bluuebunny/crossref_metadata_2025 huggingface dataset:
Self‐reported depressive symptoms in school‐age children at the time of entry into foster care*
Authors: Allen Elizabeth C , Combs‐Orme Terri , McCarter Robert J , Grossman Linda S
Published: March 2003

Objective To test the following hypotheses: (1) Children entering foster care report more depressive symptoms and have a higher prevalence of clinically significant depressive symptoms than children not in care. (2) Demographic and historical data can predict which children in foster care are at highest risk for depression.

Design Cross‐sectional study, including a comparison group.

Setting Foster Care Health Program in Baltimore, Maryland, and Baltimore City Public Schools.

Methods We administered the Children’s Depression Inventory (CDI) to 160 school‐age children entering foster care and to a comparison group of 60 urban, African‐American school children.

Results Children entering foster care had higher mean CDI scores than children in published norms (p < 0.03). A similar difference in CDI scores between children in foster care and urban, African‐American children did not reach statistical significance. Prevalence of clinically significant depressive symptoms did not differ significantly between the children in foster care, published norms, and comparison group (13.8, 10 and 8.3%, respectively). Depressive symptoms in children entering foster care were associated with age, but not with gender or ethnicity; parental history of affective disorder or substance abuse; history of abuse or neglect; or previous foster care or mental health treatment.

Conclusions Children entering foster care report more depressive symptoms than children in published norms. The prevalence of clinically significant depressive symptoms is similar for children in foster care, published norms, and urban, African‐American children. Depressive symptoms in children entering foster care are associated with age, but not with other demographic and historical variables.

Implications for Practice Children entering foster care should be a particular priority for mental health screening, with early mental health treatment when indicated.
Recurrent periorbital zosteriform herpes simplex virus infection in childhood
Authors: Villalobos Tibisay , McMahon Megan C , Rathore Mobeen H
Published: March 2003

Introduction Zosteriform herpes simplex virus (HSV) infection is an uncommon presentation of HSV recurrent cutaneous infection and it is usually misdiagnosed as zoster.

Methods We report a series of consecutive cases of zosteriform HSV that we recently managed.

Results Four cases of recurrent zosteriform HSV infection in the second division of the trigeminal nerve were seen. Immunologic evaluation determined that the patients were immunocompetent. Culture and/or direct fluorescent stain diagnosed HSV. No ocular involvement was present, and all patients responded to oral acyclovir.

Recommendations Clinicians should suspect HSV infection in patients with recurrent vesicular lesions with zosteriform appearance. Immunologic evaluation is not necessary; however, ophthalmologic examination to exclude ocular involvement is required. Oral acyclovir is useful for treatment.
A study of the efficacy of antipyretic drugs in the prevention of febrile seizure recurrence
Authors: Esch Adrianus van , Steyerberg Ewout W , Moll Henriëtte A , Offringa Martin , Hoes Arne W , Habbema J Dik F , Derksen‐Lubsen Gerdarda
Published: March 2003

ObjectiveTo estimate the potential preventive effect of antipyretic drugs on the recurrence of febrile seizures (FS).

DesignAn experimental and a descriptive patient series, both prospectively followed, were combined in this study.

Setting/participantsChildren who visited the outpatient department of the Sophia Children’s Hospital because of a FS experienced between the age of 10 and 36 months.

InterventionA treatment group of 109 children was offered treatment with ibuprofen or acetaminophen syrup during fever, a control group of 103 children was not offered antipyretic treatment. This was not a randomized trial. In an intention‐to‐treat analysis, the risk of any recurrence and the number of recurrences per fever were compared between both groups. In an additional on‐treatment analysis, we compared the number of recurrences per fever between the control group and the children in the treatment group who actually received the study medication during fever. Effect measures were odds ratio (OR) as estimated by the Mantel–Haenszel procedure and hazard ratios (HR) as estimated by Cox regression.

ResultsAccording to the intention‐to‐treat analysis, the hazard ratio of any recurrence in the treatment group compared with the control group was 1.1 [95% confidence interval (CI), 0.7–1.8]. The recurrence risk per fever was 15% in the treatment group and 12% in the control group (OR, 1.2; 95% CI, 0.7–2.3). In the exploratory on‐treatment analysis, the recurrence risk in the treatment group was estimated 6.9% in the treatment group versus 12% in the control group (OR, 0.5; 95% CI, 0.2–1.3).

Conclusions/implications for practiceWe conclude that antipyretic treatment may have little or no preventive effect on the recurrence of febrile seizures in common practice. Some reduction of the risk of a recurrence may be acquired under optimal circumstances, namely that fever is noticed at once and that antipyretic drugs can be administered on time.
Provision of health and education services in school children with chronic fatigue syndrome
Authors: Tillett Angela , Glass Sharon , Reeve Anne , Burt Annette
Published: March 2003

Background Chronic fatigue syndrome (CFS) in childhood may have a profound effect on a child's life in terms of schooling, social activity and family interaction. Many reports have been based on specialist clinics with little information about CFS in children in the general population and the health and education services provided.

