bluuebunny/crossref_metadata_2025_split huggingface dataset:
HEALTH MAINTENANCE ORGANIZATIONS TURN TO SPIRITUAL HEALING
Authors: L. J. F. 
Published: December 2021

The psychological and spiritual sides of healing, long poor cousins of mainstream medicine, are finding new support from some institutions with growing power in medical care: health maintenance organizations (HMOs).
At a recent conference here, Dr Herbert Benson, President of the Harvard Medical School's Mind/Body Medical Institute, said that his office at Harvard was now getting five or six calls a week from HMOs that were interested in the medical uses of relaxation and other nontraditional treatment methods. The reason, he said, is clear: if such methods succeed reliably in reducing workload, they are "just plain money in the bank for the HMOs."
. . . The recent conference in Boston was a milestone in the growth of interest in what is sometimes called behavioral medicine.
A few years ago this would have been the farthest fringe of medicine. And even now there was a hint of sideshow. There were snake handlers here, and some recommended the snakes as a way to induce relaxation.
Antenatal Phenobarbital Therapy and Neonatal Outcome II: Neurodevelopmental Outcome at 36 Months
Authors: Shankaran Seetha , Woldt Eunice , Nelson Jay , Bedard Mary , Delaney-Black Virginia 
Published: December 2021

Objective. To evaluate the effect of antenatal phenobarbital (PB) therapy on neurodevelopmental outcome at 36 months.
Design. Prospective, randomized, controlled trial.
Setting. Single-institution study.
Subject and Interventions. Children born to women who participated in the study evaluating the effect of antenatal phenobarbital (PB) on neonatal intracranial hemorrhage were prospectively followed to 3 years of age.
Outcome Measures. Physical growth, neurologic examinations, and developmental testing (McCarthy Scales of Children's Abilities). Comparisons between groups were made on all children and those born to multiple gestations.
Results. Forty-one children born to women who received 10 mg/kg PB before delivery and 55 children in the control group were evaluated. Three children, all in the control group, had growth parameters (height, weight, and head circumference) below the fifth percentile. The McCarthy General Cognitive Index (standard, 100 ± 16) was 93 ± 20 in the PB group and 85 ± 18 in the control group. The subscores tended to be higher in the PB group than in the control group, with higher quantitative scores in the PB group (44 ± 11 vs 39 ± 8). Neurologic deficits were noted in 2 of 41 in the PB group and in 6 of 55 in the control group.
Conclusions. Infants born to women who received antenatal PB therapy had similar neurodevelopmental outcomes as infants born to women who did not receive PB. No adverse effects of PB exposure were detected.
Epidural Hemorrhage: Is It Abuse?
Authors: Shugerman Richard P. , Paez Angela , Grossman David C. , Feldman Kenneth W. , Grady M. Sean 
Published: December 2021

Objective. To determine whether children presenting with epidural hemorrhage (EDH) are as likely to have been abused as are children presenting with subdural hemorrhage (SDH).
Design. Retrospective chart review. Setting. Level I regional trauma center and a regional children's hospital.
Patients. All children at both institutions 3 years old or younger with a diagnosis of EDH or SDH identified by a search of the computerized trauma registry and hospital medical records from 1985 through 1991.
Measurement and Results. Complete records were found for 93 of 94 eligible subjects. The diagnosis of accidental or inflicted injury was ascertained from the patient's hospital medical record or the records of Child Protective Services. Of all subjects (n = 93), 52% (48/93) were male and the median age was 15 months. Abuse was diagnosed in 47% (28/59) of children with SDH and 6% (2/34) of those with EDH. Other significant injuries were found in 47% of children with SDH and 18% of children with EDH. There was no statistically significant difference between the two groups with respect to the likelihood of identifying a skull fracture, the need for surgical evacuation of the hemorrhage, or mortality.
Conclusions. Our data are consistent with current biomechanical concepts of intracranial injury. EDHs result from brief linear contact forces that commonly occur in unintentional falls. SDHs are caused by global high-energy rotational acceleration/deceleration forces that are commonly generated in episodes of abuse. Compared with SDH, EDH rarely results from abuse.
NEW HEART FOR RETARDED WOMAN
Authors: L. J. F. 
Published: December 2021

