bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigation of a cluster of syphilis among heterosexuals in an English town
Authors: Moussa R , Sundkvist T , Emmett L
Published: September 2011

A cluster of five (3 primary and 2 early latent) cases of syphilis were identified in young heterosexuals in the east of England. Three were symptomatic at presentation. No further cases linked to this cluster have been diagnosed since June 2010. Effective partner notification is key to the identification and treatment of infected contacts.
Prospects for knowledge exchange in health policy and management: Institutional and epistemic boundaries
Authors: Martin Graham , Currie Graeme , Lockett Andy
Published: September 2011

Objectives:

There have been calls for greater exchange between research and practice in health care policy and management, but little empirical research on what commissioners of research and researchers themselves consider appropriate, good quality research knowledge. This paper addresses this gap, considering the views of commissioners and producers of policy and management research in health care and other fields.

Methods:

Qualitative semi-structured interviews with 18 commissioners and producers of research, in central government, the NHS and other commissioning organizations, and in universities and independent sector providers.

Results:

Commissioners and producers agreed that research often fails to fulfil policy-makers’ and managers’ needs, and that greater interaction is required to improve this relationship. However, they offered differing accounts of the nature of research knowledge (as a ‘product’ or a ‘mindset’), and of what constitutes value, validity and originality in research, reflecting the differing priorities and pressures faced by the two groups.

Conclusions:

Efforts to promote greater interaction between research, policy and practice, and more critical, reflexive engagement between policy-makers, managers and researchers, are likely to face significant obstacles given these competing constructions of research knowledge and their reinforcement by divergent priorities.
Provider Diversity in the English NHS: A Study of Recent Developments in Four Local Health Economies
Authors: Allen Pauline , Turner Simon , Bartlett Will , Perotin Virginie , Matchaya Greenwell , Zamora Bernarda
Published: September 2011

Objectives

To assess the impact of provider diversity on quality and innovation in the English NHS by mapping the extent of diverse provider activity and identifying the differences in performance between Third Sector Organisations (TSOs), for-profit private enterprises, and incumbent organizations within the NHS, and the factors that affect the entry and growth of new providers.

Methods

Case studies of four local health economies. Data included: semi-structured interviews with 48 managerial and clinical staff from NHS organizations and providers from the private and third sector; some documentary evidence; a focus group with service users; and routine data from the Care Quality Commission and Companies House. Data collection was mainly between November 2008 and November 2009.

Results

Involvement of diverse providers in the NHS is limited. Commissioners' local strategies influence degrees of diversity. Barriers to entry for TSOs include lack of economies of scale in the bidding process. Private providers have greater concern to improve patient pathways and patient experience, whereas TSOs deliver quality improvements by using a more holistic approach and a greater degree of community involvement. Entry of new providers drives NHS trusts to respond by making improvements. Information sharing diminishes as competition intensifies.

Conclusions

There is scope to increase the participation of diverse providers in the NHS but care must be taken not to damage public accountability, overall productivity, equity and NHS providers (especially acute hospitals, which are likely to remain in the NHS) in the process.
Value of the Electronic Medical Record for Hospital Care: A Review of the Literature
Authors: Uslu Aykut , Stausberg Jürgen
Published: September 2011

Electronic medical records (EMRs) are a core means to reduce hospital costs and to improve quality of hospital care. In this work, empirical studies between 2004 and 2010 were analyzed to summarize the evidence of economic and medical benefits achieved. Using Medline, 578 articles were retrieved with seven studies compliant with the inclusion criteria. Five studies supported a reduction of costs; another study found a negative effect. Relating to health care quality, five studies gave at least positive indices, while another found mixed results. The small number of relevant studies might be due to a shift from hospital care to outpatient and ambulatory care. In view of the good evidence from local implementations, the pervasion of EMRs is surprisingly low. This corresponds with intermingled results based on analyses of secondary data from large samples of hospitals. More public awareness is needed to convince health care providers to implement EMRs.
Realizing the Value Proposition: A Longitudinal Assessment of Hospitals′ Total Factor Productivity
Authors: Huerta Timothy R. , Ford Eric W. , Ford William F. , Thompson Mark A.
Published: September 2011

U. S. hospitals are under continual pressure both to increase productivity and to improve quality through the use of Health Information Technology. This paper analyzes 3,187 US hospitals, using data reported to the American Hospital Association, to assess changes in productivity over a five‐year period (2002‐2006). The Malmquist Indices derived indicate that Total Factor Productivity (TFP) and Efficiency Change (EFFCH) both increased during that timeframe. The low Technological Change (TC) index indicates that improvements to organizational processes did not contribute substantially to productivity. A secondary analysis examined the use of Computerized Physician Order Entry (CPOE) in relationship to the three indices. TFP trended positively for those hospitals further into the CPOE implementation process.
Evolution of an Early Illness Warning System to Monitor Frail Elders in Independent Living
Authors: Alexander Gregory L. , Rantz Marilyn , Skubic Marjorie , Koopman Richelle J. , Phillips Lorraine J. , Guevara Rainer D. , Miller Steven J.
Published: September 2011

