bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Being a Chief Resident Predict Leadership in Pediatric Careers?
Authors: Alpert Joel J. , Levenson Suzette M. , Osman Cindy J. , James Sabin 
Published: December 2021

Objective.Many organizations make efforts to identify future pediatric leaders, often focusing on chief residents (CRs). Identifying future leaders is an issue of great importance not only to the ultimate success of the organization but also to the profession. Because little is known regarding whether completing a CR predicts future leadership in medicine, we sought to determine if former pediatric CRs when compared with pediatric residents who were not CRs reported more often that they were leaders in their profession.Design/Methods.Twenty-four pediatric training programs stratified by resident size (&lt;18, 18–36, and &gt;36) and geography (East, South, Midwest, and West) were selected randomly from the Graduate Medical Education Directory(American Medical Association, Chicago, IL). Program directors were contacted by mail and telephone and asked to provide their housestaff rosters from 1965–1985. The resulting resident sample was surveyed by questionnaire in 1995.Results.Fifteen of 17 program directors (88%) who possessed the requested data provided 1965–1985 rosters yielding a sample of 963 residents. Fifty-five percent of the resident sample (533) responded. Fifty-eight of the respondents had not completed a pediatric residency, leaving a survey sample of 475. Thirty-four percent (163) were CRs. The sample had a mean age of 47, 67% were male and 87% married. Fellowships were completed by 51%. More former CRs compared with non-CRs (75% vs 64%), more former fellows than non-fellows (75% vs 60%) and more males than females (74% vs 55%) reported they were professional leaders. These associations persisted in a logistic regression that controlled for CR status, gender, marital status, and fellowship status as leadership predictors. Former CRs, former fellows, and men were, respectively, 1.8, 2.3, and 2.3 times more likely to report professional leadership.Conclusions.Pediatric residents who were former CRs and/or fellows, and males were more likely to report professional leadership. Although men were more likely to report professional leadership, with more women entering pediatrics the reported gender differences will likely disappear over time.
The Unmet Health Needs of America's Children
Authors: Newacheck Paul W. , Hughes Dana C. , Hung Yun-Yi , Wong Sabrina , Stoddard Jeffrey J. 
Published: December 2021

Objective.Unmet need for health care is a critical indicator of access problems. Among children, unmet need for care has special significance inasmuch as the failure to obtain treatment can affect health status and functioning in the near- and long-term. The purpose of this study was to present current prevalence estimates and descriptive characteristics of children with unmet health needs using nationally representative household survey data.Methods.We analyzed 4 years of National Health Interview Survey data spanning 1993 through 1996. Our analysis included 97 206 children &lt;18 years old. Measures of unmet need for medical care, dental care, prescription medications, and vision care were obtained from an adult household member (usually the mother) responding for the child. Bivariate and multivariate analyses were used to assess the degree to which unmet need was related to the demographic and socioeconomic characteristics of the child and family.Results.Overall, 7.3% (4.7 million) of US children experienced at least 1 unmet health care need. Dental care was the most prevalent unmet need. After adjustment for confounding factors, near-poor and poor children were both about 3 times more likely to have an unmet need as nonpoor children (adjusted odds ratio [95% confidence interval] = 2.89 [2.52, 3.32], 3.0 [2.53, 3.56], respectively). Uninsured children were also about 3 times more likely to have an unmet need as privately insured children (adjusted odds ratio [95% confidence interval] = 2.92 [2.58, 3.32]).Conclusions.Despite the nation's great wealth, unmet health needs remain prevalent among US children. A combined public policy that addresses financial and nonfinancial barriers to care is required to reduce the prevalence of unmet need for health care.
Evaluation of New York State's Child Health Plus: Methods
Authors: Szilagyi Peter G. , Shone Laura Pollard , Holl Jane L. , Rodewald Lance E. , Jennings Jacqueline , Zwanziger Jack , Mukamel Dana B. , Trafton Sarah , Dick Andrew W. , Barth Richard , Raubertas Richard F. 
Published: December 2021

