bluuebunny/crossref_metadata_2025 huggingface dataset:
Population-Based Patterns and Predictors of Prostate-Specific Antigen Screening Among Older Men in the United States
Authors: Drazer Michael W. , Huo Dezheng , Schonberg Mara A. , Razmaria Aria , Eggener Scott E.
Published: March 2011

Purpose

For patients who elect to have prostate cancer screening, the optimal time to discontinue screening is unknown. Our objective was to describe rates and predictors of prostate-specific antigen (PSA) screening among older men in the United States.

Methods

Data were extracted from the population-based 2000 and 2005 National Health Interview Survey (NHIS). PSA screening was defined as a PSA test as part of a routine exam within the past year. Demographic, socioeconomic, and functional characteristics were collected, and a validated 5-year estimated life expectancy was calculated. Age-specific rates of PSA screening were determined, and sampling weight-adjusted multivariate regressions were fitted to determine predictors of screening among men age 70 years or older.

Results

The PSA screening rate was 24.0% in men age 50 to 54 years, and it increased steadily with age until a peak of 45.5% among age 70 to 74 years. Screening rates then gradually declined by age, and 24.6% of men age 85 years or older reported being screened. Among men age 70 years or older, screening rates varied by estimated 5-year life expectancy: rates were 47.3% in men with high life expectancies (≤ 15% probability of 5-year mortality), 39.2% in men with intermediate life expectancies (16% to 48% probability), and 30.7% in men with low life expectancies (> 48% probability; P < .001). In multivariate analysis, estimated life expectancy and age remained independently associated with PSA screening (P < .001 for each).

Conclusion

Rates of PSA screening in the United States are associated with age and estimated life expectancy, but excessive PSA screening in elderly men with limited life expectancies remains a significant problem. The merits and limitations of PSA should be discussed with all patients considering prostate cancer screening.
Biopsy Misidentification Identified by DNA Profiling in a Large Multicenter Trial
Authors: Marberger Michael , McConnell John D. , Fowler Ivy , Andriole Gerald L. , Bostwick David G. , Somerville Matthew C. , Rittmaster Roger S.
Published: March 2011

Purpose

The Reduction by Dutasteride of Prostate Cancer Events (REDUCE) prostate cancer risk reduction study randomly assigned 8,231 men to dutasteride or placebo for 4 years. Protocol-mandated biopsies were obtained after 2 and 4 years. After the discovery of three cases of biopsy sample misidentification in the first 2 years, all protocol-mandated biopsy samples were DNA tested to verify biopsy identity.

Methods

Biopsy and blood DNA profiling was performed retrospectively for the year 2 scheduled biopsies and prospectively for the year 4 scheduled biopsies. Toward the end of year 2, multiple changes were made to improve sample handling and chain of custody.

Results

Of the 6,458 year 2 and 4,777 year 4 biopsies, 26 biopsies reflecting 13 sample handling errors at year 2 (0.4%) and one biopsy reflecting one sample handling error at year 4 (0.02%) were confirmed to be mismatched to the patient for whom they were originally submitted. Of 6,733 reference blood samples profiled, 31 (0.5%) were found to be mismatched to the patient's verified identity profile. Sample identification errors occurred at local research sites and central laboratories.

Conclusion

Biopsy misidentification is a potential problem in clinical laboratories and clinical trials. Until now, biopsy misidentification has not been studied in the setting of a large, multinational clinical trial. In the REDUCE study, process improvement initiatives halfway through the trial dramatically reduced biopsy mismatches. The potential for biopsy mismatches in clinical trials and clinical practice is an under-recognized problem that requires rigorous attention to details of chain of custody and consideration of more widespread DNA identity testing.
Long-Term Outcome and Quality of Life of Patients With Endometrial Carcinoma Treated With or Without Pelvic Radiotherapy in the Post Operative Radiation Therapy in Endometrial Carcinoma 1 (PORTEC-1) Trial
Authors: Nout Remi A. , van de Poll-Franse Lonneke V. , Lybeert Marnix L.M. , Wárlám-Rodenhuis Carla C. , Jobsen Jan J. , Mens Jan Willem M. , Lutgens Ludy C.H.W. , Pras Betty , van Putten Wim L.J. , Creutzberg Carien L.
Published: March 2011

Purpose

To determine the long-term outcome and health-related quality of life (HRQL) of patients with endometrial carcinoma (EC) treated with or without pelvic radiotherapy in the Post Operative Radiation Therapy in Endometrial Carcinoma 1 (PORTEC-1) trial.

Patients and Methods

Between 1990 and 1997, 714 patients with stage IC grade 1 to 2 or IB grade 2 to 3 EC were randomly allocated to pelvic external-beam radiotherapy (EBRT) or no additional treatment (NAT). HRQL was evaluated with the Short Form 36-Item (SF-36) questionnaire; subscales from the European Organisation for Research and Treatment of Cancer (EORTC) PR25 module for bowel and bladder symptoms and the OV28 and CX24 modules for sexual symptoms; and demographic questions. Analysis was by intention-to-treat.

