bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antibody Response of Low Birth Weight Infants to Haemophilus influenzae Type b Polyribosylribitol Phosphate-Outer Membrane Protein Conjugate Vaccine
Authors: Munoz Angel , Salvador Agnes , Brodsky Nancy L. , Arbeter Allan M. , Porat Rachel 
Published: December 2021

Objective. To evaluate the effectiveness in low birth weight (LBW) infants of the currently recommended immunization schedule for conjugated Haemophilus influenzae type b (HIB) vaccine.
Methods. We quantified antibody responses in 36 preterm infants with a mean birth weight of 1060 g and a mean gestational age of 28 weeks. Infants were immunized with 0.5 mL of HIB vaccine at 2 and 4 months' postnatal age. Specific HIB antibodies were quantified on cord blood, immediately before each immunization and 2 months after the last immunization.
Results. Even though the geometric mean titers increased significantly during the study period, they were still markedly lower than values reported in term infants. After the second immunization, only 24 infants (67%) attained antibody concentrations of more than 0.25 µg/mL, defined as seropositivity. Also, only 53% of infants achieved antibody concentrations of more than 1.0 µg/mL compared with 92% as reported in term infants. Stepwise logistic regression identified gestational age of 27 weeks or less and the amount of intravenous immunoglobulin received as the significant variables influencing the antibody response after the first immunization. The incidence of side effects was negligible.
Conclusions. We conclude that LBW infants, and especially those born at 27 or less weeks' gestation, do not respond as effectively to the HIB vaccine. We speculate that reevaluation of the current immunization schedule may be required for very LBW infants.
Parents' Attitudes Toward Firearm Injury Prevention Counseling in Urban Pediatric Clinics
Authors: Haught Karen , Grossman David , Connell Frederick 
Published: December 2021

Objectives. To examine characteristics and experiences associated with gun ownership among parents of pediatric patients who attend urban pediatric clinics and to determine the receptivity of these parents to firearm injury prevention counseling.
Design. A focus group discussion was followed by a cross-sectional survey.
Setting. Four public pediatric clinics in a large metropolitan area were included.
Participants. A focus group discussion was held with parents and was used to develop the questionnaire, which was then distributed over a 6-week period to parents accompanying children to the clinic. The anonymous, self-administered questionnaire was completed by 510 parents or guardians, with an 88% response rate.
Results. Twenty percent of respondents reported that they had a firearm in the home. Twenty-seven percent of respondents had experienced having a family member shot. Eighty-two percent of all respondents indicated that they would find information about the safest way to store a gun helpful or very helpful. Of all respondents, 47% would follow and an additional 37% would think over a provider's advice not to keep guns in the home. Gun owners were less inclined to report that they would follow this advice (19%), but 55% of the gun owners would think over this advice. Only 6% of all respondents reported that they would ignore or be offended by such advice.
Conclusions. Children attending public urban pediatric clinics are exposed to guns in their homes, and their parents appear to be receptive to firearm injury prevention counseling from their child's health care providers.
The Role of Dietary Fiber in the Development and Treatment of Childhood Obesity
Authors: Kimm Sue Y. S. 
Published: December 2021

Childhood obesity is viewed as a public health problem in the United States because of its assumed high prevalence and increasing secular trend. The best estimate of the genetic contribution to obesity ranges from 5% to 25%. Environmental factors play a major role in obesity development. Low income and a low level of education have been associated with obesity, particularly among white women. Caloric intake as a risk factor for obesity has not been clearly established. This lack of a clear-cut association may be attributable to the problem of accurately measuring caloric intake. Several studies have linked increased total fat intake, rather than caloric intake, with obesity. Some studies have linked television viewing to obesity in children.
Obesity is rare among the populations of developing countries, where dietary fiber intake is high. Explanations for the role of dietary fiber in obesity include a reduced caloric density of the foods, a slower rate of food ingestion, and possible effects on satiety. Most studies on the role of fiber in the treatment of obesity have been somewhat limited by lack of comparison groups, inadequate sample sizes, and short durations of the observations. However, although limited, the available evidence suggests that fiber potentially could play a useful role in weight reduction. For children, fiber administration should be considered as an adjuvant therapy rather than a primary modality, because fiber might aid in promoting satiety during meals and curbing hunger between meals. More research is needed, however, to assess further the efficacy of high-fiber diets in the treatment of childhood obesity. For now, however, increasing dietary fiber as a part of a health-promoting dietary pattern presents an attractive public health possibility as a means for prevention of chronic diseases. Preventing childhood obesity could be a part of the health benefit resulting from a population-based recommendation for optimal fiber intake.
Fiber in the Diet of US Children: Results of National Surveys
Authors: Saldanha Leila G. 
Published: December 2021

