bluuebunny/crossref_metadata_2025_split huggingface dataset:
Congenital adrenal hyperplasia family studies using the short ACTH test
Authors: KREUTZMANN D. J. , COWELL C. T. , HOWARD N. J. , SOUZA M. De , SILINK M. 
Published: March 2008

Abstract Because of the increasing use of 17‐hydroxyprogesterone (17OHP) levels with the short adrenocorticotrophic hormone (ACTH) test in the detection of 21‐hydroxylase deficiency, the diagnostic efficiency of the test was evaluated in patient and family studies of congenital adrenal hyperplasia due to 21‐hydroxylase deficiency and of congenital adrenal hyperplasia due to 11‐hydroxylase (11OH) deficiency (the latter disorder now overlapse basally with the milder non‐classical 21‐hydroxylase deficiency [NC‐CAH]).Stimulated 17‐hydroxyprogesterone level (17OHP30), 17‐hydroxyprogesterone increase (Δ17OHP) and the ratio 17‐hydroxyprogesterone increase to cortisol increase (Δ17OHP/Δcortisol) were the parameters from the short ACTH test derived for assessment. 17‐OHP30 provided complete differentiation of NC‐CAH from the controls and heterozygotes, but overlap between NC‐CAH and 11‐OH occurred. Complete differentiation of NC‐CAH from 11‐OH was achieved using Δ17OHP. The heterozygotes showed best differentiation from the controls using Δ17OHP/Δcortisol with a diagnostic accuracy of 70%, however marked overlap of heterozygotes and NC‐CAH with 11‐OH was found.The short ACTH test proved to be a valuable technique with the further detection of homozygotes (n= 3) and heterozygotes (n= 5) in the 13 families studied. However, when interpreting the short ACTH test a careful choice of parameters should be made. It should be kept in mind that mild NC‐CAH patients can only be differentiated from 11OH patients by using Δ17OHP.
Outcomes following the use of rational guidelines in the management of jaundiced newborn infants
Authors: COCKINGTON R. A. , DREW J. H. , EBERHARD A. 
Published: March 2008

Abstract In 1975, rational guidelines for management of the jaundiced newborn infant were introduced to the Mercy Maternity Hospital, Melbourne. The guidelines were produced as four charts, each chart covering a particular birthweight range. The charts have been used widely.The effect of introduction of the charts has been examined by comparing the years 1971–74 with 1975–77. An overall decrease occurred in the use of phototherapy, without an increase in the use of exchange transfusion or in those with a serum bilirubin level above 339 μmol/L. The difference was not explained by an alteration in the spectrum of causes of jaundice. Long‐term follow‐up of jaundiced infants managed according to these guidelines revealed a satisfactory outcome despite a significant reduction in active treatment. The associated avoidance of potential side effects of treatment of the jaundiced newborn infant warrants consideration of the use of these charts by other neonatal units.
Fetal echocardiography in the diagnosis of congenital heart disease
Authors: MELLICK J. D. , RADFORD D. J. , GALBRAITH A. J. 
Published: March 2008

Abstract Fetal echocardiography provides an opportunity to diagnose congenital heart disease as early as the midtrimester of pregnancy, allowing for proper planning of perinatal care and counselling of the parents. This paper reviews the accuracy and outcomes of fetal cardiac ultrasound studies at The Prince Charles Hospital over the past 4 years.A total of 43 fetuses, of gestational ages 16–39 weeks, were studied. The indications for these were: previous sibling with cardiac anomaly (16 cases); abnormal heart on obstetric ultrasound scan (USS) (13 cases); abnormalities found on obstetric USS with normal appearing heart (one case); fetal bradycardia (seven cases); fetal tachycardia (four cases); irregular fetal heart beat (two cases).At birth all fetuses assessed because of a previously affected sibling were normal. Of the 13 referred because of structural heart lesions suspected on obstetric USS, eight were abnormal, four were normal and one was terminated without autopsy. Important rhythm disturbances occurred in nine of the 11 referred because of abnormal heart rates. One false positive diagnosis of a possible coarctation was made, and in four cases an abnormality was noted on USS but the diagnosis was not completely correct. Nine of the 19 infants with abnormalities detected have died.Fetal echocardiography is an accurate and useful method of diagnosing congenital heart disease in utero. Although the mortality of affected fetuses is high, antenatal diagnosis allows planning of medical care and offers the greatest chance of a successful outcome.
It's time: The future of school health in Australia
Authors: OBERKLAID F. 
Published: March 2008

