bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Evaluation of an Innovative Multimedia Educational Software Program for Asthma Management: Report of a Randomized, Controlled Trial
Authors: Homer Charles , Susskind Oded , Alpert Hillel R. , Owusu MPM§; Celestina , Schneider Lynda , Rappaport Leonard A. , Rubin David H. 
Published: December 2021

Background.Asthma continues to be a substantial cause of morbidity in pediatric populations. New strategies are needed to provide cost-effective educational interventions for children with asthma, particularly those in the inner city.Objective.To assess the effectiveness of a multimedia educational software program about asthma.Setting.A hospital-based primary care clinic and an affiliated neighborhood health center.Design.Randomized, controlled trial.Population.Children 3 to 12 years old with physician-diagnosed asthma.Intervention.An interactive educational computer program, Asthma Control, designed to teach children about asthma and its management. Using a graphic display of a child going through simulated daily events, the game emphasizes: 1) monitoring; 2) allergen identification; 3) use of medications; 4) use of health services; and 5) maintenance of normal activity. Control group participants reviewed printed educational materials with a research assistant.Outcomes.Acute health care use (emergency department and outpatient) was the primary outcome. Secondary outcome measures included maternal report of asthma symptom severity, child functional status and school absences, satisfaction with care, and parental and child knowledge of asthma.Results.A total of 137 families were enrolled in the study (76 intervention, 61 control). Both intervention and control groups showed substantial improvement in all outcomes during the 12-month follow-up period. Aside from improvement in knowledge after use of the computer program, no differences were demonstrated between the 2 groups in primary or secondary outcome measures. Children reported enjoyment of program use.Conclusions.This trial of an educational software program found that it did not produce greater improvement than occurred with review of traditional written materials. Because both groups showed substantial improvement over baseline, computer-based education may be more cost-effective. Alternatively, improvements in illness severity over time may overshadow the effects of such interventions.Rigorous comprehensive evaluations such as this are necessary to assess new interventions intended to improve management and outcomes of asthma.
Uninsured Children With Psychosocial Problems: Primary Care Management
Authors: McInerny Thomas K. , Szilagyi Peter G. , Childs George E. , Wasserman Richard C. , Kelleher Kelly J. 
Published: December 2021

Objective.Nearly 14% of children in the United States are uninsured. We compared the prevalence of psychosocial problems and mental health services received by insured and uninsured children in primary care practices.Methods.The Child Behavior Study was a cohort study conducted by Pediatric Research in Office Settings and the Ambulatory Sentinel Practice Network. Four hundred one primary care clinicians enrolled an average sample of 55 consecutive children (4–15 years old) per clinician.Results.Of the 13 401 visits to clinicians with 3 or more uninsured patients, 12 518 were by insured children (93.4%) and 883 were by uninsured children (6.6%). A higher percentage of adolescents, Hispanic children, those with unmarried parents, and those with less educated parents were uninsured. According to clinicians, uninsured children and insured children had similar rates of psychosocial problems (19%) and severe psychosocial problems (2%). For children with a clinician-identified psychosocial problem, we found no differences in clinician-reported counseling, medication use, or referral to mental health professionals.Conclusions.Among children served in primary care practices, uninsured children have similar prevalence of clinician-identified psychosocial and mental health problems compared with insured children. Within their practices, clinicians managed uninsured children much the same way as insured children.psychosocial problems, uninsured children, pediatrics, family medicine, primary care.
Exposure to Violence Among Urban School-Aged Children: Is It Only on Television?
Authors: Purugganan Oscar H. , Stein Ruth E. K. , Silver Ellen Johnson , Benenson Blanche S. 
Published: December 2021

Objective.
To measure exposure to different types of violence among school-aged children in a primary care setting.

Design.
Child interviews using an instrument measuring 4 types of exposure (direct victimization, witnessing, hearing reports, media). Violent acts measured include being beaten up, chased/threatened, robbed/mugged, stabbed/shot, killed.

Setting.
Pediatric primary care clinic of large urban hospital.

