bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sample Size: Profound Implications of Mundane Calculations
Authors: Lantos John D. 
Published: December 2021

Controversies in the design of clinical trials excite a small but feisty group of academicians. On one side of the controversy is a group I call the "rigorists," who argue that clinical medicine must be based only on facts that are established by scientifically rigorous clinical trials.1,2 Arguments for scientific rigor have an attractive purity about them that is both mathematical and moral. The simple certainties of statistical science can lead one to believe that, if only we would live by them, we would achieve not only low P values but universal peace and harmony as well. Thus, it may be considered not just good science but an ethical requirement of good research that studies be of sufficient size to give statistically significant results.
No moral argument can confront such assertions head on. Nobody argues, for example, that studies ought to be of insufficient size to give meaningful results. Instead, on the other side of this debate we find a group whom I call "apologists," who make arguments about why, even though scientific rigor is the highest good, other considerations sometimes dictate that medical practice be based on knowledge that falls short of the highest scientific standards. These arguments can be based on the physician's primary loyalty to his or her patient,3-5 to the difficulties in deciding whether or not a sufficient state of uncertainty about the relative merits of two treatments exists to ethically justify clinical trials,6,7 or on the special difficulties in obtaining informed consent or randomizing patients in particular populations.8-10
Chronic Fatigue in Children: Illness or Disease?
Authors: CARTER BRYAN D. , EDWARDS JOSEPH F. , MARSHALL GARY S. 
Published: December 2021

To the Editor.—
Recently, Van Aerde1 strongly criticized the study by Smith and colleagues2 on grounds that the authors confused the symptom "chronic fatigue" with "chronic fatigue syndrome (CFS)," because many of their patients failed to meet published criteria3 for CFS. In this regard, it is useful to differentiate "illness" from "disease," as recently done by Green and Stuy.4 "Illness" can be viewed as a disvalued change that occurs in a person's state of being, whereas "disease" more specifically refers to a detrimental series of biological or pathogenetic events.
A Whistleblower's Perspective on the Needleman Case
Authors: SCARR SANDRA 
Published: December 2021

To the Editor.—
It is remarkable that Herbert Needleman continues to attack me as a whistleblower in his case. Dr Ernhart and I reported suspicions of his misconduct.1 His colleagues at the University of Pittsburgh found him guilty of deliberate misrepresentations2 in his publications.
From October 1990 to the present, Dr Needleman's continuing troubles with scientific integrity have resulted from inquiries and investigations conducted serially by 1) Dr Ernhart and me, 2) the Office of Scientific Integrity at the National Institutes of Health (NIH-OSI), 3) the Inquiry Panel at the University of Pittsburgh, 4) the Hearing Board at the University of Pittsburgh, and 5) the Office of Research Integrity (ORI) at the Office of the Secretary of Health and Human Services (successor to NIH-OSI).
Day Care for the Child With Acquired Immunodeficiency Syndrome and the Child of the Drug-Abusing Mother
Authors: Heagarty Margaret C. 
Published: December 2021

In time, history may very well show that in this nation the decade of the 1980s was one of the most disastrous periods of all time for children, especially urban poor children. Not only did the number of children living in poverty increase dramatically, but two new agents, one viral and the other chemical, were introduced into urban disadvantaged communities. These two agents have had serious effects on the lives, the growth and development, indeed on the very survival of large numbers of children living in our major cities. The two agents are the human immunodeficiency virus (HIV), which causes acquired immunodeficiency syndrome (AIDS), and the chemical agent, cocaine, or its less expensive version, crack. Both AIDS and drug addiction, especially to cocaine, have had profound effects on the lives of many families and children. The affected children, who are now entering the day-care systems of our cities, pose new problems and dilemmas for the physicians, teachers, and administrators responsible for these programs.
AIDS
By August 1991 more than 3000 children with AIDS had been reported to the Centers for Disease Control.1 Most were infected in the perinatal period by transmission of HIV from an infected mother. They are, for the most part, of African-American or Hispanic ethnicity. They are both disadvantaged and poor. While children with AIDS can be found in virtually all regions of the nation, especially in the urban setting, pediatric AIDS continues to cluster in four areas: New York, New Jersey, Florida, and California.
Because of maternal transmission of HIV antibody, all infants of infected pregnant women will be antibody positive at birth, but only about 30% of these infants will in fact develop AIDS.
Ensuring Quality, Affordable Child Care: Mobilizing for Action
Authors: Schroeder Patricia , Reder Nancy D. 
Published: December 2021

