bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of Suicidal Drug Overdose
Authors: Marks Andrea 
Published: December 2021

INCIDENCE AND EPIDEMIOLOGY
Suicide is the third leading cause of death among adolescents, and yet for each fatality it is estimated that between 50 to 200 adolescents survive a suicide attempt. Most of the survivors have taken overdoses of drugs commonly found at home.
The rate of suicide attempts that do not result in death peaks in adolescence. The male to female ratio is 1/2 and self-poisoning is usually the method. In contrast, suicide fatality rates generally increase with age. Overall, suicide is the ninth leading cause of death in the United States; the male to female ratio is 3/1; and the method used most often is fire-arms. Clearly, suicidal behavior by adolescents is a major health problem in the United States today. The usual challenge for the pediatrician is first managing an acute drug overdose and then facilitating subsequent psychosocial evaluation of the troubled youth. The key challenge is identification of disturbed individuals and their families prior to any suicidal acts.
DIAGNOSIS AND PHYSIOLOGIC MANAGEMENT
Most young people who present with a suicidal drug overdose are not comatose; many are asymptomatic. In such situations a careful history may be obtained from the patient to determine: the events surrounding the ingestion, which drug or drugs were taken, how much, and when the ingestion occurred.
Rashes with Ampicillin
Authors: Kraemer Michael J. , Smith Arnold L. 
Published: December 2021

Ampicillin, first introduced in 1961, has probably become the most widely used penicillin in clinical pediatrics.
STRUCTURE ACTIVITY RELATIONSHIPS
All penicillins contain the 6-amino penicillanic acid moiety (Fig 1). Its structure includes a thiazolidine ring (A), a β-lactam ring (B), the source of antibacterial activity, and an acyl side chain (R), containing a variety of substitutions creating the family of semisynthetic penicillins. The only difference between ampicillin and penicillin G is the presence of an amino group in the acyl side chain (Fig 1).
PHARMACOLOGY AND BACTERIOLOGY
Ampicillin is a semisynthetic penicillin, active against Streptococus pneumoniae and certain Gram-negative bacteria, including most Haemophilus influenzae, Escherichia coli, and certain Proteus species. Compared to penicillin G, it has increased stability in acid solutions: a property facilitating oral administration and absorption. It penetrates into most body tissues; effective entry into CSF, however, occurs only with inflamed meninges. The serum half-life with normal renal function varies from four hours in newborns1 to 1.3 hours in adults.2 Ampicillin can cause an allergic, or nonallergic skin rash (Fig 2).
ALLERGY
Allergy (for the purposes of this discussion) is defined as a specific immunologic interaction, between either antigen and antibody, or antigen with a sensitized lymphocyte, resulting in a clinically deleterious effect. Implicit is a prior contact with the antigen.
Children and Divorce
Authors: Wallerstein Judith S. 
Published: December 2021

Children and adolescents experience severe stresses during the process of parental divorce. As a consequence, the pediatrician can expect to be called upon frequently to provide information and counsel to the divorcing parents, to the children, or to other family members directly, as well as to the physicians in other branches of medicine and concerned members of related disciplines whose professional work brings them into significant contact with these troubled families.
INCIDENCE
The number of children and adolescents who are caught in the process of marital dissolution has soared to more than 1 million new children each year since 1972. It has been estimated that between 32% and 46% of all children who grow up in the 1970s will experience either the separation or divorce of their parents.
Although research about the effects of divorce on children and adolescents is limited, some of the findings are worrisome. Our five-year study of the effects of divorce on a group of 131 California children and adolescents found a significant number at risk during the postdivorce years. Five years after the marital separation, 37% of these youngsters, who were drawn from a normal population, were considered to be suffering with various manifestations of moderate to severe depression, including learning below capacity in school, difficulties with peers, sexual acting out, minor delinquency, explosive anger, continued preoccupation with the divorce, and a general pervasive neediness.
Management of Status Epilepticus
Authors: Menkes John H. 
Published: December 2021

Status epilepticus is one of the few neurologic emergencies in the practice of pediatrics. A patient is considered to be in status when seizures occur so frequently as to prevent emergence from the postictal phase induced by one attack before the occurrence of the next.
There are four sequential aspects to the management of the patient in status: maintenance of vital functions, drug therapy to control the convulsions, assigning a cause for the condition, and lastly, prevention of further convulsions.
MAINTENANCE OF VITAL FUNCTIONS
A significant percentage of patients die in the course of status epilepticus, or shortly thereafter. Fatalities have ranged from 23% in all ages to 4% in an exclusively pediatric series. The physician treating the child in status should act promptly to maintain an adequate airway, prevent aspiration of mucus, and secure the child from injury induced by the violence of the convulsions. Hyperthermia and hypotension should be vigorously corrected. Whenever there is cyanosis, oxygen should be administered.
From experimental work we have learned that convulsions lasting longer than 20 to 30 minutes may induce brain damage. Several systemic factors acting singly or in concert are believed to be responsible. Hyperpyrexia and arterial hypotension have been singled out as inducing damage to nerve cells, particularly within the cerebellum.
COMMENTARY ON ACHALASIA
Authors: RANDOLPH JUDSON G. 
Published: December 2021

