bluuebunny/crossref_metadata_2025_split huggingface dataset:
Injuries in Child-Care Centers: Rates, Severity, and Etiology
Authors: Alkon Abbey , Kaiser Pamela J. , Tschann Jeanne M. , Boyce W. Thomas , Genevro Janice L. , Chesney Margaret 
Published: December 2021

Injuries are the leading cause of mortality among children.1 To develop effective injury prevention programs, more information is needed regarding the incidence, severity, and etiology of injuries sustained by children of different age groups and in different settings.
Childhood injury research has focused primarily on severe injuries and the physical environmental hazards that contribute to those injuries.2-4 Although the incidence of severe injuries is critically important from the perspective of morbidity and mortality, these injuries are relatively rare and consequently difficult to study. Scheidt5 has suggested that it may be useful to determine whether there are reliable markers of risk for severe injuries that are based on more frequently occurring events or easily observable indicators. Minor injuries, the most common type of injury that occurs in child-care settings,6-8 may be a marker of risk for severe injuries; however, previous research has not investigated the relationship between minor and severe injuries.
Childhood injury research has also typically focused on a single category of etiologic factors, generally either environmental factors such as climbing equipment and impact surfaces,2,9 or child factors such as aggression, overactivity, and personal characteristics.10-11 The relative importance of different etiologic factors and the joint contributions of child-related and environmental factors have not been thoroughly examined.
Research on childhood injuries indicates that a small subgroup of children, usually 15% to 20% of a sample, sustain the majority of injuries in any given setting.6,8,10,12 This phenomenon may be the result of chance or characteristics of the subgroup that may differ from those of other children.
Health in Child Day Care: The Physician—Child-Care-Provider Relationship
Authors: Taras Howard L. 
Published: December 2021

Health promotion and disease prevention strategies for child day-care have not kept pace with the needs of children. One example is the inconsistent interaction between community physicians and child-cane providers. Although there isn't yet data documenting benefits of increased communication between health practitioners and child-care professionals, there is speculation by many that these sorts of physician-community liaisons will help to close serious gaps in current health-care practices.1-3 This paper reviews how increased physician involvement could improve the health situation in child day care and explores ways physicians can become more involved.
THE HEALTH NEEDS
Need for Consultants
There are basic and predictable health issues that arise from grouping young children together. They are topics for research and discussion among epidemiologists, medical investigators, and other health professionals. The issues include exclusion criteria for attendance in day care, spread of respiratory and gastrointestinal infections,4 the potential for childhood viruses to affect unborn children of pregnant care givers,5 medication policies,6 and the pros and cons of "sick-care" centers.7 Other health issues such as child development and emotional, behavioral, and nutritional health of children are also under study.8 This body of literature has served to define most health consultation needs of child day-care programs. Few day-care centers on family day-care homes actually use a health consultant.9 It is hoped that publication of the American Public Health Association's and American Academy of Pediatrics' (APHA/AAP's) National Health and Safety Performance Standards10 and its distribution to health professionals and child-care providers will help to change that. Its success depends partly on whether health professionals will be available, willing, and trained to serve as health consultants.
Economic Issues in Child-Care Policy
Authors: Bergmann Barbara R. 
Published: December 2021

There are four important, interrelated issues in child-care policy, on which economists can make contributions. One is the adequacy of the supply of "affordable" child care. A second is the proper role of government, if any, in providing or paying for child care. A third is whether the public could afford to have the government provide child care, assuming that such provision was deemed appropriate and desirable. A fourth is the standards of quality that should be mandated by the government for federal or private-sector child-care facilities. The standard literature tends to be scant on all of these topics.1,2
Economists are seldom unanimous in their opinions, and they certainly do not agree on child-care issues. The now-sizeable school of economists led by Milton Friedman, whose members have staffed the administrations of the last two US presidents, believe that, with very few exceptions, government interventions into the economic functioning of the citizens and their businesses are pernicious.
Economists faithful to this tradition argue that parents should buy child care out of their own incomes from nongovernmental providers and that those providers should be regulated minimally if at all.
An opposing point of view is that child care is different in important ways from such commodities as shoes and strawberries. Children are the direct consumers of child care, and government intervention in protection of their interests is justified because they lack abilities that can be assumed to reside in the usual participants in the economy. Further, child care provided by or subsidized by government is an indispensable ingredient of any program aimed at bringing about the rescue of the 20% of American children who are officially designated as poor, who are living in conditions that should not be tolerated by a rich and civilized country.1
An International Perspective on Child Day-Care Health
Authors: MD, PhD Patrick Olin , Tandon B. N. , Meme Julius S. , Ford-Jones E. Lee , Belsey Mark , Chang Albert 
Published: December 2021