Background.The State Children's Health Insurance Program (SCHIP) is the largest public investment in child health care in 30 years, targeting 11 million uninsured children, yet little is known about the impact of health insurance on uninsured children. In 1991 New York State implemented Child Health Plus (CHPlus), a health insurance program that was a prototype for SCHIP. A study was designed to measure the association between CHPlus and access to care, utilization of services, and quality of care.Methods.The setting was a 6-county region in upstate New York (population 1 million) around and including the city of Rochester. A before-and-during design was used to compare children's health care for the year before they enrolled in CHPlus versus the first year during CHPlus, for 1828 children (ages 0–6.99 years at enrollment) who enrolled between November 1, 1991 and August 1, 1993. An additional study involved 187 children 2 to 12.99 years old who had asthma. Parents were interviewed to assess demographic characteristics, sources of health care, experience with CHPlus, and impact of CHPlus on their children's quality of care and health status. Medical charts were reviewed to measure utilization and quality of care, for 1730 children 0 to 6.99 years and 169 children who had asthma. Charts were reviewed at all primary care offices and at the 12 emergency departments and 6 public health department clinics in the region. CHPlus claims files were analyzed to determine costs during CHPlus and to impute costs before CHPlus from utilization data.Analyses.Logistic regression and Poisson regression were used to compare the means of dependent measures with and without CHPlus coverage, while controlling for age, prior insurance type, and gap in insurance coverage before CHPlus.Conclusions.This study developed and implemented methods to evaluate the association between enrollment in a health insurance program and children's health care. These methods may also be useful for evaluations of SCHIP.
A Profile of the Population Enrolled in New York State's Child Health Plus
Authors: Holl Jane L. , Dick Andrew W. , Shone Laura Pollard , Rodewald Lance E. , Zwanziger Jack , Mukamel Dana B. , Trafton Sarah , Raubertas Richard F. , Szilagyi Peter G. 
Published: December 2021

Background.The recently enacted State Children's Health Insurance Program (SCHIP), designed to provide affordable health insurance for uninsured children, was modeled in part on New York State's Child Health Plus (CHPlus), which was implemented in 1991. All SCHIP programs involve voluntary enrollment of eligible children. Little is known about characteristics of children who enroll in these programs.Objectives.To provide a profile of children enrolled in CHPlus between 1993 and 1994 in the 6-county upstate New York study area, and to estimate the participation rate in CHPlus.Methods.A parent interview was conducted to obtain information about children, 0 to 6.9 years old, who enrolled in CHPlus in the study area. Two school-based surveys and the Current Population Survey were used to estimate health insurance coverage. Enrollment data from New York State's Department of Health, together with estimates of the uninsured, were used to estimate participation rates in CHPlus.Results.Most children enrolled in CHPlus in the study area were white. Although 17% of all children in the study area who were &lt;13 years old and living in families with incomes below 160% of the federal poverty level were black, only 9% of CHPlus-enrolled children were black. Twenty-one percent of enrolled children were uninsured during the entire year before enrollment and 61% of children had a gap in coverage lasting &gt;1 month. Children were generally healthy; only 4% had fair or poor health. Eighty-eight percent of parents of enrolled children had completed high school or a higher level of education. Parents reported that loss of a job was the main reason for loss of prior health insurance for their child. Most families learned about CHPlus from a friend (30%) or from their doctor (26%). The uninsured rate among children in the study area was approximately 4.1%. By 1993, the participation rate in CHPlus was about 36%.Conclusion.Blacks were underrepresented in CHPlus. Because the underlying uninsured rate was relatively low and parental education and family income were relatively high, the effects of CHPlus observed in this evaluation may be conservative in comparison to the potential effects of CHPlus for other populations of children. Participation rates during the early years of the program were modest.
HERPANGINA: CLINICAL AND LABORATORY ASPECTS OF AN OUTBREAK CAUSED BY GROUP A COXSACKIE VIRUSES
Authors: KRAVIS LILLIAN P. , HUMMELER KLAUS , SIGEL M. MICHAEL , LECKS HAROLD I. 
Published: December 2021

