bluuebunny/crossref_metadata_2025_split huggingface dataset:
DOCTORS DENOUNCE US GUIDELINES ON DRUGS TO TREAT HIGH BLOOD PRESSURE
Authors: L. J. F. 
Published: December 2021

A group of blood pressure experts launched an effort to overturn US guidelines on which drugs doctors should use to treat high blood pressure.
The seven experts attacked the recommendations of a National Institutes of Health advisory panel that doctors should first try treating patients with either a diuretic drug, which rids blood of excess water, or a so-called beta-blocker, which cuts the heart's pumping pressure.
The experts charged the recommendations theaten to hamstring doctors in their choice of drugs for high blood pressure patients, discouraging particularly the use of newer classes of drugs called ACE inhibitors and calcium-channel blockers. These drugs may work better and with fewer side effects and doctors should feel free to tailor their choice of drugs to each patient, they argued.
Four of the seven experts attacked the guidelines at a news conference in Dallas during the annual meeting of the American Heart Association. The news conference, which wasn't part of the meeting, coincided with publication of the October issue of the American Journal of Hypertension, edited by Dr. John H. Laragh, head of the cardiovascular center at New York Hospital. The Journal carries articles and editorials denouncing the guidelines.
Pediatric Equestrian Injuries: Assessing The Impact of Helmet Use
Authors: Bond G. Randall , Christoph Richard A. , Rodgers Bradley M. 
Published: December 2021

Objective. To assess the impact of helmet use on the pattern, and severity of pediatric equestrian injuries.
Design. A prospective observational study of all children less than 15 years of age who were brought to the University of Virginia children's Emergency Department with horse-related injuries.
Results. During the two-year period of the study, 32 children were evaluated. Two children were injured when a horse stepped on them. Thirty children fell from or were thrown from a horse. Of these, 20 were wearing a helmet. Head injuries were more frequent in those patients not wearing helmets. The mean Modified Injury Severity Scale (MISS) score for riders without a helmet (12.9) was significantly higher (more severe) than that for helmeted riders (2.8). All three patients with a Glascow Coma Score &lt;15 on arrival were not wearing a helmet at the time of injury. The frequency of hospitalization was significantly higher for those not wearing a helmet. Compared with other common mechanisms of childhood injury the mean Modified Injury Severity Scale score of injured riders was exceeded only by that of pedestrians struck by a car.
Conclusion. Equestrian injuries are more severe than those suffered from other common pediatric mechanisms. Helmet use is associated with decreased frequency and severity of central nervous system injury.
FDA APPROVES FIRST VACCINE TO PREVENT HEPATITIS A INFECTION
Authors: L. J. F. 
Published: December 2021

Federal health officials yesterday licensed the first vaccine in the United States to prevent hepatitis A, a serious and common viral liver infection.
The Food and Drug Administration said it gave SmithKline Beecham P.L.C. approval to sell the vaccine. The company said it would begin distributing the vaccine, Havrix, in the next several weeks.
The United States was the 41st country to license Havrix. An FDA spokeswoman said the agency wanted to be sure that the vaccine caused no significant adverse effects. An estimated 1.3 million people in Europe and Asia have received Havrix since 1991.
Reappraisal of Lytic Cocktail/Demerol, Phenergan, and Thorazine (DPT) for the Sedation of Children
Authors:   Committee on Drugs
Published: December 2021

This Policy Statement was retired January 2005.
The DPT lytic cocktail remains a widely used sedative and analgesic for pediatric patients. Neither the combination itself nor its dosage is based on sound pharmacologic data. There is a high rate of therapeutic failure as well as a high rate of serious adverse reactions, including respiratory depression and death, associated with its use.
Even when it is effective, DPT appears to lack many of the desirable characteristics of a sedative for children. Specifically, the dose cannot be titrated easily and individually, the onset of action is significantly delayed (20 to 30 minutes), the duration of sedation is protracted (5 to 20 hours), the duration of analgesia is much shorter (1 to 3 hours), and no anxiolytic or amnestic properties exist.
IMMUNOTHERAPY AS A TREATMENT OF AMERICAN CUTANEOUS LEISHMANIASIS: PRELIMINARY STUDIES IN BRAZIL
Authors: Mayrink W. , Magalhaes P. A. , Michalick M. S.M. 
Published: December 2021

