bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Prospective, Controlled Evaluation of Home Chemotherapy for Children With Cancer
Authors: Close Pamelyn , Burkey Edith , Kazak Anne , Danz Patricia , Lange Beverly 
Published: December 2021

Objectives. Infusion of chemotherapy at home provides an alternative to hospitalization for children with cancer. Few programs of pediatric home chemotherapy have been described or evaluated. The purpose of this work was to compare prospectively chemotherapy in the hospital to chemotherapy at home with respect to billed medical charges, out-of-pocket expenses, and quality of life.
Methods. Eligibility criteria for home therapy were defined. Parents and nurses were trained. Billed charges, loss of wages, out-of-pocket expenses, medical outcome, and quality of life of 14 patients for one course of chemotherapy in the hospital were compared with those for an identical course at home.
Results. Daily charges for chemotherapy were $2329 ± 627 in the hospital and $1865 ± 833 at home; out-of-pocket costs, $68 ± 31 and $11 ± 6, respectively; and loss of income, $265 ± 233 and $67 ± 107, respectively. Patients' independence, well-being, appetite, mood, and school work were significantly better at home, and parental time at work and with the family was greater.
Conclusion. Administration of selected chemotherapy at home results in lower billed charges, reduced expenses, reduced loss of income for parents, and a more satisfying lifestyle for patients and parents.
Congenital Nonobstructive, Nonhemolytic Jaundice: Effect of Tin-Mesoporphyrin
Authors: Rubaltelli Firmino F. , Dario Cinzia , Zancan Lucia 
Published: December 2021

Tin-protoporphyrin (SnPP) and tin-mesoporphyrin (SnMP) have been proposed for the treatment of Crigler-Najjar (CN) disease type 1;1,2 in fact, both drugs moderate the hyperbilirubinemia to some extent.1,2 These compounds bind to heme oxygenase far more avidly than does heme itself, thus blocking access of the natural substrate to the binding site of the enzyme and inhibiting heme degradation and bilirubin production.3-5 Because these synthetic compounds do not contain iron and thus cannot bind oxygen, they cannot be oxidatively transformed into bilirubin by the enzyme heme oxygenase and therefore remain intact until they are excreted.
Recently, SnPP was administered to a 2.5-month-old girl,1 and two 17-year-old boys were successfully treated with two cycles of prolonged SnMP therapy.2
Letter to the Editor
Authors: Kattwinkel John 
Published: December 2021

I can offer the following in response to Dr Rosenbloom’s letter:
Although the concept of a "hired gun" may be distasteful to most of us, it is not necessarily bad. If a witness is well prepared, restricts testimony to issues about which he/she is truly an expert, and testifies responsibly, there is no ethical or moral reason that such a person should not do so frequently and effectively. In fact the conscientious expert witness can make a valuable contribution to maintaining and improving the quality of medical care.
Injury Prevention Counseling by Pediatricians: A Benefit-Cost Comparison
Authors: Miller Ted R. , Galbraith Maury 
Published: December 2021

Objectives. The American Academy of Pediatrics believes that health education, through office-based counseling, can contribute to childhood injury prevention. This report extends previously published work on the effectiveness of primary care-based counseling and compares the costs and estimated monetary value of the benefits of safety counseling targeting children ages 0 to 4 years.
Methods. We estimate the savings achievable with comprehensive childhood injury prevention counseling organized around the three Framingham Safety Surveys used in The Injury Prevention Program (TIPP) developed by the American Academy of Pediatrics. We verify the estimated savings by comparing them with the effects of pediatrician counseling from separate analyses of the most fully evaluated interventions—in child motor vehicle occupant injuries, burns, and falls.
Results. TIPP pediatrician injury counseling sessions between the ages of 0 and 4 years can achieve estimated savings of $880 per child or $80 per visit. If all 19.2 million children ages 0 to 4 years completed TIPP, we estimate that $230 million would be saved annually in medical spending, and injury costs would decline $3.4 billion. Each dollar spent on TIPP childhood injury prevention targeting children ages 0 to 4 years returns nearly $13.
Conclusion. TIPP pediatrician injury counseling is a cost-effective method of preventing childhood injuries and should be more widely adopted.
INCREASED SERUM PHOSPHOLIPASE A2 ACTIVITY IN MALAWIAN CHILDREN WITH FALCIPARUM MALARIA
Authors: Vadas P , Taylor TE , Chimsuku L 
Published: December 2021

