bluuebunny/crossref_metadata_2025_split huggingface dataset:
Beliefs and Practices Regarding Childhood Vaccination Among Urban Pediatric Providers in New Jersey
Authors: Askew George L. , Finelli Lyn , Lutz James , DeGraaf Janet , Siegel Bruce , Spitalny Kenneth 
Published: December 2021

Background. In 1991, the fourth largest measles outbreak in the nation (824 cases) occurred in the Jersey City, New Jersey area. Data from a subsequent intervention trial in Jersey City demonstrated that vaccinations were more likely to be delayed for children who had received care from private rather than public clinic providers. In addition, failure to administer multiple indicated vaccines at a single visit was associated with vaccination delay, and reluctance to administer multiple vaccines was more common among private providers. These findings prompted an investigation of vaccination beliefs and practices among urban pediatric providers.
Methods. A telephone survey of vaccination beliefs and practices was administered to all pediatric providers in both private and public clinics in the Paterson and Jersey City areas.
Results. Private providers were less likely than public clinic providers to consider vaccinating children during emergency room visits (relative risk [RR] = 2.2; 95% confidence interval [CI] = 1.2-4.2) or hospital admissions (RR = 13.2; 95% CI = 1.9-92.7) and less likely to believe that all recommended vaccine doses should be administered simultaneously (RR = infinite; lower 95% confidence limit = 3.0). Private providers were less likely to consider administering live-virus vaccines to children with minor acute illnesses and low-grade fever (RR = 2.2; 95% CI = 1.2-3.8) or killed-virus vaccines to children with minor acute illnesses without fever (RR = 3.4; 95% CI = 1.4-8.5) or with low-grade fever (RR = 2.2;95% CI = 1.2-3.9). Private providers were more likely to believe that multiple injections should be avoided because of potential psychological and physical trauma to the child (RR = 4.0; 95% CI = 1.3-12.3).
Conclusions. Adherence to Standards for Pediatric Immunization Practices by pediatric providers could improve vaccine coverage rates among urban children.
Elevated Serum Lactate Correlates With Intracranial Hemorrhage in Neonates Treated With Extracorporeal Life Support
Authors: Grayck Eva Nozik , Meliones Jon N. , Kern Frank H. , Hansell Doug R. , Ungerleider Ross M. , Greeley William J. 
Published: December 2021

Objectives. To correlate the initial and maximal lactate levels with the occurrence of intracranial hemorrhage (ICH) and survival in patients treated with extracorporeal life support (ECLS).
Design. Retrospective chart review.
Setting. Pediatric intensive care unit.
Patients. Eighty-two neonatal patients placed on ECLS for respiratory failure due to sepsis, meconium aspiration, or persistent pulmonary hypertension of the newborn.
Measurements. The initial lactate level measured within 6 hours of initiating ECLS and the maximal lactate level measured throughout the ECLS course were collected. Lactate levels were described as mean lactate ± SE (mM). Head ultrasound reports and survival were reviewed. Platelet counts and activated clotting times (ACTs) were examined.
Results. The mean initial and maximal lactate levels were higher in ECLS patients who developed ICH (initial: 10 ± 1.7 mM vs 6.4 ± 0.8 mM, p = .05 and maximal: 12.4 ± 2.5 mM vs 7.9 ± 0.8 mM, p = .04). Initial and maximal lactate levels were also elevated in nonsurvivors (initial: 11.7 ± 3 mM vs 6.4 ± 0.7 mM, p = .01 and maximal: 14.8 ± 3.3 mM vs 7.8 ± 0.8 mM, P &lt; .01). Platelet counts and ACT did not differ in patients with and without ICH.
Conclusions. Lactate is a useful marker for the development of ICH in ECLS patients. In addition, elevated lactates during ECLS identify a subgroup of patients with poor outcome. Prospective studies are needed to determine whether the incorporation of this information into pre-ECLS and ECLS management will decrease the occurrence of ICH and improve survival.
WHAT EXACTLY MAKES A HOSPITAL THE ‘BEST’?
Authors: L. J. F. 
Published: December 2021