Results

Median follow-up was 13.3 years. The 15-year actuarial locoregional recurrence rates were 5.8% for EBRT versus 15.5% for NAT (P < .001), and 15-year overall survival was 52% versus 60% (P = .14). Of the 351 patients confirmed to be alive with correct address, 246 (70%) returned the questionnaire. Patients treated with EBRT reported significant (P < .01) and clinically relevant higher rates of urinary incontinence, diarrhea, and fecal leakage leading to more limitations in daily activities. Increased symptoms were reflected by the frequent use of incontinence materials after EBRT (day and night use, 42.9% v 15.2% for NAT; P < .001). Patients treated with EBRT reported lower scores on the SF-36 scales “physical functioning” (P = .004) and “role-physical” (P = .003).

Conclusion

EBRT for endometrial cancer is associated with long-term urinary and bowel symptoms and lower physical and role-physical functioning, even 15 years after treatment. Despite its efficacy in reducing locoregional recurrence, EBRT should be avoided in patients with low- and intermediate-risk EC.
Bones of Contention: Corpse Traffic and Ottoman-Iranian Rivalry in Nineteenth-Century Iraq
Authors: Ateş Sabri
Published: March 2011

This article examines Ottoman responses to Iranians bringing corpses for burial in holy Shi`i sites in Ottoman Iraq, and focuses on questions of sovereignty, frontiers, commerce, and sanitation. Bringing together the Shi`is of both sides of the Ottoman-Iranian frontier, this curious border crossing constituted a major point of contention between the Ottoman Empire and Safavid and Qajar Iran. One of the most persistent religio-economic activities of Middle Eastern history, corpse traffic continued almost unabated until the emergence of cholera as a global health threat. The emergence of cholera and discussions around corpse traffic and pilgrimage to the `atabat helped transform one of the longest running unresolved issues of the Islamic world: namely, the undefined border between the Ottoman Empire and Iran.
Sacred Plants and the Cultic Beverage Haoma
Authors: Abdullaev Kazim
Published: March 2011

The relationship between the sacred drink haoma and narcotic plants is a major focus in studying the religious and ritualistic traditions of the ancient people of Indo-Iran and Central Asia. This study addresses this question through an analysis of archaeological data gathered at the Margiana and Bactria geographical locations, which were the home to the Sakas Haomavarga people. This analysis argues that the haoma drink was used as a means of transcending the ordinary state of mind in order to connect with the supranatural realms of reality. Therefore haoma was upheld as a sacred potion among the Iranian-speaking people of the ancient world.
`Ayn al-Qudat al-Hamadhani, His Work, and His Connection with the Early Chishti Mystics
Authors: Papan-Matin Firoozeh
Published: March 2011

`Ayn al-Qudat (AD 1096/98–1131) was a significant scholar of Islamic mysticism whose teachings inspired others and especially the early Chishti mystics of India. This article discusses the importance of `Ayn al-Qudat through an analysis of his work and his reception by medieval and modern scholars. It argues that marginal manuscript evidence from `Ayn al-Qudat's writing suggests the possibility of contact between him and his teacher, Ahmad ibn Muhammad Ghazzali (d. AD 1126), and their contemporary Chishti mystic sheikh, Qutb al-Din Mawdud (d. AD 1133).
Fayzi's Illuminationist Interpretation of Vedanta: The Shariq al-ma`rifa
Authors: Ernst Carl W.
Published: March 2011

The Mogul court poet Fayzi (AD 1547–95) is credited with the composition of the Shariq al-ma`rifa, a Persian text offering an interpretation of Indian philosophy drawing on Sufi and Neoplatonic (Illuminationist) terms and categories. This article examines how the author subordinates Vedantic thought to an Islamicate framework.
Bazaars, Merchants, and Trade in Late Antique Iran
Authors: Daryaee Touraj
Published: March 2011

This essay discusses the formation of an economy in late antiquity with the coming of the Sassanian Empire in 224 CE. Local, imperial, regional, and international trade and the role of the state and traders and their relation with one another are previewed. Based on surviving evidence, one can see that a vibrant bazaar economy had developed in cities, protected by the imperial government and at times through the resettlement of populations from outside of the Iranian plateau and Mesopotamia. These local economies in turn created an imperial network by the Sassanians but acted autonomously. Trade networks were mainly developed based on religious affiliation, and they created connections throughout Asia to control commodities such as silk and other precious goods. Through Sassanian protection (224–651 CE) of trade, their Byzantine rivals were unable to gain an economic foothold in Asia. In the international trade provided by the Silk Road and the sea route, China and India became important centers of production, while the Iranians, such as the Sogdians, Bactrians and Persians, acted as traders and intermediaries in the Eurasian trade. These structures created in late antiquity by the Sassanian Empire in Asia were inherited by the Muslims in the seventh century CE and were continued and expanded.
Amman Cosmopolitan: Spaces and Practices of Aspiration and Consumption
Authors: Schwedler Jillian
Published: March 2011