AbstractSchool medical services in Australia have a long tradition of providing community‐based services to school‐aged children, and in some states to preschool children. Conceived as a public health measure early this century, doctors and nurses worked in schools to address the health issues of the time, which were largely to do with nutrition, hygiene, and infectious diseases.1 It was perceived that many children had poor access to medical care, and began school with unaddressed health problems which often had a deleterious effect on their learning. Doctors were often employed by education authorities and only transferred to health departments many years later. In some states the service was expanded subsequently to include preschool children, based on the concept that the earlier problems were detected the earlier they could be treated appropriately and the greater the benefits to the child.While social structures, community needs and paediatric morbidity patterns have changed dramatically over recent years, there is a widespread perception that in some states school medical services have not yet embraced fully the changing needs of the population of school children they are designed to serve. Hamstrung by political expediency (with decision‐making driven by political rather than scientific considerations) and bureaucratic inertia, school nurses and doctors often operate in structures and systems that are urgently in need of review and reorganization. In this paper the rationale for current processes will be reviewed critically, a model of school health services focused on contemporary paediatric needs is proposed, and a set of factors which are considered essential to the development of the school health services of the future is outlined.
Unintentional injuries to students at school
Authors: LANGLEY J. D. , CHALMERS D. , COLLINS B. 
Published: March 2008

Abstract Unintentional injuries at school have been identified as a significant public health problem. A major barrier to the development of injury prevention policy has been the absence of national data on the circumstances of injuries to students which occur at school. This study sought to determine the incidence, nature, and circumstances of injuries which resulted in death or hospitalization. Fatalities were identified from national mortality data for 1977‐86 inclusive. Coroners' files were then examined to obtain details of the circumstances of injury. Hospitalization cases were identified from the national hospital discharge summary for 1986.Fifteen fatalities were identified. The circumstances of the deaths were diverse with the most frequent event being a fall (n= 4). A total of 1013 first admissions to hospital were identified, giving an overall incidence rate of 152/100000 students/year. Injury rates declined with increasing age, and males had higher rates than females for all ages. Fractures of the upper and lower limbs and intracranial injury represented more than three‐quarters of all injury. The two leading causes of injury, falls, and incidents involving striking against or being struck by a person or object, represented 89% of all incidents. The use of playground equipment and involvement in sporting activity were two of the more common aspects of many injury events.The results suggest that prevention policy should place emphasis on those in their first 2 years of schooling, falls from playground equipment, provision of protective equipment for sporting activities, sporting activities designed to minimize physical contact, establishment of standardized injury referral procedures, first‐aid training, and a standardized injury reporting system.
The spectral analysis of cough sounds in childhood respiratory illness
Authors: DAWSON K. P. , THORPE C. W. , TOOP L. J. 
Published: March 2008

ABSTRACTCough is the commonest symptom of childhood respiratory disease and at times may be the predominant feature. The characteristic sound of the cough is often considered by the clinician as a useful diagnostic feature in such conditions as croup and whooping cough. This has prompted a closer study of the physical basis of the cough sounds and their relationship to the pathological processes in the airway.1 Keleman et al.2 have demonstrated that there are at least three phases to any particular cough, that is, an initial burst due to air turbulence and tissue vibration, followed by a noisy phase, and the final vocalic burst as the glottis forcefully cuts off the air flow. These studies have led to the development of computer assisted methods of evaluation of cough.3 In turn, sound spectral analysis techniques, which have been used extensively to study lung sounds in asthma,4 have been applied to cough sounds.5,6 A microcomputer‐based system which allows rapid performance of such analyses has been devised and described recently.6
Antinuclear antibodies using HEp‐2 cells in normal children and in children with common infections
Authors: ALLEN R. C. , DEWEZ P. , STUART L. , GATENBY P. A. , STURGESS A. 
Published: March 2008