Make sure your fax machine is turned on and full of paper when you leave your office Wednesday night, read an advisory to more than 125 major medical centers...
... Fax machines around the country whirred into action as U.S. News and World Report notified the winners of its annual rankings of the best hospitals. That same morning, about 100 reporters and editors received bulging press packets touting the winners.
U.S. News's 6-year-old Consumer guide to hospitals has become the hottest marketing tool in the health-care industry, a public-relations gold mine for the winning medical centers. The magazine wins, too, because the "Best Hospitals" issue generally sells slightly better than the average U.S. News and leads to a booming business selling reprints to winning hospitals.
But the rankings—which this year include 128 hospitals in 16 specialties—are also coming under fire. Officials at two major hospitals, University Hospitals of Cleveland and Hospital of the University of Pennsylvania, say the list is little more than a popularity contest because the methodology is flawed.
Sudden Infant Death Syndrome in Relation to Weather and Optimetrically Measured Air Pollution in Taiwan
Authors: Knöbel Harald H. , Chen Chien-Jen , Liang Kung-Yee 
Published: December 2021

Objective. To examine the possible role of weather and air pollution in sudden infant death syndrome (SIDS) and suffocation.
Methods. Poisson regression analysis was carried out to measure the association between daily rates of SIDS per 1000 live births and daily average values of visibility and temperature in Taiwan between 1981 and 1991. The optimetrical measure of air pollution was used to represent pollution over a whole area rather than at a point source.
Results. Mortality from SIDS per 1000 live births was 3.3 times greater in the lowest category of visibility on the day of death than in the highest category; this rate ratio was 3.4 for the average visibility during the 9 days before death. Adjustment for population size, season, level of urbanization, incidence of deaths from respiratory tract infections, temperature, air pressure, sunshine, rainfall, relative humidity, and windspeed increased these rate ratios to 3.8 and 5.1, respectively. This suggests that the relationship between air pollution and SIDS is not biased by ecological confounders. For temperature the rate ratios were between 3.3 and 4.0.
Conclusions. Our findings confirm the association of climatic temperature and air pollution with SIDS.
Continuing Risk for Hepatitis B Virus Transmission Among Southeast Asian Infants in Louisiana
Authors: Mahoney Francis J. , Lawrence Margaret , Scott Cathy , Le Quan , Lambert Steve , Farley Thomas A. 
Published: December 2021

Objective. Implementation and evaluation of a hepatitis B vaccination program for Southeast Asian infants in Louisiana.
Methods. A baseline seroprevalence survey of hepatitis B virus (HBV) infection in US-born Southeast Asian children was conducted in 1991 before the implementation of a vaccination program. Hepatitis B vaccination and postvaccination serologic testing of survey participants 10 years of age and younger was performed. Eighteen months after the hepatitis B vaccine was integrated into infant immunization schedules in July 1993, a vaccination coverage survey was performed.
Results. Baseline serologic testing was conducted on 96% of persons from 225 randomly selected households in a Southeast Asian community in Louisiana. Of 676 US-born children, 28 (4.1%) had chronic HBV infection; 61% of children with chronic HBV infection were born to hepatitis B surface antigen (HBsAg)-negative women. Among children born to HBsAg-negative women, the prevalence of chronic HBV infection increased with age, reaching 7.3% for children 13 to 16 years of age. Children born to HBsAg-negative women and living with carriers were 5.4 times more likely to have evidence of HBV infection than were children who did not live with carriers. Before the survey, only one child had received three doses of hepatitis B vaccine. In July 1993, 43% of Southeast Asian infants 9 to 18 months of age born in Louisiana had received three doses of hepatitis B vaccine. Infants who received immunizations from private providers were more likely to be fully vaccinated than were infants who received services from public sector clinics (prevalence ratio, 2.1; 95% confidence interval, 1.4,3.1).
Conclusions. HBV transmission occurs throughout childhood in US-born Southeast Asian children, and the prevalence of chronic HBV infection approaches that of the country of origin. Few US-born Southeast Asian children have received hepatitis B vaccine. Because of the high rates of early childhood HBV transmission and the high risk of chronic infection in Asian and Pacific Islander communities, prevention efforts should be enhanced to ensure that all Asian and Pacific Islander infants receive hepatitis B vaccine in the first 12 months of life and that older children are vaccinated.
Serologic Responses to Bartonella and Afipia Antigens in Patients With Cat Scratch Disease
Authors: Szelc-Kelly Cynthia M. , Goral Simin , Perez-Perez Guillermo I. , Perkins Bradley A. , Regnery Russell L. , Edwards Kathryn M. 
Published: December 2021

