bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Rate of Increase in Blood Pressure in Children 5 Years of Age Is Related to Changes in Aerobic Fitness and Body Mass Index
Authors: Shea Steven , Basch Charles E. , Gutin Bernard , Stein Aryeh D. , Contento Isobel R. , Irigoyen Matilde , Zybert Patricia 
Published: December 2021

Objective. To determine whether changes in aerobic fitness and body mass index are related to the age-related rise in blood pressure in healthy preschool children.
Study design. Longitudinal analyses of 196 free-living children aged 5 years at baseline who were followed over a mean of 19:7 months. Aerobic fitness was assessed using a treadmill All measures were obtained on multiple occasions at scheduled visits as part of a longitudinal cohort study.
Setting. An inner-city medical center.
Outcome measures. Blood pressure was measured using an automated Dinamap device.
Results. Mean systolic blood pressure was 95.3 mmHg (SD 8.38) at baseline and increased by 4.46 mmHg per year. Mean diastolic blood pressure was 53.9 mmHg (SD 5.81) at baseline and did not change significantly. Children in the highest quintile of increase in fitness had a significantly smaller increase in systolic blood pressure compared to children in the lowest quintile (2.92 vs 5.10 mmHg/year; P = .03). Children in the lowest quintile of increase in body mass index did not differ significantly in rate of increase in systolic blood pressure compared to children in the highest quintile (3.92 vs 4.96 mmHg/year). In a multiple regression model including baseline systolic blood pressure, fitness, height, body mass index, and other covariates, greater increase in fitness (P = .03) and lesser increase in body mass index (P &lt; .01) were associated with lower rates of increase in systolic blood pressure. In a similar multivariate analysis, an increase in fitness was also associated with a lower rate of increase in diastolic blood pressure (P = .02)
Conclusion. Young children who increase their aerobic fitness or decrease their body mass index reduce the rate of the age-related increase in blood pressure. These observations may have implications for development of interventions directed at the primary prevention of hypertension.
Immunization Referral Practices of Pediatricians in the United States
Authors: Ruch-Ross Holly S. , O'Connor Karen G. 
Published: December 2021

Objective. Concerned about alarmingly low rates of immunization among some young US children as well as disturbing trends in vaccine availability and delivery, the American Academy of Pediatrics sought to examine national trends in referral for immunization among US pediatricians.
Methods. A self-administered eight-page questionnaire on issues in childhood immunization was mailed to a random sample of the AAP's 36 000 US resident members. Four rounds of the survey yielded a sample size of 1246, for a response rate of 77%.
Results. A majority of respondents reported referral of some patients for immunization; reported reasons for referral focused on issues of cost to the patient. Personal characteristics of pediatricians (age and gender) were not related to referral practices. Pediatricians practicing in solo or group settings were 2.8 times as likely as those in clinics or other settings to refer patients for immunization. Those in nonmetropolitan areas were nearly twice as likely as those in large metropolitan areas to refer for immunization. When setting and location were controlled, pediatricians who reported that their states had programs to provide all vaccines free or at reduced cost were much less likely to indicate that they referred patients for immunization.
Conclusions. A majority of US pediatricians refer some of their patients to other providers for immunizations because of financial reasons. Children outside of metropolitan areas may be at particular risk for problems of availability of and access to immunizations. This study raises, once again, the issue of differential health care access for children based on payment mechanisms.
Practice Parameter: Management of Hyperbilirubinemia in the Healthy Term Newborn
Authors:   PROVISIONAL COMMITTEE ON QUALITY IMPROVEMENT,   SUBCOMMITTEE ON HYPERBILIRUBINEMIA
Published: December 2021

Each year approximately 60% of the 4 million newborns in the United States become clinically jaundiced. Many receive various forms of evaluation and treatment. Few issues in neonatal medicine have generated such long-standing controversy as the possible adverse consequences of neonatal jaundice and when to begin treatment. Questions regarding potentially detrimental neurologic effects from elevated serum bilirubin levels prompt continuing concern and debate, particularly with regard to the management of the otherwise healthy term newborn without risk factors for hemolysis. Although most data are based on infants with birth weights ≥2500 g, "term" is hereafter defined as 37 completed weeks of gestation.
Under certain circumstances, bilirubin may be toxic to the central nervous system and may cause neurologic impairment even in healthy term newborns. Most studies, however, have failed to substantiate significant associations between a specific level of total serum bilirubin (TSB) during nonhemolytic hyperbilirubinemia in term newborns and subsequent IQ or serious neurologic abnormality (including hearing impairment). Other studies have detected subtle differences in outcomes associated with TSB levels, particularly when used in conjunction with albumin binding tests and/or duration of exposure. In almost all published studies, the TSB concentration has been used as a predictor variable for outcome determinations.
Factors influencing bilirubin toxicity to the brain cells of newborn infants are complex and incompletely understood; they include those that affect the serum albumin concentration and those that affect the binding of bilirubin to albumin, the penetration of bilirubin into the brain, and the vulnerability of brain cells to the toxic effects of bilirubin.
Nocturnal Enuresis and Behavioral Problems in Adolescence: A 15-Year Longitudinal Study
Authors: Fergusson David M. , Horwood L. John 
Published: December 2021

