bluuebunny/crossref_metadata_2025_split huggingface dataset:
BUREAUCRATS TAKING OVER!
Authors: L. J. F. 
Published: December 2021

Academic medicine seemed to offer the best of both worlds: plenty of time for research, some teaching, and limited practice responsibilities.
Today, it all seems somehow lost: the independence, the time, the easily acquired grants, the lifestyle, and the security. Control has been wrested from medicine and is in the hands of bureaucrats, politicians, and CEOs. Patients—or consumers as they are now known—are distrustful and litigious. Lawyers are ever present and increasingly skilled at pitting one doctor against another. Academic health centers are locked in fierce battles for survival, and all physicians worry about the future.
Why has this happened?
The usual response to this questions mentions four major factors that have precipitated a health care "crisis," largely by driving up the costs of medical care: 1) the spectacular (and expensive) advances in medical technology and treatment; 2) changes in society, including epidemics of violence, drug abuse, economic disenfranchisement, and AIDS, which have added considerably to the nation's health care needs; 3) the shifting demographics of American society, particularly the growing numbers of elderly, who consume a disproportionate share of health care; and 4) the economic realities of global competition, in which American products lose a competitive edge because of the escalating health insurance costs of large employers.
To this list may be added two other factors: the unrealistic expectations of consumers, and the unchecked growth of physician specialists.
Surfactant Replacement in Neonates With Early Chronic Lung Disease
Authors: Pandit Paresh B. , Dunn Michael S. , Kelly Edmond N. , Perlman Max 
Published: December 2021

In the article entitled "Surfactant Replacement in Neonates With Early Chronic Lung Disease" by Pandit et al that appeared in the June issue of Pediatrics (pages 851-854), there was an error in the Results section (page 852). The third sentence in this section should read:
"Of note, the birth weights of seven patients were less than 750 g; two were between 750 and 1000 g; and one weighed 1100 g."
The Initiation or Withdrawal of Treatment for High-Risk Newborns
Authors:   Committee on Fetus and Newborn, 1994 to 1995
Published: December 2021

As medical technology has advanced, outcomes for high-risk newborns have greatly improved. With advanced technology such as assisted ventilation, it is now possible to keep some terminal, severely ill, or extremely premature infants alive for long periods of time. The result of such treatment is that dying may be prolonged or that the infant will survive with profound neurologic or other debilitating problems.1 The medical treatment of infants should be based on what is in their best interest. However, because the infant's "best interest" is not always clear, parents and health care givers are often faced with difficult treatment decisions when faced with the situation of a severely ill, extremely premature, or terminally ill infant.
The Treatment Dilemma
If intensive treatment uniformly resulted in saving infants at risk, it would be the obvious choice for all severely ill infants. This outcome, of course, does not always occur. If intensive treatment is not provided to very ill infants, most of them will die, but some may survive with significant neurodevelopmental disability, in part because specific treatments were withheld. The following dilemma therefore exists: intensive treatment of all severely ill infants sometimes results in prolongation of dying or occasionally iatrogenic illness; nonintensive treatment results in increased mortality and unnecessary morbidity. The overall outcomes of either approach are disappointing.
Strategy for Care
A reasonably acceptable approach to this dilemma is an individualized prognostic strategy.2,3 In this setting, care is provided for the individual infant at the appropriate level based on the expected outcome at the time care is initiated.
Letters to the Editor
Authors: Shira James E. 
Published: December 2021

The Committee on Hospital Care (COHC) was indeed remiss in failing to include the hospital pharmacist in the list and description of essential unit personnel in its statement "Staffing Patterns for Patient Care and Support Personnel in a General Pediatric Unit."1 The omission was truly unintentional and unfortunate.
We sincerely appreciate Dr Oddis' valuable comments and wholeheartedly concur with his message that pharmacists provide many essential services both to patients and the other members of the health care team on the pediatric unit.
Taste Counts!
Authors: Lallier Chuck 
Published: December 2021

