bluuebunny/crossref_metadata_2025_split huggingface dataset:
Maxillofacial Training is No Longer than Other Surgical Specialties
Authors: Cameron Malcolm , Westcott Lucy 
Published: February 2008

INTRODUCTION There is a perception that the training pathway for oral and maxillofacial surgery (OMFS) is unduly long and arduous, as consultant oral and maxillofacial surgeons must be doubly qualified (that is, hold degrees in medicine and dentistry) and be holders of two higher fellowships. MATERIALS AND METHODS We reviewed the data regarding the average age of National Training Number (NTN) holders and GMC data on the year of first registration and the year of entry onto a specialist surgical list for all 9 surgical specialties. RESULTS The results showed the average age of the surgical SpR populations ranged from 33.5 to 38.2 years with an average age of 36.14 years. OMFS SpR's average age is 37.69 years. The GMC data showed the average number of months from full to specialist registration ranged from 90.83 months to 135.24 months, with OMFS surgeons having the lowest average. CONCLUSIONS These data suggest that OMFS surgeons are of a similar age to other surgeons whilst in training. In addition, they have the shortest transit time between full GMC registration and entry onto the specialist list. The length of this training even with dual qualification is similar to other surgical specialties.
Wedding Rings are not a Significant Source of Bacterial Contamination Following Surgical Scrubbing
Authors: Al-Allak A , Sarasin S , Key S , Morris-Stiff G 
Published: February 2008

INTRODUCTION Despite some evidence that the wearing of rings may increase the microbial load, there is currently nothing to suggest that viable bacteria remain following a standard surgical scrub. The aim of the study was to examine the distribution and type of microbial flora seen on the hands of doctors following a standard surgical scrub. MATERIALS AND METHODS Ten surgeons and 10 anaesthetists, all of whom wore wedding rings on the fourth finger of their left hand, participated in the study. Each individual was asked to ‘scrub-up’ as for their normal first scrub of the day. Following completion of washing, the wedding ring was removed, its internal circumference swabbed and the swab placed in a culture medium. Volunteers placed each hand palm-down on separate agar plates. The plates were incubated and the number of colonies counted and classified. RESULTS The culture plates of one of the anaesthetists were damaged in transit leaving a total of 19 subjects for analysis. In all the palm imprint plates, coagulase-negative staphylococci were grown. One surgeon grew coagulase-negative staphylococci from the ring swab. A Candida spp. from the right hand of one surgeon was grown. There was no statistically significant difference between the number of colony-forming units (CFUs) cultured from the right and left (ring-wearing) hands of the surgeons (P = 0.260) and anaesthetists (P = 0.345). There was no statistical difference in CFUs when surgeons were compared with anaesthetists (P = 0.383 for right hand and P = 0.234 for left). CONCLUSIONS This preliminary study would suggest that a traditional band wedding ring is not a source of a bacterial load following a standard surgical scrub procedure and, as such, there is no requirement for their removal pre-operatively.
Effectiveness of the 7-Valent Pneumococcal Conjugate Vaccine in Children With Sickle Cell Disease in the First Decade of Life
Authors: Adamkiewicz Thomas V. , Silk Benjamin J. , Howgate James , Baughman Wendy , Strayhorn Gregory , Sullivan Kevin , Farley Monica M. 
Published: February 2008

