bluuebunny/crossref_metadata_2025_split huggingface dataset:
Infant Sleep Position: A Telephone Survey of Inner-city Parents of Color
Authors: Johnson C. Merle , Borkowski Margaret M. , Hunter Kimberly E. , Zunker Christie L. , Waskiewicz Katherine , Evans Jason M. , Hether Nicholas W. , Coletta Frances A. 
Published: December 2021

Objective.To assess what positions parents were placing their infants to sleep and their opinion about sleep positioning.Design.A prospective telephone survey of parents of 2-month-old infants with repeated measures at 4 months that began during the second wave of the Back to Sleep campaign in 1994.Participants.African-American, Hispanic, Asian, and American Indian parents from inner cities in the north central United States.Results.Preference for prone positioning existed at both 2 and 4 months (over 40%). Twenty-four percent of parents disagreed with the recommendations of the American Academy of Pediatrics regarding supine or lateral positioning.Conclusions.Although prone sleep positioning has decreased over the past 5 years, many inner-city parents of color prefer this over supine. The Back to Sleep campaign appears effective in changing attitudes and medical personnel appear influential in promoting risk reductions associated with sudden infant death syndrome. More efforts are clearly needed to convince parents who disagree with and resist recommendations.sleep, infants, SIDS, African-Americans, Back to Sleep (campaign).
Differences in Knowledge of Hepatitis B Among Vietnamese, African- American, Hispanic, and White Adolescents in Worcester, Massachusetts
Authors: Wiecha John M. 
Published: December 2021

Objective.
To assess the level of knowledge about hepatitis B of Vietnamese adolescents, a group at high risk for hepatitis B, and compare it to the knowledge of adolescents of other races and ethnicities.

Methods.
A sample of 2816 adolescents was surveyed in 1993 in 2 middle schools and 2 high schools in Worcester, Massachusetts, using a self-administered multilingual questionnaire.

Results.
Knowledge of hepatitis B was low overall. Vietnamese respondents were more likely than were other students to know that hepatitis B affects the liver (35.6% vs 22.6%). However, they were much less likely than were other students to correctly identify sex with an infected person as a risk factor for infection (13.7% vs 32.8%). Independent predictors of this knowledge were: white race; older age; attending high school versus middle school; having been taught about hepatitis B in school; knowing the definition of hepatitis B; reporting better grades; having a family member with hepatitis B; and being more highly acculturated.

Conclusions.
Adolescent knowledge about risk of infection was low in this study. Attention should be directed at providing health education on hepatitis B to adolescents, particularly to Vietnamese. Health care providers, community health educators, and others engaged in the effort to control and eradicate hepatitis B should be sensitive to the unique educational and cultural needs of high-risk southeast Asian adolescent populations.
Sink or Swim—Clinicians Don't Often Counsel on Drowning Prevention
Authors: Barkin Shari , Gelberg Lillian 
Published: December 2021

Objective.Drowning is one of the leading causes of injury death for young children in the United States. This study examined primary care providers' knowledge of and counseling on drowning prevention.Methods.A random sample of 465 Los Angeles County pediatricians, family physicians, and pediatric nurse practitioners who serve families with young children received mailed questionnaires; 325 (70%) responded.Results.About two thirds of clinicians did not know that injury deaths attributable to drowning were more common than those attributable to toxic ingestions and firearm injuries in young children. Only one third of clinicians stated they counseled on drowning prevention. Counseling drowning prevention was positively associated with female gender (odds ratio: 1.97; 95% confidence interval: 1.64, 2.30) and negatively associated with an attitude that drowning prevention counseling was less important than other injury prevention topics (odds ratio: .73; 95% confidence interval: .61, .85). Clinician specialty, age, years out from training, proportion of well-child examinations in a typical week, having children, practice setting, and knowledge of drowning injury deaths were not significant in multivariate analysis.Conclusion.The belief of clinicians that it is less important to counsel on drowning prevention than other injury prevention topics poses a substantial challenge to their providing such education to families with young children.drowning, counseling, physician's role.
Reducing the Risk of Alcohol-Exposed Pregnancies: A Study of a Motivational Intervention in Community Settings
Authors:   The Project CHOICES Intervention Research Group*
Published: December 2021