The causal relationship between certain Coxsackie group A viruses and the disease entity herpangina first reported by Huebner and his associates in 1951 is confirmed.
Outbreaks of herpangina in Philadelphia during the summer of 1951 are described.
Coxsackie group A viruses of three different immunologic types were isolated from stools or throat swabs, or both, obtained from 17 of the 21 patients involved in the outbreaks.
A rise in complement-fixing and neutralizing antibody titers against homologous virus strains during convalescence was demonstrated in 3 patients.
Asymptomatic carriers of Coxsackie group A virus are described. Evidence is presented suggesting that two children with herpangina acquired their infection from such a carrier.
The criteria used in making a laboratory diagnosis of infection with Coxsackie virus are discussed.
FUNCTION OF ADRENAL CORTEX IN PREMATURE INFANTS
Authors: LANMAN JONATHAN T. 
Published: December 2021

Urinary formaldehydogenic steroid excretions were measured in eight premature infants without recognized disease for varying periods up to 2 months of age. A balance study for Na, K and N was carried out in one infant.
Urinary formaldehydogenic steroid excretion did not change measurably during the first 10 days of life, and was not significantly different from adult normal values when compared on a surface area basis. Calculations from the data of other investigators indicate that infant values are from 1 to 5 times those of adults when compared by surface area.
Urinary formaldehydogenic steroid excretions rose significantly with age when the entire period of study for all infants was included. This rise occurred during the period of fetal cortical involution and is evidence that the fetal zone is not an important source of formaldehydogenic steroids.
The nitrogen and electrolyte balance study revealed a loss of K in the first 2 days of life which was disproportionately greater than the loss of N during the postnatal fasting period. The formaldehydogenic steroid excretion did not change measurably at this time, so that the study does not support the concept of changed adrenal function as a cause for this K/N disproportion. The electrolyte-regulating hormones can, however, vary independently of other adrenal functions. Acute inanition in the neonatal period of fasting is suggested as a possible cause for the disproportion.
EPIDEMIC SHIGELLA GASTROENTERITIS (BACILLARY DYSENTERY) IN AN ENDEMIC AREA
Authors: FEIG MILTON 
Published: December 2021

The clinical aspects of acute bacillary dysentery as observed in an outbreak among a general population group in a highly endemic area are presented; age-specific clinical variations are noted.
The onset was abrupt in all cases and all age-groups. The height of the illness in 84% of 106 cases was reached in 24 hours, more rapidly than in the "classical" form (3 to 5 days).
The presence of blood in the stools was noted in about 25% of all cases; in about 25% of the 0 through 5 year age-group, 50% of the 6 through 10 year group, 37½% of the 11 through 15 year age-group, and 9 to 10% in the groups 16 years of age and over.
The median number of stools was 9 to 10 daily, with no significant difference among the various age-groups.
Fever was present in 65% of the children 10 years of age and under (55 cases), and in 35% of the older age-groups (40 cases).
Vomiting is more frequent among the younger age-groups; weakness becomes a more frequent complaint with advancing age.
The median duration of illness was 5.5 days in 100 cases. There was no correlation observed between age and duration.
Recurrences are more frequently observed in the youngest age-groups—36% of all cases (14) under one year of age, 28% of 39 cases between 1-2 years of age. About 9% of the 26 and over age-group (34 cases) recurred, and practically none in the intervening groups.
No relationship was observed between the tendency towards recurrences in households with multiple cases as compared with single cases.
All the fatalities were under one year of age. Two deaths occurred in the cases studied, yielding an age-specific death rate of 14.3% for this group. Five other deaths in cases not included in this report are noted, all under one year of age; 2 caused by "infant diarrhea" and 3 by bronchopneumonia with "chronic diarrhea" as a contributing cause.
The role of acquired immunity in the modification of bacillary dysentery can be evaluated from studies of attack rates and the clinical course of the disease, through age-specific groupings. Investigators should clearly define such basic terms as duration, recurrences, etc., when reporting so that necessary comparisons and/or data summation can be made.
Gestational Age, Parent Education, and Education in Adulthood
Authors: Bilsteen Josephine Funck , Alenius Suvi , Bråthen Magne , Børch Klaus , Ekstrøm Claus Thorn , Kajantie Eero , Lashkariani Mariam , Nurhonen Markku , Risnes Kari , Sandin Sven , van der Wel Kjetil A. , Wolke Dieter , Andersen Anne-Marie Nybo 
Published: December 2021