Objectives To review cases of CFS in school age children (5–18 years) within the East Suffolk area and determine the health and education services provided.

Methods Cases were identified by consultation with the three local health trusts and the education department. Provision of services was determined by review of hospital and school health records. School attendance was determined by postal questionnaire to the school in each case.

Results A total of 32 cases were identified, with diagnosis at a peak age of 15 years and 5.8 months as the mean duration of symptoms prior to diagnosis. Some 28 cases were referred by their GP to an acute paediatrician. Only one case was referred to the school medical service. The majority (28/32) received a rehabilitation programme provided by either a child psychiatrist or physiotherapist. Only half the cases were attending school more than half‐time and 10 were not attending school at all and were receiving home tuition. Two of these had never received local paediatric review to confirm the diagnosis or plan management. Follow‐up was highly variable and rarely involved school medical services.

Implications A significant number of children with CFS were identified in this semirural school‐age population. Poor involvement of community child services reduced the opportunity for liaison between health and education and made identification of cases difficult. Paediatric review should be mandatory before home tuition is instituted, appropriate referral to psychiatric services encouraged and regular school follow‐up organized to review progress. Close liaison between all health and education services is imperative in planning the provision of services and providing a coherent programme of rehabilitation.
Prevalence of elevated blood lead levels in nigerian children
Authors: Pfitzner Mark A , Thacher Tom D , Pettifor John M , Zoakah A I , Lawson Juliana O , Fischer Philip R
Published: March 2003

Objective

To determine the prevalence and risk factors of elevated blood lead levels in young, urban Nigerian children.

Design

A randomized cluster sample of children aged 6–35 months.

Setting

Jos, a community in north central Nigeria.

Outcome measurement

Blood lead level.

Results

Of 218 children evaluated, 70% of the children had blood lead levels in excess of 10 μg/dL. Mean blood lead levels were 15.2 ± 1.4 μg/dL; median blood lead concentration was 12.0 (range 1– > 60 μg/dL). Mean lead concentrations were higher in those who professed the Islamic faith, used eye cosmetics, lived near a battery smelter, or lived in a certain geographical area. Pica was not associated with increased blood lead concentrations. Forward stepwise regression analysis revealed religion, area of residence, and proximity to a battery smelter as the variables which jointly predicted increased blood lead concentrations.

Conclusion

A majority of the studied children in Jos, Nigeria have lead levels placing them at risk for intellectual impairment. The cause of lead intoxication appears to be multifactoral. Further studies should investigate the causality of these associations prior to the implementation of a primary preventive public health measure.
Denial of authorization to pediatric managed‐care patients at an urban emergency department
Authors: Kohlmeier Pamela S , Zautcke John L , Fraker Lesa D , Stevens Jeremy S
Published: March 2003

Objective To assess whether some pediatric Health Maintenance Organization (HMO) patients denied authorization for payment of emergency department (ED) services do not meet established nonemergent triage criteria and thus might be at risk for poor outcomes.

Design A consecutive case surveillance.

Setting and participants A Chicago inner city university‐based ED with a total patient volume of 42 000 patient visits per year, of which 30% are pediatric. Managed care is approximately 20%. Participants who were denied authorization for payment of ED services by their HMO were age 0–16 and subsequently left the ED without treatment.

Variables studied Data were collected from the ED nurse's triage notes. Chief complaint, vital signs, and focused examination were used to categorize patients as emergent, urgent, or nonemergent based on previously published pediatric emergency department triage criteria.

Results A total of 83 pediatric HMO patients between 0 and 16 years of age were denied authorization for payment of ED services and subsequently left the ED without treatment in the study period. Of these, only eight patients (9.6%) met criteria to be categorized as nonemergent, and 75 (90.4%) met criteria to be categorized as emergent or urgent. Of these 75 patients, 17 (22.7%) had abnormal vital signs as the sole criteria for the emergent/urgent categorization, 16 (21.3%) had chief complaints considered emergent, and 42 (56.0%) had chief complaints considered urgent. One patient was not categorized into either group because he had left the ED before his HMO's authorization decision was rendered.

Conclusion The results suggest that many of our pediatric HMO patients denied payment for ED services are being placed at risk for poor outcomes. The results highlight the haphazard nature of telephone authorization by HMOs and question the safety of this triage practice. The patients who are denied authorization for payment of ED services and subsequently leave the ED need to be further studied to determine their ultimate outcomes.
Sexual health services: what do teenagers want?
Authors: Wilson Andrew , Williams Rosemary
Published: March 2003

Background Multi‐agency approaches based on assessment of local need have been recommended to reduce the incidence of teenage pregnancy. This paper explores the views of local teenagers on current and future provision of sexual health services in one part of Leicester, UK.

Aim To examine current provision and the views of teenagers on how these could be improved.

