bluuebunny/crossref_metadata_2025 huggingface dataset:
Characteristics of Primary Care Trusts in financial deficit and surplus – a comparative study in the English NHS
Authors: Badrinath Padmanabhan , Currell Rosemary Anne , Bradley Peter M
Published: June 2006

Background

Recently the financial status of primary care trusts has come under considerable scrutiny by the government, and financial deficits have been blamed on poor local management of resources. This paper examines the factors that differ between those Primary Care Trusts (PCT) in financial deficit and those in surplus, using readily available data at PCT level. PCTs are the National Health Service organisations in England responsible for improving the health of their population, developing primary and community health services, and commissioning secondary care services.

Methods

A descriptive comparative study using data from 58 PCTs; 29 in greatest financial surplus and 29 in greatest deficit in the English National Health Service.

Results

Nearly half the study deficit PCTs (14 out of 29) are in the East of England and of the 29 surplus PCTs, five each are in Birmingham and Black Country Strategic Health Authority (SHA), and Greater Manchester SHA. The median population density of the deficit PCTs is almost seven times lower than that of surplus PCTs (p = 0.004). Surplus PCTs predominantly serve deprived communities. Nearly half the surplus PCTs are 'spearhead' PCTs compared to only one of the deficit PCTs. Percentage population increase by local authority of the PCT showed that on average deficit PCTs had 2.7 times higher change during 1982–2002 (13.37% for deficit and 4.94% for surplus PCTs). Work pressure felt by staff is significantly higher in deficit PCTs, and they also reported working higher amount of extra hours due to work pressures. The proportion of dispensing general practitioners is significantly higher in deficit PCTs 40.5% vs. 12.9% (p = 0.002). Deficit PCTs on average received £123 less per head of registered population compared to surplus PCTs.

Conclusion

The two groups of PCTs serve two distinct populations with marked differences between the two. Deficit PCTs tend to be in relatively affluent and rural areas. Poor management alone is unlikely to be the cause of deficits, and potential reasons for deficits including rurality and increased demand for health services in more affluent communities need further in-depth studies.
Fusion of mental health and incapacity legislation
Authors: Dawson John , Szmukler George
Published: June 2006

The enactment of a single legislative scheme governing nonconsensual treatment of both ‘physical’ and ‘mental’ illnesses, based on incapacity principles, has been mooted in recent law reform debates in the UK. We propose a framework for such legislation and consider in more detail the provisions it should contain. The design of legislation that combines the strengths of both incapacity and civil commitment schemes can be readily imagined, based on the criteria for intervention in England and Wales found in the Mental Capacity Act 2005. Such legislation would reduce unjustified legal discrimination against mentally disordered persons and apply consistent ethical principles across medical law.
Kerr/Haslam Inquiry into sexual abuse of patients by psychiatrists
Authors: Kennedy Peter
Published: June 2006

Nearly 1000 pages of the Kerr/Haslam Inquiry report published in July 2005 tell in detail how, over a period of more than two decades, according to many female patients, two male psychiatrists working from the same hospital were able to sexually abuse them. By the time police investigations and the Inquiry were complete, a total of 67 patients had declared themselves victims of William Kerr and at least 10 of Michael Haslam. Kerr was convicted in 2000 on one count of indecent assault. He was considered too ill to face trial but was convicted on trial of the facts. Haslam was convicted on four counts of indecent assault in 2003 and was given a 3-year prison sentence.
Emergency psychiatric assessments: implications for senior house officer training
Authors: Woodall Alan A. , Roberts Seren , Slegg Gary P. , Menkes David B.
Published: June 2006

Aims and Method

In order to examine the opportunities for senior house officers (SHOs) to undertake emergency psychiatric assessments we conducted a retrospective cohort study of such assessments in a district general hospital.

Results

Senior house officers conducted few assessments for self-harm compared with psychiatric liaison nurses (P< 0.001), and were involved in only 40% of emergency referrals where psychiatric opinion was requested. Senior house officers continue to undertake more assessments out of hours than any other group (P< 0.01).

Clinical Implications

Although the introduction of psychiatric liaison nurses has improved capacity and reduced waiting times for emergency assessment, the opportunity for SHOs to undertake emergency assessments has been reduced, particularly with regard to assessment of suicidal risk following self-harm. These results suggest the need for better monitoring of SHO experience, particularly in the light of service developments that have an impact on psychiatric training.
Low-cost, email-based system for self blood pressure monitoring at home
Authors: Nakajima Kazuki , Nambu Masayuki , Kiryu Tohru , Tamura Toshiyo , Sasaki Kazuo
Published: June 2006

We have developed a low-cost monitoring system, which allows subjects to send blood pressure (BP) data obtained at home to health-care professionals by email. The system consists of a wrist BP monitor and a personal computer (PC) with an Internet connection. The wrist BP monitor includes an advanced positioning sensor to verify that the wrist is placed properly at heart level. Subjects at home can self-measure their BP every day, automatically transfer the BP data to their PC each week, and then send a comma-separated values (CSV) file to their health-care professional by email. In a feasibility study, 10 subjects used the system for a mean period of 207 days (SD 149). The mean percent achievement of measurement in the 10 subjects was 84% (SD 12). There was a seasonal variation in systolic and diastolic BP, which was inversely correlated with temperature. Eight of the 10 subjects evaluated the system favourably. The results of the present study demonstrate the feasibility of our email-based system for self-monitoring of blood pressure. Its low cost means that it may have widespread application in future home telecare studies.
Digital image compression should be limited in diabetic retinopathy screening
Authors: Basu Ansu
Published: June 2006

