bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE PEDIATRICIAN AND THE PUBLIC
Authors: PARKER MARY E. 
Published: December 2021

For the past few years, many patients have been unable to secure adequate nursing care because there are not enough nurses in the whole world to give it. Unfortunate as this is, it has had one salutary effect. It aroused the public, the administrators of institutions, the physicians and the nurses to the need for doing "something" so that this situation will not continue and will not occur again.
This is very similar to the situation in World War I and immediately following. At that time also there was a shortage of nurses, and a committee of outstanding people in medicine and nursing sat down to try to find out what was wrong and to make recommendations to make things right. Out of this in 1923 came the Goldmark Report. The recommendations were excellent and are still good today, but little was done about them. Then came the depression, and there were too many nurses for the people who could afford to pay for this service. This situation gradually improved until we had reached the other extreme, a shortage of nurses due to expansion of nursing service in hospitals and public health agencies and the needs of the armed forces. Much criticism was leveled at the nursing profession, some of it justified, some of it not justified.
REMODELING MEDICAL EDUCATION
Authors: MITCHELL JOHN MCK. 
Published: December 2021

THE position of science in the modern world has been aptly compared to that of the church in medieval times. Just as the manifestos of the church were then accepted without question, today the pronouncement that "it has been scientifically proved" is sufficient authority for the general public.
In somewhat similar vein, a statement to the effect that medical education has not kept pace with the rapid changes in medical practice is accepted without critical analysis by many physicians and taken to mean that a sweeping revision of the entire medical curriculum is indicated. Is this position justifiable? Should we choose a new site, lay a new foundation and erect a new edifice to house medical education? Or is the old building structurally so sound that it would be better to modernize it from within? Can additions be made without spoiling the "lines" which are of such symmetry that they have been admired throughout the world?
This is a question of great importance to which I will not attempt to give a categorical answer. On the other hand, there is no doubt that the present building is in urgent need of a thorough house cleaning, and that some remodeling is in order.
It is the objective of this paper to offer suggestions for certain simple changes and additions which are needed now.
Student Body
We must face the fact that there is a wide variation in the level of instruction among the approximately 800 approved colleges in the United States. This is clearly attested by the great difference in the mean scores of students from the different colleges on the Medical College Admission Test.
ALBUMIN THERAPY IN NEPHROSIS
Authors: GALAN ENRIQUE , GARCÍA OTTO , ESTABLE MANUEL PEREZ , FAES ORLANDO GARCÍA , PRADO ELISEO , ALFONSO GILBERTO 
Published: December 2021

Twelve nephrotic children were treated with intravenous injections of low-sodium concentrated human plasma albumin. Favorable response, as judged by the decrease in weight and edema and the increase in diuresis, was only seen in five cases.
Lack of therapeutic effect on nephrotic edema was due in the majority of cases to the great urinary loss of injected albumin and to the inability of the kidney to excrete the edema fluid mobilized into the circulation by the osmotic effect of albumin.
Error in Dr. Gold's Letter
Authors: Soyka Lester F. 
Published: December 2021

The June 1975 issue of Pediatrics contains a letter to the editor from Arnold P. Gold, M.D. (p. 897). In this letter he attempted to correct an error in reporting the desired serum level of diphenylhydantoin. His original numbers probably should have been 10 to 20 mg/liter, in that the usually quoted desired diphenylhydantoin blood level is 10 to 20 µg/ml, not 100 ml, as he states.
I thought I would call this to your attention for it may leave a number of readers confused.
Possible Complications of the Levodopa-Propranolol Test
Authors: Rowe David W. , Sare Zlatko , Kelley Vincent C. 
Published: December 2021