AbstractAntinuclear antibody (ANA) immunofluorescence tests, using HEp‐2 cells, were performed on 100 children without a history of connective tissue disease. Eighteen (18%) were positive at titres < 1:40, nine (9%) being greater than 1:160. Interlaboratory variability was demonstrated with some specimens. No association with possible intercurrent infection was found to account for positive results. Of 44 children with proven infections five (11%) were positive. Antinuclear antibody may be found in some normal children when using the sensitive HEp‐2 cell substrate, and in the absence of clinical features should not necessarily suggest the presence of a connective tissue disease.
Assessment of cardiac function by M‐mode echocardiography in selenium‐deficient phenylketonuric children
Authors: GORDON S. J. , LATHAM S. C. , SPINK J. D. , GALBRAITH A. J. 
Published: March 2008

AbstractSelenium (Se) deficiency is associated with cardiac and skeletal muscle dysfunction. Twenty well children aged 2‐16 years (10 male) attending the Phenylketonuria (PKU) Clinic at the Royal Children's Hospital, Brisbane, had low Se levels (mean 0.29±0.02 s.e.m. μmol/L; normal range 0.56‐1.16 μmol/L). Their myocardial function was assessed at rest and after exercise provocation by M‐mode echocardiography in order to exclude occult left ventricular dysfunction. At rest, fractional shortening (FS) was normal (mean 38.1±1.1 s.e.m.%, n= 20). After exercise, FS increased significantly (P <0.001) from 37.6±1.4% to 44.3±1.2%, n= 12). This was associated with a significant rise (P <0.001) in heart rate (HR) from 77.3±3.1 beats/min to 125.8±5.2 beats/min (n= 12). The normal resting FS and normal increase in FS and HR with exercise is evidence against significant cardiac impairment in this group of Se‐deficient children.
What do medical students know about childhood asthma?
Authors: FITZCLARENCE C. A. B. , HENRY R. L. 
Published: March 2008

AbstractA questionnaire designed to measure knowledge about childhood asthma was completed by 216 of the 311 (69%) undergraduate medical students at the University of Newcastle. First year students had a mean score of 16.2 (maximum possible score was 31) which was similar to the background community score of 13.0 obtained in a group of parents with no close contact with asthma. Knowledge about asthma increased over each of the 5 years of the medical course. Final‐year students had a mean score of 28.7 (range: 25‐31) which was similar to a group of parents thought by their paediatricians to have a high level of knowledge about asthma (mean: 25.3, range: 18‐31).The progression of knowledge over the 5 years of the course provided interesting information about the learning process. Although second year students completed the questionnaire after a term devoted to coursework in respiratory medicine, only 26% were able to name two preventive agents and 21% named three agents useful during acute attacks of asthma. Third year students gave correct responses in 39 and 45% of cases, respectively, and the correct response rates rose to 78 and 97% in the fifth year. This was probably because the theoretical knowledge needed to be acquired and tested against a clinical scenario before it could be used.The study demonstrated an increase in knowledge about asthma throughout the problem‐based medical course. In addition to providing information about the educational process, it provided information about the questionnaire which was able to measure a range of knowledge and not just extremes of asthma knowledge.
Depression in mothers and behaviour problems with their preschool children
Authors: WILLIAMS H. , CARMICHAEL A. 
Published: March 2008

ABSTRACTA follow‐up study of 224 families of a birth cohort of 272 families in a multi‐ethnic poor socio‐economic municipality in Melbourne when the children were 4 years old showed that 27% of the mothers were depressed. There was no difference in the depression rate between Australian‐born and immigrant mothers, a finding in marked contrast to the first year of the study when the depression rate was significantly higher in those immigrant mothers who had been in Australia for less than 3 years, were unable to speak English and who did not have an extended family or close friends. Depression in this group of mothers was attributed to resettlement problems, which over a period of three years had ameliorated.At 4 years the most important factor associated with depression in both Australian‐born and immigrant mothers was the quality of marital relationships. Lack of an intimate support relationship made mothers more vulnerable to the stresses of child care and rearing, home‐making and life events. In Australian‐born mothers only, another significant factor in vulnerability to depression, was their early childhood experiences of being reared in a disruptive home or in an institution and of being unwanted. In immigrant mothers, but not in Australian‐born mothers, life events were significantly correlated with depression.The depressed mothers, both Australian‐born and immigrant, perceived their 4 year old children to have significantly more behavioural problems than mothers who were not depressed.
Methadone levels and neonatal withdrawal
Authors: MACK G. , THOMAS D. , GILES W. , BUCHANAN N. 
Published: March 2008