Digital colour retinal photography is a useful modality for diabetic retinopathy screening. Unlike film photography, the size of the image depends on the resolution of the acquired image. With the availability of high-resolution digital cameras, larger images requiring greater storage-memory will inevitably be generated. Image compression may then be necessary so that these images can be viewed conveniently, archived and transmitted across computer networks. Unfortunately with the paucity of clinical studies on retinal image compression, more research is necessary to develop evaluation tools to identify optimum image compression ratios for diabetic retinopathy screening.
Post-transcriptional regulation of microRNA expression
Authors: Obernosterer Gregor , Leuschner Philipp J.F. , Alenius Mattias , Martinez Javier
Published: June 2006

microRNAs (miRNAs) are endogenous, noncoding ∼22-nucleotide RNA molecules that have recently emerged as fundamental, post-transcriptional regulators of cognate target gene expression. Many mammalian miRNAs are expressed in a tissue-specific manner, a phenomenon that has so far been attributed to transcriptional regulation. We here show by Northern blots and in situ hybridization experiments that the expression of mammalian miRNAs can be regulated at the post-transcriptional level. In particular, miR-138 is spatially restricted to distinct cell types, while its precursor, pre-miR-138-2, is ubiquitously expressed throughout all tissues analyzed. Furthermore, pre-miR-138-2 is exported from the nucleus to the cytoplasm, suggesting that cleavage of this pre-miRNA by Dicer is restricted to certain tissues and cell types. Thus, differential processing of pre-miRNAs might be an alternative mechanism to control miRNA function.
Behavioral Predictors of Substance-Use Initiation in Adolescents With and Without Attention-Deficit/Hyperactivity Disorder
Authors: Ernst Monique , Luckenbaugh David A. , Moolchan Eric T. , Leff Michelle K. , Allen Rachel , Eshel Neir , London Edythe D. , Kimes Alane
Published: June 2006

OBJECTIVE. Our goal was to examine substance-use initiation in healthy adolescents and in adolescents who have been diagnosed with attention-deficit/hyperactivity disorder.

METHODS. Seventy-eight adolescents (28 healthy and 50 with attention-deficit/hyperactivity disorder) participated in an ongoing longitudinal study of predictors of substance use. The substances most commonly reported were tobacco, alcohol, and marijuana. Aggression, conduct problems, hyperactivity, impulsivity, inattention, anxiety/depression, social difficulties, and somatic complaints were assessed at study entry and tested as predictors for later substance use.

RESULTS. With an average of 4 years into the study, 37 adolescents had not used any substances, 41 had experimented with at least 1 substance, and 29 experimented with >1 substance. Psychiatric diagnoses (attention-deficit/hyperactivity disorder, attention-deficit/hyperactivity disorder and conduct disorder, and attention-deficit/hyperactivity disorder and depression/anxiety) did not influence reports of substance use. Distinct behavioral measures collected at study entry predicted use of different substances. In a multivariate analysis, aggression had the greatest association with tobacco smoking and marijuana use. Impulsivity was associated with alcohol use. Severity of drug exposure, indexed by the number of substances used, was predicted by aggression.

CONCLUSIONS. This 4-year longitudinal study captured the onset of substance use, not abuse. Behavioral predictors differed with the type of substance used. These behavioral characteristics may raise suspicion among pediatricians for enhanced risk for substance-use initiation.
Mental Health Care Services for Children With Special Health Care Needs and Their Family Members: Prevalence and Correlates of Unmet Needs
Authors: Ganz Michael L. , Tendulkar Shalini A.
Published: June 2006

OBJECTIVES. To estimate the prevalence and correlates of unmet needs for mental health care services for children with special health care needs and their families.

METHODS. We use the National Survey of Children With Special Health Care Needs to estimate the prevalence of unmet mental health care needs among children with special health care needs (1–17 years old) and their families. Using logistic-regression models, we also assess the independent impact of child and family factors on unmet needs.

RESULTS. Substantial numbers of children with special health care needs and members of their families have unmet needs for mental health care services. Children with special health care needs who were poor, uninsured, and were without a usual source of care were statistically significantly more likely to report that their mental health care needs were unmet. More severely affected children and those with emotional, developmental, or behavioral conditions were also statistically significantly more likely to report that their mental health care needs went unmet. Families of severely affected children or of children with emotional, developmental, or behavioral conditions were also statistically significantly more likely to report that their mental health care needs went unmet.

CONCLUSIONS. Our results indicate that children with special health care needs and their families are at risk for not receiving needed mental health care services. Furthermore, we find that children in families of lower socioeconomic status are disproportionately reporting higher rates of unmet needs. These data suggest that broader policies to identify and connect families with needed services are warranted but that child- and family-centered approaches alone will not meet the needs of these children and their families. Other interventions such as anti-poverty and insurance expansion efforts may be needed as well.
Effects of Breast Milk on the Severity and Outcome of Neonatal Abstinence Syndrome Among Infants of Drug-Dependent Mothers
Authors: Abdel-Latif Mohamed E. , Pinner Jason , Clews Sara , Cooke Fiona , Lui Kei , Oei Julee
Published: June 2006

OBJECTIVE. The purpose of this research was to assess the effects of breast milk on the severity and outcome of neonatal abstinence syndrome.