This paper describes the evolution of an early illness warning system used by an interdisciplinary team composed of clinicians and engineers in an independent living facility. The early illness warning system consists of algorithms which analyze resident activity patterns obtained from sensors embedded in residents′ apartments. The engineers designed an automated reasoning system to generate clinically relevant alerts which are sent to clinicians when significant changes occur in the sensor data, for example declining activity levels. During January 2010 through July 2010, clinicians and engineers conducted weekly iterative review cycles of the early illness warning system to discuss concerns about the functionality of the warning system, to recommend solutions for the concerns, and to evaluate the implementation of the solutions. A total of 45 concerns were reviewed during this period. Iterative reviews resulted in greater efficiencies and satisfaction for clinician users who were monitoring elder activity patterns.
Materialization of Regional Health Information Networks in Greece: Electronic Health Record Barriers & Enablers
Authors: Katehakis Dimitrios G. , Halkiotis Stelios , Kouroubali Angelina
Published: September 2011

This paper draws upon the experience of production level implementations, initiated through public procurement, of four regional health information networks (RHINs). The RHINs are being implemented in four regional health authorities (RHAs) in Greece to support patient‐centred services. This paper focuses on three key areas: (i) engineering issues related to the deployment of an integrated electronic health record (EHR) system, (ii) management issues regarding implementation and planning, and (iii) socio‐organizational issues influencing the outcome of large scale EHR implementations. The complexity of the health sector is also presented focusing on EHR barriers and enablers at institutional and regional levels. Reasons why EHR system implementations have not progressed as expected are also discussed.
Modeling Security-Check Queues
Authors: Zhang Zhe George , Luh Hsing Paul , Wang Chia-Hung
Published: September 2011

Motivated by the waiting lines between the U.S.–Canadian border crossings, we investigate a security-check system with both security and customer service goals. In such a system, every customer has to be inspected by the first-stage inspector, but only a proportion of customers need to go through the second stage for further inspection. This “further inspection proportion,” affecting both security screening and the system congestion, becomes a key decision variable for the security-check system. Using a stylized two-stage queueing model, we established the convexity of the expected waiting cost function. With such a property, the optimal further inspection proportion can be determined to achieve the balance of the two goals and the service capacities can be classified into “security-favorable,” “security-unfavorable,” or “security-infeasible” categories. A specific capacity category implies if the security and customer service goals are consistent or in conflict. In addition, we have verified that the properties discovered in the stylized model also hold approximately in a more general multiserver setting. Numerical results are presented to demonstrate the accuracy and robustness of the approximations and the practical value of the model.

This paper was accepted by Assaf Zeevi, stochastic models and simulation.
Competing Matchmakers: An Experimental Analysis
Authors: Hossain Tanjim , Minor Dylan , Morgan John
Published: September 2011

Platform competition is ubiquitous, yet platform market structure is little understood. Theory models typically suffer from equilibrium multiplicity—platforms might coexist or the market might tip to either platform. We use laboratory experiments to study the outcomes of platform competition. When platforms are primarily vertically differentiated, we find that even when platform coexistence is theoretically possible, markets inevitably tip to the more efficient platform. When platforms are primarily horizontally differentiated, so there is no single efficient platform, we find strong evidence of equilibrium coexistence.

This paper was accepted by Peter Wakker, decision analysis.
Encouraging People to save for their Future: Augmenting Current Efforts with Positive Visions of the Future
Authors: Ellen Pam Scholder , Wiener Joshua L. , Fitzgerald M. Paula
Published: September 2011

Despite significant policy efforts to encourage Americans to save for retirement, the U.S. retirement savings rates have declined for more than two decades. Current policies and programs are largely driven by three implicit theories of why people do and do not save: trait theory, life cycle, and education. The authors’ purpose is not to identify a singular best theory but rather to demonstrate the need to expand the theories used to address the retirement savings problem. Toward that end, they empirically examine each traditional theory and simultaneously explore the additional power of complementary theories: future-self theory and imagery. The results show that variables grounded in trait theory, life cycle, and education are significantly related to retirement planning. Moreover, people who reported greater and more vivid imagery of a positive future retired self had engaged in more retirement preparation, accounting for a significant amount of variance beyond the traditional theories.
Circulating lipocalin 2 is associated with body fat distribution at baseline but is not an independent predictor of insulin resistance: the prospective Cyprus Metabolism Study
Authors: Liu Xiaowen , Hamnvik Ole-Petter R , Petrou Michael , Gong Huizhi , Chamberland John P , Christophi Costas A , Kales Stefanos N , Christiani David C , Mantzoros Christos S
Published: September 2011

Objective

Lipocalin 2 (LCN2 or NGAL), a protein derived from neutrophils, macrophages, adipocytes, and other cells, has been proposed to be a link between obesity and insulin resistance (IR), but animal and cross-sectional human studies have revealed conflicting results. We studied the association of serum lipocalin 2 with anthropometric, metabolic, and cardiovascular risk markers in young healthy men cross-sectionally and, for the first time, prospectively after 2 years of follow-up, with and without adjustment for potential confounders including serum creatinine.

Design

Two hundred and seventy-two participants were randomly selected from the Cyprus Metabolism Study (1056 men, 18 years), of whom 93 subjects participated in the follow-up study 2 years after baseline assessment. Associations were also explored between total and free leptin levels (to serve as positive controls) and anthropometric metabolic variables.

Results

In the cross-sectional study, lipocalin 2 levels were marginally correlated in the unadjusted model with central fat distribution but not with body weight or total body fat mass. After adjusting for age, smoking, activity, body mass index, fat percentage, waist-to-hip ratio, and serum creatinine, no correlation was found with any cardiovascular risk factor. There was no correlation with the homeostasis model assessment of IR (HOMA-IR) at baseline. In the prospective analyses, baseline levels of lipocalin 2 were not predictive of any variables in unadjusted or adjusted models. As expected, total and free leptin were associated with anthropometric and metabolic variables both cross-sectionally and prospectively.

