bluuebunny/crossref_metadata_2025 huggingface dataset:
Host‐plant acceptance on mineral soil and humus by the pine weevil Hylobius abietis (L.)
Authors: Björklund Niklas , Nordlander Göran , Bylund Helena
Published: March 2003

1 The pine weevil Hylobius abietis (L.) (Coleoptera, Curculionidae) is an economically important pest of conifer forest regeneration in Europe and Asia.

2 Soil scarification, which usually exposes mineral soil, is widely used to protect seedlings from weevil attack. However, the mechanism behind this protective effect is not yet fully understood.

3 Field experiments were conducted to determine the pine weevil's responses to visual and odour stimuli from seedlings when moving on mineral soil and on undisturbed humus surface.

4 One experiment measured the number of pine weevils approaching seedlings, with and without added host odour, on mineral soil and undisturbed humus. Seedlings with added host odour attracted more weevils on both soil types. Unexpectedly, somewhat more weevils approached seedlings surrounded by mineral soil.

5 In a similar experiment, feeding attacks on seedlings planted directly in the soil were recorded. Only half as many seedlings were attacked on mineral soil as on undisturbed humus.

6 In the first experiment, the weevils were trapped 2.5 cm from the bases of the seedlings' stems, whereas they could reach the seedlings in the experiment where seedlings were planted directly in the soil. We conclude that the pine weevils' decision on whether or not to feed on a seedling is strongly influenced by the surrounding soil type and that this decision is taken in the close vicinity of the seedling. The presence of pure mineral soil around the seedling strongly reduces the likelihood that an approaching pine weevil will feed on it.
Infant physiology and neuronal development on diffusion‐weighted magnetic resonance imaging
Authors: Finan A. , Yarnold R. , Wailoo M. , Petersen S. , Horsfield M. , Rickett A. , Morgan B.
Published: March 2003

Fifty infants (10 normal; 20 IUGR; 20 ‘at risk’) are studied longitudinally. Postnatal physiological development is assessed by measuring age‐related deep body temperature patterns with sleep. Neuronal development is estimated by measuring cerebral myelination by diffusion‐weighted magnetic resonance imaging (MRI).

Correlation between myelination and physiological development are measured for each group, variations between individuals are identified and factors that might relate to variations are assessed for impact.
Selective brain cooling in animals: internal carotid’s significance for sudden infant death syndrome
Authors: Du Boulay G. , Lawton M. , Wallis A.
Published: March 2003

Objective How risk factors for sudden infant death syndrome (SIDS) interrelate is not clear. Perhaps normal brain‐cooling mechanisms are frustrated. Some mammals have selective brain cooling. Scrutiny of the relationship between body core and brain temperatures in mammals with cerebral vascular systems like man was planned.

Design/sample Pilot studies were undertaken in five rabbits (Orytolagus cuniculus) and three monkeys (Macaca mulatta). The first showed that the parietal lobe of the brain was cooled relative to rectal temperature while the body was being heated which suggested that brain cooling might be mediated by cooled carotid arterial blood.

Measurements In the monkeys (10.5–11.4 kg) direct temperature measurements (calibration against the internal carotid thermocouple to an accuracy of 0.2 °C for the right cerebral hemisphere and 0.15 °C for the left: r = 0.99, P < 0.001) were monitored in the internal carotid, the brain and the rectum, as well as room air. Monkeys were anaesthetized, not intubated and breathing spontaneously, heavily wrapped and laid on a heated pig farrowing pad. In one monkey the subsequent period of cooling was interrupted by causing the monkey to breathe warm air from a hair dryer.

Results Internal carotid blood was found to be 1.5–2.0 °C cooler than body core, presumably because of its proximity to the respiratory airway. Brain temperature remained substantially hotter than carotid blood. Both rose as the body temperature increased to 39.5–40.8 °C, at which point brain temperature rise began to outstrip the rises in the body and carotid blood, presumably due to brain metabolism.

When body heating was withdrawn, all temperatures fell, but on breathing warmed air, although rectal temperature continued to fall, carotid and brain temperature again rose.

Conclusions and implications Carotid blood limits the rise of cerebral temperature caused by brain metabolism. The conditions under which this mechanism may fail include body core pyrexia and a rise in inspired air temperature. The phenomenon may explain the operation of risk factors for SIDS. Further implications suggest a related cooling mechanism for the brainstem and lead to questions about cooling of the uterus during pregnancy.1,2
Improving compliance with tuberculin skin test interpretation in children
Authors: Boom Julie A , Hughes Connie , Brown Teneille , Rutstein Richard M
Published: March 2003

Objective  To evaluate the effect of a quality improvement initiative which utilized educational interventions combined with a phone follow‐up program on the rate of return for tuberculin skin test (TST) interpretation.

Design Before and after trial with analysis of practice records for all TSTs placed.

Setting/Sample
 The study was conducted in a resident and attending primary care practice in an urban children's hospital. All children (n = 1315) who had TSTs placed during August and October of 1995 and August and October of 1996 were included in the study.

