bluuebunny/crossref_metadata_2025_split huggingface dataset:
CONTROLLED STUDY OF LINEAR GROWTH IN ASTHMATIC CHILDREN DURING TREATMENT WITH INHALED GLUCOCORTICOSTEROIDS
Authors: Randolph Christopher 
Published: December 2021

Purpose of the Study. To determine the impact of short term inhaled budesonide on linear growth in school children with mild asthma.
Study Population. Forty-three school children with mild asthma.
Methods. A randomized double blind parallel group study with three dose groups of 200, 400, and 800 µg of budesonide per day administered with a 750-mL spacer (Nebuhaler). Each group received budesonide for 8 consecutive weeks. Placebo was given 4 weeks before or after budesonide.
Findings. Compared with placebo, children treated with 800 µg of budesonide had a statistically significant lower leg growth velocity by 0.26 mm/week (P &lt; .0012; t = 5.0; df = 11; 95% confidence interval, 0.14 to 0.37 mm/week). There was no statistically significant difference in the growth velocity between 200 or 400 µg of budesonide treatments and placebo.
Reviewer's Comments. This study was conducted with knemometry, a method utilized in measuring the length of the lower leg with apparent high reproducibility and accuracy. Unfortunately, the correlation between growth of the lower leg and chronic growth is undear. Several steroid studies in the past have indicated that budesonide up to levels of 800 µg does not interfere with long term growth. Thus, the impact of the study is unclear at present. Clearly, a longer term study is necessary to determine the outcome of these children. Additionally, it would be important to see the impact of budesonide in chronic asthma with greater severity, which itself may interfere with growth.
YOUR DOCTOR IS NOT IN, BY JANE M. ORIENT
Authors: L. J. F. 
Published: December 2021

The government has signed a contract to pay $850,000 for development of "practice guidelines" and "protocols" to tell doctors how to treat an ear infection, a $20 problem. If the Clinton administration has its way, there will be protocols for the treatment of virtually every ailment. Yet there is no evidence that protocols save money or improve quality. Nurses, for instance, outperform protocols in deciding how to treat abdominal pain.
So why aren't doctors raising a cry of alarm? Many have been browbeaten into submission, or have discovered that it's easier to play the game than to buck the system. But also, a different type of person is entering medical practice these days. Although the evidence is largely anecdotal, Dr. Orient says that the best students are avoiding medical schools and the schools are lowering their standards. (In 1990, 16% of medical graduates flunked the national boards, compared with 9% in 1984.)
HOW THE CLINTON HEALTH PROPOSAL WAS CONCEIVED AND PROPAGATED
Authors: L. J. F. 
Published: December 2021

... The working groups contained more than 1000 participants, not 511, as claimed by the Task Force. Nearly half of the members were private citizens.
Large numbers worked for managed-care interests, most notably the Robert Wood Johnson Foundation and the Henry J. Kaiser Family Foundation. Both foundations have supported managed-care reform in several states. In addition, six members the White House passed off as Congressional staffers turned out to be Robert Wood Johnson fellows assigned to the staffs of four Democratic Senators; all were on the foundation's payroll.
Dozens of other private interests were represented in the working groups—Aetna, Prudential, Kaiser-Permanente, health czar Ira Magaziner's former consulting company Telesis, to name a few. Conspicuously absent were physicians in private practice.
The Task Force spent at least $4 million and possibly as much as $16 million on expenses, salaries, and consulting fees. In the charter it filed with the GSA in March 1993, the Task Force said expenses would total $100 000.
Scalding Water Temperatures
Authors: LUKEFAHR JAMES L. , EZEKIEL KALAVALLI 
Published: December 2021

