bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of Videotaping to Evaluate Pediatric Resident Performance of Health Supervision Examinations of Infants
Authors: McCormick David P. , Rassin Glennda M. , Stroup-Benham Christine A. , Baldwin Constance D. , Levine Harold G. , Persaud Donna I. , Wolf Wendy J. 
Published: December 2021

Study objectives. To demonstrate reliability of a method for evaluating pediatric resident performance of health supervision examinations of infants using real patients and to evaluate pediatric resident performance of health supervision examinations of infants before and after an educational intervention consisting of a 6-month ambulatory rotation combined with video-assisted review of resident performance of the examination.
Design. Longitudinal cohort study in which all seond-year residents were enrolled. Residents' preintervention (baseline) videotapes were compared with postintervention videotapes. Each resident served as his or her own control.
Setting. University hospital pediatric resident continuity clinic.
Subjects. Sixteen second-year pediatric residents who were participating in a required 6-month ambulatory rotation.
Method and main results. Reliability study: Using a 51-item instrument derived from the American Academy of Pediatrics Guidelines for Health Supervision, trained raters blind to the sequence and dates of the videotaped health supervision examinations independently rated 44 resident encounters (a minimum of two raters per tape) and achieved good interrater reliability (κ = 0.80). Intervention study: After a 6-month ambulatory rotation which included resident-faculty reviews of preintervention videotapes, residents showed a 14% mean improvement in performance scores for the examination (P &lt; .05).
Conclusions. The results indicate that videotaped health supervision examinations using real patients can be reliably evaluated by observational techniques in a continuity practice. A 6-month ambulatory block rotation coupled with video-assisted interactive review of examinations is associated with measurable improvement in resident performance on the postintervention test.
Fluticasone Propionate Aqueous Nasal Spray Is Safe and Effective for Children With Seasonal Allergic Rhinitis
Authors: Grossman Jay , Banov Charles , Bronsky Edwin A. , Nathan Robert A. , Pearlman David , Winder John A. , Ratner Paul H. , Mendelson Louis , Findlay Steven R. , Kral Kenneth M. , Field Elizabeth A. , Rogenes Paula R. 
Published: December 2021

Introduction. Fluticasone propionate aqueous nasal spray, a new topical corticosteroid preparation, is effective when given as 200 µg once daily in patients (&gt; 12 years of age) with seasonal allergic rhinitis.
Study objective. To evaluate the efficacy and safety of fluticasone propionate aqueous nasal spray in children aged 4 to 11 years with seasonal allergic rhinitis.
Study design. Multicenter, randomized, double-blind, placebo-controlled, parallel-group.
Patients. Two hundred fifty children aged 4 to 11 years with moderate-to-severe nasal symptoms, a positive skin test reaction to a late-summer or autumn allergen, a history of seasonal allergic rhinitis, and documentation of an unsatisfactory response to conventional treatment.
Interventions. Children were randomly assigned to receive fluticasone propionate, either 100 µg or 200 µg, or placebo, given by intranasal spray once daily in the morning for 14 days.
Measurements and results. Severity of nasal symptoms (obstruction, rhinorrhea, itching, and sneezing) was recorded on visual analog scales by investigators at weekly visits and by patients (or adult guardian) daily in the evening. According to investigator and patient ratings, both fluticasone propionate 100 µg/d and 200 µg/d lowered total nasal symptom scores when compared with placebo. Both dosages of fluticasone propionate were more effective than placebo on the basis of investigatorrated overall clinical evaluation of efficacy at the end of treatment, with significant improvement (as opposed to moderate or mild improvement, no change or worsening) noted in 21% to 29% of the active-treatment groups vs 9% in the placebo group. There were no significant differences between the two fluticasone propionate dosages in any efficacy measurement. Morning plasma cortisol concentrations and frequency of drug-related adverse events were similar in the fluticasone propionate and placebo groups.
Conclusion. In children as young as 4 years, 100 µg of fluticasone propionate aqueous nasal spray given once daily is as effective as 200 µg given once daily, the usual adult dose for the treatment of seasonal allergic rhinitis. Both fluticasone propionate dosages were well tolerated and neither dosage appears to interfere with the hypothalamic-pituitary-adrenal axis in children.
Oxygen Saturation and Breathing Patterns in Children
Authors: Poets Christian F. , Stebbens Valerie A. , Samuels Martin P. , Southall David P. 
Published: December 2021