Neoliberal reforms often have the effect of creating exclusions, but less addressed are the precise ways in which shifting practices of work and leisure have allowed citizens to reimagine their relation to the more desirable dimensions of economic liberalization. These include access to private commercial spaces such as malls and other locations where elite establishments are concentrated and to employment in the expanding sector of the service economy, namely, in high-end restaurants, bars, and exclusive nightclubs. Through a study of “aspiring cosmopolitans” in Amman, Jordan, I examine new experiences of negotiating social status and cultural codes in multiple locales. New sites of leisure allow some middle- and lower middle-class Jordanians to insert themselves into Jordan's (relatively) new cosmopolitan leisure economy—physically and sometimes also economically—in ways that entail self-conscious negotiations with sites of cultural production and cultural capital. These practices of representation can be described as crossings in spatial terms (from East to West Amman), in economic terms (from a lower to a higher social class), and in cultural terms (from working- and middle-class citizens to aspiring cosmopolitans). Without rejecting the critique that neoliberal economic reforms produce widespread and economically devastating exclusions and disenfranchisement, this article aims nonetheless to illuminate some of the ways in which lines of exclusion are being negotiated and challenged by some of those who might otherwise find themselves on the losing side of neoliberal promises.
Reading between Public and Private in the Late Ottoman Empire and the Early Turkish Republic
Authors: Fortna Benjamin C.
Published: March 2011

This article examines the concepts of public and private in the late Ottoman Empire and the early Turkish Republic through the worlds of child readers. It interrogates the shifting lines of demarcation between public and private against the background of children learning to read and being exposed to an increasing array of written material, some of it supplied by the state and some by the private sector. It begins by delineating the relationship between public and private in this period before turning first to the contexts in which this reading took place and then to the content of these new reading materials. Drawing on evidence from a range of children's reading matter and childhood memoirs, I argue that the experience of reading served to blur the distinction between public and private and to contribute to the reconfiguring of the realms of public and private space. In short, reading—and the many and sometimes mixed messages it provided to children in this period of flux—helped to effect the transformation of the categories of private and public life and to unsettle the notions of physical and mental space of young readers.
“Awakening a Horrible Monster”: Negotiating the Jazz Public in 1920s Istanbul
Authors: Woodall G. Carole
Published: March 2011

Istanbul of the 1920s evoked a period of transition and redefinition in the aftermath of World War I and the onset of the Turkish Republic (1923). Precisely, what position Istanbul would occupy as well as its constituents in the nascent republic was in flux. Debates around distinctly modern, transnational cultural practices emerged in Istanbul's illustrated press, determining the parameters, albeit ambiguous, around modern life. One such debate centered upon jazz and its respective dances, namely the Charleston. Jazz represented a distinctively interwar, transnational sound. Cultural critics perceived the movement and rhythms as “uncontrollable” and difficult to describe. Critic Akil Cem had even proposed that the Charleston steps be “tamed” by limiting the steps from twenty to five, while writer Fikret Adil referred to jazz as “awakening a horrible monster.” The jazz public exuded a heterogeneous, cosmopolitan character that blurred public borders in terms of class hierarchies and gendered, linguistic, and ethnic boundaries, and threatened an emerging Turkish cultural order. Both the narratives of American jazz exceptionalism and a predominant 1930s-centric Turkish nationalist narrative marginalized if not rendered silent the 1920s Istanbul jazz scene. In this article, I historicize jazz and highlight a transnational border crossing of performers and cultural products. By so doing, I place the city as being a participant of an urban transnational latitude. Specifically, I look at how jazz was identified, criticized, and appropriated by engaging with various printed and visual materials. I argue that the “horrible monster” of jazz was the site of negotiating different notions of the public in 1920s Istanbul.
Is Islam a Threshold for Escape or an Insurmountable Barrier? Women Bargaining with Patriarchy in Post-Islamist Sudan
Authors: Tønnessen Liv
Published: March 2011

This article explores women's bargaining with a patriarchal Islamic state in Sudan. The article is situated within the realm of the literature on post-Islamism, which claims that Islamism becomes compelled both by its own internal contradictions and by societal pressure to reinvent itself through a “secular,” “democratic,” and “feminist” transformation of Islamic theology. The emergence of Islamic feminisms is thus regarded as a paradoxical consequence of the spaces that Islamism created in the course of participation in the political game. The article argues that women are continuously bargaining with patriarchy in Sudan, but the processes of renegotiating women's rights within the context of an Islamic state do not only take an Islamic feminist direction as post-Islamist scholars propose. What we see in contemporary Sudan is different types of women's (non)movements offering qualitatively different and competing interpretations of the shari'a. The processes of (re-)Islamization and post-Islamization in Sudan are thus conflated. The paradoxical consequence of Islamism in Sudan is that women's activism is seen in not only those acts that resist patriarchy, but also those acts that aim to preserve patriarchy. It is based on fieldwork in Sudan in 2006, 2007, 2008, and 2009.
Islam as Ideology of Tradition and Change: The “New Jihad” in Swat, Northern Pakistan
Authors: Akhtar Aasim Sajjad
Published: March 2011

