bluuebunny/crossref_metadata_2025 huggingface dataset:
Pharmacy Automation and Technology - What Will the Next Generation of Your Patients Expect and Demand?
Authors: Felkey Bill G. , Fox Brent I.
Published: April 2010

The next US Census is quickly approaching. We have already seen a changing demographic in this country. The changes are more pronounced in some areas, while being less obvious in others. As the US demographics continue to change, how will this impact your institution's relationship with its patients? More important, how might language barriers impact your patients' care? These topics are addressed below.
Recent Publications on Medications and Pharmacy
Authors: Sterling Jacyntha A.
Published: April 2010

Hospital Pharmacy presents this feature to keep pharmacists abreast of new publications in the medical/pharmacy literature. Articles of interest regarding a broad scope of topics are abstracted monthly. Suggestions or comments may be addressed to Jacyntha Sterling, Drug Information Specialist at Saint Francis Hospital, 6161 S Yale Ave, Tulsa, OK 74136 or e-mail: jasterling@saintfrancis.com .
Molecular characterisation of ‘transmembrane protein 192’ (TMEM192), a novel protein of the lysosomal membrane
Authors: Schröder Bernd , Wrocklage Christian , Hasilik Andrej , Saftig Paul
Published: April 2010

Transmembrane protein 192 (TMEM192) has been previously identified in proteomic analyses of lysosomal membranes. TMEM192 does not exhibit any significant homology to known protein families and possesses four potential transmembrane segments. To approach the molecular role of TMEM192, a detailed biochemical characterisation of this protein was performed. Expression constructs of fusion proteins containing TMEM192 and appended epitope tags were constructed. In HeLa cells these proteins were detected in membranes of lysosomes/late endosomes. To examine endogenous TMEM192, a TMEM192-specific antibody was generated and validated. With this antibody colocalisation of endogenous TMEM192 with lysosomal and late endosomal markers was demonstrated. Using Percoll density gradient centrifugation and immunoblotting, co-sedimentation of major portions of both TMEM192 and the lysosomal proteins LAMP-2 and cathepsin D into high-density fractions was observed. Interestingly, in contrast to many other lysosomal proteins no N-glycosylation of TMEM192 could be detected. Western blotting of reduced and non-reduced samples and co-immunoprecipitation experiments indicated TMEM192 to be a homodimer with one or more interchain disulphide bridges. TMEM192 was found to be strongly expressed in human kidney, liver, lung and pancreas tissue. The widespread tissue distribution could suggest an important role of TMEM192 for lysosomal function.
Epidemiology of Pediatric Holiday-Related Injuries Presenting to US Emergency Departments
Authors: D'Ippolito Anthony , Collins Christy L. , Comstock R. Dawn
Published: April 2010

OBJECTIVE:

The objective of this study was to calculate injury rates and describe the epidemiology of holiday-related injuries among children who were aged ≤19 years and presented to US emergency departments (EDs) from 1997 through 2006.

METHODS:

Data on holiday-related injuries obtained from the US Consumer Product Safety Commission's National Electronic Injury Surveillance System were analyzed.

RESULTS:

From 1997 through 2006, an estimated 5710999 holiday-related injuries sustained by children who were aged ≤19 years presented to US EDs. The greatest number of injuries occurred on Labor Day followed by Memorial Day, Fourth of July, and Halloween. Children who were younger than 5 years sustained a greater proportion of injuries than other age groups. The face, finger/hand, and head were the most commonly injured body parts. Lacerations, contusion/abrasions, fractures, and sprain/strains were the most common diagnoses. Overall, the majority of injuries that occurred on holidays were classified as sports and recreation–related. In addition, home structure–related and home furnishing–related injuries were prevalent. Injuries that were associated with fireworks were more likely to occur on the Fourth of July than any other holiday, yet fireworks accounted for only a small proportion of Fourth of July injuries.

CONCLUSIONS:

Most injuries that were sustained on holidays and required ED treatment were not holiday-specific but were associated with more general activities. Parents should be aware that holidays present a risk not only for holiday-specific injuries but also for more general, “everyday” injuries.
Reduction of Severe Hyperbilirubinemia After Institution of Predischarge Bilirubin Screening
Authors: Mah Michael P. , Clark Steven L. , Akhigbe Efe , Englebright Jane , Frye Donna K. , Meyers Janet A. , Perlin Jonathan B. , Rodriguez Mitch , Shepard Arthur
Published: April 2010

OBJECTIVE:

The objective of this study was to demonstrate efficacy of universal predischarge neonatal bilirubin screening in reducing potentially dangerous hyperbilirubinemia in a large, diverse national population.

METHODS:

This was a 5-year prospective study directed at neonates who were aged ≤28 days and evaluated at facilities of the Hospital Corporation of America with a serum bilirubin level of ≥20.0 mg/dL. This time frame includes periods before, during, and after the initiation of systemwide institution of a program of universal predischarge neonatal bilirubin screening. The primary outcome measures were serum bilirubin 25.0 to 29.9 and ≥30.0 mg/dL. Neonatal phototherapy use during these years was also analyzed.

RESULTS:

Of the 1028817 infants who were born in 116 hospitals between May 1, 2004, and December 31, 2008, 129345 were delivered before implementation and 899472 infants were delivered after implementation of this screening program in their individual hospitals. With a program of universal screening, the incidence of infants with total bilirubin 25.0 to 29.9 mg/dL declined from 43 per 100000 to 27 per 100000, and the incidence of infants with total bilirubin of ≥30.0 mg/dL dropped from 9 per 100000 to 3 per 100000 (P = .0019 and P = .0051, respectively). This change was associated with a small but statistically significant increase in phototherapy use.