Objective. To obtain information on breathing patterns and oxygenation in children.
Design. Overnight tape recordings of arterial oxygen saturation (Sao2 Nellcor N200 in beat-to-beat mode), photoplethysmographic waveforms, and breathing movements in 70 healthy children (mean age 8.0 years, range 2 through 16). Analysis of recordings for pauses in breathing movements of ≥4 seconds (apneic pauses), for episodes in which Sao2 fell to ≤90% (desaturations) and, only during the state of regular breathing, for baseline Sao2 heart rate, and respiratory rate.
Results. Both baseline heart rate and respiratory rate decreased with increasing age (r = –.7 and –.3, respectively, P &lt; .01). Baseline Sao2 was similar to that previously observed in infants (median 99.5%, range 95.8 to 100, 5th centile 96.6%). Every recording showed apneic pauses, with a frequency that did not vary consistently with age (median 7.7/h, range 0.6 to 25.5). One hundred nineteen apneic pauses in 43 recordings lasted for 15 to 19.9 seconds, and 23 lasted for ≥20 seconds (longest 28.8 seconds). The number of episodic falls in Sao2 to ≥90% decreased with age (r = –.3, P &lt; .01); such episodes were found in 47% of children aged 2 through 6 years, but in only 13% of those aged 12 through 16 years. The 95th centile for desaturation frequency in the total group was 0.6/h. In six episodes in four patients, Sao2 fell to ≤80%.
Conclusions. Apneic pauses, some of which can last for more than 20 seconds, are a normal phenomenon in healthy children and adolescents, but only a small minority of apneic pauses affect blood gas homeostasis. Information concerning oxygenation may be more relevant to our understanding of the maturation of respiratory control than the recording of breathing signals alone.
Questions About Electrographic Seizures in Newborns
Authors: SCHER MARK S. 
Published: December 2021

In Reply.—
I would like to thank Drs Scheller and Sotero for their comments regarding our retrospective study of electrographic seizures in neonates. As we have previously reviewed,1 there are several unresolved issues with respect to the reported incidence and diagnostic criteria of neonatal seizures. Diagnostic inaccuracies with respect to both the underestimation as well as overestimation of seizures still exist. Healthy patients with suspicious movements or encephalopathic infants with abnormal movements reflective of a brain disorder may occur independent of seizures.
BLOOD OF LOVED ONES IS NO SAFER THAN GENERAL SUPPLY, STUDY FINDS
Authors: L. J. F. 
Published: December 2021

SAN FRANCISCO, Nov. 11 (AP)—Blood donated by family members and friends is more likely to carry hepatitis and some other diseases than is blood from anonymous donors, a Government study has found...
The study, financed by the National Institutes of Health, is the first large-scale examination of the safety of directed donations, Mr. Williams said. It involved examination of the records of 1,099,341 donations by 699,702 donors in Los Angeles, Oklahoma City, Detroit, San Francisco and the Baltimore-Washington area.
One screening test showed that 2.6 percent of donations from friends and relatives were infected with hepatitis B, compared with 1.8 percent of blood-bank donations, Mr. Williams said.
Donations from friends and family members were also more likely to be contaminated with hepatitis C, syphilis and a virus HTLV-1, that can cause cancer.
YOUTHS SET HOMELESS MAN AFIRE IN SUBWAY
Authors: L. J. F. 
Published: December 2021

A 31-year-old homeless man was seriously injured early yesterday after four teen-agers set him on fire as he lay sleeping in a Bronx subway station, the transit police said. A 25-year-old man on his way to work grabbed a fire extinguisher from a token booth and doused the flames.
The victim, whose name was not released, was listed in critical condition at Bronx Municipal Hospital Center with burns over 75 percent of his body...
Fourteen homeless people were set on fire from January through April in the city's subways, the transit police said. One of them died.
Woman Confesses in Deaths of Children
Authors: L. J. F. 
Published: December 2021