The article by Collu et al. (56:262, August 1975) suggests that the simultaneous administration of propranolol with levodopa decreases the number of nonresponders to the levodopa-stimulated growth hormone tests and provides a safe test to determine growth hormone reserve. We recently have used their protocol and have experienced complications in two patients.
Case Reports. An apparently normal 6-year-old boy with short stature complained of headache and nausea 60 minutes after administration of the test dose of levodopa and propranolol; sweetened orange juice was given and he vomited shortly thereafter.
Treatment of Chronic Childhood Asthma With Beclomethasone Dipropionate Aerosol: I. A Double-Blind Crossover Trial in Nonsteroid-Dependent Patients
Authors: Klein Robert , Waldman David , Kershnar Harvey , Berger William , Coulson Anne , Katz Roger M. , Rachelefsky Gary S. , Siegel Sheldon C. 
Published: December 2021

Twenty-two children with chronic asthma requiring daily administration of bronchodilators but not steroids were administered 400 µg of beclomethasone dipropionate aerosol (BDA) or a placebo (vehicle) in a double-blind crossover study. The experimental design consisted of four study periods (four weeks each): (1) baseline, (2) BDA or placebo treatment, (3) washout, (4) BDA or placebo treatment. Evaluation of effectiveness was assessed by daily symptom and medication scores, Wright Peak Flow (WPF) measurements three times each day, and weekly spirometry. Pituitary-adrenal function was evaluated by diurnal measurement of cortisol level, intravenous (IV) metyrapone tests, and IV adrenocorticotropic hormone responses. Quantitative throat cultures for Candida were taken monthly.
Twenty-one of 22 patients correctly identified BDA. The mean weekly symptom score was 76.5 ± 10.8 (mean ± SE) during placebo compared to 21.3 ± 5.3 during BDA therapy (P &lt; .005). The number of attacks per week was 7.1 ± 1.4 in those receiving placebo and 1.6 ± 0.6 in those receiving BDA (P &lt; .005). Mean medication score was 39.6 ± 3.6 during placebo and 21.6 ± 1.3 during BDA therapy (P &lt; .005). Mean weekly average WPF measurements increased 33% with BDA therapy compared to placebo. Eighty percent of patients showed an increase in forced expiratory volume in one second and in maximum midexpiratory flow rate during BDA therapy. All throat cultures were negative. No pituitary-adrenal function suppression was noted in any of the parameters studied.
BDA was shown to be highly effective in controlling asthma and produced no adverse effects.
Adolescent Health Concerns, Problems, and Patterns of Utilization in a Triethnic Urban Population
Authors: Parcel Guy S. , Nader Philip R. , Meyer Michael P. 
Published: December 2021

All aspects of health (concerns, perceived adequacy of knowledge, problems, sources of care, and utilization of health care resources) were significantly influenced by the ethnic background, grade level, or sex of the 3,255 high school students surveyed in an urban triethnic community of 65,000. Variation in needs was not consistent for any one ethnic group, sex, or age group.
The highest ranked concerns and problems were school, drugs, sex, getting along with parents and adults, acne, depression, and overweight. Ninety-one percent reported they often or sometimes worry about their health. Sources of medical care were family physician (56.8%) and hospital emergency room (15.9%). Reported visits in the past year were none (27.5%); one (24.1%); two to three (32.2%); and four or more (14.7%).
In analyzing responses according to sex, grade, and ethnic background, several implications are apparent: (1) many of the concerns and problems identified require educational as well as health care services; (2) the diverse perceived health needs of an entire high school population indicate that the traditional one-semester general health course for all is grossly inadequate; and (3) students' concerns and problems are not limited to the areas of drugs, venereal disease, and unwanted pregnancy.
The study is presented as a model for the needs assessment phase of planning and delivering adolescent health care and health education services for a community.
Medical Team
Authors: Ranahan Margaret 
Published: December 2021