A woman with Down syndrome who was at first refused a heart-lung transplant because doctors did not think she was smart enough to handle the effects underwent the operation today.
The woman, Sandra Jensen, 35, is believed to be the first seriously retarded person in the United States to receive a major transplant. She was listed in critical but stable condition after the five-hour operation, which occurred after Stanford Medical Center reversed course.
"I'm ecstatic," said Dr. William Bronston, a state rehabilitation administrator and friend of Ms. Jensen who had helped lead the fight for her transplant. "This is a miracle. The struggle to get Sandra on the transplant list was really a struggle to get everyone in the country on the list."
Changing Hospital Practices to Increase the Duration of Breastfeeding
Authors: Wright Anne , Rice Sydney , Wells Susan 
Published: December 2021

Objective. To change the breastfeeding policy in a university teaching hospital in accord with the Ten Steps to Successful Breastfeeding of the United Nations Children's Fund and World Health Organization and to assess the impact of hospital practices on the duration of breastfeeding.
Methods. One hundred ninety-two and 392 postpartum women in a maternity ward were interviewed in 1990 and 1993, respectively, regarding how they were feeding their infants and feeding practices in the hospital. Between these two periods, the hospital infant-feeding policy was reviewed and revised in accord with the Ten Steps. Two hundred seventy of the mothers interviewed in 1993 were interviewed again when their infants were 4 months old regarding the duration of full and partial breastfeeding.
Results. By 1993, more newborns were put to the breast in the first hour of life (63.2% vs 24.8%); fewer breastfed infants were fed foods other than breast milk (27.9% vs 46.7%); and more mothers received breastfeeding guidance from hospital staff (81.9% vs 61.3%). The duration of breastfeeding in 1993 was longer for women who did not receive formula in the hospital, who were not given discharge packs containing formula and/or coupons, and who roomed-in more than 60% of the time. These associations persisted after controlling for confounding.
Conclusion. Infant-feeding policies and practices are amenable to change, and policies such as the Baby Friendly Hospital Initiative may contribute to an increase in the duration of breastfeeding.
Acute Isoniazid Neurotoxicity in an Urban Hospital
Authors: Kurbasic Mirzada Pasic , Badgett J. Thomas 
Published: December 2021

In the May issue of Pediatrics, Dr Shah and collaborators pointed out an increased incidence of isoniazid (INH) neurotoxicity.1
At the Children's University Hospital in Tuzla, Bosnia, and Herzegovina, four patients (age range, 6 to 9 years) were admitted for INH neurotoxicity in a 15-month period.2 None of them had liver dysfunction or metabolic disturbance, such as acidosis or hyperglycemia. All intoxications were accidental. Patients responded well to high doses of intravenous pyridoxine, including two with seizures and coma that had been unresponsive to treatment with phenobarbital and diazepam, respectively, before admission.
Progress Toward Integrating Hepatitis B Vaccine Into Routine Infant Immunization Schedules in the United States, 1991 Through 1994
Authors: Woodruff Bradley A. , Stevenson John , Yusuf Hussain , Kwong Sandy L. , Todoroff Karen P. , Hadler James L. ,   Connecticut Hepatitis B Project Group, Hoyt Muriel A. , Mahoney Frank J. 
Published: December 2021

