bluuebunny/crossref_metadata_2025_split huggingface dataset:
Turner Syndrome and Osteoporosis: Mechanisms and Prognosis
Authors: Rubin Karen 
Published: December 2021

Despite only limited reports of a greater number of fractures during childhood or adulthood, osteoporosis historically has been described as a feature in Turner syndrome, because of the frequent observation of radiographic osteopenia and the coarse trabecular pattern of the carpal bones on radiographs. The pathogenesis of the skeletal demineralization remains unclear, but the data support the concept of an intrinsic bone defect that is then exacerbated by a number of hormonal factors, including the growth-regulating hormones, the gonadal steroids, and possibly the calcium-regulating hormones. The advent of more refined methods, such as single- and dual-photon absorptiometry and dual energy x-ray absorptiometry, has led to improved insights into bone mineral density (BMD) status in Turner syndrome (TS). A major limitation of these projection methods is that they report areal and not true volumetric BMD, resulting in an underestimation of the true BMD in smaller subjects. In assessing BMD in TS, various methods have been used to eliminate the confounding effect of bone size. Some consistent patterns do emerge in persons with TS who are not treated with long-term growth hormone (GH) or estrogen therapy. A significant deficit in cortical bone commonly appears in childhood and usually is associated with a low bone-turnover state. Significant osteopenia at predominantly trabecular sites develops during mid- to late adolescence and persists into adulthood, when it is associated with increased bone turnover.Preliminary BMD data on patients after long-term GH therapy show an absence of osteopenia. With respect to the impact of long-term estrogen therapy, the BMD deficit in adults with TS who have been treated adequately with estrogen, but who have not been treated with GH, is less than it is in those who have been insufficiently treated or not treated at all with estrogen. The available data indicate that long-term GH treatment during the prepubertal and early to midpubertal years optimizes BMD and improves the prognosis for adequate peak bone mass being achieved after a puberty that, most often, has been induced with exogenous estrogen. Long-term treatment with estrogen and progestin that is initiated during mid- to late adolescence and is continued throughout adulthood appears necessary for a normal peak bone mass to be achieved and the BMD to be preserved well beyond the time of peak bone mass.Additional measures to prevent osteoporosis must be used, such as ensuring adequate calcium intake and ample weight-bearing activities, focusing on preventing injuries and avoiding overtreatment with thyroid hormones. Long-term surveillance with measurement of BMD and of bone turnover in a large TS population into their later adult years is necessary before it can be concluded that the osteopenia observed in TS is a nonprogressive asymptomatic bone defect of no clinical consequences.
The Psychological Consequences of Turner Syndrome and Review of the National Cooperative Growth Study Psychological Substudy
Authors: Siegel Patricia T. , Clopper Richard , Stabler Brian 
Published: December 2021

Objective. To present longitudinal data on the psychological profile of a cohort of girls with and without Turner syndrome (TS) treated for 3 years with growth hormone (GH).
Methods. Among a sample of 283 children with short stature, 37 girls with TS were recruited at 27 US medical centers. Of the original cohort, 22 girls with TS, 13 girls with isolated growth hormone deficiency (GHD), and 12 girls with idiopathic short stature were followed through 3 years of GH therapy. All were school-age, were below the 3rd percentile for height, had low growth rates, and were naive to GH therapy. Psychological tests (the Wide Range Achievement Test and the Slosson Intelligence Test) were administered to the clinical groups within 24 hours of their first GH injection and yearly thereafter. Control subjects were 25 girls with normal stature matched for age and socioeconomic status, who were tested only at baseline. One parent of each subject also completed the Child Behavior Checklist for that subject.
Results. At baseline, the clinical groups had more internalizing behavioral problems, had fewer friends, and participated in fewer activities than did the control subjects. The groups did not differ in mean IQ or academic achievement, but the TS group did have more problems in mathematics achievement. Height and growth rate significantly increased in the clinical groups over the 3 years of GH therapy, but IQ and achievement scores did not. Significant linear reductions were noted in both Internalizing and Externalizing Behavior Problems after GH treatment, with the TS group having fewer behavior problems before and after GH treatment than did the GHD–idiopathic short stature group. Decreases in specific Child Behavior Checklist subscales, including attention, social problems, and withdrawal, also were seen in the clinical groups after GH therapy.
Conclusions. The comprehensive treatment of girls with TS should include educational and behavioral interventions in addition to traditional medical therapies.
Health Care Costs of Formula-feeding in the First Year of Life
Authors: Ball Thomas M. , Wright Anne L. 
Published: December 2021