In October 1990, Congress passed legislation authorizing two new major federal programs to subsidize child care for low- and moderate-income families and to improve the quality of care. The provisions were included in the Omnibus Budget Reconciliation Act of 1990,1 a multilayered funding and taxing measure enacted by Congress in the waning days of the 101st Congress.
The battle to secure federal financial support for affordable, quality child care took nearly 20 years. The new law is significant, not just because it will provide hundreds of millions of federal dollars to help financially strapped families pay for child care, but because it represents an acknowledgment of the need for a federal child care policy. The legislation that ultimately passed, however, reflects a substantial compromise with the Act for Better Child Care (the "ABC bill") as it was originally drafted, particularly with respect to the provisions that address the aspects of child care concerned with quality. (The legislation was originally introduced in the 100th Congress as the Act for Better Child Care of 1987 by Senator Dodd (D-CT) and Rep Dale Kildee (D-MI). It was reintroduced in the 101th Congress (S 5/HR 30) but was folded into the Budget Reconciliation Act as Congress rushed to finish work on the bill and ensure its passage as part of the more comprehensive funding measure.)
Proponents of the ABC bill had originally hoped that the legislation would include federal health and safety standards for child care providers. However, the Bush administration opposed federal standards, even provisions that would have required the Department of Health and Human Services (HHS) to draft model standards that states would then be encouraged to use as guidelines.
The Changing Role and Responsibilities of a Chairman—Letters
Authors: CROOK WILLIAM G. 
Published: December 2021

To the Editor.—
I found Dr Brent's article in the July issue of Pediatrics (1992;90:50-57) informative and delightful. He said, "The chairman of today is more like a parent, satisfied with long-term rewards and muted faculty appreciation." This comment reminded me of my chief at Vanderbilt, the late Amos Christie who was such a parent to all of "his boys." He sat down with the interns and residents and listened in an unhurried manner. Not only when we were on the house staff, but during our visits back to Vanderbilt over the years.
Discharge Milk Samples
Authors: AUERBACH KATHLEEN G. 
Published: December 2021

To the Editor.—
The work of Dungy et al (Effect of Discharge Samples on Duration of Breast-feeding. Pediatrics. 1992;90:233-237) adds to our knowledge of the complexities of human lactation and breast-feeding behavior. It also raises several questions, including the following:
1. Why were six women who were practicing mixed feeding in the hospital included with the rest of the sample, all of whom were characterized as exclusively breast-feeding?
2. What were the mothers' plans pertaining to employment1 with regard to their plans to breast-feed exclusively or partially; to use a bottle for night feedings; and to use a breast pump?
3. Which breast pump was provided? Some baby milk manufacturers distribute breast pumps.
Evaluation of Febrile Infant
Authors: LEVIN JAMES E. 
Published: December 2021

To the Editor.—
Lieu et al are to be congratulated for their comprehensive use of decision analysis to model the common problem of the evaluation and treatment of the febrile infant 1 to 3 months of age.1 One of the great strengths of this method is that it can promote discussion and research by making explicit all assumptions about the effectiveness of diagnostic tests and treatments. I would like to thank Dr Lieu for fostering this discussion by making available to me the mathematical representations of this model after its publication.
Familial Vesicoureteral Reflux
Authors: NOE H. NORMAN , PEEDEN J. N. 
Published: December 2021