BACKGROUND. The incidence of and mortality from invasive pneumococcal disease are significantly higher in children with sickle cell disease than in the general pediatric population. The objective of this population-based study was to assess the effect of pneumococcal conjugate vaccine on rates of invasive pneumococcal disease among children with sickle cell disease.PATIENTS AND METHODS. Records, including the history of pneumococcal conjugate vaccine administration, of 1247 children born after 1983 residing in metropolitan Atlanta, Georgia, with confirmed hemoglobinopathies were linked to an active surveillance database for invasive pneumococcal disease for the period of January 1, 1995, through January 1, 2003. The incidence of invasive pneumococcal disease and the percentage of rate reduction were estimated before and after pneumococcal conjugate vaccine licensure. Survival analysis was used to estimate the effect of pneumococcal conjugate vaccine on invasive pneumococcal disease rates while accounting for herd immunity.RESULTS. A significant decline in invasive pneumococcal disease in children with sickle cell disease ≤10 years of age was noted after pneumococcal conjugate vaccine licensure, from 1.7 infections per 100 person-years (1995–2000) to 0.5 infections per 100 person-years (2001–2002), which represents a 68% reduction. The effectiveness of ≥1 dose of pneumococcal conjugate vaccine was estimated by crude analysis to be 84.5% and by stratified survival analysis to be 81.4% when controlling for the presence of herd immunity in the 2 years after pneumococcal conjugate vaccine licensure. Serotype 6A invasive pneumococcal disease represented 36% of invasive pneumococcal disease before pneumococcal conjugate vaccine licensure and 0% after pneumococcal conjugate vaccine licensure, suggesting a protective effect against this pneumococcal conjugate vaccine-related serotype.CONCLUSIONS. Invasive pneumococcal disease significantly decreased in children with sickle cell disease ≤10 years of age after pneumococcal conjugate vaccine licensure. Pneumococcal conjugate vaccine was effective even when controlling for herd immunity. Extending guideline recommendations for catch-up vaccination beyond 4 years of age should be considered.
Effects of Asthma Education on Children's Use of Acute Care Services: A Meta-analysis
Authors: Coffman Janet M. , Cabana Michael D. , Halpin Helen Ann , Yelin Edward H. 
Published: February 2008

OBJECTIVE. National Heart, Lung, and Blood Institute clinical practice guidelines strongly recommend that health professionals educate children with asthma and their caregivers about self-management. We conducted a meta-analysis to estimate the effects of pediatric asthma education on hospitalizations, emergency department visits, and urgent physician visits for asthma.PATIENTS AND METHODS. Inclusion criteria included enrollment of children aged 2 to 17 years with a clinical diagnosis of asthma who resided in the United States. Pooled standardized mean differences and pooled odds ratios were calculated. Random-effects models were estimated for all outcomes assessed.RESULTS. Of the 208 studies identified and screened, 37 met the inclusion criteria. Twenty-seven compared educational interventions to usual care, and 10 compared different interventions. Among studies that compared asthma education to usual care, education was associated with statistically significant decreases in mean hospitalizations and mean emergency department visits and a trend toward lower odds of an emergency department visit. Education did not affect the odds of hospitalization or the mean number of urgent physician visits. Findings from studies that compared different types of asthma education interventions suggest that providing more sessions and more opportunities for interactive learning may produce better outcomes.CONCLUSIONS. Providing pediatric asthma education reduces mean number of hospitalizations and emergency department visits and the odds of an emergency department visit for asthma, but not the odds of hospitalization or mean number of urgent physician visits. Health plans should invest in pediatric asthma education or provide health professionals with incentives to furnish such education. Additional research is needed to determine the most important components of interventions and compare the cost-effectiveness of different interventions.
Effect of a School-Entry Vaccination Requirement on Racial and Ethnic Disparities in Hepatitis B Immunization Coverage Levels Among Public School Students
Authors: Morita Julie Y. , Ramirez Enrique , Trick William E. 
Published: February 2008

OBJECTIVE. We evaluated the overall effect of Illinois’ school-entry mandate on hepatitis B vaccination coverage levels and racial/ethnic differences in vaccination coverage before and after the mandate.
METHODS. In 1997, the Illinois Department of Public Health mandated hepatitis B vaccination before entry into 5th grade. We conducted a retrospective cohort study of 6 consecutive Chicago public schools’ 12th-grade classes; 4 entered 5th grade before the mandate (premandate cohorts) and 2 afterward (postmandate cohorts). We used Chicago public schools’ vaccination database and calculated annual coverage levels for 2nd through 12th grades; the cohorts entered 12th grade during 2000–2005. We compared hepatitis B vaccination coverage levels according to race/ethnicity and coverage levels for the premandate and postmandate cohorts.
RESULTS. We evaluated 106 541 students. The postmandate cohort had significantly higher hepatitis B vaccination coverage levels than the premandate cohort at 5th-grade (38.2% vs 4.3%) and 9th-grade (85.0% vs 37.4%) entry. For 9th-grade students, compared with white students, black students were less likely to have received hepatitis B vaccination before the mandate; this disparity decreased for the first postmandate cohort. For Hispanic students, the disparity was less pronounced and also decreased after the mandate. By 9th grade in the postmandate cohorts, coverage levels for all racial/ethnic groups exceeded 80%.
CONCLUSIONS. There was a dramatic decrease in the disparity of hepatitis B vaccination coverage between white and black or Hispanic students. School-entry requirements effectively increased hepatitis B vaccination coverage levels regardless of race or ethnicity and should be considered for other recently recommended adolescent vaccines.
Detection of Hypoglycemia by Children With Type 1 Diabetes 6 to 11 Years of Age and Their Parents: A Field Study
Authors: Gonder-Frederick Linda , Zrebiec John , Bauchowitz Andrea , Lee Jarim , Cox Daniel , Ritterband Lee , Kovatchev Boris , Clarke William 
Published: February 2008