Intervention  Medical staff were re‐educated regarding TST screening. Patients families were given written information about tuberculosis. Physicians and nursing staff discussed TST screening with the patients' families prior to TST placement. All patients received a series of three reminder telephone calls on three consecutive days to remind them to return for TST interpretation followed by a letter if necessary. The following data were collected: date of birth, age, zip code, type of provider, transit time from the hospital, type of health insurance, number of telephone calls made, and return status for TST interpretation. Return rates were compared pre‐ and post‐intervention.

Results  A total of 1315 TSTs were placed during the pre‐ (n = 611) and post‐(n = 704) intervention periods. Return rates increased from 6.2 to 61.5%. Attendings' patients and those with private insurance were more likely to return. There was no relationship to season, age or distance from the practice.

Conclusions  Targeted screening programs utilizing more effective methods for TST interpretation should be considered.
Population screening for anaemia in the inner city
Authors: Moy Robert , Aukett Anne
Published: March 2003

Objective An evaluation of the effectiveness and acceptability of a screening programme for anaemia linked to routine child health surveillance.

Design A community‐based study of the screening process with re‐evaluation after treatment and again 9 months later, supported by a questionnaire study of the opinions of GPs, health visitors and parents.

Setting Child Health clinics and GP surgeries in an area of Birmingham with high levels of deprivation and ethnic minority groups.

Subjects All 625 children turning 21 months of age during a 2‐month period who were resident in the study area.

Main outcome measures Attendance for screening, haemoglobin result, compliance with medication, and post‐treatment haemoglobin.

Results Sixty‐three per cent of the target population attended for blood screening. 46% of 365 children tested were anaemic (Hb < 110 g/L). The thumb‐prick blood test was acceptable to children, parents and health visitors. Two months of iron therapy was effective in raising haemoglobin by a mean of 15.5 g/l, but one‐third of cases were noncompliant with oral iron. At 30 months of age, haemoglobin tended to fall in those previously not anaemic at 21 months from a mean of 122.2 to 115.5 g/l, and 33% who had been successfully treated later relapsed.

Conclusions The effectiveness of the programme from the public health perspective was reduced by nonattendance. Nevertheless, it could identify and treat anaemic children successfully. Despite shortcomings, we feel that screening is a useful adjunct to ongoing primary prevention of anaemia.
What do general practitioners and paediatricians want from discharge letters?
Authors: Turner Steve , Birrell Ginny
Published: March 2003

Objectives To ascertain the relative importance ascribed by general practitioners and hospital paediatricians to items of information given in paediatric final discharge letters, and determine general practitioner preference for the format of such letters.

Design A questionnaire was sent to 158 local general practitioners and 24 hospital‐based paediatricians.

Setting A district general hospital serving both a large industrialized urban area and a rural catchment area in Northern England.

Results One hundred and twenty‐eight (81.0%) general practitioners and 23 (95.8%) hospital paediatricians responded. There was consensus on which items of information were essential. These included correct diagnosis; correct drug dosage, frequency and duration; dates of admission; investigations performed; admission ward; case history, and admitting/responsible consultant. There were differences as to the essential nature of which doctor wrote the letter; why the child was admitted; parental information given.

Conclusions Many features of paediatric inpatient discharge letters are regarded with the same priority by general practitioners and hospital paediatricians. However, there are some important differences in preferences between these groups of doctors.
Vantage point
Authors: Kaufman Neal , Reich Jessica
Published: March 2003

As part of its Managed Care & Early Childhood Development Initiative, the nonprofit organization Children Now is holding conference calls for health professionals about delivering early childhood development services in managed care settings. The call topics reflect the strategies from Children Now's report Right Time, Right Place: Managed Care & Early Childhood Development, which include expanding the pediatric team with family advocates and child development specialists, using group well‐child visits, linking pediatric care to community resources and other interventions. The topic for the fifth call was home visiting. This paper is an edited transcript of the call. The call began with presentations by panelists and then addressed questions and comments from the audience. Key issues discussed include the outcomes of evaluations of home visiting programs, the background, training and supervision of home visitors and setting appropriate goals for home visiting programs.
Is a universal school entry hearing screen worthwhile?
Authors: Henderson Ruth E , Newton Nancy
Published: March 2003

Objectives To assess the effectiveness of a universal school entry hearing screen (sweep audiogram).

Methods Information was obtained from the audiology service and Community Child Health records, if available, for children who had an abnormality detected by the screen. Questionnaires were sent to general practitioners to enquire about the subsequent management.

Results Of the 4501 children screened, an abnormality was detected in 227 children. The yield for new, clinically significant bilateral sensorineural hearing losses requiring aiding was nil, whereas that for new [i.e. previously unknown to the Ear, Nose and Throat (ENT) department], significant cases of conductive hearing loss requiring surgical management was 0.5%. The response rate from the questionnaire was 81.3%. Eighty children were referred to ENT with a range of hearing loss of 11–50 decibels (dBHL) better ear average. This resulted in surgical management in 52.