CONCLUSIONS:

A comprehensive program of prevention, including universal predischarge neonatal bilirubin screening, significantly reduces the subsequent development of bilirubin levels that are known to place newborns at risk for bilirubin encephalopathy.
Glomerular Filtration Rate Reference Values in Very Preterm Infants
Authors: Vieux Rachel , Hascoet Jean-Michel , Merdariu Dana , Fresson Jeanne , Guillemin Francis
Published: April 2010

OBJECTIVE:

In very preterm infants, there is a high risk for impaired kidney function; therefore, access to normal ranges of glomerular filtration rate (GFR) for age and definition of a reliable normal range of glomerular clearance is essential. Despite this, updated GFR reference values for use in clinical practice are not available. The objective of this study was to determine GFR reference values in very preterm infants aged 27 to 31 weeks' gestation.

METHODS:

This was a multicenter, prospective cohort study. Infants were recruited to the study before 48 hours of life. Glomerular clearance was measured at inclusion, then weekly for the first month. Reference values were determined by measurement of 12-hour urine specimens and generation of a linear regression model with repeated measures after removal of risk factor components. Validation was checked with a bootstrap technique for infants who were not exposed to significant risk factors.

RESULTS:

This study included 275 infants. Median GFR reference values (mL/min per 1.73 m2) in infants aged 27 to 31 weeks' gestation ranged from 7.9 to 30.3 on day 7, 10.7 to 33.1 on day 14, 12.5 to 34.9 on day 21, and 15.5 to 37.9 on day 28.

CONCLUSIONS:

The GFR reference values, presented in this article as 3rd, 10th, 50th, 90th, and 97th percentiles, should be useful in NICUs for adaptation of drug doses to glomerular clearance and in defining infants who present with altered GFR and who need additional investigation and close follow-up to adjust fluid intake and drug dosage.
Glycemic Control in Pediatric Type 1 Diabetes: Role of Caregiver Literacy
Authors: Hassan Krishnavathana , Heptulla Rubina A.
Published: April 2010

OBJECTIVE:

Poorly controlled diabetes may occur because caregivers of children with type 1 diabetes fail to comprehend provided diabetes education. We hypothesized that poorly controlled diabetes is associated with lower literacy/numerical skills of caregivers of children with type 1 diabetes.

METHODS:

Primary caregivers were evaluated by using Newest Vital Sign (NVS) and a sociodemographic questionnaire. The NVS identifies individuals who are at risk for low health literacy by measuring general literacy/numeracy skills and yields an overall estimate of health literacy. The NVS scores are interpreted to suggest inadequate, limited, or adequate literacy.

RESULTS:

Two hundred caregivers of children who had type 1 diabetes with mean hemoglobin A1c (HbA1c) of 8.8 ± 1.9%, age of 11.8 ± 3.7 years, duration of disease of 4.8 ± 3.3 years, and BMI of 20.8 ± 4.4 kg/m2 participated. HbA1c in those of inadequate literacy (10.4 ± 2.2%) was significantly higher than in those of adequate literacy (8.6 ± 1.7%; P < .001). HbA1c in those whose caregivers had limited literacy (9.5 ± 2.2%) did not differ significantly from the other 2 groups. On adjusting for independent covariates, we found that children whose caregivers had at least 50% correct math answers had better glycemic control (8.5 ± 1.7%) than those who failed (9.8 ± 2.1%; P < .0005).

CONCLUSIONS:

Literacy and numerical skills of caregivers significantly influence glycemic control of their children with type 1 diabetes. Assessing literacy/numeracy skills of caregivers and addressing these deficiencies may be crucial in optimizing glycemic control.
The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis
Authors: Bartick Melissa , Reinhold Arnold
Published: April 2010

BACKGROUND AND OBJECTIVE:

A 2001 study revealed that $3.6 billion could be saved if breastfeeding rates were increased to levels of the Healthy People objectives. It studied 3 diseases and totaled direct and indirect costs and cost of premature death. The 2001 study can be updated by using current breastfeeding rates and adding additional diseases analyzed in the 2007 breastfeeding report from the Agency for Healthcare Research and Quality.

STUDY DESIGN:

Using methods similar to those in the 2001 study, we computed current costs and compared them to the projected costs if 80% and 90% of US families could comply with the recommendation to exclusively breastfeed for 6 months. Excluding type 2 diabetes (because of insufficient data), we conducted a cost analysis for all pediatric diseases for which the Agency for Healthcare Research and Quality reported risk ratios that favored breastfeeding: necrotizing enterocolitis, otitis media, gastroenteritis, hospitalization for lower respiratory tract infections, atopic dermatitis, sudden infant death syndrome, childhood asthma, childhood leukemia, type 1 diabetes mellitus, and childhood obesity. We used 2005 Centers for Disease Control and Prevention breastfeeding rates and 2007 dollars.

RESULTS:

If 90% of US families could comply with medical recommendations to breastfeed exclusively for 6 months, the United States would save $13 billion per year and prevent an excess 911 deaths, nearly all of which would be in infants ($10.5 billion and 741 deaths at 80% compliance).

