bluuebunny/crossref_metadata_2025_split huggingface dataset:
The "88% Saturation Test": A Simple Lung Function Test for Young Children
Authors: Wagner Carol L. , Brooks John G. , Pratt Kimberly , Richter Susan E. , Phelps Dale L. 
Published: December 2021

Objective. The 88% saturation test (88%-SAT) was developed as an alternative to standard spirometry for those young children unable to perform standard forced expiratory maneuvers. In adults, this test revealed rapid desaturation in those persons with a history of asthma when compared with healthy control subjects. Similar findings in children were tested.
Setting. Tertiary care hospital.
Patients. Thirty-three former premature infants (28.3 ± 2.3 weeks gestation), aged 5 to 7 years, who were participating in a follow-up study, were enrolled in this study.
Design. The study compared the 88%-SAT with standard spirometry and respiratory health characteristics ascertained through a parental questionnaire. The 88%-SAT consists of continuous measurement of hemoglobin saturation by pulse oximetry (Sao2) while the subject breathes a nonhumidified 12% oxygen and nitrogen mixture for 10 minutes or until Sao2 decreases to 88%, whichever occurs first. Abnormal 88%-SAT was defined as a decrease of Sao2 to 88% within the 10-minute period, and abnormal spirometry was defined using standardized values.
Results. Of the 20 children who successfully completed both spirometry and the 88%-SAT, 10 had normal spirometry results and did not desaturate to 88%, and 5 had abnormal spirometry and 88%-SAT results. Four children did not desaturate during the 88%-SAT, but had abnormal spirometry results, and one child had abnormal 88%-SAT results, but normal spirometry.
Ten additional children completed the 88%-SAT, but not standard spirometry. Three children were unable to complete either test. Of those 30 children tested, 7 (23%) had a history of reactive airways disease, and all 7 had abnormal 88%-SAT results. The 88%-SAT had greater sensitivity (100% vs 75%) and specificity (87% vs 63%) than spirometry in identifying children with known reactive airways disease.
The mean McCarthy general cognitive index (GCI) of the group performing both spirometry and the 88%-SAT (n = 20) achieved a mean (± SD) GCI of 96.2 ± 16.7, and the group (n = 30) that completed the 88%-SAT had a mean (± SD) GCI of 75.2 ± 26.3 (χ2 P &lt; .012). The 10 children able to perform only the 88%-SAT had a mean GCI (± SD) of 72.8 ± 26.9, and the 3 children unable to perform either test had a mean GCI (± SD) of 63 ± 11.
Conclusions. Our data suggest that the 88%-SAT may be more effective than spirometry for identifying reactive airways disease in young, uncooperative, or developmentally delayed children. The dry air of the hypoxic inspired gas may function as an airway challenge, leading to decreased oxygenation in patients with reactive airways.
Potential Impact of Linking an Emergency Department and Hospital-Affiliated Clinics to Immunize Pre-School-Age Children
Authors: Bell Louis M. , Lopez Nereida I. , Pinto-Martin Jennifer , Casey Rosemary , Gill Frances M. 
Published: December 2021

Objective. To determine whether the use of an urban pediatric emergency department (ED) to immunize pre—school-age children would result in an improvement in the percentage fully vaccinated by the end of the second year of life.
Design. A retrospective cohort study of two groups: (1) 100 consecutive children (ED group) enrolled at one of two hospital-affiliated primary care clinics were chosen from the ED patient logs if their second birthday occurred in the 12 months prior to November 1990; and (2) 91 age-matched control children (control group) were chosen at random from the same hospital-affiliated clinics' enrollment logs without regard to ED use. The health care provided during the first 2 years of life for each group was compared.
Results. The mean number of visits to the ED in the first 2 years of life by the ED group was significantly greater than that of the control group (2.9 [SD] ± 2.5 vs 1.1 ± 1.4; P &lt; .001) during the first 2 years of life. In 67% of ED visits, children would have been well enough to receive a vaccination. Both groups had similar types and numbers of visits to the primary clinics. For example, the ED group had 10 ± 5 visits by age 2 years compared with the control group, which had 9 ± 4 visits. There was no significant difference in actual immunization percentages achieved in the clinic, with 62% of the ED group having received four diphtheria, pertussis, and tetanus vaccinations; three oral poliovirus vaccinations; and one measles, mumps, and rubella vaccination by age 2 compared with 69% of control children. There were more missed vaccination opportunities during clinic visits in the ED group (7.4 vs 4.6 per 100 clinic visits; P &lt; .01). If immunizations were offered in the ED to those children who needed them, immunization percentages would have been increased an average of 20% compared with percentages achieved in the clinic alone.
Conclusion. Routine vaccinations in the ED would significantly increase immunization percentages in children enrolled in two hospital-affiliated clinics. Close linkage and coordination between the ED and hospital-affiliated clinics may improve preventive health care in urban children who use EDs.
Comparison of Liquid and Dried Blood for Neonatal Hemoglobinopathy Screening: Laboratory and Programmatic Issues
Authors: Papadea Christine , Eckman James R. , Kuehnert Rachel S. , Platt Allan F. 
Published: December 2021