Treatment of American cutaneous leishmaniasis has been successful with antimony compounds for 80 years. There are certain conditions where the chemotherapy cannot be used—pregnant women and patients with heart or renal disease. A group in Brazil carried out a sequential trial (not a random controlled trial) of vaccine composed of killed parasites from five stocks of the leishmania, while another group received the traditional therapy of antimony. The immunotherapy program was intensive requiring 10 daily injections followed by a 10-day free period. Of 62 patients (aged 3 to 70 years) so treated, 47 (76%) were considered clinically cured; 41 required 2-10 of the 10-day treatment courses; and the other 6 required 11-19 courses. There were no adverse effects. Results were better in patients with single cutaneous and multiple cutaneous lesions, and less effective in those patients with mucocutaneous lesions.
The authors make the point that because leishmaniasis occurs especially in rural areas, it would be possible to give patients a supply of syringes and vials and have self-administration at home, whereas, with the antimony treatment, close supervision of patients is necessary.
Slow Prepubertal Linear Growth but Early Pubertal Growth Spurt in Patients With Shunted Hydrocephalus
Authors: Löppönen Tuija , Saukkonen Anna-Liisa , Serlo Willy , Lanning Peter , Knip Mikael 
Published: December 2021

Objective. To evaluate growth and to compare anthropometric measures and the degree of physical maturation in children with shunted hydrocephalus with those in healthy children.
Methods. One hundred fourteen patients (62 male) and 73 healthy subjects (38 male) 5 to 20 years of age were analyzed for growth data and current auxology, stage of puberty, and bone age.
Results. Boys with hydrocephalus were shorter than control boys during their first 8 years of age, and no catch-up growth was observed until puberty. Girls with hydrocephalus were of the same size at birth as the control girls, but their linear growth retarded during the first years of life, leading to reduced relative height between the age of 5 to 8 years. The pubertal growth spurt occurred earlier in boys with hydrocephalus (age at midgrowth spurt, 12.1 vs 13.3 years), and a similar trend was seen in girls (10.0 vs 10.7 years). The final height was again reduced, especially in boys. Patients with hydrocephalus were more obese than control subjects, girls more often than boys. Relative bone age was retarded in prepubertal (-0.42 vs 0.32 SD) and accelerated in pubertal patients (0.54 vs -0.19 SD).
Conclusions. Children with hydrocephalus experience slow linear growth in prepuberty, but they have an earlier adolescent growth spurt. Together these factors result in a reduced final height. An increase in relative weight emerges in the preadolescent period, and this phenomenon is accentuated after puberty, leading to an increased prevalence of obesity.
Association Between Postpartum Substance Use and Depressive Symptoms, Stress, and Social Support in Adolescent Mothers
Authors: Barnet Beth , Duggan Anne K. , Wilson Michele D. , Joffe Alain 
Published: December 2021