CONCLUSIONS:

Current US breastfeeding rates are suboptimal and result in significant excess costs and preventable infant deaths. Investment in strategies to promote longer breastfeeding duration and exclusivity may be cost-effective.
Dextranomer/Hyaluronic Acid for Pediatric Vesicoureteral Reflux: Systematic Review
Authors: Routh Jonathan C. , Inman Brant A. , Reinberg Yuri
Published: April 2010

OBJECTIVE:

Published success rates of dextranomer/hyaluronic acid (Dx/HA) injection for pediatric vesicoureteral reflux (VUR) vary widely. Our objective of this study was to assess whether underlying patient or study factors could explain the heterogeneity in reported Dx/HA success rates.

METHODS:

We searched the Cochrane Controlled Trials Register and Medline, Embase, and Scopus databases from 1990 to 2008 for reports in any language, along with a hand search of included study bibliographies. Articles were assessed and data abstracted in duplicate, and differences were resolved by consensus. Conflict of interest (COI) was determined by published disclosure. Meta-regression was performed to adjust for patient as well as study-level factors.

RESULTS:

We identified 1157 reports, 89 of which were reviewed in full with 47 included in the pooled analysis. Of 7303 ureters that were injected with Dx/HA, 5633 (77%) were successfully treated according to the authors' definition. Injection success seemed to vary primarily on the basis of the preoperative reflux grade. After adjustment for VUR grade, other factors, such as the presence or absence of COI disclosure, were not significant. Studies were markedly heterogeneous overall.

CONCLUSIONS:

The overall per-ureter Dx/HA success rate was 77% after 3 months, although success rates varied widely among studies. Increased VUR grade negatively affected success rates, whereas COI, patient age, and injected Dx/HA volume were not significantly associated with treatment outcome after adjustment for VUR grade. There is a significant need for improved reporting of VUR treatments, including comparative studies of Dx/HA and other VUR treatments.
Safety of Influenza Vaccine Administration in Egg-Allergic Patients
Authors: Chung Erica Y. , Huang Lin , Schneider Lynda
Published: April 2010

OBJECTIVE:

Current guidelines recommend that egg-allergic patients receive an influenza vaccine skin test before the influenza vaccine. This study evaluated the safety of bypassing the skin test and administering graded doses of influenza vaccine to egg-allergic children.

METHODS:

We conducted a retrospective chart-review study of egg-allergic patients aged 6 months to 18 years who received the vaccine skin test and/or a 2-dose graded influenza vaccine. Between influenza seasons 2002–2003 and 2006–2007, egg-allergic patients underwent a vaccine skin test before influenza vaccine administration. Starting in 2006–2007, the skin test was removed from our protocol and egg-allergic patients received the influenza vaccine in 2 graded doses. All vaccinated patients were observed for adverse reactions.

RESULTS:

Two hundred sixty-one egg-allergic patients were evaluated for influenza vaccine administration, and 171 went on to receive the vaccine. Of the 56 patients who received the skin test before the influenza vaccine, 95% (exact 95% confidence interval [CI]: 85.1–98.9) tolerated the vaccine without a serious adverse reaction. This rate was unchanged after the vaccine skin test was removed from the protocol. Of the 115 patients who received the vaccine without a preceding skin test, 97% (exact 95% CI: 91.3–99.0) tolerated the vaccine without serious adverse reaction. The tolerance rate ratio was 1.01 (95% CI: 0.97–1.06).

CONCLUSION:

The results of our study suggest that egg-allergic patients without anaphylaxis to egg may safely receive the influenza vaccine in a 2-dose, graded fashion without a vaccine skin test.
Accuracy of Computer-Generated, Spanish-Language Medicine Labels
Authors: Sharif Iman , Tse Julia
Published: April 2010

OBJECTIVE:

We evaluated the accuracy of translated, Spanish-language medicine labels among pharmacies in a borough with a large Spanish-speaking population.

METHODS:

A cross-sectional, telephone survey of all pharmacies in the Bronx, New York, was performed. Selected pharmacies were visited to learn about the computer software being used to generate Spanish medicine labels. Outcomes included the proportion of pharmacies providing Spanish medicine labels, frequency of computerized translation, and description of Spanish medicine labels produced.

RESULTS:

Of 316 pharmacies, 286 (91%) participated. Overall, 209 (73%) provided medicine labels in Spanish. Independent pharmacies were significantly more likely to provide Spanish labels than were hospital or chain pharmacies (88% vs 57% vs 32%; P < .0001). Pharmacies that provided Spanish labels mostly commonly (86%) used computer programs to do so; 11% used lay staff members, and 3% used a professional interpreter. We identified 14 different computer programs used to generate Spanish labels, with 70% of pharmacies using 1 of 3 major programs. We evaluated 76 medicine labels generated by 13 different computer programs. Overall, 32 Spanish labels (43%) included incomplete translations (a mixture of English and Spanish), and 6 additional labels contained misspellings or grammar errors, which resulted in an overall error rate of 50%.

CONCLUSIONS:

Although pharmacies were likely to provide medicine labels translated into Spanish, the quality of the translations was inconsistent and potentially hazardous. Unless regulations and funding support the technological advances needed to ensure the safety of such labeling, we risk perpetuating health disparities for populations with limited English proficiency.
Blood Lead Levels and Delayed Onset of Puberty in a Longitudinal Study of Russian Boys
Authors: Williams Paige L. , Sergeyev Oleg , Lee Mary M. , Korrick Susan A. , Burns Jane S. , Humblet Olivier , DelPrato Julie , Revich Boris , Hauser Russ
Published: April 2010

OBJECTIVE:

We evaluated the association of blood lead levels (BLLs) with pubertal onset in a longitudinal cohort of Russian boys.