Objectives. To compare laboratory and programmatic issues in neonatal hemoglobin screening in two systems using either liquid cord blood or heel puncture blood dried on filter paper (DB) to determine the accuracy of hemoglobin phenotype; the collection rate of cord blood versus DB; and the types of and reasons for errors.
Methods. Cord blood samples for 6904 newborns were analyzed by electrophoresis in a large hospital laboratory. DB samples on the same cohort were analyzed by isoelectric focusing in a state public health laboratory.
Results. Interlaboratory concordance was 99.4% for 6904 matched specimen pairs, which included 27 disease and 596 carrier phenotypes. In 42 pairs, discordances for potential disease phenotypes occurred with cord blood samples. Errors involving carrier phenotypes occurred in 15 cord blood samples and 14 DB samples. Inconclusive results requiring repeat testing occurred more often in the cord blood testing system (92) than in the DB system (23). Clerical transcriptions and limitations of the techniques accounted for most laboratory errors. Noncompliance in sample collection occurred more frequently with cord blood (181) than DB (86).
Conclusions. Both systems are subject to errors, but are equally reliable for neonatal hemoglobinopathy screening.
Predictors of Early Grade Retention Among Children in the United States
Authors: Byrd Robert S. , Weitzman Michael L. 
Published: December 2021

Background. Despite increasing concerns regarding school readiness, little is known about child health correlates of early school failure among the general child population. The results of this study, conducted to investigate health and social factors associated with early grade retention in a nationally representative sample of children in the United States, are reported here.
Design. Analyses of data derived from interviews with parents of 9996 children ages 7 to 17 years who participated in the Child Health Supplement to the 1988 National Health Interview Survey.
Main Outcome Measures. History of repeating kindergarten or first grade.
Results. Nationally, 7.6% of children repeated kindergarten or first grade. In a logistic regression model, factors independently associated with increased risk of grade retention were: poverty [Odds Ratio (OR) 1.7, 95% confidence interval (CI) 1.4, 2.1], male gender (OR 1.5, CI 1.3, 1.9), low maternal education (OR 1.4, CI 1.1, 1.8); deafness (OR 1.9, CI 1.4, 2.6), speech defects (OR 1.7, CI 1.1, 2.6), low birth weight (OR 1.6, CI 1.2, 2.2), enuresis (OR 1.6, CI 1.1, 2.2), and exposure to household smoking (OR 1.4, CI 1.1, 1.7). High maternal education (OR 0.6 CI 0.4, 0.9) and residence with both biological parents at age 6 years (OR 0.7, CI 0.6, 0.9) were independently associated with a decreased risk of retention. Recurrent otitis media, black race, and low maternal age, although associated with early grade retention in bivariate analyses, were not independently associated with grade retention in a model that controls for these other factors and for the age cohort of the child. Although omitted from the above predictive model because of uncertainty about its temporal relation to early grade retention in this dataset, behavior problems at the time of interview have a strong independent association (OR 1.9, CI 1.5, 2.5) with prior early retention.
Conclusions. This is the first study that uses national data to investigate how health and social factors individually and collectively contribute to early grade retention. It demonstrates that early retention is common, that a number of extremely common child health problems are independently associated with it, and that the magnitude of the heightened risk associated with these problems is similar to that of many of the well-recognized and difficult to change family and social risk factors for early retention. The successful implementations of Pub L 99-457 (The Education for All Handicapped Children Act Amendments of 1986) services in communities nationwide, and the improvement in the educational performance of large numbers of children will be facilitated by pediatricians' advocacy and surveillance for problems that place children at risk for educational failure, and by effective referral to and collaboration with nonpediatric child and family services.
Penicillin- and Cephalosporin-Resistant Streptococcus pneumoniae: An Emerging Microbial Threat
Authors: Leggiadro Robert J. 
Published: December 2021