Scholarly interest in religio-political movements in the Muslim world has increased dramatically in recent times. Given the considerable variety of movements that are inspired by Islam, it is imperative that overly general and descriptive analyses be avoided in favor of thoroughly contextualized studies of individual movements. In this article I adopt an interdisciplinary approach bridging the fields of history, anthropology, and politics to study the emergence of what I call the “new jihad in Swat” in northern Pakistan spearheaded by the Tehrik-e-Nifaz-e-Shariati-Muhammadi (TNSM) and Tehrik-e-Taliban Pakistan (TTP). Acknowledging the importance of the wider geopolitical environment, I argue that the rise of the TNSM and TTP is a function of the historical salience of Islamic (jihad) idiom in Pashtun society, localized sources of discontent, and historical-structural changes that have facilitated the emergence of a distinct agenda of “Shariatization.” My findings are based on extensive interaction with Swatis, both in their homes and workplaces, over an extensive period. I have also interviewed many who have been residing in refugee camps after May 2009. I conclude that the wider geostrategic environment, class, and other social cleavages in Swat and the ideational power of Islam ensure that spaces for the “new jihad” will continue to proliferate in Swat and its environs.
Globalization and the Production of Difference: A Case Study of the Neoliberal Production of Hindu Nationalism in India
Authors: Chatterjee Ipsita
Published: March 2011

The dominant discourse on neoliberal globalization emphasizes a shrinking of physical distance, barriers, and time lag through greater interactions, flows, and communications working toward an integrated global economy. The restructuring of global space through neoliberal economic policies, however, has not resulted in such integration. The nation and region have been reformulated around fragmented ideologies of religion and ethnicity, often conforming to their respective political boundaries or claiming newer boundaries. The local has stubbornly refused erasure by resisting secular waves of economic integration. This fragmentation is popularly ascribed to be the result of an ontologically inward-looking nature of retrogressive local spaces such as the nations, regions, and communities. It is not coincidental that the sudden rejuvenation of difference on various local scales is occurring at the very moment when neoliberal regime of production has acquired global acceptance. Through a case study of Hindu nationalism, this article indicates how the neoliberal regime formulated at the global scale actually produces India materially and symbolically. The local is materially produced through biased neoliberal economic policies, which create certain patterns of development, quality of life, and prosperity. This material production is not separate from the symbolic production of Hindu fundamentalist national popular discourse. The “Hindu India” of the global village is not in antagonistic confrontation with the secular global regime of production but is created by it.
Multistage Mass Spectrometry in Quality, Safety and Origin of Foods
Authors: Aiello Donatella , De Luca Damiano , Gionfriddo Emanuela , Naccarato Attilio , Napoli Anna , Romano Elvira , Russo Anna , Sindona Giovanni , Tagarelli Antonio
Published: March 2011

Quality and safety control and the validation of origin are hot issues in the production of food and its distribution, and are of primary concern to food and agriculture organization. Modern mass spectrometry (MS) provides unique, reliable and affordable methodologies to approach with a high degree of scientificity any problem which may be posed in this field. In this review the contribution of mass spectrometry to food analysis is presented aiming at providing clues on the fundamental role of the basic principles of gas-phase ion chemistry in applied research fields. Applications in proteomics, allergonomics, glycomics, metabolomics, lipidomics, food safety and traceability have been surveyed. The high level of specificity and sensitivity of the MS approach allows the characterization of food components and contaminants present at ultra-trace levels, providing a distinctive and safe validation of the products.
Determination of drug concentrations using dried blood spots: investigation of blood sampling and collection techniques in Crl:CD(SD) rats
Authors: Stokes Alan H , Moose Tammy A , Parry Simon P , Barfield Matthew , Lovatt Cerys A , Dopson Wesley J , Melich David , Overvold Carol R , Gade Sonya D , Spooner Neil
Published: March 2011

Dried bloodspot (DBS) technology has been available for many decades but only in the last five years has it been considered for routine bioanalysis of blood samples collected on preclinical and clinical studies as part of a drug development programme. Advantages of using DBS versus typical plasma samples include smaller blood volumes, less processing of the samples (e.g. no centrifugation) and no requirement for storing or shipping of the samples at frozen temperatures. The current study compared blood concentrations (AUC0− t and Cmax) from rats given an oral dose of acetaminophen (APAP) using two different sampling sites (caudal venepuncture versus tail snip), two different collection methods (3 separate 15 μL ethylenediaminetetraacetic acid [EDTA]-coated capillary tubes versus an EDTA integrated capillary blood collection system) and variability between blood spots on one card. There were no noteworthy differences (i.e. two-fold or greater) in blood concentrations of APAP using the different sites or methods. Furthermore, comparisons of the APAP blood concentrations in the original spot to a duplicate bloodspot from the same bloodspot card were within 12% of the original concentration.
Increased understanding of platinum anticancer chemistry
Authors: Reedijk Jan
Published: March 2011

The development of a few worldwide routinely used Pt(II) coordination compounds is described from a mechanistic point of view and related to the molecular aspects of Pt-DNA binding. Mechanistic knowledge developed from these studies is applied nowadays for the design and synthesis of new bifunctional and trifunctional compounds, aimed for use as improved anticancer drugs.
Prevalence of Chronic Health Conditions in Children With Intellectual Disability: A Systematic Literature Review
Authors: Oeseburg Barth , Dijkstra Geke J , Groothoff Johan W , Reijneveld Sijmen A , Jansen Daniëlle E. M. C
Published: March 2011