Conclusion We found a small yield from the school entry screen, and, with a robust preschool service in place and effective reactive system for testing school age children, there may be justification for dismantling the school entry screen.
A personal child health record for children with a disability
Authors: Moore John , Brindle Annette , Goraya Paramjit , Monk Sarah , Rennie Deanne , Tamhne Rashmin , Watterson Jennifer , Stretch David
Published: March 2003

Objectives To test whether a child health record designed for preschool children with a disability would: (a) be used; (b) be valued by carers; (c) change the perception of the health care received by the child; or (d) influence the amount of communication between the family and a professional who is seeing their child.

Methods Ninety‐nine families participated, and of these, 67 received the record as the intervention and 32 were controls. After use, copies of the record were examined, and carers completed a satisfaction questionnaire. The families were randomized into three groups for two‐phase controlled questionnaire studies to measure changes in the families' perception of their child's health care and the degree of communication between the family and the professional.

Results Satisfaction questionnaires were returned by 53 (79%) of those who received a record, and most of the responses were favourable. Of the 39 (58%) who returned copies, nearly all had made some use of the record, and 24 had made entries in its diary section. There was no accompanying change that could be measured in the perception of the child's health care or in the amount of communication between families and professionals.

Conclusions Those who participated in this small study appreciated the new disability section added to the standard child health record. Copies returned for inspection had nearly all been used. The lack of a detectable change in the family's perception of their child's health care or in communication between families and professionals suggests that the value of the record is limited to its use as an aide‐mèmoire.
Longitudinal study of behaviour disorders in low birthweight infants.
Authors: Sidebotham Peter
Published: March 2003

A cohort study of a geographically defined population of survivors of < 1500 g birthweight born in 1980 and 1981 and age‐, sex‐, and school‐matched controls. The aim was to compare the prevalence of childhood and adolescent behavioural problems. Rutter and Conners questionnaires, completed by parents and teachers at age 8 and 14 years were assessed.

From an initial 40 321 births, there were 399 of birthweight < 1500 g, of whom 219 survived to age 8 years. Forty‐two were excluded because of clinical disability. 167 cases were compared with matched controls. At age 14, both parent and teacher questionnaires showed an increased prevalence of behavioural problems in cases compared with controls. Pervasive behavioural problems (parents’ and teachers’ responses concordant) were present in 9% of cases and 3% of controls.
Psychopharmacotherapy in children and adults with intellectual disability.
Authors: Reading Richard
Published: March 2003

The prevalence of psychiatric disorders is increased in children and adults with intellectual disability. Brain damage or dysfunction interact with social and family factors to increase susceptibility to mental illness. Psychiatric disorders in the context of genetic syndromes are commonly overlooked, and there is substantial underdiagnosis of mental disorders because of the atypical and non‐specific clinical presentations, and the frequent assumption that psychiatric symptoms are an inherent part of the underlying intellectual disability. There is a strong need for evidence‐based practice in the use of drugs in this population, especially since many are unlicensed for use in children. There is an urgent need to understand and establish the pharmacokinetics, pharmacodynamics, and side‐effect profiles of psychotropic medication in this population. Positive trends in pharmacotherapy include the use of atypical antipsychotics instead of the classic antipsychotics, serotonin‐specific reuptake inhibitors (SSRIs) rather than tricyclic antidepressants and newer antiepileptic drugs. Another welcome trend is the use of SSRIs instead of antipsychotics in the long‐term management of challenging behaviour in this population.
Effectiveness of child health surveillance in lowering age of referral and surgery for undescended testis
Authors: Studnik Stefan , Lewis Helen , John Anthony
Published: March 2003

Objective To ascertain the effectiveness of the child health Surveillance (CHS) in terms of referral age and time of surgery for undescended testis (UDT).

Design, Setting and Participants Retrospective study of 106 children aged 1–15 years from Trafford, Greater Manchester (UK) who underwent orchidopexy between 1 December 1993 and 31 December 1998. Cases identified from a NW Regional Database and from hospital information departments.

Main variables studied Age at referral and surgery, source of referral, pattern of referral to six different hospitals, time span between referral and surgery.

Main outcome measures Referral to appropriate surgeon at key ages of 12 and 24 months of age (standards 90 and 95%, respectively). Orchidopexy performed by 24 months and 60 months of age (standards 75 and 95%, respectively).

Results Overall, 20% were referred by the age of 12 months and 35% by the age of 24 months. Subsequently, 20% underwent surgery by the age of 24 months and 66% by 60 months.

Conclusions Neither of the achievement standards was fulfilled. Although referral for UDT has improved, the timing of referrals and surgery is still unacceptably delayed.

Implications for practice Active measures are recommended to improve the education and awareness of the health visitors, GPs and the parents that early referral and surgery for children with UDT is essential.
‘Epipen’ training: a survey of the provision for parents and teachers in West Lothian
Authors: Clegg Sarah K , Ritchie Joan M
Published: March 2003

Objectives To examine the training given to parents and teachers caring for children in West Lothian with an EpiPen®.

Design Questionnaires relating to training in EpiPen® use and provision for an anaphylactic emergency were sent to the children’s parents and another questionnaire to the head teachers of the school they were attending.

Subjects All 44 children of school age in West Lothian identified as having been prescribed an EpiPen® were included in the study. Eighty percent of parents and 84% of head teachers responded.