Method A questionnaire was developed from literature review and focus group interviews. It was administered to 13–16‐year‐olds in two schools, and by post to 16–19‐year‐olds, using the age‐sex registers of five of the seven local practices.

Results Of the 399 school attenders aged 13–16 years sampled, 394 (98.7%) completed the questionnaire. The postal questionnaire was sent to 1255 teenagers aged 16–19 years. After removal of wrong addresses, the response rate was 317 of 1213 (26.1%). In total, 711 people completed the questionnaire, of whom 459 (64.6%) were male. General practitioners and pharmacists were the main suppliers of contraception for females and males, respectively, with lack of awareness of the range and location of sexual health services. Major barriers included fears about embarrassment, confidentiality and being examined, especially in general practice.

Conclusions Our results suggest that in this locality, the priority should be informing teenagers about existing services, and ensuring confidentiality is both practised and publicised. A leaflet to this effect has been produced and disseminated.

Implications for practice Qualitative and quantitative methods are helpful in assessing local need for teenage services and in directing their development.
Not yet ‘Back to Sleep’: sleep position for infants in two inner‐city clinics
Authors: Colson Eve R , Stille Christopher J , Payton Jessica , Bernstein Bruce , Dworkin Paul
Published: March 2003

Objective To estimate the occurrence of prone sleep among a group of infants in two inner‐city clinics and examine the factors associated with parents' choice of sleep position

Methods A convenience sample of 80 parents (76 mothers and 4 fathers) was interviewed between June and October 1997, during their healthy, term infant's 2‐week health supervision visit. The interview included questions about sleep position practices, knowledge, and beliefs; knowledge about Sudden Infant Death Syndrome (SIDS); education about SIDS; and socio‐demographic data. All participants received post‐interview SIDS education.

Results Thirty‐one percent of parents reported that they placed their infants to sleep in the prone position at least some of the time. Factors associated with prone sleeping included prior child‐rearing experience (P = 0.005) and the opinion of other people that were regarded as important (P = 0.0001). Only 20% of parents usually had their child sleep on its back. The majority worried that the child would vomit and choke while lying on its back. Parents who chose to position their infant to sleep on its back were less likely to describe themselves as Hispanic (P = 0.025) and more likely to remember being told to have the infant sleep on its back by a health care provider (P = 0.001). Just over one‐half of parents recall receiving sleep position instructions from a health care provider. More than 60% of these parents remember being told to place the infant on the side, 24% the back and none prone. Teen parents were more likely to remember being given sleep instructions (P = 0.033). Parents with older children were less likely to remember receiving sleep position instructions (P = 0.001).

Conclusions/implications for practice Many parents in our urban practice still put their children to sleep in the prone position at least some of the time. Family and friends, as well as prior child‐rearing experience influence the choice. Parents are more likely to choose the supine position if they are instructed to do so by a health care provider. However, many parents do not recall such instruction being routinely given by their health care provider and have concerns for the safety of supine sleeping. Efforts to promote sleeping on the back should address parental concerns and health care provider practice.
Addressing barriers to change: an RCT of practice‐based education to improve the management of hypertension in the elderly.
Authors: Bhrolchain Cliona Ni
Published: March 2003

Method A randomised, single‐blind, controlled trial of incorporating an exploration of barriers to changing practice into an educational strategy for GPs was conducted in 18 practices. Both groups of practices received visits during which they received the results of a previous audit on the management of hypertension in the elderly. The nine intervention practices were encouraged to explore barriers that would prevent them from implementing the pertinent research findings, in addition to an exploration of the issues and creation of a practice action plan. Control groups received the education without the element of exploring barriers to change. The outcome measures were changes in response to a questionnaire before and after the educational intervention.

Results There were statistically significant differences between the two groups after the educational visit. Those practices who were encouraged to explore barriers to change were more likely to show change in behaviour compared to the control group. All the intervention practices produced an action plan for improving the performance, whereas none of the controls did so. The intervention practices also showed more concordance in management protocols after the intervention.

Conclusion Addressing the barriers preventing practitioners from implementing research findings is effective in implementing change.
Pharmacotherapy of attention‐deficit/hyperactivity disorder reduces risk for substance use disorder.
Authors: Nathwani Ashok
Published: March 2003

The aim of this study (from Massachusetts General Hospital and Harvard School of Public Health) was to assess the risk for substance use disorders (SUD) associated with previous exposure to psychotropic medication in a longitudinal study of boys with attention‐deficit/hyperactivity disorder (ADHD). The incidence of SUD throughout adolescence was compared in a sample of 56 medicated subjects with ADHD, 19 nonmedicated subjects with ADHD, and 137 non‐ADHD control subjects. Nonmedicated subjects with ADHD were at a significantly increased risk for any SUD at follow‐up compared with non‐ADHD control subjects. Subjects with medicated ADHD were at a significantly reduced risk for a SUD at follow‐up relative to nonmedicated subjects with ADHD. The take‐home message was that untreated ADHD was a significant risk factor for SUD in adolescence, but pharmacotherapy was associated with a significantly reduced risk.
Environmental illness: educational needs of pediatric care providers
Authors: Woolf Alan , Cimino Sabrina
Published: March 2003

Background Assessing the impact of children's exposures to environmental toxins is an emerging new subspecialty in clinical pediatrics. However, pediatric health professionals in practice may not be familiar with critical information necessary to diagnose and manage environmental toxic exposures in children.

