bluuebunny/crossref_metadata_2025_split huggingface dataset:
Human Immunodeficiency Virus [Acquired Immunodeficiency Syndrome(AIDS) Virus] in the Athletic Setting
Authors:   Committee on Sports Medicine and Fitness
Published: December 2021

Because athletes may bleed following trauma, they represent a theoretical risk to others if they are infected with the human immunodeficiency virus [HIV, acquired immunodeficiency syndrome (AIDS) virus]. Two questions have concerned coaches, athletic trainers, and school administrators: Should an athlete known to be infected with HIV be allowed to participate in competitive sports, and should the universal precautions recommended for health care workers be used when handling athletes' blood and body fluids?
The risk of infection from skin exposure to the blood of a child or adolescent infected with HIV is unknown, but it is apparently minute and is much less than the risk of HIV infection by needlesticks from infected patients of approximately 1:250. Although it is theoretically possible that transmission of HIV could occur in sports such as wrestling and football in which bleeding and skin abrasions are common, no such transmission has been reported in these sports. There is one report of possible transmission of HIV involving a collision between soccer players. However, this report from Italy remains undocumented.
If an HIV-infected athlete would choose to pursue another sport, this possible risk to others would be avoided; but, in the absence of any proven risk, involuntary restriction of an infected athlete is not justified. Informing others of the athlete's status would probably lead to his or her exclusion due to inappropriate fear and prejudice and therefore should also be avoided. This advice must be reconsidered if transmission of HIV is found to occur in the sports setting.
Hypercholesterolemia Screening Questioned
Authors: STEINER NANCY J. 
Published: December 2021

In Reply.—
As stated in the title and text of the paper, the specific objective of this research is to evaluate the efficacy of screening strategies based on selected risk factors to identify all adolescents with hypercholesterolemia. The findings demonstrate that targeted screening does not detect effectively all individuals with hypercholesterolemia. Therefore, the logical alternative for a practitioner who wants to identify all teens with hypercholesterolemia must be to screen all individuals.
Although Dr Sheps agrees with my findings that the American Academy of Pediatrics' criteria for hypercholesterolemia screening are not predictive of high cholesterol levels in adolescents, he disagrees with the conclusion that to identify adequately all individuals with hypercholesterolemia, all teens must be screened.
Chronic Fatigue Immune Dysfunction Syndrome: An Epidemic?
Authors: SADEH AVI , CARSKADON MARY A. , ACEBO CHRISTINE , DAHL RONALD 
Published: December 2021

To the Editor.—
The report described a study of 15 adolescents with a complaint of chronic fatigue.1 In an effort to encompass all possible sources of chronic fatigue, evaluation of the patients included physical examinations, virologic tests, and psychological studies.
We believe that insufficient attention was given to assessing the sleep-wake system as a possible source of chronic fatigue in at least some of these adolescents. Certainly, inadequate sleep (which is common among adolescents, see Carskadon2) can result in symptoms of chronic fatigue.
COAGULATION STUDIES IN THE NEWBORN INFANT
Authors: HEYN RUTH M. , ROZENFELD IRVING H. , GROSSMAN BURTON J. , STUART JAMES D. 
Published: December 2021

Determinations of the whole blood clotting time, prothrombin concentration, protamine titration, platelet count, and clot lysis were done on 10 infants with erythroblastosis fetalis on the first, third and fifth days of life.
On the first day of life the average whole blood clotting time was 27 minutes as compared to an average of 14 minutes in the normal infant. The protamine titration was increased beyond normal adult values in 60% of the infants as compared with 23% of normal infants. The prothrombin concentration was comparable to that of the normal infant.
Eight of these infants received replacement transfusions and repeat determinations of the above factors immediately after transfusion showed a return to normal of the protamine titration.
Heparin sensitivity tests done on three of the treated infants before and after transfusion were essentially normal.
On the third day of life the average whole blood clotting time was 10½ minutes in the treated infants as contrasted with 25 minutes in the normal infant. Protamine titrations were normal in all infants. The average prothrombin concentration was 77% as compared with 65% in the normal three day infant.
On the fifth day of life all determinations were normal except for those from three infants who had increased protamine titrations.
OXIMETER STUDIES IN NEWBORN INFANTS DURING CRYING
Authors: PREC KLARA J. , CASSELS DONALD E. 
Published: December 2021

