WorldWideScience

Sample records for undernourished children utilizing

  1. Undernourished Children and Milk Lactose.

    Science.gov (United States)

    Grenov, Benedikte; Briend, André; Sangild, Per T; Thymann, Thomas; Rytter, Maren H; Hother, Anne-Louise; Mølgaard, Christian; Michaelsen, Kim F

    2016-03-01

    Lactose is an important energy source in young mammals, and in fully breast-fed human infants, it constitutes around 40% of the total daily energy intake. The role of lactose in feeding of undernourished infants and young children is not well described. A narrative review of the potential positive and negative effects of lactose in the treatment of undernourished children. Searches were conducted using PUBMED and Web of Science up to July 2015. Relevant references in the retrieved articles were included. Lactose may exhibit several health benefits in young children, including a prebiotic effect on the gut microbiota and a positive effect on mineral absorption. Studies in piglets suggest there might also be a stimulating effect on growth, relative to other carbohydrates. Lactose intolerance is a potential concern for undernourished children. Most undernourished children seem to tolerate the currently recommended (low lactose level) therapeutic foods well. However, a subgroup of severely undernourished children with secondary lactase deficiency due to severe diarrhea or severe enteropathy may benefit from products with even more restricted lactose content. At limited extra costs, lactose or lactose-containing milk ingredients may have beneficial effects if added to food products for undernourished children. Lactose may be an overlooked beneficial nutrient for young and undernourished children. Research is needed to define the balance between beneficial and detrimental effects of lactose in undernourished children at different ages and with different degrees of diarrhea and intestinal integrity. © The Author(s) 2016.

  2. Undernourished children and milk lactose

    DEFF Research Database (Denmark)

    Grenov, Benedikte; Briend, André; Sangild, Per Torp

    2016-01-01

    BACKGROUND: Lactose is an important energy source in young mammals, and in fully breast-fed human infants, it constitutes around 40% of the total daily energy intake. The role of lactose in feeding of undernourished infants and young children is not well described. OBJECTIVE: A narrative review...... of the potential positive and negative effects of lactose in the treatment of undernourished children. METHODS: Searches were conducted using PUBMED and Web of Science up to July 2015. Relevant references in the retrieved articles were included. RESULTS: Lactose may exhibit several health benefits in young...... children, including a prebiotic effect on the gut microbiota and a positive effect on mineral absorption. Studies in piglets suggest there might also be a stimulating effect on growth, relative to other carbohydrates. Lactose intolerance is a potential concern for undernourished children. Most...

  3. The clinical and anthropometric profile of undernourished children ...

    African Journals Online (AJOL)

    Background. Although Botswana is a middle-income country, undernutrition among children younger than 5 years of age is still seen in various parts of the country. There is little information on the clinical and anthropometric profile of undernourished children in this age group admitted to hospitals in Francistown, Botswana.

  4. Cryptosporidium infection in undernourished children with HIV/AIDS ...

    African Journals Online (AJOL)

    Background: AIDS and Protein energy malnutrition (PEM) severely impair the immune system Cryptosporidium has over the last two decades emerged as a life threatening disease. The study attempts to determine the prevalence of Cryptosporidium infection in malnourished children with HIV/AIDS. Method: Blood and stool ...

  5. SMALL INTESTINAL ENTEROPATHY IN UNDERNOURISHED CHILDREN IN THREE URBAN SLUMS IN SOUTH INDIA

    Directory of Open Access Journals (Sweden)

    Praburam P. M

    2016-01-01

    Full Text Available Introduction: Growth faltering is a common health issue in the developing countries. At times we are unable to attribute this growth faltering to lack of adequate nutrients in food or ongoing disease conditions alone. With this study we aim to assess the possibility of the existence of subclinical malabsorption in children with undernutrition. Methods: A cross sectional study was conducted on a sample of 161 children from a birth cohort of 377 children who were under follow up from birth for health and disease in three of the urban slums of Vellore. The prevalence of small intestinal enteropathy, as assessed by a 5 hour urinary d-xylose excretion test, was compared between undernourished and well-nourished children. Correlation between undernutrition, d-xylose malabsorption and previous documented illnesses including viral, bacterial or parasitic infections/ infestations was also studied. Results: Xylose test result was abnormal in 41% (25 of 61 of undernourished children as against 26% (26 of 100 of well-nourished children, with p value of 0.047 and Odds ratio of 1.976 with 95% confidence interval between 1.003 and 3.895. Conclusion: There is a statistically significant association between undernutrition and small intestinal enteropathy.