Conclusions

We demonstrate that lipocalin 2 is not an independent predictor of metabolic and cardiovascular risk factors in young men cross-sectionally or prospectively.
Disentangling Prenatal and Postnatal Maternal Genetic Effects Reveals Persistent Prenatal Effects on Offspring Growth in Mice
Authors: Wolf Jason B , Leamy Larry J , Roseman Charles C , Cheverud James M
Published: September 2011

Mothers are often the most important determinant of traits expressed by their offspring. These “maternal effects” (MEs) are especially crucial in early development, but can also persist into adulthood. They have been shown to play a role in a diversity of evolutionary and ecological processes, especially when genetically based. Although the importance of MEs is becoming widely appreciated, we know little about their underlying genetic basis. We address the dearth of genetic data by providing a simple approach, using combined genotype information from parents and offspring, to identify “maternal genetic effects” (MGEs) contributing to natural variation in complex traits. Combined with experimental cross-fostering, our approach also allows for the separation of pre- and postnatal MGEs, providing rare insights into prenatal effects. Applying this approach to an experimental mouse population, we identified 13 ME loci affecting body weight, most of which (12/13) exhibited prenatal effects, and nearly half (6/13) exhibiting postnatal effects. MGEs contributed more to variation in body weight than the direct effects of the offsprings’ own genotypes until mice reached adulthood, but continued to represent a major component of variation through adulthood. Prenatal effects always contributed more variation than postnatal effects, especially for those effects that persisted into adulthood. These results suggest that MGEs may be an important component of genetic architecture that is generally overlooked in studies focused on direct mapping from genotype to phenotype. Our approach can be used in both experimental and natural populations, providing a widely practicable means of expanding our understanding of MGEs.
Epigenetic QTL Mapping inBrassica napus
Authors: Long Yan , Xia Wei , Li Ruiyuan , Wang Jing , Shao Mingqin , Feng Ji , King Graham J , Meng Jinling
Published: September 2011

There is increasing evidence that epigenetic marks such as DNA methylation contribute to phenotypic variation by regulating gene transcription, developmental plasticity, and interactions with the environment. However, relatively little is known about the relationship between the stability and distribution of DNA methylation within chromosomes and the ability to detect trait loci. Plant genomes have a distinct range of target sites and more extensive DNA methylation than animals. We analyzed the stability and distribution of epialleles within the complex genome of the oilseed crop plant Brassica napus. For methylation sensitive AFLP (MSAP) and retrotransposon (RT) epimarkers, we found a high degree of stability, with 90% of mapped markers retaining their allelic pattern in contrasting environments and developmental stages. Moreover, for two distinct parental lines 97% of epialleles were transmitted through five meioses and segregated in a mapping population. For the first time we have established the genetic position for 17 of the 19 centromeres within this amphidiploid species. Epiloci and genetic loci were distributed within distinct clusters, indicating differential detection of recombination events. This enabled us to identify additional significant QTL associated with seven important agronomic traits in the centromeric regions of five linkage groups.
Rapid GAL Gene Switch of Saccharomyces cerevisiae Depends on Nuclear Gal3, Not Nucleocytoplasmic Trafficking of Gal3 and Gal80
Authors: Egriboz Onur , Jiang Fenglei , Hopper James E
Published: September 2011

The yeast transcriptional activator Gal4 localizes to UASGAL sites even in the absence of galactose but cannot activate transcription due to an association with the Gal80 protein. By 4 min after galactose addition, Gal4-activated gene transcription ensues. It is well established that this rapid induction arises through a galactose-triggered association between the Gal80 and Gal3 proteins that decreases the association of Gal80 and Gal4. How this happens mechanistically remains unclear. Strikingly different hypotheses prevail concerning the possible roles of nucleocytoplasmic distribution and trafficking of Gal3 and Gal80 and where in the cell the initial Gal3–Gal80 association occurs. Here we tested two conflicting hypotheses by evaluating the subcellular distribution and dynamics of Gal3 and Gal80 with reference to induction kinetics. We determined that the rates of nucleocytoplasmic trafficking for both Gal80 and Gal3 are slow relative to the rate of induction. We find that depletion of the nuclear pool of Gal3 slows the induction kinetics. Thus, nuclear Gal3 is critical for rapid induction. Fluorescence-recovery-after-photobleaching experiments provided data suggesting that the Gal80–Gal4 complex exhibits kinetic stability in the absence of galactose. Finally, we detect Gal3 at the UASGAL only if Gal80 is covalently linked to the DNA-binding domain. Taken altogether, these new findings lead us to propose that a transient interaction of Gal3 with Gal4-associated Gal80 could explain the rapid response of this system. This notion could also explain earlier observations.
MicroRNA Sequence Variation Potentially Contributes to Within-Species Functional Divergence in the NematodeCaenorhabditis briggsae
Authors: Jovelin Richard , Cutter Asher D
Published: September 2011

