Archives of Pediatrics & Adolescent Medicine

Haggerty, Robert J.

1995 Archives of Pediatrics & Adolescent Medicine

doi: 10.1001/archpedi.1995.02170210011001pmid: 7633534

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract WHILE I AM and have been a strong advocate for universal entitlement to health services for all Americans, the failure of the Clinton Plan in 1994, the concerns we all had with the compromises necessary in that plan to achieve even a basic package of services for all children, and the resultant impact on children, have caused me to reconsider whether we should not, as pediatricians, get behind a children-first program (which would include maternal health care) and deal with the issue of who controls this system. These issues are closely related. First, why a "Children and Mothers First" bill? It became apparent in the 1994 debate that to provide access to even a minimal package of services for all of our citizens was so costly that, in the present political climate, it was unlikely to be deemed affordable. In the process of reducing the package to a minimal base,

Roark, Robert;Petrofski, Jason;Berson, Eric;Berman, Stephen

1995 Archives of Pediatrics & Adolescent Medicine

doi: 10.1001/archpedi.1995.02170210013002pmid: 7633535

Abstract Objectives: To determine theoretical practice patterns and Medicaid practices in the management of persistent and recurrent otitis media by family physicians and pediatricians in Colorado. Methods: Members of the Colorado chapters of the American Academy of Pediatrics and the Colorado Academy of Family Medicine were surveyed with the use of two hypothetical case management scenarios for which they were asked to indicate which International Classification of Diseases, Ninth Revision, Medicaid codes they would use. Physicians were presented with two case scenarios (one involving a persistent asymptomatic middle ear effusion and the second involving recurrent otitis media) and were asked to choose from a variety of management options, including observation, antibiotic therapy, decongestants, corticosteroids, antibiotic prophylaxis, and referral for ventilation tube surgery. Results: Family physicians would have prescribed high-cost antibiotics (amoxicillin plus clavulanate potassium, cefaclor, or cefixime) to treat persistent middle ear effusions twice as often as pediatricians would have (P<.002). At the 6-week visit, 50 family physicians (43%) would administer an oral decongestant either alone or in combination with other therapy as compared with 16 (14%) of pediatricians (P<.001). Family physicians would refer patients for ventilating tube surgery three times more often than pediatricians at the 9-week visits (P<.001). Recurrent episodes of acute otitis media would be managed similarly by both physician groups. Respondents reported a wide variety of International Classification of Diseases, Ninth Revision, coding, often coding persistent effusions as acute otitis or as unspecified otitis media. Conclusions: The findings of this survey document the wide variation in practice patterns for treating children with persistent otitis media and children with recurrent otitis media in Colorado.(Arch Pediatr Adolesc Med. 1995;149:839-844) References 1. Howie VM, Schwartz RH. Acute otitis media: one year in general pediatric practice . AJDC . 1983;137:155-158. 2. Schappert SM. Office Visits for Otitis Media: United States, 1975-1990 . In: Advance Data from Vital and Health Statistics, Centers for Disease Control . Atlanta, Ga: National Center for Health Statistics; 1992:214. 3. Mandel EM, Bluestone CD, Paradise JL, et al. Efficacy of myringotomy with and without tympanostomy tube insertion in the treatment of chronic otitis media with effusion in infants and children: results for the first year of a randomized clinical trial . In: Lim DJ, ed. Recent Advances in Otitis Media With Effusion . Philadelphia, Pa: BC Decker Inc; 1984:308-312. 4. Berman S. Otitis media with effusion: its relationship to language development, intellectual functioning and academic performance . Adv Behav Pediatr . 1981;2:129. 5. Teele DW, Klein JO, Chase C, Menyuk P, Rosner BA, Greater Boston Otitis Media Study Group. Otitis media in infancy and intellectual ability, school achievement, speech, and language at age 7 years . J Infect Dis . 1990;160:83-94.Crossref 6. Nuss R, Berman S. Medical management of persistent middle ear effusion . Am J Asthma Allergy Pediatr . 1990;4:17-22. 7. Stool SE, Berg AO, Berman S, et al. Otitis media with effusion in young children . In: Clinical Practice Guidelines in Young Children . Rockville, Md: Agency for Health Care Policy and Research, Public Health Service, US Dept of Health and Human Services; July 1994. Clinical Practice Guideline 12. AHCPR Publication 94-0622. 8. Green SM, Rothrock SG. Single-dose intramuscular ceftriaxone for acute otitis media in children . Pediatrics . 1993;91:23. 9. Rosenfield RM, Post JC. Meta-analysis of antibiotics for the treatment of otitis media with effusion . Otolaryngol Head Neck Surg . 1992;106:378-386. 10. Berman S, Roark R, Luckey D. Theoretical cost effectiveness of management options of children with persisting middle ear effusions . Pediatrics . 1994;93:353-363.

Woodin, Kathleen A.;Rodewald, Lance E.;Humiston, Sharon G.;Carges, Marjorie S.;Schaffer, Stanley J.;Szilagyi, Peter G.

1995 Archives of Pediatrics & Adolescent Medicine

doi: 10.1001/archpedi.1995.02170210019003pmid: 7633536

Abstract Objective: To determine parent and physician opinions regarding the administration of multiple childhood immunizations by injection. Design: Confidential mailed survey to physicians and residents; interview of parents during office visits for immunizations. Participants: Physicians and parents from Rochester, NY. Results: The survey included 215 practicing physicians and 74 residents; response rate was 82%. Of the 197 parents interviewed, 93% were mothers, 68% were white; the mean (±SD) age was 25.8±5.2 years, with 12.8±1.8 years of education; 59% had private insurance, and 35% had Medicaid coverage. Of the parents, 31% had strong concerns about their child receiving a single injection; an additional 10% (total, 41% vs 31%; X2=4.05, P=.04) had the same concerns about their child receiving three injections. More practicing physicians than parents had strong concerns about children 7 months old or younger receiving three injections (60% vs 41%; X2=7.71, P≤.01). Physician concern increased further when physicians were asked about administration of four injections (80% vs 60%; X2=18.77, P<.001). Of the parents, 64% preferred one rather than two visits to have three injections administered, if their physician recommended it; 58% still preferred one visit even if four injections were needed. Conclusions: Physicians have more concerns than parents about the administration of multiple injections at a single visit. Pain for the child was the main concern of all respondents. While most physicians have strong concerns about administering three or more injections at one visit, most parents prefer this practice. Continued education and reassurance of parents and physicians is needed to address concerns about children becoming "pincushions" from immunizations.(Arch Pediatr Adolesc Med. 1995;149:845-849) References 1. Committee on Infectious Diseases, American Academy of Pediatrics. Report of the Committee on Infectious Diseases . Elk Grove Village, III: American Academy of Pediatrics; 1994. 2. Centers for Disease Control, Advisory Committee on Immunization Practices. General recommendations on immunization . MMWR Morb Mortal Wkly Rep . 1994;43:1-38. 3. Paradiso PR, Hogerman DA, Madore DV, et al. Safety and immunogenicity of a combined diphtheria, tetanus, pertussis and Haemophilus influenzae type b vaccine in young infants . Pediatrics . 1993;92:827-832. 4. Centers for Disease Control, Advisory Committee on Immunization Practices. Recommendations for use of Haemophilus b conjugate vaccines and a combined diphtheria, tetanus, pertussis, and Haemophilus b vaccine . MMWR Morb Mortal Wkly Rep . 1993;42:1-15. 5. Faden H. Poliovirus vaccination: a trilogy . J Infect Dis . 1993;168:25-28.Crossref 6. Gold R, Scheifele D, Barreto L, et al. Safety and immunogenicity of Haemophilus influenzae vaccine (tetanus toxoid conjugate) administered concurrently or combined with diphtheria and tetanus toxoids, pertussis vaccine and inactivated poliomyelitis vaccine to healthy infants at two, four and six months of age . Pediatr Infect Dis J . 1994;13:348-355.Crossref 7. Dagan R, Botujansky C, Watemberg N, et al. Safety and immunogenicity in young infants of Haemophilus b-tetanus protein conjugate vaccine, mixed in the same syringe with diphtheria-tetanus-pertussis-enhanced inactivated poliovirus vaccine . Pediatr Infect Dis J . 1994;13:356-361.Crossref 8. Lieu TA, Cochi SL, Black SB, et al. Cost-effectiveness of a routine varicella vaccination program for US children . JAMA . 1994;271:375-381.Crossref 9. Takahashi M. Current status and prospects of live varicella vaccine . Vaccine . 1992;10:1007-1014.Crossref 10. Kuter BJ, Weibel RE, Guess HA, et al. Oka/Merck varicella vaccine in healthy children: final report of a 2-year efficacy study and 7-year follow-up studies . Vaccine . 1991;9( (suppl) ):643-647.Crossref 11. Gray GC, Palinkas LA, Kelley PW. Increasing incidence of varicella hospitalizations in United States Army and Navy personnel: are today's teenagers more susceptible? Should recruits be vaccinated? Pediatrics . 1990;86:867-873. 12. Margolis HS, Shapiro CN. Who should receive hepatitis A vaccine? Considerations for the development of an immunization strategy . Vaccine . 1992;10 ( (suppl) ):585-587.Crossref 13. Bancroft WH. Hepatitis A vaccine . N Eng J Med . 1992;327:488-490.Crossref 14. Pichichero ME, Kochman L, Porcelli SC, Anderson PW. Memory 2D type antibody (Ab) responses of two-year-old children to pneumococcal (Pn) type 6A-diphtheria toxoid (D) conjugate vaccines . Pediatr Res . 1989:27:96. Abstract. 15. Keyserling HL, Anderson EL, Martin JT. Immunogenicity of tetravalent (types 6B, 14, 19F, 23F) pneumococcal conjugate vaccine in infants . Pediatr Res . 1993:33:172. 16. Steinhoff MC, Edwards K, Keyserling H, et al. A randomized comparison of three bivalent Streptococcus pneumoniae glycoprotein conjugate vaccines in young children: effect of polysaccharide size and linkage characteristics . Pediatr Infect Dis J . 1994;13:368-372.Crossref 17. Tristram DA, Welliver RC, Mohar CK, et al. Immunogenicity and safety of respiratory syncytial virus subunit vaccine in seropositive children 18-36 months . J Infect Dis . 1993;167:191-195.Crossref 18. Tristam DA, Wellliver RC. Respiratory syncytial virus vaccines: can we improve on nature? Pediatr Ann . 1993;22:716-718. 19. Scheife D, Barreto L, Meekison W, Guasparini R, Friesen B. Can Haemophilus influenzaetype b-tetanus toxoid conjugate vaccine be combined with diphtheria toxoidpertussis vaccine-tetanus toxoid? Can Med Assoc J . 1993;149:1105-112. 20. Edwards KM, Decker MD. Combination vaccines: hopes and challenges . Pediatr Infect Dis J . 1994;13:345-347.Crossref 21. Ellis RW, Douglas RG. New vaccine technologies . JAMA . 1994;271:919-931.Crossref 22. Committee on Infectious Diseases. Universal hepatitis B immunization . Pediatrics . 1992;89:795-799. 23. Attitude Measurement Corp. Advertising Awareness and Impact Study . (September) 1992. 24. Hall CB, Margolis HS. Hepatitis B immunization: premonitions and perceptions of pediatricians . Pediatrics . 1993;91:841-842. 25. Gorlick G. Are we turning kids into pincushions? Contemp Pediatr . 1991;8:23. 26. Freed GL, Bordley WC, Clark SJ, Konrad TR. Reactions of pediatricians to a new CDC recommendation for universal immunization of infants with hepatitis B vaccine . Pediatrics . 1993;91:699-702. 27. Freed GL, Bordley WC, Clark SJ, Konrad TR. Universal hepatitis B immunization of infants: reactions of pediatricians and family physicians over time . Pediatrics . 1994;93:747-751. 28. Melman ST, Chawla T, Kaplan JM. Parental perspectives on the administration of multiple immunizations at a single well-child visit . AJDC . 1993:147:438. 29. Maikler VE. Effects of a skin refrigerant/anesthetic and age on the pain responses of infants receiving immunizations . Res Nurs Health . 1991;14:397-403.Crossref 30. Uhari M. A eutectic mixture of lidocaine and prilocaine for alleviating vaccination pain in infants . Pediatrics . 1993;92:719-721. 31. French GM, Painter EC, Coury DL. Blowing away shot pain: a technique for pain management during immunization . Pediatrics . 1994;93:384-388. 32. Schechter NL, Bernstein BA, Beck A, Hart L, Scherzer L. Individual differences in children's response to pain: role of temperament and parental characteristics . Pediatrics . 1991;87:171-177. 33. Lewis M, Ramsay DS, Suomi SJ. Validating current immunization practices with young infants . Pediatrics . 1992;90:771-773. 34. King GE, Hadler SC. Simultaneous administration of childhood vaccines: an important public health policy that is safe and efficacious . Pediatr Infect Dis J . 1994;13:394-407.Crossref 35. Szilagyi PG, Rodewald LE, Humiston SG. Immunization practices of pediatric residents: are they meeting current standards? Pediatr Infect Dis J . 1994;13:536-537.Crossref 36. Loewenson PR, White KE, Osterholm MT, MacDonald KL. Physician attitudes and practices regarding universal infant vaccination against hepatitis B infection in Minnesota: implications for public health policy . Pediatr Infect Dis J . 1994;13:373-378.Crossref