Objective. We assessed progress toward universal infant immunization against hepatitis B, which was first recommended in November 1991.
Methods. Multiple data sources were used to describe vaccination policies and trends in infant hepatitis B vaccine coverage.
Results. As of June 1993, 51% of the 63 local, state, and territorial immunization programs recommended hepatitis B vaccination of all newborns shortly after birth. The number of first dosages of hepatitis B vaccine administered to infants in public sector clinics increased rapidly from late 1992 to 1993, and at the end of 1993 was approximately two thirds the number of first dosages of other infant antigens. In a nationwide survey of hospital nurseries 47% offered hepatitis B vaccine to all newborns. Of 3982 sampled newborns in these hospitals, 36.2% had been vaccinated before discharge. In San Francisco and Connecticut, where public health officials encouraged hospitals to offer hepatitis B vaccination, first-dose coverage at discharge was 82.3% in 1994 and 69.1% in 1993, respectively. Coverage was higher in healthier infants and lower in infants of older or bettereducated mothers. Results from the National Health Interview Survey demonstrate that three-dose completion at 12 months of age increased from less than 1% of children born in 1989 to 40% of children born in the fourth quarter of 1992. Vaccination at birth increased from less than 1% of infants born in 1989 to 32% of infants born in the second half of 1993.
Conclusions. Infant hepatitis B vaccination has expanded rapidly since national recommendations were made; however, universal coverage has not been achieved.
Fetal Alcohol Syndrome—An Ophthalmological and Socioeducational Prospective Study
Authors: Strömland Kerstin , Hellström Ann 
Published: December 2021

Background. The eye is a sensitive indicator of adverse effects of prenatal alcohol exposure. Anomalies of the eyes and their adnexa are known to be associated with the fetal alcohol syndrome (FAS), although long-term effects of these malformations are unknown.
Design. A prospective ophthalmologic follow-up (median, 11 years; range, 4 to 19 years) was performed in 25 children with FAS. Their social situation and educational status were also investigated.
Results. All but one of the children had ophthalmologic abnormalities. Fundus anomalies were observed in 23 children, of whom 19 had optic nerve hypoplasia. Thirteen children had concomitant strabismus. Microphthalmos, buphthalmos, phthisis, microcornea, coloboma of the iris and uvea, blepharoptosis, cataract, persistent hyperplastic primary vitreous, and nystagmus were observed in single cases. The dysmorphology of the eyes remained unchanged during the follow-up period. In 2 children with severe mental retardation and, initially, very poor vision, the severe visual handicap persisted. Seventeen children had an initial visual acuity ≥20/70, which remained unchanged in 10 children and improved in 7 children, despite the presence of optic nerve hypoplasia in 14 of the children. Ten mothers died, 8 of them because of alcohol-related diseases, and only 4 of the mothers were able to take care of their children. Sixteen children went to schools for the mentally retarded, and only 3 children had a normal school education without extra teaching assistance.
Conclusions. In children with FAS, the major sequela, ie, brain damage, remains despite extensive medical, educational, and social support. The presence of ophthalmic signs, which persisted but did not deteriorate during the follow-up period, strengthens the diagnosis of FAS, and the high frequency of ocular involvement indicates the importance of a complete ophthalmologic evaluation in children with FAS.
Ingredients of Urban Pediatric Health Care: Fourth World Pediatrics
Authors: Rosen John F. 
Published: December 2021

The article by Fairbrother et al1 is an indictment of the quality of care provided to disadvantaged children in "Medicaid Mills" in New York City. The missed opportunities to immunize and to test for lead poisoning and tuberculosis represent misused opportunities that are avoidable and tragic.
The International Covenant on the Rights of the Child was adopted by the United Nations (UN) General Assembly on November 19, 1989.2 This covenant stated the principle that children require safeguards and care, including the highest attainable standard of health and access to facilities to ensure that no child is deprived of her or his right to such health services.
Letter To The Editor
Authors: Halsey Neal A. 
Published: December 2021

A three-dose series of the 10-µg Engerix-B hepatitis B vaccine induced antibody concentrations of ≥10 milli-international units per mL (mIU/mL) in 97% of adolescents, and this regimen has been approved by the Food and Drug Administration for routine immunization.1,2
Because vaccine cost is an important factor, it makes sense to vaccinate with the lowest approved dose that will induce high rates of immunity. The approval of the 10-µg dose should be welcomed by pediatricians and others providing health care for adolescents as it will be easier to provide vaccine to all adolescents at a lower cost.
Varicella Vaccination
Authors: Sohn William J. 
Published: December 2021