Objective The objective of this study was to investigate the perceptions of pediatricians, nurses, and nurse practitioners regarding their own practices and educational needs concerning pediatric environmental exposures.

Methods Health professionals attending a general pediatric postgraduate course were administered a 22‐item questionnaire on their practices and educational needs in children's environmental health.

Results A total of 93% of participants returned usable questionnaires. Within the previous 6 months, over 90% of pediatricians and nurse practitioners had diagnosed food poisoning; almost 50% had diagnosed lead poisoning; 50% had diagnosed a child's illness as due to exposure to a toxic chemical; and 24% had diagnosed ‘building‐related illness.’ Although 90% of pediatricians and 82% of nurses and nurse practitioners stated that they routinely asked families about parental occupations, only 35% of both groups asked about parental hobbies. Only 58% of the groups asked about smoke detectors in the home, and only 18% of nurses and 9% of pediatricians queried families about their use of radon detectors. Over 70% of all three groups indicated a high interest level in the following postgraduate educational topics: taking in environmental history, breast milk contaminants, food allergies, food contamination, and illness related to tobacco smoke. Topics that did not garner as high an interest level included: childhood lead poisoning, radon poisoning, and building‐related illness.

Conclusion Pediatric health professionals commonly diagnose environment‐related illnesses, and they include such topics during well child care. They indicate a variety of educational needs concerning pediatric environmental health issues.

Implications for practice Health care professionals are increasingly asked by parents to include environmental toxins among the possible causes of a child's ill health. Our results suggest that clinicians recognize their own need for further training in the principles of pediatric environmental health. Further research is needed in determining which modalities are best suited to achieve such educational objectives.
Normal bowel habit during the first 6 weeks in healthy, term infants
Authors: Griffin Anna , Beattie R Mark
Published: March 2003

Objective The bowel habit in the first few weeks is relevant in the assessment of symptoms which are often nonspecific and may or may not be indicative of underlying pathology. There is very little available data. We therefore undertook a study to investigate the normal bowel habit in healthy, term infants.

Design, setting and sample Infants were assessed by the health visitor at the initial contact (10–14 days) and at the 6‐week check. Details of feeding method and bowel habit were collected by simple questionnaire.

Results A total of 238 infants were recruited after 14 exclusions; 87.3% of babies passed meconium within 24 and 99.2% within 48 hours of birth. The majority of infants at 2 weeks passed at least one stool every day (95.3%). At 6 weeks most babies (87.8%) continued to pass a daily stool, although the range widened, with 98.3% passing a stool within the range three or more per day to once every 3 days.

Implications for practice This study suggests in the first 2 weeks of life that most infants have a daily bowel motion. By 6 weeks, although the range has increased, 98.3% will have a bowel motion at least once every 3 days. This means a bowel frequency of less than every 3 days is unusual and requires consideration of underlying pathology.
The Swiss paediatrician and the social problems of families
Authors: Carrel Rebecca , Klingler Jean , Ryffel Meinrad , Vuille Jean‐Claude , Westkæmper Reinhard , Zumstein Matthias
Published: March 2003

Objective The objective of this section of the study ‘Schoolchildren in the Pediatric Practice’ was to describe the current experiences of the practising paediatrician in dealing with the social problems of their patients and families.

DESIGN For the base study, paediatricians in private practice used a standardized form to register schoolchildren who came to the practice on selected days during the two year‐long research segments. Personal, demographic, social and medical information was recorded. During the semi‐structured interview at the end of the study, each paediatrician contributed highly personal examples, insights, and opinions about the psycho‐social dimension of childcare.

SETTING AND SAMPLE Thirty‐four paediatricians practising in the canton of Bern, Switzerland collected a sample of 5971 schoolchildren, aged 6–16 years.

Results The paediatricians recorded a definite or suspected case of social problems in the schoolchild's family in 20% of the sample. Quotations from the physicians are used to illustrate what kind of problems they see, how they access information, how willing they are to assist with a problem, and how well formal training prepared them for the task. A total of 83% of the paediatricians denounced the inadequacies of their formal preparation in this area.