OBJECTIVES. The objectives of this study were to (1) assess accuracy of hypoglycemia detection in children with type 1 diabetes and their parents, using personal digital assistant technology to collect glucose estimates and meter readings, (2) identify demographic, clinical, and psychological predictors of individual differences in accuracy, and (3) test whether poor hypoglycemia detection is a risk factor for severe hypoglycemia in children.
METHODS. Sixty-one children aged 6 to 11 and their parents completed 70 trials, over 1 month, of a survey programmed on a personal digital assistant, which asked them to rate symptoms, estimate current blood glucose level, and then measure blood glucose level. For the subsequent 6 months, parents reported children's severe hypoglycemia episodes bimonthly.
RESULTS. Both parents and children showed poor ability to recognize high or low blood glucose levels, making clinically significant errors as frequently as clinically accurate estimates. Parents failed to recognize &gt;50% of readings &lt;3 mmol/L (&lt;55 mg/dL) and made potentially dangerous errors such as believing the blood glucose level was high when it was low 17% of the time. Children were significantly more accurate at recognizing their hypoglycemia but still failed to detect &gt;40% of episodes. Higher depression scores for children related to lower accuracy. Children who were less accurate at detecting hypoglycemia subsequently experienced more severe hypoglycemia.
CONCLUSIONS. Ability to recognize hypoglycemia is a significant problem for children with type 1 diabetes and their parents. For children, poor ability to detect low blood glucose levels may be a significant and underappreciated risk factor for severe hypoglycemia. More effort is needed to provide education and training designed to improve hypoglycemia detection in this population.
Predictors of Persistent and New-onset Fatigue in Adolescent Girls
Authors: ter Wolbeek Maike , van Doornen Lorenz J. P. , Kavelaars Annemieke , Heijnen Cobi J. 
Published: February 2008

OBJECTIVE. The purpose of this study was to investigate the stability of fatigue in adolescents and to explore whether psychological, somatic, and lifestyle factors are involved in the onset and persistence of fatigue during adolescence.METHODS. In this longitudinal study, a total of 653 adolescent girls (aged 14.40 ± 1.45 years) who previously participated in an epidemiological study filled out questionnaires 6 (T2) and 12 (T3) months after the initial assessment (T1). Fatigue severity, depression, anxiety, and chronic fatigue syndrome–related symptoms were assessed. We determined the prevalence of severely fatigued cases at T2 and T3 and evaluated whether persistently fatigued participants initially differed from nonfatigued participants and participants with transient fatigue. We examined which factors predicted the development of new-onset fatigue and investigated whether changes in fatigue covaried with changes in other complaints and changes in lifestyle.RESULTS. Of all participants who were severely fatigued at T1, 25.7% were persistently fatigued throughout the study. Persistently fatigued participants had higher levels of depression and anxiety at the beginning of the study, were less physically active, and slept shorter. New-onset fatigue was predicted by depression, less physical activity, and more nightlife activities. Interestingly, new onset was not predicted by initial levels of fatigue. Persistently fatigued participants did not differ in initial fatigue severity from short-term fatigued patients. A decrease in fatigue severity was associated with a decrease in depression, anxiety, and chronic fatigue syndrome–related symptoms and, to a lesser extent, with an increase in physical activity and sleep duration.CONCLUSIONS. The stability of severe fatigue among adolescents is substantial. The involvement in the onset and persistence of fatigue suggests that both preventive and therapeutic strategies with respect to fatigue treatment in adolescents should concentrate on emotional well-being. Moreover, adolescents at risk should be stimulated to spend more time on physical activities and to sleep longer.
A Population-Based, Multisite Cohort Study of the Predictors of Chronic Idiopathic Thrombocytopenic Purpura in Children
Authors: Glanz Jason , France Eric , Xu Stan , Hayes Taru , Hambidge Simon 
Published: February 2008