The symptoms and findings so nicely described in the accompanying clinical report of an 8-year-old boy are those of an obstructed distal esophagus which has led to chronic mucus production, nutritional deprivation with poor weight gain, and aspiration pneumonia. It is an extraordinary clinical paradox that these signs and symptoms are exactly the same for the obstructed gastroesophageal junction, and for the wide open reflux seen with pernicious gastroesophageal reflux.
Achalasia is characterized by failure of the gastroesophageal junction to relax during swallowing. The term achalasia (A-without + chalasia-relaxation), means failure of relaxation. The defect is rare in children and has been seen in very few infants.
Prenatal Genetic Diagnosis
Authors: Milunsky Aubrey 
Published: December 2021

The fundamental philosophy of prenatal genetic diagnosis is to enable prospective parents at risk to have children selectively, unaffected by a specific hereditary disorder.1 In practice, this new technology has allowed healthy children to be born to many couples who, without the reassurance that it is now possible to extend to them, would not have had any on any further children. Indeed, it is clear that the number of children born because of the opportunities provided by prenatal diagnosis exceeds the number of pregnancies terminated on account of fetal genetic disease.
Despite the availability of prenatal diagnosis for more than a decade, utilization has been slow. Even today, the vast majority of states provide studies for less than 10% of women aged 35 years or more. In Massachusetts, where strenuous efforts at professional and public education have been made, utilization in this age category is about 20%. In the United States, the remarkable tardiness in the application of this valuable technology may be related to earlier concerns about the risk and accuracy of second trimester amniocentesis. Today, however, the explanations are more likely to be a lack of awareness of the indications for prenatal genetic studies and antipathy to abortion. Virtually all states now have at least a single prenatal diagnostic facility or are able to use laboratories in an adjoining state.
School Failure
Authors: D Paul H. 
Published: December 2021

Numerous factors may contribute to a child's failure to learn. Certain causes of school failure, such as specific learning disabilities, mental retardation, sensory impairment, and chronic illness may be regarded as intrinsic characteristics of the child. Other causes, such as family dysfunction, social problems, and ineffective schooling, are characteristics of the child's environment. Still other influences on school performance, such as temperamental dysfunction, attention deficits, and emotional illness, may be viewed as the consequence of the interaction between the child and his or her environment. The reasons for a child's school failure must not be considered in isolation but rather within the context of social and environmental circumstances.
Evaluation must consider the myriad of reasons for a child's school failure and attempt to identify "clusters" of adverse influences on school performance. Detailed information must be sought from the student, parents, and school system through the history and physical examination. Questionnaires are useful in data gathering. Ancillary methods of assessment that may be of value include neurodevelopmental screening and laboratory studies. Further investigations and referrals, particularly psychoeducational evaluation, are of major importance.
Traditional roles of the pediatrician in school failure include the treatment of underlying medical conditions, counseling, the coordination of further investigations and referrals, and the facilitation of communication with community services and resources.
Management of the Child With Multiple Injuries
Authors: Robertson William O. 
Published: December 2021

Featured in this issue is a comprehensive update by Martha Bushore aimed at the practicing pediatrician confronted with a multiply injured child. It is not to be a quick referral piece available for consultation at the time of the disaster; rather, it is best consumed and digested slowly in one's favorite chair—far removed from the blare of the television set—and certainly not after a full dinner!
Dr Bushore has produced a particularly tightly written review with at least one telling idea in almost every sentence. Even though she has structured her message along traditional lines of organization logic (thus making the sequence easy to follow), the subject itself remains a conceptually difficult one to read through critically.
Sexual Behavior: Can the Pediatrician Counsel Adolescents?
Authors: Nazarian Lawrence F. 
Published: December 2021

Dr Hardy has done the pediatrician a favor by delineating so clearly and sensibly the practitioner's role in counseling adolescents in the area of sexuality. She even addresses the problem of accomplishing this task in the context of a busy schedule, and those of us in practice appreciate her focusing on the practical aspects of this responsibility. But even more needs to be said about the real-world issues of counseling about sexuality.
Many adolescents, even those receiving regular care, see the pediatrician for 15 minutes every other year. How can we possibly influence their management of a life force as potent as sexuality with such brief contact? Does it even make sense to try?
Premature Sexual Activity, Pregnancy, and Sexually Transmitted Diseases: The Pediatrician's Role as a Counselor
Authors: Hardy Janet B. 
Published: December 2021