Objective. Substance use by pregnant teenagers is an important public health problem, but published data on alcohol and illicit drug use by parenting teenagers are virtually nonexistent. This study determined the prevalence of alcohol and drug use in adolescent mothers in the first 4 months postpartum and explored associated psychosocial characteristics.
Methods. Teenagers attending a comprehensive adolescent pregnancy and parenting program were enrolled consecutively during a routine third trimester prenatal visit. Alcohol use since delivery was determined by self-report at 4 months postpartum using an instrument developed for the 1984 Survey of Drug Abuse Among Maryland Adolescents. Illicit drug use was measured with anonymous quantitative urine drug screens at 2 and 4 months postpartum. Depressive symptoms, stress, and social support were assessed at 2 and 4 months postpartum using validated, self-administered instruments. Differences in demographic characteristics, peer group influences, and psychosocial variables between substance users and nonusers were evaluated.
Results. Participants (125/129 eligible) were predominantly African-American, mean age 16.3 years. Completed assessments were obtained from 110 at 2 months and 105 at 4 months postpartum. Forty-two percent screened positive for illicit drugs at a postpartum visit or reported using alcohol since delivering their baby and were classified as substance users. Thirty-one percent of subjects reported alcohol use since delivery. Marijuana was the most prevalent illicit drug (14%), followed by opiates (5%), and cocaine (4%). When substance users were compared with nonusers, 44% versus 24% scored depressed (P = .02), 62% versus 43% had high stress (P = .04), and 62% versus 44% reported a high need for social support (P = .07). Results of logistic regression, after controlling for age, indicated that illicit substance and/or alcohol use was 3.3 times greater for those who were depressed, 2.8 times greater if they reported friends' using illicit drugs, and 6.7 times greater if the adolescent reported smoking cigarettes since delivery.
Conclusions. This study indicates that alcohol and drug use are common among this sample of postpartum teenage mothers and that depression, stress, high support need, and peer group drug use are associated factors. Although this study cannot determine whether depression and stress precede or result from use of substances, attention to these factors appears warranted in the care of adolescent mothers.
Response to Dr Stone
Authors: Pearson Howard A. 
Published: December 2021

Dr Elsa Stone, in her usual organized and lucid fashion, has presented the case for inclusion of pediatric nurse practitioners (PNPs) in private pediatric practices. She bases her conclusions on her nearly 10 years of positive experience with a PNP in her own practice in Connecticut. Dr Stone describes the PNP population and demography, describes the training curriculum of PNPs, and discusses the scope of work of these individuals. She concludes that "there is substantial evidence that PNPs provide quality health care and that collaborative teams of pediatricians and PNPs can provide high-quality, cost-effective care to a broader spectrum of children than can be served by either profession alone."
The American Academy of Pediatrics (AAP) has insisted for several years that there is a shortage of pediatricians to meet the expanding needs of the children of the United States. Furthermore, pediatricians—because of system changes—will be expected increasingly to provide a variety of time-intensive services. Dr Stone believes that many of these services can be well provided by PNPs.
Within the AAP, there have been some concerns about the role of PNPs. Of particular worry seems to be the possibility that PNPs might decide to practice independently, leading to a lower quality of care for their patients. Less often stated, but clearly an issue, is that PNPs are viewed by some pediatricians as potential competitors. Dr Stone's demographic analysis of what PNPs are currently doing is relevant to these concerns. One third of PNPs work in private pediatric practices or health maintenance organizations.
An Investigation Into Why Adolescents May Reject Norplant
Authors: Wiemann Constance M. , Berenson Abbey B. 
Published: December 2021

Objectives. To identify characteristics of patients 18 years of age and younger who would and would not consider using levonorgestrel implants (Norplant) for contraception and to isolate potential barriers to its use.
Study Design. Survey of 323 adolescents attending family planning or obstetrics clinics between April 29 and October 27,1992. For purposes of analyses, patients were stratified by their willingness to consider using Norplant. Statements about Norplant that differentiated between groups were considered significant barriers. Additional analyses were conducted for the sample, stratified by pregnancy status, race and ethnicity, parity, and Norplant class attendance.
Results. Sixty-four percent of participants stated that they would be willing to consider using Norplant. These adolescents were significantly older, were more likely to already have given birth or have had abortions, planned to delay (additional) childbearing for 5 or more years, aspired to receive college educations, and reported lower annual household incomes than did adolescents unwilling to consider using the device. Identified barriers to Norplant use included misinformation, perceived advantages, physical aversions, perceived efficacy, fertility concerns, social influences, and concerns about safety and side effects.
Conclusions. Misperceptions and concerns about safety and side effects will prevent many adolescents from using Norplant. Recent negative publicity surrounding its use will intensify this problem. Health care providers must work to remove these barriers so that sexually active adolescents can make informed decisions about contraceptives.
Comparison of Topical Anesthetics Without Cocaine to Tetracaine-Adrenaline-Cocaine and Lidocaine Infiltration During Repair of Lacerations: Bupivacaine-Norepinephrine Is an Effective New Topical Anesthetic Agent
Authors: Smith Gary A. , Strausbaugh Steven D. , Harbeck-Weber Cynthia , Shields Brenda J. , Powers Jean D. , Hackenberg Douglas 
Published: December 2021