Objective. Because fiber intake among children in the United States is poorly documented, our objectives were to determine intakes and sources of fiber in the diets of children 2 to 18 years of age and to examine the trends.
Methods. We used the US Department of Agriculture's 1977 to 1978 and 1987 to 1988 Nationwide Food Consumption Surveys for our analysis. Children were classified by age and gender groups, 2 to 5 years, 6 to 11 years, boys 12 to 18 years, and girls 12 to 18 years. The percentages of children meeting the American Health Foundation's fiber recommendations for children were also determined.
Results. Analyses of the US Department of Agriculture's 1977-1978 and 1987-1988 survey data indicate that (1) large percentages (55% to 90%) of children are not meeting minimum fiber intake recommendations established by the American Health Foundation; (2) mean fiber intakes declined between 1977-1978 and 1987-1988; (3) fiber from fruits and vegetables declined during this period; and (4) fiber from grains, especially from ready-to-eat breakfast cereals, increased significantly. The results also show that eating breakfast contributes to meeting daily fiber recommendations.
Conclusions. Given the importance of fiber in promoting optimum gastrointestinal function in childhood and in treating chronic diseases such as heart disease, diabetes, and cancer in adulthood, the trends documented in this article are disturbing and suggest that efforts are needed to encourage the consumption of fiber-rich foods among children.
CLOSING OF MEDICAL SCHOOLS
Authors: L. J. F. 
Published: December 2021

A private study commission is urging "the wholesale closing" of US medical schools during the next decade to avert a glut of doctors.
The Pew Health Professions Commission on Thursday urged a similar retrenchment ent in pharmacy schools and elimination of at least 10% of nurse training programs.
It called for constricting the pipeline of foreign doctors who come to this country to train and usually wind up practicing here.
. . . The provocative study, funded by the Pew Charitable Trusts, a private philanthropy, did not sit well with leaders of academic medicine.
Update on Tuberculosis Skin Testing of Children
Authors:   COMMITTEE ON INFECTIOUS DISEASES
Published: December 2021

In January 1994, the Committee on Infectious Diseases published detailed guidelines on tuberculin skin testing of infants, children, and adolescents for the detection of tuberculous infections. This supplement to the 1994 statement is written to update and clarify several issues regarding the frequency of skin testing for children at increased risk of acquiring tuberculosis. In this document, children will refer to infants, children, and adolescents. The recommendations regarding the preferred use of the Mantoux skin test and the interpretation of skin test results remain unchanged and will not be repeated here. The interpretation guidelines for indurations of 5, 10, and 15 mm in diameter basically remain unchanged (Table 1).
The overall emphasis to control tuberculosis in the United States should be placed on access to health care, a thorough history taking of exposure to infectious persons, timely and effective contact investigations, proper interpretation of Mantoux skin tests, and appropriate use of therapy, including directly observed therapy. Variations in the epidemiology of tuberculosis in different locations reinforce the importance of communication with local public health officials and/or experts on tuberculosis. Existing publications can assist in assessing the local risk of acquiring tuberculosis. The recommendations should be considered regardless of previous BCG vaccine administration.
The American Academy of Pediatrics continues to encourage focusing tuberculin skin testing on children who are at increased risk of acquiring tuberculosis. Routine tuberculin testing, including school-based programs that include populations at low risk, has either a low yield of positive results or a large number of false-positive results and represents an inefficient use of limited health care resources.
Adenosine Infusion Improves Oxygenation in Term Infants With Respiratory Failure
Authors: Konduri G. Ganesh , Garcia Daisy C. , Kazzi Nadya J. , Shankaran Seetha 
Published: December 2021