I've read a number of articles on oral rehydration, including Cohen et al in the May 1995 issue of Pediatrics. The question "Why don't general pediatricians accept the use of oral rehydration?" comes up repeatedly.
There's a simple answer. We do. The problem is kids don't. They don't like the taste of the oral rehydration solutions and I don't blame them. I've tried it, in sickness and in health. The stuff tastes like lightly sugared sea water.
INFLUENCE OF SPACER DEVICE ON DRUG DELIVERY TO YOUNG CHILDREN WITH ASTHMA
Authors: Joos Thad H. 
Published: December 2021

Purpose of the Study. To evaluate the effectiveness of three different spacer devices for the delivery of an inhaled corticosteroid in asthmatic children 10 to 25 months of age.
Methods. The three spacers used were: Nebuhaler, Babyspacer, and Aerochamber (only the Aerochamber is available in the United States). Twenty children received in a crossover pattern 200 µg, in a single dose, of budesonide via a spacer and tightly-fitting face mask. A special filter was interposed between the face mask and the infant to catch the inhaled budesonide, which was then measured. In addition, the flow rates generated by the infants were determined as well as the budesonide remaining in the spacers.
Results. Both the Nebuhalen and Babyspacen were convincingly better than the Aenochamben in the amount of active drug as measured in the filter. The investigators felt that the amount deposited on the filter was an indicator of how much would reach the lungs.
Discussion. The Aerochamber had been the spacer of choice of the authors' before the study was completed, so the results were unexpected.
Reviewer's Comments. We have all used spacers to some degree and truly wonder how much medicine the patient really does receive. I feel Drs Agertoft and Pedersen have come up with an excellent way to resolve this dilemma.
EFFICACY OF ALBUTEROL IN THE MANAGEMENT OF BRONCHIOLITIS
Authors: Lee Napoleon , Kettelhut Brett , Kobayashi Roger H. 
Published: December 2021

Purpose of the Study. To determine the efficacy and safety of albuterol (0.15 mg/kg per dose) in the management of bronchiolitis.
Study Population. Eighty-eight infants (mean age, 5.5 months old) with their first episode of wheezing due to bronchiolitis were enrolled. Exclusionary criteria included previous treatment with bronchodilators, mechanical ventilation, or a history of cardiorespiratory diseases.
Methods. This was a double-blind, placebo-controlled study with infants randomly assigned into four treatment groups: 1) those who received nebulized albuterol (0.15 mg/kg) 2) those who received oral albuterol, 3) those who received nebulized placebo, and 4) those who received oral placebo.
Patients were assessed at baseline, 30 minutes, and 60 minutes after treatment for respiratory rate (RR), symptom score (SC), heart rate (HR), and pulse oximeter (SPO2). Seventy-five had nasopharyngeal aspirate cultures perfomed.
Results. Thirty-six (48%) of nasopharyngeal aspirates were positive for respiratory syncytial virus (RSV) and were equally distributed among the four groups. Four others had cultures positive for other viruses. HR, RR, SC, and SPO2 did not differ after 30 minutes and 60 minutes from initial treatment for groups 1, 3, and 4. Results were similar for group 2 except for an increase in heart rate (+15 beats/min) at 60 minutes (P = .006). Hospital admission rates were similar for all four groups.
Reviewer's Comments. Albuterol in either form did not alter the course of bronchiolitis in infants. Care in selection of study infants was taken to identify those infants with wheezing due to a viral bronchiolitis and exclude other causes of wheezing.
HIV-Infected Adolescents With Hemophilia: Adaptation and Coping
Authors: Brown Larry K. , Schultz Janet R. , Gragg Rod A. ,   Hemophilia Behavioral Intervention Evaluation Project
Published: December 2021