METHODS. We conducted a retrospective chart review of 190 drug-dependent mother and infant pairs. Patients were categorized according to the predominant type of milk consumed by the infant on the fifth day of life (breast milk: n = 85 or formula: n = 105). The Finnegan's scoring system was used to monitor withdrawal, and medication was commenced if there were 2 scores of ≥8.

RESULTS. Mean Finnegan scores were significantly lower in the breast milk group during the first 9 days of life even after stratifying for prematurity and exposure to polydrug and methadone. Significantly fewer infants required withdrawal treatment in the breast milk group. The median time to withdrawal occurred considerably later in breast milk group. In a multivariate analysis controlled for exposure to drugs of high risk of neonatal abstinence syndrome, polydrug, and prematurity, breast milk group was associated with lower need for neonatal abstinence syndrome treatment.

CONCLUSIONS. Breast milk intake is associated with reduced neonatal abstinence syndrome severity, delayed onset of neonatal abstinence syndrome, and decreased need for pharmacologic treatment, regardless of the gestation and the type of drug exposure.
Quality of Reporting of Randomized, Controlled Trials in Cerebral Palsy
Authors: Anttila Heidi , Malmivaara Antti , Kunz Regina , Autti-Rämö Ilona , Mäkelä Marjukka
Published: June 2006

OBJECTIVES. In conducting reviews on the effectiveness of physiotherapy interventions on children with cerebral palsy, the assessment of trials can be hampered by problems in reporting. Therefore, we set out to evaluate trial reporting by using the Consolidated Standards of Reporting Trials (CONSORT) statement recommendations.

METHODS. Randomized, controlled trials published in 1990 or later were identified in literature searches for reviews on the effectiveness of physiotherapy interventions on children with cerebral palsy. Two independent reviewers evaluated the trial reporting by using a modified 33-item Consolidated Standards of Reporting Trials checklist.

RESULTS. We identified 15 randomized, controlled trials. Almost half (48%) of the applicable items were reported adequately. Inadequate reporting was found in the following items: outcome measures, sample-size determination, details of the sequence generation, allocation concealment and implementation of the randomization, success of assessor blinding, recruitment and follow-up dates, intention-to-treat analysis, precision of the effect size, co-interventions, and adverse events.

CONCLUSIONS. Only a small number of sufficiently reported trials were found. Because nearly all items had been described in at least 1 article, high-quality reporting seems feasible. Assessment of trials depends on appropriate reporting, and poor reporting jeopardizes judgments on the clinical implications. Authors of randomized, controlled trials are encouraged to follow the Consolidated Standards of Reporting Trials criteria. There is a clear need to improve the quality of reporting of trials in this field.
Cerebral Perfusion Abnormalities in Children With Sturge-Weber Syndrome Shown by Dynamic Contrast Bolus Magnetic Resonance Perfusion Imaging
Authors: Evans Amlyn L. , Widjaja Elysa , Connolly Daniel J. A. , Griffiths Paul D.
Published: June 2006

OBJECTIVE. Sturge-Weber syndrome is characterized by leptomeningeal angiomatosis and a facial naevus that is usually unilateral. Magnetic resonance imaging is the cornerstone of confirming the disease and judging the extent of the abnormalities. It has been shown, however, that brain perfusion abnormalities on nuclear medicine imaging often are more extensive than the abnormal leptomeningeal enhancement on magnetic resonance. In this article, we assess the utility of magnetic resonance perfusion in demonstrating perfusion abnormalities in pediatric cases of Sturge-Weber syndrome.

METHODS. Magnetic resonance perfusion studies were performed on 7 consecutive children who presented to our department with clinically suspected Sturge-Weber syndrome. The extent of time to peak abnormality on dynamic gadolinium bolus magnetic resonance perfusion imaging was compared with the extent of leptomeningeal enhancement and the presence of venous abnormalities.

RESULTS. Good magnetic resonance perfusion data were obtained in all 7 cases. Perfusion abnormalities were closely anatomically related to meningeal enhancement on postcontrast T1-weighted imaging. However, perfusion abnormalities were found consistently in the vicinity of developmental venous anomalies that were present in 4 of 7 cases. In 1 child, there was a perfusion deficit in the cerebellar lobe contralateral to the leptomeningeal angiomatosis, consistent with crossed cerebellar diaschisis.

CONCLUSIONS. Magnetic resonance perfusion is a sensitive indicator of perfusion abnormalities in Sturge-Weber syndrome and can be performed easily at the same time as the diagnostic scan. Magnetic resonance perfusion imaging therefore is useful in the assessment of this disease. This approach has the extra advantage of correlating the perfusion abnormalities with the high-resolution imaging that is provided from magnetic resonance imaging.
Quality-of-Care Indicators for the Neurodevelopmental Follow-up of Very Low Birth Weight Children: Results of an Expert Panel Process
Authors: Wang C. Jason , McGlynn Elizabeth A. , Brook Robert H. , Leonard Carol H. , Piecuch Robert E. , Hsueh Steven I. , Schuster Mark A.
Published: June 2006

OBJECTIVE. To develop a set of quality indicators for the neurodevelopmental follow-up care of very low birth weight (VLBW; <1500 g) children.