ABSTRACTThe purpose of this study was to observe the effects of methadone exposure in utero, with special reference to maternal and neonatal methadone concentrations and neonatal withdrawal. Two groups of mother‐infant pairs were studied. In the first group, serum methadone concentrations were determined in infants at 1, 6 and 24 h after delivery. In the second group, blood was obtained at 24, 48, 72 and 96 h after birth. There was no correlation between neonatal serum levels and the intensity of withdrawal symptoms. There was no relationship between maternal methadone dose at delivery or maternal serum levels and neonatal methadone levels. The results of this study may be complicated by the prenatal exposure of the neonates to other drugs of abuse apart from methadone.
Progressive hearing loss in children with congenital cytomegalovirus
Authors: HICKSON L. M. H. , ALCOCK D. 
Published: March 2008

ABSTRACTCase studies of five children with congenital cytomegalovirus (CMV) who were referred for audiological evaluation are presented. Significant deterioration of hearing was noted in all cases within the first 4 years of life. It is essential that neonates with congenital CMV be referred for hearing assessment and that the child's hearing be monitored on a long‐term basis. Early intervention is vital for the speech and language development of hearing‐impaired child.
Duration of hospitalization in extremely preterm infants
Authors: YU V. Y. H. , SHAH V. , GOMEZ J. M. , McCLOUD P. I. 
Published: March 2008

AbstractThis study reports the age at hospital discharge of 233 survivors and age at death of 209 infants who were born at 23‐28 weeks gestation over a 10 year period, 1977‐86. The mean duration of hospitalization of survivors was 95 days and was inversely related to maturity at birth; those born at 23‐25 weeks remained in hospital on average 1‐2 weeks beyond term while those born at 26‐28 weeks went home on average at term or 1 week before term. The mean age at death was 12 days: 53% within 1 day, 23% between 2 and 7 days, 15% between 8 and 28 days and 9% between 28 days and 1 year. The proportions of death in the post‐neonatal period for infants born at 23‐24 weeks, 25‐26 weeks and 27‐28 weeks were 2, 9 and 16% respectively. There was no significant trend in prolonged hospitalization of survivors or postponement of neonatal deaths to the post‐neonatal period over the 1977‐86 period. Nevertheless, both neonatal and post‐neonatal mortality should continually be monitored in this extremely preterm group.
Hepatitis A and B infections in transfusion‐dependent thalassaemia from endemic areas
Authors: LI A. M. C. , CHANG W. K. 
Published: March 2008

ABSTRACTAbstract The aim of this study was to determine the prevalence of previous hepatitis A virus (HAV) and B virus (HBV) infection which is in 64 transfusion‐dependent (TD) patients with thalassaemia including 26 patients who were transfused before blood donors were screened for HBV. Serial blood samples taken from these 64 patients and 10 non‐TD β‐thalassaemia intermedia patients during a 3 year period, were tested for antibody to HAV (anti‐HAV), hepatitis B surface antigen (HBsAg), antibody to HBsAg (anti‐HBs), antibody to core antigen (anti‐HBc) and when indicated, antibody to Delta virus (anti‐Delta) and HBV DNA. Liver function tests were performed also. Similar tests were conducted on 50 donor blood units. None of the 64 TD patients had evidence of past HAV infection but 50% of blood donors had evidence of past infection (P <0.001). Only 2 brothers and their mother were positive for HBsAg, and 38 patients (59.4%) had persisting HBV antibodies compared with 26% of blood donors (P <0.001). Our TD thalassaemic patients acquired passive immunity from donor plasma, which protected them against HAV and possibly modified the outcome of HBV infection.
Suppression of adrenal function in children on inhaled steroids
Authors: CHANG C. C. C. , TAM A. Y. C. 
Published: March 2008