Objective. To compare the effectiveness of four topical anesthetics that do not contain cocaine with that of topical tetracaine-adrenaline-cocaine (TAC) and lidocaine infiltration during laceration repair in children.
Design. This was a randomized, blinded trial.
Setting. The study was conducted in the emergency department of a large children's hospital.
Participants. Subjects were children 2 years of age or older with a laceration 5 cm or less in length that required suturing.
Interventions. Patients were randomly assigned to receive one of four noncocaine-containing topical anesthetics, topical TAC, or lidocaine infiltration anesthesia before laceration repair.
Outcome Measures. Outcome measures assessed pain perceptions using a Visual Analogue Scale, Likert scale, and Anesthetic Effectiveness scale. Distress behaviors of patients were measured with the Restrained Infants and Children Distress Rating Scale.
Results. Two hundred forty patients were enrolled in the study. Using α = 0.05 and β = 0.2, there was statistical power to detect differences of 0.3 to 1.3 U for the outcome measures used. The bupivacaine-norepinephrine topical solution (Bupivanor) performed better than the other three new topical preparations. It provided effective wound anesthesia during laceration repair, especially for lacerations of the face and scalp, where it was consistently rated as effective as TAC and 1% lidocaine infiltration by all observer groups for all outcome measures. There was a 4% overall wound complication rate, including one wound infection.
Conclusion. Bupivanor is an effective alternative to TAC and lidocaine infiltration for local anesthesia during laceration repair, especially on the face and scalp. The effectiveness of Bupivanor on the face is important, because it is here where TAC is most likely inadvertently to come into contact with mucous membranes and result in systemic toxicity. Because pain and distress scores did not take into consideration the pain associated with the initial injection of lidocaine, the findings of this study conservatively estimate Bupivanor's effectiveness compared with lidocaine infiltration.
Racial (Black-White) Differences in Insulin Secretion and Clearance in Adolescents: The Bogalusa Heart Study
Authors: Jiang Xiaozhang , Srinivasan Sathanur R. , Radhakrishnamurthy Bhandaru , Dalferes Edward R. , Berenson Gerald S. 
Published: December 2021

Objective. Earlier we found black-white contrast in insulin levels in adolescents. The purpose of this study is to assess whether this difference is attributable to alterations in insulin secretion and/or clearance.
Methods. Fasting circulating insulin and C-peptide concentrations were examined in 1157 adolescents aged 11 to 18 years from a biracial community. Fasting plasma C-peptide, C-peptide to insulin ratio, and glucose to insulin ratio were used as indices of insulin secretion, hepatic insulin clearance, and insulin sensitivity, respectively.
Results. After adjusting several covariates (age, sexual maturation, and obesity), black adolescents had higher insulin levels (14.99 vs 12.66 µU/mL in girls). However, they had lower C-peptide levels than their white counterparts, indicating lower insulin secretion by pancreatic beta cells in black adolescents. Moreover, black adolescents had lower levels of C-peptide to insulin ratio than white adolescents (0.14 vs 0.17), suggesting reduced hepatic insulin clearance in black adolescents. In addition, significantly lower levels of glucose to insulin ratio in black girls suggest a reduced insulin sensitivity in this group. Further, differences in insulin levels between white and black girls disappeared after adjusting for differences in C-peptide to insulin ratio.
Conclusion. These data suggest that elevated insulin levels observed in black adolescents, especially in black girls, may be attributed to their decreased hepatic insulin clearance, not hypersecretion of insulin.
Inhalant Abuse
Authors:   COMMITTEE ON SUBSTANCE ABUSE,   COMMITTEE ON NATIVE AMERICAN CHILD
Published: December 2021