A systematic review of the prevalence rates of chronic health conditions in populations of children with intellectual disability was provided. We identified 2,994 relevant studies by searching Medline, Cinahl, and PsycINFO databases from 1996 to 2008. We included the 31 studies that had sufficient methodological quality. The 6 most prevalent chronic health conditions in children with intellectual disability were epilepsy (22.0/100), cerebral palsy (19.8/100), any anxiety disorder (17.1/100), oppositional defiant disorder (12.4/100), Down syndrome (11.0/100), and autistic disorder (10.1/100). The reported prevalence rates of chronic health conditions in this population was much higher than in the general population. However, both the number of studies that were included and the number of chronic health conditions they reported about were limited. There is an urgent need for better evidence on the prevalence of chronic health conditions among children with intellectual disability.
Hier, da und dort– regionale Variation und standardsprachlicher Gebrauch bei den primären Lokaldeiktika im Deutschen
Authors: Möller Robert
Published: March 2011

There is much disagreement with respect to the adequate description of the primary local demonstratives in German. This is partly due to the fact that functions of da have been considered which are not properly locative deictic. However, the problem appears to derive first and foremost from regional differences on the one hand and the influence of written language on the other. In day-to-day language there is considerable variation in the use of local demonstratives. Two-level systems predominate: the most widespread is hier – da, but regionally hier – dort or da – dort are also usual, although a complete parallelism between these oppositions is not always present. For the (intended) standard language use, this is the point of departure (real deixis is normally connected to the proximity situation); but through the orientation of spoken language towards written language, in which the local demonstrative dort is preferred to da for reasons of clarity, dort generally comes into play additionally as a variant which is given a higher value.
Androgen receptor CAG repeat length polymorphism modifies the impact of testosterone on insulin sensitivity in men
Authors: Möhlig Matthias , Arafat Ayman M , Osterhoff Martin A , Isken Frank , Weickert Martin O , Spranger Joachim , Pfeiffer Andreas F H , Schöfl Christof
Published: March 2011

Objective

Low circulating testosterone concentrations have been associated with insulin resistance (IR). Androgen action is mediated by the androgen receptor (AR) whose activity is modulated by a polymorphic CAG repeat sequence within exon 1. An interaction between testosterone and CAG repeat length (CAG length) with respect to IR has been described in women.

Objective

We investigated such a putative interaction between testosterone and the CAG length with respect to IR in men with normal glucose tolerance.

Design

Cross-sectional study.

Methods

In 113 non-diabetic men calculated free testosterone, the CAG length, and a multiplicative interaction term were investigated by multiple linear regression analysis for an association with IR, as indicated by homeostasis model assessment (HOMA %S).

Results

In a multivariate regression analysis adjusted for age and body mass index, free testosterone, CAG length, and a multiplicative interaction term were significantly associated with IR (P=0.001, P=0.001, P=0.01 respectively). The model explained 36.6% of the variation of IR and predicted that in carriers with a CAG length of 23, changes in testosterone would only minimally affect IR. For CAG lengths longer than 23, however, an increase in testosterone would improve IR, namely the longer the CAG length, the greater the effect. In contrast, in the case of CAG lengths shorter than 23, the effect of increasing testosterone would be the opposite.

Conclusions

In men, testosterone and the AR CAG repeat length polymorphism interacted with respect to IR. The interpretation of the association between testosterone and IR seems to require consideration of the AR CAG repeat polymorphism.
Dynamic changes in leptin distribution in the progression from ovum to blastocyst of the pre-implantation mouse embryo
Authors: Schulz Laura C , Roberts R Michael
Published: March 2011

The hormone leptin, which is primarily produced by adipose tissue, is a critical permissive factor for multiple reproductive events in the mouse, including implantation. In the CD1 strain, maternally derived leptin from the oocyte becomes differentially distributed among the blastomeres of pre-implantation embryos to create a polarized pattern, a feature consistent with a model of development in which blastomeres are biased toward a particular fate as early as the two-cell stage. In this study, we have confirmed that embryonic leptin is of maternal origin and re-examined leptin distribution in two distinct strains in which embryos were derived after either normal ovulation or superovulation. A polarized pattern of leptin distribution was found in the majority of both CD1 and CF1 embryos (79.1 and 76.9% respectively) collected following superovulation but was reduced, particularly in CF1 embryos (29.8%;P<0.0001), after natural ovulation. The difference in leptin asymmetries in the CF1 strain arose between ovulation and the first cleavage division and was not affected by removal of the zona pellucida. The presence or absence of leptin polarization was not linked to differences in the ability of embryos to normally develop to blastocyst. In the early blastocyst, leptin was confined subcortically to trophectoderm, but on blastocoel expansion, it was lost from the cells. Throughout development, leptin co-localized with LRP2, a multi-ligand transport protein, and its patterning resembled that noted for the maternal-effect proteins OOEP, NLRP5, and PADI6, suggesting that it is a component of the subcortical maternal complex with as yet unknown significance in pre-implantation development.
The Influence of Family Characteristics on Perinatal Decision Making
Authors: Marcello Kirstie R. , Stefano John L. , Lampron Kim , Barrington Keith J. , Mackley Amy B. , Janvier Annie
Published: March 2011

OBJECTIVE:

To determine whether parental characteristics affect estimates of best interests and intervention decisions for preterm infants.