METHODS:

A total of 489 Russian boys were enrolled in 2003–2005, at 8 to 9 years of age, and were monitored annually through May 2008. Cox proportional-hazards models were used to evaluate the association of BLLs at enrollment with time to pubertal onset during follow-up monitoring.

RESULTS:

A total of 481 boys had BLLs, with a median of 3 μg/dL and 28% with values of ≥5 μg/dL. The proportion of pubertal boys increased with age, from 12% at age 8 to 83% at age 12 for testicular volume of >3 mL, from 22% to 90% for genitalia stage 2 or higher, and from 4% to 40% for pubic hair stage 2 or higher. After adjustment for potential confounders including BMI and height, boys with high BLLs (≥5 μg/dL) had 24% to 31% reduced risk of pubertal onset, on the basis of testicular volume of >3 mL (hazard ratio [HR]: 0.73 [95% confidence interval [CI]: 0.55–0.97]; P = .03), genitalia staging (HR: 0.76 [95% CI: 0.59–0.98]; P = .04), and pubic hair staging (HR: 0.69 [95% CI: 0.44–1.07]; P = .10), compared with those with lower BLLs. Pubertal onset occurred 6 to 8 months later, on average, for boys with high BLLs, compared with those with BLLs of <5 μg/dL.

CONCLUSION:

Higher BLLs were associated with later pubertal onset in this prospective study of peripubertal Russian boys.
Symptoms or Symptom-Based Scores Cannot Predict Acute Otitis Media at Otitis-Prone Age
Authors: Laine Miia K. , Tähtinen Paula A. , Ruuskanen Olli , Huovinen Pentti , Ruohola Aino
Published: April 2010

OBJECTIVE:

Acute symptoms are used to diagnose and manage acute otitis media (AOM). We studied whether AOM could be predicted by the reason for parental suspicion of AOM or by the occurrence, duration, and/or severity of symptoms. We also compared scores including or excluding tympanic-membrane examination of children with and without AOM.

PATIENTS AND METHODS:

Children aged 6 to 35 months with parental suspicion of AOM were eligible. Before tympanic-membrane examination, we registered on a structured questionnaire the reason for parental suspicion of AOM, symptoms, and score components.

RESULTS:

Of 469 children studied, 237 had AOM and 232 had respiratory tract infection without AOM. The most common reason for parental suspicion of AOM, restless sleep, was not predictive for AOM (RR: 1.0 [95% CI: 0.8–1.2]), nor was ear-rubbing (relative risk [RR]: 0.7 [95% confidence interval (CI): 0.5–1.0]). Neither the occurrence of fever (RR: 1.2 [95% CI: 1.0–1.4]) nor the highest mean temperature within 24 hours predicted AOM, nor did the occurrences of ear-related, nonspecific, respiratory, or gastrointestinal symptoms. The duration and severity of symptoms were not predictive for AOM, although rhinitis lasted longer and conjunctivitis was more severe in children with AOM. The clinical/otologic score (median: 4.0 vs 2.0; P = .000) and the AOM total-severity index (11.0 vs 6.0; P = .000), both including symptoms and tympanic-membrane examination, were higher in those with AOM. The AOM severity-of-symptom scale, based solely on symptoms, was equal in children with and without AOM (6.0 vs 6.0; P = .917).

CONCLUSIONS:

AOM cannot be predicted by the occurrence, duration, or severity of symptoms at otitis-prone age. Likewise, solely symptom-based scores do not differentiate between respiratory tract infections with or without AOM. Thus, tympanic-membrane examination is crucial in the diagnosis and severity classification of AOM in clinical practice and research settings.
Evaluation of the PHQ-2 as a Brief Screen for Detecting Major Depression Among Adolescents
Authors: Richardson Laura P. , Rockhill Carol , Russo Joan E. , Grossman David C. , Richards Julie , McCarty Carolyn , McCauley Elizabeth , Katon Wayne
Published: April 2010

OBJECTIVE:

To examine the validity of the Patient Health Questionnaire 2 (PHQ-2), a 2-item depression-screening scale, among adolescents.

METHODS:

After completing a brief depression screen, 499 youth (aged 13–17 years) who were enrolled in an integrated health care system were invited to participate in a full assessment, including a longer depression-screening scale (Patient Health Questionnaire 9-item depression screen) and a structured mental health interview (Diagnostic Interview Schedule for Children). Eighty-nine percent (n = 444) completed the assessment. Criterion validity and construct validity were tested by examining associations between the PHQ-2 and other measures of depression and functional impairment.

RESULTS:

A PHQ-2 score of ≥3 had a sensitivity of 74% and specificity of 75% for detecting youth who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for major depression on the Diagnostic Interview Schedule for Children and a sensitivity of 96% and specificity of 82% for detecting youth who met criteria for probable major depression on the Patient Health Questionnaire 9-item depression screen. On receiver operating characteristic analysis, the PHQ-2 had an area under the curve of 0.84 (95% confidence interval: 0.75–0.92), and a cut point of 3 was optimal for maximizing sensitivity without loss of specificity for detecting major depression. Youth with a PHQ-2 score of ≥3 had significantly higher functional-impairment scores and significantly higher scores for parent-reported internalizing problems than youth with scores of <3.