Results Of the parents who responded, 23% had received no training in the use of EpiPen®. Of those parents who had received training, only 11% had been offered a training review. Forty‐two percent of the schools surveyed had no named person responsible for the care of the child with the EpiPen®. Only 62% of schools had a member of staff who had received EpiPen® training, and only 35% of schools had a health care plan for the allergic pupil. Both parents and head teachers expressed concerns about the lack of information received.

Conclusions Parents and school staff caring for children in West Lothian with an EpiPen® do not receive adequate training in how to use the device in an emergency. The authors suggest changes to clinical practice aimed at improving the training provided and make specific recommendations relevant to West Lothian.
Children with chronic health conditions in the Nordic countries in 1996 – influence of socio‐economic factors
Authors: Grøholt Else‐Karin , Stigum Hein , Nordhagen Rannveig , Köhler Lennart
Published: March 2003

Objective To give estimates of the prevalence of various chronic health conditions among children in the Nordic countries in 1996, and to describe socio‐demographic correlates of the chronic conditions.

Design Analyses of the 1996 Nordic study on health and well‐being of children.

Setting Nationally representative sample of non‐institutionalized children in the Nordic countries.

Sample A total of approximately 10 000 children aged 2–17 years selected from population registries in Sweden, Iceland, Norway, Finland and Denmark.

Interventions None.

Results The total prevalence of chronic health conditions among children in the Nordic countries was 14.5%. Asthma, allergic rhinitis and eczema were most frequent among the listed diagnostic categories, accounting for about half of the cases. With the exception of asthma, the prevalence of all the selected conditions varied across the Nordic countries. All the diagnostic categories showed a social gradient in prevalence. Thus, the prevalence was for all the diagnostic categories higher among children from low‐educated, worker or low‐income families when compared with families of higher social classes. The prevalence of asthma was, for instance, higher among children from low‐educated compared to high‐educated families [odds ratio (OR) = 1.67, 95% confidence interval (CI) = 1.08–2.57], whereas the prevalence of eczema was higher in children from worker compared to white‐collar families (OR = 1.62, CI = 1.26–2.07).

Conclusion The data presented in this article show that there is an association between low socio‐economic status and the prevalence of various selected chronic health conditions among children in the Nordic countries.
Infant and pre‐school child health promotion: what do health visitors and general practitioners think is important and what do they record?
Authors: Hampshire Amanda J , Blair Mitch E , Crown Nicola S , Avery Anthony J , Williams Idris
Published: March 2003

Objective To identify health visitors' and general practitioners' views on pre‐school child health promotion and to describe the health promotion content of child health surveillance reviews during the first year of life.

Setting and sample One health visitor and general practitioner from 28 general practices in Nottingham, UK. Personal child health records of 2001 infants registered with the 28 practices.

Methods Each health visitor and general practitioner were interviewed using a semi‐structured interview schedule. Copies of child health surveillance reviews recorded in personal child health records of infants during their first year of life were collected and analysed.

Results Injury prevention and healthy eating were identified by health visitors and general practitioners as the most important health promotion topics to discuss with parents of pre‐school children. The health visitor was the member of the primary care team most frequently said to have a role in discussing health promotion. Health visitors were more likely than general practitioners to say they discussed health promotion at child health surveillance reviews (p = 0.0004). Few general practitioners said they discussed injury prevention at child health surveillance reviews. Health promotion issues were poorly recorded in personal child health records.

Conclusions Although health visitors and general practitioners say they discuss health promotion at pre‐school child health surveillance reviews, it is not well recorded during the first year of life. Redesigning the child health surveillance review pages in personal child health records could encourage health visitors and general practitioners to discuss and record health promotion during child health surveillance reviews.
Temperament of pre‐term infants at 9 months of age
Authors: Langkamp Diane L , Pascoe John M
Published: March 2003

Objective To compare temperament of pre‐term infants without severe neurologic problems born at 34 weeks gestation or earlier with that of healthy, term infants at 9 months of age by maternal ratings and perceptions. We also compared temperament ratings at 9 months of age with ratings performed at 4 months of age to examine stability of temperament from 4 to 9 months of age.

Sample When their infants were 9 months old, mothers of 34 pre‐term and 40 term infants completed the Infant Temperament Questionnaire (ITQ).

Methods The ITQ assesses temperament by maternal ratings of specific infant behavior and by mothers' more subjective perceptions of temperament.

Results Mothers rated pre‐term infants as having more negative mood (p = 0.003), being less adaptable (p = 0.01), more intense (p = 0.04) and as having a lower sensory threshold (p = 0.04). By maternal perceptions, 73% of term infants, compared with only 38% of pre‐term infants, were described as ‘easier than average’ (p = 0.006). By comparing the ITQ ratings at 9 months with temperament ratings of the same children at 4 months of age, we found significant stability in all dimensions of temperament among term infants, but not among pre‐term infants.

Conclusions Pre‐term infants without severe neurologic problems have a more difficult temperament at 9 months of age than term infants.