OBJECTIVE. The objective of this study was to identify risk factors for developing chronic idiopathic thrombocytopenic purpura in a cohort of pediatric patients with idiopathic thrombocytopenic purpura.
METHODS. We conducted a retrospective cohort analysis of 259 children who were diagnosed with idiopathic thrombocytopenic purpura between 1991 and 2000 at 1 of 8 managed care organizations that comprise the Vaccine Safety Datalink. We reviewed the charts of 595 potential patients with idiopathic thrombocytopenic purpura from the 8 Vaccine Safety Datalink sites and excluded patients with known causes of thrombocytopenia. Chronic idiopathic thrombocytopenic purpura was defined as having thrombocytopenia for 6 months beyond the initial diagnosis. The risk for developing chronic idiopathic thrombocytopenic purpura was assessed using simple and multivariable analyses.
RESULTS. Of the 259 cases of idiopathic thrombocytopenic purpura, 197 (76%) were acute, 60 (23%) were chronic, and 2 (1%) could not be determined. Among the acute cases, the mean duration of illness was 22 days. There was 1 serious bleeding outcome in the cohort. In multivariable regression analysis, the patients with chronic illness were older, less likely to present with mucosal bleeding, less likely to have had an acute illness before diagnosis, and more likely to present with a platelet count &gt;20000/μL than children with acute idiopathic thrombocytopenic purpura. In particular, children whose illness was diagnosed at ≥10 years of age and who had platelet counts ≥20000/μL had an approximate fivefold risk for progressing to chronic disease when compared with children who presented at ≤2 years of age with platelet counts &lt;20000/μL.
CONCLUSIONS. Although idiopathic thrombocytopenic purpura tends to be a benign and self-limited condition, acute and chronic idiopathic thrombocytopenic purpura seem to be distinct illnesses defined by age, platelet count, bleeding symptoms, and the presence of acute illness before diagnosis. Physicians should be aware of these differences when advising their patients and families.
Breastfeeding Helps Explain Racial and Socioeconomic Status Disparities in Adolescent Adiposity
Authors: Woo Jessica G. , Dolan Lawrence M. , Morrow Ardythe L. , Geraghty Sheela R. , Goodman Elizabeth 
Published: February 2008

OBJECTIVES. Studies suggest that breastfeeding is protective for later obesity; however, this association has not held among all racial and socioeconomic status groups. Racial and socioeconomic status differences in breastfeeding behavior have also been noted. In this study, we formally test whether breastfeeding mediates the relationship between race and socioeconomic status with adolescent adiposity.METHODS. Data were analyzed from 739 black and white 10- to 19-year-old adolescents who participated in a large, school-based study. Parents provided information on parental education, used to measure socioeconomic status, and whether the child was breastfed as an infant. BMI was used to measure adolescent adiposity and was analyzed as a continuous measure (BMI z score) using linear regression and categorically (BMI ≥85th and ≥95th percentile) using logistic regression.RESULTS. Black adolescents and those without a college-educated parent were less likely to have been breastfed for &gt;4 months. Race and parental education were each independent predictors of BMI z score and of having BMI ≥85th percentile or BMI ≥95th percentile. When added to the model, being breastfed for &gt;4 months was also independently associated with lower BMI z score and lower odds of having BMI ≥85th percentile or BMI ≥95th percentile. Inclusion of being breastfed for &gt;4 months resulted in a 25% decrease in racial and parental education differences in adolescent BMI z score, supporting partial mediation.CONCLUSIONS. Having been breastfed for &gt;4 months was associated with lower adolescent BMI z score and lower odds of having a BMI ≥85th percentile or BMI ≥95th percentile, independent of race or parental education. Furthermore, these analyses suggest that being breastfed for &gt;4 months partially explains the relationship between social disadvantage and increased adiposity. Increasing breastfeeding duration could result in lower adolescent adiposity for all racial and socioeconomic status groups and potentially minimize socioeconomic disparities in adiposity.
Efficacy of Cognitive Behavioral Therapy for Adolescents With Chronic Fatigue Syndrome: Long-term Follow-up of a Randomized, Controlled Trial
Authors: Knoop Hans , Stulemeijer Maja , de Jong Lieke W. A. M. , Fiselier Theo J. W. , Bleijenberg Gijs 
Published: February 2008