I am writing to comment on the letter to the editor from Dr. Austin, which appeared in the October 1975 issue of Pediatrics (page 620). I am currently enrolled in the pediatric nurse associate program at the Mayo Clinic and am from Palo Alto, California. I feel that he made strong points and that his arguments still stood after Ms. McAtee and Dr. Silver's reply.
Before entering this program I was a pediatric staff nurse at a very busy community hospital; thus, I understand what Dr. Austin meant by the value of a trusted, medically competent person lighting the path of the child as he meets the various milestones-in sickness and in health-that life offers him.
Child-Initiated Care: The Use of School Nursing Services by Children in an “Adult-Free” System
Authors: Lewis Charles E. , Lewis Mary Ann , Lorimer Ann , Palmer Beverly B. 
Published: December 2021

An experimental child-initiated care system was developed in an elementary school that permitted children, ages 5 to 12, to act independently of adults in seeking care from a nurse practitioner. Over 300 children were observed for two years. The patterns of use of services displayed by them were similar to those of adults. Seventeen percent did not make a visit to the nurse during the two-year period, and approximately 15% of the children accounted for over 50% of all of the visits. Rates of utilization were associated with those variables known to affect adult pattern of use: sex (female), social class(more affluent), ordinal position (only children or youngest children), and health orientations. The pattern of use was not associated with the presence of known medical problems.
Analysis of data on the utilization of pediatric services by these children indicated a significant association between the patterns of being taken to pediatricians and use of services in school. The mother's pattern of use of care was also significantly associated with her pattern of use of pediatric care for her children.
The children's health-related beliefs and expectations were examined before this child-initiated care system was initiated and at the end of the first and second years of operation. Significant treatment effects were observed in the predicted direction in several elements of the health-belief model, i.e.,perceived vulnerability and severity. In addition, children who had used the system placed greater emphasis on their own responsibilities for maintaining their health. Despite these changes in beliefs, utilization behaviors were not altered.
Unsuspected Hyperosmolality of Oral Solutions Contributing to Necrotizing Enterocolitis in Very-Low-Birth-Weight Infants
Authors: WILLIS DIANA M. , CHABOT JOANN , RADDE INGEBORG C. , CHANCE GRAHAM W. 
Published: December 2021

In recent years necrotizing enterocolitis (NEC) has become a major problem in neonatal intensive care units. Recent incidences as high as 8% in all infants with a birth weight less than 2.5 kg and 14% in those with a birth weight less than 1.5 kg have been reported from one center.1Despite intensive searches for possible causative factors, no definite entity has been identified, but asphyxia,2 circulatory changes associated with exchange transfusion,3 umbilical vessel catheterization,4 immature immune status,5infection,6-8 and hypertonic feedings9 have all been implicated.
In the course of a series of nutritional studies involving thriving very-low-birth-weight infants we
Regional ambulatory care for children with diabetes
Authors: LESSER ARTHUR 
Published: December 2021

The problem of the distribution of physicians in the United States continues to be a serious obstacle to access to medical care. Experiences with a variety of initiatives in recent years confirm that there are no simple solutions to complex problems and that continued efforts and experimental programs are needed. Among these are more imaginative and less insular uses of the resources that we have.
In this issue (p. 492), Giordano et al. describe a program designed to bring to diabetic children living in rural and urban areas of northern Florida the technical and professional services of a medical school
Results of an Immunization Audit
Authors: BLOOM JOHN E. 
Published: December 2021

To the Editor:
The provocative article by McDaniel et al. (Pediatrics 56:504, October 1975) regarding private practice immunization stimulated me to carry out our own audit, following the authors' criteria as closely as possible. Ours is a three-pediatrician, urban group which utilizes three full-time pediatric nurse practitioners. We reviewed 400 “active” cases (at least one office contact in the past year). Forty-seven patients had incomplete immunizations,giving us an 87.3% completeness record according to the
Do Edicts Have Any Effect on Circumcision Rate?
Authors: SCHWARK THOMAS E. 
Published: December 2021

To the Editor:
The literature continues to be replete with the continuing discussion(argument?) about the practice of routine neonatal circumcision. Although it is easy to find opinions, often emotionally stated, a search of the literature failed to reveal any current reference to the actual frequency of this procedure. For this reason it seems appropriate to report the incidence of neonatal circumcision in U.S. Air Force hospitals. During calendar year 1974 there were 16,400 male
Three Englishmen Favor Circumcision and Why They Do
Authors: JOHN-HUNT D. ST. , NEWILL R.G.D. , GIBSON O. B. 
Published: December 2021