Mounting evidence points to differences in gene regulation as a major source of phenotypic variation. MicroRNA-mediated post-transcriptional regulation has emerged recently as a key factor controlling gene activity during development. MicroRNA genes are abundant in genomes, acting as managers of gene expression by directing translational repression. Thus, understanding the role of microRNA sequence variation within populations is essential for fully dissecting the origin and maintenance of phenotypic diversity in nature. In this study, we investigate allelic variation at microRNA loci in the nematode Caenorhabditis briggsae, a close relative of C. elegans. Phylogeographic structure in C. briggsae partitions most strains from around the globe into a “temperate” or a “tropical” clade, with a few strains having divergent, geographically restricted genotypes. Remarkably, strains that follow this latitudinal dichotomy also differ in temperature-associated fitness. With this phylogeographic pattern in mind, we examined polymorphisms in 18 miRNAs in a global sample of C. briggsae isolates and tested whether newly isolated strains conform to this phylogeography. Surprisingly, nucleotide diversity is relatively high in this class of gene that generally experiences strong purifying selection. In particular, we find that miRNAs in C. briggsae are substantially more polymorphic than in Arabidopsis thaliana, despite similar background levels of neutral site diversity between the two species. We find that some mutations suggest functional divergence on the basis of requirements for target site recognition and computational prediction of the effects of the polymorphisms on RNA folding. These findings demonstrate the potential for miRNA polymorphisms to contribute to phenotypic variation within a species. Sequences were deposited in GenBank under accession nos. JN251323–JN251744.
Fitness Landscapes: An Alternative Theory for the Dominance of Mutation
Authors: Manna Federico , Martin Guillaume , Lenormand Thomas
Published: September 2011

Deleterious mutations tend to be recessive. Several theories, notably those of Fisher (based on selection) and Wright (based on metabolism), have been put forward to explain this pattern. Despite a long-lasting debate, the matter remains unresolved. This debate has focused on the average dominance of mutations. However, we also know very little about the distribution of dominance coefficients among mutations, and about its variation across environments. In this article we present a new approach to predicting this distribution. Our approach is based on a phenotypic fitness landscape model. First, we show that under a very broad range of conditions (and environments), the average dominance of mutation of small effects should be approximately one-quarter as long as adaptation of organisms to their environment can be well described by stabilizing selection on an arbitrary set of phenotypic traits. Second, the theory allows predicting the whole distribution of dominance coefficients among mutants. Because it provides quantitative rather than qualitative predictions, this theory can be directly compared to data. We found that its prediction on mean dominance (average dominance close to 0.25) agreed well with the data, based on a meta-analysis of dominance data for mildly deleterious mutations. However, a simple landscape model does not account for the dominance of mutations of large effects and we provide possible extension of the theory for this class of mutations. Because dominance is a central parameter for evolutionary theory, and because these predictions are quantitative, they set the stage for a wide range of applications and further empirical tests.
Clinical Presentation and Treatment of Transfusion-Associated Babesiosis in Premature Infants
Authors: Simonsen Kari A. , Harwell Joseph I. , Lainwala Shabnam
Published: September 2011

We review here 7 cases of neonatal transfusion-associated babesiosis at a NICU in the northeast United States. Transfusion from 2 infected units of blood resulted in the 7 cases described. The clinical presentation was highly variable in this cohort; the extremely low birth weight neonates were the most severely affected. Antibiotic therapy was effective in neonates with mild and asymptomatic infection; however, double-volume exchange blood transfusion with prolonged multidrug treatment was required for the 2 most severe cases. The risk of Babesia microti infection is not eliminated through current blood-bank practices. Neonatologists in endemic areas should have a high index of suspicion for babesiosis in premature infants exposed to blood transfusions.
Statistical Uncertainty of Mortality Rates and Rankings for Children's Hospitals
Authors: Feudtner Chris , Berry Jay G. , Parry Gareth , Hain Paul , Morse Rustin B. , Slonim Anthony D. , Shah Samir S. , Hall Matt
Published: September 2011

OBJECTIVES:

Hospitals are being required to report publically their adjusted mortality rates, which are then being used to rank hospitals. Our objectives were to assess the statistical reliability of the determination of a hospital's adjusted mortality rate, of comparisons of that rate with the rates of other hospitals, and of the use of those rates to rank the hospitals.

METHODS:

A cross-sectional study of 473 383 patients discharged from 42 US children's hospitals in 2008 was performed. Hospital-specific observed/expected (O/E) mortality rate ratios and corresponding hospital rankings, with 95% confidence intervals (CIs), were examined.

RESULTS:

Hospitals' O/E mortality rate ratios exhibited wide 95% CIs, and no hospital was clearly distinguishable from the other hospitals' aggregated mean mortality performance. Only 2 hospitals' mortality performance fell outside the comparator hospitals' 95% CI. Those hospitals' 95% CIs overlapped with the overall comparator set's 95% CI, which suggests that there were no statistically significant hospital outliers. Fourteen (33.3%) of the 42 hospitals had O/E ratios that were not statistically different from being in the 95% CI of the top 10% of hospitals. Hospital-specific mortality rate rankings displayed even broader 95% CIs; the typical hospital had a 95% CI range that spanned 22 rank-order positions.

CONCLUSION:

Children's hospital-specific measures of adjusted mortality rate ratios and rankings have substantial amounts of statistical imprecision, which limits the usefulness of such measures for comparisons of quality of care.
Recurrence and Outcomes of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Children
Authors: Finkelstein Yaron , Soon Gordon S. , Acuna Patrick , George Mathew , Pope Elena , Ito Shinya , Shear Neil H. , Koren Gideon , Shannon Michael W. , Garcia-Bournissen Facundo
Published: September 2011

OBJECTIVES:

To report clinical course, etiology, management, and long-term outcomes of children suffering from Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN).