  6. Perceptions of Child Body Size and Health Care Seeking for Undernourished Children in Southern Malawi.

    Science.gov (United States)

    Flax, Valerie L; Thakwalakwa, Chrissie; Ashorn, Ulla

    2016-12-01

    Child undernutrition affects millions of children globally, but little is known about the ability of adults to detect different types of child undernutrition in low-income countries. We used focused ethnographic methods to understand how Malawian parents and grandparents describe the characteristics they use to identify good and poor child growth, their actual or preferred patterns of health seeking for undernourished children, and the perceived importance of child undernutrition symptoms in relation to other childhood illnesses. Malawians value adiposity rather than stature in assessing child growth. Symptoms of malnutrition, including wasting and edema, were considered the least severe childhood illness symptoms. Parents delayed health care seeking when a child was ill. When they sought care, it was for symptoms such as diarrhea or fever, and they did not recognize malnutrition as the underlying cause. These findings can be used to tailor strategies for preventing and treating growth faltering in Malawian children. © The Author(s) 2015.

  7. Contribution of radioimmunological techniques on the management of undernourished children in Senegal

    International Nuclear Information System (INIS)

    Mbodj, M.; Gassama, S.S.; Sow, H.T.; Ndoye, O.; Ndong, B.; Diarra, M.; Sarr, M.; Diagne, I.; Diouf, S.

    2007-01-01

    Malnutrition in children continues to be a major health burden in Senegal. The main objective of this study was to discuss the existence of a thyroid disease induced by the various deficiencies, among which iodine, in these children and to assess the effects of the treatment on the thyroid function. Materials and methods Sixty eight children divided in a random way in two groups according to the addition or not of marine algae Hypnea to the traditional nutritional supplementation were included in the study. To appreciate at the same time the nutritional and biological state and to follow the evolution under treatment, the anthropometric parameters were the ratios: weight/age, weight/size, and height/age. Radioimmunoassays of free T3, free T4 and immunoradiometric assays of TSH were carried out in undernourished children before and after supplementation enriched or not in algae. Other blood parameters were measured among them protides, magnesium, and hemoglobin. Results They showed two types of biological abnormalities: low T3 syndrome (8.6%), compensated functional hypothyroidism (9%). The treatment induced neither iodine overload, nor thyroid disease. Conclusion In the program of nutritional rehabilitation, the isotopic techniques allow us to establish the low prevalence (17.6%) of the disturbances of the thyroid function (low T3 syndrome and compensated functional hypothyroidism, thus providing the differential diagnosis), and to confirm the absence of any thyroid disease induced by the iodine supply of the marine algae Hypnea. (authors)

  8. Body Composition, Muscular Strength and Bone Status among Undernourished Children in Malaysia

    International Nuclear Information System (INIS)

    Chong, Kar Hau; Poh, Bee Koon

    2014-01-01

    Full text: Despite significant advances in social and economic development, undernutrition remains a devastating public health problem that affects millions of children across the globe, particularly in developing nations. It is important to understand how changes in nutritional status affect physical health and function, so that undernutrition-related alterations can be identified and interpreted correctly. This paper aimed to determine the impact of undernutrition in children through the assessment of three nutrition-related indicators: body composition, muscular strength and bone status. This study is part of the Nutrition Survey of Malaysian Children, which is part of the four-country South East Asian Nutrition Surveys (SEANUTS). A total of 208 school children (102 boys, 106 girls) in the age range of 7 to 10 years were included in this analysis, of which 104 were underweight (WAZ<-2SD) and 104 were normal-weight group (-2SD≤WAZ≤+2SD), individually-matched for sex, age, and ethnicity. Anthropometric measurements included weight and height; and body composition was measured by bioelectrical impedance analysis. Muscular strength of both hands was assessed independently by hand-held dynamometer. Bone status was evaluated using a radial quantitative ultrasound system at one-third distal radius of the non-dominant hand. Anthropometric measurements and bone status were not significantly different between the sexes. Boys had significantly higher muscular strength and lean mass (p<0.05), but lower fat mass when compared to the girls (p<0.01). In both sexes, the undernourished group presented significantly lower anthropometric and body composition measurements and muscular strength than their normal-weight counterparts (p<0.001). However, no significant differences were observed for bone status between the two weight groups in boys (p = 0.09) and girls (p = 0.98). These findings imply that undernutrition can have profound negative impact on body composition as well