Implications To better prepare the paediatrician for a job with an increasing psycho‐social dimension, it is recommended to develop a model curriculum in psycho‐social paediatrics, to increase the use of the option for a practicum in a private practice during formal training, to press for coverage by health insurance for a wider scope of activities, and to address the issues implicated in networking with other child‐assistance professionals.
Children and famine: long‐term impact on development
Authors: Galler Janina R , Barrett L Robert
Published: March 2003

The current and long‐term effects of famine and malnutrition on cognitive and behavioral development are reviewed. The brain is vulnerable to the effects of insults during critical periods of brain development from the second trimester of pregnancy until 2 years of age. Malnutrition experienced at these ages will have lifelong consequences that are not reversed by adequate nutrition. Long‐term effects of prenatal, postnatal and childhood malnutrition have been reported even after a long period of recovery from the illness itself. We summarize results of our longitudinal study in Barbados in which we followed individuals, now 28–34 years of age, who experienced moderate to severe malnutrition during their first year of life and a healthy comparison group from the same classrooms. Our studies showed that malnutrition had a negative impact on cognitive and behavioral functioning throughout childhood and adolescence, even after controlling for socioeconomic conditions and other factors in the home environment. The most striking finding in our series of studies was a fourfold increase from 15% to 60% in the frequency of attention deficit disorder following infantile malnutrition. Attention deficits persisted at least through adolescence and was closely associated with poor performance on a national high school examination at 11 years of age. We conclude that, under conditions of famine, it is important to include early and comprehensive interventions to reverse not only medical conditions resulting from malnutrition, but also cognitive and behavioral deficits arising from famine. In the absence of appropriate interventions, compromised behavioral function may continue long beyond the episode, may impact on the quality of life over the long‐term of survivors, and increase costs to society.
Response to the 1999 earthquakes by paediatric training centres in Turkey: a call for action
Authors: Ertem Ilgi Ozturk , Cin Sukru
Published: March 2003

OBJECTIVE To assess the response of Turkish paediatric residency training centres to the two earthquakes that hit Turkey in 1999, causing a total of 18 310 deaths and affecting a population of approximately 2 million.

METHODS A semi‐structured questionnaire was mailed to the directors of all 26 major paediatric training centres in Turkey. This questionnaire requested information on whether the centres: sent monetary aid, supplies, or paediatricians to the sites; treated child casualties; or developed programmes to enhance health care delivery to children affected by the disaster.

RESULTS Of the 21 training centres that responded to the questionnaire, 90% provided monetary aid or supplies, and 73% sent paediatricians to the sites. Although a total of 236 paediatricians from these centres volunteered or were employed at the sites, most were involved in caring for adults as well as children and were unable to provide continuous programmes for children. Paediatric training centres collaborated most frequently with the Ministry of Health and non‐governmental organizations in delivering services but collaboration with UNICEF and the Turkish paediatric associations was rare. More than half of the centres identified a need for training in disaster management and for organizing programmes related to the special needs of children in advance of disasters.

CONCLUSIONS Despite the immediate mobilization of paediatric training centres after the earthquakes in Turkey, comprehensive health care services to children did not receive a paediatric input. A collaborative multidisciplinary model led by experienced paediatricians that serves children and their families specifically is needed during and after disasters.
Pediatric issues in complex emergencies
Authors: Burkle Frederick M
Published: March 2003

Complex emergencies represent the final pathway of disrupted states leading to conflict and war. Victims of complex emergencies are primarily civilians, with children predominating. The decade of the 1990s has led to the professionalization of relief workers and improved standards of care. Pediatric providers have assumed roles as consultants, advocates and practitioners of care, but future requirements call for increased capacity and capability to meet pediatric demands.
Hyperbaric oxygen for children with cerebral palsy: a randomised multicentre trial.
Authors: Reading Richard
Published: March 2003

Background The use of hyperbaric oxygen for children with cerebral palsy has spread worldwide, despite little scientific evidence of efficacy. We carried out a randomized trial to assess the efficacy and side‐effects of this form of therapy in children with cerebral palsy.

Methods One‐hundred and eleven children with cerebral palsy aged 3–12 years were randomly assigned hyperbaric oxygen (n = 57) or slightly pressurized room air (n = 54). All children received 40 treatments over 2 months. Hyperbaric oxygen treatment was 1 hour in 100% oxygen at 1.75 atmospheres absolute (ATA); children on slightly pressurized air received air at 1.3 ATA (the lowest pressure at which pressure can be felt, thereby ensuring the maintenance of masking). The main outcome measure was gross motor function. Secondary outcomes included performance in activities of daily living, attention, working memory, and speech.

Findings For all outcomes, both groups improved over the course of the study, but without any difference between the two treatments. The score on the global gross motor function measure increased by 3.0% in the children on slightly pressurized air and 2.9% in those on hyperbaric oxygen. The mean difference between treatments was –0.40 (95% CI –1.69 to 0.90, p = 0.544). Other changes were seen in speech, attention, memory, and functional skills. Ear problems occurred in 27 children treated by hyperbaric oxygen and in 15 treated with hyperbaric air (p = 0.004).

Interpretation In this study, hyperbaric oxygen did not improve the condition of children with cerebral palsy compared with slightly pressurized air. The improvement seen in both groups for all dimensions tested deserves further consideration.