Objectives. To test the feasibility and impact of a motivational intervention in reducing drinking and/or increasing effective contraception in women who are at risk for an alcohol-exposed pregnancy.
Methods. A multisite single-arm pilot study was conducted in 6 community settings in 3 large cities. A total of 2384 women were screened for eligibility; 230 were eligible on the basis of their alcohol use and lack of contraception. Of the eligible women, 190 consented and were enrolled, and 143 (75.3%) completed the 6-month follow-up. The intervention consisted of 4 manual-guided motivational counseling sessions delivered by mental health clinicians and 1 contraceptive counseling session delivered by a family planning clinician. Outcome measures include intervention completion rates, alcohol use (frequency, quantity, and bingeing), contraceptive use and effectiveness, and risk for alcohol-exposed pregnancy.
Results. Among women who completed the 6-month follow-up, 68.5% were no longer at risk of having an alcohol-exposed pregnancy; 12.6% of women who completed the program reduced drinking only; 23.1% used effective contraception only; and 32.9% reported both. Results were consistent across the 6 diverse high-risk settings.
Conclusions. This study provides evidence that providing 4 sessions of motivational interviewing plus a contraception counseling session is feasible and strongly suggests that this intervention can decrease the risk of alcohol-exposed pregnancy in women in high-risk settings. Additional investigation in a randomized controlled trial is warranted.
Sharing Prescription Medication Among Teenage Girls: Potential Danger to Unplanned/Undiagnosed Pregnancies
Authors: Daniel Katherine Lyon , Honein Margaret A. , Moore Cynthia A. 
Published: December 2021

Objective. The objective of this study was to determine how often children and adolescents share prescription medications and, because of teratogenic concerns, assess specific reasons why girls might engage in medication-sharing behaviors.
Methods. Data were collected as part of Youthstyles, a mail survey of children and adolescents 9 through 18 years of age (764 girls and 804 boys) about health issues, attitudinal variables, and media preferences. Information collected by the survey included the respondent’s history of borrowing or sharing prescription medications, the frequency with which sharing occurred, the reasons why medications might be borrowed or shared, and who influences their decisions to borrow or share medication.
Results. A total of 20.1% of girls and 13.4% of boys reported ever borrowing or sharing medications. Of the girls surveyed, 15.7% reported borrowing prescription medications from others, and 14.5% reported sharing their prescription medication with someone else. The reported likelihood of sharing increased with age. Medication sharing or borrowing was not a “one time only” emergency use for many: 7.3% of girls 15 through 18 years of age had shared medications &gt;3 times. Reasons that girls gave for why they would share medications included having a prescription for the same medicine (40.2%), getting the medication from a family member (33.4%), having the same problem as the person who had the medication (29%), or wanting something strong for pimples or oily skin (10.5%).
Conclusions. Medication sharing is relatively common among children and adolescents and is more common among girls than boys. An adolescent who receives a medication via sharing does not receive the appropriate information about its actions and possible negative interactions with other medications or any other associated risks. Sharing potentially teratogenic drugs is of special concern. Many barriers exist to communicating the risk about teratogenic drugs to women and girls, particularly if they are not planning a pregnancy or are unaware that they are already pregnant. These findings suggest the need for basic research on issues related to the dangers of medication sharing and teratogenic risks, as well as the development of successful approaches to communicate these risks.
Attention-Deficit/Hyperactivity Disorder in School-Aged Children: Association With Maternal Mental Health and Use of Health Care Resources
Authors: Lesesne Catherine A. , Visser Susanna N. , White Carla P. 
Published: December 2021