Objective.To determine the excess cost of health care services for three illnesses in formula-fed infants in the first year of life, after adjusting for potential confounders.Methods.Frequency of health service utilization for three illnesses (lower respiratory tract illnesses, otitis media, and gastrointestinal illness) in the first year of life was assessed in relation to duration of exclusive breastfeeding in the Tucson Children's Respiratory Study (n = 944) and the Dundee Community Study (Scottish study, n = 644). Infants in both studies were healthy at birth and represented nonselected, population-based samples. Children were classified as never breastfed, partially breastfed, or exclusively breastfed, based on their feeding status during the first 3 months of life. Frequency of office visits and hospitalizations for the three illnesses was adjusted for maternal education and maternal smoking, using analysis of variance. Cost estimates, from the perspective of the health care provider/payer, were based on the direct medical costs during 1995 within a large managed care health care system.Results.In the first year of life, after adjusting for confounders, there were 2033 excess office visits, 212 excess days of hospitalization, and 609 excess prescriptions for these three illnesses per 1000 never-breastfed infants compared with 1000 infants exclusively breastfed for at least 3 months. These additional health care services cost the managed care health system between $331 and $475 per never-breastfed infant during the first year of life.Conclusions.In addition to having more illnesses, formula-fed infants cost the health care system money. Health care plans will likely realize substantial savings, as well as providing improved care, by supporting and promoting exclusive breastfeeding.
Screening, Early Identification, and Office-based Intervention With Children and Youth Living in Substance-abusing Families
Authors: Werner Mark J. , Joffe Alain , Graham Antonnette V. 
Published: December 2021

All health care professionals with clinical responsibility for the care of children and adolescents must be able to recognize, as early as possible, associated health problems or concerns in children of substance-abusing parents, and to be able to assist these children and families in seeking treatment and promoting health. Health care providers can have a tremendous influence on families of substance-abusing parents because of their understanding of family dynamics and their close long-standing relationship with the family. Information about family alcohol and other drug use should be obtained as part of routine history-taking and when there are indications of family dysfunction, child behavior or emotional problems, school difficulties, and recurring episodes of apparent accidental trauma, and in the setting of recurrent or multiple vague somatic complaints by the child or adolescent. In many instances, family problems with alcohol or drug use are not blatant; rather, their identification requires a deliberate and skilled screening effort.Combining the principles of anticipatory guidance, screening, and early identification, with the acknowledgment that families should be included in the process, leads to a clear conclusion that screening for children affected by parental substance abuse must occur at all ages across infancy, childhood, and adolescence. Health care providers need to be trained in the identification and management of children and youth exposed to parental addiction. Such training must begin during undergraduate education in the health professions and be reinforced by role-modeling among health professions faculty as well as practicing providers.
Prevention and Intervention Strategies With Children of Alcoholics
Authors: Emshoff James G. , Price Ann W. 
Published: December 2021

Objective.
This article was designed to give pediatricians a basic knowledge of the needs of children who live in families with alcoholism. It briefly presents issues involved in the identification and screening of such individuals and provides primary attention to a variety of preventive and treatment strategies that have been used with school children of alcoholics (COAs), along with evidence of their effectiveness.