Objective. It is estimated that 70% of individuals with factor VIII deficiency hemophilia who received blood products before 1985 are infected with human immunodeficiency virus (HIV). The goal of the current study was to assess how adolescents with hemophilia cope with reminders of their HIV status, because adaptation is likely to have implications for these individuals' quality of life and adherence to safer sex recommendations.
Methods. Participants included 297 HIV-positive adolescents with hemophilia who were recruited from 11 sites across the United States. Adolescents reported on the use and effectiveness of strategies for coping with reminders of their HIV status.
Results. A significant degree of distress was reported in response to such reminders, with anger being the most commonly reported emotion. Although a wide variety of coping strategies had been tried, participants reported using resignation (80.9%), self-calming (78.8%), and distraction (76.4%) most frequently in their attempts to cope with reminders of HIV. Self-blame (3.6%), engaging in risky behaviors (22.2%), thinking about sex (25.4%), and drug/alcohol use (29.1%) were used least. These adolescents tended to rate more active cognitive and behavioral coping strategies (eg, cognitive restructuring, seeking social support, physical activity) as most effective, whereas passive strategies (eg, wishful thinking, blaming others) were reported to be least helpful. Those individuals who reported being distressed by reminders of HIV endorsed most of the coping strategies significantly more often than the nondistressed group, although ineffective strategies were commonly chosen. Sexually active adolescents were more likely than their abstinent peers to cope by thinking about sex, engaging in risky behaviors, or using alcohol and drugs.
Conclusion. In this population of adolescents who have known their serostatus for several years, distress about everyday reminders of HIV appears to be associated with ineffective coping strategies.
Determinants of Growth From Birth to 12 Months Among Breast-Fed Honduran Infants in Relation to Age of Introduction of Complementary Foods
Authors: Cohen Roberta J. , Brown Kenneth H. , Canahuati Judy , Rivera Leonardo Landa , Dewey Kathryn G. 
Published: December 2021

Objectives. To evaluate the impact of introducing complementary foods to exclusively breast-fed infants at 4 vs 6 months on growth from 6 to 12 months, and to compare growth patterns of Honduran infants with those of breast-fed infants in the United States.
Design. Randomized intervention trial from 4 to 6 months and longitudinal study of infants from birth to 12 months.
Setting. Low-income communities in San Pedro Sula, Honduras.
Subjects. Primiparous, breast-feeding mothers and their infants (n = 141) recruited from public maternity hospitals.
Intervention. Infants were randomly assigned to exclusive breast-feeding to 6 months, or exclusive breast-feeding with addition of hygienically prepared, nutritionally adequate complementary foods at 4 months, with or without maintenance of baseline breast-feeding frequency. After 6 months, mothers continued to breast-feed and also fed their infants home-prepared foods after receiving instruction in appropriate feeding practices.
Outcome Measures. Infant weight was measured monthly during the first year of life and infant length monthly from 4 to 12 months.
Statistical Analysis. Growth parameters were compared between the Honduran and US cohorts using multiple-regression and repeated-measures analysis of variance. Stepwise multiple regression was used to identify determinants of infant growth.
Results. There were no differences in growth patterns by intervention group. Mean birth weight of the Honduran infants was significantly less than that of a cohort of breast-fed infants in an affluent US population (n = 46) (2889 ± 482 vs 3611 ± 509 g), but the Honduran infants exhibited rapid catch up in weight in the first few months of life, and the cohorts were similar in weight by 3 months. Mean weight and length gain were similar to those of the US cohort from 4 to 9 months but were lower from 9 to 12 months. Mean length for age was significantly less than that of the US cohort from 4 to 12 months; this was attributable to the difference in maternal height (12 cm shorter in Honduras on average). Within the Honduran cohort, growth velocity of low birth weight infants (&lt;2500 g; n = 28) was similar to that of their normal birth weight peers; thus, the former subgroup remained smaller than the latter throughout the first year of life.
Conclusions. In poor populations, when breast-feeding is exclusive for the first 4 to 6 months, continues from 6 to 12 months, and is accompanied by generally adequate complementary foods, faltering in weight does not occur before 9 months among infants born with birth weights of more than 2500 g.
Pediatric Office-Based Smoking Intervention: Impact On Maternal Smoking and Relapse
Authors: Wall Michael A. , Severson Herbert H. , Andrews Judy A. , Lichtenstein Ed , Zoref Leslie 
Published: December 2021