DESIGN AND METHODS:

The study consisted of an anonymous questionnaire given to nurses, physicians, and students. The study included scenarios of 3 sets of parents, including a 16-year-old teenager, a couple who were lawyers, and a couple with a history of in vitro fertilization, about to deliver at 2257 weeks, 24 weeks, or 2757 weeks. Respondents were asked whether active intervention is in the infant's best interests and whether they would comply with family decisions.

RESULTS:

A total of 1105 questionnaires were sent out, with 829 respondents in Canada and the United States. At 2257 weeks' gestation, 21% of the respondents thought that resuscitation was in the infant's best interest; among respondents who did not agree, 59% would intervene if the parents wished. At 2757 weeks' gestation, 95% of respondents thought that resuscitation was in the infant's best interest, yet 34% would accept comfort care. Estimates of best interest, and willingness to comply, varied significantly by parental characteristics. At 2257 weeks' gestation, 17% of respondents believed that resuscitation was in the best interest of the teenaged mother's infant compared with 26% of respondents who believed that resuscitation was in the best interest for the infants of the others; this difference persisted at 24 weeks. At 2257 and at 24 weeks' gestation, compliance with active care despite believing that it not in the infant's best interest was significantly more frequent for the in vitro fertilization couple and the lawyers than for the teenaged mother. At 27 weeks' gestation, more than 93% of respondents complied for all parents.

CONCLUSIONS:

Caregivers frequently are ready to intervene actively, or not, despite believing that it is against the infant's best interest. Willingness to do so varies according to parental characteristics.
Provider Demonstration and Assessment of Child Device Technique During Pediatric Asthma Visits
Authors: Sleath Betsy , Ayala Guadalupe X. , Gillette Chris , Williams Dennis , Davis Stephanie , Tudor Gail , Yeatts Karin , Washington Deidre
Published: March 2011

OBJECTIVE:

The purposes of this study were to (a) describe the extent to which children use metered dose inhalers, turbuhalers, diskuses, and peak flow meters correctly, and (b) investigate how often providers assess and demonstrate use of metered dose inhalers, turbuinhalers, diskuses, and peak flow meters during pediatric asthma visits.

PATIENTS AND METHODS:

Children ages 8 through 16 with mild, moderate, or severe persistent asthma and their caregivers were recruited at 5 pediatric practices in nonurban areas of North Carolina. All of the medical visits were audiotape-recorded. Children were interviewed after their medical visits, and their device technique was observed and rated by the research assistants.

RESULTS:

Of the patients, 296 had useable audiotape data. Only 8.1% of children performed all of the metered dose inhaler steps correctly. Older children were more likely to get more of the metered dose inhaler steps correct. Of the children, 22% performed all of the diskus steps correctly, 15.6% performed all of the turbuhaler steps correctly, and 24% performed all of the peak flow meter steps correctly. The majority of providers did not demonstrate or assess child use of metered dose inhalers, turbuhalers, diskuses, or peak flow meters during pediatric asthma visits.

CONCLUSIONS:

There is a need for providers to demonstrate proper asthma medication and monitoring device techniques to children and to have children demonstrate to proficiency. The 2007 National Heart, Lung, and Blood Institute expert panel report on the diagnosis and management of asthma encourages providers to educate children on these techniques.
Parent Diet Modification, Child Activity, or Both in Obese Children: An RCT
Authors: Collins Clare E. , Okely Anthony D. , Morgan Philip J. , Jones Rachel A. , Burrows Tracy L. , Cliff Dylan P. , Colyvas Kim , Warren Janet M. , Steele Julie R. , Baur Louise A.
Published: March 2011

OBJECTIVES:

Outcomes of childhood obesity interventions are rarely reported beyond 1 year. We hypothesized that the impact on the BMI z score from a child-centered physical-activity program in combination with a parent-centered dietary-modification program would be greater than either program conducted alone at 24 months' after baseline.

PARTICIPANTS AND METHODS:

A total of 165 overweight prepubertal children (68 boys, aged 5.5–9.9 years, mean BMI z score: 2.8) were randomly assigned to either a child-centered physical-activity program, a parent-centered dietary-modification program, or both conducted together in an assessor-blinded 6-month intervention.

RESULTS:

Using linear mixed models, all groups reduced their mean (95% confidence interval) BMI z score at 24 months from baseline (P < .001) (the activity and diet group: −0.24 [−0.35 to −0.13]; the diet-only group: −0.35 [−0.48 to −0.22]; activity-only group −0.19 [−0.30 to −0.07]). There was a significant group-by-time interaction (P = .04) with the activity + diet and the diet-only groups showing a greater reduction than the activity-only group. For waist z score and waist-to-height ratio, there was a significant time effect (P < .0001) at 24 months but no between-group differences (P > .05). Some metabolic outcomes improved at 24 months, although there were no between-group differences (P > .05).

