bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Behavioral and Emotional Well-Being of School-age Children With Different Birth Weights
Authors: McCormick Marie C. , Workman-Daniels Kathryn , Brooks-Gunn Jeanne 
Published: December 2021

Objective. To describe the mental and emotional well-being of children born at different birth weights assessed at school age and to identify neonatal, intervening health, and sociodemographic and environmental factors associated with mental and emotional well-being.
Methods. To address this issue, we used a prospective cohort study involving two previously studied cohorts, which were recontacted at 8 to 10 years of age to provide a multisite sample of 247 children weighing 1000 g or less at birth, 364 weighing 1001 to 1500 g, 724 weighing 1501 to 2500 g, and 533 weighing more than 2500 g. Maternal reports were obtained on three standardized measures of mental and emotional well-being (the Rand General Well-being Scale, the Behavior Problem Index, and the Harter Scale of Child Competence) and on intervening health, sociodemographic, and environmental variables. Neonatal variables were derived from records at birth. Statistical techniques included analysis of variance and ordinary least squares multiple regression.
Results. Lower birth weight children did not differ on the General Well-being Scale but were more likely to have behavior problems and to be considered less competent. Other important correlates of mental and emomotional well-being included childhood illness, maternal mental health, home environment score, and exposure to household cigarette smoking.
Conclusion. Although lower birth weight children have poorer mental and emotional well-being, a substantial portion of this adverse outcome reflects modifiable environmental factors.
Surfactant Replacement Therapy for Meconium Aspiration Syndrome
Authors: Findlay Richard D. , Taeusch H. William , Walther Frans J. 
Published: December 2021

Objective. The pathophysiology of meconium aspiration syndrome (MAS) is related not only to mechanical obstruction of the airways and chemical injury to the respiratory epithelium but also to surfactant inactivation by meconium. A randomized, controlled study was performed to determine whether high-dose surfactant therapy improves the pulmonary morbidity of term infants ventilated for MAS.
Methods. Forty term infants receiving mechanical ventilation for MAS were enrolled in this trial, in which the infants in the study group (n = 20) received up to four doses of 150 mg (6 mL)/kg beractant (Survanta), instilled every 6 hours by continuous infusion for 20 minutes via a side hole endotracheal tube adapter, and the infants in the control group (n = 20) received 6 mL/kg air placebo.
Results. Mean arterial-to-alveolar Po2 ratio values increased from 0.09 to 0.11 at 1 and 6 hours with a concomitant slight decrease in oxygenation index values from 23.7 to 19.7 at 1 hour and 20.7 at 6 hours after the first dose of surfactant. Oxygenation improved cumulatively after the second and third dose of surfactant, with mean arterial-to-alveolar Po2 ratios and oxygenation indices of 0.18 and 12.1 at 6 hours after the second dose of surfactant and 0.31 and 5.9 at 6 hours after the third dose of surfactant, eliminating the need for a fourth dose in any infant in the study group. After three doses of surfactant, persistent pulmonary hypertension had resolved in all but one of the infants in the study group versus none of the infants in the control group. No air leaks developed in any of the 20 infants in the study group after surfactant therapy, and only 1 infant required extracorporeal membrane oxygenation. Air leaks developed in 5 of the 20 infants in the control group, and 6 underwent extracorporeal poreal membrane oxygenation. The duration of mechanical ventilation, oxygen therapy, and admission was significantly shorter in the surfactant group than in the control group.
Conclusion. Surfactant replacement therapy, if started within 6 hours after birth, improves oxygenation and reduces the incidence of air leaks, severity of pulmonary morbidity, and hospitalization time of term infants with MAS.
COLLATERAL DAMAGE
Authors: Joffe Alain 
Published: December 2021

