child labor is also widespread and apparently has increased in frequency over the past decade. An estimated 1 to 2 million American children and adolescents are employed under unlawful, often exploitative conditions—working under age, for long hours, at less than minimum wage, on dangerous, prohibited machinery. Widespread employment of children in sweatshops—establishments that repeatedly violate fair labor as well as occupational health and safety standards—has been documented.2,3 Tens of thousands of children are employed in illegal farm labor. Detected violations of child labor laws increased fourfold from 1983 to 1989.4
LEGAL CONTEXT
Since 1938, child labor in the United States has been regulated under the federal Fair Labor Standards Act (FLSA).5 Under this Act, employment in any hazardous nonagricultural occupation is prohibited for all children less than 18 years old. No child under 18 may work in mining, logging, construction, on a motor vehicle, or with power-driven machinery. The Act imposes additional restrictions on the employment of children under age 16 and sets limits on the number of hours a child may work on school days (no more than 3 hours per day for 14- and 15-year-olds). In agriculture, where legal restrictions are much less stringent, work with power-driven equipment and hazardous pesticides is prohibited only until age 16, and all work on family farms is exempt from legal protection. Work permits are a central aspect of the administration of FLSA.
Surfactant Replacement in Neonates With Early Chronic Lung Disease
Authors: Pandit Paresh B. , Dunn Michael S. , Kelly Edmond N. , Perlman Max 
Published: December 2021

Objective. To study the effect of a single dose of exogenous bovine surfactant on oxygen and ventilatory requirements of neonates with early chronic lung disease.
Study design. Prospective pilot study.
Setting. Three regional neonatal intensive care units.
Methods. Infants 7 to 30 days old with birth weights less than 1500 g were eligible if they required a fraction of inspired oxygen (FIO2) of more than 0.4, had stable ventilatory requirements for 24 hours before study entry, and showed diffuse haziness on chest radiographs. Those with patent ductus arteriosus or active infection or those receiving steroid therapy were excluded. After treatment with the surfactant, differences in FIO2 and the ventilator efficiency index were analyzed using the Wilcoxon signed rank test.
Results. Ten patients were recruited. Median values (range): birth weight, 693 g (530 to 1100 g); gestation, 25 weeks (24 to 27 weeks); and postnatal age at study entry, 13 days (9 to 30 days). The FIO2 decreased significantly between 0 and 1 hour after surfactant administration, from a median (range) of 0.67 (0.47 to 0.88) to 0.39 (0.28 to 0.63). This effect was sustained for 24 hours (median FIO2, 0.36). Although the FIO2 subsequently increased to 0.49 (range, 0.35 to 0.88) at 72 hours, it was significantly lower than that entry before the study. There was a trend toward an increase in the ventilator efficiency index at 24 and 48 hours.
Conclusions. A single dose of surfactant is effective in reducing oxygen requirements in neonates with early chronic lung disease. Surfactant replacement may be useful adjunctive therapy in these neonates.
Good Nutrition is the Issue
Authors: Kretchmer Norman 
Published: December 2021

House Resolution (HR) 999 is the stimulus for this commentary. HR 999 would give block grants to states to provide nutritional assistance to economically disadvantaged individuals and families. As a result of this proposal, fifty different nutritional programs will emerge. It is stated within the bill that each state will be permitted maximum flexibility. Chaos will ensue if each state makes its own criteria for nutrition, and each state will probably re-invent the wheel.
Finances aside for the moment, the issue is good nutrition for the country's children, regardless of the economic status of the individual. Nutritional requirements for children cannot be influenced by the individual preferences or prejudices of each state.