Objective. To investigate the association between the mental health status of mothers and attention-deficit/hyperactivity disorder (ADHD) in their school-aged children and to characterize the health care access and utilization of families affected by ADHD.Methods. Survey logistic regression procedures were used to investigate the association between activity-limiting mental health conditions in mothers and ADHD in their school-aged children using 1998 National Health Interview Survey data. A total of 9529 mother-child dyads were included in the final analysis.Results. The prevalence of ADHD among children aged 4 to 17 years was 6.3%. Survey logistic regression statistics revealed an association between an activity-limiting depression, anxiety, or emotional problem in mothers and ADHD in their children. This association persisted after controlling for the gender, age, and race of the child; household income (as a function of the 1997 poverty level); and type of family structure as reported by the mother (adjusted odds ratio [OR]: 4.2; 95% confidence interval [CI]: 2.2–8.1). Mothers of a child with ADHD were 13 times more likely to have consulted with a mental health professional about their child’s health within the past year despite reporting an inability to afford prescription medications (OR: 3.3; 95% CI: 2.2–4.9) and mental health care (OR: 7.4; 95% CI: 4.6, 11.8) for the child.Conclusions. Maternal mental health is significantly associated with the presence of ADHD in school-aged children. This finding further supports a link between maternal mental health and behavioral outcomes in children. Health care utilization and access findings support a family-oriented system of care.
Safety of Thimerosal-Containing Vaccines: A Two-Phased Study of Computerized Health Maintenance Organization Databases
Authors: Verstraeten Thomas , Davis Robert L. , DeStefano Frank , Lieu Tracy A. , Rhodes Philip H. , Black Steven B. , Shinefield Henry , Chen Robert T. ,   for the Vaccine Safety Datalink Team
Published: December 2021

Objective. To assess the possible toxicity of thimerosal-containing vaccines (TCVs) among infants.
Methods. A 2-phased retrospective cohort study was conducted using computerized health maintenance organization (HMO) databases. Phase I screened for associations between neurodevelopmental disorders and thimerosal exposure among 124 170 infants who were born during 1992 to 1999 at 2 HMOs (A and B). In phase II, the most common disorders associated with exposure in phase I were reevaluated among 16 717 children who were born during 1991 to 1997 in another HMO (C). Relative risks for neurodevelopmental disorders were calculated per increase of 12.5 μg of estimated cumulative mercury exposure from TCVs in the first, third, and seventh months of life.
Results. In phase I at HMO A, cumulative exposure at 3 months resulted in a significant positive association with tics (relative risk [RR]: 1.89; 95% confidence interval [CI]: 1.05–3.38). At HMO B, increased risks of language delay were found for cumulative exposure at 3 months (RR: 1.13; 95% CI: 1.01–1.27) and 7 months (RR: 1.07; 95% CI: 1.01–1.13). In phase II at HMO C, no significant associations were found. In no analyses were significant increased risks found for autism or attention-deficit disorder.
Conclusions. No consistent significant associations were found between TCVs and neurodevelopmental outcomes. Conflicting results were found at different HMOs for certain outcomes. For resolving the conflicting findings, studies with uniform neurodevelopmental assessments of children with a range of cumulative thimerosal exposures are needed.
Impact of the Phenylalanine Hydroxylase Gene on Maternal Phenylketonuria Outcome
Authors: Güttler Flemming , Azen Colleen , Guldberg Per , Romstad Anne , Hanley William B. , Levy Harvey L. , Matalon Reuben , Rouse Bobbye M. , Trefz Friedrich , de la Cruz Felix , Koch Richard 
Published: December 2021

Objective. The aim of the present study was to examine to what extent maternal and offspring phenylalanine hydroxylase (PAH) genotypes in conjunction with maternal IQ and dietary control during pregnancy are related to cognitive development in offspring of women with phenylketonuria (PKU).
Methods. PAH gene mutations were determined in 196 maternal PKU subjects and their offspring. The women were grouped according to PAH genotype, which predicts the metabolic phenotype (severe PKU, mild PKU, and mild hyperphenylalaninemia [MHP]). IQ was determined in both the mothers (Wechsler Adult Intelligence Scale–Revised at &gt;18 years) and their children (Wechsler Intelligence Scale for Children–Revised at ≥6–7 years of age).
Results. According to PAH genotypes, 62% of the women exhibited severe PKU, 19% exhibited mild PKU, and 19% exhibited MHP. Maternal IQ increased, and the assigned phenylalanine (Phe) levels decreased with decreasing severity of PAH genotype. In offspring of mild maternal PKU, multiple regression analysis showed offspring IQ to be significantly related to maternal IQ but not to Phe exposure during pregnancy, which was &lt;750 μmol/L in all cases of mild PKU. In offspring of mothers with severe PKU and average Phe exposure during pregnancy of 360 to 750 μmol/L, multiple regression analysis revealed both maternal IQ and Phe exposure to be significant predictors of offspring IQ. When average Phe exposure was &lt;360 μmol/L, cognitive development was normal (mean IQ: 105), whereas an average Phe exposure of &gt;750 μmol/L severely depressed offspring IQ (mean IQ: 56) in this group regardless of maternal IQ. It could not be documented that the offspring PAH genotype affects cognitive development.
Conclusion. Female individuals with severe PKU should be offered a diet for a lifetime. If good metabolic control is established, then women with PKU will have children with IQ scores that are not influenced by their disease.
The “Every Child Deserves a Medical Home” Training Program: More Than a Traditional Continuing Medical Education Course
Authors: Moore Bob , Tonniges Thomas F. 
Published: December 2021