Waneta E. Hoyte said her five children died because they cried.
"In a signed confession, she said she smothered her children, Erik, James, Julie, Molly and Noah, because their screaming made her feel useless.
"It was the thing that caused me to kill them all because I didn't know what to do for them," Mrs. Hoyt said in a confession taken by investigators hours before her arrest last week on five counts of murder.
The statement, one of two provided to investigators by Mrs. Hoyt, transformed what had been a textbook case of so-called crib death of her five children more than 20 years ago into another kind of family cataclysm: an unthinkable crime..." Mrs. Hoyt now renounces the confession. She now claims she signed the statements only to stop questioning by police.
Do Young Boys With Fragile χ Syndrome Have Macroorchidism?
Authors: Lachiewicz Ave M. , Dawson Deborah V. 
Published: December 2021

Objective. Macroorchidism is one of the most well-described clinical characteristics of men with fragile χ syndrome, but little information has been available regarding macroorchidism in prepubertal boys with fragile χ. The purpose of this study was to learn whether macroorchidism is a characteristic of fragile χ syndrome in prepubertal boys.
Methods. Clinical assessments were performed on 73 boys, 2.2 to 10.2 years, in whom fragile χ either had been diagnosed or who had been referred for fragile χ evaluations because of developmental delays. As part of these assessments, we measured testicular volumes using Prader orchiometer beads to find out if macroorchidism occurs before the onset of puberty.
Results. From 2.2 through 7 years, boys with fragile χ have significantly larger mean testicular volumes than boys without fragile χ, but macroorchidism (≥4.0 mL or ≥2 times normal) only occurred in 1 of 27 boys with fragile χ. From 8 to 10 years, all our patients with fragile χ had clinically enlarged testicles (≥3.75 mL), and 7 of 9 boys with fragile χ had macroorchidism (≥4.0 mL). The testicular volumes of control subjects were all ≤3.0 mL.
Conclusions. These findings suggest that macroorchidism occurs in some prepubertal boys with fragile χ, but in this series it did not occur until age 6 and usually did not occur until after age 8.
Camphor Revisited: Focus on Toxicity
Authors:   Committee on Drugs
Published: December 2021

This Policy Statement was retired April 2013.
This commentary updates a previous AAP statement developed by the Committee on Drugs concerning camphor.1 The original commentary reflected the level of concern among pediatric practitioners and poison centers about the toxicity of camphor. Since the original statement, the Food and Drug Administration (FDA) has recognized camphor as a safe and effective topical antitussive, analgesic, anesthetic, and antipruritic agent.2 Following the approval process in 1983, the FDA required that the concentration of camphor in products not exceed 11%.2 Higher concentrations were not more effective and could cause more serious adverse reactions if accidentally ingested. Most reported camphor-related fatalities involved agents containing a concentration greater than 11%.
Ingestion of potentially toxic substances by children is related to the availability of a product in their environment. Camphor remains widely available (Table). The toxicity of camphor when inappropriately used is well documented.3-6 Ingestion is the most common route of potentially toxic exposure, with rapid onset of toxic effects. The risk of toxicity relates to both the concentration of camphor in the ingested product and the rate of absorption of camphor into the body.
From 1985 through 1989, 32 362 human exposures to camphor were reported to the American Association of Poison Control Centers.7-11 From 1985 through 1989, life-threatening toxicity occurred in 33 children as the result of camphor ingestion. During this period, there were no Childhood deaths as the result of camphor ingestion. In 5 cases, the products ingested contained more than 11% camphor even though they had been discontinued in 1983. In 14 cases, the products contained between 10% and 11% camphor.
Utilization of Prenatal Diagnosis For Cystic Fibrosis Over the Past Seven Years
Authors: Jedlicka-Köhler Ilse , Götz Manfred , Eichler Irmgard 
Published: December 2021