Tap water scald burns are the most frequent cause of nonfatal burn injuries in United States children. Most of these burns occur in the home, and hot water heater thermostat settings below 60°C (140°F) significantly decrease the risk of such burns in young children. The American Academy of Pediatrics and other safety-promotion organizations recommend that thermostats be set at 49 to 53°C (120 to 130°F), and ordinances encouraging lower hot water temperatures exist in some localities.
We advise our pediatric colleagues that consumer products manufacturers do not always follow these recommendations in their published guidelines for product use. Specifically, we have found that four of five major manufacturers of automatic dishwasher detergent recommend hot water thermostat settings of 60°C or higher. (See Table.)
The Effects of Bundling on Infant Temperature
Authors: Grover Geeta , Berkowitz Carol D. , Thompson Marita , Berry Lynne , Seidel James , Lewis Roger J. 
Published: December 2021

Objective. To determine whether bundling elevates rectal and/or skin temperature of young infants.
Design. Randomized, prospective study stratified by age.
Setting. Clinical Studies Center at a teaching hospital in Los Angeles.
Patients. Sixty-four well, full-term infants (ages 11 to 95 days).
Interventions. Control infants (n = 28) were dressed in a disposable diaper and terry coveralls. Bundled infants (n = 36) were dressed as control infants, plus a cap, a receiving blanket, and a thermal blanket. All infants were monitored in an open crib (room temperature 72° to 75°F). Rectal and skin (anterior mid-lower leg) temperatures and infant states were measured at 5-minute intervals from time 0 to 60 minutes and at 62 and 65 minutes.
Results. The mean skin temperature of bundled infants increased by 2.67°C/hr; mean rectal temperature increased by 0.06°C/hr. The mean skin temperature of nonbundled infants increased by 1.5°C/hr; mean rectal temperature decreased by less than 0.01°C/hr. Comparing bundled infants to nonbundled controls, there was a significant rise in skin temperature (P = .0001) but not in rectal temperature (P &gt; .05, Wilcoxon rank sum test). The study had a power &gt; 98% to detect a rise of .5°C in rectal temperature over 60 minutes. The 95% confidence interval for the change in rectal temperature in bundled infants was -0.03 to + 0.15°C.
Conclusions. Bundling a healthy infant in a temperate external environment causes an increase in skin temperature, but not in rectal temperature. Elevated rectal temperatures should therefore, rarely if ever be attributed to bundling.
Surveillance for Transmission of Hepatitis B in Child Day Care
Authors: Foy Hjordis M. , Swenson Paul D. , Freitag-Koontz M. Jayne , Boase Janice , Tianji-Yu  , Alexander E. Russell 
Published: December 2021

Relatively little is known about the risk of transmission of hepatitis B virus (HBV) in day-care centers; the virus is primarily spread by blood and other body secretions. Gradual horizontal transmission of hepatitis B has been observed in homes for the mentally retarded.1-3 Horizontal spread in children appears to be of equal importance with vertical transmission in countries where hepatitis B is endemic.4 These infections, which usually are asymptomatic, may result in chronic carriage and may go undetected unless children are tested for hepatitis B markers. Studies in day-care centers in Okinawa, where HBV carriage is relatively common, suggest that transmission may occur in day-care centers.5 Case reports of HBV transmission in school or day-care settings in the US6 and Italy7 have been published.
Our study was undertaken to determine whether there is evidence of horizontal transmission of HBV infections in US day-care facilities. To evaluate this, we screened for the antibody to hepatitis B core antigen (anti-HBc), a marker which is seen both in those who have recovered from hepatitis B and those who are carriers.8 Capillary blood specimens, obtained by finger prick, were used. Children who tested positive had venous blood specimens drawn and their families were approached for consent to draw venous specimens also from the household members to evaluate if the infection may have originated in the family. The venous specimens were tested also for additional markers, especially for hepatitis B surface antigen (HBsAg), which is found during acute infection and in carriers, and antibody to HBsAg (anti-HBs) which develops after infection and immunization.
Child Care and Child Health: Use of Population Surveys
Authors: Cain Virginia S. 
Published: December 2021