The arterial oxygen saturation was determined in 135 healthy newborn infants during sleep and while crying with a direct reading single scale oximeter. In the first group, consisting of infants from one hour and 30 minutes to 3 days of age, 66% showed a decrease of oxygen saturation with crying, 27% an increase and 6.8% no change. In the second group, which includes all infants between 4 and 9 days of age, 59% showed an increase in saturation with crying, 21% a decrease and 22.4% no change. In comparison, the mean results in these two groups are in the opposite direction. These changes are statistically significant. Twenty-eight infants were studied also while breathing oxygen (73%-98.5%), and the results compared with those in room air were found to show an identical trend.
It is concluded that increases in arterial oxygen saturation with crying, which occur most frequently in older infants, are probably due to an increase in alveolar oxygen tension secondary to improved pulmonary ventilation during crying.
The paradoxic decrease in saturation during crying, which was found in a large percentage of infants of the younger group, is suggestive of the presence of a transitory venous-arterial shunt. This shunt could be either through atelectatic areas of the lung or through the foramen ovale, which is only functionally closed and can open whenever the pressure in the right auricle exceeds the left auricular pressure. There is some available evidence to support the latter possibility.
Hypercalcemia in Association with Subcutaneous Fat Necrosis of the Newborn: Studies of Calcium-Regulating Hormones
Authors: COOK JENNIFER S. , STONE MARY SEABURY , HANSEN JAMES R. 
Published: December 2021

Subcutaneous fat necrosis of the newborn is an uncommon disorder that occurs during the first few weeks of life as firm subcutaneous nodules on the cheeks, buttocks, back, arms, and thighs. This disorder, which initially was described by Harrison and McNee in 1926,1 typically affects full-term newborns who have experienced perinatal distress. Subcutaneous fat necrosis of the newborn usually resolves over a period of months, but may result in death due to its association with hypercalcemia.
The association between subcutaneous fat necrosis of the newborn and hypercalcemia was first reported by Clay in 19562; however, the mechanism that results in hypercalcemia remains incompletely understood.3-7
Meconium Aspiration Syndrome (MAS)
Authors: WAAGE GUNNAR 
Published: December 2021

To the Editor.—
In the article "Intratracheal Suctioning, Systemic Infection, and the Meconium Aspiration Syndrome," Wiswell and Henley review their experience with meconium-stained babies from 1985 to 1989.
Dr Wiswell compares two groups of neonates, those intubated and those not intubated. The rationale for not intubating neonates included (1) the lack of meconium in the hypopharynx, (2) the apparent vigor of the child, and (3) thin-consistency meconium. The literature agrees that the majority of meconium-stained neonates fall into such a category; however, Dr Wiswell finds only 19% of neonates in this category.
Behavior, Biology, and the Meanings of Temperamental Constructs
Authors: Kagan Jerome 
Published: December 2021

The renascence of temperamental constructs in discussions of both normal and pathologic development, after almost a century of polite suppression, is accompanied by the same methodologic and epistemologic issues that plague all inquiry into the relation between biologic and psychologic phenomena. During the half-century following World War I, when behavioristic explanations were ascendant, the burden of explanation for many behaviors rested on conditioned habits acquired through contingent interaction with the environment. If a habit happened to become associated with a physiologic reaction, it was usually treated as an epiphenomenon of the conditioned response.
The study of temperamentally based behaviors has changed this attitude because the physiology is not viewed as epiphenomenal. Many investigators assume that children who belong to a particular temperamental category inherit a low or a high threshold for particular physiologic reactions to specific incentives. The sequence of behavioral profiles that develops is a joint product of both the child's physiology and the environments encountered. For example, about 20% of healthy 1- to 2-year-old white children react consistently to unfamiliar events that are difficult to assimilate or to cope with—like thunderstorms, large animals, or strangers—with both limbic discharge and an initial restraint on activity, sometimes accompanied by withdrawal. We call such children inhibited.1 The limbic activity accompanies the behavioral phenomena without being causal in the traditional meaning of that term.
It is also understood that the temperamentally inhibited child must be differentiated from the shy child who was not born with any temperamental bias favoring limbic reactivity to unfamiliarity, but happened to experience an environment that promoted the acquisition of timidity and restraint.
Carnation Marketing Practices
Authors: MACDONALD LAURIE 
Published: December 2021