I have a concern regarding Dr Kohl's statement about a Varivax booster. I agree that this would be the "obvious remedy," but would everybody get a booster?
In my practice, I ask all my young mothers who have had one dose of measles vaccine whether they have received their second dose. Although this is anecdotal, only 30% say yes. The reason is twofold. One is that young healthy adults don't go to doctors very often, and, two, adult practitioners are not as "phobic" as pediatricians concerning immunizations.
Acute Pharyngitis: Etiology and Diagnosis
Authors: Bisno Alan L. 
Published: December 2021

Acute pharyngitis may be caused by a wide variety of microbial agents (Table 1). The relative importance of each of these agents varies greatly depending on a number of epidemiologic factors, including age of the patient, season of the year, and geographic locale.
Viruses
Most cases of acute pharyngitis are viral in etiology and involve the pharynx as well as other portions of the respiratory tract as manifestations of the common cold, influenza, or croup. Examples include the rhinoviruses, coronaviruses, influenza A and B, and the parainfluenza viruses. Certain viral infections causing sore throat may exhibit clinical manifestations that are rather distinctive. Examples include enteroviruses (herpangina due to Coxsackie A), Epstein-Barr virus (infectious mononucleosis), cytomegalovirus (cytomegalovirus mononucleosis), adenovirus (pharyngoconjunctival fever, acute respiratory disease of military recruits), and herpes simplex virus (pharyngitis, gingivitis, and stomatitis). In many instances, however, the illnesses caused by these agents may overlap so broadly with that of streptococcal pharyngitis as to be clinically indistinguishable. Thus, Epstein-Barr virus, adenovirus, and herpes virus may all cause fever, exudative pharyngitis, and cervical adenitis.
Several studies have documented the role of primary herpesvirus type 1 infection as a cause of acute pharyngitis in college students.1-4 Herpesvirus type 2 can occasionally cause a similar illness as a consequence of oral-genital sexual contact.5 Although herpesvirus infections may involve the anterior oral cavity (vesicular or ulcerative gingivostomatitis) as well as the posterior pharynx, they do not routinely do so. Only about one-fourth of students with culturally and serologically proven primary herpes simplex type 1 pharyngitis studied by Glezen et al,2 for example, had gingivostomatitis.
Clinical and Virologic Features of Hepatitis C Virus Infection Associated With Intravenous Immunoglobulin
Authors: Jonas Maureen M. , Baron Miriam J. , Bresee Joseph S. , Schneider Lynda C. 
Published: December 2021

Objective. To characterize the clinical features of hepatitis C virus (HCV) infection associated with the administration of intravenous immunoglobulin (IVIG) in patients with varied immunodeficiencies.
Design. Prospective collection of clinical and virologic logic data in patients determined to have HCV exposure associated with Gammagard.
Setting. Outpatient department of children's Hospital tal, Boston.
Patients. Twenty-one patients with evidence of HCV infection were identified during a screening program initiated to detect infection in exposed individuals. They ranged from 5 to 53 years of age; 14 were children under age 18.
Results. Six patients presented with severe clinical hepatitis before detection by screening, 13 were detected by screening only, and 2 were first detected by screening and subsequently developed symptomatic hepatitis. Follow-up is available on 20 patients; 4 without viremia at identification have remained clinically well. Hepatitis and viremia have resolved in 2, 2 additional subjects have developed normal alanine aminotransferase (ALT) values with persistent viremia, and 13 have biochemical and/or virologic evidence of chronic hepatitis. Eight patients (7 children) have undergone liver biopsies; 7 have histologic findings of chronic hepatitis, 5 have mild fibrosis, and 2 have moderate fibrosis. HCV genotypes 1a and 1b were observed with equal frequency in this group.
Conclusions. Some HCV infections associated with IVIG had a more severe, acute course than is ordinarily described. This may be attributable to host factors, such as immunodeficiencies, or virologic factors, such as inoculum or genotype. Although a large percentage (87.5%) of these individuals developed chronic infection, the natural history is not as yet completely defined.
Neonatal Mortality and Length of Newborn Hospital Stay
Authors: Beebe Susan A. , Britton John R. , Britton Helen L. , Fan Pelly , Jepson Bryan 
Published: December 2021