Chase, Cynthia;Vibbert, Martha;Pelton, Stephen I.;Coulter, David L.;Cabral, Howard

1995 Archives of Pediatrics & Adolescent Medicine

doi: 10.1001/archpedi.1995.02170210024004pmid: 7543334

Abstract Objective: To examine mental and motor development in children with vertically transmitted human immunodeficency virus (HIV) infection in the first 30 months of life. Design: Prospective longitudinal study comparing two groups: children with HIV infection and HIV-exposed but uninfected children. Setting: Pediatric Immunodeficiency Clinic at Boston (Mass) City Hospital, Boston University Medical Center. Study Participants: Twenty-four children with vertically transmitted HIV infection and 27 children who were born to HIV-infected mothers and became HIV negative served as controls. Socioeconomic status, gestational age, and prenatal drug exposure were comparable in the two groups. Measurements/Results: Using the Bayley Scales of Infant Development, all children were assessed at least once between 4 and 16 months and again between 17 and 30 months of age. Individual mean mental and motor scores were calculated for the early and later age span. Motor development in the infected group was delayed in comparison to the seroreverter group in both age spans and remained stable in both groups over time. Mental development was comparable in the two groups at 4 to 17 months, but HIV infection was associated with delay in mental development at 17 to 30 months of age. Conclusion: Early and persistent delay in motor development and deceleration in mental development in late infancy distinguishes many children who are HIV infected from exposed but uninfected children, but there is significant variability in early neurodevelopmental outcome among children with HIV infection.(Arch Pediatr Adolesc Med. 1995;149:850-855) References 1. Epstein LG, Sharer LR, Oleske JM, et al. Neurologic manifestations of human immunodeficiency virus infection in children . Pediatrics . 1986;78: 678-687. 2. Belman AL. AIDS and pediatric neurology . Neurol Clin . 1990;8:571-603. 3. Kozlowski PB. Neuropathology of HIV infection in children . In: Crocker AC, Cohen HJ, Kastner TA, eds. HIV Infection and Developmental Disabilities: A Resource Book for Service Providers . Baltimore, Md: PH Brookes Publishing Co; 1992:25-32. 4. Belman AL, Ultmann MH, Horoupian D, et al. Neurological complications in infants and children with acquired immunodeficiency syndrome . Ann Neurol . 1985;18:560-566.Crossref 5. Ultmann MH, Diamond GW, Ruff HA, et al. Developmental abnormalities in infants and children with acquired immunodeficiency syndrome (AIDS): a follow-up study . Int J Neurosci . 1987;32:661-667.Crossref 6. Durako S, Muenz L, Hittelman J, et al. Impact of HIV infection on neurodevelopment in perinatally infected children. In: Program and abstracts of the Seventh International Conference on AIDS/STD World Congress; June 1991; Florence, Italy. Abstract 2137. 7. Wachtel RC, Tepper VJ, Houck DL, Nair P, Thompson C, Johnson JP. Neurodevelopment in pediatric HIV-1 infection: a prospective study . AIDS HIV Infect Fetus Adolesc . 1993;4:198-203. 8. Chase C, Coulter D, Vibbert M, Woodward P, Harris M, Mitrano J. Mental and motor development in HIV-infected and seroreverter infants. In: Programs and abstracts of Neuroscience of HIV Infection: Basic Clinical Frontiers, Eighth International Conference on AIDS/STD World Congress; July 17, 1992; Amsterdam, the Netherlands. Abstract 34. 9. Bayley N. Bayley Scales of Infant Development . San Antonio, Tex: Psychological Corp; 1969. 10. Schneider JW, Chasnoff IJ. Cocaine abuse during pregnancy: its effect on infant motor development: a clinical perspective . Top Acute Care Rehab . 1989; 2:59-69. 11. Neuspiel DR, Hamel SC. Cocaine and infant behavior . J Dev Behav Pediatr . 1991;12:55-64.Crossref 12. Chasnoff IJ, Griffith DR, Freier C, Murray J. Cocaine/polydrug abuse in pregnancy: 2-year follow-up . Pediatrics . 1992;89:284-289. 13. Streissguth AP, Barr HM, Sampson PD, Darby BL, Martin DC. IQ at age 4 in relation to maternal alcohol use and smoking during pregnancy . Dev Psychobiol . 1989;25:3-11.Crossref 14. Fried PA, O'Connell CM, Watkinson B. 60- and 72-month follow-up of children prenatally exposed to marijuana, cigarettes, and alcohol: cognitive and language assessment . J Dev Behav Ped . 1991:13:383-391.

Dahl, Ronald E.;Bernhisel-Broadbent, Jan;Scanlon-Holdford, Sheila;Sampson, Hugh A.;Lupo, Mark

1995 Archives of Pediatrics & Adolescent Medicine

doi: 10.1001/archpedi.1995.02170210030005pmid: 7633537

Abstract Objectives: To test hypotheses based on clinical impressions that children with atopic dermatitis (AD) have frequent sleep-related problems, including difficulty falling asleep, night waking due to itching and scratching, and daytime symptoms of tiredness and irritability. Design: Sleep habits and behaviors were assessed using the Child Sleep Behavior Scale (a 22-item Likerttype questionnaire for parents) in children with AD compared with normative data for age. Twelve questions were added to the questionnaire to address sleep-related habits relevant to night time pruritus, and to assess daytime behavioral symptoms of inadequate sleep. Setting: Tertiary care center. Patients: Fifty-nine children between ages 5 and 12 years meeting criteria for AD representing a referral population to a regional center. Results: Compared with normative data, children with AD showed notable differences for nine of the 22 items on the sleep questionnaire, including the following: greater difficulty falling asleep, frequent night waking, less total sleep, and greater difficulty awakening for school. The children with AD also reported frequent daytime tiredness and irritability, and the severity of AD symptoms showed moderate correlations with sleep problems and with daytime behaviors suggestive of inadequate sleep. Difficulty falling asleep and night waking correlated with daytime behavior and discipline problems. Conclusions: Children with AD often have disrupted sleep and daytime behavioral difficulties associated with insufficient sleep. Improved sleep may be an important treatment focus in the clinical management of children with AD.(Arch Pediatr Adolesc Med. 1995;149:856-860) References 1. Home J. Why We Sleep: The Functions of Sleep in Humans and Other Mammals . New York, NY: Oxford University Press Inc; 1988. 2. Dahl RE. Child and adolescent sleep disorders In: Kaufman DM, Solomon GE, Pfeffer CR, eds. Child and Adolescent Neurology For the Psychiatrist . Baltimore, Md: Williams & Wilkins; 1992:169-194. 3. Blaylock WK. Atopic dermatitis: diagnosis and pathobiology . J Allergy Clin Immunol . 1976:57:62.Crossref 4. Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis . Acta Dermatol Venereol Suppl (Stockh) . 1980;92:44-47. 5. Hanifin JM. Atopic dermatitis . J Allergy Clin Immunol . (February) 1984;73:2-11.Crossref 6. Johnson ML, Roberts J. Prevalence of dermatologic disease among persons 1-74 years of age: United States . Atlanta, Ga: Centers for Disease Control; 1979. US Dept of Health, Education, and Welfare publication PH 5 79-1660. 7. Taylor B, Wadsworth M, Wadsworth F, et al. The changing prevalence of reported eczema in Great Britain since the 1939-1945 war . Lancet . 1984;2:1255-1257.Crossref 8. Monti JM, Vignale R, Monti D. Sleep and nighttime pruritis in children with atopic dermatitis . Sleep . 1989;12:309-314. 9. Ferber R. Sleeplessness, night awakening, and night crying in the infant and toddler . Pediatr Rev . 1987;9: (3) :69-82.Crossref 10. Sampson HA. The role of immediate food hypersensitivity in the pathogenesis of atopic dermatitis . J Allergy Clin Immunol . 1983;71:473-458.Crossref 11. Fisher BE, Pauley C, McGuire K. Children's sleep behavior scale: normative data on 870 children in grades 1 to 6 . Percept Mot Skills . 1989;68:227-236.Crossref 12. Dahl RE. Sleep disorders. In: Riddle MA, ed. Child and Adolescent Psychiatric Clinics of North America: Child and Adolescent Psychopharmocology. Philadelphia, Pa: WB Saunders Co. In press. 13. Buysse DJ. Drugs affecting sleep, sleepiness and performance . In: Monk TH, ed. Sleep, Sleepiness and Performance . New York, NY: John Wiley & Sons Inc; 1991;249-306. 14. Harris JC, Carel CA, Rosenberg LA, Joshi P, Leventhal BG. Intermittent high dose corticosteroid treatment in childhood cancer: behavioral and emotional consequences . J Am Acad Child Adolesc Psychiatry . 1986;25:120-124Crossref 15. 1986. 16. Avital A, Steljes DG, Pasterkamp H, Kryger M, Sanches I, Chernick V. Sleep quality in children with asthma treated with theophylline or cromolyn sodium . J Pediatr . 1991;119:979-984.Crossref