In Reply.—
We are happy to address Dr Roscelli's concerns regarding our paper on familial reflux screening; we are not in complete agreement with him, however. First of all, the incidence of vesicoureteral reflux in the healthy human being is accepted as being 0.4% to 1.8%.1 The only study to show a significantly higher rate was the Kollerman study referred to by Dr Roscelli. This study has been roundly criticized because it was performed with high pressure injection, and it is the only such study to show a high rate of reflux in healthy children.
Beyond Pediatrics: The Health and Survival of Disadvantaged Children E. H. Christopherson Lectureship on International Child Health
Authors: Werner David 
Published: December 2021

As an uncertified "village health worker," for me it is a great honor to speak at the annual meeting of the American Academy of Pediatrics. Yet I feel uneasy. Today as we convene, 60 000 children will die unnecessarily, of undernutrition and the disease of poverty.
As pediatricians living in today's "new world order," you are faced with a daunting and in some ways paradoxical challenge. This is partly because the health and well-being of children is to such a large extent determined by factors outside the realm of medicine and pediatrics. It is also because pediatricians, along with so many other resources, are unequally and unfairly distributed. Ninety percent of all pediatricians are in North America and Western Europe, which claim only 15% of the world's children. This means that the vast majority of children—and certainly those in greatest need—live in places where there is no pediatrician.
Please don't get me wrong! I'm not suggesting you catch the next plane to Calcutta to play "great white doctor" in the City of Joy. In the long run, you can probably do much more for children of poor countries by standing up for their health and rights here at home.
If I were asked what American pediatrician in recent times has made the biggest contribution to the future health and well-being of the world's children, I would suggest Dr Benjamin Spock. Not because of his famous books on baby care, but because of his infamous protests and civil disobedience in opposition to militarism, nuclear arms, environmental destruction, social injustice, and the institutionalized inequities that compromise the health, survival, and prospects for the future of so many of our planet's children.
The Physician-Doctor Relationship
Authors: Christoffel Katherine Kaufer 
Published: December 2021

Judging from discussions in medical journals and at professional meetings, pediatricians and other physicians are increasingly aware of their relationships with patients, patients' families, medical co-workers, laboratory personnel, insurance company representatives, legislators, regulators, lawyers, reporters, students, and spouses. There is, however, little discussion of a central relationship that affects all the others: the physician-doctor relationship. It arises because "physician" is not a description of a person, but rather of a role that a person—the doctor—plays.
PHYSICIANS AND DOCTORS
The doctor's coat, stethoscope, and title are a costume that facilitates the performance of the role of physician. It helps the doctor and others to suspend disbelief that this person is a physician: objective; busy yet available; knowledgeable, skilled; undaunted by always private, sometimes smelly, and occasionally fatal problems. These traits of the physician are often important to filling the role, because they allow patients to entrust themselves to the physician, and the doctor to accept the trust and to go on when the going gets tough.
But the traits of the physician contrast sharply with those of the person who fills the role of physician—the doctor. That person is, like other people, subjective, unavailable when busy, often ignorant and unskilled for the job in hand, and likely to be upset by personal and life-threatening problems. The discrepancy between the traits of the doctor (a person) and the physician (a role the person plays) gives rise to a rélationship (the physician-doctor relationship) that is central to what physicians do. Understanding this central relationship is likely to be both important and interesting.
Hair-Grooming Syncope Seizures
Authors: LEWIS DONALD W. , FRANK L. MATTHEW 
Published: December 2021