If we are committed to the health and development of children, we need to recognize that the vast majority of the world's women are working women. In Africa, 80% of the women are actively engaged in economic activities outside the home. The "economic miracle" in Southeast Asia was made possible by the nimble fingers of thousands of women working in textile and electronics factories.
There is need for pre-day-care advocacy for infants, through promotion of breast feeding and maternity leave. When the mother returns to work, the standard of the International Labor Organization should be applied, namely "...the care of children while the parents are working cannot be ignored because it forms a focal point on which three main concerns of development policy—work, health, and education—converge." Several principles emerged from the presentations in the international panel:
1. Child-care programs must be community based, using the resources of the families and the community organizations themselves.
2. Programs require the active involvement of the communities, women's groups, and other partners.
3. Programs are modified by innovations created by community organizations, universities, and other groups.
4. Programs require the mobilization of trained young men and women into the field of early childhood education and development.
This international panel provided an overall uniting theme, that throughout the world the hope for the survival and better life for children unites parents of every country and every creed. This is one of the most powerful and strongest motivational resources in the world. We need to recognize the power of this hope and address that hope, providing with a certain degree of humility that there exist no single model, and no single country has all the answers. By respecting the ideas of the many innovations and different approaches of women, parents, and families, we can find the answers. There is a clear need for national networks as well as for international networks, exchanges of information, sharing of experience, and mobilization of the social resources in advocating early childhood education and development for the world's children.
Translating Science Into Practice in Child Day-Care Settings
Authors: Roper William L. , Thacker Stephen B. , Teutsch Steven M. 
Published: December 2021

We trust our children, indeed our world's future, to care givers in day-care settings for as much as 8 to 10 hours each day. Through hard work and good science, the US and other countries have established rigorous health standards for day care, but we must do more. We must give others—the institutions and the individuals who care for our children—the tools to foster a healthful environment and promote healthy behaviors. The vision of the Centers for Disease Control and Prevention (CDC) is "healthy people in a healthy world to achieve a quality life." We must work together to make that vision a reality for our children in day care.
Our paper addresses translating scientific knowledge into practice and making prevention a practical reality. We outline the concepts underlying the assessment of the effectiveness of prevention activities and illustrate its use in three case studies from child day care. We close with a description of the prevention effectiveness program recently initiated at CDC.
PREVENTION EFFECTIVENESS
It is important to assess the effectiveness of prevention practices to ensure that public health programs are built on scientifically sound strategies for improving the quality of life and reducing unnecessary morbidity and premature mortality.1 There are three basic approaches to prevention: clinical, behavioral, and environmental. Clinical prevention strategies rely on the one-on-one, provider-to-patient interaction, which underlie immunization and screening programs. These interactions usually occur within our regular health-care delivery system.
Behavioral techniques use a broad array of strategies to encourage lifestyle changes, such as exercise and healthful diets.
Developmental and Service Needs of School-Age Children With Human Immunodeficiency Virus Infection: A Descriptive Study
Authors: Papola Pamela , Alvarez Mayra , Cohen Herbert J. 
Published: December 2021

Objective. To describe the developmental functioning and service needs of a group of school-age children with human immunodeficiency virus (HIV) infection.
Design. Retrospective data were collected through chart reviews and follow-up telephone calls to primary care givers.
Setting. A multidisciplinary team provided care at a developmental diagnostic and treatment center.
Patients. Cases were 90 school-age children (ages 5 to 14 years) with presumed perinatally acquired HIV infection.
Results. Forty-four percent of the 86 children on whom there were diagnoses were functioning in the low average to average range of intelligence, whereas 56% were functioning in the borderline range or lower. Fifty percent of the children demonstrated significant language impairments, with 28% also demonstrating an articulation disorder. Thirty-six of the children (42%) were formally diagnosed as having emotional/behavioral disorders. Eighty-six of the children were in school-based programs and of that group, 74% were in special education classes and receiving related services.
Conclusions. Most of the children in this study demonstrated deficits in the cognitive and learning areas, although they are clearly functioning better than earlier studies of children with HIV infection would have predicted. Their service needs include alternative living arrangements, remedial education, and psychotherapeutic interventions. The children's increasing longevity will place strains on the respective service systems.
Reducing the Risk of Human Immunodeficiency Virus Infection Associated With Illicit Drug Use
Authors:   Provisional Committee on Pediatric AIDS
Published: December 2021