METHODS:

We conducted a study of all pediatric patients with SJS or TEN admitted between 2000 and 2007 to the Hospital for Sick Children and Children's Hospital Boston, and particular attention was paid to clinical manifestations, etiology, mortality, and long-term outcomes.

RESULTS:

We identified 55 cases of SJS (n = 47), TEN (n = 5), or SJS/TEN overlap syndrome (n = 3). Drugs were identified as the most likely etiologic agent in 29 children (53%); antiepileptic drugs were the most common agents (n = 16), followed by sulfonamide antibiotics (n = 7) and chemotherapy drugs (n = 2). Acute Mycoplasma pneumoniae infection was confirmed in 12 children (22%), and herpes simplex virus was confirmed in 5 children (9%). Treatment regimens differed significantly between participating sites and included systemic antimicrobial agents (67%), systemic corticosteroids (40%), and antiviral drugs (31%). Intravenous immunoglobulin was administered to 21 children (38%), of whom 8 received concomitant systemic corticosteroids. Ten children (18%) had recurrence of SJS up to 7 years after the index episode, and 3 experienced multiple recurrences. Twenty-six children (47%) suffered long-term sequelae that mostly involved the skin and eyes.

CONCLUSIONS:

Mortality rate in children was lower than that reported in adults, but half of affected children suffered long-term complications. The recurrence rate of SJS was high (1 in 5), which suggests vulnerability and potential genetic predisposition. In the absence of standardized management guidelines for these conditions, treatment regimens differed significantly between participating institutions.
Age-Specific Differences in Outcomes After Out-of-Hospital Cardiac Arrests
Authors: Nitta Masahiko , Iwami Taku , Kitamura Tetsuhisa , Nadkarni Vinay M. , Berg Robert A. , Shimizu Naoki , Ohta Kunio , Nishiuchi Tatsuya , Hayashi Yasuyuki , Hiraide Atsushi , Tamai Hiroshi , Kobayashi Masanao , Morita Hiroshi ,   for the Utstein Osaka Project
Published: September 2011

OBJECTIVE:

We assessed out-of-hospital cardiac arrests (OHCAs) for various pediatric age groups.

METHODS:

This prospective, population-based, observational study included all emergency medical service-treated OHCAs in Osaka, Japan, between 1999 and 2006 (excluding 2004). Patients were grouped as adults (>17 years), infants (<1 year), younger children (1–4 years), older children (5–12 years), and adolescents (13–17 years). The primary outcome measure was 1-month survival with favorable neurologic outcome.

RESULTS:

Of 950 pediatric OHCAs, resuscitations were attempted for 875 patients (92%; 347 infants, 203 younger children, 135 older children, and 190 adolescents). The overall incidence of nontraumatic pediatric OHCAs was 7.3 cases per 100 000 person-years, compared with 64.7 cases per 100 000 person-years for adults and 65.5 cases per 100 000 person-years for infants. Most infant OHCAs occurred in homes (93%) and were not witnessed (90%). Adolescent OHCAs often occurred outside the home (45%), were witnessed by bystanders (37%), and had shockable rhythms (18%). One-month survival was more common after nontraumatic pediatric OHCAs than adult OHCAs (8% [56 of 740 patients] vs 5% [1677 of 33 091 patients]; adjusted odds ratio: 2.26 [95% confidence interval: 1.63–3.13]). One-month survival with favorable neurologic outcome was more common among children than adults (3% [21 of 740 patients] vs 2% [648 of 33 091 patients]; adjusted odds ratio: 2.46 [95% confidence interval: 1.45–4.18]). Rates of 1-month survival with favorable neurologic outcome were 1% for infants, 2% for younger children, 2% for older children, and 11% for adolescents.

CONCLUSION:

Survival and favorable neurologic outcome at 1 month were more common after pediatric OHCAs than adult OHCAs.
Risk Factors for Childhood Mental Health Symptoms: National Longitudinal Study of Australian Children
Authors: Bayer Jordana K. , Ukoumunne Obioha C. , Lucas Nina , Wake Melissa , Scalzo Katherine , Nicholson Jan M.
Published: September 2011

OBJECTIVE:

To determine predictors of child externalizing (behavioral) and internalizing (emotional) symptoms in a national population sample.

METHODS:

Data were collected in 3 biennial waves (2004, 2006, and 2008) from 2 cohorts in the Longitudinal Study of Australian Children, initially including 5107 children 0 to 1 year of age and 4983 children 4 to 5 years of age. The primary outcomes were child externalizing and internalizing symptoms. Relationships between potential risk factors and child mental health outcomes were described by using linear regression.

RESULTS:

In unadjusted analyses, children's mental health symptoms were predicted by a large number of risk factors. In multivariate models, early childhood factors (birth through 5 years) explained 30% and 18% of variations in externalizing and internalizing symptoms, respectively, at 4 to 5 years of age. Middle childhood (5–9 years of age) factors explained 20% and 23% of variations in externalizing and internalizing symptoms, respectively, at 8 to 9 years of age. Harsh discipline was a strong consistent predictor of externalizing symptoms in both age groups, whereas poorer child physical health, maternal emotional distress, harsh discipline, and overinvolved/protective parenting (younger cohort only) predicted internalizing symptoms consistently.

