bluuebunny/crossref_metadata_2025_split huggingface dataset:
Detection of Human Immunodeficiency Virus Type 1 (HIV-1) DNA and p24 Antigen in Breast Milk of HIV-1-Infected Ugandan Women and Vertical Transmission
Authors: Guay Laura A. , Hom David L. , Mmiro Francis , Piwowar Estelle M. , Kabengera Sam , Parsons Jana , Ndugwa Christopher , Marum Lawrence , Olness Karen , Kataaha Peter , Jackson J. Brooks 
Published: December 2021

Objective. To determine the correlation between the detection of human immunodeficiency virus type 1 (HIV-1) in breast milk, the duration of breastfeeding, and vertical transmission of HIV-1 infection in Ugandan women.
Methods. A prospective study of HIV-1 infection in pregnant Ugandan women and their infants has been ongoing since 1990 with follow-up of mother-infant pairs for at least 2 years. Expressed breast milk specimens were collected from 201 HIV-1-seropositive and 86 HIV-1-seronegative Ugandan women approximately 6 weeks after delivery. The presence of HIV-1 DNA in the cellular fraction of the breast milk was detected by polymerase chain reaction (PCR), and HIV-1 p24 antigen was detected in the cell-free breast milk supernatant using p24 antigen enzyme immunoassay (EIA) after immune complex dissociation (ICD). The duration of breastfeeding and the clinical status of the mothers and their children were recorded. HIV-1 EIA, Western blot, PCR, or p24 antigen detection were used for the determination of the HIV-1 infection status of the children.
Results. Of the 201 HIV-1-infected women studied, 47 had HIV-1-infected children, 143 had children who seroreverted, and 11 had children of indeterminate status. Breast milk supernatants were available for ICD p24 antigen testing from 188 of the HIV-1-infected women and none had detectable p24 antigen. Breast milk cell pellets were available and contained amplifiable DNA in 125 of the HIV-1-infected women (20 transmitters, 104 nontransmitters, 1 indeterminate). HIV-1 DNA was detected by PCR in 72% (75/104) of nontransmitters and 80% (16/20) of the transmitters. The duration of breastfeeding by transmitter mothers (15.8 months) was not significantly different from nontransmitter mothers (14.4 months).
Conclusions. No correlation was found between the detection of HIV-1 in breast milk or the duration of breastfeeding and transmission of HIV-1 infection in this study of Ugandan women.
Neurodevelopmental Outcome at 36 Months' Corrected Age of Preterm Infants in the Multicenter Indomethacin Intraventricular Hemorrhage Prevention Trial
Authors: Ment Laura R. , Vohr Betty , Oh William , Scott David T. , Allan Walter C. , Westerveld Michael , Duncan Charles C. , Ehrenkranz Richard A. , Katz Karol H. , Schneider Karen C. , Makuch Robert W. 
Published: December 2021

Objectives. Low-dose indomethacin has been shown to prevent intraventricular hemorrhage (IVH) in very low birth weight neonates, and long-term neurodevelomental follow-up data are needed to validate this intervention. We hypothesized that the early administration of low-dose indomethacin would not be associated with adverse cognitive outcome at 36 months' corrected age (CA).
Methods. We enrolled 431 neonates of 600 to 1250 g birth weight with no IVH at 6 to 12 hours in a randomized, prospective trial to determine whether low-dose indomethacin would prevent IVH. A priori, neurodevelopmental follow-up examinations, including the Stanford-Binet Intelligence Scale and Peabody Picture Vocabulary Test-Revised, and standard neurologic examinations were planned at 36 months' CA.
Results. Three hundred eighty-four of the 431 infants survived (192 [92%] of 209 infants receiving indomethacin versus 192 [86%] of 222 infants receiving saline), and 343 (89%) children were examined at 36 months' CA. Thirteen (8%) of the 166 infants who received indomethacin and 14 (8%) of 167 infants receiving the placebo were found to have cerebral palsy. There were no differences in the incidence of deafness or blindness between the two groups. For the 248 English-monolingual children for whom IQ data follow, the mean gestational age was significantly younger for the infants who received indomethacin than for those who received the placebo. None of the 115 infants who received indomethacin was found to have ventriculomegaly on cranial ultrasound at term, compared with 5 of 110 infants who received the placebo. The mean ± SD Stanford-Binet IQ score for the 126 English-monolingual children who had received indomethacin was 89.6 ± 18.92, compared with 85.0 ± 20.79 for the 122 English-monolingual children who had received the placebo. Although maternal education was strongly correlated with Stanford-Binet IQ at 36 months' CA, there was no difference in educational levels between mothers of the infants receiving indomethacin and the placebo.
Conclusions. Indomethacin administered at 6 to 12 hours as prophylaxis against IVH in very low birth weight infants does not result in adverse cognitive or motor outcomes at 36 months' CA.
A Review of the Outcomes of Parental Use of Nonabusive or Customary Physical Punishment
Authors: Larzelere Robert E. 
Published: December 2021