Objective. This study examines the relationships between nocturnal enuresis in childhood and measures of behavioral adjustment in adolescence using data collected during the course of a 15-year longitudinal study of a birth cohort of New Zealand children.
Method. Data was collected on patterns of nocturnal bladder control at annual intervals to the age of 13 years. At ages 11, 13, and 15 years measures of conduct problems, attention deficit behaviors, and anxiety/withdrawal were gathered.
Results. The analysis showed that children who were bed-wettting after the age of 10 years as a result of either primary or secondary enuresis had increased rates of behavioral problems up to the age of 15 years with these children having mean behavior scores that were between .30 to .65 standard deviations higher than children who ceased bed-wetting before the age of 5 years. Regression analysis indicated that these associations were largely spurious and arose because the age of cessation of bed-wetting was correlated with a series of factors (gender, social maturity, childhood IQ, family social background, family stress, and parental conflict) that were also associated with increased rates of adolescent behavior problems. However, even after adjusting for these factors, children who were bed-wetting after the age of 10 years showed slight increases in rates of conduct problems and attention deficit behaviors up to the age of 13 years and increased rates of anxiety/withdrawal up to the age of 15 years.
Conclusions. It is concluded that bed-wetting after the age of 10 years is associated with small but detectable increases in risks of conduct problems, attention deficit behaviors, and anxiety/withdrawal in early adolescence. These results show that although it is not the case that children showing nocturnal enuresis are at markedly increased risks of serious psychiatric problems, it may be prudent to determine the extent to which children who are bed-wetting after the age of 10 years show increases in anxious or problem behaviors.
Chylous Ascites: A Sign of Unsuspected Child Abuse
Authors: Olazagasti Juan C. , Fitzgerald Joseph F. , White Susan J. , Chong Sonny K. F. 
Published: December 2021

Chylous fluid accumulation in the peritoneal cavity is associated with pathology in the lymphatic system. Primary (congenital) chylous ascites develops during the first year of life, while secondary (acquired) chylous ascites, resulting from lymphatic obstruction or trauma, can arise at any time during life. Both lead to spillage of chyle into the peritoneal cavity from ruptured lacteals and lymphatic ducts. Radiographic findings suggestive of intentional injury have been observed in most published cases of secondary chylous ascites resulting from child abuse.1-4
We present a child with chylous ascites who was initially thought to have lymphangiectasia but who was later found to be a victim of abuse.
Accepting the Unthinkable
Authors: Little George A. , Brooks John G. 
Published: December 2021

The editor of this journal has drawn our attention to "an incredible story".1 He juxtaposed two 1994 New York Times articles2,3 and a letter to the editor published in 19734 that relate to an important article published in 1973.5 Comment about the matter has also appeared in Science.6
The fundamental issue is that new information concerning an original study by Steinschneider et al that focused on apnea and sudden infant death syndrome (SIDS) has emerged. It now appears that the deaths of two children of one family from the study cohort of five children of three families may have been murder.
Infant Feeding Practices and Their Possible Relationship to the Etiology of Diabetes Mellitus
Authors:   Work Group on Cow's Milk Protein and Diabetes Mellitus
Published: December 2021

1. Insulin-dependent diabetes mellitus develops within a group of individuals who carry specific diabetes susceptibility traits. Because all of the potential diabetes "susceptibility genes" are not known, currently it is not possible to identify all individuals at risk. It appears, however, that a small percentage of such individuals will ever develop clinical diabetes mellitus.
2. The autoimmune destructive process may be triggered by a number of environmental events.
3. Early exposure of infants to cow's milk protein may be an important factor in the initiation of the β cell destructive process in some individuals. It is not known whether the cow's milk protein in commercially available infant formulas is associated with this process.
4. The avoidance of cow's milk protein for the first several months of life may reduce the later development of IDDM or delay its onset in susceptible individuals.
5. Research directed toward further defining the possible relationship between infant feeding practices and the development of IDDM is needed.
FAXING—150 YEARS OLD!
Authors: L. J. F. 
Published: December 2021