BACKGROUND
Adults born preterm (&lt;37 weeks) have lower educational attainment than those born term. Whether this relationship is modified by family factors such as socioeconomic background is, however, less well known. We investigated whether the relationship between gestational age and educational attainment in adulthood differed according to parents’ educational level in 4 Nordic countries.

METHODS
This register-based cohort study included singletons born alive from 1987 up to 1992 in Denmark, Finland, Norway, and Sweden. In each study population, we investigated effect modification by parents’ educational level (low, intermediate, high) on the association between gestational age at birth (25–44 completed weeks) and low educational attainment at 25 years (not having completed upper secondary education) using general estimation equations logistic regressions.

RESULTS
A total of 4.3%, 4.0%, 4.8%, and 5.0% singletons were born preterm in the Danish (n = 331 448), Finnish (n = 220 095), Norwegian (n = 292 840), and Swedish (n = 513 975) populations, respectively. In all countries, both lower gestational age and lower parental educational level contributed additively to low educational attainment. For example, in Denmark, the relative risk of low educational attainment was 1.84 (95% confidence interval 1.44 to 2.26) in adults born at 28 to 31 weeks whose parents had high educational level and 5.25 (95% confidence interval 4.53 to 6.02) in adults born at 28 to 31 weeks whose parents had low educational level, compared with a reference group born at 39 to 41 weeks with high parental educational level.

CONCLUSIONS
Although higher parental education level was associated with higher educational attainment for all gestational ages, parental education did not mitigate the educational disadvantages of shorter gestational age.
A NEED FOR PEDIATRIC GUIDANCE
Authors: Solnit Albert J. 
Published: December 2021

Although psychotic states of childhood constitute only a small percentage of children's psychiatric and behavior disorders, there is an impressionistic consensus among pediatricians and child psychiatrists that there has been a significant increase of these conditions in clinical practice. Early valuable observational studies by Potter,1 Bradley,2 Kanner,3 Rank,4 and Putnam,5 and Bender and her group6 called attention to the autistic psychoses of childhood. In these reports there was a lack of consensus about etiological factors.
Initially, the formulations from these early studies led to a polarization of opinion about etiological factors with the extreme poles of biological (nature) and experiential (nurture) factors being well represented.
OUR CHALLENGES FOR THE 70'S President's Address, 1970
Authors: Mapes Russell W. 
Published: December 2021

For any national organization striving to keep pace with increasingly diverse responsibilities and objectives, there are appropriate times when that organization must pause, reflect, and project before moving forward to meet the goals to which it has dedicated its programs and priorities.
This year marks the 40th anniversary of the American Academy of Pediatrics. It was June 23, 1930 that 35 pediatricians met in Harper Hospital in Detroit to establish the Academy as the organization to speak for the interests and health of children, as well as the interests of its pediatric members. This year also marks the beginning of a new decade, a decade which holds great promise for the future of pediatrics but a decade which also presents significant challenges which we must meet if we are to deliver quality health care to all children.
The American Academy of Pediatrics is indeed fortunate to be able to draw from the accomplishments of a progressive history of achievement, distinguished by the vision of its early founders. In the 1920's the medical community widely predicted that pediatrics was disappearing as a specialty, that in a few years it would merge into the field of general medicine. Concern was also expressed that pediatrics was not sufficiently represented in the echelons of organized medicine and, consequently, the cause of child health was not being served adequately.
To pediatricians like Isaac A. Abt, the first president of the Academy, to John L. Morse, its first vice-president, and to Clifford G. Grulee, the Academy's pioneering executive director, these were very real challenges, but they were not causes for pessimism or defeatism.
Letters to the Editor
Authors: Neumann Hans H. 
Published: December 2021