Pediatricians are commonly consulted to evaluate children following their first, apparently unprovoked, convulsion. Keenly aware of the old adage that "all that shakes isn't epilepsy," we are ever mindful of the common mimickers of epileptic seizures that include breath-holding spells, benign paroxysmal vertigo, hyperventilation syndromes, narcolepsy-cataplexy, night terrors, and syncopal events. We present the clinical features of 15 children referred for evaluation of witnessed convulsions at home with similar histories of seizures precipitated by hair grooming and accompanied by presyncopal symptoms.
METHODS
The records of children referred to our neurology clinics from 1982 to 1992 for evaluation of seizures in temporal relationship to hair grooming were retrospectively reviewed.
Sudden Infant Death Syndrome and Sleeping Position
Authors: KATTWINKEL JOHN , BROOKS JOHN G. , MYERBERG DAVID 
Published: December 2021

In Reply.—
Dr Nichols describes a baby who was found dead in the supine position after having been placed prone. The presence of lymphocytes and milk globules in the lung suggests that this baby may have been experiencing chronic aspiration. The relationships of these findings to the baby's death and sleeping position are thought-provoking and open to several interpretations. Is Dr Nichols proposing that the chronic aspiration was occurring in the baby's usual prone position, but that death did not occur until the baby rolled supine?
Screening for Treatable Disorders
Authors: ARNOLD GEORGIANNE 
Published: December 2021

To the Editor.—
I wish to commend Dr Ellen Wright Clayton on her thoughtful commentary concerning issues in state newborn screening programs. The trauma of false-positive tests on families and the availability of a state-owned "DNA bank" consisting of newborn screening blotters are both issues which require consideration. I also share her grave concerns about society or state intervention in the rights of parents who carry genetic disorders to procreate. However, I take exception to the concept that parents should be allowed to choose whether or not their children will be screened for treatable disorders.
The Lead Debate
Authors: MUSHAK PAUL 
Published: December 2021

To the Editor.—
March 1993 marks the fourteenth anniversary of Prof Herbert Needleman's landmark publication on the neurobehavioral effects of low-level lead exposures in asymptomatic children.1 This study provided the major impetus to the subsequent huge number of well-done epidemiological, experimental toxicological, and mechanistic studies on lead from around the world. (More than 1500 health-relevant lead papers were indexed in Chemical Abstracts for 1991 alone.) These studies, in turn, provided the wherewithal for an informed, scientific expert consensus that childhood lead poisoning from low-level exposures is a major environmental health problem.2-7
Lactic Acid and Breast-Feeding
Authors: WALKER MARSHA 
Published: December 2021

To the Editor.—
I read the article, "Infant Acceptance of Postexercise Breast Milk" (Pediatrics 1992;89:1245-1247). Although it may be noteworthy that postexercise breast milk contains higher levels of lactic acid which change its taste, does this observation necessitate the recommendation to give a breast-fed baby supplemental feedings after the mother exercises? If the mother feeds the baby before exercising and the baby requires another feeding after the exercise, it is highly unlikely that he will suffer from caloric deprivation or malnutrition if he does not take a full feeding at that time.
Pediatric Poisoning Hazards
Authors: WOOLF ALAN , LIEBELT ERICA , LOVEJOY FREDERICK H. 
Published: December 2021

To the Editor.—
Drs Litovitz and Manoguerra, through their research recently reported in Pediatrics,1 have performed an important service for those of us interested in the prevention of early childhood poisoning. By analyzing calls according to their frequency and the risk of a fatal or near-fatal outcome after an acute poisoning, employing a "hazard score," the authors catalog and compare various potentially toxic agents ranking them for preventability. However the authors have neglected to discuss some limitations of their research which have an important bearing on its interpretation and the applicability of their results and conclusions to public policies concerned with poisoning prevention.
Pediatric Poisoning Hazards
Authors: LITOVITZ TOBY , MANOGUERRA ANTHONY 
Published: December 2021

In Reply.—
Drs Woolf, Liebelt, and Lovejoy offer an interesting commentary on this study, and we certainly concur with a number of their points. We regret any impression that these data are infallible, an impression which might have been conveyed by our failure to discuss the validity of the American Association of Poison Control Centers (AAPCC) pediatric dataset. This is an area which remains to be studied.
However, we assert that their statements regarding the limited accuracy of the death data in the AAPCC dataset have not been substantiated and are based erroneously on published comparisons which are limited to fatal adult poisonings.1,2
Stewart Smiled
Authors: BAXTER JIM K. 
Published: December 2021