As the welfare-reform debate begins to boil, the place to begin is with an elemental fact: no child in America asked to be here.
Each was summoned into existence by the acts of adults. And no child is going to be spiritually improved by being collateral damage in a bombardment of severities targeted at adults who may or may not deserve more severe treatment from the welfare system.
Phil Gramm says welfare recipients are people "in the wagon" who ought to get out and "help the rest of us pull." Well. Of the 14 million people receiving Aid to Families with Dependent Children, 9 million are children. Even if we get all these free-riders into wee harnesses, the wagon will not move much faster.
Lead Poisoning Risk Determination in a Rural Setting
Authors: Schaffer Stanley J. , Kincaid Martha S. , Endres Nathan , Weitzman Michael 
Published: December 2021

Objectives. To determine the prevalence of elevated blood lead levels among children living in a rural area and to determine the effectiveness of the Centers for Disease Control and Prevention (CDC) Lead Risk Assessment Questionnaire and additional questionnaire items in correctly identifying rural children having elevated blood lead levels.
Research Design. Comparison of results of a questionnaire that is intended to identify children as being at low or high risk for lead poisoning with children's blood lead levels.
Setting. The three practice sites of the only pediatric group in a rural county of upstate New York.
Patients. A consecutive sample of 705 children ages 6 to 72 months who were seen for health supervision visits between June and September 1993.
Results. Sixty-nine percent of the children were considered to be at high risk for lead poisoning by the CDC questionnaire. Overall, 8.4% of the children in the study had blood lead levels of 10 µg/dL (0.48 µmol/L) or higher, and 2.1% had blood lead levels of 15 µg/dL (0.72 µmol/L) or higher. No significant difference was noted between the percentages of high-and low-risk children who had elevated blood lead levels. To devise a more effective lead risk assessment tool for children in this setting, the two items from the CDC questionnaire and the two additional items that had the greatest predictive utility were combined to form a short alternative questionnaire. The alternative questionnaire thus consisted of items concerning whether the child has a sibling or playmate with lead poisoning, whether the child lives near an industry that potentially may release lead, whether the child lives in rented or owner-occupied housing, and whether the child has a parent who is a migrant farm worker. Children categorized as high risk with the alternative questionnaire were much more likely to have elevated blood lead levels than those who were categorized as low risk. The alternative questionnaire was very effective in correctly identifying children with elevated blood lead levels. Eighty-eight percent of children having blood lead levels of 10 µg/dL or higher and 100% of children having blood lead levels of 15 µg/dL or higher were classified as high risk by the questionnaire. Children classified as low risk were very unlikely to have elevated blood lead levels; 98% of low-risk children had blood lead levels of less than 10 µg/dL, and 100% had blood lead levels of less than 15 µg/dL.
Conclusions. These results suggest that the CDC lead risk assessment questionnaire is of limited benefit in identifying rural children with blood lead levels 10 µg/dL or higher or 15 µg/dL or higher. An alternative questionnaire, however, seems to have marked clinical utility for identifying rural children with elevated blood lead levels.
Injuries to Children Related to Shopping Carts
Authors: Smith Gary A. , Dietrich Ann M. , Garcia C. Teresa , Shields Brenda J. 
Published: December 2021

Study Objective. To describe the epidemiology of shopping cart-related injuries among children and to consider targeted prevention strategies based on these epidemiologic findings.
Design. A consecutive series of patients.
Setting. The emergency department of a large, academic children's hospital.
Participants. Sixty-two children treated for shopping cart-related injuries during a 15-month period.
Results. Children ranged in age from 4 months to 10 years (mean, 2.8 years). Thirty-three children (53%) were boys. Twelve patients (19%) arrived via ambulance. Forty-nine children (79%) had injuries to the head, including one child admitted to the hospital. Eleven children (18%) had fractures, including 5 (8%) with skull fractures. Nine patients (14%) had lacerations, and 30 patients (48%) had superficial injuries (ecchymoses or abrasions). The most common mechanism of injury was falling out of the carts (58% of children), followed by cart tip-overs (26% of children). Injuries caused by falls from the carts occurred across the entire age range, whereas injuries caused by cart tip-overs were most frequent among children 1 year of age or younger. The sitting position was associated with tip-over injuries, and standing in the cart basket was associated with falling from the cart.
Conclusions. Shopping cart-related injuries cause serious pediatric morbidity, especially among children younger than 5 years of age, and are potentially fatal. Based on identified age-specific mechanisms of injury, currently used prevention strategies are not sufficient. The use of infant seats and restraining belts is an inadequate strategy for prevention of shopping cart-related injuries among children 1 year of age or younger, because cart tip-over is an important mechanism of injury in this age group. Shopping carts should be redesigned to decrease the tip-over hazard. Transportation of children in shopping carts of current design should be prohibited.
Bicycle Helmet Use Patterns Among Children
Authors: Rodgers Gregory B. 
Published: December 2021