Objectives. 1) To develop and implement an innovative, interactive, and nontraditional continuing medical education (CME) curriculum to educate primary care physicians, pediatric office staff, child health advocates, allied health care professionals, and parents of children with special health care needs (CSHCN) about the medical home concept of care and 2) to identify key partners in communities to plan the CME program and ultimately plan for fostering medical homes at the community and state levels.Methods. Participant outcomes for the CME program and planning process include 1) explaining the elements of the medical home concept as applied to their practice environment or child’s care; 2) understanding the concepts, skills, and information necessary to care successfully for CSHCN who are enrolled in managed care organizations; 3) accurately describing trends and developments in caring for CSHCN; 4) identifying programs in the community that serve CSHCN; and 5) assessing and, if necessary, improving pediatric office practices to ensure that they are sensitive to families of children and youths with special health care needs.Conclusion. A diverse national committee that included physicians, nonphysicians, and family members developed the Medical Home Training Program curriculum. The medical home curriculum was written to meet the needs of the local community. The training program can offer CME credit and use a direct, outcome-based adult learning technique (eg, determine short- and long-term goals). Furthermore, the program parallels and complements the Healthy People 2010 goals and objectives.
EFFECTS OF HYDRAZINOPHTHALAZINE (APRESOLINE®) ON BLOOD PRESSURE AND RENAL FUNCTION IN CHILDREN WITH ACUTE NEPHRITIS
Authors: MCCRORY W. W. , RAPOPORT M. 
Published: December 2021

The response of hypertension occurring in acute nephritis in children to apresoline® has been studied. Significant temporary reductions in elevated blood pressure were produced by parenteral and oral apresoline® in 5 of 7 children with acute nephritis. The effect of this agent in two patients with hypertension and chronic renal disease was less impressive.
Studies of changes in renal function following parenteral administration of apresoline® were made in seven children with acute nephritis. Significant temporary depressions of the glomerular filtration rate and urine flow were observed in every instance in which apresoline® induced a fall in systemic blood pressure.
Apresoline® did not regularly induce an increase in renal plasma flow in these subjects. Changes in renal plasma flow were variable, and even decreases were observed. Even though apresoline® can induce a fall in blood pressure in children with hypertension and acute nephritis, this response may be associated with a temporary depression in renal excretory function.
INFECTIOUS MONONUCLEOSIS ENCEPHALITIS
Authors: WALSH FAITH C. , POSER CHARLES M. , CARTER SIDNEY 
Published: December 2021

A case of severe encephalitis due to infectious mononucleosis is reported. An eight year old white boy developed meningeal signs, intermittent coma, opisthotonos, extensor spasms, mild papilledema and hyperpyrexia two weeks after the onset of a sore throat and cervical lymphadenopathy. The diagnosis of infectious mononucleosis was confirmed by a heterophile antibody titer of 1:1024.
The neurologic complications of the disease are uncommon in adults and are even more unusual in children. Only seven cases were found in the literature. Any or all parts of the nervous system may become involved; cerebrospinal fluid abnormalities may be the only manifestations of such involvement. The prognosis in children has been uniformly favorable with little or no neurologic residuals.
Electroencephalographic and cerebrospinal fluid studies made on patients with infectious mononucleosis indicate a higher incidence of nervous system involvement than is evident by clinical examination.
Serial heterophile agglutination determinations in patients with unexplained nervous system manifestations may clarify the diagnosis.
EDUCATION
Authors: POWERS GROVER F. , WASHBURN ALFRED H. 
Published: December 2021