Objective. First trimester prenatal diagnosis (PD) by DNA analysis for cystic fibrosis (CF) has been available for parents of affected children since May 1986.
Methods. In a prospective study 37 couples with a single child affected by CF were investigated. Fathers and mothers were interviewed simultaneously, and their attitudes towards further childbearing and potential utilization of PD ascertained. Parental answers were treated as one. A 7-year follow-up allowed comparison between intended and actual behavior.
Results. At the time of the interview, 16 parents (43%) were determined to have further children. Nineteen parents (51%) said they would certainly or probably utilize PD in case of pregnancy. Their predominant reason for favoring PD was the strong desire to have a healthy child (47%). Among the 18 rejectors (49%) the fear of an unsolvable conflict in case of an affected fetus prevailed (39%). Twenty-four pregnancies actually occurred in 18 families. Utilization of PD was arranged in five (21%) and finally performed in four (17%) cases.
Conclusion. Availability of PD does not substantially change the reproductive behavior of parents of children with CF. Reasons for this were multifactorial, with anticipated difficulty in deciding to continue or terminate pregnancy being predominant.
Excessive Infant Crying: A Controlled Study of Mothers Helping Mothers
Authors: Wolke Dieter , Gray Pat , Meyer Renate 
Published: December 2021

Objective. To determine the efficacy of behavioral management counseling in the treatment of persistent, excessive infant crying (&gt;3 hours per day).
Design. Two treatments, one no treatment control group. Infants were group-matched according to baseline fuss/cry levels, sociodemographic, and infant variables. Treatments were carried out sequentially by the same counselors.
Setting. Telephone counseling by volunteers (mothers) of CRY-SIS, a national support group for the parents of crying infants.
Patients and interventions. Sequential sample of 27 mother-infant pairs receiving treatment 1 (Tr1, empathy: talking through the problem), 21 receiving treatment 2 (Tr2, behavioral management: specific care taking suggestions) and 44 receiving no treatment (C, controls). Infants were between 1 to 5 months of age.
Measurements and results. Mother-infant pairs had a pretreatment baseline assessment and a posttreatment follow-up (3 months after baseline) using 1-week diaries. Total fuss/cry duration reduced significantly more in the behavioral management group (by 51%) than the empathy group (37%) or the control group (35%). This was mainly due to significantly reduced evening fussing/crying in Tr2 (67%) compared with Tr1 (45%) and C (42%). No differences in total number of fuss/cry bouts/day were found. However, the number of fuss/cry bouts reduced significantly more in the evening in Tr2 (by 55%) compared with Tr1 (27%) and C (32%). Behavioral management mothers evaluated the same counselors as more sympathetic, knowledgeable, and understanding. Tr2 was also perceived by mothers to have helped them more in reducing the crying problem, coping with the infant, and improving the relationship with their infant than Tr1. No effects of treatment on infant difficult temperament were found.
Conclusions. Behavioral management was more effective in reducing fussing/crying than spending time with the mother talking through the problem or just waiting for spontaneous remission. Treatment by suitably but briefly trained lay counselors is an inexpensive and successful treatment option.
A Program to Limit Donor Exposures to Neonates Undergoing Extracorporeal Membrane Oxygenation
Authors: Rosenberg Ellen M. , Chambers Linda A. , Gunter Jean M. , Good Joseph A. 
Published: December 2021