Malaria is a multisystem disease with a mortality rate of 5 to 30% even with optimal treatment. Earlier studies have shown increased circulating levels of TNF in the plasma of patients as an independent predictor of severe or fatal disease. TNF has already been shown to facilitate the release of proinflammatory enzyme phospholipase A2 from various cells in vitro. Because both TNF and PLA2 are increased in patients with septicemia and because TNF levels are already shown to be increased in patients with malaria, the authors studied the relationship between TNF levels, severity of disease, and PLA2 activity.
Seventy-five children (age 3 months to 10 years) with severe malaria due to Plasmodium falciparum and 34 controls (age 2 to 5 years) taking part in the malaria survey at a school in the same region in Malawi were included in the study. The children were afebrile and aparasitemic. Many of these children had cerebral malaria with coma. Twenty patients had uncomplicated falciparum malaria and 55 had cerebral malaria. Ten of them (all with cerebral malaria) died. In addition to examining the children, particularly for neurological status, laboratory studies obtained included the blood count, hematocrit, leukocyte count, thick blood smears for quantitative evaluation of parasitemia, and measurement of PLA2 activity.
Mean plasma PLA2 activity in 34 healthy controls was 424 U/mL, whereas in the 75 patients with malaria the mean value was 53 804 U/mL. In the 45 children who were available for follow-up 1 month later after treatment the mean plasma PLA2 activity was 2546 U/mL. The high mean plasma level was not different between children with cerebral malaria and those with uncomplicated malaria. However the PLA2 activity in 28 children with profound coma was much higher than in other patients with malaria. The initial plasma PLA2 activity was predictive of outcome. Patients who had levels higher than 60 000 U/mL had a higher mortality rate (33%) compared with those with values less than 60 000 U at (8.3%). There was also a significant correlation between TNF and plasma PLA2 activity. Pretreatment serum PLA2 activity also correlated with the intensity of parasitemia. The cerebral spinal fluid PLA2 activity was not elevated even in those patients with severe malaria.
The biological role of this observation is unclear. However, selective inhibition of PLA2 may be a new target for future therapy because PLA2 is proinflammatory enzyme.
African-American Youth: Essential Prevention Strategies for Every Pediatrician
Authors: Murray-Garcia Jann 
Published: December 2021

National statistics of morbidity and mortality warrant our urgent attention to the issue of effective prevention strategies among African-Americans. Implicit, explicit, and often internalized messages of inferior value, negative expectations, and expendability remain a part of everyday life for African-American youth. This sociopolitical disenfranchisement has a direct impact on their health and development and on our ability to provide effective preventive and therapeutic intervention.
Pediatricians enjoy a deserved perception of expertise in those areas that bear directly on the healthy physical and psychosocial development of all children. We have not heretofore optimally exploited this perceived and real expertise in prevention efforts among African-American children. We ourselves are in need of reeducation. We need to first shatter the insidious conceptual barriers of our own impotence as well as the perceived impotence of African-American patients in our collective abilities to inspire and affect change. On a patient-by-patient basis, among our regional pediatric communities and in the public policy arena, we can be involved in the process that restores to our African-American patients a sense of full citizenship and potential within our society. Without adoption of this process of sociopolitical reenfranchisement, our best-intended efforts at prevention in this community will always tragically fall short of their full and critically needed potential.
PATHOLOGIST SAYS FIVE CHILDREN DIED OF DELIBERATE SUFFOCATION
Authors: L. J. F. 
Published: December 2021