Annibale, David J.;Hulsey, Thomas C.;Wagner, Carol L.;Southgate, W. Michael

1995 Archives of Pediatrics & Adolescent Medicine

doi: 10.1001/archpedi.1995.02170210036006pmid: 7633538

Abstract Objective: To determine whether the risk of cesarean section following uncomplicated pregnancies has been reduced by current obstetric practices by comparing the neonatal risk of vaginal deliveries with the risk incurred following abdominal delivery in otherwise uncomplicated pregnancies. Design: Observational, cohort study. A subpopulation of 11 702 women without complications of pregnancy was identified from a perinatal database, classified by subsequent mode of delivery, and compared for neonatal morbidity. This analysis was repeated after the cesarean section group was further narrowed to include only "repeated elective" deliveries. Setting: Low-risk inborn setting. Tertiary care (level III nursery) referral center and a community (level II nursery) hospital. Intervention: Cesarean section performed electively, for cephalopelvic disproportion, or for failure to progress. Outcome Variables: Chosen prior to data analysis: neonatal mortality and morbidity. Results: Groups differed with regard to ethnicity and sex. Infants who were delivered by cesarean section were more likely to have 1-minute Apgar scores less than 4, require intermediate or intensive nursery care at admission (6.3% vs 1.3% [P<.001]), and require greater respiratory support (mechanical ventilation, 1.6% vs 0.3%; oxygen therapy, 4.9% vs 1.4%; or room air, 93.5% vs 98.4% [P<.001 ]) than infants who were delivered vaginally. Similar results were found when patients who were delivered vaginally and by repeated elective cesarean section were compared. Conclusion: Although reports have recently emerged suggesting otherwise, abdominal delivery following an uncomplicated pregnancy remains a risk factor for adverse neonatal outcome despite current obstetric practices.(Arch Pediatr Adolesc Med. 1995;149:862-867) References 1. Shearer EL. Cesarean section . Soc Sci Med . 1993;37:1223-1231.Crossref 2. Taffel SM. Cesarean section in America: dramatic trends, 1970-1987 . Stat Bull Metrop Insur Co . (October) -December 1989:2-11. 3. Usher RH, Allen AC, McLean FH. Risk of respiratory distress syndrome related to gestational age, route of delivery, and maternal diabetes . Am J Obstet Gynecol . 1971;111:826-832. 4. Flaksman RJ, Vollman JH, Benfield DG. latrogenic prematurity due to elective termination of the uncompleted pregnancy . Am J Obstet Gynecol . 1978;132: 885-888. 5. Diddle AW, Gibbs V, Lambeth S. Fetal mortality and prematurity with repeat abdominal delivery . Am J Obstet Gynecol . 1959;77:719-730. 6. Maisels MJ, Rees R, Marks K, Friedman Z. Elective delivery of the term fetus: an obstetrical hazard . JAMA . 1977;238:2036-2039.Crossref 7. Creasy RK, Resnik R. Maternal-Fetal Medicine: Principles and Practice . 2nd ed. Philadelphia, Pa: WB Saunders Co; 1989. 8. Press S, Tellechea C, Pregen S. Cesarean delivery of full-term infants: identification of those at risk for requiring resuscitation . J Pediatr . 1985;106:477-479.Crossref 9. Hogston P. Is a paediatrician required at caesarean section? Fur J Obstet Gynecol Reprod Biol . 1987;26:91-93.Crossref 10. Boon AW, Milner AD, Hopkin IE. Lung volumes and lung mechanics in babies born vaginally and by elective and emergency lower segmental cesarean section . J Pediatr . 1981;98:812-814.Crossref 11. Hägnevik K, Lagercrantz H, Sjögvist BA. Establishment of functional residual capacity in infants delivered vaginally and by elective cesarean section . Early Hum Dev . 1991;27:103-110.Crossref 12. Jacobstein MD, Hirschfeld SS, Flinn C, Riggs T, Fanaroff A. Neonatal circulatory changes following elective cesarean section . Pediatrics . 1982;69:374-376. 13. Primhak RA, Herber SM, Whincup G, Milner RDG. Which deliveries require paediatricians in attendance? BMJ . 1984;289:16-18.Crossref 14. Burt RD, Vaughn TL, Daling JR. Evaluating the risks of cesarean section . Am J Public Health . 1988;78:1312-1314.Crossref 15. Parilla BV, Dooley SL, Jansen RD, Socol ML. latrogenic respiratory distress syndrome following elective repeat cesarean delivery . Obstet Gynecol . 1993; 81:392-395. 16. Schreiner BL, Stevens DC, Smith WL, Lemons JA, Golichowski AM, Padilla LM. Respiratory distress following elective repeat cesarean section . Am J Obstet Gynecol . 1982;143:689-692. 17. Heritage CK, Cunningham MD. Association of elective repeat cesarean section delivery and persistent pulmonary hypertension of the newborn . Am J Obstet Gynecol . 1985;152:627-629.Crossref 18. Rosen MG, Chik L. The association between cesarean birth and outcome in vertex presentation . Am J Obstet Gynecol . 1984;150:755-759.Crossref 19. Bryan H, Hawrylyshyn P, Hogg-Johnson S, et al. Perinatal factors associated with the respiratory distress syndrome . Am J Obstet Gynecol . 1990;162:476-481.Crossref 20. Keszler M, Carbone MT, Cox C, Schumacher RE. Severe respiratory failure after elective repeat cesarean delivery . Pediatrics . 1992;89:670-672. 21. Desprats R, Dumas JC, Giroux M, et al. Maternal and umbilical concentrations of fentanyl after epidural analgesia for cesarean section . Fur J Obstet Gynecol Reprod Biol . 1991;42:89-94.Crossref 22. Dick W, Traub E, Kraus H, Töllner U, Burghard R, Muck J. General anaesthesia versus epidural anaesthesia for primary caesarean section—a comparative study . Fur J Anaesthiol . 1992;9:15-21. 23. Hulsey TC, Alexander GR, Robillard PY, Annibale DJ, Keenan A. Hyaline membrane disease . Am J Obstet Gynecol . 1993;168:572-576.Crossref 24. Bloom RS, Cropley C. Lesson 1 . In: AHA/AAP Neonatal Resuscitation Steering Committee, Chameides L, eds. Textbook of Neonatal Resuscitation . Elk Grove Village, Ill: American Academy of Pediatrics Publications; 1990:1-17.

Boehm, Kathryn E.;Duggan, Anne K.;Dinerman, Linda M.;McGowan, Mary P.

1995 Archives of Pediatrics & Adolescent Medicine

doi: 10.1001/archpedi.1995.02170210042007pmid: 7633539

Abstract Objective: To examine mutual support of inner-city parents and how it relates to the father's expected role as a parent. Design: Cross-sectional study. Setting: An urban teaching hospital in inner-city Baltimore, Md. Patients or Other Participants: Inner-city—dwelling parents whose neonates were born at an urban teaching hospital between March and May 1992. Intervention: Data were collected through structured independent interviews with each parent during the neonate's hospitalization. Main Outcome Measures: General social support was assessed by Sarason's Social Support Questionnaire. Paternal involvement was defined as the father's expected accessibility, engagement in child-rearing tasks, and decision-making responsibility during infancy. Results: Most mothers and fathers cited the other parent as a source of general support. Most believed that the other parent would help and would not hinder them in their role as parent. For mothers, the father's expected accessibility, engagement, and decision-making responsibility was positively correlated with his general support. For the fathers, expected accessibility was positively related to general support from the mother. As parents' mutual support increased, so did concordance in their expectations of the father's role. Conclusions: Many inner-city parents do rely on each other. Pediatricians can promote shared parenting by recognizing and building on this mutual support.(Arch Pediatr Adolesc Med. 1995;149:868-872) References 1. Furstenberg FF, Brookes-Gunn J, Morgan SP. Adolescent Mothers in Later Life . Cambridge, Mass: Cambridge University Press; 1987. 2. Kotelchuch M. The infant's relationship to the father: experimental evidence . In: Lamb ME, ed. The Role of the Father in Child Development . New York, NY: John Wiley & Sons Inc; 1976:329-344. 3. Pedersen FA, Rubinstein J, Yarrow LJ. Infant development in father absent families . J Genet Psychol . 1979;135:51-61.Crossref 4. Furstenberg FF. Unplanned Parenthood . New York, NY: Free Press; 1976. 5. Shinn M. Father absence and children's cognitive development . Psychol Bull . 1978;85:295-324Crossref 6. Anderson E. Where's dad? Paternal deprivation and delinquency . Arch Gen Psychiatry . 1968;18:641-649.Crossref 7. Lamb ME. The Father's Role: Cross-Cultural Perspectives . Hillsdale, NJ: Lawrence Gribaum Associates Publishers; 1987:7-11. 8. Belsky J. The determinants of parenting: a process model . Child Dev . 1984; 55:83-96.Crossref 9. Cobb S. Social support as a moderator of life stress . Psychosom Med . 1976; 38:300-314.Crossref 10. Sarason IG, Levine HM, Basham RB, Sarason BR. Assessing social support: the Social Support Questionnaire . J Pers Soc Psychol . 1983;44:127-139.Crossref 11. Barrera M. Distinctions between social support concepts, measures, and models . Am J Community Psychol . 1986;14:413-445.Crossref 12. Heitzmann CA, Kaplan RM. Assessment of methods for measuring social support . Health Psychol . 1988;7:75-109.Crossref 13. Sarason BR, Shearin EN, Pierce GR, Sarason IG. Interrelations of social support measures: theoretical and practical implications . J Pers Soc Psychol . 1987; 52:813-832.Crossref 14. Sarason IG, Sarason BR, Shearin EN. Social support as an individual difference variable: its stability, origins, and relational aspects . J Pers Soc Psychol . 1986a;90:845-855.Crossref 15. Sarason BR, Sarason IG, Hacker A, Basham RB. Concomitants of social support: social skills, physical attractiveness, and gender . J Pers Soc Psychol . 1985;49:469-480.Crossref 16. Sarason IG, Sarason BR. Experimentally provided social support . J Pers Soc Psychol . 1986b;50:1222-1225.Crossref 17. Ray SA, McLoyd VC. Fathers in hard times: the impact of unemployment and poverty on paternal and marital relations . In: Lamb ME, ed. The Father's Role: Applied Perspectives . New York, NY: John Wiley & Sons Inc; 1986. 18. Hardy JB, Duggan AK. Teenage fathers and the fathers of infants of urban, teenage mothers . Am J Public Health . 1988;78:919-922.Crossref 19. Hardy JB, Duggan AK, Masnyk K, Pearson C. Fathers of children born to young urban mothers . Fam Plann Perspect . 1989;21:159-163.Crossref

Roberts, David G.;Johnson, Candice E.;Carlin, Susan A.;Turczyk, Virginia;Karnuta, Mary A.;Yaffee, Karen

1995 Archives of Pediatrics & Adolescent Medicine

doi: 10.1001/archpedi.1995.02170210047008pmid: 7633540

Abstract Objectives: To determine the natural history of middle ear effusion (MEE) in newborns and compare the results of pneumatic otoscopy with tympanometry and acoustic reflex measurements in the evaluation of the middle ear of neonates. Design: A descriptive natural history study with comparison of three evaluation methods for MEE. Setting: County hospital nursery and pediatric clinic. Participants: Sixty-eight full-term, healthy neonates were studied on day 1 of life; 65 on day 2; and 24 on day 3. Thirty-eight infants returned at 2 weeks of age, and from this group, 23 returned at 2 months of age. Interventions: Two independent observers performed otoscopy. An audiologist performed tympanometry and ipsilateral acoustic reflex measurements. Infants were evaluated daily from birth by all three methods for up to 3 days. Main Outcome Measure: The time to resolution of MEE as determined by three methods. Results: In the first 3 hours of life, all babies examined had MEE diagnosed in both ears. By the third day, MEE apparently had resolved in 73% of ears by otoscopy, 88% by acoustic reflex measurements, and 92% by tympanometry. At 2 weeks, MEE was present by otoscopy in 13% (10/75 of ears). These were primarily newly acquired MEEs. Interobserver agreement by otoscopy as determined by k scores was moderate on days 1 and 3, poor on day 2, and excellent at 2 weeks and 2 months. Conclusions: Middle ear effusion diagnosed by otoscopy apparently resolves in 72 hours in most neonates. Interobserver agreement of otoscopists was excellent after babies were discharged from the nursery, suggesting that pneumatic otoscopy can be used to diagnose MEE in neonates this age. Most MEEs that are diagnosed 2 weeks and 2 months after birth are new and asymptomatic.(Arch Pediatr Adolesc Med. 1995;149:873-877) References 1. deSa DJ. Infection and amniotic aspiration of middle ear in stillbirths and neonatal deaths . Arch Dis Child . 1973;48:872-880.Crossref 2. McLellan MS, Webb CH. Ear studies in the newborn infant . J Pediatr . 1961; 58:523-527.Crossref 3. Paradise JL, Smith CG, Bluestone CD. Tympanometric detection of middle ear effusion in infants and young children . Pediatrics . 1979;58:198-210. 4. Groothuis JR, Sell SH, Wright PF, Thompson JM, Altemeier WA. Otitis media in infancy: tympanometric findings . Pediatrics . 1979;63:435-442. 5. Marchant CD, McMillan PM, Shurin PA, et al. Objective diagnosis of otitis media in early infancy by tympanometry and ipsilateral acoustic reflex thresholds . J Pediatr . 1986;109:590-595.Crossref 6. McMillan PM, Marchant CD, Shurin PA. Ipsilateral acoustic reflexes in infants . Ann Otol Rhinol Laryngol . 1985;94:145-148. 7. McMillan PM, Bennett MJ, Marchant CD, Shurin PA. Ipsilateral and contralateral acoustic reflexes in neonates . Ear Hear . 1985;6:320-324.Crossref 8. Kramer MS, Feinstein AR. Clinical biostatistics LIV: the biostatistics of concordance . Clin Pharmacol Ther . 1981;29:111-123.Crossref 9. McLellan MS, Brown Jr, Rondeau H, Shoughro E, Johnson RA, Hale AR. Embryonal connective tissue and exudate in ear . AJDC . 1964;108:164-170. 10. Shurin A, Pelton SI, Klein JO. Otitis media in the newborn infant . Ann Otol Rhinol Laryngol . 1976;85:216-222. 11. Piza JE, Gonzalez MP, Northrup CC, Eavey RD. Meconium contamination of the neonatal middle ear . J Pediatr . 1989;115:910-914.Crossref 12. Jaffe BF, Hurtado F, Hurtado E. Tympanic membrane mobility in the newborn . Laryngoscope . 1967;80:36-48.Crossref 13. Cavanaugh RM. Pneumatic otoscopy in healthy full-term infants . Pediatrics . 1987;79:520-523. 14. Shurin PA, Pelton SI, Finkelstein BA. Tympanometry in the diagnosis of middle ear effusion . N Engl J Med . 1977;296:412-417.Crossref 15. Holte L, Cavanaugh RM, Margolis RH. Ear canal mobility and tympanometric shape in young infants . J Pediatr . 1990;117:77-80.Crossref 16. Pestalozza G, Cusmano G. Evaluation of tympanometry in diagnosis and treatment of otitis media of the newborn and of the infant . Int J Pediatr Otorhinolaryngol . 1980;2:75-82.Crossref 17. Himelfarb MZ, Popelka GR. Tympanometry in normal neonates . J Speech Hear Res . 1979;22:179-191. 18. Keith RW. Middle ear function in neonates . Arch Otolaryngol . 1975;101:376-379.Crossref 19. Keith RW. Impedance audiometry with neonates . Arch Otolaryngol . 1973;97: 465-467.Crossref 20. Geddes NK. Tympanometry and the stapedial reflex in the first five days of life . Int J Pediatr Otorhinolaryngol . 1987;13:293-297.Crossref 21. McCandless GA, Allred PL. Tympanometry and emergence of the acoustic reflex in infants . In: Harford ER, Bess FH, Bluestone CD, et al, eds. Impedance Screening for Middle Ear Disease in Children . New York, NY: Grune & Stratton; 1978:56-67.