Implications for practice Health care providers need to be aware that many pre‐term children have difficult temperament, so that they may counsel parents about behavior issues more effectively.
Immunisation status amongst children attending special schools
Authors: Tuffrey Catherine , Finlay Fiona
Published: March 2003

Objective To determine whether children with disabilities attending special schools have the same immunisation uptake rate as the local general child population.

Design Cross‐sectional survey of computer database of immunisation records for the area.

Setting Community population of Bath clinical area, south‐west England.

Sample

The 136 children attending three special schools in the area and 272 randomly selected age and sex matched controls.

Measurement

Uptake rates of all vaccines covered by the routine immunisation schedule in the UK.

Results

Immunisation rates for the children in the special schools were significantly lower (59%) than those of control children attending normal schools (83%). The immunisations which children in special schools were less likely to have received were pertussis, measles and rubella.

Conclusions

Children with severe learning and physical disabilities who attend special schools in the area studied are less likely to be fully immunised than their peers attending mainstream schools. These children have the right to receive the appropriate protection against infectious disease and may in fact be particularly vulnerable to these diseases. Steps should be taken to determine why they are not fully immunised and plans made to improve the uptake rate.
How do child care center personnel define fever?
Authors: Juhn Young J , Sauver Jennifer St. , Shapiro Eugene D , McCarthy Paul L
Published: March 2003

Background Children with ‘fever’ are routinely excluded from child care centers, resulting in disruption of parental work schedules. Little is known about how child care centers define fever in states that do not provide guidelines.

Objective To determine the frequency of temperature thresholds for the definition of fever used by child care centers that are either lower or higher than thresholds commonly used and to identify factors associated with their use.

Methods We interviewed a random sample of 1632 child care program directors in Connecticut. Child care centers were classified into three groups based on their temperature threshold for definitions of fever by oral temperature: (1) group with lower fever threshold (<99.5°F); (2) group with mid‐range fever threshold (99.5–100°F); or (3) group with higher fever threshold (>100°F).

Results Of the 115 directors randomly selected and then contacted, 100 (87%) agreed to be interviewed. Of the 100, one center did not have a numerical definition of fever. Eight centers used a lower temperature threshold, 60 centers used a standard or mid‐range temperature threshold, and 31 centers used a higher temperature threshold. The multinomial logistic regression model indicated that directors without a college degree were more likely to use higher or lower temperature threshold for the definition of fever compared to those with a degree (p < 0.05).

Conclusions There is substantial variation in the definition of fever used by child care centers. Directors without a college degree may be target groups for continuing education of what constitutes fever in child care settings. In addition, implementation of state‐wide standards for definition of fever in child care programs should be advocated.
Persistent early feeding difficulties and subsequent growth and developmental outcomes
Authors: Motion Sara , Northstone Kate , Emond Alan , Team The ALSPAC Study
Published: March 2003

Aim To investigate the prevalence of feeding difficulties in infancy, and to determine whether feeding difficulties in the first 15 months can be predictive of poor growth or developmental impairments in the pre‐school years.

Methods Data on infant feeding behaviour and developmental milestones were collected prospectively, using self‐completion questionnaires, from the parents of the 14 138 live births in the Avon Longitudinal Study of Parents and Children.

Results Weak sucking (18%), and choking with feeding (55%) were common at 4 weeks of age, and 3.3% of parents described great difficulties with feeding their children at 15 months. Children who had persistent feeding problems at 1, 6, and 15 months had a prevalence of 2.6/1000. This study group had a higher prevalence of delayed motor milestones, with delayed walking at 18 months (p < 0.0001) and inability to run at 30 months (p < 0.0001); delayed language development at 18 months (p = 0.041), and impairment of articulation of speech at 38 months (p = 0.012). They also demonstrated difficult behaviours, with more frequent episodes of temper tantrums (p = 0.004) and meal refusal (p < 0.0001) at 18 months. There were reductions in the mean scores for motor skills (p = 0.001), communication (p = 0.01) and total development (p < 0.0001) at 18 months. At 30 months, 22% of the parents reported concern regarding their child's weight (p = 0.0001), and the mean weight Z scores at 9 and 18 months for this group were lower than the remaining population, although the differences did not reach statistical significance.

Conclusions Feeding difficulties were widely reported by parents of infants at 4 weeks of age, and thus did not have a predictive value in identifying children who were subsequently noted to have developmental impairments. The children with persistently difficult feeding throughout their first 15 months had significant impairments in their motor, language and behavioural development, and may benefit from early referral for assessment.
Catch‐up vaccination – the case of hepatitis B: identifying barriers and facilitating factors
Authors: Pesach Shvartzman , Sasson Nakar , Aya Peleg , Friger Michael , Amnon Lahad , Hava Tabenkin
Published: March 2003

Background Hepatitis B vaccine was introduced into the regular immunization schedule in Israel in 1992. At the time, a need for a catch‐up vaccination for those aged 4–18 years, became apparent.

Study objective To evaluate the vaccination rate for hepatitis B among children aged 4–18 years.

Subjects The study population consisted of a national sample of 1500 children aged 4–18 years, registered at large family practices and pediatric centres, belonging to Clalit Health Services (Health Maintenance Organization).