  9. Body composition and physical fitness of undernourished South African rural primary school children

    NARCIS (Netherlands)

    Monyeki, M.A.; Koppes, L.L.J.; Kemper, H.C.G.; Monyeki, K.D.; Toriola, A.L.; Pienaar, A.E.; Twisk, J.W.R.

    2005-01-01

    Objective: The purpose of this study was to determine the relationships between the body composition characteristics, body mass index (BMI), sum of skinfolds (SSF), % body fat (%BF), fat-free mass (FFM) and waist-to-hip ratio (WHR), and nine physical fitness items in undernourished rural primary

  10. Using the Uganda National Panel Survey to analyze the effect of staple food consumption on undernourishment in Ugandan children

    Directory of Open Access Journals (Sweden)

    Michelle M. Amaral

    2017-07-01

    Full Text Available Abstract Background The United Nations’ Millennium Development Goals Report, 2015, documents that, since 1990, the number of stunted children in sub-Saharan Africa has increased by 33% even though it has fallen in all other world regions. Recognizing this, in 2011 the Government of Uganda implemented a 5-year Nutrition Action Plan. One important tenet of the Plan is to lessen malnutrition in young children by discouraging over-consumption of nutritionally deficient, but plentiful, staple foods, which it defines as a type of food insecurity. Methods We use a sample of 6101 observations on 3427 children age five or less compiled from three annual waves of the Uganda National Panel Survey to measure undernourishment. We also use the World Health Organization’s Child Growth Standards to create a binary variable indicating stunting and another indicating wasting for each child in each year. We then use random effects to estimate binary logistic regressions that show that greater staple food concentrations affect the probability of stunting and wasting. Results The estimated coefficients are used to compute adjusted odds ratios (OR that estimate the effect of greater staple food concentration on the likelihood of stunting and the likelihood of wasting. Controlling for other relevant covariates, these odds ratios show that a greater proportion of staple foods in a child’s diet increases the likelihood of stunting (OR = 1.007, p = 0.005 as well as wasting (OR = 1.011, p = 0.034. Stunting is confirmed with subsamples of males only (OR = 1.006, p = 0.05 and females only (OR = 1.008, p = 0.027, suggesting that the finding is not gender specific. Another subsample of children aged 12 months or less, most of whom do not yet consume solid food, shows no statistically significant relationship, thus supporting the validity of the other findings. Conclusion Diets containing larger proportions of staple foods are associated with greater

  11. Evaluation of the impact of a nutritional program for undernourished children in Brazil

    NARCIS (Netherlands)

    Santos, Iná S; Gigante, Denise P; Coitinho, Denise C; Haisma, Hinke; Valle, Neiva C J; Valente, Gicele

    2005-01-01

    To assess the effectiveness on child growth and body composition of a supplementary feeding program (Milk Supplement Program), a prospective, controlled study was conducted in Northeast Brazil. When entering the Program, children from 10 municipalities with the highest coverage rates in the Program

  12. Nutritional Status and Infectious Disease of Undernourished Children under five in Desa Cipacing, Jatinangor Subdistrict, West Java, from April to December 2012

    Directory of Open Access Journals (Sweden)