Weismann, Douglas N.;Dusdieker, Lois B.;Cherryholmes, Keith L.;Hausler, William J.;Dungy, Claibourne I.

1995 Archives of Pediatrics & Adolescent Medicine

doi: 10.1001/archpedi.1995.02170210052009pmid: 7633541

Abstract Objective: To determine the risk of lead poisoning among children enrolled in day care centers with elevated environmental lead burdens. Design: Survey. Setting: Six day care centers on properties owned by a major state-supported university. Patients and Other Participants: One hundred fifty-five of 234 eligible children (mean age, 4.8 years) enrolled in these centers were screened by questionnaire for risk factors of lead exposures. Blood samples for lead levels were also obtained. Observations of day care activities relative to lead exposure risks were recorded. Analyses of lead levels in paint, dust, and/or soil samples at the six centers were obtained. Main Outcome Measures: Prevalence of elevated blood lead levels and associated behavioral risk factors for lead exposure in children attending day care centers. Results: Elevated levels of lead in paint (2.4% to 40% lead) were present in all day care facilities. Three day care centers had elevated lead levels in windowsill dust (62 000 to 180 000 g of lead per square meter) or soil (530 to 1100 mg of lead per kilogram). Questionnaires documented low risk for lead exposure to children in the home environments. Direct observations in the day care setting revealed optimal supervision and hygiene of the children. Blood lead levels were less than 0.5 μmol/L (10 μg/dL) in all but one of the 155 children screened. Conclusions: Children attending day care centers with high environmental lead burdens need further documentation of blood lead levels, at-risk behaviors, and lead exposure risks in the home environments as an adjunct to the instigation of lead abatement procedures at the day care centers.(Arch Pediatr Adolesc Med. 1995;149:878-881) References 1. Centers for Disease Control and Prevention. Preventing Lead Poisoning in Young Children: Statement by the Centers for Disease Control . Atlanta, Ga: US Dept of Health and Human Services/Public Health Service; (October) 1991. 2. Needleman HL, Bellinger DC. The health effects of low level exposure to lead . Annu Rev Public Health . 1991;12:111-140.Crossref 3. Bellinger DC, Stiles KM, Needleman HL. Low-level lead exposure, intelligence and academic achievement: a long-term follow-up study . Pediatrics . 1992;90: 855-861. 4. Dietrich KN, Berger OG, Succop PA. Lead exposure and the motor developmental status of urban 6-year-old children in the Cincinnati Prospective Study . Pediatrics . 1993;91:301-307. 5. Watson WS, Hume R, Moore MR. Oral absorption of lead and iron . Lancet . 1980; 2:236-237.Crossref 6. Ziegler EE, Edwards BB, Jensen RL, Mahaffey KR, Fomon SJ. Absorption and retention of lead in infants . Pediatr Res . 1978;12:29-34.Crossref 7. Agency for Toxic Substances and Disease Registry. The Nature and Extent of Lead Poisoning in Children in the United States: A Report to Congress . Atlanta, Ga: US Dept of Health and Human Services/Public Health Service; 1988. US Dept of Health and Human Services document 99-2966. 8. Sayre JW, Ernhart CB. Control of lead exposure in childhood: are we doing it correctly? AJDC . 1992;146:1275-1278. 9. Department of Housing and Urban Development. Notice of funding availability (NOFA) for lead-based paint (LBP) risk assessment; notice, sampling and inspection guidelines . Federal Register . 1992;57:2894-2833. 10. National Institute of Occupational Safety and Health. Manual of Analytical Methods . 3rd ed. Cincinnati, Ohio: US Dept of Health and Human Services/Public health Service, Centers for Disease Control; 1984. 11. Hausler WJ Jr, Getchell JP, Cherryholmes KL. Quality Assurance Program: University of Iowa State Hygienic Laboratory Procedure Manual . Des Moines, Iowa: The University of Iowa; 1989. 12. Parsons PJ. Blood Lead Determination by Electrothermal Atomization Atomic Absorption Spectrometry . Albany, NY: New York State Department of Health; 1991. 13. US Environmental Protection Agency. Methods for Chemical Analysis of Water and Wastes: EPA-600/4-79-020 . Cincinnati, Ohio: US Environmental Protection Agency; 1983. 14. US Environmental Protection Agency. Test Methods for Evaluating Solid Waste: Laboratory Manual, Physical/Chemical Methods, 5W 846 . 3rd ed. Cincinnati, Ohio: US Environmental Protection Agency; 1986;1A. 15. Perkin-Elmer Corporation. Atomic Absorption Laboratory Benchtop User's Guide: Publication B3601, Release 1.0 . Norwalk, Conn: Perkin-Elmer Corp; 1992. 16. Miller DT, Paschal DC, Gunter EW, Stroud PE, lo J. Determination of blood lead with electrothermal atomic absorption using a L'vov platform and matrix modifier . Analyst . 1987;112:1701-1704.Crossref 17. Sayre JW, Katzel MD. Household surface lead dust: its accumulation in vacant homes . Environ Health Perspect . 1979;20:179-182.Crossref

Feigelman, Susan;Zuravin, Susan;Dubowitz, Howard;Harrington, Donna;Starr, Raymond H.;Tepper, Vicki

1995 Archives of Pediatrics & Adolescent Medicine

doi: 10.1001/archpedi.1995.02170210056010pmid: 7633542

Abstract Objectives: To determine the characteristics of children in kinship care and their caregivers who have access to health care (a single source of health care or a single provider), and to determine the relation between indicators of access and health needs. Design: Cross-sectional. Setting: A large eastern city. Subjects: Two hundred ten children selected from households with children in kinship care in April 1989. Methods: Data were obtained from medical records, access and demographic questionnaires, and a medical and psychologic evaluation. Results: A single facility for health care was reported by 93% of the sample; two thirds of those identified one health care provider. One source of care or one provider was associated with variables such as young age at placement and medical assistance insurance. Children who did not have a single source of care were more likely to have unmet health needs (87% vs 61%, P<.05), especially unmet mental health needs (60% vs 31%, P<.05). Conclusions: Children in kinship care had good access to health care, but the level of unmet health needs was high. Children who did not have a single source of health care were more likely to have unmet health needs, especially unmet mental health needs. These findings have implications for future health care planning for children in out-of-home care.(Arch Pediatr Adolesc Med. 1995;149:882-886) References 1. Hochstadt NJ, Jaudes PK, Zimo DA, Schachter J. The medical and psychosocial needs of children entering foster care . Child Abuse Negl . 1987;11:53-62.Crossref 2. Chernoff R, Combs-Orme T, Risley-Curtiss C, Heisler A. Assessing the health status of children entering foster care . Pediatrics . 1994;93:594-601. 3. Schor EL. Foster Care . Pediatr Clin North Am . 1988;35:1241-1252. 4. Swire MR, Kavaler F. Health supervision of children in foster care . Child Welfare . 1978;57:563-569. 5. White RB, Benedict Ml, Jaffe SM. Foster child health care supervision policy . Child Welfare . 1987;66:387-398. 6. Chadwick DL. Dependency as a therapeutic process: standards for the health care of dependent children . Calif Pediatrician . 1985; (Summer) :63-66. 7. United Way. Health Services for Foster Children: A Report and Recommendations . Los Angeles, Calif: United Way; 1987. 8. Margolis PA, Cook RL, Earp JA, Lannon CM, Keyes LL, Klein JD. Factors associated with pediatricians' participation in Medicaid in North Carolina . JAMA . 1992;267:1942-1946.Crossref 9. American Academy of Pediatrics, Committee on Early Childhood, Adoption, and Dependent Care. Health care of foster children . Pediatrics . 1987;79:644-646. 10. Dubowitz H, Feigelman S, Zuravin S. A profile of kinship care . Child Welfare . 1993;72:153-169. 11. Dubowitz H, Feigelman S, Zuravin S, Tepper V, Davidson N, Lichenstein R. The physical health of children in kinship care . AJDC . 1992;146:603-610. 12. Dubowitz H, Zuravin S, Starr RH, Feigelman S, Harrington D. Behavior problems of children in kinship care . J Dev Behav Pediatr . 1993;14:386-393. 13. Andersen R, Aday LA. Access to medical care in the US: realized and potential . Med Care . 1978;16:533-546.Crossref 14. Aday LA, Fleming GV, Andersen R. Access to Medical Care in the US: Who Has It, Who Doesn't . Chicago,Ill: Pluribus Press; 1984. 15. Combs-Orme T, Kager VA, Chernoff RG. Utilization of health care by foster children: application of a theoretical model . Child Youth Serv Rev . 1991;13:113-129.Crossref 16. Wan TTH, Gray LC. Differential access to preventive services for young children in low-income urban areas . J Health Soc Behav . 1978;19:312-324.Crossref 17. Orr ST, Miller CA, James SA. Differences in use of health services by children according to race . Med Care . 1984;22:848-853.Crossref 18. Dubowitz H, Tepper V, Feigelman S, Lichenstein R, Davidson N. The Physical and Mental Health and Educational Status of Children Placed with Relatives: Final Report . Baltimore, Md: The University of Maryland; 1990. 19. Gibson JW. Compensating for missing data in social work research . Soc Work Res Abstr . 1992;28:3-8.Crossref 20. Berrick JD, Barth RP, Needell B. A comparison of kinship foster homes and foster family homes: implications for kinship foster care as family preservation . Child Youth Serv Rev . 1994;16:33-63.Crossref 21. St Peter RF, Newacheck PW, Halfon N. Access to care for poor children: separate and unequal? JAMA . 1992;267:2760-2764.Crossref 22. Weisfeld VD, ed. Access to Health Care in the United States: Results of a 1986 Survey . Princeton, NJ: Robert Wood Johnson Foundation: 1987. (Special Report, No. (2) ). 23. Hayward RA, Bernard AM, Freeman HE, Corey CR. Regular source of ambulatory care and access to health services . Am J Public Health . 1991;81:434-438.Crossref 24. Beal AC, Stein REK. Usefulness of a single source of health care as an indicator of access in an inner-city pediatric population Arch Pediatr Adolesc Med . 1994;148:62. 25. Kasper JD. The importance of type of usual source of care for children's physician access and expenditures . Med Care . 1987;25:386-398.Crossref 26. Jonas ED, Seabolt B, Leviton SP. Baltimore's Unhealthy Children: Is There a Doctor in the House? Baltimore, Md: Advocates for Children and Youth; 1991. 27. Schor EL. Health care supervision of foster children . Child Welfare . 1981;60: 313-319. 28. Halfon N, Klee L. Health services for California's foster children: current practices and policy recommendations . Pediatrics . 1987;80:183-191.

Meropol, Sharon B.