Objective. To assess the serologic response to Afipia and Bartonella, previously named Rochalimaea, in patients with cat scratch disease (CSD) and a healthy control group.
Design. Prospective, controlled trial.
Setting. Referral clinic and hospitalized patients in a university medical center.
Participants. Eighty patients with CSD and 57 healthy control subjects of similar age.
Main Outcome Measures. The immune responses to Afipia felis and Bartonella henselae were evaluated by a newly developed enzyme-linked immunosorbent assay (ELISA) in patients with CSD and healthy control subjects. Responses to B henselae were also measured by indirect fluorescent antibody (IFA) tests. Antibody levels to Bartonella quintana were measured by ELISA and IFA in a limited number of patients and control subjects.
Results. Of the 80 patients with clinical CSD, 56 had positive results of CSD skin tests. ELISA antibody levels to A felis did not differ between patients and control subjects, but immunoglobulin M (IgM) and IgG ELISA antibodies to B henselae and B quintana were significantly higher in patients than in control subjects. IFA responses to B henselae and B quintana were also significantly higher in patients than in control subjects.
Conclusion. Patients with CSD had significant serologic responses to B henselae and B quintana but not to A felis, suggesting that the causative agent of CSD is antigenically related to the Bartonella genus and not to Afipia. The Bartonella IgM ELISA and IFA assay were both sensitive and specific and may be used to establish the diagnosis of CSD.
Can Pediatric Training Manage in Managed Care?
Authors: Leslie Laurel K. 
Published: December 2021

On January 18, 1995, the University of California convened a special meeting to discuss the business operations of its five academic medical centers in San Francisco, Sacramento, San Diego, Los Angeles, and Irvine. Because of the rapid developments occurring in the maturing and competitive managed care market in California, the academic medical centers are facing unprecedented financial pressures. Charles Townsend, of the accounting firm KPMG Peat Marwick, stated that the medical centers' staff would need to be cut by at least 2500 full-time equivalents, including physicians and nurses, by the year 1999. William Kerr, Director of the University of California San Francisco Medical Center, forecasted a comprehensive restructuring and streamlining of services. Jordan Cohen, president of the Association of American Medical Colleges, described the challenges facing these five academic medical centers and others like them as "truly seismic."1
The rise of managed care medical systems during the last 5 years has led many researchers to question whether the academic medical center will survive in its current state.2-6 Market forces are changing the provision of medical care at an extremely fast pace. By 1998, an estimated 60% of people living in US cities will be covered by managed care health plans. Fewer hospital admissions, shorter hospital stays, and decreased reimbursements associated with managed care have decreased hospitals' operating gains. Academic medical centers, such as those in California, are facing pressure to lower health care delivery costs. The probable decreases in Medicare and research funds under the current Congress also threaten the financial revenues of academic medical centers.
Letters to the Editor
Authors: Hunt Patricia A. , Pellock John M. 
Published: December 2021

The report of a study of 47 children by Freeman et al1 indicated administration of carnitine did not significantly improve symptoms associated with the anticonvulsant medications valproic acid and carbamazepine. Further study has been recommended to validate the clinical impression of some workers that therapeutic carnitine may be beneficial for some patients with low carnitine levels.2 Recent experience at a large residential training and treatment center for the mentally retarded provides further pertinent information.
At Southside Virginia Training Center for the mentally retarded in Petersburg, Virginia, 40% of the residents received anticonvulsant medication for epilepsy.
Letters to the Editor
Authors: Freeman John M. 
Published: December 2021