Recent reports from South Africa,1 Spain,2 Hungary,3 Texas,4-6 and Memphis7,8 document an increasing incidence of penicillin-resistant Streptococcus pneumoniae infections in children. The emergence of penicillin-resistant pneumococci that also demonstrate decreased susceptibility to extended-spectrum cephalosporins presents an even greater clinical challenge.6-9 This commentary reviews recent developments in the epidemiology, identification, and management of penicillin- and cephalosporin-resistant pneumococcal disease in children.
Pneumococcal susceptibility to penicillin is defined as a minimal inhibitory concentration (MIC) &lt;0.1 µg/mL. Intermediate (relative) penicillin resistance is defined as an MIC from 0.1 to 1.0 µg/mL and high-level resistance as an MIC &gt;1.0 µ/mL. Pneumococcal penicillin resistance is mediated by alterations in penicillin-binding proteins involved in cell wall synthesis.10
Prevention of Periventricular Hemorrhage
Authors: Reynolds E. Osmund R. , Meek Judith 
Published: December 2021

Cerebral periventricular hemorrhage (PVH) of preterm neonates can be defined as hemorrhage arising in the germinal layer that may rupture into the ventricles or provoke hemorrhagic parenchymal infarction.
PVH has been a major focus of attention for perinatologists since the 1970s and 1980s when studies by computed tomography and echosonography showed that it was very common in neonates who were of very low birth weight (&lt; 1500 g) or born very preterm (&lt; 33 weeks gestation). Up to 50% of such neonates were affected and the prevalence in survivors was about one in three.1,2
As well as being an important cause of death, PVH has been a significant cause of neurodevelopmental impairment in surviving neonates.3
Sepsis + C-Reactive Protein
Authors: Philip Alistair G. S. 
Published: December 2021

Pourcyrous et al are to be congratulated for their careful analysis of C-reactive protein (CRP) in the setting of suspected neonatal infection.1 They were able to evaluate a large number of babies with positive blood cultures. Their approach, using an initial CRP and repeat levels at 12 and 24 hours later, is one that I have been advocating for some time,2,3 when used in conjunction with leukocyte counts.
See table in the PDF file
As the authors note, I observed that infants with group B streptococcal (GBS) infection evaluated within 12 hours of delivery may initially have normal CRY levels,4 that rise within 24 hours.
Using Mass Media to Reduce Adolescent Involvement in Drug Trafficking
Authors: Romer Daniel 
Published: December 2021

Objective. Drug trafficking among adolescents is a newly recognized high-risk behavior that seems to be involving large numbers of youths. Strategies to prevent and/or alter this behavior must be developed and evaluated. In view of the high exposure of adolescents to the mass media, interventionists seeking to reduce adolescent risk behavior have increasingly employed the media in their efforts to reduce adolescent risk behaviors in general. However, not all risk behaviors may be amenable to change as a result of this approach. Therefore, before utilizing this approach to address adolescent drug trafficking, it is important to investigate previous efforts targeting related risk behaviors.
Results. Mass media campaigns against the use of drugs have been common in the US and seem to have played a role in reducing consumption of both legal and illegal drugs. The most effective messages seem to focus on the risks of drug use and the social disapproval that attends use. The mass media may increase the influence of these antidrug messages by changing the social climate surrounding drug use.
Conclusions. The mass media may be a particularly effective way to reach adolescents and their parents in communities in which adolescent drug trafficking is prevalent and to unite the institutions that could influence adolescents against involvement in the drug trade. However, intervention efforts must also contend with the economic incentives of the drug trade in poor, central-city communities.
African-American Youth: Drug Trafficking and the Justice System
Authors: Leviton Susan , Schindler Marc A. , Orleans Renee S. 
Published: December 2021