1995 Archives of Pediatrics & Adolescent Medicine

doi: 10.1001/archpedi.1995.02170210061011pmid: 7633543

Abstract Objective: To characterize the health status of recent pediatric refugees. Research Design: Medical records of 107 pediatric refugees who underwent screening during a recent 24-month period were reviewed. Setting: A county hospital pediatric clinic in a metropolitan area with a population of 1189000. The majority of pediatric refugees who come to the Buffalo, NY, area receive a health screening in this clinic. Results: Most of the children were from Vietnam (67%), the Soviet Republics (19%), or Africa (14%). The median age was 8 years 2 months (range, 1 to 18 years). Only 39% of the children had evidence of adequate immunizations for age (39 of the children from Vietnam, two children from Africa, and one from the Soviet Republics). In 30%, physical examinations exposed conditions that required follow-up or referral to a medical or surgical specialist. Forty-two percent of the children required dental referral. Seven children were anemic; three had microcytic anemia. Of 81 children who underwent screening for hepatitis B, six (7%) were carriers, 35 (43%) were positive for hepatitis B surface antibody, and only four (5%) related a history of hepatitis exposure. Stool specimens were examined for ova and parasites in 87 children; 19 had pathogenic parasites with multiple organisms in two. Thirteen (24%) of 55 children who were tested from Vietnam, five (36%) of 14 children who were tested from Africa, and one (5%) of 18 children who were tested from the Soviet Republics had pathogenic parasites. Parasites included Ascaris lumbricoides (n=8), Necator americanus or Ancylostoma duodenale (n=5), Giardia lamblia (n=3), Trichuris trichiura (n=2), Dientamoeba fragilis (n=2), and Entamoeba histolytica (n=1). Skin testing for tuberculosis with purified protein derivative (tuberculin) was completed in 83 children, and 17 (20%) had reactive tests (21% [12/58] from Vietnam, 11% [1/9] from Africa, and 25% [4/16] from the Soviet Republics). Conclusions: Refugee children who come to the United States frequently have conditions that put them at risk of future morbidity and may require utilization of substantial health care resources. Some of these conditions represent public health concerns.(Arch Pediatr Adolesc Med. 1995;149:887-892) References 1. Report to the Congress: Refugee Resettlement Program, January 31, 1993 . Washington, DC: Office of Refugee Resettlement, Administration for Children and Families, US Dept of Health and Human Services; 1993:3-10. 2. Centers for Disease Control. Health status of Indochinese refugees . MMWR Morb Mortal Wkly Rep . 1979;28:385-393. 3. Catanzaro A, Moser RJ. Health status of refugees from Vietnam, Laos, and Cambodia . JAMA . 1982;247:1303-1308.Crossref 4. Skeels MR, Nums LJ, Mann JM. Intestinal parasitosis among Southeast Asian immigrants in New Mexico . Am J Public Health . 1982;72:57-59.Crossref 5. Waldman EB, Lege SB, Oseid B, Carter JP. Health and nutritional status of Vietnamese refugees . South Med J . 1979;72:1300-1303.Crossref 6. Bicho AJ, Keenlyside RA. Southeast Asian refugees of Rhode Island: health screening . R I Med J . 1984;67:353-355. 7. McCaw BR, DeLay P. Demographics and disease prevalence of two new refugee groups in San Francisco—the Ethiopian and Afghan refugees . West J Med . 1985;143:271-275. 8. Centers for Disease Control. Viral hepatitis type B, tuberculosis and dental care of Indochinese refugees . MMWR Morb Mortal Wkly Rep . 1980;29:1-3. 9. Centers for Disease Control. Nutritional status of Southeast Asian refugee children . MMWR Morb Mortal Wkly Rep . 1980;29:477-479. 10. Barry M, Craft J, Coleman D, Coulter HO, Horwitz R. Clinical findings in Southeast Asian refugees: child development and public health concerns . JAMA . 1983; 249;3200-3203.Crossref 11. Dewey DG, Daniels J, Teo KS, Hassel E, Otow J. Height and weight of Southeast Asian preschool children in northern California . Am J Public Health . 1986; 76:806-808.Crossref 12. Tittle BS, Harris JA, Chase PA, Morrell RE, Jackson RJ, Espinoza SY. Health screening of Indochinese refugee children . AJDC . 1982;136:697-700. 13. Goldenring JM. A high-yield workup for the new wave of immigrants . Contemp Pediatr . 1986;3:124-128. 14. Parish RA. Intestinal parasites in Southeast Asian refugee children . West J Med . 1985;143:47-49. 15. Cunningham TM. Hemoglobin E in Indochinese refugees . West J Med . 1982; 137:186-190. 16. Hurst D, Tittle B, Kleman KM, Embury SH, Lubin BH. Anemia and hemoglobinopathies in Southeast Asian refugee children . J Pediatr . 1983;102:692-697.Crossref 17. Craft J, Coleman D, Coulter HO, Horwitz R, Barry M. Hematologic abnormalities in Southeast Asian refugees . JAMA . 1983;249:3204-3206.Crossref 18. Salas SD, Heifetz R, Barrett-Connor E. Intestinal parasites in Central American immigrants in the United States . Arch Intern Med . 1990;150:1514-1516.Crossref 19. Lurio J, Verson H, Karp S. Intestinal parasites in Cambodians: comparison of diagnostic methods used in screening refugees with implications for treatment of populations with high rates of infestation . J Am Board Fam Pract . 1991;4:71-78. 20. Committee on Infectious Diseases, American Academy of Pediatrics. Active and passive immunizations: scheduling immunizations . In: Peter G, ed. Report of the Committee on Infectious Diseases . 23rd ed. Elk Grove Village, Ill: American Academy of Pediatrics; 1994:7-71. 21. NCHS Growth Charts, 1976 . Rockville, Md: National Center for Health Statistics, 1976;25. Health Resources Administration No. (76) -1120. 22. Committee on Infectious Diseases, American Academy of Pediatrics. Active and passive immunizations: refugees . In: Peter G, ed. Report of the Committee on Infectious Diseases . 23rd ed. Elk Grove Village, III: American Academy of Pediatrics; 1994:66-67. 23. Committee on Infectious Diseases, American Academy of Pediatrics. Tuberculosis . In: Peter G, ed. Report of the Committee on Infectious Diseases . 23rd ed. Elk Grove Village, Ill: American Academy of Pediatrics; 1994:484-485. 24. Children's Medical and Surgical Center of The Johns Hopkins Hospital. Agespecific indices . In: Greene MG, ed. The Harriet Lane Handbook . 12th ed. St Louis, Mo: Mosby—Year Book Inc; 1991:42. 25. Williams BC, Miller CA. Preventive health care for young children: findings from a 10-country study and directions for United States policy . Pediatrics . 1992; 89( (suppl) ):983-998. 26. Bergstein JM. Conditions associated with hematuria . In: Behrman RE, ed. Nelson Textbook of Pediatrics . 14th ed. Philadelphia, Pa: WB Saunders Co; 1992: 1326. 27. Olness K, Yip R, Indritz A, Torjesen E. Height and weight status of Indochinese refugee children: an anthropometric study of 1650 children . AJDC . 1984; 138:544-547. 28. Baldwin LM, Sutherland S. Growth patterns of first-generation Southeast Asian infants . AJDC . 1988;142:526-531. 29. Munger RG, Gomez-Marin O, Prineas RJ, Sinaiko AR. Elevated blood pressure among Southeast Asian refugee children in Minnesota . Am J Epidemiol . 1991; 133:1257-1265. 30. Goldenring JM, Castle GF. Prevalence of disease in Southeast Asian teenagers: results of screening medical examination at a residential vocational training facility . J Adolesc Health Care . 1983;4:266-269.Crossref 31. Bernier RH, Sampliner R, Gerety R, Tabor E, Hamilton F, Nathanson N. Hepatitis B infection in households of chronic carriers of hepatitis B surface antigen: factors associated with prevalence of infection . Am J Epidemiol . 1982; 116:199-211. 32. Hurie MB, Mast EE, Davis JP. Horizontal transmission of hepatitis B virus infection to United States—born children of Hmong refugees . Pediatrics . 1992; 89:269-273. 33. Franks AL, Berg CJ, Kane MA, et al. Hepatitis virus infection among children born in the United States to Southeast Asian refugees . N Engl J Med . 1989; 321:1301-1305.Crossref 34. Leichtner AM, Leclair J, Goldmann DA, Schumacher RT, Gewolb IH, Katz AJ. Horizontal nonparenteral spread of hepatitis B among children . Ann Intern Med . 1981;94:346-349.Crossref 35. Vernon TM, Wright RA, Kohler PF, Merrill DA. Hepatitis A and B in the family unit: nonparenteral transmission by asymptomatic children . JAMA . 1976;235: 2829-2831.Crossref 36. Pon EW, Ren H, Margolis H, Zhao Z, Schatz, GC, Diwan A. Hepatitis B virus infection in Honolulu students . Pediatrics . 1993;92:574-578. 37. Kashiwagi S, Hayashi J, Ikematsu H, et al. Transmission of hepatitis B virus among siblings . Am J Epidemiol . 1984;120:617-625. 38. McMahon BJ, Alward WLM, Hall DB, et al. Acute hepatitis B virus infection: relation of age to the clinical expression of disease and subsequent development of the carrier state . J Infect Dis . 1985;151:599-603.Crossref 39. Barrett-Connor E. Natural history of intestinal parasites in asymptomatic adults . J Fam Pract . 1984;19:635-639. 40. Borchardt KA, Ortega H, Mahood JD, et al. Intestinal parasites in Southeast Asian refugees . West J Med . 1991;135:93-96. 41. Centers for Disease Control. Survey of intestinal parasites—Illinois . MMWR Morb Mortal Wkly Rep . 1979;28:346-347. 42. Powell KE, Brown ED, Farer LS. Tuberculosis among Indochinese refugees in the United States . JAMA . 1983;249:1455-1460.Crossref 43. Centers for Disease Control. Tuberculosis among Indochinese refugees—United States, 1979 . MMWR Morb Mortal Wkly Rep . 1980;29:383-390. 44. Starke JR, Jacobs RF, Jereb J. Resurgence of tuberculosis in children . J Pediatr . 1992;120:839-855.Crossref 45. Advisory Committee for the Elimination of Tuberculosis. Tuberculosis among foreign-born persons entering the United States: recommendations of the Advisory Committee for the Elimination of Tuberculosis . MMWR Morb Mortal Wkly Rep . 1990;39:1-21. 46. Centers for Disease Control. Drug resistance among Indochinese refugees with tuberculosis . MMWR Morb Mortal Wkly Rep . 1981;30:273-275. 47. Melby PC, Kreutzer RD, McMahon-Pratt D, Gam AA, Neva FA. Cutaneous leishmaniasis: review of 59 cases seen at the National Institutes of Health . Clin Infect Dis . 1992;15:924-937.Crossref 48. Emanuel B, Aronson N, Shulman S. Malaria in children in Chicago , Pediatrics . 1993;92:83-85.

Crain, Ellen F.;Weiss, Kevin B.;Fagan, Michael J.

1995 Archives of Pediatrics & Adolescent Medicine

doi: 10.1001/archpedi.1995.02170210067012pmid: 7633544

Abstract Objectives: To determine whether US emergency department care for pediatric asthma conforms to the National Institutes of Health guidelines and whether the guidelines are likely to be adopted in clinical practice. Design: Mail survey conducted from January to April 1992, and stratified by hospital type (children's, public, and community). Settings: Emergency departments of US hospitals. Participants: Simple stratified random sample of emergency department directors from 376 sampled hospitals. Measurements: Self-reported data on emergency department pediatric asthma care, and knowledge and attitudes about the National Institutes of Health guidelines. Data are reported as mean (±SE). Results: Sixty-eight percent of the surveyed emergency department directors responded. During 1991, there were an estimated 1.6 million visits for pediatric asthma care. Asthma accounted for 16.9% (±9.0%) of all pediatric emergency department visits. Only 2.1% (±1.0%) reported the use of written protocols or guidelines, with significant variation by hospital type. Sixty-seven percent (±3.0%) reported the use of pulse oximetry. Eighty percent reported the use of β-agonists by inhalation as the initial treatment. Only 44.7% (±2.9%) reported the use of steroids if there was a poor response to the initial treatment. An estimated 45.5% (±3.9%) of respondents had heard of the guidelines at the time of this survey; approximately 24% reported that they had read the guidelines. Most respondents reported that the guidelines were credible, clear and concise, and likely to be adopted in their emergency department. Conclusions: These data suggest that reported pediatric asthma care in US emergency departments differs substantially from the National Institutes of Health guidelines, with considerable variation by hospital type. The guidelines appear to provide an acceptable tool for emergency departments to use in assessing their pediatric asthma care. However, in light of the lack of evidence that the guidelines will improve outcomes, the impact of national guideline adoption remains unclear.(Arch Pediatr Adolesc Med. 1995;149:893-901) References 1. Wennberg JE, McPherson K, Caper P. Will payment based on diagnosis-related groups control hospital costs? N Engl J Med . 1984;311:295-300.Crossref 2. Wise PH, Eisenberg L. What do regional variations in the rates of hospitalization of children really mean? N Engl J Med . 1989;320:1209-1211.Crossref 3. Berwick DM. Controlling variation in health care: a consultation from Walter Shewhart . Med Care . 1991;29:1212-1225.Crossref 4. Eddy DM. Clinical policies and the quality of clinical practice . N Engl J Med . 1982;307:343-347.Crossref 5. Woolf SH. Practice guidelines: a new reality in medicine . Arch Intern Med . 1990;150:1811-1818.Crossref 6. Field MJ, Lohr KN, eds. Clinical Practice Guidelines: Directions for a New Program . Washington, DC: National Academy Press; 1990. 7. Cotton P. Asthma consensus is unconvincing to many . JAMA . 1993;270:297.Crossref 8. National Asthma Education Program. Guidelines for the Diagnosis and Management of Asthma . Bethesda, Md: National Heart Lung and Blood Institute; 1991. US Dept of Health and Human Services publication 91-3042. 9. Weiss KB, Gergen PJ, Hodgson TA. An economic evaluation of asthma in the United States . N Engl J Med . 1992;326:862-866.Crossref 10. Ros SP. Emergency management of childhood bronchial asthma: a multicenter survey . Ann Allergy . 1991;66:231-234. 11. Detailed diagnoses and procedures: National Hospital Discharge Survey. Vital Health Stat 12 . 1992;No. (3) . 12. McCaig LF. National Hospital Ambulatory Medicare Survey: 1992 Emergency Summary: Advance Data From the Vital Health Statistics No. 245 . Hyattsville, Md: National Center for Health Statistics; 1994. 13. Baker MD. Pitfalls in the use of clinical asthma scoring . AJDC . 1988;142:183-185. 14. Yamamoto LG, Wiebe RA, Anaya C, et al. Pulse oximetry and peak flow as indicators of wheezing severity in children and improvements following bronchodilator treatments . Am J Emerg Med . 1992;10:519-524.Crossref 15. Geelhoed GC, Landau LI, LeSouef PN. Oximetry and peak expiratory flow in assessment of acute childhood asthma . J Pediatr . 1990;117:907-909.Crossref 16. Kerem E, Levison H, Schuh S, et al. Efficacy of albuterol administered by nebulizer versus spacer device in children with acute asthma . J Pediatr . 1993;123: 313-317.Crossref 17. Gershel JC, Goldman HS, Stein REK, Shelov SP, Ziprkowski M. The usefulness of chest radiographs in first asthma attacks . N Engl J Med . 1983;309: 336-339. 18. Scarfone RJ, Fuchs SM, Nager AL, Shane SA. Controlled trial of oral prednisone in the emergency department treatment of children with acute asthma . Pediatrics . 1993;92:513-518. 19. DiGiulio GA, Kercsmar CM, Krug SE, Alpert SE, Marx CM. Hospital treatment of asthma: lack of benefit from theophylline given in addition to nebulized albuterol and intravenously administered corticosteroid . J Pediatr . 1993;122: 464-469.Crossref 20. Siegal D, Sheppard D, Gelb A, Weinberg PF. Aminophylline increases the toxicity but not the efficacy of an inhaled beta-adrenergic agonist in the treatment of acute exacerbations of asthma . Am Rev Respir Dis . 1985;132: 283-286. 21. Rubin BK, Marcushamer S, Priel I, App EM. Emergency management of the child with asthma . Pediatr Pulmonol . 1990;8:45-57.Crossref 22. Mak H, Johnston P, Abbey H, Talamo RC. Prevalence of asthma and health service utilization of asthmatic children in an inner city . J Allergy Clin Immunol . 1982;70:367-372.Crossref 23. Butz AM, Eggleston P, Alexander C, Rosenstein BJ. Outcomes of emergency room treatment of children with asthma . J Asthma . 1991;20:255-264.Crossref 24. St. Peter RF, Newacheck PW, Halfon N. Access to care for poor children: separate and unequal? JAMA . 1992;267:2760-2764.Crossref 25. Halfon N, Newacheck PW. Childhood asthma and poverty: differential impacts and utilization of health services . Pediatrics . 1993;91:56-61. 26. Eddy DM. Clinical policies and the quality of clinical practice . N Engl J Med . 1982;307:343.Crossref 27. Woolf SH. Practice guidelines: a new reality in medicine . Arch Intern Med . 1990;150:1811-1818.Crossref 28. Brook R. Practice guidelines and practicing medicine: are they compatible? JAMA . 1989;262:3027-3030.Crossref 29. Introduction and background . In: Field MJ, Lohr KN, eds. Clinical Practice Guidelines . Washington, DC: National Academy Press; 1990:chap 1. 30. Mayo PH, Richman J, Harris HW. Results of a program to reduce admissions for adult asthma . Ann Intern Med . 1990;112:864-871.Crossref