To the Editor.—
I would like to comment on Dr Frank A. Oski's Letter to the Editor concerning low-iron infant formulas which appeared in the February 1992 issue of Pediatrics.1
Dr Oski's concern over the large volume of low-iron infant formula sold is shared by us at Carnation Nutritional Products. To this end, we broke with the industry practice of offering both low-iron and iron-fortified formulations when, in early 1989, we introduced Carnation Good Start and Carnation Follow-Up Formula in iron-fortified forms only.
Presurgical Routine Screening
Authors: LACKMANN GERD M. , TÖLLNER UWE 
Published: December 2021

To the Editor.—
We read with interest the article "Preoperative History and Coagulation Screening in Children Undergoing Tonsillectomy."1 In 1990, we performed a prospective study on the incidence of previously undetected pediatric diseases in children who were admitted to our hospital for surgical procedures.2 497 children aged 2 months to 16 years were enrolled in the study. All children were cared for by a pediatrician as well as by colleagues from specific surgical departments, eg, ear, nose, and throat surgery (50.9%), gastrointestinal surgery (17.3%), urology (12.9%), traumatology (11 .9%), oral surgery (4.2%), neurosurgery (0.4%), and others (2.4%).
Treatment of Theophylline Poisoning
Authors: STRAUSS ARTHUR , MODANL0U HOUCHANG D. 
Published: December 2021

To the Editor.—
We were interested in the report by Shannon and co-workers1 in which they described the use of multiple exchange transfusions for the treatment of an accidental toxic serum theophylline level in an infant in the postoperative phase of an arterial switch procedure. Although we have no problem with the rationale used for an invasive procedure that has multiple complication risks, we would like to emphasize the option for the use of activated charcoal products in infants who are able to tolerate orally administered medications.
Role of the Pediatrician in Setting and Using Standards for Child Care
Authors: Aronson Susan S. 
Published: December 2021

Standards for child care settings define expected performance. Other types of requirements applicable to operation of child care facilities include funding requirements, accreditation criteria, and regulations (legal requirements). During licensing inspections, program monitoring by funding agencies, evaluations by accrediting organizations, and self-evaluations, programs become aware of opportunities for improvement. The process of evaluation alone leads to improved program performance1; the majority of providers want to do a good job.
When requirements are used for systematic surveillance, the compliance data generated identify problems to be targeted for quality improvement. Training, technical assistance, linkage to existing resources, and development of new resources are common interventions that lead to improved performance in child care programs. These interventions may be applied at the level of an individual child care facility or at any level involved with child care services. Thus, training and technical assistance may be given to caregivers, to licensors, to policy makers, or to the public.
A surveillance system should continuously measure the impact of interventions and focus attention on problems that require further corrective action. When performance data from individual programs are aggregated, they provide powerful tools to assess the need for communitywide interventions. Some changes cannot be accomplished within the limited resources of an individual child care facility. Sometimes program improvement requires one or more types of intervention at the community, regional, state, and/or national level.
Updating requirements, conducting surveillance to measure compliance with requirements, and analyzing data to target interventions and measure the impact of actions on program performance are the basic elements of a systems model for improving quality in child care (see Figure).
SIDS and Sleeping Position
Authors: GUNTHEROTH WARREN G. , SPIERS PHILIP S. 
Published: December 2021

To the Editor.—
Hunt and Shannon1 decried the "precipitous action" of the task force of the American Academy of Pediatrics when the Academy recommended that "healthy infants, when being put down for sleep, be positioned on their side or back."2 Precipitous seems an inappropriate description of the Academy's conclusions which were based on 15 publications (dating back 14 years) with statistically significant increases in risk for sudden infant death syndrome (SIDS) in the prone position.
Hunt and Shannon complained that the data are "preliminary" and might lead to "iatrogenic disasters," as though the use of the prone position was novel and had unknown consequences, ignoring centuries of experience with the supine position in Asian cultures, which have extraordinarily low rates of SIDS.3
Garlic Burns
Authors: GARTY BEN-ZION 
Published: December 2021