OBJECTIVES. The purpose of this work was to assess the long-term outcome of adolescents with chronic fatigue syndrome who received cognitive behavioral therapy and to determine the predictive value of fatigue severity and physical impairments of the adolescent and the fatigue severity of the mother at baseline for the outcome of the treatment at follow-up.
PATIENTS AND METHODS. Sixty-six adolescent patients with chronic fatigue syndrome who previously participated in a randomized, controlled trial that showed that cognitive behavioral therapy was more effective than a waiting-list condition in reducing fatigue and improving physical functioning were contacted for a follow-up assessment. Fifty participants of the follow-up study had received cognitive behavioral therapy for chronic fatigue syndrome (32 formed the cognitive behavioral therapy group in the original trial, and 18 patients received cognitive behavioral therapy after the waiting period). The remaining 16 patients had refused cognitive behavioral therapy after the waiting period. The main outcome measures were fatigue severity (Checklist Individual Strength), physical functioning (Short-Form General Health Survey), and school attendance.
RESULTS. Data were complete for 61 patients at follow-up (cognitive behavioral therapy group: 47 patients; no-treatment group: 14 patients). The mean follow-up time was 2.1 years. There was no significant change in fatigue severity between posttreatment and follow-up in the cognitive behavioral therapy group. There was a significant further increase in physical functioning and school attendance (10% increase). The adolescents in the cognitive behavioral therapy group were significantly less fatigued and significantly less functionally impaired and had higher school attendance at follow-up than those in the no-treatment group. Fatigue severity of the mother was a significant predictor of treatment outcome.
CONCLUSIONS. The positive effects of cognitive behavioral therapy in adolescents with chronic fatigue syndrome are sustained after cognitive behavioral therapy. Higher fatigue severity of the mother predicts lower treatment outcome in adolescent patients.
A Guide for Monitoring Child Development in Low- and Middle-Income Countries
Authors: Ertem Ilgi O. , Dogan Derya G. , Gok Canan G. , Kizilates Sevim U. , Caliskan Ayliz , Atay Gulsum , Vatandas Nilgun , Karaaslan Tugba , Baskan Sevgi G. , Cicchetti Domenic V. 
Published: February 2008

OBJECTIVE. In low- and middle-income countries, methods for clinicians to address difficulties in language, social-emotional, cognitive, behavioral, or neuromotor development during early childhood are lacking. To fill this gap, we designed, in Turkey, the Guide for Monitoring Child Development, which aims to aid clinicians in monitoring and supporting child development and the early detection and management of developmental difficulties. The Guide for Monitoring Child Development monitoring component is a practical, open-ended interview that catalyzes communication between clinicians and caregivers and obtains a portrayal of the child's development. We report on the development and psychometric properties of the Guide for Monitoring Child Development monitoring component for children aged 0 to 24 months.METHODS. We examined the ages of attainment of Guide for Monitoring Child Development milestones and internal consistency in a cross-sectional study of healthy children receiving well-child care (study 1). In 2 clinical samples, we studied the interrater reliability between medical students and a child development specialist administering the guide (study 2), as well as the concurrent validity of the guide administered during a health visit and a comprehensive developmental assessment (study 3).RESULTS. In study 1 (N = 510), item-total scale correlations ranged from 0.28 to 0.91. An age-dependent attainment pattern was seen in all of the milestones. In study 2 (N = 92), interrater reliability between medical-student pairs and between the child development specialist and students was high (kappa scores were 0.83–0.88). In study 3 (N = 79), the sensitivity, specificity, and positive and negative predictive values were 0.88, 0.93, 0.84, and 0.94, respectively.CONCLUSIONS. The Guide for Monitoring Child Development is an innovative method for monitoring child development that is designed specifically for use by health care providers in low- and middle-income countries. Studies in Turkey provide preliminary evidence for its reliability and validity.