We read with interest the report of Drs Hunt and Pellock on screening a population of institutionalized patients for carnitine deficiency. There did not appear to be any substantial correlation between the carnitine levels and the patient's function, handicap, or the ingestion of anticonvulsants. This population could be useful for a blinded test of the reported beneficial effects of carnitine administration.
The letter from Sigma-Tau Pharmaceuticals, manufacturers of Carnitor, is, I believe, an intentionally misleading and disingenuous extension of their advertising campaign of which my quote is the opening sentence.
Description and Evaluation of Serologic Assays Used in a Multicenter Trial of Acellular Pertussis Vaccines
Authors: Meade Bruce D. , Deforest Adamadia , Edwards Kathyrn M. , Romani Theresa A. , Lynn Freyja , O'Brien Colleen H. , Swartz Christina B. , Reed George F. , Deloria Maria A. 
Published: December 2021

In the September 1995 supplement, titled Report of the Nationwide Multicenter Acellular Pertussis Trial (1995;96:547-603), two articles contain errors:
• Description and Evaluation of Serologic Assays Used in a Multicenter Trial of Acellular Pertussis Vaccines (1995;96:570-575): On page 571, the 14th line under the heading "ELISA" contains an incorrect percentage for Tween-20 in the serum incubation buffer. It should be 0.05% (vol/vol) Tween-20, not 0.5%, as printed.
Letter To The Editor
Authors: Adams Joyce A. 
Published: December 2021

I would like to attempt to allay the concerns expressed by Drs Hobbs and Wynne over the results of our study on the frequency of abnormal anogenital findings in children whose perpetrators were convicted of molestation.1
First of all, perhaps an explanation of the patient population served by the Sexual Abuse Evaluation Program at Valley Medical Center is in order. Like many programs in the United States, we saw children who were referred for evaluation after they had disclosed their abuse and had been evaluated by the child protection agencies.
Physician Experience With Pediatric Inpatient Care in Washington State
Authors: Melzer Sanford M. , Grossman David C. , Rivara Frederick P. 
Published: December 2021

Objective. To determine the frequency with which pediatricians and family physicians in Washington State serve as attending physicians for pediatric inpatients.
Design. Retrospective review of statewide hospital discharge data.
Subjects. Attending physicians for all patients younger than 18 years of age with nonsurgical diagnoses discharged from civilian hospitals in Washington State during 1989 and 1990.
Results. Using medical rosters, the self-identified specialty of the attending physician was determined for 93% (n = 181 581) of discharges. Pediatricians and family physicians were listed as attending for 61% and 28%, respectively, of all eligible patients. Statewide, 97% (n = 555) of all pediatricians and 86% (n = 939) of all family physicians served as attending physicians for at least one inpatient, including healthy newborns, during the 2-year study period. The median annual number of discharges per physician was 78 for pediatricians and 14.5 for family physicians. Excluding healthy newborns, the median annual number of discharges was 25 for pediatricians and 3 for family physicians. Five percent of the physician attending group provided inpatient care for 50% of all children hospitalized with diagnoses other than healthy newborn; 50% of attending physicians cared for 95% of the patients. In rural hospitals, where family physicians served as attending physicians for 44% of pediatric inpatients, children were 3.3 times more likely to receive their care from family physicians than those hospitalized in urban centers.
Conclusions. Most pediatricians and family physicians serve as inpatient attending physicians for hospitalized children only infrequently. These findings question whether the emphasis on inpatient care in many pediatric and family medicine training programs remains an appropriate goal.
Calf Blood Pressure: Clinical Implications and Correlations With Arm Blood Pressure in Infants and Young Children
Authors: Crapanzano Michael S. , Strong William B. , Newman Ingrid R. , Hixon R. Lester , Casal Devarra , Linder Charles W. 
Published: December 2021