Objective. Adenosine infusion causes selective pulmonary vasodilation in fetal and neonatal lambs with pulmonary hypertension. We investigated the effects of a continuous infusion of adenosine on oxygenation in term infants with persistent pulmonary hypertension of newborn (PPHN).
Design. A randomized, placebo-controlled, masked trial comparing the efficacy of intravenous infusion of adenosine to normal saline infusion over a 24-hour period.
Setting. Inborn and outborn level III neonatal intensive care units at a university medical center.
Participants. Eighteen term infants with PPHN and arterial postductal Po2 of 60 to 100 Torr on inspired O2 concentration of 100% and optimal hyperventilation (PaCo2 &lt;30 Torr) were enrolled into the study. Study infants were randomly assigned to receive a placebo infusion of normal saline, or adenosine infusion in doses of 25 to 50 µg/kg/min over a 24-hour period.
Results. Nine infants each received adenosine or placebo. The two groups did not differ in birth weight, gestational age, or blood gases and ventilator requirements at the time of entry into the study. Four of nine infants in the adenosine group and none of the placebo group had a significant improvement in oxygenation, defined as an increase in postductal PaO2 of ≥20 Torr from preinfusion baseline. The mean PaO2 in the adenosine group increased from 69 ± 19 at baseline to 94 ± 15 during 50 µg/kg/min infusion rate of adenosine and did not change significantly in the placebo group. Arterial blood pressure and heart rate did not change during the study in either group. The need for extracorporeal membrane oxygenation, incidence of bronchopulmonary dysplasia, and mortality were not different in the two groups.
Conclusion. Data from this pilot study indicate that adenosine infusion at a dose of 50 µg/kg/min improves PaO2 in infants with PPHN without causing hypotension or tachycardia. Larger trials are needed to determine its effects on mortality and/or need for extracorporeal membrane oxygenation in infants with PPHN.
Biliary Atresia, Cytomegalovirus, and Age at Referral
Authors: Tarr Phillip I. , Haas Joel E. , Christie Dennis L. 
Published: December 2021

Objective. To determine the frequency with which patients with extrahepatic biliary atresia (EHBA) are infected with cytomegalovirus (CMV) and to ascertain the age at referral to a specialty center for surgical correction of EHBA.
Methods. The charts of all patients discharged from the Children's Hospital and Medical Center between July 1, 1989 and December 31, 1993 with a new diagnosis of EHBA were reviewed to determine the frequency with which EHBA was accompanied by CMV infection. Data analyzed included age at referral and sex of patients, histopathologic evidence of CMV infection and size of bile ducts in the resected liver, and serologic (IgM) or culture diagnosis of CMV infection.
Results. Twenty-three patients with EHBA were evaluated at Children's Hospital and Medical Center in the study period. Twenty-one of the patients with EHBA were appropriately evaluated for infection with CMV and infection was documented in 5 (24%) patients. The median age of referral for all patients was 61 days (range 10 to 124 days). Infected patients were referred later (82.4 ± 28.7 days) than noninfected patients (48.8 ± 21.8 days) (P = .01) and were more likely to be girls, but the medians of the diameters of the bile ducts in the resected porta hepatis were similar. Viral inclusions were not identified in any of the liver specimens.
Conclusions. CMV infection is present in an unexpectedly large proportion of patients with EHBA at the time of referral. The establishment of CMV infection in infants with cholestasis should not deter the search for EHBA. Physicians should strive to reduce the age of referral of patients with EHBA to pediatric surgical centers by evaluating infants who remained jaundiced at 4 weeks of age.
Emotional Problems During Youth as Predictors of Stature During Early Adulthood: Results From a Prospective Epidemiologic Study
Authors: Pine Daniel S. , Cohen Patricia , Brook Judith 
Published: December 2021