Hyperbaric oxygen is not commonly sought as a complementary treatment for cerebral palsy in the UK, but clearly is in other parts of Europe. If parents do raise this as a possible option then it is very useful to have some scientific information available. This paper confirms what common sense suggests. It is hard to postulate a mechanism whereby hyperbaric oxygen could alter the underlying processes leading to the movement disorder in cerebral palsy. The authors make much of the improvement seen in both treatment and placebo groups but conclude that the active involvement of motivated parents, children and therapists in a trial probably explains this non‐specific but substantial improvement.
Child development services in Medicaid managed care organizations
Authors: Berry Carolyn A , Butler Pamela M , Budetti Peter P
Published: March 2003

Objective We explored the current state of developmental screens, child development services, mechanisms to fund screens and services, and incentives for adopting new services within managed care organizations serving Medicaid enrolees.

Design National, cross‐sectional mail survey.

Sample/setting Survey of 388 Medicaid managed care organizations (MMCO) enrolling children in 1998–99.

Results Most of the 155 plans that responded provided an array of developmental screenings and services, funded primarily through internal mechanisms or under Early and Periodic Screening, Diagnostic and Treatment (EPSDT) programs. Plan contacts expressed interest in implementing new services, particularly if additional funding was available. The most important motivators included requiring services in the Medicaid contract, enhanced capitation rates, and demonstration that providing child development services would reduce other utilization costs.

Conclusions If state Medicaid agencies want to enhance the child development services available through health plans, they could initiate steps such as requiring child development services in contracts with plans or providers; revising EPSDT language and engaging in more consistent enforcement; and enhancing capitation rates. More research on effectiveness and benefits of specific developmental screens and services is needed.
Long‐term management of obesity in paediatric office practice: experimental evaluation of two different types of intervention
Authors: Nova Aurelio , Russo Antonio , Sala Elisabetta
Published: March 2003

Objective To compare two types of intervention intended to reduce weight in obese children that can be carried out in the family paediatricians (FPs) office.

Design Controlled prospective study with randomization of FPs into two different treatment groups: routine approach (group A) and enhanced approach (group B).

Settings FPs of certain ASL (Local Health Units) in Lombardy (Northern Italy).

Subjects Obese children (excess weight (≥20% of ideal body weight), aged 3–12 years.

Main outcome measures (1) Variation in percentage overweight; (2) behavioural modifications and (3) adherence to follow‐up visits, which was also used as an indicator for FP's commitment.

Results A total of 18 of the 139 (13%) FPs contacted agreed to participate in the study and enrolled 186 children, 114 in group A and 72 in group B. Compared with starting values, a reduction in percentage overweight was observed in both groups. This reduction was significantly higher in group B (–8.8% at 6 months; –8.5% at 12 months) than in group A (–2.9% at 6 months; –2.9% at 12 months). In group B, the observed reduction in weight was associated with the changes in dietary behaviour and with the level of parental involvement. No significant variations in physical activity, computer or television use were noted within each group from 0 to 12 months and between groups at these times. The attendance of children at the 12‐month follow‐up visit was 70.2% (80/114) in group A and 69.4% (50/72) in group B; however, these values varied considerably when individual FP were considered.

Conclusions This study indicates that FPs who maintain a positive, long‐lasting, active contact with obese children and their families can significantly enhance the child's ability to lose weight.
Accuracy of assessment: the discriminative and predictive power of the Eyberg Child Behavior Inventory
Authors: Rich Brendan A , Eyberg Sheila M
Published: March 2003

Objective The discriminative and predictive power of the Eyberg Child Behavior Inventory (ECBI) was assessed using revised clinical cut‐off scores. Sensitivity, specificity, and positive and negative predictive power were calculated to evaluate the effectiveness of the revised score in screening children for treatment of disruptive behavior problems.

Sample Participants were drawn from archival samples of 196 children aged 3–6 whose mothers had completed an ECBI. The disruptive behavior group (n = 98) consisted of children referred for psychological treatment who met diagnostic criteria for Oppositional Defiant Disorder or Conduct Disorder. The non‐diagnosed group (n = 98) consisted of children visiting pediatric clinics whose mothers did not check the box on their demographic information questionnaire endorsing the presence of behavior problems.

Design Children in the non‐diagnosed group were selected to match the disruptive behavior group on socio‐economic status, age, and sex. The mothers' scores on the ECBI Intensity Scale were used to calculate the sensitivity and specificity, positive and negative predictive power, and kappa of the ECBI.

Results The ECBI Intensity Scale correctly classified 91% of the children, with 96% of the diagnosed children correctly classified and 87% of the non‐diagnosed children correctly classified.

Implications for practice This study further validates the ECBI for use as a screening measure for children in pediatric settings who require further evaluation or treatment for disruptive behavior problems.
Spatial clustering of emergency department visits by asthmatic children in an urban area: south‐western Detroit, Michigan
Authors: Meliker Jaymie R , Nriagu Jerome O , Hammad Adnan S , Savoie Kathryn L , Jamil Hikmet , Devries Jeffrey M
Published: March 2003

Objective This ecological study evaluates the correlation of asthma clusters with outdoor air pollution, race, and household income in South‐western Detroit, Michigan.