Objective. To determine the impact of a brief smoking intervention delivered by pediatricians in the context of usual well baby office visits on postnatal maternal smoking and relapse.
Setting. Forty-nine private pediatric practices including 128 practitioners.
Design. Randomization of pediatric practices into minimal and extended intervention sites with all enrolled mothers of newborns within a practice receiving the same level of intervention.
Intervention. Smoking mothers in minimal condition received a hospital packet containing written information about passive smoking and a letter advising them to quit. Those in extended condition received the hospital packet plus oral and written advice at usual well baby visits: 2 weeks, 2, 4, and 6 months.
Measurements. Smoking and relapse rates at 6 months postpartum, demographics associated with smoking status, attitudes, and knowledge in regard to passive smoking, and recall surveys of mothers in regard to receiving advice or written materials.
Results. Two-thousand nine-hundred-one mothers of newborns were enrolled in the study. Those in the extended condition had higher quit rates (5.9% vs 2.7%, P &lt; .01) and lower relapse rates (45% vs 55%, P &lt; .01) than those in the minimal condition. Mothers' educational status and the presence of a smoking partner in the home were the major demographic variables associated with smoking status at enrollment and at follow-up. Compared with smokers in the minimal condition, those in extended at 6 months postpartum had significantly better attitudes and knowledge regarding passive smoking and allowed less smoking in the home. Mothers attending extended practices reported much higher rates of receiving oral advice and written materials than those in the minimal condition.
Conclusions. A brief program can lead to major increases in the willingness of pediatricians to deliver smoking advice. A 1- to 2-minute intervention delivered in the context of usual well baby care can have a positive impact on maternal smoking and especially upon relapse prevention. A recent smoking history should be obtained from all mothers of newborns so that interventions can be aimed at both cessation and relapse prevention.
Surface Electrical Capacitance as a Noninvasive Beside Measure of Epidermal Barrier Maturation in the Newborn Infant
Authors: Okah Felix A. , Wickett R. Randall , Pickens William L. , Hoath Steven B. 
Published: December 2021

Objective. The classical studies of epidermal barrier function in infants have relied on measurement of transepidermal water loss by evaporimetry. This technique, although valuable, is, in practice, slow, expensive, and susceptible to error because of convective air currents. In this prospective study, we evaluated gestation-dependent and postnatal age-dependent changes in epidermal barrier function by measurement of skin surface electrical capacitance (SEC) in 40 newborn infants ranging from 25 to 40 weeks' gestational age. SEC was measured in picofarads with a dermal phase meter.
Methodology. The measurements were recorded continuosuly during a 12-second period from the forehead at 12 to 24 hours of life. The baseline (CBL) surface hydration at 1 second and the rate of change of SEC during probe occlusion (CSL) were used as measures of surface hydration and transepidermal water movement, respectively. In the most premature infants (&lt;30 weeks), these measurements were repeated daily for 5 days. Data were analyzed by analysis of variance after logarithmic (Ln) transformation.
Results. We found a significant difference in Ln(CBL) in infants born before and after 30 weeks' gestation (4.91 ± 0.36 Ln[pF] vs 2.67 ± 0.21 Ln[pF], respectively). Similarly, CSL was significantly different in infants born before and after 30 weeks' gestation (16.42 ± 5.55 pF/s vs 1.59 + 0.22 pF/s, respectively). In infants born at less than 27 weeks, both Ln(CBL) and CSL decreased significantly by postnatal day 5. In the term group (n = 25), CSL was significantly greater in white than in black infants (1.96 ± 1.32 pF/s vs. 0.95 ± 0.55 pF/s, respectively).
Conclusion. These results demonstrate impaired epidermal barrier properties in immature infants, less than 30 weeks' gestation, and reveal a remarkable rate of barrier maturation of this group in the first few days of postnatal life. Also, the finding of decreased CSL in black infants supports the hypothesis of differences in barrier function attributable to skin types. Overall, these findings demonstrate the feasibility of bedside SEC measurements in the evaluation of epidermal barrier properties in the newborn infant.
Letters to the Editor
Authors: Schunk Jeff E. , Harrison A. Marc , Corneli Howard M. , Nixon G. William 
Published: December 2021