To the Editor:
In concluding that adequate penile hygiene is a viable alternative to neonatal circumcision (Pediatrics 56:610, October 1975), the Task Force seems unaware of our experience in England where circumcision is not general. Gairdnerl as far back as 1949 advocated education in penile hygiene but Burrowes,2 a school medical officer, observed in 1963 “among uncircumcised 17-year-old school-boys 70%-80% have never attempted to retract the prepuce though this was possible. Most suffered from balanitis.”
Safety Tops Can Be Unsafe
Authors: MARKS LEONARD J. 
Published: December 2021

To the Editor:
The following case report describes a defect in the widely used “push down to open,” “child-proof” safety cap.
A 27-month-old boy ingested 50 ml of an antihistamine-decongestant mixture that his mother had diligently closed using its “push down to open safety top supplied by a local pharmacy. The bottle was purchased 28 days prior to ingestion, kept in a diaper bag, and used sporadically. It had last been opened one week prior
Paying for Pediatric Training and Care
Authors: North A. Frederick 
Published: December 2021

In choosing the topic for this discussion I have deliberately ignored many of the issues which face the members of the Ambulatory Pediatric Association each day: how to be more effective teachers, how to run more effective and efficient ambulatory care programs, how to conduct research relevant to the needs of children and those who care for them. Each of these topics is important. Each of them has been thoughtfully addressed by past-presidents and speakers at meetings of this association. Each forms a substantial part of the agenda of its meeting.
I have chosen to address economic and, thereby, political issues which face ambulatory pediatrics because I am convinced that how pediatric care and training are paid for will determine its scope, its content, its distribution, and the way that its practitioners are prepared.
In this discussion I hope to persuade you of the following:
• That many of the teaching, patient care, and research issues that concern us are basically economic and thereby political issues;
• That the current methods of paying for the training of house officers is a major barrier to matching their training to the needs of the children, families, and communities they will serve;
• That current methods of paying for basic preventive services for children and their families are a major barrier to the achievement of better child health;
• That there are reasonable alternatives to our present methods of paying for pediatric care and training, and that these are economically and politically feasible.
Are We Missing Amblyopia? The Answer: Preschool Screening
Authors: Pollard Zane F. 
Published: December 2021

Amblyopia is a reduced visual acuity in one eye that is not related to obvious structural or pathological anomalies.1 Most authors do not include organic causes of reduced vision such as cataract, retrolental masses, scarred cornea, chorioretinitis, and tumors in the group of patients having amblyopia. Visual acuity must be measured under monocular conditions. If a child is allowed to use his one normal eye while the visual acuity is measured, the amblyopia will go undetected. By carefully occluding one eye while the vision is measured in the fellow eye, an accurate evaluation is obtained. The diagnosis is made when there is at least a two-line difference in Snellen test types between the two eyes, e.g., 20/20 in one eye and 20/30 in the opposite eye. A conservative estimate has shown that at least 2% of the population has amblyopia.2 Amblyopia is a common finding in children with strabismus.3 If a child has strabismus, the parents and the pediatrician notice that something is wrong with the child's eyes. But, what about the child who has amblyopia and straight eyes? What percentage of children with amblyopia have straight eyes, and how can we be sure not to miss the diagnosis in these patients?
The answer is early preschool screening. The earlier the amblyopia is detected, the better the prognosis for successful treatment and the shorter the duration of intensive therapy.
A prospective study was carried out to determine what percentage of children with amblyopia have straight eyes. The results also show what percentage of patients with amblyopia might be missed if we check visual acuity only in children with strabismus.
Psychological Issues in Bone Marrow Transplantation
Authors: Gardner G. Gail , August Charles S. , Githens John 
Published: December 2021