CONCLUSIONS:

A reduction in BMI z score was sustained at 24 months by treatment with either program combination. The greatest effects were achieved through inclusion of a parent-centered diet program, indicating the importance of targeting parents within treatment and the possibility of targeting them exclusively in treating obese prepubertal children.
The Safe Environment for Every Kid Model: Impact on Pediatric Primary Care Professionals
Authors: Dubowitz Howard , Lane Wendy G. , Semiatin Joshua N. , Magder Laurence S. , Venepally Mamata , Jans Merel
Published: March 2011

OBJECTIVE:

To examine whether the Safe Environment for Every Kid (SEEK) model of enhanced primary care would improve the attitudes, knowledge, comfort, competence, and behavior of child health care professionals (HPs) regarding addressing major risk factors for child maltreatment (CM).

METHODS:

In a cluster randomized controlled trial, 18 private practices were assigned to intervention (SEEK) or control groups. SEEK HPs received training on CM risk factors (eg, maternal depression). The SEEK model included the parent screening questionnaire and the participation of a social worker. SEEK's impact was evaluated in 3 ways: (1) the health professional questionnaire (HPQ), which assessed HPs' attitudes and practice regarding the targeted problems; (2) observations of HPs conducting checkups; and (3) review of children's medical records.

RESULTS:

The 102 HPs averaged 45 years of age; 68% were female, and 74% were in suburban practices. Comparing baseline scores with 6-, 18-, and 36-month follow-up data, the HPQ revealed significant (P < .05) improvement in the SEEK group compared with controls on addressing depression (6 months), substance abuse (18 months), intimate partner violence (6 and 18 months), and stress (6, 18, and 36 months), and in their comfort level and perceived competence (both at 6, 18, and 36 months). SEEK HPs screened for targeted problems more often than did controls based on observations 24 months after the initial training and the medical records (P < .001).

CONCLUSIONS:

The SEEK model led to significant and sustained improvement in several areas. This is a crucial first step in helping HPs address major psychosocial problems that confront many families. SEEK offers a modest yet promising enhancement of primary care.
Nutritional Supplements and Other Complementary Medicines for Infantile Colic: A Systematic Review
Authors: Perry Rachel , Hunt Katherine , Ernst Edzard
Published: March 2011

BACKGROUND:

Complementary and alternative medicines often are advocated for infantile colic, yet there has been no synthesis of the evidence to inform current practice about their use.

OBJECTIVE:

To critically evaluate all randomized clinical trials of nutritional supplements and other complementary and alternative medicines as a treatment for infantile colic.

METHODS:

Five electronic databases were searched from their inception to February 2010 to identify all relevant randomized clinical trials of complementary and alternative medicines and supplements for infantile colic. Reference lists of retrieved articles were hand searched. Data were extracted by two independent reviewers, and methodological quality was assessed using the Jadad score and key aspects of the Cochrane risk of bias.

RESULTS:

Fifteen randomized clinical trials met the inclusion criteria and were included. Thirteen studies were placebo controlled. Eight were of good methodological quality. Eleven trials indicated a significant result in favor of complementary and alternative medicines. However, none of these randomized clinical trials were without flaws. Independent replications were missing for most modalities.

CONCLUSIONS:

Some encouraging results exist for fennel extract, mixed herbal tea, and sugar solutions, although it has to be stressed that all trials have major limitations. Thus, the notion that any form of complementary and alternative medicine is effective for infantile colic currently is not supported from the evidence from the included randomized clinical trials. Additional replications are needed before firm conclusions can be drawn.
Sudden Deaths and Severe Apparent Life-Threatening Events in Term Infants Within 24 Hours of Birth
Authors: Poets Anette , Steinfeldt Renate , Poets Christian F.
Published: March 2011

OBJECTIVE AND DESIGN:

To determine the incidence of and possible risk factors for unexpected sudden infant deaths (SID) and severe apparent life-threatening events (S-ALTE) that occurred within 24 hours of birth. This was a monthly epidemiologic survey.

PATIENTS AND METHODS:

Throughout 2009, every pediatric department in Germany was asked to report such cases of unexplained SID or S-ALTE in term infants after a good postnatal adaptation (10-minute Apgar score ≥ 8) to the Surveillance Unit for Rare Pediatric Conditions in Germany. The latter has a capture rate of > 95%. S-ALTE was defined as acute cyanosis/pallor and unconsciousness, requiring bagging, intubation and/or cardiac compressions. Hospitals that reported a case were asked to return an anonymized questionnaire and discharge letter as well as the autopsy protocol in SID cases.

RESULTS:

Of 43 cases reported, 17 fulfilled entry criteria, yielding an incidence of 2.6 in 100 000 live births. There were 7 deaths (ie, 1.1/100 000); 6 of the 10 S-ALTE infants were neurologically abnormal at discharge. Twelve infants were found lying on their mother's chest or abdomen, or very close to and facing her. Nine events occurred in the first 2 hours after birth; 7, were only noticed by a health professional despite the mother being present and awake.

CONCLUSIONS:

SID or S-ALTE may occur in the first 24 hours after birth, particularly within the first 2 hours. Events seem often related to a potentially asphyxiating position. Parents may be too fatigued or otherwise not able to assess their infant's condition correctly. Closer observation during these earliest hours seems warranted.
Evidence Suggests There Was Not a “Resurgence” of Kernicterus in the 1990s
Authors: Brooks Jordan C. , Fisher-Owens Susan A. , Wu Yvonne W. , Strauss David J. , Newman Thomas B.
Published: March 2011

BACKGROUND:

Although some have suggested that kernicterus disappeared in the United States in the 1970s to 1980s and dramatically reappeared in the 1990s, population-based data to support such a resurgence are lacking.