Objective. To examine the role of the legal system in adolescent drug trafficking.
Methods. Descriptive and analytic review of the literature and relevant legislation.
Findings. Utilization of young adolescents by drug "kingpins" in drug trafficking is a new practice that is highly advantageous to the employer for several legal and economic reasons. From the perspective of the drug kingpins, juveniles are particularly useful in drug trafficking because they work for lower wages. Further, even if the youth are arrested, the juvenile justice system enables their rapid return for continued service in the drug trade. From the perspective of the youth, drug trafficking offers one of the few economic opportunities available to them. Further, the numbers suggest a tremendous racial disparity in the juvenile justice system.
Conclusions. The mutual advantages to both employer and employee of using youths in drug trafficking increases the likelihood that this new practice will continue to flourish and with increasingly young children. Effective prevention and treatment interventions will need to be multifaceted, addressing the economic, educational, and social issues that have permitted the rapid emergence of adolescent drug trafficking. Finally, further investigation of the apparent racial disparities is necessary.
Children's Memory for a Salient Medical Procedure: Implications for Testimony
Authors: Merritt Kathy Ann , Ornstein Peter A. , Spicker Brenda 
Published: December 2021

Objective. Protecting sexually abused children hinges on their ability to remember and report events surrounding alleged incidents of abuse. This study was designed to provide information on young children's memory and recall of stressful experiences.
Methodology. Children's memory for features of a voiding cystourethrogram (VCUG) experience were examined because this invasive procedure is similar in many respects to incidents of sexual abuse. The recall performance of 24 3- to 7-year-olds was assessed immediately after the VCUG and after a delay of 6 weeks using a hierarchically structured interview protocol including both open-ended and more specific questions. To assess correlations between recall performance and distress, behavioral and physiological indicators of distress were measured during the procedure.
Results. The children remembered 88% of the component features of the VCUG experience at the initial assessment and 83% after 6 weeks. Behavioral and salivary cortisol measures indicated that the children were distressed during the procedure. Although several of the behavioral measures were correlated negatively with the amount of recall, levels of salivary cortisol did not predict the children's recall performance.
Conclusion. The findings suggest that, under some conditions, young children can provide accurate and detailed reports of personally experienced distressful events.
MORE MANAGED HEALTH-CARE SYSTEMS USE INCENTIVE PAY TO REWARD "BEST" DOCTORS
Authors: L. J. F. 
Published: December 2021

What It Takes to Be Rated a Good Doctor
Here are some of the more than 20 quality standards used by U.S. Healthcare Inc. to determine what level of incentive payments family practitioners, pediatricians and internists will receive for delivering high quality medical care.
• How easy is it to make appointments for checkups?
• How long is the waiting time in a doctor's office?
• How much personal concern does a doctor show for patients?
• How readily can patients obtain follow-up test results?
• Would patients recommend their doctor to others?
• Do doctors provide regular immunizations for children? Breast-cancer checks for women? Colon-cancer checks for men?
• What percent of a doctor's patients transfer to another physician's care each year?
CALCULATORS DO IMPROVE SAT MATH SCORES
Authors: L. J. F. 
Published: December 2021

Will permitting the use of calculators artificially increase SAT math test scores?
A. Not at all, so they should be allowed.
B. Yes, so they should be banned.
C. Only marginally, so they should be allowed—but scores should be adjusted to offset the effect.
The folks who run the Scholastic Aptitude Test, which will allow the use of calculators during the college entrance examination starting next year, initially said the correct answer was A. Critics insisted the right answer was B. Now, after a field test on calculator use involving 200,000 students last spring, the testing service has disclosed that C is their answer.
CLINTON OFFICIAL DEFENDS PLAN FOR VACCINES
Authors: L. J. F. 
Published: December 2021