Patients.
Convenience sample of 175 children 9–12 years old and their mothers. A total of 53% of the children were boys, 55% were Hispanic, and 40% received public assistance.

Results.
All children had been exposed to media violence. A total of 97% (170/175) had been exposed to more direct forms of violence; 77% had witnessed violence involving strangers; 49% had witnessed violence involving familiar persons; 49% had been direct victims; and 31% had witnessed someone being shot, stabbed, or killed. Exposure to violence was significantly associated with being male.

Conclusion.
Most school-aged children who visited a pediatric primary care clinic of a large urban hospital had directly experienced violence as witnesses and/or victims.
Food Insufficiency and American School-Aged Children's Cognitive, Academic, and Psychosocial Development
Authors: Alaimo Katherine , Olson Christine M. , Frongillo Edward A. 
Published: December 2021

Objective.This study investigates associations between food insufficiency and cognitive, academic, and psychosocial outcomes for US children and teenagers ages 6 to 11 and 12 to 16 years.Methods.Data from the Third National Health and Nutrition Examination Survey (NHANES III) were analyzed. Children were classified as food-insufficient if the family respondent reported that his or her family sometimes or often did not get enough food to eat. Regression analyses were conducted to test for associations between food insufficiency and cognitive, academic, and psychosocial measures in general and then within lower-risk and higher-risk groups. Regression coefficients and odds ratios for food insufficiency are reported, adjusted for poverty status and other potential confounding factors.Results.After adjusting for confounding variables, 6- to 11-year-old food-insufficient children had significantly lower arithmetic scores and were more likely to have repeated a grade, have seen a psychologist, and have had difficulty getting along with other children. Food-insufficient teenagers were more likely to have seen a psychologist, have been suspended from school, and have had difficulty getting along with other children. Further analyses divided children into lower-risk and higher-risk groups. The associations between food insufficiency and children's outcomes varied by level of risk.Conclusions.The results demonstrate that negative academic and psychosocial outcomes are associated with family-level food insufficiency and provide support for public health efforts to increase the food security of American families.
Implementing Potentially Better Practices to Reduce Lung Injury in Neonates
Authors: Burch Kelly , Rhine William , Baker Robin , Litman Fern , Kaempf Joseph W. , Schwarz Edward , Sun Shyan , Payne Nathaniel R. , Sharek Paul J. 
Published: December 2021

Objective. Adherence to basic quality improvement principles enhances the implementation of potentially better practices (PBPs) and requires extensive planning and education. Even after PBPs have been identified and acknowledged as desirable, effective implementation of these practices does not occur easily. The objective of this study was to identify and assess implementation strategies that facilitate quality improvements in the respiratory care of extremely low birth weight infants.Methods. The 9 members of the Neonatal Intensive Care Quality Improvement Collaborative Year 2000 Reducing Lung Injury focus group identified 9 PBPs in a evidence-based manner to decrease chronic lung disease in extremely low birth weight newborns. Each site implemented several or all PBPs based on a site-specific selection process. Each site was asked to submit 1 or more examples of experiences that highlighted effective implementation strategies. This article reports these examples and emphasizes the principles on which they are based.Results. The 9 participating institutions implemented a total of 57 PBPs (range: 1–9; median: 5). Including previous implementation, the 9 participating institutions implemented a total of 70 of a possible 81 PBPs before or during the study period (range: 5–9; median: 8). We report 7 approaches that facilitated PBP implementation: information availability, feedback, perseverance, collaboration, imitation, recognition of implementation complexity, and tracking of process indicators.Conclusions. Quality improvement efforts are enhanced by identifying and then implementing PBPs. In our experience, implementation of these PBPs can be difficult. Implementation strategies, such as those identified in this article, can improve the chances that quality improvement efforts will be effective.
Implementing Potentially Better Practices for Improving Family-Centered Care in Neonatal Intensive Care Units: Successes and Challenges
Authors: Moore Kimberly A. Cisneros , Coker Kara , DuBuisson Allison B. , Swett Betsy , Edwards William H. 
Published: December 2021