    Palomina Caesarea Nurhasanah

    2015-09-01

    Full Text Available Background: Undernutrition frequently occurs in children under five. If not treated, it will cause acute health effects and affect on cognitive development, social, physical work capacity and productivity. Undernutrition can be accompanied by the presence of infectious disease that can worsen the children’s nutritional status. This study aimed to describe the nutritional status and infectious disease of undernutrition children under five in Jatinangor Subdistrict. Methods: A qualitative study was carried out to 7 parents and undernourished children under five, in Desa Cipacing, Jatinangor. It was conducted from April to December 2012. The inclusion criterias were undernourished children under five with a history of infectious disease in the previous year, and the parents were willing to participate in this study. Exclusion criteria were parents and/or the children who were not at home when the collection of the data was conducted.. Data collection was conducted using measurement of nutritional status, in depth interview and environmental observation. The data were presented in tables, figures and narration. Results: Three subjects with undernutrition (-3SD to -2SD and four subjects with severe undernutrition (<-3SD. Factors affecting poor nutritional status were weight loss, no significant weight gain, diet and eating habit, and onset of disease. Commonly occurred infectious diseases were common cold, diarrhea, fever and cough. Some factors affecting infectious diseases were family member transmission, immunization, and treatment behavior. Conclusions: Poor nutritional status and infectious diseases contribute to undernutrition in children under five.

  13. Spirulina Supplements Improved the Nutritional Status of Undernourished Children Quickly and Significantly: Experience from Kisantu, the Democratic Republic of the Congo

    Directory of Open Access Journals (Sweden)

    Féfé Khuabi Matondo

    2016-01-01

    Full Text Available Aim. Despite high levels of malnutrition, there is still very little information on the nutritional benefits of Spirulina, a natural alga that provides essential amino acids, rare essential lipids, and numerous minerals and vitamins, to undernourished children in the world. Methods. We carried out a prospective study of 50 children aged between six and 60 months. The intervention group consisted of 16 children who received 10 g of Spirulina daily, as well as the local diet administered by the nutritional centre, and the control group of 34 children who just received the local diet. Both groups of children were assessed on day zero, day 15, and day 30. Results. After treatment, the weight-for-age Z scores and weight-for-height Z scores increased significantly in the intervention group. At day 15, there was a statistically significant difference between the mean corpuscular volume, total proteins, and albumin (p<0.05 in both groups, in favour of the intervention group, and at day 30, this difference extended to all of the studied parameters (p<0.05. Conclusion. This study found that the nutritional status of undernourished children who received Spirulina supplements as well as the local diet administered by the nutritional centre improved quickly and significantly.

  14. Beneficial effect of nutritional supportive plan among under-nourished children in poor families in Iran with collaborating Ministry of Health and Emam Khomeini

    International Nuclear Information System (INIS)

    Minaei, Mina; Zarei, Maryam; Araste, Razieh; Kamali, Behroo

    2014-01-01

    Full text: Malnutrition in the form of Protein – Energy Malnutrition (PEM) and micro nutrient deficiencies, is one of the most important health problems in developing countries, Iran included. The purpose of this study was to improve nutritional status among under-nourished children in poor families. Methods: A total of 50,000 children under 5 (girls and boys) in 30 provinces in Iran which suffered by moderate and severe malnutrition participated (<-2SD weight for age) in this program. Malnourished children belong to poor families were determined; weights and heights were measured and anthropometric indicators were determined based on WHO, 2007. Then, these malnourished children were introduced to Imam Khomeini Foundation. Khomeini Foundation as one of the biggest NGO in Iran which supports poor families since 1979. This study collaborated with Ministry of Welfare, Ministry of Health and Emam Khomeini. They have started to receive monthly supportive food basket which could support their daily nutritional requirements. This basket included (meat, egg, cheese, legumes, milk, tuna fish, chicken, liquid oil). Along with food support community health workers were actively involved with counseling of mothers on the nutritional requirements of children. Nutritional support cut for whoever has been improved nutritional status. However, nutritional education still had continued. Results: The results of monitoring & evaluation (according to anthropometric indicators) of this plan have shown around more than 45% of children that received food basket had consistently improved nutritional status. Conclusion: Likewise other intervention nutrition programs in developing countries this project showed that inter sector collaboration have been the best way for decreasing malnutrition in children. (author)

  15. Effects of a Cereal and Soy Dietary Formula on Rehabilitation of Undernourished Children at Ouagadougou, in Burkina Faso

    Directory of Open Access Journals (Sweden)

    Zoenabo Douamba

    2012-01-01

    Full Text Available The New Misola consists of millet soybean, peanut, vitamins, minerals, and industrial amylase. Our objective is to demonstrate that porridge made from local grains and legumes restores the nutritional balance of malnourished children. The study was carried on 304 malnourished children aged 6–48 months including 172 girls and 132 boys from Saint Camille Medical Centre. At the beginning, these malnourished children had a WHZ z-score of −3.10 and a WAZ z-score of −3.85, which reflected, according to WHO, a severe malnutrition. After eight weeks of nutritional rehabilitation, a normal WHZ of −1.41 was obtained. These children recovered more than those in a similar study performed in 2006 with the old formula of Misola. This study shows that malnutrition remains a public health problem in Burkina Faso. It should be necessary that public health services and the epidemiologists work in synergy with nutritionists and “nutrigenetics” in order to combat malnutrition efficiently.