While the health of children in the US has been a long-standing issue, concern has heightened as children are increasingly found in some type of child-care arrangement. Trends in a number of social forces in the US have resulted in more children spending greater amounts of time in the care of someone other than their parents. As children move out of the home into group-care settings such as day-care centers on preschools, they are in contact with many more children and the possibility of exposure to a variety of infectious diseases. Several studies have examined childhood disease within the context of center-based care.1-3 However, most preschool children are not in center-based care.4 A more general study of the health of children in child care requires an approach that provides data on children in a variety of child-care arrangements and covers a broader age range than that found in most day-care centers. This paper argues that the population-based sample-survey approach to the study of the health of children in child care provides the necessary breadth. However, there is a clear need for improving measurement of critical variables.
SOCIAL TRENDS
While researchers increasingly have become concerned with the child-care arrangements of children of nonemployed women, it is the revolution in women's labor-force participation that has driven the increase in use of child care in the last two decades. Among children under 6 years of age, the percentage with mothers in the labor force has increased from 29% in 1970 to 53% in 1990.5,6
The Pharmacokinetics of Injectable Allopurinol in Newborns With the Hypoplastic Left Heart Syndrome
Authors: McGaurn Susan Phillips , Clancy Robert R. , Davis Lisa E. , Krawczeniuk Motria M. , Murphy John D. , Jacobs Marshall L. , Norwood William I. 
Published: December 2021

Objective. The purpose of this investigation was to determine the pharmacokinetic disposition of intravenous allopurinol and its metabolite oxypurinol in neonates with the hypoplastic left heart syndrome (HLHS) and to evaluate the subsequent degree of xanthine oxidase inhibition using serum uric acid as a marker.
Methods. Pharmacokinetic data were evaluated in 12 stable preoperative neonates with HLHS after a single intravenous allopurinol administration of 5 mg/kg or 10 mg/kg. Pharmacokinetic parameters were determined for elimination half-life, clearance, volume of distribution, and mean residence time. Xanthine oxidase inhibition, measured by serum uric acid reduction, was also measured.
Results. Pharmacokinetic parameters revealed no statistically significant differences between a 5-mg/kg and 10-mg/kg dose of intravenous allopurinol on elimination half-life, clearance, volume of distribution, and mean residence time. Mean serum uric acid levels were significantly reduced from baseline by 39.99 and 42.94%, respectively, in the 5- and 10-mg/kg treatment groups.
Discussion. The enzyme xanthine oxidase plays a key biochemical role in the generation of toxic oxygen-derived free radicals during ischemia-reperfusion conditions. Allopurinol and its active metabolite oxypurinol inhibit xanthine oxidase, and significantly reduce the conversion of hypoxanthine to xanthine and xanthine to uric acid. Cell injury may be caused by toxic oxygen free radicals produced by ischemia-reperfusion injury such as could occur during the repair of HLHS under hypothermic total circulatory arrest. We hypothesize that allopurinol may provide protection from cellular injury in this clinical context.
Pediatric Firearm Injuries, Kansas City, 1992: A Population-Based Study
Authors: Dowd M. Denise , Knapp Jane F. , Fitzmaurice Laura S. 
Published: December 2021