Objective. Multidisciplinary teams from 11 medical center neonatal intensive care units collaborated in a quality improvement project with a focus on family-centered care.Methods. Through a process of self-analysis, literature review, benchmarking site visits, and expert consultation, 10 potentially better practice (PBP) areas were defined. Improvement activities in 4 of the 10 areas are given as examples of successes and challenges that individual centers encountered. The 4 areas are vision and philosophy, unit culture, family participation in care, and families as advisors.Results. Centers were at different places for all of the PBPs at the beginning and throughout the collaboration. Seven centers developed or revised their vision or philosophy of care statements about family-centered care. Incorporating the vision and philosophy of care into performance appraisals, hiring of new personnel, and changing unit culture to a more family-centered practice were more challenging than developing the statements. Full parent participation in care requires unrestricted access to the neonatal intensive care unit. The shift from considering parents to be “visitors” to being partners in caring for their child was more difficult for centers with restricted visitation policies. All centers developed, expanded, or started plans for establishing family advisory councils. The experience of 2 centers is described.Conclusions. Family-centered care is more of a journey than a destination. Collaborating centers in this project found themselves at different places in that journey. Through perseverance in implementing the PBPs, all have moved further along the path.
Implementation of Evidence-Based Potentially Better Practices to Decrease Nosocomial Infections
Authors: Kilbride Howard W. , Wirtschafter David D. , Powers Richard J. , Sheehan Michael B. 
Published: December 2021

Objective. Six neonatal intensive care units (NICUs) that are members of the Vermont Oxford National Evidence-Based Quality Improvement Collaborative for Neonatology collaborated to reduce infection rates. There were 7 centers in the original focus group, but 1 center left the collaborative after 1 year. Nosocomial infection is a significant area for improvement in most NICUs.Methods. Six NICUs participating in the Vermont Oxford Network made clinical changes to address 3 areas of consensus: handwashing, line management, and accuracy of diagnosis. The summary statements were widely communicated. Review of the literature, internal assessments, and benchmarking visits all contributed to ideas for change.Results. The principle outcome was the incidence of coagulase-negative staphylococcus bacteremia. There was an observed reduction from 24.6% in 1997 to 16.4% in 2000.Conclusions. The collaborative process for clinical quality improvement can result in effective practice changes.
A Clinic-Based, Comprehensive Care Model for Studying Late Effects in Long-Term Survivors of Pediatric Illnesses
Authors: Hinkle Andrea S. , Proukou Cindy , French Carol A. , Kozlowski Amy M. , Constine Louis S. , Lipsitz Stuart R. , Miller Tracie L. , Lipshultz Steve E. 
Published: December 2021

Objective. Long-term survivors of several childhood illnesses are at risk for multiple late effects of their illness or therapy, and children with documented toxic exposures may also experience long-term health consequences. Clinical studies of these effects are difficult to conduct. The Cardiovascular Status in Childhood Cancer Survivors Study is an established study that highlights the ability to perform comprehensive clinical investigations when patients are cared for in a formal, long-term follow-up clinic. This clinic model facilitates long-term retention and recruitment of patients, allowing comprehensive clinical studies of late effects of illness or exposures, in this case, of cardiovascular complications of cancer treatment during childhood.
Methods. The study is funded through the National Institute of Health Office of Cancer Survivorship. Participants are recruited from the Long-Term Survivors Clinic at the University of Rochester. The clinic provides care for all survivors of childhood cancer in the region. The Long-Term Survivors Clinic provides medical care and psychosocial and educational support to patients and facilitates coordination of care. Patients remain in close contact with clinic staff for extended periods.
Results. We recruited a representative sample of this long-term survivor population, with a wide range of ages, diagnoses, and time since diagnosis. Longitudinal collection of detailed clinical data will enable us to conduct cohort studies of late effects as well as case-control studies of toxic exposures.
Conclusions. The success of this study shows the advantages of formal programs for continued care of patients with chronic illnesses or treatment or toxic exposures. The Long-Term Survivors Clinic provides an excellent model for clinical care and research that is applicable to multiple pediatric and young adult populations.
SPECIAL REVIEWS
Authors: WEDGWOOD RALPH J. P. , COOK CHARLES D. , COHEN JONATHAN 
Published: December 2021