Dini, Eugene F.;Linkins, Robert W.;Chaney, Michael

1995 Archives of Pediatrics & Adolescent Medicine

doi: 10.1001/archpedi.1995.02170210076013pmid: 7633545

Abstract Objective: To evaluate the effectiveness of computer-generated telephone reminder calls in increasing kept appointment rates in a public health setting. Design: Randomized controlled trial. Setting: Public health clinic, Georgia. Patients: Five hundred seventeen clients with scheduled appointments during a 4-week period at immunization, women, infant, and children; well-child; or family-planning programs. Intervention: A single computer-generated telephone reminder 1 day before each client's scheduled appointment. Main Outcome Measure: Rates of kept appointments. Results: Of the 277 clients assigned to receive the intervention, 144 (52%) kept their appointments, compared with only 78 (32.5%) of 240 who were not assigned to receive a message (P<.05). Improvement in kept appointment rates associated with receiving the message was highest for the immunization-program (183% increase, P<.05), with increases of 64%, 53%, and 44% for the well-child; women, infant, and children; and family-planning programs, respectively. Conclusions: These results suggest a simple and effective method to increase kept appointment rates in a variety of public health programs.(Arch Pediatr Adolesc Med. 1995;149:902-905) References 1. The National Vaccine Advisory Committee. The measles epidemic: the problems, barriers, and recommendations . JAMA . 1991;266:1547-1552.Crossref 2. Starfield B, Simpson L. Primary care as part of US health services reform . JAMA . 1993;269:3136-3139.Crossref 3. Centers for Disease Control. Update: measles outbreak—Chicago, 1989 . MMWR Morb Mortal Wkly Rep . 1990;39:317-319,325-326. 4. Centers for Disease Control. Measles—United States, 1989 and the first 20 weeks 1990 . MMWR Morb Mortal Wkly Rep . 1990;39:353-355,361-363. 5. Centers for Disease Control. Measles—United States, 1990 . MMWR Morb Mortal Wkly Rep . 1991;40:369-372. 6. Centers for Disease Control and Prevention. Standards for pediatric immunization practices . JAMA . 1993;269:1817-1822.Crossref 7. Young S, Halpin T, Johnson D, Irvin J, Marks J. Effectiveness of a mailed reminder on the immunization of infants at high risk of failure to complete immunizations . Am J Public Health . 1980;70:422-424.Crossref 8. Moore B, Morris D, Burton B, Kilcrease D. Measuring effectiveness of service aides in infant immunization surveillance program in north central Texas . Am J Public Health . 1981;71:634-636.Crossref 9. Quattlebaum T, Darden P, Sperry L. Effectiveness of computer-generated appointment reminders . Pediatrics . 1991;88:801-805. 10. Byrne E, Schaffner W, Dini E, Case G. Infant immunization surveillance: cost vs effect: a prospective, controlled evaluation of a large-scale program in Rhode Island . JAMA . 1970;212:770-773.Crossref 11. McDowell I, Newell C, Rosser W. Comparison of three methods of recalling patients for influenza vaccination . Can Med Assoc J . 1986;135:991-997. 12. Rosser W, Hutchison B, McDowell I, Newell C. Use of reminders to increase compliance with tetanus booster vaccination . Can Med Assoc J . 1992;146: 911-917. 13. Gates S, Colborn D. Lowering appointment failures in a neighborhood health center . Med Care . 1976;14:263-267.Crossref 14. Schroeder S. Lowering broken appointment rates at a medical clinic . Med Care . 1973;11:75-78.Crossref 15. Shepard D, Moseley T. Mailed versus telephone appointment reminders to reduce broken appointments in a hospital outpatient department . Med Care . 1976; 14:268-273.Crossref 16. Fletcher S, Appel F, Bourgois M. Improving emergency room patient follow-up in a metropolitan teaching hospital . N Engl J Med . 1974;291:385-388.Crossref 17. Nazarian L, Mechaber J, Charney E, Coulter M. Effect of a mailed appointment reminder on appointment keeping . Pediatrics . 1974;53:349-352. 18. Meller W, Anderson A. The effect of appointment reminders of keeping appointments in a core city pediatric outpatient department . Minn Med . 1976: 59:625-626,659. 19. Gerson L, McCord G, Wiggins S. A strategy to increase appointment keeping in a pediatric clinic . J Community Health . 1986;11:111-121.Crossref 20. Leirer V, Morrow D, Pariante G, Doksum T. Increasing influenza vaccination adherence through voice mail . J Am Geriatr Soc . 1989;37:1147-1150. 21. Linkins R, Dini E, Watson G, Patriarca P. A randomized trial of the effectiveness of computer-generated telephone messages in increasing immunization visits among preschool children . Arch Pediatr Adolesc Med . 1994;148:908-914.Crossref 22. Stehr-Green P, Dini E, Lindegren M, Patriarca P. Evaluation of telephoned computer-generated reminders to improve immunization coverage at inner-city clinics . Public Health Rep . 1993;108:426-430.

Briss, Peter A.;Sacks, Jeffrey J.;Addiss, David G.;Kresnow, Marcie-Jo;O&apos;Neil, Joann

1995 Archives of Pediatrics & Adolescent Medicine

doi: 10.1001/archpedi.1995.02170210080014pmid: 7633546

Abstract Objectives: To measure the incidence of playground fall injuries among children attending licensed US day care centers and to evaluate how injury incidence varies with center characteristics and with the regulatory and enforcement climate in which centers operate. Design: Telephone surveys of directors of day care centers and enforcement agencies and review of written day care regulations. Setting: Probability sample of licensed day care centers in 50 states and the District of Columbia. Participants: Children attending day care centers with playgrounds. Main Outcome Measures: Medically attended playground fall injuries. Results: Among the 1740 day care centers studied, a weighted total of 89.2 injuries occurred during the 2-month study period (0.25/100 000 child-hours in day care). The most important risk factor for injury was height of the tallest piece of climbing equipment on the playground in both bivariate (P=.01) and multivariate (P=.02) analyses. Neither regulations addressing playground safety or playground surfaces nor enforcement patterns were associated with lower injury rates. Conclusions: Additional effort is needed to develop and evaluate regulations and enforcement that reduce injury risks for children while minimizing burden on day care centers. In the meantime, limiting climbing equipment heights may reduce playground injury rates.(Arch Pediatr Adolesc Med. 1995;149:906-911) References 1. Dawson DA, Cain VS. Child Care Arrangements: Health of our Nation's Children—United States, 1988 . Hyattsville, MD: US Dept of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention; 1990. 2. Rivara FP, DiGuiseppi C, Thomson RS, Calonge N. Risk of injury to children less than 5 years of age in day care versus home care settings . Pediatrics . 1989;84:1011-1016. 3. Sacks JJ, Smith D, Kaplan KM, Lambert DA, Sattin RW, Sikes K. The epidemiology of injuries in Atlanta day-care centers . JAMA . 1989;262:1641-1645.Crossref 4. Briss PA, Sacks JJ, Addiss DA, Kresnow M, O'Neil J. A nationwide study of the risk of injury associated with day care center attendance . Pediatrics . 1994; 93:364-368. 5. Sacks JJ, Holt KW, Holmgreen P, Colwell LS, Brown M. Playground hazards in Atlanta child care centers . Am J Public Health . 1990;80:986-988.Crossref 6. Aronson SS. Safe, fun playgrounds . Exchange . (May) 1988:35-40. 7. Centers for Disease Control. Playground-related injuries in preschool-aged children—United States, 1983-1987 . MMWR Morb Mortal Wkly Rep . 1988;37:629-632. 8. Landman PF, Landman GB. Accidental injuries in children in day care centers . AJDC . 1987;141:292-293. 9. American Public Health Association and the American Academy of Pediatrics. Caring for our Children: National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs . Ann Arbor, Mich: Edwards Brothers; 1992. 10. Nelson DE, Sacks JJ, Addiss DG. Smoking policies of licensed child day-care centers in the United States . Pediatrics . 1993;91:460-463. 11. Department of Health and Human Services. National Health Interview Survey Design, 1973-84, and Procedures, 1975-83: Appendix 1: Census Regions, Census Division, and States . Hyattsville, MD: Centers for Disease Control and Prevention; 1985. US Dept of Health and Human Services publication (PHS) 85-1320 (series 1, No. (18) ). 12. US Consumer Product Safety Commission. Playground Surfacing: Technical Information Guide . Washington, DC: US Consumer Product Safety Commission; 1990. 13. Reichelderfer TE, Overbach A, Greensher J. Unsafe playgrounds . Pediatrics . 1979;64:962-963. 14. Runyan CW, Gray DE, Kotch JB, Kreuter MW. Analysis of US child care safety regulations . Am J Public Health . 1991;81:981-985.Crossref 15. Shah BV. Software for Survey Data Analysis (SUDAAN) Version 6.0 . Research Triangle Park, NC: Research Triangle Institute; 1989. 16. Rothman KJ. Modern Epidemiology . Boston, Mass: Little Brown & Co Inc; 1986: 327-349. 17. Sosin DM, Keller P, Sacks JJ, Kresnow M, van Dyck PC. Surface-specific fall injury rates on Utah school playgrounds . Am J Public Health . 1993;83:733-735.Crossref 18. Ikeda RM, Briss PA, Sacks JJ, Addiss DG. Assessment of telephone survey data . Pediatrics . 1994;94:405-406. 19. Garrettson LK, Gallagher SS. Falls in children and youth . Pediatric Clin North Am . 1985;32:153-161. 20. Tobin CJ. Overhauling state licensing requirements: making quality child care a reality . J Legislation . 1985;12:213-224. 21. Morgan GG, Stevenson CS, Fiene R, Stephens KO. Gaps and excesses in the regulation of child day care: report of a panel . Rev Infect Dis . 1986;8:634-643.Crossref 22. Alexander CS, Markowitz RK. Attitudes of mothers of preschoolers toward government regulation of day care . Public Health Rep . 1982;97:572-578. 23. Cote TR, Sacks JJ, Lambert-Huber DA, et al. The effect of legislation and education on bicycle helmet use among Maryland children . Pediatrics . 1992;89:1216-1220. 24. Sosin DM, Sacks JJ. Motorcycle helmet use laws and head injury prevention . JAMA . 1992;267:1649-1651.Crossref 25. Sosin DA, Sacks JJ, Holmgreen PA. Head injury-associated deaths from motorcycle crashes: relationship to helmet-use laws . JAMA . 1990;264:2395-2399.Crossref 26. Chorba TL, Reinfurt D, Hulka BS. Efficacy of mandatory seat-belt use legislation: the North Carolina experience from 1983 through 1987 . JAMA . 1988; 260:3593-3597.Crossref 27. McCloughlin E, Vince CJ, Lee AM, Crawford JD. Project burn prevention: outcome and implications . Am J Public Health . 1982;72:241-247.Crossref 28. Erdmann TC, Feldman KW, Rivara FP, Heimbach DM, Wall HA. Tap water burn prevention: the effect of legislation . Pediatrics . 1991;88:572-577.