Objective. Adults with emotional disorders exhibit abnormalities in growth hormone secretion. If these abnormalities were to occur during childhood, they could affect growth. The purpose of this study was to examine the relationship between youth emotional disorders and stature in early adulthood.
Methods. Using data from a prospective epidemiologic study of youth psychopathologic status, we used linear regression to examine the prospective relationship between anxiety disorders (separation anxiety and overanxious disorders) or major depressive disorder in youth and stature in early adulthood.
Results. Anxiety disorders during childhood prospectively predicted relatively short stature in early adulthood among females, accounting for more than 5% of the variance in adult height. However, these associations were not found among males.
Conclusions. There may be an association between abnormalities in growth and emotional problems in youth. Further research should examine biological measures related to growth among youth with emotional disorders.
PREVENTIVE THERAPY FOR ASTHMA IN CHILDREN: A 9-YEAR EXPERIENCE IN EASTERN FINLAND
Authors: Joos Thad H. 
Published: December 2021

Purpose of the Study. The investigation was carried out to ascertain if the treatment of childhood asthma in Finland changed after the publication of consensus guidelines in 1989 in Europe.
Methods. In a well-defined geographic area of Finland with about 53 000 children under 15 years of age, the asthma care for most youngsters was given through a regional allergy center headed by a pediatric allergist. Patient records were reviewed every other year from 1985 to 1993 regarding methods of treatment such as the use of long-term preventative agents, theophylline, and sympathomimetics amines.
Results. The results were most impressive regarding the use of sodium cromoglycate, which showed a marked increase in usage beginning in 1987 so that by 1993, 58% of the asthmatic children used this compound. Inhaled steroids remained rather constant over the 5 years surveyed, the figure being 20% of the children. Slow-release theophylline products dropped considerably as did sympathomimetic agents.
Reviewer's Comments. I feel that with the widespread use of inhaled prevention medications during 1987 through 1989 for children with asthma, our Finnish colleagues were perhaps 2 to 3 years ahead of us in America.
CLINICAL VALUE OF MONITORING EOSINOPHIL ACTIVITY IN ASTHMA
Authors: Joos Thad H. 
Published: December 2021

Purpose of the Study. Eosinophils are recognized as an integral part of the inflammatory aspect of bronchial asthma. One of their granulocyte-derived proteins, eosinophilic cationic protein (ECP) has been shown in in vitro studies to be deleterious to the bronchial mucosa. The present investigation was carried out in an effort to determine if the total eosinophil count and serum ECP levels could be correlated with the degree of bronchial reactivity as seen in asthmatic children.
Methods. A total of 175 asthmatic children with a mean age of 9.8 years were divided into five treatment groups: 1) B2 agents only; 2) inhaled steroids; 3) inhaled steroids and a B2 agent; 4) cromolyn sodium; and 5) a group of newly diagnosed asthmatics treated with inhaled steroids and a B2 agent. The comparison groups were: 1) 23 nonasthmatic children with lower respiratory tract infections; 2) 45 children with stable cystic fibrosis; and 3) 87 healthy children with no atopic or asthmatic history. Pulmonary function studies were performed in all children capable of cooperating when normal and ill. Total eosinophil counts and ECP levels were determined at these times as well. The newly diagnosed asthmatics were serially followed by the above parameters every 2 weeks for 6 weeks.
Results. They found the following:
1) Total eosinophil counts were significantly elevated primarily in the atopic asthmatic, but were not correlated with asthmatic activity;
2) ECP levels were persistently elevated in the cystic fibrosis group;
3) ECP levels in the asthmatic group did, indeed, correlate with the disease activity, with atopic asthmatics having higher levels than their nonatopic counterparts.
SAFETY AND ACTIVITY OF SAQUINAVIR IN HIV INFECTION
Authors: Parry Davod E. , Lemanske Robert F. 
Published: December 2021