CONCLUSIONS:

The PHQ-2 has good sensitivity and specificity for detecting major depression. These properties, coupled with the brief nature of the instrument, make this tool promising as a first step for screening for adolescent depression in primary care.
The Pediatric Obesity Epidemic Continues Unabated in Bogalusa, Louisiana
Authors: Broyles Stephanie , Katzmarzyk Peter T. , Srinivasan Sathanur R. , Chen Wei , Bouchard Claude , Freedman David S. , Berenson Gerald S.
Published: April 2010

OBJECTIVES:

To examine 35-year trends in the prevalence of overweight and obesity among children and adolescents from Bogalusa, Louisiana.

PATIENTS AND METHODS:

Height and weight were measured for 11653 children and adolescents between 5 and 17 years of age in 8 cross-sectional surveys. The Bogalusa Heart Study contributed data from 1973–1994, and routine school screening provided 2008–2009 data. Trends in mean BMI, mean gender-specific BMI-for-age z scores, prevalence of overweight/obesity (BMI ≥ 85th percentile), and prevalence of obesity (BMI ≥ 95th percentile) according to age, race, and gender were examined.

RESULTS:

Since 1973–1974, the proportion of children and adolescents aged 5 to 17 years who are overweight (overweight plus obese) has more than tripled, from 14.2% to 48.4% in 2008–2009. Similarly, the proportion of obese children and adolescents has increased more than fivefold from 5.6% in 1973–1974 to 30.8% in 2008–2009. The prevalence of overweight or obesity, and secular changes, were similar among black and white boys and girls.

CONCLUSIONS:

In semirural Bogalusa, the childhood obesity epidemic has not plateaued, and nearly half of the children are now overweight or obese.
Impact of Very Preterm Birth on Health Care Costs at Five Years of Age
Authors: Korvenranta Emmi , Lehtonen Liisa , Rautava Liisi , Häkkinen Unto , Andersson Sture , Gissler Mika , Hallman Mikko , Leipälä Jaana , Peltola Mikko , Tammela Outi , Linna Miika ,   for the PERFECT Preterm Infant Study Group
Published: April 2010

OBJECTIVE:

We assessed the effects of very preterm birth (gestational age <32 weeks or birth weight <1501 g) and prematurity-related morbidities on health care costs during the fifth year of life.

METHODS:

The study population consisted of 588 very preterm children and 176 term control subjects born in 2001–2002. Costs of hospitalizations, visits to health care professionals and therapists, and the use of other social welfare services were assessed during the fifth year of life. Hospital visits were derived from register data and other health care contacts, and the use of social welfare services were derived from parental reports. The effects of 6 prematurity-related morbidities (cerebral palsy [CP], seizure disorder, obstructive airway disease, hearing loss, visual disturbances or blindness, and other ophthalmologic problems) on the costs of health care were studied.

RESULTS:

The average health care costs during the fifth year of life were 749€ in the term control subjects, 1023€ in the very preterm children without morbidities, and 3265€ in those with morbidities. The costs of social welfare services and therapies exceeded the hospitalization costs in all groups. Among children who were born preterm, CP was associated with 5125€ higher costs, whereas later obstructive airway diseases increased the costs by 819€ compared with individuals without these morbidities.

CONCLUSIONS:

The health care costs during the fifth year of life in very preterm children with morbidities were 4.4-fold and in those without morbidities 1.4-fold compared with those of term control subjects. This emphasizes the importance of prevention of morbidities, especially CP, to reduce the long-term costs of prematurity.
Marriage and Cohabitation Outcomes After Pregnancy Loss
Authors: Gold Katherine J. , Sen Ananda , Hayward Rodney A.
Published: April 2010

OBJECTIVE:

The goal was to evaluate marriage and cohabitation outcomes for couples who experienced a live birth or fetal death at any gestational age.

METHODS:

For married and cohabitating women who experienced live births, miscarriages, or stillbirths, we conducted a survival analysis (median follow-up period: 7.8 years), by using data from the National Survey of Family Growth, to examine the association between birth outcomes and subsequent relationship survival. The Cox proportional-hazards models controlled for multiple independent risk factors known to affect relationship outcomes. The main outcome measure was the proportion of intact marriages or cohabitations over time.

RESULTS:

Of 7770 eligible pregnancies, 82% ended in live births, 16% in miscarriages, and 2% in stillbirths. With controlling for known risk factors, women who experienced miscarriages (hazard ratio: 1.22 [95% confidence interval: 1.08–1.38]; P = .001) or stillbirths (hazard ratio: 1.40 [95% confidence interval: 1.10–1.79]; P = .007) had a significantly greater hazard of their relationship ending, compared with women whose pregnancies ended in live births.