METHODS. We reviewed the scientific literature on predictors of neurodevelopmental outcomes for VLBW children and the clinical practice guidelines relevant to their care after hospital discharge. An expert panel with members nominated by the American Academy of Pediatrics, the National Institute of Child Health and Human Development, the Vermont Oxford Network, and the California Children's Service was convened. We used a modified Delphi method to evaluate and select the quality-of-care indicators.

RESULTS. The panel recommended a total of 70 indicators in 5 postdischarge follow-up areas: general care; physical health; vision, hearing, speech, and language; developmental and behavioral assessment; and psychosocial issues. Of these, 58 (83%) indicators were in preventive care, 5 (7%) were in acute care, and 7 (10%) were in chronic care.

CONCLUSION. The quality indicators cover follow-up care for VLBW infants with various medical conditions. Given the elevated rates of long-term neurodevelopmental disabilities and the potential impact of poor health care, this new set of indicators provides an opportunity to assess and monitor the quality of follow-up care with the ultimate aim of improving the quality of care for this high-risk population.
Neurodevelopment After Neonatal Hypoglycemia: A Systematic Review and Design of an Optimal Future Study
Authors: Boluyt Nicole , van Kempen Anne , Offringa Martin
Published: June 2006

OBJECTIVE. Our goal was to assess the effect of episodes of neonatal hypoglycemia on subsequent neurodevelopment.

METHODS. We searched Medline and Embase for cohort studies on subsequent neurodevelopment after episodes of hypoglycemia in the first week of life. Reference lists of available studies were reviewed, and content experts were contacted for additional studies. Included studies were selected and appraised for methodologic quality by 2 reviewers. Methodologic quality was assessed according to well-accepted criteria for prognostic studies. Eventually, all studies were given an overall quality score: poor, moderate, or high quality. Studies in the latter 2 categories were considered for quantitative data analysis.

RESULTS. Eighteen eligible studies were identified. The overall methodologic quality of the included studies was considered poor in 16 studies and high in 2 studies. Pooling of results of the 2 high-quality studies was deemed inappropriate because of major clinical and methodologic heterogeneity. None of the studies provided a valid estimate of the effect of neonatal hypoglycemia on neurodevelopment. Building on the strengths and weaknesses of existing studies, we developed a proposal for an “optimal” future study design.

CONCLUSIONS. Recommendations for clinical practice cannot be based on valid scientific evidence in this field. To assess the effect of neonatal hypoglycemia on subsequent neurodevelopment, a well-designed prospective study should be undertaken. We submit a design for a study that may answer the still-open questions.
Community-Based Therapy for Children With Multidrug-Resistant Tuberculosis
Authors: Drobac Peter C. , Mukherjee Joia S. , Joseph J. Keith , Mitnick Carole , Furin Jennifer J. , del Castillo Hernán , Shin Sonya S. , Becerra Mercedes C.
Published: June 2006

OBJECTIVES. The goals were to describe the management of multidrug-resistant tuberculosis among children, to examine the tolerability of second-line antituberculosis agents among children, and to report the outcomes of children treated for multidrug-resistant tuberculosis in poor urban communities in Lima, Peru, a city with high tuberculosis prevalence.

METHODS. A retrospective analysis of data for 38 children <15 years of age with multidrug-resistant tuberculosis, either documented with drug sensitivity testing of the child's tuberculosis isolate or suspected on the basis of the presence of clinical symptoms for a child with a household contact with documented multidrug-resistant tuberculosis, was performed. All 38 children initiated a supervised individualized treatment regimen for multidrug-resistant tuberculosis between July 1999 and July 2003. Each child received 18 to 24 months of therapy with ≥5 first- or second-line drugs to which their Mycobacterium tuberculosis strain was presumed to be sensitive.

RESULTS. Forty-five percent of the children had malnutrition or anemia at the time of diagnosis, 29% had severe radiographic findings (defined as bilateral or cavitary disease), and 13% had extrapulmonary disease. Forty-five percent of the children were hospitalized initially because of the severity of illness. Adverse events were observed for 42% of the children, but no events required suspension of therapy for >5 days. Ninety-five percent of the children (36 of 38 children) achieved cures or probable cures, 1 child (2.5%) died, and 1 child (2.5%) defaulted from therapy.

CONCLUSIONS. Multidrug-resistant tuberculosis disease among children can be treated successfully in resource-poor settings. Treatment is well tolerated by children, and severe adverse events with second-line agents are rare.
Mirrored Symptoms in Mother and Child With Chronic Fatigue Syndrome
Authors: van de Putte Elise M. , van Doornen Lorenz J. P. , Engelbert Raoul H. H. , Kuis Wietse , Kimpen Jan L. L. , Uiterwaal Cuno S. P. M.
Published: June 2006

OBJECTIVE. Our aim with this study was to assess the relation between chronic fatigue syndrome in adolescents and fatigue and associated symptoms in their fathers and mothers, more specifically the presence of chronic fatigue syndrome-like symptoms and psychologic distress.