Design To attain this objective (1) a geographic information aystem (GIS) is utilized to evaluate the relationships between rates of emergency department (ED) admissions for asthma, race, and socio‐economic status at the neighborhood block group level of analysis; (2) cluster statistical analyses are performed using Geomed software; and (3) the asthma risk from industrial air pollution was evaluated with windrose data and Screen3 air pollution model.

Sample Data from five major hospitals with ED admissions of asthma patients (code 493), aged 0–15 years, are used to select a region of analysis with good geographical representation based on the catchment areas of hospitals in the study. A total of 2067 of the reported cases between 1 January 1993 and 30 June 1998, are successfully geocoded to a map, generating a no‐match rate of 8.4%. Data on racial characteristics, population density, and household income levels are obtained from neighborhood block groups in the 1990 census report. Locations of major polluting industries within the study area are obtained from the Toxics Release Inventory.

Results Spatial analysis identified a local asthma cluster roughly 2 km east (the predominant downwind direction) of the second and third largest air polluters (in terms of tonnage) in Wayne County. Evaluation of the industrial pollution with a focused cluster test, Screen3 air pollution model, and windrose figures, displayed weak association between ED asthma admissions and estimated levels of outdoor air pollution from these two facilities. The neighborhood block groups in the local asthma cluster are more closely correlated with high proportions of African Americans and low median household income.

Implications for practice This study illustrates the strengths and weaknesses of GIS in the public health arena. It highlights the difficulty of disentangling the effects of exposure to outdoor air pollutants and socio‐economic factors on ED asthmatics (reflecting asthma severity) among an urban population. This study also illustrates the need for population‐based, as opposed to hospital‐based, asthma data, and the need for block‐groups, as opposed to zip codes, as a spatial unit of analysis in the evaluation and analysis of asthma‐related risk factors.
Effect of recolonization with ‘interfering’ streptococci on recurrences of acute and secretory otitis media in children: randomised placebo controlled trial.
Authors: Reading Richard
Published: March 2003

Objective To study the effect of recolonization with streptococci with the ability to inhibit the growth of otopathogens (‘interfering’ activity) on the recurrence of acute otitis media in susceptible children and the effect on the frequency of secretory otitis media.

Design Double blind, randomized, placebo controlled study.

Setting Ear, nose, and throat clinic with three doctors.

Participants One hundred and thirty children prone to otitis media aged between 6 months and 6 years, 108 of whom were eligible and followed for 3 months.

Main outcome measures Recurrence of otitis media during follow up and a normal tympanic membrane at the last valid visit.

Interventions Children with no recurrences during the last month received phenoxymethylpenicillin (n = 22), and those with a recurrence within 1 month received amoxicillin clavulanic acid (n = 86), both twice daily for 10 days. These were followed by a streptococcal or placebo solution sprayed into the nose for a further 10 days. At day 60 the same spray was started for another 10 days.

Results At 3 months 22 children (42%) given the streptococcal spray were healthy and had a normal tympanic membrane compared with 12 (22%) of those given placebo. This difference was shown separately for recurrences of both acute otitis media and secretory otitis media.

Conclusions Selected bacteria with the ability to inhibit the growth of common otopathogens can be used to protect against recurrent acute otitis media and secretory otitis media in children.

I was not aware of this group's work, but it seems to make sense. However, before becoming too excited it is worth remembering that the effect size is relatively modest. Although the authors make the important point that this will have a large potential effect at a population level, a lot of this will depend on how confident patients and parent will be that it works, otherwise there will continue to be a demand for antibiotics for upper respiratory tract infections. These results clearly need to be replicated by other investigators.
Probiotics in primary prevention of atopic disease: a randomised placebo‐controlled trial.
Authors: Reading Richard
Published: March 2003

Background Reversal of the progressive increase in frequency of atopic disease would be an important breakthrough for health care and wellbeing in Western societies. In the hygiene hypothesis this increase is attributed to reduced microbial exposure in early life. Probiotics are cultures of potentially beneficial bacteria of the healthy gut microflora. We assessed the effect on atopic disease of Lactobacillus GG (which is safe at an early age and effective in treatment of allergic inflammation and food allergy).

Methods In a double‐blind, randomized placebo‐controlled trial we gave Lactobacillus GG prenatally to mothers who had at least one first‐degree relative (or partner) with atopic eczema, allergic rhinitis, or asthma, and post‐natally for 6 months to their infants. Chronic recurring atopic eczema, which is the main sign of atopic disease in the first years of life, was the primary endpoint.

Findings Atopic eczema was diagnosed in 46 of 132 (35%) children aged 2 years. Asthma was diagnosed in six of these children and allergic rhinitis in one. The frequency of atopic eczema in the probiotic group was half that of the placebo group [15/64 (23%) versus 31/68 (46%); relative risk 0.51 (95% CI 0.32–0.84)]. The number needed to treat was 4.5 (95% CI 2.6–15.6).