The most important finding of the review is that there are not enough quality studies that document detrimental outcomes of nonabusive physical punishment to support advice or policies against this age-old parental practice. Only 30 relevant journal articles were found from 1974 through 1995, an average of less than 1 1/2 per year. Next, many of the studies had methodological weaknesses, and the stronger ones were more likely to find beneficial outcomes of physical punishment. A particularly pervasive weakness was that no prospective or retrospective study controlled for the original frequency or severity of child problem behavior, which would be like studying cancer recurrences following radiation treatment without taking into account the severity or existence of the original cancer. More quality research is needed on nonabusive physical punishment. Public and private agencies should make quality research on the broader topic of parental discipline a top priority.
How parents use discipline tactics may be more important than which ones they consider off limits. Effects of physical punishment, as well as nonphysical punishment, probably depend on when and how parents implement it, its role in their overall approach to parental discipline, and the overall parentchild relationship. Other aspects of parental discipline may be more important indicators of dysfunctional parenting than whether parents spank or not.
Pediatric Head Injuries and Deaths From Bicycling in the United States
Authors: Sosin Daniel M. , Sacks Jeffrey J. , Webb Kevin W. 
Published: December 2021

Objective. To estimate the potential benefit of increasing bicycle helmet use among children and adolescents in the United States.
Design. All bicycle-related deaths (Multiple Cause-of-Death Public Use Data Tapes, 1989 through 1992) and bicycle-related injuries treated in sampled emergency departments (National Electronic Injury Surveillance System, 1989 through 1993) were used to calculate traumatic brain injury-associated death and head injury rates per 1 000 000 US residents. Preventable injuries and deaths were estimated by calculating the populationattributable risk of head injury due to nonuse of bicycle helmets.
Patients. US residents aged 0 through 19 years who were injured or who died as a result of a bicycle crash.
Results. An average of 247 traumatic brain injury deaths and 140 000 head injuries among children and adolescents younger than 20 years were related to bicycle crashes each year in the United States. As many as 184 deaths and 116 000 head injuries might have been prevented annually if these riders had worn helmets. An additional 19 000 mouth and chin injuries were treated each year. The youngest age groups had the highest proportions of both head and mouth injuries.
Conclusion. There continues to be a need to advocate for greater use of bicycle helmets, particularly among young children. Helmet design changes should be considered to prevent mouth injuries.
Children Who Have Attentional Disorders: Interventions
Authors: Culbert Timothy P. , Banez Gerard A. , Reiff Michael I. 
Published: December 2021

The treatment of attentional disorders (ADs) has been the subject of much controversy. Sound treatment programs must address a myriad of issues other than the three core symptoms of AD: inattention, impulsivity, and hyperactivity. Intervention programs purportedly leading to positive long-term outcomes have been studied inadequately. The few treatment plans shown to result in long-term improvement in outcome for children and families have used multiple modalities. Such plans integrate medical, psychological, psychosocial, and educational interventions; provide for case management; and educate and empower families as advocates. Very little actually is known about how treatments for ADs interact with each other, and it has been quite difficult to document the advantages of adding psychosocial treatments to psychopharmacologic treatments, although studies are under way to address these issues. Some of the few studies assessing the long-term efficacy of multimodality treatment programs have shown that although drug treatment alone leads to little measurable change, a combination of medication, psychological treatments, and appropriate classroom interventions leads to improved long-term outcomes. These outcomes include a reduction in antisocial behavior, improved social relationships, enhanced academic performance, improved self-esteem, and decreased delinquent behavior.
The treatment team for children who have AD should consist of a partnership that includes the child, family, significant school personnel, and the physician.
Psychosomatic Disorders: The Approach
Authors: Rickert Vaughn I. , Jay M. Susan 
Published: December 2021