Design and setting A total of 817 telephone interviews were conducted with parents of the sampled children regarding hepatitis vaccination status and facilitating factors or barriers for vaccination.

Results The overall percentage of the children vaccinated was 19%, with 14.8% receiving the full immunization course. The variables found to be significantly associated with being vaccinated were (p < 0.05): families with one to three children; first born; higher education level of parents; number of parents’ visits to the physician in the last 3 months, higher parents’ immunization status; and younger parents. The main reason for vaccination noted was a recommendation. Of those not immunized, 50% noted that the main reason was a lack of recommendation.

Conclusions and Implications forpractice The outlined factors found to be associated with vaccination might benefit others facing vaccination catch‐up programs and the central role the primary care physician has as a recommending factor. Careful planning is clearly needed in developing an effective catch‐up program.
Use of volunteers to help launch a pediatric residency program in Laos
Authors: Olness Karen , Torjesen Hakon
Published: March 2003

When five Lao physicians began their training in a 3‐year pediatric residency program in Laos in late 1997 it launched the first full‐time postgraduate medical education in the history of the country. For a poor country with 5 million people, half of them children, and only seven fully trained pediatricians, the prospect of soon adding five new pediatricians per year has substantial implications for child health.

This residency grew out of 10 years of collaboration between the Lao Faculty of Medical Sciences and a wide‐ranging group of volunteer faculty members recruited from Case Western Reserve University and many other academic centres in the United States, Canada and Thailand, with the help of an all‐volunteer organization, Health Frontiers. The collaboration grew slowly, first with a pediatric curriculum for medical students, then a series of intensive short courses in pediatrics, and finally a government‐approved residency program, based on local health needs and consistent with international standards.

This article reviews some of the academic, cultural, political, organizational and financial factors involved in the project. It suggests that the low‐cost, in‐country, volunteer‐assisted residency program being developed in Laos may emerge as an effective and affordable model for introducing postgraduate medical education in other less developed countries.
The seroepidemiology of measles in Western Europe.
Authors: Jacobson Robert M
Published: March 2003

Background The World Health Organization has targeted measles for elimination from Europe in 2007. Whether this can be achieved through routine immunization strategies now in place remains to be seen.

Methods As part of the European Seroepidemiology Network, seven Western European countries conducted age‐ and sex‐stratified serological surveys of measles antibody from 1994 to 1998. The countries included the Denmark, Finland, France, Germany, Italy, Netherlands, and the United Kingdom

Results Overall, susceptibility levels among 2‐ to 4‐year‐olds ranged from 2.9 to 29.8%, in 5‐ to 9‐year‐olds from 2.5 to 25% and 10‐ to 19‐year‐olds from 2.1 to 13.9%. Susceptibility‐profiles were categorized as low, intermediate, and high. A country's susceptibility profile was highly associated with vaccine coverage for the first dose. First‐dose coverage ranged from 91 to 97.5% for four low‐susceptibility countries, 75–85% for two intermediate‐susceptibility countries and 55% for the one high‐susceptibility country. The low‐susceptibility countries had achieved or are very close to measles elimination. In moderate susceptibility countries endemic transmission still exists as does the risk of outbreaks as pools of susceptible individuals accumulate. Only the high‐susceptibility country still reported epidemics of measles regularly occurring in 4‐year cycles.

Conclusion For the low‐susceptibility countries, the priority should be to maintain uniformly high MMR vaccine coverage for both vaccine doses. For the moderate‐susceptibility countries catch‐up campaigns may close the gap between the highly vaccinated infants and the older children who missed the new programs of infant vaccination. In the high susceptibility country the priority should be to increase infant vaccine coverage and reduce regional variation in coverage levels.

The surveys from these seven Western European countries using comparable designs provides a special opportunity to compare serological impact of measles vaccination with the epidemiology of disease. These data provide an assessment of the progress being made toward measles control in Western Europe as well as an understanding for countries around the world of the sort of coverage we will need to attain.
The UK accelerated immunization programme and sudden unexpected death in infancy: case–control study.
Authors: Reading Richard
Published: March 2003

Objectives To investigate whether the accelerated immunization programme in the United Kingdom is associated, after adjustment for potential confounding, with the sudden infant death syndrome.

Design Population‐based case–control study, February 1993 to March 1996. Parental interviews were conducted for each death and for four controls matched for age, locality and time of sleep. Immunization status was taken from records held by the parents.

Setting Five regions in England with a combined population of over 17 million.

Subjects Immunization details were available for 93% (303/325) of infants whose deaths were attributed to the sudden infant death syndrome (SIDS); 90% (65/72) of infants with explained sudden deaths; and 95% (1515/1588) of controls.