Objective. To determine the morbidity, mortality, and epidemiologic features of pediatric powder-firearm injuries in a defined urban population.
Design and setting. A population-based, descriptive epidemiologic study was conducted of firearm injuries to children in a mid-size urban community (total population: 435 178) in 1992. The population was 56% white and 39% black. Data from prehospital care providers, all city and adjacent community hospitals, and medical examiner and police records were searched for cases of firearm injury. The 1990 United States census provided denominator data.
Case definition. Subjects were all 0- to 16-year-old residents of Kansas City, Missouri who sought medical treatment at a hospital for a powder-firearm injury or who presented to the medical examiner with a fatal firearm injury in calendar year 1992.
Results. Seventy-two children met the case definition, for an incidence of 70 per 100 000 persons per year. There were 12 (16.7%) fatalities, for a mortality rate of 11.7 per 100 000 persons per year. Almost 10% of the patients sustained permanent disability. Mean and median ages of the patients were 14.9 years and 15.8 years, respectively; 79% were male and 82% were black. The majority of the children (63%) lived in census tracts with a high proportion of families in poverty. Black males had the highest rates of firearm injury, with a 1-year incidence of 233 per 100 000 persons per year. At younger than 12 years, the rates were equal among the races; however, for those 12 years and older, black adolescents had 13 times the risk of white adolescents (541 compared to 42 per 100 000 persons per year). The majority (71%) of injuries were due to assaults, with drive-by shootings the most frequent circumstance. The majority of unintentional injuries occurred to adolescents as the result of an unplanned discharge of a handgun as it was being placed in or removed from concealment. Among the patients, 39% were admitted to the hospital and 26% required surgery.
Conclusions. 1) Black male adolescents had the highest risk of firearm injury or fatality. 2) The majority of victims lived in census tracts characterized by poverty. 3) Injuries were alarmingly severe. 4) Interpersonal violence was the leading contributor to fatal and nonfatal injuries. 5) Unintentional injuries characteristically occurred during the process of weapon concealment. 6) The leading contributor to injury and death was the interaction of adolescents and guns, particularly handguns. The main implication for firearm-injury prevention in this population is the limiting of access to guns by adolescents. In addition, measures aimed at preventing violent behavior, such as education in nonviolent methods of conflict resolution, should be explored.
The Association of Consensual Sexual Intercourse During Childhood With Adolescent Health Risk and Behaviors
Authors: Resnick Michael D. , Blum Robert Wm. 
Published: December 2021

Objective. The association of childhood sexual intercourse, excluding sexual abuse, with adolescent health and risk behaviors was examined using the urban component of a statewide study on adolescent health, risky behaviors, and resiliency factors.
Methodology. A specialized cohort design was used to derive a two-group sample. Index cases consisted of all adolescents who indicated that they had first intercourse at or before age 10 years, and controls were adolescents who either had not yet had intercourse or had done so at age 16 years or older. To avoid confounding with issues of sexual abuse, all adolescents who also indicated a history of sexual abuse on the survey were removed from the analysis, so that the comparison could focus on health and behavioral correlates of respondents who did not define their childhood sexual intercourse as constituting abuse. Comparisons were conducted separately for girls and boys.
Results. A significantly greater proportion of index cases than controls indicated problem substance use by parents, poor school performance, gang involvement, frequent and unprotected sexual intercourse, history of pregnancy involvement, desire to leave the home, history of mental health treatment, emotional distress, and suicidal involvement. Logistic regression revealed significant group differences including academic risk, gang involvement, frequency of sexual intercourse, and history of mental health treatment. Correct group classification with the logit model was approximately 90% for both girls and boys.
Conclusions. The results underscore the importance of childhood sexual intercourse as an indicator of other health-compromising behaviors and risk factors. Clinicians should be alert to this clustering of risk behaviors in their psychosocial assessment of young people.
How Should Physicians Approach the Problems of Their Patients?
Authors: Bellet Paul S. 
Published: December 2021

During a recent seminar with pediatric residents to discuss the role of empathy in the doctor-patient relationship, the following dialogue occurred.
Resident: It is fine and terrific to talk about how useful empathy can be, but it does not work when children with reactive airway disease have parents who continue to smoke. I feel strongly that people should not smoke. When these children wheeze, their parents bring them to the Emergency Department and we have to see them and deal with the same problem over and over again.
Physician: Have you talked to the parents to try and understand their feelings about smoking and whether they believe it influences their child's wheezing?
Evidence of Early Adrenal Insufficiency in Babies Who Develop Bronchopulmonary Dysplasia
Authors: Watterberg Kristi L. , Scott Susan M. 
Published: December 2021