Methodology.
A literature search including both published and unpublished descriptions and evaluations of interventions with COAs.

Results.
The scope and nature of the problems of growing up in an alcoholic home are presented. The risk and protective factors associated with this population have been used as a foundation for preventive and treatment interventions. The most common modality of prevention and intervention programs is the short-term small group format. Programs for COAs should include the basic components of information, problem- and emotion-focused coping skills, and social and emotional support. Physicians are in a unique position to identify and provide basic services and referrals for COAs. School settings are the most common intervention sites, but family and broad-based community programs also have shown promise in alcohol and other drug prevention.

Conclusions.
Several COA interventions have demonstrated positive results with respect to a variety of measures including knowledge of program content, social support, coping skills, and emotional functioning. Rigorous studies are needed to understand better the complex ways children deal with parental alcoholism. A need remains for empirically sound evaluations and for the delineation of research findings.
Consideration of the Use of Health Status, Functional Outcome, and Quality-of-Life to Monitor Neonatal Intensive Care Practice
Authors: Hack Maureen 
Published: December 2021

Measures of health status, functional abilities, and quality-of-life are being used increasingly to evaluate health care practice, and to measure outcomes from the patient's perspective. There is thus a need to reassess the use of growth and neurodevelopmental status that have traditionally been used as measures of outcome after neonatal intensive care.The quality of neonatal intensive care constitutes only one factor among many that determine the functional health and quality-of-life of survivors of neonatal intensive care. These include genetic disposition, intrauterine events, the effects of sociodemographic factors on the health and development of the child, and on the parents' assessment of their child's functioning. To obtain health status, functional and quality-of-life measures, parents need to act as proxy for the child during infancy and childhood. The parents' cultural, social, and educational background and the specific experience of the parent with children may influence their responses. Furthermore, their perspective may differ from that of the child.Measures that have been used or have the potential to measure health status, functioning, and quality-of-life include the National Health Interview Survey, the National Health Insurance Study, the Functional Status II, the Multi-Attribute Health System, the Functional Independence Measure for Children, the Vineland Adaptive Behavior Scales, the Adolescent Child Health and Illness Profile, and the Child Health Questionnaire for children, infants, and toddlers. Knowledge of the validity of the use of these measures among survivors of neonatal intensive care is, however, sparse.Studies have shown that the collection of a standard core of data from various national sources with specific criteria for defining severe disability at 2 years of age is feasible in Great Britain. However, questionnaires or available national databases provide global and epidemiologic information on outcomes rather than identifying the specific pathogenesis or rates of impairments.To determine the possible deleterious effects of new therapies, specific diseases or impairments will need to be identified rather than the global effect on functioning or health related quality-of-life. Examination of the proximal neonatal impairments that predispose to later disability, such as rates of periventricular hemorrhage or retinopathy of prematurity, are probably better measures for evaluating quality of neonatal care rather than distal impairments such as cerebral palsy, growth impairments, or reactive airway disease.The ultimate goal of neonatal intensive care is to provide survival without impairment. Objective measures of specific impairments and their residual disability are thus better measures of the quality of neonatal intensive care than subjective assessments of children and their families.
INTRODUCTION
Authors: SUCHYTA ROGER 
Published: December 2021