METHOD. In this cross-sectional study, 40 adolescents with chronic fatigue syndrome according to the Centers for Disease Control and Prevention criteria were compared with 36 healthy control subjects and their respective parents. Questionnaires regarding fatigue (Checklist Individual Strength), fatigue-associated symptoms, and psychopathology (Symptom Checklist-90) were applied to the children and their parents.

RESULTS. Psychologic distress in the mother corresponds with an adjusted odds ratio of 5.6 for the presence of CFS in the child. The presence of fatigue in the mother and dimensional assessment of fatigue with the Checklist Individual Strength revealed odds ratios of, respectively, 5.29 and 2.86 for the presence of chronic fatigue syndrome in the child. An increase of 1 SD of the hours spent by the working mother outside the home reduced the risk for chronic fatigue syndrome in their child with 61%. The fathers did not show any risk indicator for chronic fatigue syndrome in their child.

CONCLUSIONS. Mothers of adolescents with chronic fatigue syndrome exhibit fatigue and psychologic symptoms similar to their child in contrast with the fathers. The striking difference between the absent association in fathers and the evident association in mothers suggests that the shared symptom complex of mother and child is the result of an interplay between genetic vulnerability and environmental factors.
Clinicians' Management of Children and Adolescents With Acute Pharyngitis
Authors: Park Sarah Y. , Gerber Michael A. , Tanz Robert R. , Hickner John M. , Galliher James M. , Chuang Ilin , Besser Richard E.
Published: June 2006

OBJECTIVE. Sore throat is a common complaint in children and adolescents. With increasing antimicrobial resistance because of antimicrobial overuse, accurate diagnosis is imperative. Appropriate management of acute pharyngitis depends on proper use and interpretation of clinical findings, rapid antigen-detection tests, and throat cultures. We surveyed pediatricians and family physicians to evaluate their management strategies for children and adolescents with acute pharyngitis and to assess the availability and use of diagnostic tests in office practice.

METHODS. In 2004, surveys were mailed to a random sample of 1000 pediatrician members of the American Academy of Pediatrics and 1000 family physician members of the American Academy of Family Physicians. We assessed factors associated with physicians using an appropriate management strategy for treating acute pharyngitis.

RESULTS. Of 948 eligible responses, 42% of physicians would start antimicrobials before knowing diagnostic test results and continue them despite negative results, with 27% doing this often or always. When presented with clinical scenarios of patients with acute pharyngitis, ≤23% chose an empirical approach, 32% used an inappropriate strategy for a child with pharyngitis suggestive of group A Streptococcus, and 81% used an inappropriate strategy for a child with findings consistent with viral pharyngitis. Plating cultures in the office was associated with an appropriate management strategy, although not statistically significant. Solo/2-person practice and rural location were both independent factors predicting inappropriate strategies.

CONCLUSIONS. here is much room for improvement in the management of acute pharyngitis in children and adolescents. Most physicians use appropriate management strategies; however, a substantial number uses inappropriate ones, particularly for children with likely viral pharyngitis. Efforts to help physicians improve practices will need to be multifaceted and should include health policy and educational approaches.
Feasibility and Safety of Insulin Pump Therapy in Children Aged 2 to 7 Years With Type 1 Diabetes: A Retrospective Study
Authors: Berhe Tseghai , Postellon Daniel , Wilson Bruce , Stone Roberta
Published: June 2006

BACKGROUND AND OBJECTIVES. Although insulin pump therapy has been successful in adults, adolescents and school children, its use has been limited in young children. The purpose of this study was to evaluate the glycemic control, safety and efficacy of continuous subcutaneous insulin infusion via pump in young children (2–7 years old) with type 1 diabetes who were transitioned from twice-a-day insulin injection (neutral protamine Hagedorn/Lente + Humalog/Novalog) to insulin pump therapy. Hemoglobin A1c, BMI, average fasting blood glucose, episodes of severe hypoglycemia, episodes of diabetic ketoacidosis, episodes of lipohypertrophy, blood glucose variability, and number of sick day calls were compared before and after insulin pump therapy.

METHODS. Data were collected retrospectively by chart review over a 2-year period during quarterly diabetes clinic visits from 33 patients who were managed on neutral protamine Hagedorn/Lente + Humalog/Novolog twice-a-day injections for at least 1 year prior to transitioning to insulin pump therapy.

RESULTS. There was a significant improvement in the average hemoglobin A1c after continuous subcutaneous insulin infusion therapy. The average fasting blood sugar was lower in the continuous subcutaneous insulin infusion group. Severe episodes of hypoglycemia and episodes of lipohypertrophy were significantly higher before insulin pump therapy initiation. There were significantly fewer sick day calls after continuous subcutaneous insulin infusion. Blood sugar variability improved significantly after insulin pump therapy. There was no significant difference in BMI or amount of carbohydrate consumed. None of the patients experienced diabetic ketoacidosis requiring emergency treatment before or after insulin pump therapy.