Objectives. To test the cortisol response to adrenocorticotrophic hormone (ACTH) in a population of very low birth weight newborns at the end of the first week of life, and to evaluate the relationship of this response to the subsequent development of bronchopulmonary dysplasia and to the total length of oxygen dependence.
Methods. Appropriate for gestational age newborns &lt;1500 g birth weight were enrolled prospectively. Response to ACTH stimulation was tested on days 5, 6, or 7. Baseline cortisol, stimulated cortisol, and magnitude of response were compared between babies who developed bronchopulmonary dysplasia (BPD), defined as oxygen dependence at 28 days, and those who recovered without BPD.
Results. In this population, the cortisol response to ACTH increased with increasing birth weight (P &lt; .001). Using birth weight as a cofactor, analysis of variance showed that patients who developed BPD (n = 34, BW 974 ± 192 g, mean ± S.D.) had significantly reduced responses to ACTH at 5 to 7 days of age compared to those who recovered (n = 25, BW 1251 ± 194 g), P = .006. Additionally, 84% of patients who recovered without BPD, but only 26% of BPD patients, achieved a prospectively defined positive cortisol response to ACTH (≥9 µg/dL; P &lt; .005). Supplemental oxygen was discontinued at a younger postconceptional age in babies with a positive cortisol response to ACTH (P &lt; .01) and fewer of those babies were on supplemental oxygen at 36-week postconceptional age (P &lt; .01).
Conclusions. At the end of the first week of life, infants who subsequently developed BPD and prolonged oxygen dependence had significantly lower cortisol secretion in response to ACTH than infants who recovered without BPD. We speculate that these babies may be unable to secrete adequate amounts of cortisol in a setting of increased stress, leaving them vulnerable to continuing lung injury.
AN ODORLESS WAY OF TESTING DIAPERS
Authors: L. J. F. 
Published: December 2021

How do diaper manufactures test new products?
Not necessarily with teams of volunteer babies.
What scientists have spent considerable time and money to come up with is synthetic feces. And now they are patented.
The invention belongs to the Kimberly-Clark Corporation, the Dallas-based company that makes, among other things, diapers, training pants, incontinence garments and baby wipes.
"...technicians have some objection to handling the real thing," explained Richard Yeo, a senior research scientist who developed the synthetic compound with another Kimberly-Clark researcher, Debra Welchel. "The real thing is a form of biologically hazardous material. Also, it's a bit difficult to obtain, even from infants."
Technicians tried to get around the problem by using mashed potatoes, peanut butter, or canned pumpkin pie mix. Messy, yes, but apparently not chemically accurate enough for science. The foods broke down too quickly, their liquids and solids separating faster than human wastes tend to do.
"The compound comes in a dry mix to which water is added for the desired consistency. The mix is made up of water-soluble components like polyvinyls, starches, natural gums, and gelatins and insoluble ones like fibers and resins. It is usually brown. Kimberly-Clark is making the compound for its labs and has no plans to sell it to anybody else.
A Longitudinal Study of Hymenal Morphology in the First 3 Years of Life
Authors: Berenson Abbey B. 
Published: December 2021

Objective. To document the effects of aging on hymenal morphology during the first 3 years of life in a cohort of nonabused girls.
Methods. Using a longitudinal design, we examined and photographed the external genitalia of 134 girls at 2 months or less and near 3 years of age; 42 of these girls were also examined near 1 year of age. The prevalence of each hymenal characteristic was calculated at each time, and differences were analyzed using the z statistic and McNemar change tests. Measurements of transhymenal diameters and the inferior rims were compared using a paired t-test.
Results. Hymenal configuration in 65% (87 of 134) of the subjects changed between birth and 3 years, usually from annular or fimbriated to crescentic. External ridges observed at birth usually resolved by 3 years, whereas intravaginal ridges were observed more often in 3-year-olds (P = .00). Analysis by race showed that the prevalence of both superior and lateral notches decreased in whites, whereas the prevalence of intravaginal ridges changed only in blacks (P = .00). Sixty-eight percent (15 of 22) of the tags present at birth were not observed at 3 years, while nine tags formed during this period. Changes observed between 1 and 3 years included increases in the mean horizontal (P = .00) and vertical (P = .02) transhymenal diameters and in the prevalence of the crescentic configuration (P = .04).
Conclusions. Changes in hymenal morphology, which may vary by race, occur in the first 3 years of life. Alterations are more pronounced in the first year than in years 2 and 3. Physicians should understand the effects of aging on the hymen's appearance to differentiate normal development from post-traumatic or infectious changes.