Objective. To describe and evaluate the helmet use patterns of children younger than 15 years of age in the United States.
Methods. A national telephone survey of bicycle riders was conducted by means of the Mitofsky-Waksberg method of random-digit dialing, a survey method intended to give all telephone numbers in the continental United States an equal probability of selection. Based on information collected in the survey, a logistic regression model was used to determine and quantify the factors associated with helmet use.
Results. Information was collected on the bicycle and helmet use patterns of a national sample of 399 children younger than 15 years of age who rode bicycles during the year preceding the survey. This sample projects to the approximately 26.4 million children who are estimated to have ridden bicycles in 1991. About 26% of all child riders owned or had the use of bicycle helmets, and about 15% were reported to have used their helmets all or more than half of the time when riding. Information is provided on the reasons the children did or did not wear helmets. The logistic regression analysis shows that helmet use by children is systematically related to their personal characteristics (eg, age and whether they had previously had bicycle-related accidents requiring medical attention), riding patterns (eg, riding surface), and household demographic characteristics (eg, geographic location and whether household members had attended college).
Conclusions. Helmet use rates among children remain low. Less than one fifth of the children who rode bicycles wore helmets all or more than half of the time in 1991. However, based on comparisons with earlier studies, the results of the analysis suggest that helmet use rates have been rising.
"Mild" Varicella—Does It Protect?
Authors: JOSEPH PAUL R. 
Published: December 2021

I read "Recommendations for the Use of Live Attenuated Varicella Vaccine" by the Committee on Infectious Diseases, which appeared in the May 1995 issue of Pediatrics. The recommendations do not address the problem of children who have had very mild cases of varicella and whether or not they should be immunized with the varicella vaccine.
About 10 years ago I began to keep records of children who had had very mild cases of varicella (under 20 lesions).
The Delivery of Immunizations and Other Preventive Services in Private Practices
Authors: Bordley W. Clayton , Margolis Peter A. , Lannon Carole M. 
Published: December 2021

Objectives. To measure the proportion of children cared for in private pediatric practices who are fully immunized and have been screened for anemia, tuberculosis (TB), and lead poisoning by 2 years of age.
Design. Cross-sectional chart review.
Setting. Fifteen private pediatric practices in central North Carolina (11 chosen randomly).
Patients. One thousand thirty-two randomly selected 2-year-old children.
Main Outcome Measures. Proportion of children immunized and screened for anemia, TB, and lead poisoning by 24 months of age and immunization and screening rates of the practices.
Results. Sixty-one percent of the children were fully immunized at 24 months of age; the rates among practices varied widely (38% to 82%). Sixty-eight percent of the children had been screened for anemia, 57% had been screened for TB, and 3% had been screened for lead poisoning. Physicians overestimated the proportions of fully immunized children in their practices by an average of 10% (range, -3% to 17%). The median number of well child visits by 2 years of age was 5 (range, 0 to 14), and only 19% of the entire sample made 8 or more well child visits, the number recommended by the American Academy of Pediatrics in the first 18 months of life. The numbers of well child and non-well child visits were the strongest predictors of complete immunization. Practice characteristics associated with being fully immunized included the use of preventive services prompting sheets (eg, flow sheets) in the medical records, not seeing the same physician for all well child care, and having nurses review patients' immunization status during their visits to the office.
Conclusions. Underimmunization and inadequate screening are significant problems in private pediatric practices in North Carolina. Physicians are unaware of the rates of underimmunization in their offices.
Informing Subjects of Epidemiologic Study Results
Authors: Bunin Greta R. , Kazak Anne E. , Mitelman Olga 
Published: December 2021