Interpretations Lactobacillus GG was effective in prevention of early atopic disease in children at high risk. Thus, gut microflora might be a hitherto unexplored source of natural immunomodulators and probiotics, for prevention of atopic disease.

Another study on probiotics, this one suggesting they may modulate the immune response in infants and so prevent atopic disease. This study suggests how the hygiene hypothesis may work, and how we might use it to successfully intervene. There is an important matter of timing, both this paper and an editorial (Murch SH (2001) Toll of allergy reduced by probiotics. Lancet357: 1057–1059) point out that these babies guts were colonized immediately at birth. If so then this could be another example of programming.

It is important not to get too carried away by the results of a small number of studies, but the message from these three is that our understanding of interactions between bacteria, hosts and the environment is entering a new phase, and one that may hold out many promises for therapeutic and preventive interventions.
Age‐related changes of the 3′APOB‐VNTR genotype pool in ageing cohorts
Authors: De BENEDICTIS G. , CAROTENUTO L. , CARRIERI G. , De LUCA M. , FALCONE E. , ROSE G. , YASHIN A. I. , BONAFÈ M. , FRANCESCHI C.
Published: March 2003

The analysis of seven different age cohorts (697 individuals from 10 to 109 years old) revealed age‐related changes in the 3′APOB‐VNTR genotype pool. By recoding the 3′APOB‐VNTR alleles into three size‐classes (small, S, 26–34 repeats; medium, M, 35–39 repeats; large, L, 41–55 repeats), an age‐related convex trajectory of the frequency of SS homozygotes was found. The frequency of SS in the genotype pool increased from the group aged 10–19 years (3.06±1.74%) to that aged 40–49 years (8.51±4.07%). Then it declined reaching the minimum value in centenarians (1.58±0.90%). The observed trajectory is in agreement with that expected by assuming crossing of mortality curves relevant to subgroups of individuals having different genotypes.
Hidden linkage: a comparison of the affected sib pair (ASP) test and transmission/disequilibrium test (TDT)
Authors: McGINNIS R. E.
Published: March 2003

I compare the transmission/disequilibrium test (TDT) and affected sib pair (ASP) test under a general algebraic model describing a bi‐allelic disease locus. Assuming linkage to a bi‐allelic marker, I derive two binomial probabilities, one for parental allele ‘transmission’ (Pt ) which determines the magnitude of the TDT χ2 statistic (χ2tdt), and a second for identity‐by‐descent (ibd) marker allele ‘sharing’ (Ps) which determines the magnitude of the ASP test statistic (χ2asp). I also consider the ASP test applied to a completely polymorphic marker and demonstrate that the probability of ASP marker allele sharing (Ps) is identical to Ps observed for a bi‐allelic marker in equilibrium with the disease locus. I present a general framework for determining the power of the TDT and ASP test based on expressions for Pt, Ps and the proportion (H/F) of ascertained parents who are informative at the marker. Two previous analytic investigations of TDT power based on the work of Ott (1989), and Risch & Merikangas (1996) are shown to be special cases of this general framework. In addition, I show the relationship between the framework I present and a third analytic investigation of TDT power for multi‐allelic markers based on the work of Sham & Curtis (1995).
Lactase haplotype frequencies in Caucasians: association with the lactase persistence/non‐persistence polymorphism
Authors: HARVEY C. B. , HOLLOX E. J. , POULTER M. , WANG Y. , ROSSI M. , AURICCHIO S. , IQBAL T. H. , COOPER B. T. , BARTON R. , SARNER M. , KORPELA R. , SWALLOW D. M.
Published: March 2003

A genetic polymorphism is responsible for determining that some humans express lactase at high levels throughout their lives and are thus lactose tolerant, while others lose lactase expression during childhood and are lactose intolerant. We have previously shown that this polymorphism is controlled by an element or elements which act in cis to the lactase gene. We have also reported that 7 polymorphisms in the lactase gene are highly associated and lead to only 3 common haplotypes (A, B and C) in individuals of European extraction. Here we report the frequencies of these polymorphisms in Caucasians from north and south Europe and also from the Indian sub‐continent, and show that the alleles differ in frequency, the B and C haplotypes being much more common in southern Europe and India. Allelic association studies with lactase persistence and non‐persistence phenotypes show suggestive evidence of association of lactase persistence with certain alleles. This association was rather more clear in the analysis of small families, where haplotypes could be determined. Furthermore haplotype and RNA transcript analysis of 11 unrelated lactase persistent individuals shows that the persistence (highly expressed) allele is almost always on the A haplotype background. Non‐persistence is found on a variety of haplotypes including A. Thus it appears that lactase persistence arose more recently than the DNA marker polymorphisms used here to define the main Caucasian haplotypes, possibly as a single mutation on the A haplotype background. The high frequency of the A haplotype in northern Europeans is consistent with the high frequency of lactase persistence.