This Policy Statement was retired May 2017.
Inhalant abuse is the intentional inhalation of a volatile substance for the purpose of achieving a euphoric state. It is also known as solvent abuse, volatile substance abuse, glue sniffing, sniffing, and huffing. Beginning with children as young as 6 years of age, it is an underrecognized form of substance abuse with a significant morbidity and mortality. This statement reviews important aspects of inhalant abuse and makes several recommendations involving prevention and education strategies to address this problem.
EPIDEMIOLOGY
As with other types of substance abuse, precise epidemiologic data on inhalant abuse are not available. The peak age of inhalant abuse is 14 to 15 years, with onset occurring in those as young as 6 to 8 years. Use declines typically by 17 to 19 years of age; however, some users may continue into adulthood.
Since 1975, the National Institute on Drug Abuse annual survey of high school seniors (Monitoring the Future) has documented a lifetime incidence of inhalant abuse of 15% to 20%, with 5% to 10% of seniors using inhalants during the previous year. This survey underestimates the true prevalence, because school dropouts, who have a relatively higher incidence of substance abuse, are not included. Although there has been a general decline in the use of most other mind-altering substances, the relative incidence of inhalant abuse has increased. Since 1988, eighth graders also have been surveyed, disclosing that inhalant abuse has increased recently and has surpassed marijuana use within this group. Nationwide mortality data are not collected; however, the United Kingdom (with a population approximately one fifth of that of the United States and the only major country in the western world that tracks deaths caused by inhalants) has documented two deaths pen week.
Cognition, Communication, and Hearing in Young Children With Cleft Lip and Palate and in Control Children: A Longitudinal Study
Authors: Jocelyn Leslie J. , Penko Maureen A. , Rode Helga L. 
Published: December 2021

Objective. To compare a group of children with cleft lip and palate (CLP) with a group of noncleft, matched control children on measures of congnitive development, speech and language abilities, and audiologic status at 12 and 24 months of age.
Design. Using a prospective, longitudinal study design, a group of 16 children with CLP and a group of 16 noncleft control children matched for race, sex, birth order, and socioeconomic status were compared using the Bayley Scales of Infant Development, the Receptive-Expressive Emergent Language Scale, the Sequenced Inventory of Communication Development—Revised (SICD-R), the Preschool Language Scale—Revised (PLSR), the mean length of utterance, audiometric evaluation, and impedance screening at 12 and 24 months of age. All were free of other congenital abnormalities or known causes of neurodevelopmental dysfunction.
Results. Children with CLP had lower mental developmental index (MDI) and psychomotor developmental index scores than control children. They had lower language comprehension scores on the SICD-R and PLS-R and lower expressive language scores on the Receptive-Expressive Emergent Language Scale, SICD-R, and PLS-R than control children. The group with CLP had a significantly higher number of children with abnormal tympanogram results or ventilation tubes at 12 and 24 months. There was a positive correlation between language test scores at 24 months and MDI scores at 24 months (r = .73 to .85). Seventy-five percent of children with CLP who had hearing loss at 12 months had MDI scores more than 1 SD below the mean versus 0% of children with normal hearing. There was a relationship between hearing status at 12 months and comprehension and expressive language scores at 24 months.
Conclusions. Children with CLP had significantly lower scores on tests of cognition, comprehension, and expressive language abilities than matched control children at 12 and 24 months of age. They also had a higher frequency of middle-ear disease and ventilation tubes than control children, although no significant difference in hearing sensitivity was found between groups. Early identification and treatment of these delays may reduce subsequent verbal deficits, hearing loss, and academic difficulties.