To the Editor.—
Stewart smiled during the spinal tap that lasted only moments. Kneeling down close, I whispered that I was proud of him, and a great little smile lit the room. It had not been that long since this procedure had my 4-year-old son surrounded by the strong arms of nurses in the great lock and shout down, straight from the eighteenth century.
Somewhere in the weeks that followed our diagnosis of acute lymphocytic leukemia, somewhere lost in that downpour of emotions and medical forms, my wife and I agreed to enroll Stewart in a study that would compare two different sedation drugs and their effects during lumbar punctures and bone marrow tests.
Ethnocultural Variations in the Prevalence and Impact of Childhood Chronic Conditions
Authors: Newacheck Paul W. , Stoddard Jeffrey J. , McManus Margaret 
Published: December 2021

Chronic physical and mental illnesses are an important contributor to childhood morbidity. National survey data indicate that childhood chronic illnesses result in more than 35 million bed days and 40 million school absence days annually.1 There is also evidence to suggest that the burden of chronic illness is growing for children.2-4 Specifically, advances in diagnosis and treatment have dramatically changed mortality rates for children with chronic conditions, with the result that many children with life-threatening chronic conditions now survive into adulthood.5,6 In addition, a new class of childhood conditions, often referred to as the "new morbidities," has emerged in recent years.4,7
Despite concern about the welfare of this population, relatively little is known about the prevalence of childhood chronic conditions or their impact, especially for minority youth. Past studies have often categorized minority populations into the general and nonspecific category of "nonwhite." Alternatively some studies have reported results only for white and black children; hence published information is particularly sparse on chronic illness among Hispanic, Asian, and Native American children.
Previous studies that have examined racial and ethnic variations in the prevalence of childhood chronic conditions can be divided into those that are based on household interviews, those based on medical records, and those based on birth-defects-monitoring systems. The results for some of the larger studies are summarized in Table 1. Excluded from this table are disease-specific studies.
Only a few household interview studies have reported results concerning racial and ethnic differences in prevalence of chronic conditions. One of the earliest household interview studies to explore racial differences derived data from a survey of parents in Alamance County, North Carolina.8
Exclusive Breast-Feeding for at Least 4 Months Protects Against Otitis Media
Authors: Duncan Burris , Ey John , Holberg Catharine J. , Wright Anne L. , Martinez Fernando D. , Taussig Lynn M. 
Published: December 2021

Objective. This study was designed to assess the relation of exclusive breast-feeding, independent of recognized risk factors, to acute and recurrent otitis media in the first 12 months of life.
Methods. Records of 1220 infants who used a health maintenance organization and who were followed during their first year of life as part of the Tucson Children's Respiratory Study were reviewed. Detailed prospective information about the duration and exclusiveness of breast-feeding was obtained, as was information relative to potential risk factors (socioeconomic status, gender, number of siblings, use of day care, maternal smoking, and family history of allergy). Acute otitis media and recurrent otitis media, defined as three or more episodes of acute otitis media in a 6-month period or four episodes in 12 months, were the outcome variables.
Results. Of the 1013 infants followed for their entire first year, 476 (47%) had at least one episode of otitis and 169 (17%) had recurrent otitis media. Infants exclusively breast-fed for 4 or more months had half the mean number of acute otitis media episodes as did those not breast-fed at all and 40% less than those infants whose diets were supplemented with other foods prior to 4 months. The recurrent otitis media rate in infants exclusively breast-fed for 6 months or more was 10% and was 20.5% in those infants who breast-fed for less than 4 months. This protection was independent of the risk factors considered.
Conclusion. These findings suggest that exclusive breast-feeding of 4 or more months protected infants from single and recurrent episodes of otitis media.