  16. Undernourishment and Public Policy in India | CRDI - Centre de ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Scientists, donors, and Indian policymakers are puzzled why India has the highest percentage of undernourished children in the world. This project explores the reasons why the country's high economic growth rate has not translated into better nutrition for its people, particularly poor women and children. It aims to shape ...

  17. The impact of public expenditure on undernourishment distribution in Mexico.

    Science.gov (United States)

    Moreno-Macías, Lidia; Palma-Solís, Marco; Zapata-Vázquez, Rita E

    2013-09-01

    The status of undernourishment in children under the age of five in Mexico is open to debate. Linked to poverty, underweight and stunting, the rates of undernourishment are reported to be diminishing, although poverty remains an incessant problem. This study was done to determine whether there is an association between public expenditure and underweight and stunting distribution in Mexico based on data from the 2006 health and population census and from macroeconomic, social, and demographic variables. We used principal component analysis to reduce the number of variables and analyze their behavior. Multiple regressions showed that underweight and stunting are significantly associated with the marginalization index, support from the Sistema Nacional para el Desarrollo Integral de la Familia (DIF) supplies and breakfast program, the gross domestic product per capita, and expenditure from the Opportunities program. Further, public expenditure aimed to combat undernourishment is inadequately oriented to address the needs of the poor.

  18. Contribution of radioimmunological techniques on the management of undernourished children in Senegal; Apport des techniques radio-immunologiques pour une meilleure prise en charge de l'enfant malnutri au Senegal

    Energy Technology Data Exchange (ETDEWEB)

    Mbodj, M.; Gassama, S.S.; Sow, H.T.; Ndoye, O.; Ndong, B. [Universite Cheikh-Anta-Diop, Lab. de Biophysique et Medecine Nucleaire, Faculte de Medecine, Dakar-Liberte (Senegal); Diarra, M. [Universite Cheikh-Anta-Diop, Lab. de Biophysique Pharmaceutique, Faculte de Pharmacie (Senegal); Sarr, M.; Diagne, I.; Diouf, S. [Universite Cheikh-Anta-Diop, Institut de Pediatrie Sociale, Dakar (Senegal)

    2007-08-15

    Malnutrition in children continues to be a major health burden in Senegal. The main objective of this study was to discuss the existence of a thyroid disease induced by the various deficiencies, among which iodine, in these children and to assess the effects of the treatment on the thyroid function. Materials and methods Sixty eight children divided in a random way in two groups according to the addition or not of marine algae Hypnea to the traditional nutritional supplementation were included in the study. To appreciate at the same time the nutritional and biological state and to follow the evolution under treatment, the anthropometric parameters were the ratios: weight/age, weight/size, and height/age. Radioimmunoassays of free T3, free T4 and immunoradiometric assays of TSH were carried out in undernourished children before and after supplementation enriched or not in algae. Other blood parameters were measured among them protides, magnesium, and hemoglobin. Results They showed two types of biological abnormalities: low T3 syndrome (8.6%), compensated functional hypothyroidism (9%). The treatment induced neither iodine overload, nor thyroid disease. Conclusion In the program of nutritional rehabilitation, the isotopic techniques allow us to establish the low prevalence (17.6%) of the disturbances of the thyroid function (low T3 syndrome and compensated functional hypothyroidism, thus providing the differential diagnosis), and to confirm the absence of any thyroid disease induced by the iodine supply of the marine algae Hypnea. (authors)

  19. The nutritional quality of an infant food from quinoa and its effect on the plasma level of insulin-like growth factor-1 (IGF-1) in undernourished children.