Objective. To investigate the effect of hospital discharge time on neonatal mortality of term newborns.
Design. Infants who were discharged home at 5 days of age or younger and who subsequently died were compared with control infants using a retrospective casecontrol design. Descriptive information was collected from records of infants who were not discharged home from the hospital of birth (because of death or transfer to a tertiary care hospital) to determine the age at which their illnesses presented.
Methods. We reviewed death certificates for all infacts with birth weights of 2500 g or greater born at 37 weeks' gestational age or greater who died in the first 28 days of life and who were born in one of four Utah counties (1985 through 1989). Of the 109 256 eligible births, 115 infants were found who had died in the neonatal period. Eighty-four infants had not been discharged home from the hospital of birth, 5 infants had had hospital stays of more than 5 days, 9 records could not be located, 17 presumed healthy infants were discharged from the hospital at 5 days of age or younger. These 17 infants were each matched with 3 control infants. Newborn nursery charts were reviewed to determine hospital discharge times for case and control infants. Descriptive information regarding the time of presentation of illness was collected for the other 89 infants.
Results. The mean age of hospital discharge was 43 ± 21 hours for the 17 case infants and 47 ± 25 hours for the 51 control infants. The odds ratio for neonatal mortality for discharge at less than 24 hours was 1.65 (95% confidence interval, 0.42 to 3.34) and for discharge at less than 48 hours was 1.16 (95% confidence interval, 0.4 to 3.34). Of the 84 infants who were not discharged home from the hospital of birth, 93% had been symptomatic by 12 hours of age, and 99% were symptomatic by 18 hours.
Conclusions. Most full-term infants who die in the neonatal period are symptomatic within the first 18 hours after birth. We could not demonstrate an association between early hospital discharge and neonatal mortality in those infants who died after discharge home.
Blood Lead Screening Practices Among US Pediatricians
Authors: Campbell James R. , Schaffer Stanley J. , Szilagyi Peter G. , O'Connor Karen G. , Briss Peter , Weitzman Michael 
Published: December 2021

Objectives. In 1991, the Centers for Disease Control and Prevention (CDC) decreased the blood lead level of concern to 10 µg/dL (0.48 µmol/L) and recommended universal screening. Because these guidelines continue to provoke controversy, we conducted a study to:1) estimate the proportion of pediatricians who are members of the American Academy of Pediatrics (AAP) who report screening for elevated blood lead levels; 2) describe their clinical practices regarding screening for elevated blood lead levels; 3) compare attitudes of universal screeners, selective screeners, and nonscreeners; and 4) identify characteristics of pediatricians who universally screen.
Design. Confidential, cross-sectional survey of a nationally representative random sample of 1610 pediatricians conducted through the AAP Periodic Survey.
Subjects. The study included 1035 responders (64% response rate). Analysis was limited to the 734 pediatricians who provide well-child care (ie, primary-care pediatricians).
Results. Fifty-three percent of pediatricians reported screening all their patients aged 9 to 36 months, 39% reported screening some, and 8% reported screening none. Among those who screen, 96% use a blood lead assay. The primary risk factors for which selective screeners screen are: history of pica (94%); living in an older home with recent renovations (92%); living in an older home with peeling paint (93%); and having a sibling who had an elevated blood lead level (88%). Among primary-care pediatricians, 73% agree that blood lead levels ≥10 µg/dL should be considered elevated, and 16% disagree. However, 89% of primary-care pediatricians believe that epidemiologic studies should be performed to determine which communities have high proportions of children with elevated blood lead levels, and 34% of primary-care pediatricians believe that the costs of screening exceed the benefits.
Conclusions. Three years after the Centers for Disease Control and Prevention issued new guidelines for the management of elevated blood lead levels, a slight majority of primary-care pediatricians in the United States who are members of the AAP report that they universally screen their appropriately aged patients, while most of the remaining pediatricians report screening high-risk patients. Many pediatricians may want additional guidance about circumstances under which selective screening should be considered.