We studied the psychological and emotional problems experienced by seven children and their families who underwent bone marrow transplantation at the University of Colorado Medical Center from 1973 to 1975. These problems included (1) anxiety and depression relating to isolation, fear of death, and painful procedures; (2) an overdependence associated with a feeling of helplessness; (3) anger directed toward both the staff and the parents; (4) a reduced tolerance for medical procedures; and (5) periodic refusal to cooperate. Initially we had been concerned that patients might become agitated, psychotic, or even suicidal. These did not occur. Severe anxiety over bodily changes was not a problem. We did not encounter prolonged refusal to cooperate, refusal to remain in isolation, or drug addiction.
Important aspects in management included an honest, straightforward, and direct discussion of all aspects of transplantation, including the potential complications and the risks of death from the underlying disease or from complications of transplantation. A firm but understanding approach to the patients appeared to be the most effective method to develop their continuing cooperation. The opportunity for patients to express verbally their fears of procedures and of death was essential. The donors needed help in working through their feelings of guilt if a transplant was not successful. The parents needed continuing psychological support for the many personal, social, and psychological difficulties which they had to face.
Computerized Growth Record for Clinic Use
Authors: Robson J. R. K. , Braunstein H. M. 
Published: December 2021

Since growth rate and growth achievement are related to the general health and welfare of the individual, routine measurement of height and weight is a necessity in the young. The procedures for surveillance require accuracy of measurement as well as accuracy in recording and retrieving data and comparison of these data with standards.
Although such a protocol is relatively simple, each one of the steps outlined involves the possibility of human mistakes. Thus, errors amounting to 10 lb in a total of 30 lb have been observed in a well-baby clinic, and variations in true weight amounting to 8 oz were usual unless the nurses were given special training in weighing techniques.1
Clinical and Serologic Testing of a Live Varicella Vaccine and Two-Year Follow-up for Immunity of the Vaccinated Children
Authors: Asano Yoshizo , Takahashi Michiaki 
Published: December 2021

A live varicella vaccine derived from the Oka strain was given to 181 children who had no history of vanicella and were seronegative by complement fixation (CF) and neutralization (NT) tests; 125 children were hospitalized and 54 were receiving steroid therapy. Overall, senoconversion was achieved in 85.1% of the children by the CF test and in 97.8% by the NT test. Clinical reaction consisting of mild fever and rash appeared in only two children.
One hundred seventy-nine of the vaccinated children were followed up by questionnaire and 51 were followed up serologically approximately two years later, at which time 10 of 51 (19.6%) were seropositive by the CF test and 50 of 51 (98.0%) by the NT test. Only one out of 80 children who had postvaccinal contact with varicella contracted mild vanicella 16 months after vaccination. None of the vaccinees developed herpes zoster.
These results suggest that this live varicella vaccine may safely and effectively be used for children with or without underlying diseases, including those receiving steroid thenapy, and that immunity of at least two years' duration is conferred upon the vaccinated subjects.
DOUBTING
Authors: Rhodes P. ,   Student
Published: December 2021

When I was a House Officer and Registrar, my colleagues and I used to smile indulgently when we saw articles entitled "Whither Medicine", written by our elderly mentors. We were sure that we knew what medicine was about. We worked in world-famous hospitals, where excellent work was being done. Our place in the sun was certain and we had to get on with obtaining higher qualifications and increased experience to prove something to ourselves and for the benefit of our future patients.
This was done. A few "dropped off the ladder" of promotion, but some of us were lucky enough to be climbing nearer to the apex of the pyramid. We were still self-confident and without doubts. After some years as a consultant, or in charge of a university department, one felt reasonably master of the subject of one's choice. There were, of course, still things to be learned, but the clinical surprises became fewer. There was no need to practise one's skills just for the sake of boosting one's ego; they could be used as they were needed for the benefit of the patient. And it was then that the question arose of what exactly was the benefit of the patient. The doubts began to creep in.