CONCLUSIONS:

National data on predictors of child mental health symptoms highlighted a small number of significant risk factors, situated in the family context and present from a very young age. This knowledge is informing population-level, randomized, prevention trials of family support programs.
Race, Ancestry, and Development of Food-Allergen Sensitization in Early Childhood
Authors: Kumar Rajesh , Tsai Hui-Ju , Hong Xiumei , Liu Xin , Wang Guoying , Pearson Colleen , Ortiz Katherin , Fu Melanie , Pongracic Jacqueline A. , Bauchner Howard , Wang Xiaobin
Published: September 2011

OBJECTIVE:

We examined whether the risk of food-allergen sensitization varied according to self-identified race or genetic ancestry.

METHODS:

We studied 1104 children (mean age: 2.7 years) from an urban multiethnic birth cohort. Food sensitization was defined as specific immunoglobulin E (sIgE) levels of ≥0.35 kilo–units of allergen (kUA)/L for any of 8 common food allergens. Multivariate logistic regression analyses were used to evaluate the associations of self-identified race and genetic ancestry with food sensitization. Analyses also examined associations with numbers of food sensitizations (0, 1 or 2, and ≥3 foods) and with logarithmically transformed allergen sIgE levels.

RESULTS:

In this predominantly minority cohort (60.9% black and 22.5% Hispanic), 35.5% of subjects exhibited food sensitizations. In multivariate models, both self-reported black race (odds ratio [OR]: 2.34 [95% confidence interval [CI]: 1.24–4.44]) and African ancestry (in 10% increments; OR: 1.07 [95% CI: 1.02–1.14]) were associated with food sensitization. Self-reported black race (OR: 3.76 [95% CI: 1.09–12.97]) and African ancestry (OR: 1.19 [95% CI: 1.07–1.32]) were associated with a high number (≥3) of food sensitizations. African ancestry was associated with increased odds of peanut sIgE levels of ≥5 kUA/L (OR: 1.25 [95% CI: 1.01–1.52]). Similar ancestry associations were seen for egg sIgE levels of ≥2 kUA/L (OR: 1.13 [95% CI: 1.01–1.27]) and milk sIgE levels of ≥5 kUA/L (OR: 1.24 [95% CI: 0.94–1.63]), although findings were not significant for milk.

CONCLUSIONS:

Black children were more likely to be sensitized to food allergens and were sensitized to more foods. African ancestry was associated with peanut sensitization.
School Absenteeism Among Children Living With Smokers
Authors: Levy Douglas E. , Winickoff Jonathan P. , Rigotti Nancy A.
Published: September 2011

OBJECTIVE:

Involuntary tobacco smoke exposure causes substantial morbidity in children. We hypothesized that children exposed to tobacco smoke in the home would have increased school absenteeism with associated costs due to lost caregiver wages/time.

METHODS:

We analyzed data on health and absenteeism among schoolchildren aged 6 to 11 years identified in the 2005 National Health Interview Survey (NHIS). We used multivariate models to assess the relationships between adult-reported household smoking and child health and school absenteeism. Analyses were adjusted for children's and parents' demographic and socioeconomic characteristics. The value of lost caregiver time was estimated by using self-reported employment and earnings data in the NHIS and publicly available time-use data.

RESULTS:

Children living with 1 or ≥2 adults who smoked in the home had 1.06 (95% confidence interval [CI]: 0.54–1.55) and 1.54 (95% CI: 0.95–2.12) more days absent from school per year, respectively, than children living with 0 smokers in the home. Living with ≥2 adults who smoked in the home was associated with increased reports of having ≥3 ear infections in the previous 12 months (adjusted odds ratio [aOR]: 2.65 [95% CI: 1.36–5.16]) and having a chest cold in the 2 weeks before interview (aOR: 1.77 [95% CI: 1.03–3.03]) but not with having vomiting/diarrhea in the previous 2 weeks (aOR: 0.93 [95% CI: 0.45–1.89]). Caregivers' time tending children absent from school was valued at $227 million per year.

CONCLUSIONS:

Tobacco smoke exposure has significant consequences for children and families above and beyond child morbidity, including academic disadvantage and financial burden.
Caminhos da formação de enfermagem: continuidade ou ruptura?
Authors: Faustino Regina Lucia Herculano , Moraes Maria Julia Barbosa de , Oliveira Maria Amélia de Campos , Egry Emiko Yoshikawa
Published: September 2011

Apresentam-se algumas reflexões sobre as atuais tendências da formação em Enfermagem frente às Diretrizes Curriculares para os Cursos de Graduação em Enfermagem, visando subsidiar as transformações no ensino de 3º grau. Volta-se especificamente para a discussão da formação da enfermeira, enfocando o desenvolvimento de competências necessárias à transformação do modelo assistencial vigente e ao trabalho em equipe multiprofissional, visando a consolidação do SUS.
Avaliação e construção de um projeto político pedagógico para a graduação em enfermagem
Authors: Oliveira Beatriz Rosana Gonçalves de , Schneider Jacó Fernando , Rizzotto Maria Lucia Frizon , Rodrigues Rosa Maria
Published: September 2011