CONCLUSIONS:

This is the first national study to establish that parental relationships have a higher risk of dissolving after miscarriage or stillbirth, compared with live birth. Given the frequency of pregnancy loss, these findings might have significant societal implications if causally related.
An automated approach to the Electric Network Frequency (ENF) criterion - Theory and practice
Authors: Cooper Alan J.
Published: April 2010

A relatively recent forensic technique developed to help establish the authenticity of audio and video recordings is the Electric Network Frequency (ENF) criterion. This paper confirms the applicability of the ENF criterion for use in mainland UK and describes an automated approach to matching ENF estimates taken from a questioned recording to a database of ENF values. It will be shown that the automated approach has the added advantage of producing statistical data capable of indicating the strength of the match. Consideration has been given to the robust extraction of ENF signals from evidential recordings and the resulting system and signal processing procedures outlined have been used successfully by the Metropolitan Police Forensic Audio Laboratory in London to extract and match ENF data from evidential recordings
to an ENF database.
Is It Ever Okay Not to Disclose Work for Hire?
Authors: Nunberg Geoffrey
Published: April 2010

In the paradigm instance, the disclosure question is straightforward. The linguist prepares an expert report on some forensic linguistic issue – e.g., the degree of similarity between two names or the meaning of a word or expression – for someone who has some legal or material interest in the question. Some time later, the linguist repeats that opinion in a publication or other public forum. Is the linguist obliged to report the circumstances of her original engagement? For the vast majority of people, the answer is probably to say yes. Even if disclosure isn’t required by rules specific to the publication or conference itself, it’s consistent with canons of scholarly and journalistic ethics that have become particularly salient in recent times. Moreover, as a purely practical matter, failure to disclose a prior consultancy relationship, is apt to appear shifty or arrogant (i.e., in presuming that your professional reputation exempts you from any charge of improbity) as well as unprofessional. Moreover, the disclosure obligation gets more complicated as we move away from the paradigmatic case along any of many dimensions. For example, what if the work was performed pro bono rather than for pay? What if the original involvement was limited merely to giving oral advice to counsel? What if the point at issue in the case is one on which you had opined in earlier work? All of these issues as may have bearing on the efforts of professional organizations to formulate a disclosure policy.
The Forensic Linguist’s Professional Credentials
Authors: Butters Ronald R.
Published: April 2010

Under current court practice, it is not difficult for anyone with a PhD in English or linguistics to be allowed to testify as a ‘linguistics expert’ in many types of cases. Linguists and professors of English may, however, find themselves in ethically questionable and professionally embarrassing situations if they attempt to assert expertise in subfields at the margins of their linguistic specialization. This paper briefly describes some such situations and suggests ways in which linguists, through such organizations as the International Association of Forensic Linguists (IAFL), the American Association for Applied Linguistics (AAAL), the International Association for Forensic Phonetics and Acoustics (IAFPA), and the Linguistic Society of America (LSA), can improve the qualifications of linguistics legal consultants without getting into the business of actually licensing experts or attempting to maintain registries of approved forensic experts. A Code of Practice could recommend such attributes of the qualified forensic linguist as specialized publication in forensic linguistics, teaching courses in forensic domains, and active membership in specialized forensic linguistic organizations and professional organizations dedicated to subfields that are most relevant to one’s area of forensic testimony (for example, for trademark expertise, organizations devoted to the study of lexicography). The pros and cons of incorporating credentialing criteria into any ‘Guidelines for Consultants’ are also presented.
Guiding Principles: Forensic Linguistics and Codes of Ethics in Other Fields and Professions
Authors: Stygall Gail
Published: April 2010

This paper analyzes Codes of Ethics of other disciplines and professions with a specialfocus on forensic issues. I also analyze a variety of university outside-consultingrequirements and their implied codes of ethics. I begin with a review of codes for traditional disciplines, such as the American Psychological Association, the American Anthropological Association, and the American Historical Association. Next, I examine special forensic codes either added on to a more general code or a separate statement only devoted to forensic issues, as the forms developed by the American College of Surgeons. There are also codes for organizations that are forensic in orientation, such as the Society of Forensic Engineers and Scientists. Linguistics organizations that have attempted codes are few. I close with an assessment of which type of codes might best fit a proposal for the Linguistic Society of America to create a code.
Expert linguists and the whole truth
Authors: Finegan Edward
Published: April 2010

The adversarial nature of legal proceedings presents challenges for a linguist whose scholarly research and expert opinion typically have asymmetrical resources and constraints. This presentation focuses on a linguist’s ethical obligations as a forensic consultant, in initial contacts with attorneys, in drafting an expert report or declaration, and in deposition testimony and trial testimony. It asks in particular whether “the whole truth” remains a consistent ethical requirement across all legal and forensic linguistic contexts. It also examines possible ethical vulnerabilities of an expert operating with a set of facts initially framed by an advocate representing only one side of a dispute in contrast to the facts and framing possible to an independent scholarly investigator. The advantages for litigants, linguists, and triers of fact of having opposing experts will also be considered.
A lawyer's perspective: Ethical, technical, and practical considerations in the use of linguistic expert witnesses
Authors: Ainsworth Janet
Published: April 2010

Linguists engaged by attorneys sometimes find their experiences as consultants and witnesses confusing and frustrating. To some extent, this may be an inevitable consequence of the adversarial justice system, but it also can reflect linguists’ misunderstanding of the obligations imposed by the ethical rules governing the practice of law. These rules can engender a skeptical assessment of the linguist’s expertise and analysis by the lawyers in the case—the hiring lawyer no less than opposing counsel. Discovery rules can create traps for the unwary expert that can undermine the expert’s credibility in this case and in cases in the future. While the hiring lawyer can properly explore the limits of what the expert can provide as helpful testimony, the linguist must resist the seductive lure of becoming a “hired gun.”
Designing, Implementing, and Evaluating an Online Resource for Professional Legal Communication Skills
Authors: Hafner Christoph A
Published: April 2010