METHODS:

We used diagnosis codes on data collection forms from the California Department of Developmental Services (DDS) to identify kernicterus cases among children born from 1988 to 1997. We examined kernicterus mortality trends in the United States from 1979 to 2006 using death certificate data from the National Center for Health Statistics.

RESULTS:

We identified 25 cases of physician-diagnosed kernicterus. This figure was augmented to reflect estimates of cases lost to infant mortality, yielding incidence estimates of 1 in 200 000 California live births, 1 in 2500 among children who received services from DDS, and 1 in 400 children with cerebral palsy. There was no significant trend in kernicterus incidence from 1988 to 1997 (P = .77). Incidence before and after the 1994 publication of the AAP practice parameter for hyperbilirubinemia in healthy term infants was not significantly different (P = .92). Nationally, there were 3 reported infant deaths from kernicterus in 1994 and 2 or fewer in the other 28 years from 1979 to 2006 (0.28 deaths per million live births): there was no significant increase in kernicterus mortality over this period.

CONCLUSION:

Data from California do not support a resurgence of kernicterus in the 1990s. Deaths from kernicterus in the United States have remained rare, with no apparent increase during the last 25 years.
Needle-Entry Angle for Lumbar Puncture in Children as Determined by Using Ultrasonography
Authors: Bruccoleri Rebecca Elaine , Chen Lei
Published: March 2011

OBJECTIVE:

The purpose of this study was to evaluate the angle for performing lumbar punctures in children aged 0 to 12 years. We hypothesized that the angle changes for different stages of development.

METHODS:

Children aged 0 to 12 years who presented to the Yale–New Haven Children's Hospital at a low-acuity triage level, in need of a lumbar puncture, their accompanying siblings and authors' children were eligible for the study. Subjects in 3 age groups were recruited and grouped as follows: group 1, 0 to 12 months; group 2, 12 to 36 months; and group 3, 3 to 12 years. Ultrasound images of the L3-L4 and L4-L5 lumbar space were taken with subjects in the lateral recumbent and sitting positions. The angle from the interspinous space to the skin was measured.

RESULTS:

Thirty-six subjects were included. The mean angles in the lateral recumbent and sitting positions were group 1, 47.8° (SD: 8.2) and 51.1° (SD: 8.5), respectively; group 2, 58.8° (SD: 6.8) and 59.6° (SD: 5.5); and group 3, 60.5° (SD: 6.6) and 61.9° (SD: 4.0). The results of group 1 were significantly different from those of groups 2 or 3 in both positions (lateral recumbent P = .00526 and 0.00160; sitting P = .0499 and .00282).

CONCLUSIONS:

The angle for lumbar puncture was more acute for infants than for older children in this study. Future studies should assess the difference in success rates of lumbar punctures when clinicians have knowledge of these angles.
Creating Healthy Camp Experiences
Authors:   Council on School Health
Published: March 2011

The American Academy of Pediatrics has created recommendations for health appraisal and preparation of young people before participation in day or resident camps and to guide health and safety practices for children at camp. These recommendations are intended for parents, primary health care providers, and camp administration and health center staff. Although camps have diverse environments, there are general guidelines that apply to all situations and specific recommendations that are appropriate under special conditions. This policy statement has been reviewed and is supported by the American Camp Association.
Impact of Cannabis Sativa (Marijuana) Smoke on Alveolar Bone Loss: A Histometric Study in Rats
Authors: Nogueira‐Filho Getulio R. , Todescan Sylvia , Shah Adnan , Rosa Bruno T. , Tunes Urbino da R. , Cesar Neto Joao B.
Published: March 2011

Background: Cannabis sativa (marijuana) can interfere with bone physiopathology because of its effect on osteoblast and osteoclast activity. However, its impact on periodontal tissues is still controversial. The present study evaluates whether marijuana smoke affects bone loss (BL) on ligature‐induced periodontitis in rats.

Methods: Thirty male Wistar rats were used in the study. A ligature was placed around one of the mandible first molars (ligated teeth) of each animal, and they were then randomly assigned to one of two groups: control (n = 15) or marijuana smoke inhalation ([MSI] for 8 minutes per day; n = 15). Urine samples were obtained to detect the presence of tetrahydrocannabinol. After 30 days, the animals were sacrificed and decalcified sections of the furcation area were obtained and evaluated according to the following histometric parameters: bone area (BA), bone density (BD), and BL.

Results: Tetrahydrocannabinol was positive in urine samples only for the rats of the MSI group. Non‐significant differences were observed for unligated teeth from both groups regarding BL, BA, and BD (P >0.05). However, intragroup analysis showed that all ligated teeth presented BL and a lower BA and BD compared to unligated teeth (P <0.05). The intergroup evaluation of the ligated teeth showed that the MSI group presented higher BL and lower BD (P <0.05) compared to ligated teeth from the control group.

Conclusion: Considering the limitations of this animal study, cannabis smoke may impact alveolar bone by increasing BL resulting from ligature‐induced periodontitis.