Testifying in the trial of a woman charged with killing her five young children, the chief forensic pathologist of the New York State Police said today that all five had been deliberately suffocated and were not, as was originally believed, victims of crib death.
The case of Mrs. Hoyt, a 48-year-old housewife raised in this rural county, has drawn national attention because the deaths of her five children had been cited for two decades as textbook cases of so-called crib death, on sudden infant death syndrome.
... Defense lawyers have declined to say whether Mrs. Hoyt will testify in her own defense.
If she does, she will no doubt face questions from the prosecution about the confession she made and signed last spring. A police investigator has testified that in her statement, which she has since recanted, she voluntarily told him how she had suffocated each of her children: Eric, Molly, and Noah were smothered with pillows. Julie was pressed against her mother's chest until her breathing stopped. James–who was 2½ years old, the only child to survive past the age of 3 months–was suffocated with a bath towel.
The prosecutor had quoted Mrs. Hoyt as saying she could not bear hen children's crying.
The defense lawyer has argued that Mrs. Hoyt's confession was signed under duress–without a lawyer present, without benefit of her reading glasses, and without having been properly instructed of her rights.
Atlantoaxial Instability in Down Syndrome: Subject Review
Authors:   Committee on Sports Medicine and Fitness
Published: December 2021

This Policy Statement was retired February 2008.
DEFINITION OF THE PROBLEM
In 1984, the American Academy of Pediatrics (AAP) published a position statement on screening for atlantoaxial instability (AAI) in youth with Down syndrome.1 In that statement, the AAP supported the requirement introduced by the Special Olympics in 1983 that lateral neck radiographs be obtained for individuals with Down syndrome before they participate in the Special Olympics' nationwide competitive program for developmentally disabled persons. Those participants with radiologic evidence of instability are banned from certain activities that may be associated with increased risk of injury to the cervical spine. This policy seemed to be prudent in light of the information available at that time. However, the AAP Committee on Sports Medicine and Fitness recently has reviewed the data on which this recommendation was based and has decided that uncertainty exists concerning the value of cervical spine radiographs in screening for possible catastrophic neck injury in athletes with Down syndrome. The 1984 statement therefore has been retired. This review discusses the available research data on this subject.
BACKGROUND
AAI, also called atlantoaxial subluxation, denotes increased mobility at the articulation of the first and second cervical vertebrae (atlantoaxial joint). This condition is found not only in patients who have Down syndrome but also in some patients who have rheumatoid arthritis, abnormalities of the odontoid process of the axis, and various forms of dwarfism.1 The causes of AAI are not well understood but may include abnormalities of the ligaments that maintain the integrity of the C-1 and C-2 articulation, bony abnormalities of C-1 or C-2, or both.1-11
Recommendations for the Use of Live Attenuated Varicella Vaccine
Authors:   Committee on Infectious Diseases
Published: December 2021

In the American Academy of Pediatrics policy statement entitled "Recommendations for the Use of Live Attenuated Varicella Vaccine" by the Committee on Infectious Diseases that appeared in the May 1995 issue of Pediatrics, there is a typographical error.
On page 793 under the heading Recommendations for Vaccine Use in the fifth line of the first paragraph the word mild should be wild.
A Call to Action: The Institute of Medicine Report on Emergency Medical Services for Children
Authors: Knapp Jane F. 
Published: December 2021

Emergency Medical Services for Chi (EMS-C) must be recognized as a public responsibility; the "market" cannot be relied on to produce the kind of planning and cooperation required to make services available to all who need them.1 The Institute of Medicine (IOM) Report on Emergency Medical Services For Children.
Each year millions of American chi become seriously ill or injured. If you have ever encountered a child who did not receive the medical care they needed or deserved under these circumstances you understand what EMS-C is all about. The familiar adage, "Children are not small adults," emphasizes that their care must be an integral part of a system not an afterthought once the adults have been addressed. The achievement of the desired level of competence for EMS-C in the larger system is hampered by many factors. These include lack of organization, equipment, training, and a tack of understanding of the child's unique problems and needs.
In response to these needs, Congress approved a demonstration grant program in 1984. The purpose of the program was threefold: to expand access to EMS-C, to improve the quality available through existing Emergency Medical Systems (EMS), and to generate knowledge and experience that would be of use to all states and localities seeking to improve their system.
Continuing interest prompted the formation of the Committee on Pediatric Emergency Medical Services by the IOM. This 19-member committee Chaired by Dr Donald N. Medearis, Jr released their report in the summer of 1993. The IOM report entitled Emergency Medical Services for Chi is available in both a soft cover 25-page summary and the full text (see Appendix).
Infantile Colic: Child and Family Three Years Later
Authors: Rautava Päivi , Lehtonen Liisa , Helenius Hans , Sillanpää Matti 
Published: December 2021