Twenty-six cases of dermatomyositis in children with follow-up studies ranging from one to 19 years are presented in order to indicate the natural history of this disease.
Of these 26 children, 10 are dead, 4 still have active disease, 4 have crippling contractures and 8 are able to lead an active normal life.
Thirteen of the children received endocrine therapy with adrenocorticotropic hormone, cortisone or testosterone. This appeared to produce at least symptomatic benefit in some cases, particularly early in the course of the active disease and, coordinated with symptomatic care, helped to tide the patients through the acute stages.
The most important treatment consists of persistent orthopedic measures and physiotherapy to minimize contractures.
Since death in this disease often results from palato-respiratory involvement, maintenance of an adequate airway and the use of a mechanical respirator may be life-saving.
INFANTILE RENAL ACIDOSIS
Authors: LIGHTWOOD R. , PAYNE W. W. , BLACK J. A. 
Published: December 2021

Thirty-five cases of renal acidosis in infants are presented. Clinically there is failure to thrive with vomiting and obstinate constipation starting from the fourth to sixth month of life. Biochemically there is a hyperchloraemic acidosis with a neutral or alkaline urine. Radiological evidence of renal calcification was present in 13 of the 35 cases.
The treatment is to give sufficient alkali (as citrate, lactate or bicarbonate) to bring the alkali reserve up to the lower limit of normal. The prognosis is good, cure resulting in all cases.
The etiology and pathology has been considered; it is suggested that the cause lies in an imbalance in the normal postnatal development of renal function.
STUDIES OF 17-HYDROXYCORTICOSTEROIDS
Authors: ELY ROBERT S. , RAILE RICHARD B. , BRAY PATRICK F. , KELLEY VINCENT C. 
Published: December 2021

An ACTH-17-hydroxycorticosteroid response test is described as a measure of adrenal cortical function in which the change in plasma concentrations of 17-hydroxycorticosteroids in response to the intramuscular injection of 25 I.U. ACTH is determined.
The limitations of this test are discussed and it is compared with other tests of adrenal cortical function.
No correlation is seen between the magnitude of steroid elevation and of eosinopenia in response to ACTH. These data suggest that the ACTH-induced eosinopenia is not mediated by elevations in the circulating concentrations of 17-hydroxycorticosteroids.
Although this test might be improved by modifying the ACTH dose or route of ACTH administration, the direct measurement of alterations in circulating concentrations of 17-hydroxycorticosteroids probably represents the most practical approach to evaluation of adrenal cortical responsiveness.
VIRAL HEPATITIS IN EARLY INFANCY
Authors: SCOTT ROLAND B. , WILKINS WARREN , KESSLER ALTHEA 
Published: December 2021

Three fatal cases of hepatitis with jaundice are reported in siblings with onset at ages of 4 weeks, 1 week, and 4 months, and death at 3 months, 4 months and 9 months, respectively.
Microscopic findings in postmortem sections of the liver were consistent with a diagnosis of viral hepatitis. From known data available it was probably of the homologous serum type.
The mother and two living siblings exhibited laboratory evidence of liver damage. Congenital viral hepatitis may simulate the clinical picture of biliary atresia.
Failure to include a consideration of viral hepatitis in the differential diagnosis of icterus in the very young infant may have serious consequences since these cases do not withstand surgical procedures, such as exploratory laparatomy, very well.
SPECIAL ARTICLE
Authors: MCDANIEL WALTON B. , RADBILL SAMUEL X. 
Published: December 2021