Objective. Indirect measurement of lower extremity blood pressure is often used in the clinical setting, although normative data after the newborn period are not readily available.
Methods. Indirect blood pressure (BP) measurement was obtained in the right arms and right calves of 148 healthy infants and young children 2 weeks to 3 years of age. All measurements were made using an oscillometric device. The infants and children were quiet or asleep and in the supine position. A BP cuff of proper size was chosen. Three measurements were made in both extremities; the average of the second and third measurements was used for all analyses.
Results. Age correlated better with calf systolic blood pressure (SBPc) than with arm SBP (SBPa) (r = .52 vs .17). Calf diastolic blood pressure (DBPc) and calf mean blood pressure (MBPc) correlated moderately poorly with age (r = .37 and .39, respectively). There was no order effect. SBPc correlated best with height (r .53), then age (r = .52), and, finally, weight (r = .51). The correlation between BPc and BPa was moderately low. The correlation of SBPc with SBPa was r = .46; that of DBPc with DBPa was r = .37; and that of MBPc with MBPa was r = .41. From birth to 6 months, SBPc was slightly lower than SBPa (1 to 3 mm Hg). SBPc increased linearly relative to SBPa and began to exceed SBPa at 6 months of age. The pattern of DBP and MBP was similar. Wide variability of blood pressure parameters was noted between the infants and children at all ages.
Conclusions. Reference data are presented for BPc and the difference between BPc and BPa in healthy infants and children from 2 weeks to 3 years of age. BPc is not equivalent to BPa and should not be arbitrarily substituted. Because of the wide variability among healthy infants and children, SBPc measurements should be interpreted with caution when evaluating for coarctation of the aorta.
Amyoplasia, the Most Common Type of Arthrogryposis: The Potential for Good Outcome
Authors: Sells Jill M. , Jaffe Kenneth M. , Hall Judith G. 
Published: December 2021

Background. Amyoplasia is the most commonly seen diagnostic subgroup of children with arthrogryposis. The natural history of these children has not been well described previously.
Methods. Review of the medical records of 38 children with amyoplasia enabled us to describe their birth characteristics, therapeutic interventions, and functional outcomes.
Results. Eighty-four percent of the children had symmetrical, four-limb involvement, which was similar to the original descriptions of amyoplasia, at birth. There was an average of 5.7 orthopedic procedures per child, and the children had multiple castings and splintings of their limbs and participated in physical and occupational therapy on a regular basis. By the age of 5 years, 85% were ambulatory, most were relatively or completely independent in their activities of daily living, and most were in regular classrooms at the appropriate grade level.
Conclusion. Although children with amyoplasia have pronounced musculoskeletal involvement at birth, which requires orthopedic and rehabilitative interventions during their childhood, their functional outcome in both physical and educational areas is excellent.
Effectiveness of Vaccination at 6 to 11 Months of Age During an Outbreak of Measles
Authors: De Serres Gaston , Boulianne Nicole , Ratnam Sam , Corriveau André 
Published: December 2021

Hypothesis. Monovalent measles vaccine can be administered to children 6 to 11 months of age during an outbreak. Efficacy and effectiveness of this control measure still have to be assessed.
Methods. During an outbreak of measles, monovalent measles vaccine was administered as part of outbreak control to children aged 6 to 11 months. Active surveillance was used to detect cases of measles occurring during the following month. Children who did not develop measles were tested for measles antibody before their revaccination at 15 months of age.
Results. Of 81 children 6 to 11 months of age, 56 were vaccinated and two received immunoglobulins; the latter were excluded from the analysis. Measles occurred in 15 of the 79 children during and after the vaccination campaign, for an overall attack rate of 19%. The attack rate among unvaccinated children was 39% (9 of 23), compared with 11% (6 of 56) among those vaccinated (relative risk = 3.6, 95% confidence interval [CI] = 1.5 to 9.1). All of those who sustained measles in the vaccinated group developed the disease within 10 days after vaccination. The overall vaccine effectiveness was 73% (95% CI = 32% to 89%) when children were classified as vaccinated as soon as they were given measles vaccine. It rose to 96% (95% CI = 72% to 99%) when children were considered vaccinated 1 week postimmunization. Nineteen infants who were vaccinated and who did not develop measles during the outbreak were tested for measles antibody status at 15 months of age before revaccination. All had plaque reduction neutralizing antibody titers greater than 120.
Conclusion.This study confirms that measles vaccination of infants aged 6 to 11 months is an effective intervention measure during measles outbreaks.
Melatonin for Insomnia and Jet Lag
Authors: TUROW VICTOR 
Published: December 2021

Recently, an adolescent patient, in for a routine physical examination, asked about the use of melatonin for insomnia. She had actually purchased a melatonin-containing product several weeks before at a local health food store, dosing herself nightly as instructed by the "guy behind the counter." Several other patients and parents have since inquired about my knowledge of this "natural remedy."
The body's internal clock, the circadian system, is regulated by the pineal gland.