The ability to use language effectively is an essential part of legal training and has been identified as an area of concern for Hong Kong law students (Redmond and Roper 2001). In order to become proficient members of the legal discourse community, law students must develop an understanding of conventional writing forms, processes and practices as well as patterns of legal reasoning and problem-solving. Although lawyers in the main agree that competence in legal English is crucial to professional competency, legal professionals also take the view that efforts to enhance such competence should be remedial in nature rather than targeted at the specific communication needs of lawyers (Hong Kong Bar Association 2001). In addition, many practitioners of legal education and training see language skills development as falling outside their area of expertise and responsibility. As a consequence, time and resources allocated to the important task of enhancing English for legal purposes are minimal.
In view of these constraints, creating computer-mediated online resources for the development of English language skills becomes a particularly attractive option. Students are able to access material in their own time, work at their own pace, learn ‘just-in-time’ for the real-world tasks that they are working on, and it is the students who are in charge of the learning process. This thesis reports on a collaborative project, involving a small team of legal academics and language professionals, to develop such online resources

Awarding Institution: Macquarie University
Date of award: April 2009
Violence against women: prevalence and associated factors in patients attending a public healthcare service in the Northeast of Brazil
Authors: Silva Maria Arleide da , Falbo Neto Gilliatt Hanois , Figueiroa José Natal , Cabral Filho José Eulálio
Published: April 2010

The prevalence of and factors associated with violence against women attended as outpatients between October 2005 and January 2006 by the Instituto Materno Infantil Professor Fernando Figueira (IMIP), Recife, Pernambuco State, Brazil, were investigated using a cross-sectional type study. 619 women over the age of 18 were included in a systematic probabilistic sample. The modified Abuse Assessment Screen (AAS) was applied and the data were evaluated statistically by way of univariate and bivariate analyses, using the χ2 or Fischer's exact test and an adjusted multivariate logistic regression model. The prevalence of violence against women was 27.5% (95%CI: 24.0%-31.2%) in the twelve-month period prior to the consultation. The associated factors were low level of schooling (OR = 2.34), a history of domestic violence (OR = 2.21) the woman being mentally disturbed (OR = 2.35), and the partner's consumption of alcohol (OR = 1.77). The prevalence of violence was high in the group of women studied, indicating the need to broaden preventive measures and all-round health care for women.
American visceral leishmaniasis dissociated from Lutzomyia longipalpis (Diptera, Psychodidae) in the State of Espírito Santo, Brazil
Authors: Pinto Israel de Souza , Santos Claudiney Biral dos , Grimaldi Jr. Gabriel , Ferreira Adelson Luiz , Falqueto Aloísio
Published: April 2010

The occurrence of American visceral leishmaniasis in the State of Espírito Santo, Brazil has always been associated with the presence of the Lutzomyia longipalpis vector. The geographic distribution of this vector in this state is related to the presence of specific geoclimatic characteristics, such as a dry climate, low elevations (< 450m), steep slopes and rocky outcrops. The occurrence of human autochthonous cases of American visceral leishmaniasis in municipalities without these geoclimatic characteristics justifies the present study and our main goal was to test the association between the occurrence of American visceral leishmaniasis and the presence of the Lu. longipalpis. Sand flies were captured monthly from July 2006 to August 2007 using Shannon and CDC traps in two municipalities with records of autochthonous American visceral leishmaniasis and one with no record. We captured 13,112 sand flies, but no Lu. longipalpis was found. The absence of Lu. longipalpis and the possible role of another American visceral leishmaniasis vector in these localities were discussed.
Estrutura e qualidade assistencial dos prestadores de serviços hospitalares à saúde suplementar no Brasil
Authors: Portela Margareth Crisóstomo , Lima Sheyla Maria Lemos , Ugá Maria Alícia Dominguez , Gerschman Silvia , Vasconcellos Maurício Teixeira Leite de
Published: April 2010

Este trabalho objetivou caracterizar os prestadores de serviços hospitalares no setor de saúde suplementar, uma vez que o conhecimento sobre tais prestadores ainda é incipiente, particularmente em relação à estrutura e à qualidade assistencial. Foi realizado um inquérito nacional, tendo como universo de interesse 3.817 hospitais. Uma amostra estratificada de 83 hospitais foi selecionada. A coleta de dados ocorreu entre setembro e dezembro de 2006, por meio de entrevistas com os dirigentes dos hospitais. Para a caracterização assistencial dos hospitais, foram contempladas variáveis relativas à capacidade instalada e produção de serviços, bem como às práticas e estruturas de garantia e monitoramento da qualidade do cuidado. A amostra final pesquisada resultou em 74 hospitais, correspondendo a um universo estimado de 3.799 unidades. Os hospitais prestadores de serviços para operadoras, majoritariamente provedores de serviços ao Sistema Único de Saúde (SUS), apresentaram baixa presença de estruturas e práticas de qualificação da gestão e de monitoramento da qualidade assistencial.
Prevalência de barreiras para a prática de atividade física em adolescentes
Authors: Santos Mariana Silva , Hino Adriano Akira Ferreira , Reis Rodrigo Siqueira , Rodriguez-Añez Ciro Romélio
Published: April 2010