We appreciate these comments. We agree with the suggestion of Drs Conners, Chamberlain, and Ochsenschlager; in fact, we employ this method ourselves!
Drs Arnold and Radkowski restate our proviso that manipulation of foreign bodies in the esophagus should not occur remote from physicians and equipment needed for resuscitation, although we note this is a somewhat theoretic precaution: no actual resuscitation or airway manipulation was required in our 415 cases. We are not sure that resident training justifies cost or inconvenience to the patient.
Response to Drs Bergman and Zurhellen
Authors: Coombs John B. 
Published: December 2021

In composing a response to these two articles, I must congratulate both presenters. Each created a stimulating summary of key components of what I consider to be the greatest challenge for practicing physicians in the future: information management. Dr Zurhellen has described an office information system that, in all probability, is enjoyed by fewer than 1 in 50 practitioners currently. Taking advantage of his position as a solo practitioner with a strong interest in computers, he has developed a system that brings greater simplicity, efficiency, and—I dare say—accuracy and precision to his office practice. The greatest challenge for the rest of us will be how to create the transition and the tremendous investment of time, financial resources, and risk that it will surely take to get where he is today.
Given the need for improvement in the daily handling of office information, and given the estimated 7500 new articles entered daily in the peer-reviewed biomedical literature, futurists predict that practitioners during the next 15 years will need to adjust both their practice style and their continuing education. They will need to assimilate new information in accordance with this estimate: 75% of what one needs to know to provide top-quality care in any given patient encounter will change during a 12-month period. Dr Bergman has provided an up-to-date glimpse of how we are preparing to meet this challenge. Practice parameters condense new acientific information that is evidence based into defined best practice for a given medical condition. Gaps in evidence-based information are filled by selected expert opinion.
AGENCY FACING REVOLT AFTER REPORT
Authors: L. J. F. 
Published: December 2021

Representative Henry Bonilla, a San Antonio Congressman in his second term, was home for a visit early this year when he received a small stream of visitors who wanted to complain about a federal agency. The visitors were local back surgeons and some physical therapists angry over a study by the agency that said most back surgery and much physical therapy used by Americans for back pain was unnecessary.
As a Republican member of the Appropriations subcommittee that deals with the agency's budget, Mr Bonilla was a good choice for the surgeons' complaints that the Agency for Health Care Policy and Research was a waste of money.
As far as battles in the current multibillion-dollar budget war go, the fight over the agency is only a tiny skirmish, because its budget is $165 million dollars.... The agency, which is supposed to evaluate the effectiveness of medical treatments, issued a set of guidelines for the public last December that said, in effect, that most of the back surgery performed in the country is unnecessary ... The agency's director, Dr Clifton Gaus, has gone on the offensive, depicting the situation as one in which back surgeons were trying to undercut his agency simply to maintain their substantial incomes... The agency was created by a law signed in 1989 by President George Bush and is supposed to study the effectiveness of medical treatments.... Dr Robert B. Keller said that the guidelines were the result of the best science available. "Those who have attacked the study," he said, "are simply trying to protect their livelihoods."
Adverse Factors Associated With Forced Sex Among Southern Adolescent Girls
Authors: Nagy Stephen , DiClemente Ralph , Adcock Anthony G. 
Published: December 2021

Objective. To identify adverse behavioral and psychological factors associated with forced sex experiences of adolescent girls compared with their sexually active counterparts.
Method. An anonymous self-report survey examining an array of psychosocial items, to which 3124 grade 8 and grade 10 female students responded.
Results. Sexually abused girls were more likely to have been pregnant, to have initiated sexual intercourse at a younger age, to indicate illegal drug use, to have feelings of depression, to express more frequent suicidal ideation, and to have been physically abused.
Conclusions. Behaviors such as gateway drug use, truancy, binge drinking of alcohol, and participation in violent episodes that were previously identified as indicators of sexual abuse did not distinguish between sexually active adolescents and those who had been sexually abused. Physicians should consider carefully a structured series of questions relating to behaviors as one approach in determining the risk of sexual abuse. Positive responses to young sexual initiation, pregnancy, illegal drug use, negative mental health states, and evidence of physical abuse are potential markers of sexual abuse in adolescent female clients.