Physicians providing preventive and primary health care for schoolaged patients are frequently confronted with difficult problems that stem from premature sexual activity among these young people. In this paper a brief description of the scope and potential costs, both human and societal, of these problems is given as background for discussion of the pediatrician's role as counselor and educator in their prevention and management.
The high frequency of sexual experience among school-aged girls and boys and the potential devastation that may result from the emerging epidemic of acquired immunodeficiency syndrome (AIDS), in combination with the pattern of multiple sex partners among adolescents, lend added urgency to the consideration of preventing these problems.
PROBLEMS ASSOCIATED WITH ADOLESCENT PREGNANCY, ABORTION, AND CHILDBEARING
The problems associated with pregnancy and childbirth among adolescents have attracted public concern and controversy since the middle 1970s when the number of births to American teenagers reached its peak. However, even though the number of births in this age group has declined as a result of the legalization of abortion and a decline in the number of teenagers in the population, the likelihood of pregnancy has declined much less, particularly among adolescents, younger than 18 years, and among the youngest teenagers. Among girls 15 years of age and younger, the pregnancy rate has been fairly stable and, among those who are white, it has continued to increase.
Substance Abuse
Authors: Macdonald Donald Ian 
Published: December 2021

Following a decade during which drug use by adolescents was viewed by many parents and other adults as a normal phase of development, the 1980s have been marked by growing awareness of the risks and costs of illegal drug use. Yet, despite the many successes of a burgeoning parents' movement, stimulated by the active leadership and support of the President and Mrs Reagan, drug use persists as a significant threat to the health and well-being of American youth.
Physicians are in a powerful position to deliver health promotion messages to patients and their parents and have an obligation to do so whenever possible. Messages delivered on a routine basis can be influential in promoting smoking, alcohol, and drug abstinence. These messages should begin early and continue throughout childhood to reinforce and strengthen the development of healthy attitudes and behaviors. The pediatrician must never be reluctant to express his or her own views regarding the health consequences of drug and alcohol use to patients or their parents. Informed pediatricians represent formidable opposition to individuals who argue that "experimental" or "recreational" use of illicit substances during the developmental years is inevitable, normal, or harmless.
Do You Know These Patients? High-Risk Pediatric Encounters
Authors: Korsch Barbara M. 
Published: December 2021

Who are the patients we come to identify as so troublesome that when we see their name on the day's schedule we hope they might cancel, or we feel tired before we get half way through the day at the thought that we have to face them? What is it about them that makes caring for them less gratifying and more difficult?
There has been a regrettable tendency to blame the patient for breakdowns in doctor-patient communication and to shift the burden of responsibility from the physician to the patients. We are all familiar with pejorative descriptions such as "the patient is a poor historian," "the patient is uncooperative," "this is a difficult patient," "this is a demanding patient," or "this is the patient I would most like to refer to my least favorite colleague." There are patients who are unpopular with all physicians, and then there are special sensitivities that make an individual physician react negatively to a particular group of patients.
Physicians may be insightful and perceptive of their own responses to other individuals and may have excellent communication skills, yet they are still only human. They are not perfect and not infrequently find themselves confronted by individual patients or families who annoy them, frustrate them, or disappoint them.
Adoption: New Tasks for the Pediatrician
Authors: Haberkern Roy C. 
Published: December 2021

Adoption involves an excess of 2,500,000 American children younger than 21 years of age and, thus, directly affects approximately 2% of American families. It profoundly touches the lives of those involved. For the pregnant, unmarried woman it offers hope for better nurture and security for her child than she may be able to provide. For the adopting couple, it offers an opportunity to love and care for a child as their own. For the adopted child, it offers a chance to have a family that is presumably able to meet his or her needs for love, guidance, and stability.
Pediatricians have provided services in different areas of the adoption process for many years. They may be asked for guidance by teenage patients who are pregnant but feel unable to care for the child themselves. Pediatricians are consulted by couples or adoption agencies to examine a child prior to adoption to assess specific problems and needs for services. They are asked for advice and assistance by families that include adopted children who find that they need help with difficulties that may or may not be specifically related to the adoption. Their help is sought by adoptees struggling with identity issues, problems in their relationships with members of their adoptive families or with others, concerns about obtaining medical information about themselves or their biologic families, or questions about attempting to establish contact with their families of origin.
Rheumatic Diseases of Childhood
Authors: Rennebohm Robert M. 
Published: December 2021