Results After all potential confounding factors were controlled for, immunization uptake was strongly associated with a lower risk of SIDS [odds ratio 0.45 (95% confidence interval 0.24–0.85)]. This difference became non‐significant [0.67 (0.31–1.43)] after further adjustment for other factors specific to the infant's sleeping environment. Similar proportions of SIDS deaths and reference sleeps (corresponding to the time of day during which the index baby had died) among the controls occurred within 48 hours of the last vaccination [5% (7/149) versus 5% (41/822)] and within 2 weeks [21% (31/149) versus 27% (224/822)]. No longer term temporal association with immunization was found (p = 0.78). Of the SIDS infants who died within 2 weeks of vaccination, 16% (5/31) had signs and symptoms of illness that suggested that medical contact was required, compared with 26% (16/61) of the non‐immunized SIDS infants of similar age. The findings for the infants who died suddenly and unexpectedly but of explained causes mirrored those for SIDS infants.

Conclusions Immunization does not lead to sudden unexpected death in infancy, and the direction of the relation is towards protection rather than risk.

More reassuring information about the safety of the accelerated course of immunization. This paper should help us reassure the public that young babies' immune systems are not too immature to handle multiple vaccines. In fact there is no logic to this view at all: Babies' immune systems are set up to be able to respond to multiple challenges, and there is mounting evidence that the lack of such challenges has its own deleterious effects on the subsequent development of the immune system.

This paper also addresses some of the research into babies’ temperature control, which suggested that the response to immunization at this age might precipitate an abnormal response in some babies. Epidemiologically, there seems to be no risk of death. The authors postulate a possible protective effect, but I think that residual confounding may account for this, despite their best efforts to avoid it.
Effect of improved housing on illness in children under 5‐year‐old in northern Malawi: cross sectional study.
Authors: Reading Richard
Published: March 2003

Objective To evaluate the effects of a Habitat for Humanity housing improvement programme in northern Malawi on the prevalence of childhood illnesses.

Design Household‐based cross‐sectional study.

Setting Rural communities centred near the small northern Malawi town of Ekwendeni.

Subjects A total of 318 children under 5 years old.

Main outcome measures Prevalence of respiratory, gastrointestinal and malarial infections according to maternal recall, laboratory, or clinical data.

Results Children living in improved homes were less likely to have respiratory, gastrointestinal, or malarial illnesses (odds ratio 0.56, 95% confidence interval 0.35–0.91) after confounding factors were controlled for. The reductions in individual diseases were not significant.

Conclusion Improved housing significantly reduced the burden of disease among children under 5 years old.
Diversity in protein, nuclear DNA, and mtDNA in South Amerinds – agreement or discrepancy?
Authors: BORTOLINI M. C. , BAPTISTA C. , CALLEGARI‐JACQUES S. M. , WEIMER T. A. , SALZANO F. M.
Published: March 2003

Two sets of markers and populations were considered in this study: (a) the variability at 17 protein loci and in the sequences of the first hypervariable segment of the mitochondrial DNA (mtDNA) were compared in 10 South American Indian tribes, in a total 3016 and 241 individuals, respectively; and (b) a triple comparison was made, in relation to 17 protein, mtDNA and six hypervariable tandem repeat loci in four Brazilian Indian tribes, involving 1567, 56 and 194 persons, respectively. Both the intrapopulational diversities and the population relationships obtained in these groups with these different sets of markers showed no significant correlation. High levels of heterogeneity were observed both at the protein and hypervariable individual loci, as well between mtDNA sites. The different positions observed for the Yanomama (but not for the other nine tribes) in the trees which summarized the protein and mtDNA data suggest some degree of asymmetric interchange related to sex between them and neighbouring tribes.
The role of consanguinity and inbreeding as a determinant of spontaneous abortion in Karachi, Pakistan
Authors: HUSSAIN R.
Published: March 2003

The effect of consanguinity and inbreeding on spontaneous abortion is assessed with the help of data from a population‐based study conducted in four squatter settlements of Karachi, Pakistan. The analysis is based on 4966 pregnancy records belonging to 873 women. Results of the multivariate analysis show that both consanguinity and inbreeding were independent risk factors for spontaneous abortion despite undertaking control for other biological and socio‐demographic factors that could confound the association. The combination of fetal and parental inbreeding led to a greater likelihood of a pregnancy ending in spontaneous abortion than one generation of inbreeding alone.
Characterization of polymorphisms at the 11β‐hydroxylase (CYP11B1) locus
Authors: SKINNER C. A. , YOUSAF N. , HONOUR J. W. , RUMSBY G.
Published: March 2003

Four sequence variants in the 11β‐hydroxylase (CYP11B1) gene are reported. One of the sequence changes occurs in exon 1 and is in linkage disequilibrium with a second variant in intron 3. The other two changes occur at adjacent nucleotides in intron 1. The finding of easily demonstrable, intragenic variants will be beneficial to the study of the role of the CYP11B1 and the adjacent aldosterone synthase (CYP11B2) gene in hypertensive disease.
A mutation screen of the TSC1 gene reveals 26 protein truncating mutations and 1 splice site mutation in a panel of 79 tuberous sclerosis patients
Authors: YOUNG J. M. , BURLEY M. W. , JEREMIAH S. J. , JEGANATHAN D. , EKONG R. , OSBORNE J. P. , POVEY S.
Published: March 2003