ABSTRACTAbstract Inhaled steroid therapy is one of the mainstays of treatment of asthma in children. Side effects, including suppression of the hypothalamic‐pituitary‐adrenal (HPA) axis, have been noted with high doses of inhaled steroids. Most studies concerning side effects have been done with mechanical nebulization devices or hand‐held metered‐dose inhalers. The present study attempts to ascertain if dry powder inhalation of beclomethasone diproprionate is associated with any significant suppression of the HPA axis. Fifteen children (10 male and 5 female) between the ages of 4 and 14 years were followed for several years in our outpatient department. They were on inhaled beclomethasone diproprionate at dosages ranging from 6.9 to 25 μg/kg per day for 4‐24 months. The short adrenocorticotrophic hormone (ACTH) test was used to evaluate function of the HPA axis. Mild suppression of the HPA axis was noted in one of the cases. The study therefore concludes that at therapeutic doses of dry powder beclomethasone diproprionate, suppression of the HPA axis can occur. However, the extent of this complication does not appear to be greater than with hand‐held or mechanical nebulization devices.
An analysis of trends in the incidence of sudden infant death in The Netherlands 1969–89
Authors: ENGELBERTS A. C. , de JONGE G. A. , KOSTENSE P. J. 
Published: March 2008

ABSTRACTThere is considerable interest in the relationship between sleeping position and the occurrence of sudden infant death syndrome (SIDS). As changes have been reported in The Netherlands in the position infants have been placed to sleep, the national Dutch sudden infant death rates were analysed over the time that such changes have taken place.The overall post‐perinatal death rate (1 week <1 year) was around 4‐4.5 per 1000 live births from 1969 until 1985. From 1985 until 1989 the rate fell from 4.1 to 2.9 per 1000 live births. During the same period the cot death/SIDS rate rose from 0.44 per 1000 in 1969 to between 1.08 and 1.31 per 1000 in 1977‐87, and subsequently fell to 0.7 per 1000 in 1989. These trends coincided with changes in prone sleeping position demonstrated in national surveys.The problems of interpreting such national data, with only 50‐60% of infant deaths being autopsied and with the possibilities of misclassification over time, are fully discussed. The data are supportive of the relationship between prone sleeping position and cot death.
An overview of retrospective case‐control studies investigating the relationship between prone sleeping position and SIDS
Authors: BEAL S. M. , FINCH C. F. 
Published: March 2008

ABSTRACTA critical overview of 19 case‐control studies that have investigated the relationship between prone sleeping position and sudden infant death syndrome (SIDS) is presented. Issues relating to the non‐comparability of the studies are described in terms of: (i) case definition; (ii) selection of controls; (iii) quality of the sleeping position data; (iv) recall bias; and (v) adjustment for confounding factors. All studies showed a positive association (2 out of the 19 studies were not significant) between prone sleeping position and SIDS. Meta‐analysis techniques applied to six of these studies, based on ‘usual’ sleeping position in cases and population representative controls, has confirmed an overall higher risk of SIDS in infants who usually sleep prone. The most common odds ratio for an association between prone sleeping position and SIDS was 2.72 (95% confidence interval 2.27‐3.26). The extent to which the methodological problems of retrospective case‐control studies interfere with our interpretations of this association are discussed.
Prone sleeping position and SIDS: Evidence from recent case‐control and cohort studies in Tasmania
Authors: DWYER T. , PONSONBY A‐L. , GIBBONS L. E. , NEWMAN N. M. 
Published: March 2008

ABSTRACTThe most recent data from the cohort and case‐control studies of SIDS and prone position recently reported from Tasmania are reviewed. The cohort analysis was based on 4103 infants born between 1 January 1988 and 1 December 1990 assessed as being at high risk at birth, of whom 29 later died of SIDS. A matched analysis which controlled for infant birthweight and maternal age indicated that prone sleeping position was associated with an increased risk of SIDS (OR 3.92, 95% Cl [1.37‐11.24]). The case‐control study was based on all (n= 55) Tasmanian SIDS deaths from October 1989 to April 1991 and matched live controls. The unadjusted odds ratio for prone position and SIDS was 5.04 (95% Cl [2.29‐11.11]). The population attributable risk percentage, based on the high risk cohort data, was 0.38 (95% Cl [0.35‐0.41]), suggesting that a significant reduction in SIDS incidence might occur if the prevalence of the prone sleeping position in the infant population were reduced. Other factors which may be important for the development of any public health interventions to reduce SIDS based on these findings are discussed.