Objective. Extracorporeal membrane oxygenation (ECMO) has dramatically improved the survival of neonates with life-threatening respiratory and cardiac failure. However, ECMO requires numerous transfusions with significant risks. This study evaluated the effects of changing transfusion practices and blood component management on blood donor exposures in neonatal ECMO.
Design. A 3-year retrospective chart review of all neonatal ECMO patients from December 1989 through November 1992 was undertaken. During this 3-year period, transfusion practices and blood product preparation were altered twice to reduce blood donor exposures. The use of apheresis platelets and fresh frozen plasma (FFP), and preserving the expiration date on packed red blood cells (PRBCs) through the use of a sterile connecting device, allowed multiple transfusions from individual donor components. In addition, education of the ECMO physicians was focused on standardizing and reducing transfused volumes.
Sixty-four surviving neonatal patients (91.4%) were evaluated. Five patients had excessive bleeding and were excluded from analysis. The remaining 59 patients were divided into three protocols based upon the transfusion practice at the time of their ECMO course. Protocol 1 received PRBCs less than 5 days of age, volume-reduced platelet concentrates, and standard FFP units up to 24 hours after thawing. Changes in transfusion practice for protocol 2 included extended outdate for PRBCs to 10 days, and using single donor apheresis platelet aliquots. The third protocol entailed the use single donor apheresis FRP aliquots in addition to the protocol 2 changes.
Results. Total PRBC transfusion volumes (721 ± 406 ml for protocol 1, 637 ± 172 ml for protocol 3) and associated blood donor exposures (5 ± 2.1 for protocol 1, 3.9 ± 0.9 for protocol 3) did not change substantially over the reviewed period. However, FFP transfusion volumes (478 ± 170 ml for protocol 1, 274 ± 63 ml for protocol 3), FFP-related donor exposures (4.5 ± 1.6 for protocol 1, 1.2 ± 0.4 for protocol 3) and platelet-related donor exposures (4.6 ± 3.6 for protocol 1, 2.5 ± 1.5 for protocol 3) were reduced progressively and significantly from protocol 1 to protocol 3 (P &lt; .01, Tukey's B test adjusted for multiple comparisons). The total number of donor exposures per patient while on ECMO was decreased from 14.1 in protocol 1 to 10.0 in protocol 2 to 7.5 in protocol 3 (P &lt; .01).
Conclusions. We conclude that the changes in blood bank component selection and management as well as physician practice were effective in substantially reducing ECMO-related transfusion volumes and the resulting donor exposures.
MOUNTING SENSE OF JOB MALAISE PROMPTS MORE HEALTH-CARE WORKERS TO JOIN UNIONS
Authors: L. J. F. 
Published: December 2021

In search of job security and a voice in health-care reform, a growing number of workers at hospitals, nursing homes, and rehabilitation facilities are joining labor unions.
Hospital workers filed 158 petitions for union elections in 1993, up from only 19 in 1989, according to a study by Management Science Associates, Inc, a labor consulting firm. And unions won 58% of health-care elections in 1993—the highest win rate in the industry since 1984, according to Modern Health Care, an industry journal.
Lead Questionnaire Not Always Efficient
Authors: Kazal Louis A. , Bullock Patricia W. 
Published: December 2021

Tejeda et al found the lead risk assessment questionnaire to be an effective screening method for identifying increased lead levels in their population.1 However, as Drs Gellert and Wagner pointed out in the same issue of Pediatrics,2 depending on the prevalence of elevated lead levels, screening may not even be necessary. Therefore, using this questionnaire may be inappropriate in certain populations.
In Arizona, Medicaid requires that physicians screen with these questions at 6, 9 to 12, 15 to 18, 24 to 36, and 48 to 60 months of age.
Postnatal Growth Preceding Sudden Infant Death Syndrome
Authors: Brooks John G. , Gilbert Ruth E. , Flemming Peter J. , Berry Peter J. , Golding Jean 
Published: December 2021

Objective. To compare postnatal growth preceding the sudden infant death syndrome (SIDS) with that of age matched controls.
Design. Retrospective case-control study. Each SIDS victim was matched with two controls on date of parental interview, postnatal age, and neighborhood. Clinical and demographic data were collected by parental interview and by review of medical records, and interval body weights were obtained from health visitors' records.
Study population. All infants dying of SIDS between 1 May, 1987 and 30 April, 1989 in a geographically defined region consisting of four health districts in Avon and North Somerset in southwest England. Seventy-eight of the 99 SIDS victims and 139 of 156 control infants were included in the final analysis.
Results. There was no significant difference between SIDS victims and the controls in either of the two indices of postnatal growth which were analyzed. The mean growth rates (± 1 SEM) between birth and the last live weight (age equivalent weight for control infants) were 27.1 ± 1.0 g/day for the SIDS cases and 28.3 ± 1.5 g/day for the control infants. The mean growth rate (± 1 SEM) between the last two live weights were 31.5 ± 2.9 and 24.9 ± 2.1 g/day for the SIDS and control infants, respectively. Stratification of the infants by sex, gestational age, maternal smoking during pregnancy, breast versus bottle feeding, or age at death, did not result in any significant differences between SIDS and controls in either of the indices of postnatal growth rate. The 20 SIDS cases which were excluded from the final analysis did not differ from 78 whose data was analyzed, with regard to established SIDS risk factors, age at death, or postmortem weight.
Conclusions. No difference was found between the postnatal growth of SIDS victims and that of age matched control infants.