Objective. To assess the feasibility and process of providing feedback to parents regarding the results of epidemiologic research, in particular to look at the importance and clarity of the information provided, parental reactions to the results, and utilization of the data provided.
Methodology. Parents who participated in an epidemiologic study of pediatric brain tumors (patient and control mothers) were sent a letter summarizing the results of the study and the Parent Study Results Survey to complete and return. The final sample used for analyses was 109 (patient) and 90 (control) mothers. Analyses were conducted to determine differences between patient and control mothers and differences among subsets defined by educational level and vital status of the patient.
Results. Mothers rated the importance and clarity of the information very highly, although patient mothers were more likely than control mothers to want more information and a telephone contact. Patient and control mothers were similar in reported sadness, anxiety, and being overwhelmed, but patient mothers felt less satisfied and relieved. Patient mothers expressed feeling more guilt and anger than control mothers, although even the levels among the patient mothers were only moderate. Close to half of all mothers commented on the inconclusiveness of the study results. Nearly all mothers indicated they would suggest that other parents participate in epidemiologic research.
Conclusions. It is valuable to many parents that they receive information about results of research in which they have participated. We found little evidence of strong negative effects to a detailed feedback letter. We recommend that evaluative data be used to guide the process of informing research participants about study results and that investigators consider making feedback letters a standard part of research protocols.
Timing of Elective Surgery on the Genitalia of Male Children With Particular Reference to the Risks, Benefits, and Psychological Effects of Surgery and Anesthesia
Authors:   Section on Urology
Published: December 2021

Technical considerations are no longer the major limiting factors in determining the timing for the surgery of undescended testes or hypospadias, because experienced pediatric urologic surgeons can perform these operations on young children safely and reliably. Important theoretical considerations suggest that early orchidopexy is preferable, particularly in minimizing the histologic injury that occurs with increasing age. There does not seem to be an increased risk when orchidopexy is performed in children 6 to 12 months of age, compared with the risk in older children, provided that it is performed by surgeons, nurses, and anesthesiologists with pediatric training and experience.
Emotional, cognitive, and body image development may be affected profoundly by both the genital deformity and the reconstructive surgery. These psychological factors are of considerable importance, in that a child's reaction to both the surgery and the anesthetic trauma varies dramatically with age. Postoperative behavioral problems such as aggressive or regressive behavior, night terrors, and anxiety may be more common at certain ages, particularly at 1 to 3 years of age. The period from 6 weeks to 15 months is a relatively good time for surgery from the viewpoint of emotional development, provided parentchild separation is minimized; this period has the additional advantage that the child's "defective status" within the family is not prolonged. The importance of the care giver's attitude toward the child may be of particular importance to the child's developing body image. Superimposed on all of these factors is the developing sexual identity of the individual, which again suggests that, in the absence of any other health factors, successful early genital surgery minimizes disturbances in the patient's psychological development.
The best time for surgery for hypospadias is between 6 and 12 months of age. Orchidopexy should be performed at or near 1 year of age. If the improved risk-to-benefit ratio for this early genital surgery is to be achieved, it is essential that children undergoing this surgery be cared for at facilities with experienced pediatric support personnel, particularly in the areas of anesthesia, urology, and nursing, who are sensitive to the special needs of children.
Committee Report: Population-to-Pediatrician Ratio Estimates: A Subject Review
Authors:   Committee on Careers and Opportunities
Published: December 2021