Pediatricians frequently encounter patients in their daily clinical practice who present having chronic or recurrent symptoms that do not suggest a physical disorder. In fact, social, emotional, or behavioral problems can constitute up to 25% of visits in a pediatric practice, and it has been estimated that as many as 68% of children who present for medical treatment have psychological factors associated with somatic complaints. These clusters of symptoms typically are referred to as a psychosomatic illness and usually require more time to treat than an acute infection such as otitis media. Additionally, the approach, diagnostic evaluation, and treatment plan require careful construction, which places an increased burden on the pediatrician to "cure" the patient and relieve parent, environment, and other associated stressors in a limited time.
Research suggests that as much as 10% of a pediatric practice is comprised of patients who have a psychosomatic diagnosis. Studies have suggested that psychosomatic symptoms peak during certain ages (age 7 for boys and at ages 6 and 16 for girls) or by diagnosis (psychogenic pain found more commonly among girls and afflicts children ages 4 to 12 years more frequently). Among children, these chronic and vague somatic symptoms frequently include recurrent abdominal pain, headache, and musculoskeletal pain.
Lyme Disease
Authors: Baltimore Robert S. , Shapiro Eugene D. 
Published: December 2021

Introduction and Definitions
Lyme borreliosis (Lyme disease) is a systemic infection caused by a spirochete, Borrelia burgdoferi. It is the most common vector-borne disease in the United States.
Lyme disease was first described in Lyme, Connecticut (hence its name), where a cluster of children who had unexplained arthritis first were brought to medical attention by one of their parents. Investigation of this "epidemic" of arthritis led to the description of Lyme arthritis and ultimately to the discovery of its bacterial etiology. The clinical manifestations of Lyme borreliosis are protean; this, coupled with the practical difficulties of confirming the diagnosis in many patients, has led to many misconceptions about Lyme disease. Indeed, there is much we do not know about the disease, which was only recognized in the US as a distinct entity slightly more than 15 years ago, and the cause of which was first identified only about 10 years ago.
Epidemiology
ECOLOGY AND TRANSMISSION
Borrelia burgdorferi is transmitted by ticks of the Ixodid species. In the US, the common vectors are Ixodes dammini (the deer tick), reported to be the same species as I scapularis, in the Northeast and the Midwest and I pacificus (the western black-legged tick) on the Pacific Coast. Ixodes ticks are much smaller than the common wood tick; the nymphal Ixodes tick is about the size of a pencil point (1 to 2 mm).
Consultation with the specialist
Authors: Rubenstein Jeffrey S. 
Published: December 2021

Case Presentation
A 2-year-old boy is brought to the emergency room by ambulance after being found "unresponsive" by his parents. He has been in good general health, has had no fever or other symptoms of infectious processes, has been taking no medications, and was "his normal self" until immediately prior to being found.
Patients who are unresponsive and unarousable are in coma. The term altered consciousness represents the spectrum of abnormalities that exists between the immediate capability for normal wakefulness and true coma. For the purposes of this review, the two terms will be used interchangeably because their causes are similar and usually differ only in severity.
Pathophysiology
Two areas of the brain are responsible for consciousness: the ascending reticular activating system (ARAS) and the cerebral cortex. The ARAS is located in the brain stem from the level of the medulla to the level of the midbrain and sends multiple afferent neurons to the cortex. Disruption of this system can lead to disorders of consciousness. The cerebral cortex is the much more common site where dysfunction can cause coma. Any injury or illness that affects the cerebral cortex globally can cause coma or altered consciousness.
Differential Diagnosis
Altered consciousness in children can be caused by injuries or illnesses that affect the central nervous system directly or can be a manifestation of other systemic disease (Table 1).
Consultation with the Specialist
Authors: DeAngelis Catherine 
Published: December 2021