Although the office fax machine has only become popular in the past decade, this year sees its 150th anniversary. It was patented on 27 May 1843, 30 years even before the telephone. But whereas the telephone quickly established itself as an essential tool for business, commercial success has been much longer coming for a machine that could transmit pictures and documents, within seconds, from one office to another.
The inventor of the idea was Alexander Bain, who was born in 1810. Bain, a Scotsman from a remote croft in Caithness, is reputed to have performed his early experiments using cattle jawbones for hinges, heather for springs and metal plates buried in the earth for batteries. He was apprenticed to a clockmaker in Wick and invented the first electric clock, which used electromagnetism to pull a pendulum from side to side. He then moved to London and patented his fax machine.
Injuries in Child Day Care: An Overview
Authors: Rivara Frederick P. , Sacks Jeffrey J. 
Published: December 2021

Injuries in child day care are a microcosm of the overall problem of childhood injury. In 1985 the National Academy of Sciences characterized injury as the most important public health problem in America.1 Although infectious diseases account for substantial morbidity among children—including the needs for medical care and hospitalization—injury is the most common cause of serious disability and death to children. Over the last 25 years there have been remarkable reductions in morbidity and mortality from other causes of childhood death, particularly those from infections and more recently from childhood cancer.2 Unfortunately, the reduction in childhood death from injuries has been minimal.2 Thus, addressing injuries to children in child-care and other settings is a public health priority.
INCIDENCE OF INJURIES
Approximately 25% of children annually incur injuries requiring medical care, either in the emergency department or the physician's office.3 The most common injury event is a fall. Falls are a particular problem because they can result in head trauma and permanent disability. Falls are the main cause of traumatic brain injury in children and account for 55% of traumatic brain injury requiring admission to the hospital.4 Contrary to popular belief, outcomes from head injuries in children are worse than outcomes in adults.5
Comparison of injuries to children in out-of-home child care (OOHCC) and in home care (HC) requires the calculation of comparable incidence rates. All children in OOHCC also spend time in HC, so comparisons based on population denominators are not accurate. In addition, unlike most infectious diseases—for which illnesses occur following an incubation period—injuries occur immediately after the exposure.
Day-Care Injuries in the Data Base of the Canadian Hospitals Injury Reporting and Prevention Program
Authors: Mackenzie Susan G. , Sherman Gregory J. 
Published: December 2021

BACKGROUND
This account of injuries suffered by children in day-care settings uses information from the data base of the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP). The aim of CHIRPP, inaugurated in 1990 by Health and Welfare Canada and the 10 Canadian pediatric hospitals, is to make an important contribution to reducing the incidence and severity of injuries in Canada. This is to be accomplished through an emergency room-based surveillance system that allows identification of existing and new injury hazards. Since the inception of CHIRPP, three general hospitals have joined the program. The data base includes a wealth of information about how injuries happen and is available to provide quick answers about injury occurrence as well as for more detailed research.
MATERIALS AND METHODS
Each injured person (or, in the case of a child, the accompanying adult) who arrives at the emergency room of a CHIRPP hospital is asked to complete a one-page self-administered questionnaire that collects demographic information and information about when, where, and how the injury occurred. On the other side of the form the examining physician records the nature of up to three injuries and how the case was handled in the emergency room (eg, treated and released, admitted). Completed CHIRPP forms are sent to the Laboratory Centre for Disease Control, Health and Welfare Canada where the information is entered into the main CHIRPP data base, usually within 3 months of the injury's occurrence. In addition to coded information, each record includes a one-line description of how the injury happened.
Comprehensive Services in Child-Care Settings: Prevalence and Correlates
Authors: Hofferth Sandra L. , Kisker Ellen Eliason 
Published: December 2021

At the beginning of 1990, 80 000 day-care centers in the US were serving about 4 million preschool children.1 This represents threefold increase since 1976 to 1977 in the number of centers and a fourfold increase in enrollments. Approximately 118 000 regulated family day-care providers were serving about 700 000 children. There were between 550 000 and 1.1 million nonregulated family day-care homes that were serving an unknown number of children. The number of regulated family day-care homes and the number of children enrolled in those homes increased since the mid-1970s, though not as much as the number enrolled in centers. About 17% of the children enrolled in center-based programs and 5% of those enrolled in regulated family day-care homes came from families receiving public assistance. Low-income families are overrepresented in Head Start and other sponsored non-profit programs.
The fact that increasing numbers of children are enrolled in early education and care programs presents an opportunity to serve the needs of disadvantaged children who may not necessarily receive nutritious meals, environmental stimulation, developmental screening, and adequate preventive health care at home. Programs such as Head Start, for example, are required to provide a comprehensive set of services in addition to a developmentally appropriate curriculum.
In the first part of this paper we examine the general health and safety procedures followed by center staff and family day-care providers for sick children ill providers. The extent to which providers conform to health and safety provisions will be examined. For example, do providers maintain records, obtain medical releases, have the phone number of a physician, have an emergency medical plan, have a list of persons to whom the child may be released, and conduct fire drills?
Costs Associated With Gastrointestinal-Tract Illness Among Children Attending Day-Care Centers in Houston, Texas
Authors: Hardy Alison M. , Lairson David R. , Morrow Ardythe L. 
Published: December 2021