O objetivo deste estudo foi analisar a prevalência de barreiras e sua associação com a prática de atividades físicas em adolescentes. O presente estudo, transversal, avaliou uma amostra representativa de escolares do ensino médio da rede pública da cidade de Curitiba-PR, Brasil. Um total de 1.609 escolares (59,7% do gênero feminino) entre 14 e 18 anos de idade reportou, por meio de um questionário, o nível de atividade física e as barreiras para a prática de atividades físicas. Para verificar a associação entre a prevalência de barreiras e a atividade física foi realizada uma análise de regressão logística para cada barreira investigada ajustando para variáveis de confusão (idade e nível socioeconômico). As análises foram realizadas separadamente para meninos e meninas. Apenas 22% dos meninos e 9% das meninas atingiram a atual recomendação para atividade física. Entre as 12 barreiras investigadas, apenas "não ter alguém para levar" não diferiu entre os gêneros. Para todas as outras, a percepção de barreiras foi maior entre as meninas (p < 0,05). "Não ter a companhia dos amigos" e "ter preguiça" foram as barreiras mais reportadas pelos meninos (30,4%) e meninas (51,8%), respectivamente; no entanto a barreira mais fortemente associada com maior prevalência de níveis insuficientes de atividade física foi "preferir fazer outras coisas" para meninos (OR = 5.02 (2,69 - 9,37); p < 0,05) e meninas (OR = 7.10 (3,71 - 13,60); p < 0,05). As barreiras percebidas para a prática de atividades físicas foram mais prevalentes entre as meninas e diferiram em grau de importância entre os gêneros.
Periodontitis in individuals with diabetes treated in the public health system of Belo Horizonte, Brazil
Authors: Silva Aline Mendes , Vargas Andréa Maria Duarte , Ferreira Efigênia Ferreira e , Abreu Mauro Henrique Nogueira Guimarães de
Published: April 2010

OBJECTIVE: The aim of the present study was to investigate the prevalence of periodontitis among individuals with diabetes who use the public health system in the city of Belo Horizonte-Minas Gerais, Brazil, and the association of this condition with socioeconomic, behavioral and clinical variables. METHODS: A cross-sectional study was carried out on a calculated sample of 300 individuals with diabetes. Periodontitis was defined as clinical attachment loss (CAL) > 3 mm in two or more non-adjacent teeth or those that exhibited CAL > 5 mm in 30.0% of teeth. All subjects were over 30 years of age and underwent a periodontal examination. Socioeconomic and behavioral characteristics as well as medical history and dental history were obtained from a structured interview. Multivariate analysis was conducted using Poisson regression. RESULTS: Among the individuals with diabetes, 6.7% exhibited good periodontal health, 68.0% exhibited gingivitis and 25.3% exhibited periodontitis. The following variables were associated with periodontitis after adjustment: male (PR 1.67 95% CI 1.12, 2.49), individuals with diabetes for more than eight years (PR 1.63 95% CI 1.63, 2.38), smokers (PR 1.71 95% CI 1.10, 2.65); individuals with more than 12 missing teeth (PR 2.67 95% CI 1.73, 4.15) CONCLUSIONS: Multiple determinants are associated with the prevalence of periodontitis among patients with diabetes.
Indicadores de atenção básica em saúde bucal: associação com as condições socioeconômicas, provisão de serviços, fluoretação de águas e a estratégia de saúde da família no Sul do Brasil
Authors: Fischer Tatiana Konrad , Peres Karen Glazer , Kupek Emil , Peres Marco Aurélio
Published: April 2010

Foram analisados os indicadores de saúde bucal do pacto de atenção básica do SUS (cobertura, razão de exodontias em relação aos procedimentos individuais e cobertura de procedimentos coletivos na população de até 14 anos de idade) em municípios do Sul do Brasil (n = 1159) entre 2000 e 2005. Além disso, foram testadas as associações dos indicadores com variáveis socioeconômicas, de provisão de serviços odontológicos, fluoretação de águas e cobertura da saúde bucal na estratégia de saúde da família. Associaram-se positivamente com o aumento da cobertura, o Estado (RS com a menor), população rural, IDH, número de dentistas pela população e cobertura da saúde bucal no PSF. Para razão de exodontias foram associados o Estado (SC e RS maiores), negativamente com população rural, IDH, número de dentistas pela população e cobertura da saúde bucal no PSF e positivamente o índice de Gini. Procedimentos coletivos foram associados negativamente ao índice de Gini, intensidade de indigência e razão do número de dentistas pela população e positivamente com o Estado (menor no RS), população rural, IDH e cobertura da saúde bucal no PSF.
Who's in Charge of Children's Environmental Health at School?
Authors: Paulson Jerome , Barnett Claire
Published: April 2010

Children spend many hours each week in and around school buildings. Their short- and long-term health outcomes and ability to learn are affected by numerous environmental factors related to the school buildings, the school grounds, the school transportation system, and the use of various products and materials in and around the school. Many school buildings are old, and they—and even newer buildings—can contain multiple environmental health hazards. While some districts self-report they have environmental health policies in place, no independent verification of these policies or their quality exists. Teachers and other staff, but not children who are more vulnerable to hazards than adults, are afforded some protections from hazards by Occupational Safety and Health Administration (OSHA) regulations, by their employment contracts, or through adult occupational health services. Major environmental problems include: indoor air quality, lighting, pests and pesticides, heavy metals and chemical management issues, renovation of occupied buildings, noise, and cleaning processes and products. No agency at the federal or state levels is charged with ensuring children's health and safety in and around school buildings. No systematic means exists for collecting data about exposures which occur in the school setting. Recommendations are made for dealing with issues of data collection, federal actions, state and local actions, and for building the capacity of the Environmental Protection Agency and the Centers for Disease Control and Prevention-designated and funded Pediatric Environmental Health Specialty Units (PEHSU) in responding to and evaluating risks to children's environmental health in schools.