Dear Colleague:
The American Academy of Pediatrics Department of Committees and Sections are pleased to present this supplement to PEDIATRICS. This is the fourth supplement devoted entirely to abstracts of presentations given at the Academy's Annual Meeting. It contains a vast array of subspecialty information in a structured abstract format, which will be indexed in the journal and be retrievable through all of the document delivery systems that feature PEDIATRICS. It will also be available on the yearly CD ROM update of PEDIATRICS. In addition this publication will serve as a guide and timetable for the Academy's Section programs which will be offered at the AAP 1999 Annual Meeting to be held October 9-13 in Washington, DC. Please remember to bring this, your complimentary copy, to the meeting! A limited number of additional copies for your personal use or distribution to colleagues will be available at the meeting.
Sections are arranged alphabetically. A Section's educational schedule appears first, followed by the complete text of the abstracts. Abstracts are identified by a number that appears in the left column of the schedule; this same number will identify the expanded text. Abstracts are numbered consecutively within each Section. Please note that the Section on Allergy has elected to print their schedule only.
A great deal of time and effort has been volunteered by the Academy Section members to develop these programs and to write and coordinate the abstracts for this special supplement.
In particular, we would like to acknowledge the contributions of of Kathleen Ozmeral (editor); Larry Mahoney, MD (Cardiology); Andrew Spooner, MD (Computers and Other Technologies); Niranjan Kissoon, MD (Critical Care); Daniel Isaacman, MD (Emergency Medicine), Flaura Winston, MD (Injury and Poison Prevention); Robert Cady, MD (Orthopaedics); Bruce Maddem, MD (Otolaryngology); William Engle, MD (Perinatal Pediatrics); Max Langham, MD (Surgery); Thomas Abramo, MD (Transport Medicine); and Craig Peters, MD (Urology).
I believe that we have planned a full schedule of informative and educational Section activities at the Annual Meeting and hope that this abstract compendium/program guide will be useful to all attendees. As always, Section programs are open to all registrants, and you should feel free to move from one section meeting to another as topics of interest to you are presented throughout each day.
Our sponsor for this project, Pasteur Merieux Connaught, concurs with the Academy that the continuing education of our members and allied health colleagues is of paramount importance. We appreciate the company's support in helping to bring this project to AAP members and PEDIATRICS subscribers. The abstracts will also be available on computer disk at the Annual Meeting at the Pasteur Merieux Connaught exhibit booth (Booth #809).
We look forward to seeing you in Washington DC.
Impact of an Encounter-Based Prompting System on Resident Vaccine Administration Performance and Immunization Knowledge
Authors: Shaw Judith S. , Samuels Ronald C. , Larusso Elizabeth M. , Bernstein Henry H. 
Published: December 2021

Objectives.To evaluate an encounter-based immunization prompting system on resident performance in administering vaccines and knowledge of immunization guidelines.Design/Methods.Prospective randomized, controlled trial. Subjects were first- and second-year pediatric residents in a hospital-based continuity clinic. The intervention group received manual prompts of immunizations due. Postclinic chart review compared immunizations due with those administered. Acceptable and unacceptable reasons for not administering vaccines were assigned. Resident knowledge was measured by a 70-item examination.Results.The intervention group had significantly less missed opportunities/vaccine administration errors (11.4% vs 21.6%). The most common reason for unacceptable errors in the intervention group: vaccine was given too early; in the control group: vaccine was postponed to next visit. Pre- and postintervention knowledge scores were similar: intervention group (75.5% vs 80.7%, control group; 76.5% vs 81.3%).Conclusion.An immunization prompting system in a hospital-based pediatric resident continuity clinic reduced missed opportunities/vaccine administration errors without significantly impacting resident knowledge of immunization guidelines.immunization schedule, vaccination, immunization, prompting systems, resident education.
ALYMPHOCYTOSIS
Authors: DONOHUE W. L. 
Published: December 2021

This study describes an unusual fatal disease in a child, which was characterized by fever, hepatomegaly, splenomegaly and a leucopenia in which the striking feature was a lymphocytopenia.
Postmortem examination revealed a widespread "idiopathic" atrophy and necrosis of the lymphoid tissue. An associated finding was an extensive monilia infection of the oesophagus.
SHOE-FITTING FLUOROSCOPES
Authors: WHEATLEY GEORGE M. 
Published: December 2021