CONCLUSIONS. Continous subcutaneous insulin infusion therapy in young children with type 1 diabetes is a safe, effective and superior alternative to a twice-a-day insulin regimen.
Severe Fatigue in Adolescents: A Common Phenomenon?
Authors: ter Wolbeek Maike , van Doornen Lorenz J.P. , Kavelaars Annemieke , Heijnen Cobi J.
Published: June 2006

OBJECTIVE. The purpose of this study was to determine the prevalence of severe fatigue in adolescent boys and girls, to explore the role of lifestyle factors in fatigue, and to investigate whether severe fatigue in a healthy population is associated with depression, anxiety, and comorbid factors also observed in chronic fatigue syndrome patients.

METHODS. In a sample of 1718 boys and 1749 girls, fatigue severity and duration were measured using a multidimensional questionnaire (Checklist Individual Strength). In addition, self-reports of depressive symptoms, anxiety, chronic fatigue syndrome-related symptoms, and lifestyle characteristics were assessed by means of questionnaires. Prevalence rates of severe fatigue and severe fatigue for ≥1 month, based on a clinical cutoff score of the Checklist Individual Strength, were determined for boys and girls separately, and gender-specific predictors of fatigue were identified by multiple regression analysis.

RESULTS. The data showed high prevalence rates of severe fatigue in adolescents. Remarkable differences between boys and girls were observed: 20.5% of girls and 6.5% of the boys scored above the clinical cutoff score on the Checklist Individual Strength. Of these subjects 80.0% of the girls and 61.5% of the boys reported severe fatigue for ≥1 month. Of the examined lifestyle characteristics, only sleep characteristics and the participation in sports played a role in predicting fatigue in both genders. Moreover, in girls, fatigue was associated with higher age, an early menarche, medication use, and the absence of an additional job. Overall, girls scored higher on depression, anxiety, and chronic fatigue syndrome-related symptoms. However, the relation between fatigue and these comorbid symptoms did not differ between genders. In both girls and boys, the duration of fatigue was positively related to fatigue severity, severity of depression and anxiety, and the number of chronic fatigue syndrome-related symptoms.

CONCLUSIONS. Fatigue prevalence among adolescents is high, especially in girls. Adolescent girls seem to be more vulnerable to symptoms of fatigue and comorbidity than boys. Interestingly, despite a female predominance in complaints, the relation between fatigue and depression, anxiety, and chronic fatigue syndrome-related symptoms was not gender specific and emerged as a cluster. In both genders, fatigue duration was associated with the severity of fatigue and the level of psychological comorbidity and chronic fatigue syndrome-related symptoms, and we, therefore, hypothesize that enduring severe fatigue may form a risk factor for the development of chronic fatigue syndrome.
Solicited Adverse Events After Influenza Immunization Among Infants, Toddlers, and Their Household Contacts
Authors: Skowronski Danuta M. , Jacobsen Karen , Daigneault Jocelyne , Remple Valencia P. , Gagnon Linda , Daly Patricia , Arsenault Gillian , Landry Monique , Pielak Karen , Duval Bernard , Tam Theresa , De Serres Gaston
Published: June 2006

OBJECTIVES. We assessed adverse events, including oculorespiratory syndrome, following influenza immunization during the first year of a publicly-funded program for infants, toddlers and their household members in Canada.

METHODS. Parents bringing infants and toddlers for influenza immunization to clinics in Quebec or British Columbia consented to structured telephone interview 5 to 10 days later. One adult provided information for all household members. Symptom experience commencing before and after immunization was assessed. Non-immunized persons also served as a comparison group for immunized household members.

RESULTS. Sample included 690 immunized infants and toddlers and 1801 household members, 1374 immunized. Only fussiness, fever, decreased appetite, drowsiness, and nasal congestion/coryza were reported for >5% of infants/ toddlers within 72 hours of immunization, but only arm discomfort was reported among >5% of immunized household contacts. In multivariate analysis, muscle ache was the only systemic symptom reported more often by immunized household members compared to non-immunized persons. Oculorespiratory symptoms were infrequent and there was no difference between immunized and non-immunized household members in their report. Less than 1% of adults required time off work because of adverse events following influenza immunization in the household. Less than 2% of subjects experiencing an adverse event following influenza immunization were considered unlikely to be vaccinated again.

CONCLUSION. Influenza vaccine is well-tolerated by infants, toddlers and their household members. Post-marketing observational designs are an expedient way to assess adverse events following influenza immunization. These methods should be established and rehearsed annually in preparation for a pandemic.
Pediatric Residency Training in Child Abuse and Neglect in the United States
Authors: Narayan Aditee Pradhan , Socolar Rebecca R.S. , St Claire Karen
Published: June 2006

BACKGROUND. Child abuse and neglect are leading public health problems with significant morbidity and mortality. Previous studies indicate that physicians often lack knowledge and confidence in addressing child abuse and neglect.

OBJECTIVES. Our goal was to assess the child abuse and neglect curricula in pediatric residency programs as reported by chief residents and to identify levels of preparedness of residents to address child abuse and neglect on graduation. We analyzed variables related to preparedness.

METHODS. A 28-item survey was sent to chief residents of all 203 Accreditation Council for Graduate Medical Education–accredited pediatric residency programs in the United States from 2004–2005. We performed descriptive, bivariable, and multivariable analyses.