Objective. To assess differences in family functioning or child-rearing attitudes within families with previously colicky infants and to assess whether the children differed in their behavior, development, or frequency of allergies.
Study Design. A controlled, prospective study with infants (3 months to 3 years of age) and their families.
Participants. Three hundred thirty-eight infants with and 866 infants without exhibited colic and their families.
Methods. Questionnaires to mothers and nurses regarding infantile colic (3 months of age); questionnaires to mothers, fathers, and nurses regarding interactions within the family, parents' satisfaction with daily life, child caring, child behavior, and development (3 years old); the Denver Developmental Screening Test (parents filled out at home during the whole 3 years of infant development); the Achenbach Behavior Checklist for 2- to 3-year-old children (the 3-year visit at a well baby clinic).
Results. The families of previously colicky infants demonstrated more dissatisfaction with the arrangements of daily family responsibilities and with the amount of both leisure time and shared activities. The children in the colic group had more sleeping problems and more frequent temper tantrums (at 3 years of age) than the control group.
Conclusions. The families with colicky infants had more distress 3 years later. Families with colicky infants should be provided practical support in improving daily family functioning and child rearing. In addition, underlying problems in family relationships should be managed appropriately.
Life Events and Other Risk Factors for Somatic Symptoms in Adolescence
Authors: Poikolainen Kari , Kanerva Riitta , Lönnqvist Jouko 
Published: December 2021

Objective. To determine mental health risk factors related to somatic symptoms, common in adolescence.
Design. Cross-sectional study.
Setting. Ten schools, corresponding approximately to Us senior high schools, in two cities in Finland.
Subjects. A total of 1429 adolescents with no serious disease or injury during the previous 12 months.
Results. Frequent or rather frequent occurrence of two or more symptoms was reported by 44% of the female students and 28% of the male students during the past 6 months. Regression analyses showed that among female students, somatic symptoms were associated positively with serious illness or injury in the family, an increased number of arguments between parents, and breaking up with boyfriends or girlfriends; among male students, symptoms were associated with an increased absence of a parent from the home and trouble with siblings; and among both sexes, they were associated with failing examinations. Among male students, changing to new schools was associated with fewer symptoms. Symptom scores associated positively with trait anxiety, trait depression, an immature defense style, and alcohol or drug use among both sexes. Among male students, smoking was associated with more symptoms, and among female students, high self-esteem was associated with fewer symptoms.
Conclusions. These findings suggest that mental health risk factors are strong correlates of somatic symptoms among adolescents with no serious disease. Follow-up studies are needed to clarify the predictive value of these factors.
THALIDOMIDE MAKES A COMEBACK
Authors: L. J. F. 
Published: December 2021

Thalidomide, the drug responsible for the deformities of thousands of babies born in the 1950s, appears to be making a comeback. Scientists have recently reported that the sedative, once widely prescribed in Europe for morning sickness but long since banned for such use, may inhibit the AIDS virus as well as alleviate certain symptoms associated with tuberculosis and cancer.
The first American patent for thalidomide was issued in 1958, but last week Gilla Kaplan, an associate professor of immunology at Rockefeller University who pioneered the new thalidomide research, received a patent covering new potential applications for the drug.
"Thalidomide is really the treatment of choice for leprosy," she said. "It alleviates the weight loss and fevers. I figured if I knew how thalidomide worked I would understand what is causing the symptoms."
"... thalidomide slows the body's production of a substance known as tumor necrosis factor alpha, a protein that at normal levels actually helps combat infection and malignant cells. But high concentrations of the protein appear to result in fever, weight loss, and other symptoms in patients with cancer, tuberculosis, and AIDS.
Independent Parental Administration of Prednisone in Acute Asthma: A Double-Blind, Placebo-Controlled, Crossover Study
Authors: Grant Cameron C. , Duggan Anne K. , DeAngelis Catherine 
Published: December 2021