THE dangers of radiation have been recognized for many years. Even experienced physicians use x-ray equipment with extreme care and only when benefits from diagnosis and treatment can be expected to outweigh possible harm.
It is not surprising, therefore, that roentgenologists and public health departments have become increasingly disturbed over the use of x-ray shoe-fitting machines in retail shoe stores. The New York State Department of Health and the New York City Department of Health have recently altered the Sanitary Code in order to regulate the use of fluoroscopes in shoe stores.
THE PEDIATRICIAN AND THE SPECIES: SOME IMPLICATIONS OF OUR ACHIEVEMENTS
Authors: Zuelzer Wolf W. 
Published: December 2021

I am deeply grateful to Dean Smart, Professor Court, Dr. Walker, and the other members of the Department of Child Health for the honor of this invitation,* but I cannot help wondering whether I would have had the courage to accept it if I had known beforehand what the Jacobson Lecture entails. It is one thing to address a gathering of professional colleagues on some innocuous subject of a strictly technical nature, but an altogether different thing to face members of every faculty of this University with a talk supposed to be of general interest. The physician is rarely called upon to leave the comfortable regions of shop talk for the wide open spaces of public debate, nor, broadly speaking, is he eager to venture into such dangerous territory where he might be blown about by the winds of controversy.
PROFESSIONAL INSULARITY
The reasons for this reticence are not hard to find. For one thing, we don't like being contradicted, least of all by laymen. Regrettably, the aura of mystery which from time immemorial has served us as a protective cloak has been dispelled by an enlightened public, and our social prestige has suffered somewhat from the levelling forces of the democratic age. Still, the doctor remains the arbiter of life and death and as such speaks with the voice of authority. His experience at the bedside and in his office conditions him to expect acquiescence, and he is prone to transfer this expectation from his patients to the public at large and to be surprised and hurt when it is disappointed.
PULMONARY ATRESIA WITH INTACT VENTRICULAR SEPTUM: REPORT OF 50 CASES
Authors: Shams Ali , Fowler R. S. , Trusler G. A. , Keith J. D. , Mustard W. T. 
Published: December 2021

Fifty cases of pulmonary atresia with intact ventricular septum were reviewed. The patients were divided into two groups depending on the size of the right ventricle. Clinical, roentgenographic, and electrocardiographic findings in each group are discussed. The most reliable method for determining the size of the right ventricle is selective angiography with injection of dye into the right ventricle.
Up until 1967, with or without having surgery, patients of both groups died. Since then emergency cardiac catheterization and balloon septostomy followed by operative creation of a Potts' anastomosis and ligation of patent ductus arteriosus has improved results in patients with a small right ventricle.
DIETARY PAMPERING OF ENGLISH CHILDREN IN 1754 AND THE PHYSICIAN'S MALEVOLENT ROLE IN CHILD HEALTH, ACCORDING TO THE HONORABLE MRS. SEYMOUR
Authors: C. T. E. 
Published: December 2021

Mothers in the past were no less interested in books about child care than are today's mothers. Any collector of books of this genre will soon find his bookshelves completely filled with eighteenth and nineteenth century items.
The most striking characteristic of these earlier predecessors of Doctors Spock and Gesell was their emphasis on the connection between daily tactics and moral strategy; practical advice was never given without constant doses of moral lessons as the excerpt below will prove:
In England there is one general Method of spoiling Children; it is by foolish Indulgencies. The Observation is a very common one; but those who make it do not know half its Force: It is not only that by these Indulgencies we make them peevish and tyranical (sic); though this were enough: we lay the Foundation of Ill Health, and bad Habits; and by that single Fault of pampering them in their Diet, we entail upon them Diseases, and we rob them of that Chearfulness (sic) of Disposition which is so amiable and so agreeable; for it depends, as already said, on Health.
If we look into the Generality of Families in which there are Children we shall find them eating ten Times a-day, and drinking all Day long. At their regular meals they eat what is improper. There are some few, who, to avoid this, run into the contrary Extreme, while the rest feed them immoderately, they starve them. One sees the first of these Faults universal; the other is met withal among some few Families of Quality.