Stevens-Simon, Catherine;Lowy, Rochelle

1995 Archives of Pediatrics & Adolescent Medicine

doi: 10.1001/archpedi.1995.02170210086015pmid: 7633547

Abstract Objective: To examine the relation between childbearing and educational and vocational achievements of American females high school students. Data Source: Articles published in English during the past decade about the educational, vocational, and socioeconomic sequelae of childbearing among female high school students. Data Selection: Articles that did not contain data about the relation between adolescent childbearing and educational and vocational achievement were excluded. Data Synthesis: Most females who begin childbearing during adolescence obtain less schooling and poorer-paying jobs than do females who postpone childbearing. The reasons for this are elusive. Differences in the family and cultural backgrounds of early (high school–age) and later (18 years and older) childbearers explain some but not all of the association between early childbearing and educational and vocational underachievement. The effect of childbearing preferences on the educational and vocational achievements of teenagers has not been studied adequately. Lack of concrete information could result in underestimation of the effect of early childbearing on the socioeconomic well-being of young Americans, and create the impression that adolescent pregnancy is an adaptive response to urban poverty. Conclusions: As much as the long-term socioeconomic sequelae of adolescent childbearing reflect factors that influence the judgments young people make about the costs and benefits of contraception and parenthood, adolescent childbearing is a means of adapting to urban poverty. Thus postponing adolescent conceptions and parenthood may have a less important effect on the socioeconomic well-being of young Americans than expected.(Arch Pediatr Adolesc Med. 1995;149:912-915) References 1. Furstenberg FF, Brooks-Gunn J, Morgan SP. Adolescent mothers and their children in later life . Fam Plann Perspect . 1987;19:142-151.Crossref 2. Miller BC. Adolescent parenthood, economic issues, and social policies . J Fam Econ Issues . 1992;13:467-475.Crossref 3. Klerman LV. Adolescent pregnancy and parenting controversies of the past and lessons for the future . J Adolesc Health . 1993;14:553-361.Crossref 4. Stevens-Simon C, White M. Adolescent pregnancy . Pediatr Ann . 1991;20:322-331.Crossref 5. Moore KA. Teenage childbearing: unresolved issues in research/policy debate . Fam Plann Perspect . 1988;22:189-209. 6. Hardy JB, Zabin LS. Adolescent Pregnancy in an Urban Environment . Baltimore Md; Urban & Schwarzenberg; 1991. 7. Miller BC. Families, science, and values: alternative views of parenting effects and adolescent pregnancy . J Marriage Fam . 1993;55:7-21.Crossref 8. Hayes CD, ed. Risking the Future . Washington, DC: National Academic Press; 1987;1. 9. Furstenberg FF. Teenage childbearing and cultural rationality: a thesis in search of evidence . Fam Relations . 1992;41:239-243.Crossref 10. Geronimus AT. Teenage childbearing and social and reproductive disadvantage: the evolution of complex questions and the demise of simple answers . Fam Relations . 1991;40:463-471.Crossref 11. Geronimus AT. Teenage childbearing and social disadvantage: unprotected discourse . Fam Relations . 1992;41:244-248.Crossref 12. Upchurch DM, McCarthy J. The timing of a first birth and high school completion . Am Sociol Rev . 1990;55:224-234.Crossref 13. Upchurch DM, McCarthy J, Ferguson LR. Childbearing and schooling: disentangling temporal and causal mechanisms . Am Sociol Rev . 1993;58:738-740.Crossref 14. Anderson DK. Adolescent mothers drop out . Am Sociol Rev . 1993;58:733-738.Crossref 15. Hoffman SD, Foster EM, Furstenberg FF. Reevaluating the costs of teenage childbearing . Demography . 1993;30:1-13.Crossref 16. Grogger J, Bronars S. The socioeconomic consequences of teenage childbearing: findings from a natural experiment . Fam Plann Perspect . 1993;25:156-174.Crossref 17. Stevens-Simon C, Parsons J, Montgomery C. What is the relationship between postpartum withdrawal from school and repeat pregnancy among adolescent mothers? J Adolesc Health Care . 1986;7:191-194.Crossref 18. Stevens-Simon C, Beach R. Care of pregnant teenagers in school . J Sch Health . 1992;62:304-309.Crossref 19. Abrahamse AF, Morrison PA, Waite LJ. Teenagers willing to consider single parenthood: who is at greatest risk? Fam Plann Perspect . 1988;20:13-18.Crossref 20. Elster AB, Ketterlinus R, Lamb ME. Association between parenthood and problem behavior in a national sample of adolescents . Pediatrics . 1990;85:1044-1050. 21. Trussell J, Hatcher RA, Cates W, Stewart FH, Kost K. Contraceptive failure in the United States: an update . Stud Fam Plann . 1990;21:51-54.Crossref 22. Newcomer S, Baldwin W. Demographics of adolescent sexual behavior, contraception, pregnancy and STDs . J Sch Health . 1992;62:265-270.Crossref 23. Leigh BC, Morrison DM, Trocki K, Temple MT. Sexual behavior of American adolescents: results from a US national survey . J Adolesc Health . 1994;15: 117-125.Crossref 24. Apter D, Viinikka L, Vihko R. Hormonal pattern of adolescent menstrual cycles . J Clin Endocrinol Metab . 1978;47:944-954.Crossref 25. Stevens-Simon C, McAnarney ER. Subfecundity: a prenatal risk factor in for adults but not for adolescents . J Adolesc Health Care . 1990;11:432-436.Crossref 26. Rainey DY, Stevens-Simon, C, Kaplan DW. Self-perception of infertility among female adolescents . AJDC . 1993;147:1053-1056. 27. Zabin LS, Astone NM, Emerson MR. Do adolescents want babies? the relationship between attitudes and behavior . J Res Adolesc . 1993;3:67-86.Crossref 28. Matsuhashi Y, Felice ME, Shragg P, Hollingsworth DR. Is repeat pregnancy in adolescents a 'planned' affair? J Adolesc Health Care . 1989;10:409-412.Crossref 29. Furstenberg FF. As the pendulum swings: teenage childbearing and social concern . Fam Relations . 1991;40:127-138.Crossref 30. Zabin LS, Clark SD. Why they delay: a study of teenage family planning clinic patients . Fam Plann Perspect . 1981;13:205-217.Crossref 31. Stevens-Simon C, Reichert S. Child sexual abuse and adolescent pregnancy . Arch Pediatr Adolesc Med . 1994;148:23-27.Crossref 32. Stevens-Simon C, Beach R, Eagar R. Contraception after a negative pregnancy test during adolescence . Adolesc Pediatr Gynecol . 1993;6:83-85.Crossref 33. Brooks-Gunn J, Chase-Lansdale PL. Children having children: effects on the family system . Pediatr Ann . 1991;20:467-481.Crossref 34. Zabin LS, Stark HA, Emerson MR. Reasons for delay in contraceptive clinic utilization: adolescent clinic and non-clinic populations compared . J Adolesc Health . 1991;12:225-232.Crossref 35. Levinson R. Contraceptive self-efficacy: a perspective on teenage girls' contraceptive behavior . J Sex Res . 1986;22:347-369.Crossref 36. Gabriel A, McAnarney ER. Parenthood in two subcultures: white middle-class couples and black low-income adolescents in Rochester, New York . Adolescence . 1983;18:595-608. 37. Jessor R. Risk behavior in adolescence: a psychosocial framework for understanding and action . J Adolesc Health . 1991;12:597-605.Crossref 38. DuRant R, Jay S. The adolescent heterosexual relationship and its association with the sexual and contraceptive behavior of black females . AJDC . 1989;143: 1467-1472.

Greenberg, Larrie;Sahler, Olle Jane Z.;Siegel, Benjamin;Sarkin, Richard;Sharkey, Suzanne A.

1995 Archives of Pediatrics & Adolescent Medicine

doi: 10.1001/archpedi.1995.02170210090016pmid: 7633548

Abstract Since the advent of the clerkship at The Johns Hopkins Medical School in the late 19th century, this model has been the backbone of clinical training for medical students throughout the world. Despite the pervasiveness of clerkships, little information exists about the faculty that oversees them administratively. We documented the reported academic credentials, professional development, and support systems for pediatric clerkship directors in the United States and Canada. Our findings should be useful to clerkship directors and department chairpersons across disciplines. (Arch Pediatr Adolesc Med. 1995;149:916-920) References 1. Bradford WD, Schofield JR. Study of required clerkships in internal medicine in US and Canadian medical schools . J Med Educ . 1986;61:157-162. 2. Noel GL. Development of an internal medicine clerkship by a department of medicine . J Med Educ . 1983;58:788-795. 3. Sahler OJZ, Lysaught JP, Greenberg LW, Siegel BS, Caplan SE, Nelson, KG. A survey of undergraduate pediatric education: progress in the 1980s? AJDC . 1988;142:519-523. 4. Patel VL, Dauphinee WD. The clinical learning environments in medicine, paediatrics, and surgery clerkships . Med Educ . 1985;19:54-60.Crossref 5. Mellinkoff SM. The medical clerkship . N Engl J Med . 1987;1317:1089-1091.Crossref 6. Moore JW. Student preceptor systems in clinical clerkship work . South Med J . 1933;26:1074-1077.Crossref 7. Flood CA. Clinical clerkships for undergraduate students . J Assoc Am Med Coll . 1939;14:145-149.Crossref 8. Harvey AM, Brieger GA, Abrams SL, McKusick VA. A Model of Its Kind: A Centennial History of Medicine at Johns Hopkins . Baltimore, Md: The Johns Hopkins University Press; 1989;1:165-166, 327.

Poplausky, Maurice R.;Haller, Jack O.

1995 Archives of Pediatrics & Adolescent Medicine

doi: 10.1001/archpedi.1995.02170210095017pmid: 7633549

Abstract AN 11-DAY-OLD female infant was brought to her physician because of screaming and irritability after feedings. A diagnosis of abdominal colic was made, and the infant's formula was changed. The postprandial screaming and irritability continued, and the mother sought a second opinion. The infant was now found to have lost weight and to have a rapid respiratory rate. The mother was told that the child might have a cardiac condition, and the infant was brought for further workup. A chest radiograph was obtained (Figure 1). Denouement and Discussion Coarctation of the Aorta Coarctation of the aorta is a common congenital disorder of unknown origin and accounts for 6% of congenital anomalies.1 Martin et al2 have found that radiologists suggest coarctation infrequently, despite the well-described radiologic signs. A chest radiograph in this case showed a low aortic knob (Figure 2). The remainder of the radiograph was unremarkable. An echocardiogram References 1. DeLuca SA. Coarctation of the aorta . Am Fam Phys . 1990;42:1285-1288. 2. Martin EC, Strafford MA, Gersony WM. Initial detection of coarctation of the aorta: an opportunity for the radiologist . AJR Am J Roentgenol . 1981;137: 1015-1017.Crossref 3. Woodring JH, Rhodes RA. Posterosuperior mediastinal widening in aortic coarctation . AJR Am J Roentgenol . 1984;144:23-25.Crossref 4. Garman JR, Hinson RE, Eyler WR. Coarctation of the aorta in infancy: detection on chest radiographs . Radiology . 1985;85:418-422.Crossref 5. Stern J, Lander P, Palayew MJ. Coarctation of the aorta: additional signs . Can Assoc Radiol J . 1979;30:40-45.