The entire coding region of the TSC1 gene has been screened for mutations in 79 unrelated patients with tuberous sclerosis. Causative mutations have been found in 27 of these patients and five other variations in the gene have been identified. 26 of the mutations are predicted to cause premature truncation of the protein product of the gene and one mutation is in a splice site. The mutation screen has revealed that TSC1 mutations are rarer in sporadic tuberous sclerosis patients than in familial cases. We have also found that the only previously described case of non‐penetrance can no longer be described as such, and that a single ungual fibroma is not necessarily diagnostic of tuberous sclerosis, important findings for the genetic counselling of tuberous sclerosis patients.
C73R is a hotspot mutation in the uroporphyrinogen III synthase gene in congenital erythropoietic porphyria
Authors: FRANK J. , WANG X. , LAM H‐M. , AITA V. M. , JUGERT F. K. , GOERZ G. , MERK H. F. , POH‐FITZPATRICK M. B. , CHRISTIANO A. M.
Published: March 2003

Congenital erythropoietic porphyria (CEP) results from profoundly deficient activity of the fourth enzyme of the haeme biosynthetic pathway, uroporphyrinogen III synthase (UROIIIS). CEP is a rare, recessively inherited disorder, and mutations in the UROIIIS gene detected in CEP patients are heterogeneous. The notable exception to this rule is a single missense mutation, designated C73R, which represents over 40% of all mutant UROIIIS alleles. In this study, we investigated three separate families with CEP from different ethnic backgrounds. We performed haplotype analysis using two microsatellite markers that closely flank the UROIIIS gene on chromosome 10q24, spanning a region of 4 cM on the GB4 linkage panel. Haplotype analysis revealed the occurrence of C73R on different haplotypes in four out of four disease chromosomes studied. The results are consistent with the hypothesis that C73R is a hotspot mutation for CEP, and does not represent wide dispersion of a single ancestral mutant C73R allele.
Surnames, HLA genes and ancient migrations in the Po Valley (Italy)
Authors: GUGLIELMINO C. R. , DE SILVESTRI A. , ROSSI A. , DE MICHELI V.
Published: March 2003

Population samples from Liguria, Piacenza and Pavia provinces, and North Lombardy are compared for surnames and HLA gene frequencies. The genetic structure inferred from the principal coordinate analysis of surname frequencies is different from that inferred from HLA gene frequencies. The latter may represent ancient migrations, since surnames are relatively recent genetic markers dating from a.d. 1500. Ligurian and Celts were the ancient inhabitants of this northern Italy geographic area. Genetic distances, derived from HLA gene frequencies, and represented with an unrooted tree show the presence of a Ligurian and a Celtic pole. The aggregation of the subpopulations to each pole accords with the history and the archaeological findings in the area.
Susceptibility to spina bifida; an association study of five candidate genes
Authors: MORRISON K. , PAPAPETROU C. , HOL F. A. , MARIMAN E. C. M. , LYNCH S. A. , BURN J. , EDWARDS Y. H.
Published: March 2003

Clues regarding candidate genes which influence susceptibility to spina bifida and anencephaly come from the identification of folate‐associated risk factors and from studies of mouse mutants showing neural tube anomalies. On this basis we selected five candidate genes; CBS, MS, MTHFR, T (Brachyury) and BRCA1 for genetic analysis in 31 Dutch and 48 British NTD families. Ten polymorphisms, two for each gene, were used in transmission tests for disequilibrium (TDT). In six instances more than 50 transmissions from heterozygous parents could be examined. Using TDT we find evidence for an association between an allele at the T gene and liability to NTD in the embryo. Data from British and Dutch populations showed the same trend and in combination gave a χ2TDT=4.89, P=0.03 (OR 2.39, CI 95% 1.02–5.61). No association, in either population group, was found for CBS, MS and MTHFR, the enzymes most directly associated with the known risk factors in folate metabolism. The possibility of complex genetic interactions was explored; the data show that a Gly919 MS variant occurs more frequently in combination with the MTHFR thermolabile variant in mothers of NTD offspring (OR 3.94, CI 95% 1.0–16.3).
Construction of a bacterial artificial chromosome (BAC) contig across the minimally deleted region in 13q14.3 in B‐cell chronic lymphocytic leukemia
Authors: HAWTHORN L. A. , COWELL J. K.
Published: March 2003

Loss of heterozygosity (LOH) analysis in B‐cell chronic lymphocytic leukemia (BCLL) has indicated that a frequent genetic event is loss of alleles from an approximately 500 kb region in 13q14.3, distal to the retinoblastoma gene. We have used DNA markers from this region to isolate and characterize a series of bacterial artificial chromosomes (BACs) which span the region between markers D13S319 and D13S25, which represents the common region of LOH. This entire region appears to be contained within only two minimally overlapping BACs, representing a maximum distance of approximately 350 kb. This BAC contig has been used to position known STS, EST and gene markers within the region. We have also used a modified differential display/RNA fingerprinting procedure designed to isolated transcribed sequences from YACs to isolate two transcribed units from the region which have also been positioned within the contig. The construction of a BAC contig with minimal redundancy provides the ideal resource from which to begin to identify candidate genes related to BCLL.