This statement is intended to assist pediatricians, health care administrators, and policymakers in evaluating an area's or a population's demand for pediatricians; it is not meant to recommend an ideal number of children per pediatrician based on need. This statement provides a variety of numbers to work with, ranging from low ratios, reflecting the number of children currently in the health care system that can be seen realistically by pediatricians (see Table), to high ratios, reflecting the current use of pediatricians by the entire population younger than 21 years of age (see the models of Miller et al8 and Hicks and Glenn6,7).
In applying the models, it is important to keep in mind the several previously discussed factors that affect the ratio of children per pediatrician. Other factors that also must be considered when examining ratios are differences in physician productivity that may vary according to gender, personal characteristics or lifestyles, and geographic location. In addition, local differences in demand for pediatric services will vary according to child health status and use of services. Finally, universal access to health care and/or managed care would increase the demand for pediatric services. Limitations in available data prevent the ability of the models to be used for subspecialty care or for outpatient care provided in hospitals.
There is currently a lack of information examining ratios, quality of care, and health outcomes. Studies linking these three issues are greatly needed. Also needed are studies that focus on the appropriate number of children per pediatric subspecialist.
Colic Is Pain
Authors: Rogers William B. 
Published: December 2021

In August 1993 and again in September 1994 Pediatrics featured articles on colic.1,2 Like most articles on this subject the only treatments discussed were behavioral management, distraction techniques, and reassurance.1-3 Primary care doctors are never told what to do when we get a call at 1 AM and are asked, "Doctor, my baby has been crying now for 2 hours and I can't get him to stop! What can I do?"
I will not believe that colicky crying is due to some vague disturbed parent-infant relationship that needs only counseling and reassurance.1-6
More Questions Than Answers
Authors: Raju Tonse N. K. 
Published: December 2021

Although the study by Goldstein et al1 that appeared in the February 1995 issue of Pediatrics is quite interesting, I am afraid that more questions remain unanswered in their article. I have a few concerns:
1) The authors do not provide data regarding the frequency of abnormal neurologic outcome, nor do they provide any paradigms based on sensitivity, specificity, and predictive values of the variables considered to "predict" neurologic outcome in their cohort. I think that this is a major weakness of the article, which makes one wonder whether there was any such predictive ability for the studied variables.
An Evaluation of Measles Revaccination Among School-entry-aged Children
Authors: Watson John C. , Pearson John A. , Markowitz Lauri E. , Baughman Andrew L. , Erdman Dean D. , Bellini William J. , Baron Roy C. , Fleming David W. 
Published: December 2021

Background. A two dose measles vaccination schedule is recommended routinely for all schoolentry-aged children. We evaluated this recommendation by determining both measles antibody seroprevalence and the response to revaccination in seronegative children in this age group.
Methods. Children 4 to 6 years of age who had received a single dose of measles vaccine between the ages of 15 to 17 months were tested for measles antibody by using an enzyme-linked immunosorbent assay (ELISA) microneutralization technique. Seronegative children were revaccinated and again tested for measles antibody (immunoglobulin M [IgM] and neutralizing).
Results. Of 679 children tested, 37 (5.4%) were seronegative. Seronegativity was not significantly associated with age, sex, race, age at initial vaccination, time since vaccinalion, or maternal year of birth. However, children of mothers with a college degree were 12 times more likely to be seronegative than children of mothers who never attended college (P&lt; .01). Of the 37 seronegative children, 36 seroconverted after revaccination—33 producing IgM measles antibody, suggestive of a primary immune response. The cost per seroconversion would have been an estimated $415 if all 679 children had been revaccinated.
Conclusions. Revaccination reduces the pool of children who are susceptible to measles. Although the cost per seroconversion is high, a two-dose schedule should reduce the substantial costs of controlling measles outbreaks by reducing the number of outbreaks.