RESULTS. The response rate was 71%. Most programs taught didactics on physical and sexual abuse, but only 54% included domestic violence. Ninety-three percent of respondents rated their didactics as useful or very useful. Forty-one percent of programs required mandatory clinical rotations in child abuse and neglect, 57% offered elective rotations, and 25% offered no rotations at all. Respondents rated the levels of preparedness of graduating residents to address child abuse and neglect as: very well (12%), well (54%), somewhat well (28%), or not well (6%). Preparedness was significantly associated with didactic usefulness, number of hours of didactics, total number of inpatient cases of child abuse and neglect seen, percent of residents completing mandatory rotations, number of sexual abuse cases during mandatory rotation, number of physical abuse cases during mandatory rotation, and length of mandatory rotation.

CONCLUSIONS. Mandatory clinical experiences in child abuse and neglect improve the preparedness of graduating residents to identify and evaluate patients for child abuse and neglect. Perhaps residency training in child abuse and neglect should be a required subspecialty rotation with more explicit curricular content than in the current mandates.
In Vitro and In Vivo Photosensitization by Protoporphyrins Possessing Different Lipophilicities and Vertical Localization in the Membrane
Authors: Bronshtein Irena , Aulova Svetlana , Juzeniene Asta , Lanl Vladimir , Ma Li‐Wei , Smith Kevin M. , Malik Zvi , Moan Johan , Ehrenberg Benjamin
Published: June 2006

Photodynamic therapy (PDT) is being evaluated in clinical trials for treatment of various oncologic and ophthalmic diseases. The main cause for cell inactivation and retardation of tumor growth after photoactivation of sensitizers is very short‐lived singlet oxygen molecules that are produced and have limited diffusion distances. In this paper we show that the extent of biological damage can be modulated by using protoporphyrin, which was modified to increase its lipophilicity, and which also places the tetrapyrrole core deeper within the membrane by the carboxylate groups being anchored at the lipid: water interface. The uptake of the parent molecule (PPIX) and its diheptanoic acid analogue (PPIXC6) by WiDR and CT26 cells was investigated by fluorescence microscopy and by fluorescence intensity from the cells. The uptake of PPIXC6 increased almost linearly with incubation length for over 24 h, whereas for PPIX only 1h was needed to reach maximal intracellular concentration. Fluorescence microscopy of both cell lines indicated that both drugs were distributed diffusely in the plasma membrane and cytoplasm, but remained outside the nucleus. The efficiency of in vitro inactivation of WiDr and CT26 cells increased with the length of the alkylcarboxylic chain. Tumors in mice that were treated with PPIX‐PDT grew more slowly than control tumors. However, tumors that were given PPIXC6 followed by light exposure showed a significant delay in their growth.
Symposium‐in‐Print: Singlet Oxygen Invited Review
Authors: Redmond Robert W. , Kochevar Irene E.
Published: June 2006

Singlet oxygen (1O2) is unique amongst reactive oxygen species formed in cells in that it is an excited state molecule with an inherent upper lifetime of 4 μs in water. Whether the lifetime of 1O2 in cells is shortened by reactions with cellular molecules or reaches the inherent maximum value is still unclear. However, even with the maximum lifetime, the diffusion radius is only ?220 nm during three lifetimes (?5%1O2 remaining), much shorter than cellular dimensions indicating that the primary reactions of 1O2 will be subcellularly localized near the site of 1O2 formation. This fact has raised the question of whether spatially resolved cellular responses to 1O2 occur, i.e. whether responses can be initiated by generation and reaction of 1O2 at a particular subcellular location that would not have been produced by 1O2 generation at other subcellular sites. In this paper, we discuss examples of spatially resolved responses initiated by 1O2 as a function of distance from the site of generation of 1O2. Three levels are recognized, namely, a molecular level where the primary oxidation product directly modifies the behavior of a cell, an organelle level where the initial photo‐oxidation products initiate mechanisms that are unique to the organelle and the cellular level where mediators diffuse from their site of formation to the target molecules that initiate the response. These examples indicate that, indeed, spatially resolved responses to 1O2 occur in cells.
Nutrient and Trace Element Leaching following Mine Reclamation with Biosolids
Authors: Stehouwer Richard , Day Rick L. , Macneal Kirsten E.
Published: June 2006

Mine reclamation with biosolids increases revegetation success but nutrient addition well in excess of vegetation requirements has the potential to increase leaching of NO3 and other biosolids constituents. A 3‐yr water quality monitoring study was conducted on a Pennsylvania mine site reclaimed with biosolids applied at the maximum permitted and standard loading rate of 134 Mg ha−1 Zero‐tension lysimeters were installed at 1‐m depth 1 yr before reclamation: three in the biosolids application area, one in a control area (no biosolids). Before reclamation, all water samples had pH in the range 4.7 to 6.2, acidity <20 mg L−1, and very low levels of all other measured parameters. Following reclamation, percolate water in the biosolids‐treated area had lower pH and greater acidity than the control area. Acidity was greatest during the first winter following biosolids application, decreased during the spring, and showed a similar pattern but with much smaller concentrations the second year. Maximum first‐ year leachate NO3 concentrations were ∼300 mg L−1 and half as large the second year. Estimated inorganic N leaching loss during the first 2 yr after biosolids application was 2327 kg N ha−1 Aluminum, Mn, Cu, Ni, Pb, and Zn followed similar leaching patterns as did acidity, and their mobilization appeared to be the result of the increased acidity. These results indicate that large applications of low‐C/N‐ratio biosolids could negatively impact area water quality and that biosolids reclamation practices should be modified to reduce this possibility.
Comparison of Escherichia coli and Campylobacter jejuni Transport in Saturated Porous Media
Authors: Bolster Carl H. , Walker Sharon L. , Cook Kimberly L.
Published: June 2006