Injection and other illicit drug use plays a major role in the transmission of infection with human immunodeficiency virus (HIV), including cases among infants, children, and adolescents.1,2 Transmission to adolescents and adults occurs either directly from contaminated drug paraphernalia, including needles and syringes, or through sexual contact with an infected partner. Transmission to infants occurs transplacentally or perinatally from mothers who are most often either drug users themselves, or who have become infected from sexual partners who are injection drug users. It is therefore clear that a reduction in the transmission of HIV infection secondary to illicit drug use and the use of contaminated injection equipment is a pediatric concern and should be part of any prevention program.
The adverse consequences of illicit drug use are multiple and certainly not limited to the potential acquisition and transmission of HIV infection. Ideally, treatment and prevention programs should seek to reduce drug use itself, not solely HIV infection. However, many users of injection drugs do not enter drug treatment, remain in treatment, or maintain complete abstinence while in treatment. Therefore, promoting safer injection practices can provide an important public health benefit in lowering the risk of HIV transmission, while simultaneous efforts continue to reduce and eliminate drug use.
Initiatives with the singular objective of increasing access to sterile equipment are understandably controversial, as they do not directly address the causes and broader consequences of illicit drug use. In addition, there are continuing concerns that any program increasing access to sterile needles and syringes might actually increase injection drug use by creating the impression of relative safety and tacit community approval for such behavior.
Type of Day-Care Setting and Risk of Repeated Infections
Authors: Collet J.-P. , Burtin P. , Bossard N. , Ducruet T. , Kramer M. S. , Floret D. 
Published: December 2021

As a direct result of demographic and sociologic changes, increasing numbers of children are attending day care in all industrialized countries. Unfortunately, the close physical contact among children in day care favors the transmission of infectious diseases. Previous studies have focused mainly on the risk of upper respiratory tract infection (URTI) and otitis media, which are reported to occur two to three times more frequently in children attending day care centers than in those cared for at home.1-7 Similarly day-care attendance has been found to be associated with an increased risk of lower respiratory tract infections (LRTI),8 gastroenteritis,9 as well as with the dissemination of infections caused by hepatitis A,10 cytomegalovirus,11 and H. influenzae type b.12
Despite convincing evidence for a higher risk of infection in day-care centers, most parents do not have an acceptable alternative to day care. It may be more useful, therefore, to identify the types of day-care structures associated with lower infectious risks. Family day care, in which several children are cared for in another family setting, offers a viable alternative to group day care, but previous studies have provided conflicting information on the risk of respiratory infections and otitis media in this setting. In four studies, the risks observed in family day care were very close to those of children who remained at home3-5,8; in two, they were intermediate between the risks at home and those in formal day-care centers6,7; while in two others, they were very close to those in day-care centers.13 These conflicting results can be explained by several factors including the lack of strict definitions for the different types of day-care settings and failure to control for the potentially important confounding differences in the number of children attending each type, the age range (from 2 to 60 months), and the time per week spent in the setting.
Joint Committee on Infant Hearing 1994 Position Statement
Authors:   Joint Committee on Infant Hearing
Published: December 2021

This 1994 Position Statement was developed by the Joint Committee on Infant Hearing. Joint committee member organizations that approved this statement and their respective representatives who prepared this statement include the American Speech-Language-Hearing Association (Allan O. Diefendorf, PhD, Chair; Deborah Hayes, PhD; and Evelyn Cherow, MA, ex officio); the American Academy of Otolaryngology—Head and Neck Surgery (Patrick E. Brookhouser, MD, and Stephen Epstein, MD); the American Academy of Audiology (Terese Finitzo, PhD, and Jerry Northern, PhD); the American Academy of Pediatrics (Allen Erenberg, MD, and Nancy Roizen, MD); and the Directors of Speech and Hearing Programs in State Health and Welfare Agencies (Thomas Mahoney, PhD, and Kathie J. Mense, MS).
The Joint Committee on Infant Hearing endorses the goal of universal detection of infants with hearing loss as early as possible. All infants with hearing loss should be identified before 3 months of age, and receive intervention by 6 months of age.
I. BACKGROUND
In 1982, the Joint Committee on Infant Hearing recommended identification of infants at risk for hearing loss in terms of specific risk factors and suggested a follow-up audiologic evaluation until an accurate assessment of hearing could be made (Joint Committee on Infant Hearing, 1982; American Academy of Pediatrics, 1982). In 1990, the Position Statement was modified to expand the list of risk factors and recommend a specific hearing screening protocol.
In concert with the national initiative Healthy People 2000 (US Department of Health and Human Services, Public Health Service, 1990), which promotes early identification of children with hearing loss, this 1994 Position Statement addresses the need to identify all infants with hearing loss.
Surfactant Therapy In Neonates With Respiratory Deterioration Due to Pulmonary Hemorrhage
Authors: Pandit Paresh B. , Dunn Michael S. , Colucci Enza A. 
Published: December 2021