A child or adolescent who has ataxia should stimulate a pediatrician to consider a broad array of possible diagnoses. The incoordination of muscle action can be caused by pathology located anywhere from the cerebral cortex to the involved muscle. Ataxia can be frightening to all involved, and the tendency is to call a neurologist quickly. However, without the information gathered from a careful history and physical examination, unnecessary expensive tests might be ordered and consultation with the neurologist would not be efficient.
The Table provides an extensive but not exhaustive list of possible causes of ataxia. However, the omitted diagnoses are extremely rare and most likely would be made only by a subspecialist after an exhaustive evaluation. The most common causes of ataxia generally can be diagnosed and managed by the general pediatrician. They fall in the categories of acute infectious, postinfectious, and metabolic etiologies. The diagnoses that are life-threatening if not diagnosed and treated rapidly must be considered first, and they also fall primarily in the infectious and metabolic categories. These include acute bacterial infections and metabolic aberrations, such as hypoglycemia, hyponatremia, hyperammonemia, and ingestion of alcohol and other drugs and toxins. Neoplasias and vascular problems are less common but also can fall in this category; they generally require management by a subspecialist.
Tongue-tie: Management of a Short Sublingual Frenulum
Authors: Levy Paul A. 
Published: December 2021

Tongue-tie, or ankyloglossia, historically has been believed to cause speech defects, as well as breastfeeding difficulties and dental problems. St. Mark wrote, "The string of his tongue was loosed and he spoke plain," and midwives in the 15th century reportedly kept a fingernail sharp to cut the frenula of all newborns in an attempt to prevent possible speech problems. Only within the last century has it become acceptable not to perform frenulotomy for children who have ankyloglossia.
During early development the tongue is fused to the floor of the mouth. Cell death and resorption free the tongue, with the frenulum left as the only remnant of the initial attachment.
Alcohol Abuse
Authors: Takahashi Ayame , Franklin John 
Published: December 2021

Introduction
Alcohol and illicit drug use and associated problems within the adolescent population continue to be a great concern. Accidental death and injury in this age group frequently is alcohol- or drug-related. Venturesomeness and impulsiveness combined with alcohol can produce disastrous results. Alcohol use is more likely to cause an adolescent to be sexually irresponsible, which can lead to sexually transmitted diseases and pregnancy. There has been an alarming growth in human immunodeficiency virus (HIV)-positive rates recently among the adolescent population. Finally, teenagers who abuse alcohol are more likely to drop out of school, thus damaging their long-term employment prospects.
Definition
The American Psychiatric Association in its Diagnostic and Statistical Manual of Mental Disorders IV (DSM IV) defines alcohol dependence, a substance use disorder, as a maladaptive pattern of alcohol use leading to clinically significant impairment or distress as manifested by three of the following seven symptoms occurring during the same 12-month period: tolerance; withdrawal; use greater than intended; inability to cease use; time-consuming activities associated with use; social, occupational, or recreational dysfunction; and continued use despite knowledge of physical or psychological problems. Abuse is defined as one or more of the following: failure to fulfill major roles at home or school, recurrent use in hazardous situations, recurrent legal problems, and use despite persistent social or interpersonal problems.
Knee Problems in Adolescents
Authors: Garrick James G. 
Published: December 2021

Among children and adolescents there are few, if any, anatomic regions giving rise to as many orthopedic problems as the knee. Not only is the knee most commonly injured in sports and recreational activities, it is also the anatomic area that most often requires surgical intervention as a result of the injuries.
Unlike the ankle in which the majority of injuries are sprains (ligament injuries), the knee encompasses almost unparalled anatomic diversity, thus incurring injuries involving ligaments, tendon, articular cartilage, fibrocartilage (menisci), and bone—all with great frequency. Coexistence of many of these injuries makes establishing a precise diagnosis exceedingly difficult, even for the orthopedist specializing in knee problems. Yet in the majority of instances, absolute diagnostic precision is not necessary for appropriate management. Indeed, many if not the majority of knee injuries seem to heal themselves adequately if only given the appropriate opportunity.
There are four conditions that merit immediate orthopedic referral: (1) intra-articular fractures, (2) grade III sprains (complete ligament tears), (3) grade III strains (complete muscle or tendon tears), and (4) mechanical blockage of normal knee motion. The majority of the remaining problems are initially managed nonoperatively and require referral only if recalcitrant. Thus, the initial evaluation of a knee problem requires that only two questions be answered: (1) should it be immediately referred, and (2) if not referred, how should it be managed?
Motor Vehicle Injury in Childhood
Authors: Christoffel Katherine K. , Tanz Robert 
Published: December 2021