Due to the difficulties in testing for specific pathogens, water samples are tested for the presence of nonpathogenic indicator organisms to determine whether a water supply has been contaminated by fecal material. An implicit assumption in this approach is that where pathogenic microorganisms are present fecal indicator organisms are present as well; yet surprisingly few studies have been conducted that directly compare the transport of indicator organisms with pathogenic organisms in ground water environments. In this study we compared the cell properties and transport of Escherichia coli, a commonly used indicator organism, and Campylobacter jejuni, an important enteropathogen commonly found in agricultural wastes, through saturated porous media. Differences in cell properties were determined by measuring cell geometry, hydrophobicity, and electrophoretic mobility. Transport differences were determined by conducting miscible displacement experiments in laboratory columns. Under the experimental conditions tested, C. jejuni was much more negatively charged and more hydrophobic than E. coli In addition, C. jejuni cells were slightly longer, narrower, and less spherical than E. coli The variations in cell properties, primarily surface charge, resulted in significant differences in transport between these two microorganisms, with the transport of C. jejuni exceeding that of E. coli when conditions favored low attachment rates, thus calling into question the usefulness of using E. coli as an indicator organism for this important pathogen.
3,4‐Dimethylpyrazol Phosphate Effect on Nitrous Oxide, Nitric Oxide, Ammonia, and Carbon Dioxide Emissions from Grasslands
Authors: Menéndez S. , Merino P. , Pinto M. , González‐Murua C. , Estavillo J. M.
Published: June 2006

Intensively managed grasslands are potentially a large source of NH3, N2O, and NO emissions because of the large input of nitrogen (N) in fertilizers. Addition of nitrification inhibitors (NI) to fertilizers maintains soil N in ammonium form. Consequently, N2O and NO losses are less likely to occur and the potential for N utilization is increased, and NH3volatilization may be increased. In the present study, we evaluated the effectiveness of the nitrification inhibitor 3,4‐dimethylpyrazol phosphate (DMPP) on NH3, N2O, NO, and CO2emissions following the application of 97 kg N ha−1as ammonium sulfate nitrate (ASN) and 97 kg NH4+–N ha−1as cattle slurry to a mixed clover–ryegrass sward in the Basque Country (northern Spain). After slurry application, 16.0 and 0.7% of the NH4+–N applied was lost in the form of N2O and NO, respectively. The application of DMPP induced a decrease of 29 and 25% in N2O and NO emissions, respectively. After ASN application 4.6 and 2.8% of the N applied was lost as N2O and NO, respectively. The application of DMPP with ASN (as ENTEC 26; COMPO, Münster, Germany) unexpectedly did not significantly reduce N2O emissions, but induced a decrease of 44% in NO emissions. The amount of NH4+–N lost in the form of NH3following slurry and slurry + DMPP applications was 7.8 and 11.0%, respectively, the increase induced by DMPP not being statistically significant. Levels of CO2emissions were unaffected in all cases by the use of DMPP. We conclude that DMPP is an efficient nitrification inhibitor to be used to reduce N2O and NO emissions from grasslands.
Using Surface Water Application to Reduce 1,3‐Dichloropropene Emission from Soil Fumigation
Authors: Gao Suduan , Trout Thomas J.
Published: June 2006

High emissions from soil fumigants increase the risk of detrimental impact on workers, bystanders, and the environment, and jeopardize future availability of fumigants. Efficient and cost‐effective approaches to minimize emissions are needed. This study evaluated the potential of surface water application (or water seal) to reduce 1,3‐dichloropropene (1,3‐D) emissions from soil (Hanford sandy loam) columns. Treatments included dry soil (control), initial water application (8 mm of water just before fumigant application), initial plus a second water application (2.6 mm) at 12 h, initial plus two water applications (2.6 mm each time) at 12 and 24 h, standard high density polyethylene (HDPE) tarp, initial water application plus HDPE tarp, and virtually impermeable film (VIF) tarp. Emissions from the soil surface and distribution of 1,3‐D in the soil‐gas phase were monitored for 2 wk. Each water application abruptly reduced 1,3‐D emission flux, which rebounded over a few hours. Peak emission rates were substantially reduced, but total emission reduction was small. Total fumigant emission was 51% of applied for the control, 46% for initial water application only, and 41% for the three intermittent water applications with the remaining water treatment intermediate. The HDPE tarp alone resulted in 45% emission, while initial water application plus HDPE tarp resulted in 38% emission. The most effective soil surface treatment was VIF tarp (10% emission). Surface water application can be as effective, and less expensive than, standard HDPE tarp. Frequent water application is required to substantially reduce emissions.