Five things have been said about garlic: it assauges hunger, warms the body, brings joy, increases virility and destroys intestinal lice. There are those who say that it engenders love and dispels envy.
—Babylonian Talmud: Baba Kama (first gate) page 82
Garlic (Liliaceae Allium sativum) has been used for centuries by many cultures as a remedy for a variety of illnesses. Herodotus spoke about the medical use of garlic in Egypt, 3000 years BC. Hippocrates, in the fifth century BC, used garlic to treat a variety of infections, including leprosy, intestinal disorders, and chest pain. In the Middle Ages garlic was used for protection against the plague.
Long-term Psychosocial Sequelae of Chronic Physical Disorders in Childhood
Authors: Pless Ivan B. , Power Christine , Peckham Catherine S. 
Published: December 2021

Objective. This study was designed to examine the long-term psychosocial sequelae of chronic physical disorders that begin during childhood.
Design. We analyzed data from a national birth cohort. 12 537 children were followed until age 23 years—76% of all born in Britain during one week in 1958. Of these, 1667 had a chronic disorder before age 16 and 1279 were included in the 23-year follow-up.
Measures. Outcome measures included self-reported psychological disturbances between ages 16 and 23, scores on the Malaise Inventory, social class, educational qualifications, unemployment, and social activities.
Results. The total cumulative incidence rate before 16 years was 109.5 per 1000. Demographic comparisons showed that the group with chronic physical disorders was similar to those free of chronic disorders in all respects except the sex ratio. Men with chronic physical disorders had significantly higher relative risks for abnormal scores on the Malaise Inventory (1.52, confidence interval [C]]1.13, 2.05); specialist psychological care (1.43, CI 1.00, 2.03); poor educational qualifications (1.26, CI 1.08, 1.47); periods of unemployment (1.20, CI 1.03, 1.41); and less social drinking (1.36, CI 1.15, 1.60). In contrast, women only had a significantly elevated risk for having seen a mental health specialist (1.32, CI 1.02, 1.71). Among the men some of the risks were further elevated for those in specific diagnostic groups. These findings are examined in the light of postulates about the impact of chronic physical disorders as a whole and in an attempt to explain the striking sex differences. For clinicians they provide further reason to justify concern about the psychosocial aspects of care for children with chronic disorders.
Helicobacter pylori in Children With Acquired Immunodeficiency Syndrome
Authors: BLECKER U. , KEYMOLEN K. , SOUAYAH H. , LEVY J. , VANDENPLAS Y. 
Published: December 2021

To the Editor.—
It has been demonstrated that the presence of Helicobacter pylori-associated gastritis is rare in adults with acquired immunodeficiency syndrome (AIDS).1 To investigate the prevalence of H pylori infection in pediatric AIDS patients, we examined 19 children, aged 1 to 14 years (mean age 5 years 11 months), of mainly central African ethnic origin. They were compared to an asymptomatic control population of comparable age (n = 52; mean age = 5 years, 10 months) and ethnic origin.
Risk Factors for Acute Wheezing in Infants and Children: Viruses, Passive Smoke, and IgE Antibodies to Inhalant Allergens
Authors: Duff Angela L. , Pomeranz Elaine S. , Gelber Lawrence E. , Price G. Weyman , Farris Holly , Hayden Frederick G. , Platts-Mills Thomas A.E. , Heymann Peter W. 
Published: December 2021