Purpose of the Study. To assess the in vivo antiviral activity and tolerability of saquinavir in a dose-response study design.
Study Population. Forty-nine adult male, zidovudinenaive, human immunodeficiency virus (HIV)-positive patients with few or no symptoms of HIV infection and CD4 counts less than 500/mm3.
Methods. Patients were stratified according to symptoms or no symptoms of HIV infection and were randomized to receive saquinavir at 25 mg (10 patients), 75 mg (12 patients), 200 mg (12 patients), or 600 mg (10 patients) all orally tid for 16 weeks. Five patients in each group had symptoms of HIV infection. Patients were evaluated at baseline, weekly for the first 4 weeks and then at 6, 8, 12 and 16 weeks. Virus isolation and quantification was performed at baseline and 4-weekly intervals. HIV RNA was measured by polymerase chain reaction (PCR). No statistical tests were performed.
Results. Trends were reported and depicted graphically in the article. Patients in the higher dosage groups (particularly 600 mg tid) showed increasing CD4 counts and a reduction in viral load as measured by quantitative PCR for HIV RNA over the treatment period. Little difference was seen between the two lower dosage treatment groups. Data from all patients (including 8 who did not complete the 16 weeks of study) were analyzed for drug tolerability; reported adverse events were mild and considered by investigators mostly to be unrelated to the treatment.
Conclusions and Reviewers' Comments. Saquinavir is a highly specific inhibitor of HIV proteases that are essential for the final assembly of viable viral particles in HIV replication.
Acute Response to Inhaled Nitric Oxide in Newborns With Respiratory Failure and Pulmonary Hypertension
Authors: Day Ronald W. , Lynch Joanna M. , White Keith S. , Ward Robert M. 
Published: December 2021

Objective. Systemic oxygenation is improved by inhaled nitric oxide therapy in some newborns with respiratory failure and pulmonary hypertension. Our results with inhaled nitric oxide were reviewed to determine factors associated with an acute improvement in systemic oxygenation.
Methods. Newborns with oxygenation indices of 25 to 40 were prospectively randomized to receive conventional therapy with or without 20 ppm inhaled nitric oxide. All newborns with oxygenation indices greater than 40 were treated with inhaled nitric oxide. Hemodynamic, blood gas, and Doppler ultrasound measurements were performed before and after 30 to 60 minutes of observation or therapy. The severity of lung disease was classified by the chest radiograph as: (1) normal or focal disease; (2) moderate diffuse disease—diffuse lung disease with well-defined heart borders; or (3) severe diffuse disease—diffuse lung opacification with indistinct heart borders.
Results. Heart rate, blood pressure, and ductal diameters did not change. Blood gases and ductal shunting acutely improved only in patients treated with inhaled nitric oxide. Patients with normal lung fields or focal disease had the greatest degree of improvement in systemic oxygenation. Changes in oxygenation were not influenced by gestational age, baseline blood gases, the proportion of right-to-left ductal shunting, prior treatment with a surfactant, or the use of conventional or high-frequency jet ventilation. Collectively, blood gases and ductal shunting did not improve with inhaled nitric oxide in patients with lung hypoplasia or severe diffuse lung disease. Sustained improvement in oxygenation occurred in 87% of patients with oxygenation indices greater than 40 in whom oxygenation indices less than 40 acutely developed after exposure to nitric oxide, whereas 90% of patients in whom oxygenation indices less than 40 did not acutely develop were treated with extracorporeal membrane oxygenation or ultimately died.
Conclusions. Inhaled nitric oxide acutely improves systemic oxygenation in many newborns with respiratory failure and pulmonary hypertension. The diagnosis and chest radiograph are helpful in identifying patients who will have favorable acute responses to therapy. In patients with severe hypoxemia, the need for invasive support with extracorporeal membrane oxygenation may be determined by an acute trial of inhaled nitric oxide.