The preceeding letters emphasize some very valid points, among them the fact that distortions of useful acts can become classifiable as symptoms, as Dr. Palmeri observes.
Regarding the comments by Dr. Leonard, Solnit, and Lourie: In the wide range of activities labelled pica, a variety of contributing or coexisting factors, such as emotional deprivation, cannot be ignored. There was certainly no intention to extend the conclusions to all deviant appetites. Dr. Gutelius emphasized the factor of ingestion in defining pica.
TRANSIT TIME RELATED TO CLINICAL FINDINGS IN CHILDREN WITH RECURRENT ABDOMINAL PAIN
Authors: Dimson Samuel B. 
Published: December 2021

Carmine was used as a marker to estimate the transit time through the gut of 306 children with recurrent abdominal pain (RAP) of whom 96 had migraine as well. They were compared with a further 160 children with migraine alone.
Clinical examination revealed that having rectal constipation was present in 66 (22%) of children with RAP and transit was delayed in 91% of them. They presented distinctive features which suggest that rectal constipation alone may be a cause of RAP. In the remaining 240 children (78%) colonic spasm was thought to be responsible for attacks of abdominal pain. Transit time was prolonged in 44% and the colon was tender in 45% of cases. Colonic tenderness was associated more often with migraine and with a greater incidence and severity of intestinal delay than when colonic tenderness was absent. However in neither subgroup did the coexistence of migraine further delay intestinal transit. Children with migraine alone showed a delay in transit in 27% of cases, possibly accounted for mostly by colonic constipation, but delay is almost doubled in incidence and severity if abdominal pain supervenes with colonic tenderness.
It is suggested that when rectal constipation has been excluded, children with RAP should be classified as cases of colonic spasm in view of the strong similarity with spastic colon of adults.
COR TRIATRIATUM WITH INTACT SUBDIVIDING DIAPHRAGM AND PARTIAL ANOMALOUS PULMONARY VENOUS CONNECTION TO THE PROXIMAL LEFT ATRIAL CHAMBER (AN UNREPORTED TYPE)
Authors: Wilson James W. , Graham Thomas P. , Gehweiler John A. , Canent Ramon V. 
Published: December 2021

The clinical, cardiac catheterization, and postmortem findings are presented in a 9-day-old infant with cor triatriatum, anomolous pulmonary venous connections, and a hypoplastic left ventricle.
The dorsal accessory left atrial chamber did not communicate with the ventral or proximal left atrium, but did have a small connection with the right atrium. The left superior pulmonary vein connected with the accessory left atrium while the left inferior pulmonary vein connected with the proximal left atrium. The latter pulmonary venous connection has not been described previously in classical cor triatriatum and raises new embryological considerations.
The Police and the Underprotected Child, by C. J. Flammang. Springfield, Illinois: Charles C Thomas, 1970, 310 pp., $11.75
Authors: Fontana Vincent J. 
Published: December 2021

This well-organized book should prove useful to a variety of professional persons who deal with the problem of child abuse and neglect, whether they be police, social workers, lawyers, physicians, nurses, or others responsible for child care. The author gives a systematic, comprehensive coverage of child abuse and neglect as it presently exists in our society.
The role the police play in the protection of the abused child has been one of confusion. Different philosophies exist between the police and some of the medical and social agencies as to what are the responsibilities of the police to the maltreated child; this issue is dealt with in proper perspective by the author, clearly explaining the concept of protecting the child versus prosecution of the offenders.