OVERVIEW OF EPIDEMIOLOGY
In 1980 approximately 2 million Americans of all ages sustained motor vehicle injuries, and more than 52,000 died. Of the victims, nearly one quarter of a million injuries and 4,100 deaths involved children less than 15 years of age. The National Highway Traffic Safety Administration (NHTSA) has estimated that approximately 2/100 infants born today will die in a traffic accident, and that two thirds of all infants born today will suffer injuries in such an accident. A statement by the American Association of Automotive Medicine, in its Guide for Medical Association Committee on Traffic Safety, helps to put the problem of motor vehicle injury further into perspective: "Cardiovascular disease, cancer, and stroke claim more lives, but many more young people, with many more remaining years of life, are killed or injured on the highway."
In the United States, motor vehicle injury is the leading killer of children aged 1 to 4 years and of young adults; it ranks ahead of the malignancies, infectious diseases, and congenital anomalies (Table 1). For infants &lt;1 year of age, although the sudden infant death syndrome (SIDS) and diseases related to perinatal and birth disorders lead the list, motor vehicle mortality is actually higher for infants than for older children (Fig 1).
Glomerulonephritis
Authors: McCrory Wallace W. 
Published: December 2021

The term glomerulonephritis is used to identify a group of renal disorders in which the major injury involves the glomerulus rather than the tubules, interstitial tissue, or vasculature. Primary glomerulonephritis (GN) refers to disorders that occur solely or primarily in the kidney in contrast to those associated with systemic diseases (ie secondary GN) (see Table 1).
The adjective acute (acute glomerulonephritis [AGN]) defines a characteristic clinicopathologic association with distinctive features of etiology, pathology, course, and prognosis. The majority of instances of AGN appear to occur after infection, and a number of bacterial and viral infections have been etiologically incriminated (Table 2).
Post streptococcal AGN (PSAGN) is the most common type. The clinical picture of AGN due to other infections may be indistinguishable from that usually associated with PSAGN. Only the absence of a prior streptococcal illness as evidenced by bacteriologic and serologic studies, and the temporal association with a viral syndrome distinguish such a patient. As the immediate and long-term prognosis of nonstreptococcal AGN is not as well known as that of PSAGN, a diligent effort should be made to identify the etiologic agent.
CLINICAL CHARACTERISTICS
AGN can be asymptomatic and only evident by laboratory findings. This has been the presentation in at least 50% of cases of PSAGN.
Rectal Bleeding in Childhood
Authors: Hillemeier Craig 
Published: December 2021

The passing of blood through the rectum is not an uncommon event in the pediatric age group. The most likely etiology varies to a large degree depending upon the age of the patient. Fortunately, the risk of malignancy in children with lower gastrointestinal (GI) tract bleeding is considerably less than that of adults, and the degree of the invasive diagnostic work-up can often be far less extensive than that used in an adult with a similar clinical presentation.
Bleeding anywhere throughout the GI tract will cause blood to be present in the stools. Melena refers to the passage through the rectum of black tarry stools and usually denotes bleeding from the upper gastrointestinal tract or small bowel. The tarry stools may be intermingled with maroon or red blood. Hematochezia is a passage of bright red blood through the rectum and usually indicates a source of bleeding low in the GI tract, often in the colon. However, inasmuch as blood exerts a strong Cathartic action, massive upper GI tract hemorrhage may occasionally present as bright red blood passed through the rectum. In most instances a negative gastric aspirate for blood will assure that the bleeding is distal to the ligament of Treitz
Many substances ingested by children may simulate fresh or chemically changed blood.