Substantial costs occur each year due to infectious illness attributable to day-care center attendance by young children.1-3 Estimates of the value of work missed by parents in the US due to day-care-associated upper respiratory tract and diarrheal illness combined have ranged from $1602 million to $4003 million per year. Infectious diarrhea is one of the most common illnesses among young children. Several epidemiologic studies have shown increased risk of developing infectious diarrhea with attendance in group care, especially among children under 3 years of age.4-6 The cost burden of diarrheal illness among children attending day-care centers (DCCs) has not been adequately quantified, and few analyses have considered the effect that the type of care arrangement given ill children exerts on cost.
To estimate the cost burden of gastrointestinal-tract illness in day-care centers (DCCs), we used data collected during a 16-month cohort study of rotavirus diarrhea in four DCCs. In addition, we surveyed parents to assess factors affecting cost of illness and to assess the range of ill-child-care options used by parents.
METHODS
Selection of Day Care Centers
Four DCCs in Houston, Texas, were selected for participation in the rotavirus cohort study from a list of licensed DCCs generated by the Texas Department of Human Services. Potential study sites were centers with sufficient numbers of infants and toddlers located within a 7-mile radius of the University of Texas Medical School. Center directors gave informed consent for their centers to participate in the study.
Day-Care Center Population
From October 1989 through April 1991, children age 1-18 months with no known underlying disease in four licensed DCCs were enrolled in the rotavirus cohort study.
American Public Health Association/American Academy of Pediatrics National Health and Safety Guidelines for Child-Care Programs: Featured Standards and Implementation
Authors: Hawks Debra , Ascheim Joan , Giebink G. Scott , Graville Stacey , Solnit Albert J. 
Published: December 2021

In response to the potential for illness and injury in group care for children and a growing need for national guidance on health and safety aspects of child care, the American Public Health Association (APHA) and the American Academy of Pediatrics (AAP) developed national health and safety guidelines for child-care programs. This collaborative effort culminated in the publication, Caring for Our Children—National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs.1
The APHA/AAP guidelines address the following technical content areas:
• environmental quality;
• prevention and control of infectious diseases;
• injury prevention and control;
• general health;
• nutrition;
• prevention and management of child abuse;
• staff health;
• children with special needs;
• health concerns related to social environment and child development;
• health and safety organization and administration.
While all of these content areas are important in terms of health and safety, some tend to receive more attention. Certain standards in each of the featured content areas are highlighted on the basis of the perceived significance to care givers and health professionals; the reflection of new knowledge and state of the art; possible controversy; on considerations for implementation.
HEALTH CONCERNS RELATED TO SOCIAL ENVIRONMENT AND CHILD DEVELOPMENT
This technical area describes the standards on social environment and child development in the service of promoting physical and mental health. One of the most substantial achievements was to describe the qualifications, numbers, and availability of adults caring for young children in out-of-home settings.1 The National Research Council in its report, Who Cares for America's Children?
The Use of Alternative Medicine by Children
Authors: Spigelblatt Linda , Laîné-Ammara Gisèle , Pless I. Barry , Guyver Adrian 
Published: December 2021

Objective. Alternative medicine (AM) is of growing interest to the general public. Although several studies have been published concerning its use in adults, the use by children is less well known. The purpose of this study is to determine the frequency with which alternative medicine is employed in a pediatric population that also uses conventional medicine. A second goal is to investigate the sociodemographic factors that influence the choice of these forms of therapy.
Methods. Parents of children consulting the general outpatient clinic of a university hospital completed a self-administered questionnaire asking about previous use of AM for themselves or their children.
Results. Based on 1911 completed questionnaires, 208 children (11%) previously consulted one or more AM practitioners. Chiropractic, homeopathy, naturopathy, and acupuncture together accounted for 84% of use. Children who used AM differed significantly from those who only used conventional medicine in that they were older than the nonusers, their mothers were better educated, and their parents also tended to use AM.
Conclusion. The findings indicate that AM is an aspect of child health care that no longer can be ignored. Being aware of these practices will enable physicians to discuss alternative therapies with parents in order to ensure the continuity of essential conventional treatments.