Objective. To examine the prevalence of viral infection, passive smoke exposure, and IgE antibody to inhaled allergens in infants and children treated for acute wheezing.
Design. Case-control study of actively wheezing children who were compared with children without respiratory tract symptoms.
Setting. University of Virginia Pediatric Emergency Room.
Patients. Convenience sample of 99 wheezing patients (2 months to 16 years of age) and 57 control patients (6 months to 16 years of age).
Measurements and results. Serum IgE antibody to inhalant allergens, measured by radioallergosorbent test (RAST), was uncommon in wheezing and control patients under age 2. After 2 years of age, the percentage of RAST-positive patients increased markedly and was significantly higher in wheezing patients than controls after age 4 (72%, n = 54, and 30%, n = 40, respectively, P &lt; .001). Total IgE levels and nasal eosinophilia were strongly correlated with a positive RAST after age 2. Viral pathogens, predominantly respiratory syncytial virus, were identified in nasal washes from 70% (n = 20) of wheezing patients younger than 2 years of age compared with 20% of controls (n = 10), P &lt; .05. After age 2, viruses, particularly rhinovirus, were isolated in washes from 31% (n = 70) of wheezing patients, 64% of whom were also RAST-positive. Levels of cotinine, a nicotine metabolite, were elevated (≥10 ng/mL) in saliva from a large percentage of smoke-exposed, wheezing patients under 2 (74%, n = 19) compared with those over 2 (14%, n = 51), P &lt; .001. Odds ratios for wheezing were significant for virus (8.2, confidence interval [CI] = 1.3 to 5.0), and cotinine (4.7, CI = 1.0 to 21.3) in children under 2, and IgE antibody by RAST (4.5, CI = 2.0 to 10.2), virus (3.7, CI = 1.3 to 10.6), and the combination of IgE antibody and virus (10.8, CI = 1.9 to 59.0) were significant risk factors after age 2.
Conclusion. Wheezing children younger than 2 years of age had a high rate of viral infection and a low rate of IgE antibody to inhalant allergens. When these children were exposed to passive smoke, salivary cotinine levels were elevated suggesting heavy exposure. After 2 years of age, sensitization to inhaled allergens became increasingly important and viruses remained a significant risk factor for wheezing. These data support recommendations to reduce tobacco smoke exposure at home, especially for young patients, and to consider sensitization to inhaled allergens and allergen avoidance in wheezing children at an early age, particularly after age 2 years.
Advertising in Pediatrics
Authors: ALDEN ERROL R. , DOW JEAN 
Published: December 2021

The practice of publishing advertising in the journal is occasionally questioned by our readers, as is the process by which ads are screened prior to publication. Some believe that the presence of any advertising somehow contaminates the objectivity of a professional journal; others take issue with particular advertisements. The purpose of this commentary is to make readers aware of the Academy's policies and procedures as they relate to this practice.
The most frequent question is, why does Pediatrics carry advertising at all? The simple answer is that journal advertising provides a significant source of revenue for Pediatrics and provides a source of financial support for other Academy programs. Indeed, many worthwhile programs and projects designed for the benefit of children and AAP members could not be undertaken without this and other sources of income.
Different Views on Adolescent Abortion
Authors: MALLORY GEORGE B. , MALLORY SUSAN B. 
Published: December 2021

We are writing to express strong disagreement with the perspective expressed in the recent article by Fleming and O'Connor (Pediatrics. 1993;91:561-565) with reference to adolescent abortion. Although there is virtue in using clinical scientific language in analysis of controversial issues, the seemingly objective approach used by the authors can obfuscate the real issues when issues of morality are involved. We do not quibble with the survey or its analysis in the results section, but we disagree with several points in the discussion.
The discussion begins with the statement that "there is general agreement in the literature that abortion is one of the safest medical procedures with no clear evidence of long-term negative effects."
A LESS COSTLY REGIMEN OF ALGLUCERASE TO TREAT GAUCHER'S DISEASE
Authors: Figueroa Michael L. , Rosenbloom Barry E. , Kay Andrea C. , L. J. F. 
Published: December 2021

Alglucerase (Ceredase) provides effective enzyme-replacement treatment for patients with Gaucher's disease, but at the usually recommended dose of 60 U per kilogram of body weight every two weeks (130 U per kilogram per month), it costs $382,200 per year for a 70-kg patient. Theoretical considerations suggest that more frequent administration would be more efficient...
The treatment of Gaucher's disease with smaller total doses of alglucerase given more frequently yields satisfactory results. A dose of 2.3 U per kilogram three times weekly yields major financial benefits with no sacrifice of therapeutic effect. Even taking into account the ancillary costs of more frequent administration, this method of administering alglucerase reduces the annual cost of the drug for a 70-kg patient to about $100,000. (N Engl J Med. 1992;327:1632-1636.)