Este trabalho apresenta os resultados de uma experiência que teve como objetivo principal avaliar o Projeto Político Pedagógico - PPP do Curso de Enfermagem da UNIOESTE - Campus de Cascavel e pensar uma nova proposta curricular para o curso. Para isso elaborou-se um projeto de pesquisa a ser desenvolvido por todos os docentes que ministravam aulas no curso, com a participação de alunos, egressos e profissionais da rede de serviços de saúde que serve de campo para as atividades práticas e os estágios dos alunos. Os dados obtidos subsidiaram a proposta de construção do novo projeto político-pedagógico, que passou a vigorar em 2003. Além da elaboração de uma nova proposta pedagógica, definiu-se estratégias para uma avaliação continuada do processo de implantação do PPP, a ser realizada ao final de cada período letivo.
Estratégias para a implantação de uma nova proposta pedagógica na escola de enfermagem da Universidade Federal da Bahia
Authors: Fernandes Josicelia Dumêt , Ferreira Silvia Lucia , Torre Maristela P. S. La , Rosa Darci De Oliveira Santa , Costa Heloniza O. G.
Published: September 2011

Este artigo apresenta uma reflexão sobre o processo de construção do Projeto Pedagógico da Escola de Enfermagem da UFBA. A socialização dessa experiência pretende contribuir com outras instituições de ensino de enfermagem que, para atender às novas DCENF, passarão a vivenciar processos semelhantes ou que, no momento, passam pelo mesmo processo. O artigo traz alguns antecedentes e a fundamentação legal da mudança, apresentando os pressupostos que norteiam a atual proposta, bem como a organização curricular, os principais desafios e algumas estratégias de superação dos mesmos . Embora sejam apontados alguns aspectos que precisam de aprofundamento por parte do corpo docente, como a transversalidade de conteúdos, a gestão acadêmica, o processo de avaliação e a operacionalização da proposta, as autoras concluem que o debate não se esgota neste momento. Por se tratar de um processo dinâmico em construção, outros desafios poderão surgir exigindo novas estratégias para seu (re) direcionamento.
Participação na construção de um projeto político pedagógico na enfermagem
Authors: Beck Carmem Lúcia Colomé , Budó Maria de Lourdes Denardin , Terra Marlene Gomes , Camponogara Silviamar , Padoin Stella Maris de Mello , Blois Janice de Moraes
Published: September 2011

Trata-se de um relato de experiência que apresenta o percurso realizado pela comunidade acadêmica do Curso de Enfermagem da Universidade Federal de Santa Maria na construção do Projeto Político Pedagógico. A metodologia que norteou a construção do mesmo foi a realização de seminários que reuniram docentes, discentes, servidores e enfermeiros que atuam em campos de aulas práticas e estágios supervisionados. Para a organização do projeto foram utilizados os marcos referencial, conceitual e estrutural adaptados de Saupe e Alves. O Curso encontra-se na etapa de elaboração do Marco Estrutural, devendo programar seminários que compreendam as discussões acerca da metodologia de ensino, da elaboração de plano de acompanhamento e avaliação da implantação do PPP, bem como de capacitação docente.
O exercício de liberdade e autonomia na academia: uma prática pedagógica no estágio curricular supervisionado
Authors: Alonso Ilca L. Keller
Published: September 2011

Este artigo apresenta uma reflexão sobre uma experiência de ensino desenvolvida no Curso de Graduação em Enfermagem da Universidade Federal de Santa Catarina no decorrer do estágio curricular supervisionado enfocando o exercício de autonomia, responsabilidade, competência e compromisso dos alunos no mundo profissional da enfermagem. O encaminhamento pedagógico desta atividade está na articulação entre pensamento e ação através da problematização da realidade da prática de forma a aproximar os acadêmicos do seu papel profissional.
Um relato de experiência de quem vivencia a reforma psiquiátrica no Brasil
Authors: Marzano Maria Luisa Rietra , Sousa Célia Antunes C. de
Published: September 2011

Trata-se de um estudo descritivo, fundamentado em revisões bibliográficas, desenvolvido na disciplina de Políticas de Saúde, do curso de Mestrado da Universidade do Rio de Janeiro (UNIRIO), com o objetivo de relatar nossa experiência de trabalho na atenção psicossocial, na qual estivemos envolvidas nos últimos 4 anos, abordando as estratégias do Ministério da Saúde direcionadas para a reestruturação da atenção à saúde mental no Brasil. Verifica-se necessidade de intervenções objetivas para efetivar este processo, entre os quais a construção de uma sólida rede ampliada de atenção à saúde mental, a municipalização das ações de saúde, reduzindo o risco de uma fragmentação dos serviços e a implicação dos familiares e da sociedade na atenção e reinserção da pessoa portadora de transtorno mental.
Análise psicométrica inicial da versão brasileira do DISABKIDS Atopic Dermatitis Module
Authors: Deon Keila Cristiane , Santos Danielle Maria de Souza Sério dos , Bullinger Monika , Santos Claudia Benedita dos
Published: September 2011