Trying to allay concerns expressed by members of Congress and by drug company executives, a Clinton Administration official said today that the Government would not waste money or vaccine in a new program to inoculate millions of children from low-income families.
Drug company executives and some lawmakers have criticized the Administration's plan, saying the Government was trying to buy far more vaccine than would be needed to immunize children eligible for the free shots under the program. ... Congress has set aside $460 million for the project this year.
The Administration plans to store much of the vaccine at a Federal warehouse in Burlington, NJ. She said the Government would manage distribution of the vaccine under a contract with Federal Express of Memphis, TN.
Dr. R. Gordon Douglas, Jr., president of the vaccine division of Merck & Company, said, "A federally operated megawarehouse for storage and shipping of up to 80 percent of this nation's pediatric vaccines is a public health crisis in the making."
At a congressional hearing on May 18, Senator Dale Bumpers, Democrat of Arkansas, said he doubted that the warehouse would be ready to ship vaccines by Oct. 1, when the program is supposed to begin.
"GSA's track record has been an unmitigated disaster as long as I can remember," the senator said, "I don't have very much confidence in GSA."
The Effectiveness of Parent Counseling in Managing Colic
Authors: Carey William B. 
Published: December 2021

Colic, or excessive crying in young infants, continues to be described typically in pediatric textbooks as being of uncertain cause and as having no generally satisfactory solution. Despite this confusion and pessimism, much is now known about predisposing factors and successful management. The paper by Wolke, Gray, and Meyer in this issue of Pediatrics (Excessive infant crying: a controlled study of mothers helping mothers) makes a significant further contribution to understanding the interactional nature of the problem and the effectiveness of parent counseling about infant management in reducing the amount of crying.
Researchers now usually define colic as &gt;3 hours a day of irritability, fussing, and crying on &gt;3 days in any 1 week (and perhaps also for 3 weeks or more) during the first 3 or 4 months of life in an infant who is otherwise healthy and well fed.1
THE NURSE PARADIGM
Authors: L. J. F. 
Published: December 2021

Because one of the most revolutionary parts of health care reform in America is bound to be the burgeoning role that nurses will play, including providing many of the services that were once confined to physicians. Their new prominence will benefit patients—and raise some new questions about the importance of tender loving care and the economic value of medical services.
Exhibit A in what the president of Columbia-Presbyterian Medical Center in New York City calls "a major paradigm shift" is that hospital's decision to give its nurse practitioners admitting privileges, further blurring the line between what doctors do and what nurses can.
Dr. William T. Speck, the president of Columbia-Presbyterian, says that, in his hospital, which is both a prominent teaching and research center and the health care nucleus of a sprawling urban area, giving nurse practitioners more authority simply made good sense.
Letter to the Editor
Authors: Wiswell Thomas E. 
Published: December 2021

Doctors Anderson and Schwarz have misinterpreted the data from our recent report.1 We found an increasing number of circumcisions among older boys precisely at the time the circumcision frequency rate was increasing among neonates. We suspect the increases in both populations was due to several factors—the 1989 Ad Hoc Statement on Circumcision and the general increased awareness of the potential health benefits of the procedure.
I am astounded that these physicians have stated there are no other countries in the western world with a rise in the rate of neonatal circumcision.
FLORIDA APPROVES MEASURE ON RIGHT TO BREAST-FEED IN PUBLIC
Authors: L. J. F. 
Published: December 2021

TALLAHASSEE, Fla., March 3—In an action that is being hailed by women's and health groups as an important symbolic victory, the Florida Legislature has enacted what is apparently the first state measure guaranteeing women the right to breast-feed their children in public.
By a unanimous vote, the Florida Senate on Tuesday passed a bill that amends the state's statutes on indecent exposure, lewd and lascivious behavior and obscenity to exempt and protect nursing mothers from arrest or harassment by law-enforcement or private security officials.
The bill also endorses breast-feeding as the preferred method of nurturing an infant and condemns "the vicious cycle of embarrassment and ignorance" and "archaic and outdated moral taboos" surrounding the practice.
The measure has been praised by organizations like La Leche League, a breast-feeding advocacy group, which describes it as the first instance in the nation of a state's codifying support for breast-feeding.