Objective. To determine the effectiveness of a single dose of prednisone administered by a parent to a child early in an asthma attack.
Design. A randomized, double-blind, placebo-controlled, crossover study with children enrolled for 12 months (6 months prednisone, 6 months placebo).
Setting. A primary-care clinic and emergency department of an inner-city teaching hospital from March 1992 through May 1993.
Children. Children 2 to 14 years of age enrolled in this clinic who had made two or more outpatient (emergency department or primary-care clinic) visits for acute asthma in the preceding year.
Selection. There were 204 eligible children, of whom 86 were contacted and enrolled; of these, 78 (91%) completed the study.
Intervention. Capsules containing prednisone (2 mg/kg up to 60 mg) or placebo. Parents were instructed to give their child one capsule for an asthma attack that had not improved after a dose of the child's regular acute asthma medicine.
Measurements. Parents were interviewed every 3 months. Computerized patient records and chart reviews were used to verify parent reports. Outcome measures were the numbers of outpatient visits and hospitalizations for treatment of acute asthma.
Results. Neither the total number of attacks nor the number for which medicine was used differed significantly by arm of study. There was a larger number of attacks resulting in outpatient visits when children were in the group that received prednisone (1.1 ± 0.59 versus 0.59 ± 0.86). This trend was less pronounced but persisted when limited to attacks for which the medicine was given (0.58 ± 0.99 versus 0.35 ± 0.55). Neither the number of attacks resulting in admission nor the number of hospital days differed significantly by arm of study.
Conclusions. A single dose of prednisone available for use at home early in an asthma attack was associated with an increase in outpatient visits made for acute asthma. When prednisone was given for an attack, there was no reduction in outpatient visits. This intervention can not be recommended for children with asthma. These results should be confirmed in other pediatric populations.
The Cost of Implementation of the Clinical Laboratory Improvement Amendments of 1988—The Example of Pediatric Office-Based Cholesterol Screening
Authors: Tershakovec Andrew M. , Brannon S. Diane , Bennett Michael J. , Shannon Barbara M. 
Published: December 2021

Objective. To measure the additional costs of office-based laboratory testing due to the implementation of the Clinical Laboratory Improvement Amendments of 1988 (CLIA '88), using cholesterol screening for children as an example.
Methods. Four-to ten-year-old children who received their well child care at one of seven participating pediatric practices were screened for hypercholesterolemia. The average number of analyses per day and days per month were derived from the volume of testing completed by the practices. Nurses and technicians time in the screening process were measured and personnel costs were calculated based on salary and fringe benefit rates. Costs of supplies, analyzing control samples, instrument calibration, and instrument depreciation were included. Costs estimates of screening were then completed. CLIA '88 implementation costs were derived from appropriate proficiency testing and laboratory inspection programs.
Results. In six practices completing a low volume of testing, 2807 children (5 to 6 children per week) were screened during the observation period, while 414 (about 25 children per week) were screened in one high-volume practice implementing universal screening over a 4-month period. For the six low-volume practices, the cost of screening was $10.60 per child. This decreased to $5.47 for the high-volume practice. Estimated costs of CLIA '88 implementation, including additional proficiency testing and laboratory inspection, added $3.20 per test for the low-volume practices, and $0.71 per test for the high-volume testing.
Conclusions. Implementation of CLIA adds significantly to the cost of office-based chemistry laboratory screening. Despite these additional expenses, the cost of testing is still within a reasonable charge for laboratory testing, and is highly sensitive to the volume of tests completed.