Objective. To study the effect of exogenous bovine surfactant on oxygen and ventilatory requirements in neonates with respiratory deterioration due to pulmonary hemorrhage.
Design. Retrospective case series.
Setting. Three regional neonatal intensive care units.
Methods. Infants who received surfactant following a clinically significant pulmonary hemorrhage during the time period July 1991 to December 1993 were identified from a database. Infants were excluded if any other cause was found to explain their deterioration. The primary outcome was change in respiratory status following surfactant therapy, as reflected by oxygenation index (OI) and arterial/Alveolar oxygen ratio. Data points were taken as averages of 3 through 6 hours and 0 through 3 hours for the 6 hours before and after surfactant. Differences were analyzed using analysis of variance for repeated measures, with treatment and time as co-variates.
Results. Fifteen patients fulfilled inclusion criteria. Median values (range): birth weight, 960 g (595 to 4045); age at pulmonary hemorrhage, 24.4 hours (0.3 to 62); and interval between pulmonary hemorrhage and surfactant therapy, 10 hours (3.7 to 46.5). Mean OI improved from 24.6, at 0 to 3 hours presurfactant, to 8.6 at 3 to 6 hours postsurfactant (P .001). No patient deteriorated following surfactant therapy. The primary respiratory diagnosis was respiratory distress syndrome (RDS) in 8, meconium aspiration syndrome in 3, and isolated pulmonary hemorrhage in 4. All those with RDS had also received surfactant before their pulmonary hemorrhage.
Conclusions. Exogenous surfactant appears to be useful adjunctive therapy in neonates with a clinically significant pulmonary hemorrhage. Its use for this indication should be further investigated by a randomized controlled trial.
Is Continuity of Care Preserved in Children Who Utilize the Pediatric Emergency Department?
Authors: Vivier Patrick M. , Lewander William J. , Block Stanley H. , Simon Peter R. , Alario Anthony J. , Linakis James G. 
Published: December 2021

Objective. Inner city families often use multiple sites for nonemergent medical care, including the pediatric emergency department. This practice raises concerns about continuity of care. The present study examined one aspect of continuity of care: Do children who receive care in a pediatric emergency department return to their primary care site so that appropriate follow up may be obtained?
Methods. Over a 4-week period two groups of neighborhood health center children were studied: Those who sought care at the pediatric emergency department and those who were "walk-ins" at the health centers. All visits during the 4-week study period which resulted in a recommendation for the child to be seen within 6 weeks at the health centers were included in the analysis.
Results. During the study period there were 87 patient visits to the pediatric emergency department with a documented physician instruction to be seen at their health center within 6 weeks. In 66 (76%) of the cases, the patient was seen at one of the health centers during the 6 weeks following the pediatric emergency department visit. There were 146 "walk-in" visits to the health centers with a documented physician instruction to be seen again at the health centers during the 6 weeks following the walk-in visit. In 111 (76%) of the cases, the patient was seen during the 6-week period.
Conclusion. Our study shows that revisit rates were comparable for the two groups. We conclude that the rate of compliance with follow-up recommendations is similar for those who utilized the pediatric emergency department versus those who used the primary care site.
LIFETIME COSTS OF BIRTH DEFECTS CALCULATED
Authors: L. J. F. 
Published: December 2021

Coinvestigators at the University of Utah and the University of California, Davis and Berkeley, estimated the indirect mortality and morbidity costs, as well as the direct costs of medical care, developmental services, and special education over the entire lifespan of those born with each birth defect in California in 1988. They found that net per capita medical costs in 1988 dollars are largest for spina bifida ($99 000); heart defects such as truncus arteriosus ($209 000), tetralogy of Fallot ($109 000), and single ventricle ($99 000); and cerebral palsy ($142 000). Long-term care costs for those with cerebral palsy and Down syndrome are high, largely reflecting expenditures for State developmental services. Total special education costs in California are substantial, exceeding 20% of total medical costs for many conditions. They are particularly high for those with Down syndrome ($37.1 million), cerebral palsy ($28.6 million), and spina bifida (5.3 million).
Athrough birth defects are the leading cause of infant death in the United States, most children with birth defects do not die in infancy, note the researchers. They conclude that, based on their estimates of societal costs, additional research on the etiology and epidemiology of birth defects could lead to new strategies and, thus, have a net economic benefit.
For more information, see "Estimates of the Economic Costs of Birth Defects," by Norman J. Waitzman, PhD, Patrick S. Romano, MPH, and Richard M. Scheffler, PhD, in the Summer 1994 issue of Inquiry 31, pp. 188-204.
Research Activities, A.H.C.P.R., October/November 1994