IN RECENT years much has been written about various aspects of medical education. I would hesitate to add another article to the literature were it not for a specific invitation from Dr. Grover Powers to contribute to his section in Pediatrics. This is a privilege and an opportunity which I welcome.
For the past 65 to 70 years pediatricians have striven—and for the most part successfully—to establish in medical schools separate departments of pediatrics. They have argued that pediatrics was an important specialty. They have pointed out that the small infant is a very different sort of organism than the school child; and that the latter presents very different health problems than does the mature adult. They have demonstrated conclusively that anatomic structure, physiologic functioning and responses to disease, or to therapeutic measures, are all unique for particular age levels.
The Child Research Council and the Department for the Study of Human Growth, University of Colorado School of Medicine, Denver.
SPECIFIC SERUM ANTIBODIES TO INFECTIOUS DISEASE AGENTS IN TARAHUMARA INDIAN ADOLESCENTS OF NORTHWESTERN MEXICO
Authors: Gajdusek D. Carleton , Rogers Nancy G. 
Published: December 2021

A serologic-epidemiologic survey has been made on serum specimens collected at Sisoguichi in the Sierra Madre Occidentalis of Northwestern Mexico of 50 adolescent Tarahumara Indian boys and 6 adult Tarahumara. Search for evidence of previous contact with, and presumably, present immunity to 17 viruses, 5 rickettsiae, toxoplasma, 17 leptospiral serotypes, the treponeme of syphilis, and 5 bacteria has been conducted by use of tests for 53 specific antibodies, using mouse and tissue culture neutralization, complement-fixation, hemagglutination-inhibition, flocculation, treponemal immobilization, agglutination-lysis, and agglutination procedures.
Poliomyelitis antibodies to all 3 types were found in 51 per cent of the adolescents, while 78 per cent had antibodies to type 1, 90 per cent to type 2 and 63 per cent to type 3.
Mumps complement-fixing antibody was present in significant titer in 74 per cent of the adolescents, that for herpes simplex in 72 per cent and that for the psittacosislymphogranuloma venereum group in 18 per cent. These results are compared to data in the literature for other population groups. Three of fifty boys had specific complement-fixing antibody to epidemic typhus. Three of the fifty-six subjects studied had specific neutralizing antibody to encephalomyocarditis virus. The significance of this virus as a cause of aseptic meningitis and of other central nervous system disease in childhood is discussed elsewhere in this journal. There the suggestion is made, on the basis of the data summarized, that cases of encephalomyocarditis virus infection may be found in children in the United States once clinicians search for it as the cause of obscure central nervous system infections in young patients. Significant negative results include the absence of evidence for previous contact among these Tarahumara with any of 7 arthropod-borne viruses occurring in North America (EEE, WEE, SLE, VEE, CE, CT, YF), dengue types 1 and 2, lymphocytic choriomeningitis, murine typhus, Rocky Mountain spotted fever, rickettsialpox and Q fever. Only 1 boy had positive leutic serology.
Serologic surveys of this type offer the possibility of evaluating the infectious disease problem in a community in which little medical observation has been made and of adding significant new epidemiologic information to data obtained from records of reportable diseases in communities where accurate reporting of infectious diseases has long been the practice.
MUCORMYCOSIS
Authors: Harris Jerome S. 
Published: December 2021

The present report is that of a child with the typical symptomatology of Mucormycosis of the central nervous system. The diagnosis was established during life by biopsy and culture. The organism was identified as Rhizopus arrhizus, a member of the family Mucoraceae. The patient recovered on therapy which consisted of rigid control of the diabetes, desensitization against the fungus and the administration of iodides.
The literature on "Mucor'" infections in humans has been reviewed with particular reference to the rare instances of involvement of the nervous system. The typical story is that of a poorly controlled diabetic patient who develops a fulminating orbital or nasal infection and dies in a few days with signs of invasion of the central nervous system. Examination reveals a necrotizing, inflammatory and vascular occlusive process in which broad non-septate hyphae may be seen. Until the present case, diagnosis has not been made during life, the infecting fungus has not been cultured or identified and no patient has survived.