Darmstadt, Gary L.;Tunnessen, Walter W.

1995 Archives of Pediatrics & Adolescent Medicine

doi: 10.1001/archpedi.1995.02170210097018pmid: 7633550

Abstract A HEALTHY 8-year-old girl presented with a 6-week history of an acute, generalized skin eruption. Her palms and soles had become thickened and scaly over a 3-year period prior to eruption of the rash. Approximately 1 week before the eruption, she had mild pharyngitis. Over 1 to 2 days, erythema and scaling developed on her elbows, knees, scalp, and face. Over the following 1 to 2 weeks, the eruption spread over her upper and lower extremities and lastly over her trunk. The rash became increasingly hyperkeratotic and orangish-red in hue, and it covered 80% of her total body surface area (Figure 1 through Figure 4). Editor's Note There is no charge to authors for the publication of color pictures that appear in the Picture of the Month.Catherine D. DeAngelis, MD Denouncement and Discussion Juvenile Pityriasis Rubra Pilaris Pityriasis rubra pilaris (PRP) is an uncommon, chronic papulosquamous disorder of unknown cause. References 1. Griffiths WAD. Pityriasis rubra pilaris . Clin Exp Dermatol . 1980;5:105-112.Crossref 2. Gelmetti C, Schiuma AA, Cerri D, Gianotti F. Pityriasis rubra pilaris in childhood: a long-term study of 29 cases . Pediatr Dermatol . 1986;3:446-451.Crossref 3. Soeprono FF. Histologic criteria for the diagnosis of pityriasis rubra pilaris . Am J Dermatopathol . 1986;8:277-283.Crossref 4. Blauvelt A, Nahass GT, Pardo RJ, Kerdel FA. Pityriasis rubra pilaris and HIV infection . J Am Acad Dermatol . 1991;24:703-705.Crossref 5. Borok M, Lowe N. Pityriasis rubra pilaris: further observations of systemic retinoid therapy . J Am Acad Dermatol . 1990;22:792-795.Crossref 6. Dicken CH. Isotretinoin treatment of pityriasis rubra pilaris . J Am Acad Dermatol . 1987;16:297-301.Crossref

Olcay, Lale;Seçmeer, Gülten;Göǧüş, Safiye;Akçören, Zuhal

1995 Archives of Pediatrics & Adolescent Medicine

doi: 10.1001/archpedi.1995.02170210099019pmid: 7633551

Abstract A 13-YEAR-OLD girl was admitted because of fever, dyspnea, chest pain, and cough. Three days prior to admission, a moderately sore throat, anorexia, dry cough, and weakness had developed. On admission, her temperature was 38°C; heart rate, 152 beats/min; respirations, 44 breaths per minute; and blood pressure, 110/70 mm Hg. She was in moderate respiratory distress. There was cyanosis of the lips. Oropharynx and the tonsils were moderately hyperemic. Diminution of bronchial breath sounds over the right middle and lower zones was noted, and crepitant rales were heard over the lung fields. Results of the remainder of the physical examination were not remarkable. The hemoglobin level was 129.5 g/L; hematocrit, 0.40; and white blood cell count, 1.6× 109/L, with 0.7 lymphocytes, 0.2 polymorphonuclear cells, 0.08 immature forms, rare atypical lymphocytes, and no toxic granulation. Thrombocytes were abundant; erythrocytes were normochromic and normocytic. A chest radiograph demonstrated disseminated patchy References 1. Dunnilll MS. Pulmonary Pathology . 2nd ed. New York, NY: Chuchill Livingstone Inc; 1987:147-170. 2. Goslings WRO, Mulder J, Djajadiningrat J, Masurel N, Schuddeboom HI. Staphylococcal pneumonia in influenza in relation to antecedent staphylococcal skin infection . Lancet . 1959;2:428-430.Crossref 3. Huxtable KA, Tucker AS, Wedgwood RJ. Staphylococcal pneumonia in childhood . AJDC . 1964;108:262-269. 4. Schwarzmann SW, Adler JL, Sullivan RJ, Marine WM. Bacterial pneumonia during the Hong Kong influenza epidemic of 1968-1969 . Arch Intern Med . 1971; 127:1037-1041.Crossref 5. Spencer H, Liebow AA. Pathology of The Lung (Excluding Pulmonary Tuberculosis) . 3rd ed. New York, NY: Pergamon Press Inc; 1977;1:151-191. 6. Gresham GA, Gleeson-White MH. Staphylococcal bronchopneumonia in debilitated hospital patients: a report of fourteen fatal cases . Lancet . 1957;1:651-653.Crossref 7. Mitchell AB, Shaw Dunn RI, Less TW, Hedges CK. Staphylococcal pulmonary infection . Lancet . 1961;2:670-672. 8. Carfrae DC, Bell EJ, Grist NR. Fatal haemorrhagic pneumonia in an adult due to respiratory syncytial virus and Staphylococcus aureus . J Infect . 1982;4:79-80.Crossref

McCrindle, Brian W.;Newman, Alice;Murphy, Trudy;Corey, Mary;Stevens, Marion;Haslam, Robert H.;Freedom, Robert M.;King, Susan M.

1995 Archives of Pediatrics & Adolescent Medicine

doi: 10.1001/archpedi.1995.02170210102020pmid: 7633552

Abstract The screening of Canada's blood supply for evidence of human immunodeficiency virus (HIV) infection began in November 1985. Exact estimates of the risk for HIV infection from exposure to blood products from this time period are unknown. For the majority of pediatric patients, HIV infection is either acquired perinatally or by blood product exposure.1 The incubation period for transfusion-related HIV infection in children may be prolonged, compared with perinatally acquired infection or transfusion-related infection in adults, and new cases of infection may yet be undiagnosed. Many of these children are now of an age to be sexually active and may be unaware of their potential for HIV transmission. Donor "look-back" programs have had only limited success in detecting these cases,2-5 and the practices and attitudes regarding HIV screening by physicians providing care for children are unknown. We sought to determine the demographic, practice, and attitudinal factors in conjunction with References 1. Jones DS, Byers RH, Bush TJ, Oxtoby MJ, Rogers MF. Epidemiology of transfusion-associated acquired immunodeficiency syndrome in children in the United States, 1981 through 1989 . Pediatrics . 1992;89:123-127. 2. Ng AT, Conway MA, Blanda E, Killigrew RM, Eastman CA. Tracing HIV-infected blood recipients: large-scale recipient screening vs look-back testing . JAMA . 1987;258:201-202.Crossref 3. Denson SE, Hoots WK, Pickering LK, et al. 'Look back' program for blood product recipients: experience with the pediatric population in Houston, Texas . Pediatr Infect Dis J . 1988;7:596-598.Crossref 4. Allen PJ, Koepke JA. Look-back: transfusion-acquired HIV infection at Duke University Medical Center . N C Med J . 1988;49:657-661. 5. Busch MP. Let's look at human immunodeficiency virus look-back before leaping into hepatitis C virus look-back . Transfusion—Philadelphia . 1991; 31:655-661.Crossref 6. Fisher MC. Transfusion-associated acquired immunodeficiency syndrome: what is the risk? Pediatrics . 1987;79:157-160.Crossref 7. Busch MP, Young MJ, Samson SM, et al. Risk of human immunodeficiency virus (HIV) transmission by blood transfusions before the implementation of HIV-1 antibody screening . Transfusion—Philadelphia . 1991;31:4-11.Crossref 8. Kleinman SH, Niland JC, Azen SP, et al. Prevalence of antibodies to human immunodeficiency virus type 1 among blood donors prior to screening: The Transfusion Safety Study/NHLBI Donor Repository . Transfusion—Philadelphia . 1989;29:572-580.Crossref 9. Hwang LY, Beasley RP, Busch MP, Lane PK, Vyas GN. Human immunodeficiency virus seroprevalence among blood product recipients in San Francisco before transfusion . Transfusion—Philadelphia . 1989;29:113-118.Crossref 10. Eisenstaedt RS, Getzen TE. Screening blood donors for human immunodeficiency virus antibody: cost-benefit analysis . Am J Public Health . 1988;78:450-454.Crossref 11. Mendelson DN, Sandler SG. A model for estimating incremental benefits and costs of testing donated blood for human immunodeficiency virus antigen (HIV-Ag) . Transfusion—Philadelphia . 1990;30:73-75.Crossref 12. Donegan E, Johnson D, Remedios V, Cohen S. Mass notification of transfusion recipients at risk for HIV infection . JAMA . 1988;260:922-923. 13. Taylor KM, Shapiro M, Skinner HA, Eakin J, Kelner M. Understanding physicians' response to AIDS . Can Med Assoc J . 1989;140:597-602. 14. Searle ES. Knowledge, attitudes, and behaviour of health professionals in relation to AIDS . Lancet . 1987;1:26-28.Crossref 15. Milne RIG, Keen SM. Are general practitioners ready to prevent the spread of HIV? BMJ . 1988;296:533-535.Crossref 16. Shultz JM, MacDonald KL, Heckert KA, Osterholm MT. The Minnesota AIDS Physician Survey: a statewide survey of physician knowledge and clinical practice regarding AIDS . Minn Med . 1988;71:277-283.

Meyers, Alan

1995 Archives of Pediatrics & Adolescent Medicine

doi: 10.1001/archpedi.1995.02170210104021pmid: 7633553

Abstract Bye and coworkers1 have provided extremely valuable data on the efficacy of corticosteroid therapy in treating Pneumocystis carinii pneumonia (PCP) in children infected with human immunodeficiency virus. However, I believe that some of the statistical analyses shown in their Table are incorrect and that the errors have influenced some of their conclusions. Using their data, I performed χ2 analysis using Epi Info, Version 5,2 the statistical software package distributed by the Centers for Disease Control and Prevention, Atlanta, Ga. The results are shown in the Table. This reanalysis shows that there is not a significant difference in the incidence of adverse reactions to a combination of trimethoprim and sulfamethoxazole between the two groups or a difference in the proportion of patients who presented with PCP as the initial manifestation of human immunodeficiency virus infection. The reduction in the proportion of patients requiring mechanical ventilation is of marginal References 1. Bye MR, Cairns-Bazarian AM, Ewig JM. Markedly reduced mortality associated with corticosteroid therapy of Pneumocystis carinii pneumonia in children with acquired immunodeficiency syndrome . Arch Pediatr Adolesc Med . 1994;148:638-641.Crossref 2. Dean AG, Dean JA, Burton AH, Dicker RC. Epi Info, Version 5: A Word Processing, Database, and Statistics Program for Epidemiology on Microcomputers . Stone Mountain, Ga: USD Inc; 1990.

Bye, Michael R.

1995 Archives of Pediatrics & Adolescent Medicine

doi: 10.1001/archpedi.1995.02170210104022

Abstract We would like to thank Dr Meyers for his careful attention to our article1 and his analysis of our data. We used a χ2 goodness of fit analysis of the data. We compared the two groups using data from the earlier group that did not receive corticosteroids as the "expected" data. Since "no steroids" was the standard of care at the time, we thought that this was a reasonable approach. We now recognize that this statistical method was not the optimal approach. Dr Meyers uses χ2 of independent proportion with Yates' correction, with which he directly compares the two groups. With this method, the difference in mortality rates remains significant. However, he does not find significant differences between the groups in need for mechanical ventilation, drug reaction, frequency of PCP being the first manifestation of disease, and mortality rates between the corticosteroid-treated group and the References 1. Bye MR, Cairns-Bazarian AM, Ewig JM. Markedly reduced mortality associated with corticosteroid therapy of Pneumocystis carinii pneumonia in children with acquired immunodeficiency syndrome . Arch Pediatr Adolesc Med . 1994;148:638-641.Crossref

Pomerance, Herbert H.

1995 Archives of Pediatrics & Adolescent Medicine

doi: 10.1001/archpedi.1995.02170210107023

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract Pediatric Orthopedics: A Guide for the Primary Care Physician contains a wealth of information with regard to orthopedic conditions and disease processes seen by the primary care practitioner. The book is divided into sections, including "The Orthopedic Examination," "Extremity Pain/Limp," "Child Abuse," Developmental Orthopedics," "Motor Delay," "Congenital Skeletal Defects," "Abnormal Skeletal Growth," "Sports Injuries," "Spinal Disease," "Trauma," and "Arthritic States." The descriptive material is good. There are hundreds of excellent illustrations, photographic, radiologic, and schematic. However, only one of these illustrations is cross-referenced in the text. I searched but could not find another. The value of the monograph is reduced by this, since most readers will want to study text along with pictorial representations that are not always on the same page as the text. Hand in hand with this, legends contain more material than is necessary for identification. If referenced appropriately, most of this material, including some of

1995 Archives of Pediatrics & Adolescent Medicine

doi: 10.1001/archpedi.1995.02170210109024

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.