The pediatrician frequently encounters children and adolescents with musculoskeletal complaints that raise the possibility of rheumatic disease. The purposes of this article are: to review an approach to the evaluation of "joint" symptoms and to review the pharmacology, use, and adverse effects of nonsteroidal anti-inflammatory drugs.
RHEUMATOLOGIC HISTORY
Systematic collection of the historical details is fundamental in the evaluation of "joint" complaints (Table 1).
Age and Sex
The child's age and sex provide initial clues. For example, suspicion that a young girl (less than 5 years of age) with knee swelling might have monoarticular juvenile rheumatoid arthritis is heightened simply because of her age and sex. (At onset of their disease, almost 20% of all patients with juvenile rheumatoid arthritis are young girls with pauciarthritis, most commonly involving the knee.) Suspicion that an older boy (10 years of age or older) with axioskeletal complaints might have an enthesopathy syndrome is increased, in part, because of his age and sex. of the age and sex predilections of various rheumatic conditions is, therefore, helpful.
Chief Complaint
The chief complaint is often directive. For example, the complaint "his knees hurt every night" or "his legs hurt at night" is not characteristic of children who have juvenile rheumatoid arthritis or other well-defined inflammatory arthritides.
Childhood Asthma: Overview
Authors: Goldenhersh M. J. , Rachelefsky Gary S. 
Published: December 2021

DEFINITION
Asthma is a syndrome characterized by increased responsiveness of the trachea and bronchi to various stimuli and is manifested by widespread reversible narrowing of the airways that changes in severity either spontaneously or as a result of therapy.1 The hyperresponsiveness ("twitchiness") of airways is a fundamental abnormality and is dynamic in nature. Asthma is a disease of persistent or recurrent airway inflammation characterized by the presence of inflammatory cells (eosinophils and polymorphonuclear cells), edema of the wall, and changes in epithelial cells. Airway response to allergens and certain irritants may be acute (occurring within minutes to one hour following exposure), delayed or late (occurring within four to eight hours following exposure), or dual (combination of acute and late phase). Some reactions are only delayed. The late phase reaction is largely attributed to ongoing inflammation. Because of the variability of its presentation (complete v partial reversibility of airways obstruction, hyperreactivity accompanying other respiratory disease, chronic cough, or recurrent pneumonia with or without wheeze), children have often been denied appropriate antiasthmatic medications and their symptoms have been attributed instead to "wheezy bronchitis," "recurrent bronchiolitis," "spastic bronchitis," or "wheezy baby syndrome." For years pediatricians have been schooled to approach the wheezing child skeptically ("all that wheezes is not asthma").
Problem Behavior of Adolescents
Authors: Irwin Charles E. , Ryan Sheryl A. 
Published: December 2021

The health problems of adolescents have recently become the focus of new and unprecedented attention by public health officials and physician organizations. By traditional outcome measures of morbidity and mortality, the health status of adolescents in the United States is excellent. Outpatient physician use and hospital discharge rates for the age group 11 to 20 years remain the lowest of any age cohort.1 Because of these low frequency utilization rates and apparent excellent health status, the pediatrician has a major challenge: how to identify emergent problems in his or her preadolescent and adolescent patients.
These data concern primarily short-term, medical outcomes and provide little information about rates of chronic medical and psychologic disability, rates of change of behaviors during the second decade of life, and, most important, behavior-related problems, which often have their onset during adolescence. A different picture of adolescent health emerges when the causes of mortality are assessed. In 1986, 80% of the deaths in this age group were from accidents, homicides, and suicides—an increase from 51% in 1950. Furthermore, when the rate of change of mortality is evaluated during the second decade, there is a 200% increase, the largest in any single decade of the lifespan.2 Although hospitalization rates are low in this age group, leading discharge diagnoses, excluding pregnancy-related causes, are injuries and poisonings.
Childhood Asthma: Management
Authors: Goldenhersh M. J. , Rachelefsky Gary S. 
Published: December 2021

The goals of childhood asthma treatment are straightforward: facilitation of parent/patient understanding and acceptance of the disease prevention of patient physical and emotional disability. Patient/family education should be instituted at the time diagnosis is made, such that the patient and involved family members are familiarized with the short-term and long-term care that will be necessary. Setting realistic goals for asthmatic children that allow for a normal life-style (regular school attendance, participation in physical activities, etc) is helpful.
Successful management of childhood asthma requires knowledge, experience, and time. The demands on the physician can be tremendous. Patient management will be dictated by the age of the patient, the severity of the disease, and the social and financial resources of the involved family. The pediatrician with extra effort can provide appropriate care for the child with mild asthma. The moderate to severe asthmatic child (particularly those with evidence of chronic obstruction) are probably best managed by a team approach. Referral to a subspecialist who has the experience, updated knowledge, and time to institute both an educational and treatment program will benefit the patient with moderate to severe asthma (Table 1). The subspecialist assists in appropriate alteration of treatment plans in accordance with patient progress and may serve as a useful advisor to the pediatrician.