THE Philadelphia Pediatric Society has presented to the library of the College of Physicians of Philadelphia, an important work published in 1565 entitled: Five Books on the Feeding and Management of Children From Birth by Simon de Vallambert, thereby making an outstanding contribution to the historical and pediatric literary resources of Philadelphia, for the book is one of the earliest classics in the history of pediatrics, the first of its kind to be written in the French language, and one of the earliest in any modern language.
The medical care of children in the modern complete overall welfare sense is as old as archeological records go. One of the earliest records of mankind is a relatively short fragment of Egyptian papyrus written in the Sixteenth Century B.C., usually referred to as the Berlin Papyrus, For Mother and Child, which consists of a collection of incantations against two diseases of infants and various charms to facilitate childbirth, as well as prescriptions and incantations for the protection of infants. This fascinating text makes it possible for us to look into the Egyptian nursery. Just as a mother today knows lullabies with which she croons the crying baby to sleep, so the Egyptian mother was skillful in making amulets and using correct soothing words for the child who was sick, restless or threatened by evil.
Before the printing press was invented, literary efforts were transmitted in manuscript form. Through the centuries a number of such manuscripts have endured which pertain to matters of pediatric interest. Then came the printed book and, as soon as it did, pediatric printed works appeared.
NITROGEN BALANCES IN A PATIENT WITH FIBROCYSTIC DISEASE OF THE PANCREAS AND A PATIENT WITH THE CELIAC SYNDROME AND THE EFFECT OF AUREOMYCIN
Authors: Caughey Ronald H. , McCrory Wallace W. , Kaye Robert 
Published: December 2021

1. Nitrogen and electrolyte balance studies were carried out in 1 infant with fibrocystic disease of the pancreas and 1 infant with the celiac syndrome.
2. The addition of Aureomycin® to the control regimen was not associated with any apparent beneficial effect on clinical status, weight gain or nitrogen and electrolyte balance in either subject.
3. Gelatin supplementation of a high protein diet did not enhance nitrogen retention in the celiac subject.
4. The subject with the celiac syndrome exhibited a fairly normal absorption of nitrogen which was offset by a large loss of nitrogen in the urine.
5. The infant with fibrocystic disease of the pancreas compensated to some extent for an impaired nitrogen absorption by an efficient utilization of the absorbed nitrogen.
REVIEW ARTICLE
Authors: Scrimshaw Nevin S. , Behar Moisés , Pérez Carlos , Viteri Fernando 
Published: December 2021

The principal nutritional problems of school children in Central America and Panama are those of a lack of sufficient protein of good quality, vitamin A, and riboflavin. Where tortillas prepared from lime-treated corn are not used, calcium deficiency is also evident. In many areas the high incidence of endemic goiter reflects an absolute or relative deficiency of iodine. Because supplementary feeding of nursing infants, and particularly the feeding of the child after weaning, are poorly carried out in the area, malnutrition is almost universal among children of these ages in low income and rural groups.
This is reflected in the tendency for growth and bone maturation, which parallels that for U. S. children during the first months after birth, to be severely retarded during the period from 1 to 4 years. During these ages either the cumulative effect of the poor diet or the poor diet plus some additional stress, results in the child developing Infantile Pluricarencial Syndrome (I.P.S.). Infectious diarrhea is a frequent precipitating cause. The I.P.S. of Central America, characterized by edema, skin and hair changes, retardation in growth and development, apathy, diarrhea and anorexia, is not essentially different from kwashiorkor.
The basically poor nutritional state of many pre-school children is defined and given the name incipient I.P.S. or prekwashiorkor. Nutritional surveys reveal physical signs compatible with a deficiency of vitamin A and sometimes also of riboflavin. In general deficiencies of niacin, ascorbic acid, vitamin D and thiamine are not recognized. Anemias are frequent and usually of a macrocytic type. In hookworm infested areas an appreciable amount of microcytic anemia may also be observed.
Investigations in progress by the Institute of Nutrition of Central America and Panama (INCAP) in the area include: continued nutritional and dietary surveys; studies of the effect of vitamin B12 and antibiotics on growth; studies of the physiopathology of I.P.S., and the development of vegetable mixtures and other dietary means of improving child feeding practices at low cost.