OBJETIVO: Analisar as propriedades psicométricas iniciais da versão brasileira de instrumento de avaliação da qualidade de vida relacionada à saúde de crianças e adolescentes com dermatite atópica. MÉTODOS: Estudo transversal realizado com amostra de 52 crianças e adolescentes, com idades entre oito e 18 anos, diagnosticados com dermatite atópica, e seus responsáveis, recrutados em serviço de dermatologia de hospital universitário na cidade de São Paulo, SP, em 2009. Foram avaliadas a validade de construto, a confiabilidade de consistência interna e a correlação entre as respostas de crianças e adolescentes e seus responsáveis da versão brasileira do Atopic Dermatitis Module (DISABKIDS-ADM). RESULTADOS: A confiabilidade de consistência interna foi satisfatória, com coeficiente alfa de Cronbach aceitável para as dimensões constantes no instrumento (0,7024/0,8124 e 0,7239/0,8604). A análise multitraço-multimétodo para validade convergente mostrou valores maiores que 0,30 para todos os itens. Quanto à validade discriminante, a análise revelou resultados satisfatórios. A concordância entre as versões self e proxy foi avaliada pelo coeficiente de correlação intra-classe, com valores de 0,8173 para impacto e 0,7629 para estigma. CONCLUSÕES: Diante dos resultados encontrados, considera-se que o instrumento DISABKIDS-ADM pode ser utilizado por pesquisadores brasileiros depois de finalizado seu processo de validação, por seus resultados iniciais apontarem propriedades psicométricas satisfatórias, que permitem considerá-lo um instrumento válido e confiável.
Comportamento sexual de estudantes de um curso de medicina do Rio de Janeiro
Authors: Aragão Júlio César Soares , Lopes Claudia de Souza , Bastos Francisco Inácio
Published: September 2011

O uso consistente de preservativos constitui a principal estratégia de prevenção do HIV/aids, bem como de outras infecções sexualmente transmissíveis (ISTs). Neste contexto, o perfil de uso de preservativos em estudantes de Medicina é de especial interesse, principalmente quando consideramos o papel de formadores de opinião desempenhado pelos profissionais médicos. Este estudo investiga o padrão de comportamento sexual e sua associação com o uso de preservativos entre estudantes do curso de Medicina de uma universidade privada de um município do interior do Estado do Rio de Janeiro. Dados relativos a 643 estudantes de Medicina foram colhidos por meio de um questionário anônimo e autopreenchível. As análises foram conduzidas utilizando-se a regressão de Poisson com variância robusta para o cálculo das razões de prevalência brutas e ajustadas. A maioria dos alunos respondeu já ter iniciado vida sexual (85,3%). O parceiro da primeira relação sexual foi, em sua maioria, o(a) namorado(a) (55,1%), e o local da coitarca mais frequentemente relatado foi a própria casa (27,1%). O método anticoncepcional mais frequentemente utilizado na coitarca foi o preservativo (90,1%). Na análise bivariada, o fator que se mostrou mais estreitamente associado ao uso inconsistente do preservativo foi a presença de parceria estável, achado corroborado pela análise multivariada, após ajuste por sexo, idade e renda (RP = 1,95 IC 95% 1,47 − 2,57). Estes achados são compatíveis com a hipótese de que indivíduos inseridos em parcerias estáveis têm menor percepção de risco por suporem que a estabilidade de seus relacionamentos lhes conferiria proteção relativa contra as ISTs e HIV/aids.
O processo de aprendizagem do residente de anestesiologia: uma reflexão sobre o cuidado ao paciente
Authors: Nascimento Leonel Alves do , Tramontini Cibele Cristina , Garanhani Mara Lúcia
Published: September 2011

Pesquisa descritiva de abordagem qualitativa. O objetivo do estudo é identificar o cuidado com o paciente cirúrgico dispensado pelo residente de anestesiologia e o compartilhamento deste cuidado com a equipe cirúrgica, bem como as percepções desse residente sobre o autocuidado. A análise dos discursos dos nove residentes entrevistados resultou na construção de seis categorias: (a) escolha da especialidade: proximidade com o intensivista, imediatismo das ações e analgesia; (b) cuidados com o paciente cirúrgico: apresentação de ações de rotina e da técnica anestésica empregada; (c) compartilhamento do cuidado com os outros profissionais: o residente compreende sua importância, mas compartilha pouco; (d) preceptoria médica: existe uma ambivalência de sentimentos − satisfação pela proximidade com o docente, pela orientação e resolução de problemas, e insatisfação pelo pouco tempo dedicado às atividades acadêmicas e despreparo docente; (e) autocuidado: os residentes negligenciam o autocuidado, devido principalmente à extensa carga horária. As repercussões desta postura são relatadas como nervosismo, impaciência, diminuição da criatividade e do humor, e propensão a erros.
Abordagem dos problemas éticos em pediatria: sugestões advindas da prática
Authors: Guedert Jucélia Maria , Grosseman Suely
Published: September 2011

No atendimento à criança, os profissionais da saúde lidam com situações geradoras de problemas éticos, que requerem competência para a tomada de decisões. Visando fornecer subsídios ao desenvolvimento dessa competência na graduação em Medicina, o objetivo deste estudo foi analisar estratégias sugeridas por médicos que atuam em ensino e assistência pediátrica para melhor abordagem dos problemas éticos vivenciados no cotidiano profissional. Trata-se de uma pesquisa quali-quantitativa, descritiva, aprovada no CEP-HIJG, com 72 médicos de dois hospitais e 16 da atenção primária, que responderam a um questionário semiestruturado. Realizou-se análise de conteúdo e descritiva com medidas de tendência central. Foram sugeridas como estratégias: abordagem sistemática e reflexão sobre ética e bioética, baseada em problemas cotidianos, na graduação, residência e atuação profissional; maior abordagem do tema em eventos médicos; elaboração de normas e orientações claras sobre problemas éticos; reflexão sobre o tema durante o ensino-aprendizagem e nas relações profissionais; e constituição de grupos especializados para ajudar na tomada de decisões. As estratégias são viáveis e deveriam ser consideradas no planejamento de ações institucionais e educacionais em Pediatria.