    Science.gov (United States)

    Ruales, Jenny; de Grijalva, Yolanda; Lopez-Jaramillo, Patricio; Nair, Baboo M

    2002-03-01

    An infant food product was manufactured by drum drying a pre-cooked slurry of quinoa (Chenopodium quinoa, Willd) flour. The chemical composition shows that the product is a potential source of valuable nutrients, like protein (16%), vitamin E (19 mg/kg), thiamine (0.7 mg/100 g), iron (70 mg/kg), zinc (48 mg/kg) and magnesium (1.8 g/kg), all the values expressed on dry basis, to pre-school children (of 5 years of age). The animal feeding experiments with rats showed a net protein utilisation (NPU) of 68, digestibility (TD) 95 and biological value (BV) 71. The level of insulin-like growth factor-1 (IGF-1) in the plasma of the children who consumed a supplementary portion of 2 x 100 g of the above infant food product showed an increase after a period of 15 days, while the plasma level of IGF-1 in the children of the control group as well as the reference group did not show any significant increase.

  20. [Body mass index and tri-ponderal mass index of 1,453 healthy non-obese, non-undernourished millennial children. The Barcelona longitudinal growth study].

    Science.gov (United States)

    Carrascosa, Antonio; Yeste, Diego; Moreno-Galdó, Antonio; Gussinyé, Miquel; Ferrández, Ángel; Clemente, María; Fernández-Cancio, Mónica

    2018-02-22

    Body mass index-for age (BMI) and tri-ponderal mass index-for-age (TMI) values of healthy non-underweight, non-obese millennial children have not been reported until now. We aimed to obtain these values. Longitudinal growth study (1995-2017) of 1,453 healthy non-underweight, non-obese millennial children, from birth (n = 477) or from 4 years of age (n = 976) to 18 years in girls and 19 years in boys (25,851 anthropometric measurements). In each sex, mean BMI-for-age values increased from birth to one year, declined until 5and increased from then onwards. Mean TMI-for-age values decreased abruptly during the first 6years of age and slowly thereafter, in both sexes. Although, at some ages, mean BMI-for age values differed statistically between sexes, differences were scant and of poor clinical significance. The same occurred for TMI-for-age values. BMI-for-age cut-off values to define underweight status (-2 SD) were similar to those proposed by Cole and the WHO for both sexes. However, BMI-for-age cut-off values to define obesity (+2 SD) were lower in both sexes (1.0-5.3) than those proposed by Cole and similar to those proposed by the WHO until 12 in girls and 14 in boys and lower (1.0-4.8) from these ages onwards. BMI-for-age and TMI-for-age values of healthy non-underweight, non-obese millennial children are provided. No clinically relevant differences were observed between sexes. These values may be used to measure underweight status and obesity in present pediatric populations and to evaluate the relationship between BMI-for-age and TMI-for-age in a clinical setting. Copyright © 2018. Publicado por Elsevier España, S.L.U.

  1. Corn-soy-blend fortified with phosphorus to prevent refeeding hypophosphatemia in undernourished piglets

    DEFF Research Database (Denmark)

    Hother Nielsen, Anne-Louise; Lykke Jensen, Mikkel; Martinussen, Torben

    2017-01-01

    BACKGROUND: Phosphorus (P) levels in refeeding diets are very important as undernourished children are at risk of hypophosphatemia during refeeding. For this reason, conventional corn-soy-blends (CSB) have been reformulated by the World Food Programme to obtain a mono-calcium-phosphate fortified...

  2. ‘Urmitella timonensis’ gen. nov., sp. nov., ‘Blautia marasmi’ sp. nov., ‘Lachnoclostridium pacaense’ sp. nov., ‘Bacillus marasmi’ sp. nov. and ‘Anaerotruncus rubiinfantis’ sp. nov., isolated from stool samples of undernourished African children

    Directory of Open Access Journals (Sweden)

    T.-P.-T. Pham

    2017-05-01

    Full Text Available We report here the main characteristics of five new species ‘Urmitella timonensis’ strain Marseille-P2918T (CSUR P2918, ‘Blautia marasmi’ strain Marseille-P2377T (CSUR P2377, ‘Lachnoclostridium pacaense’ strain Marseille-P3100T (CSUR P3100, ‘Bacillus marasmi’ strain Marseille-P3556T (CSUR P3556 and ‘Anaerotruncus rubiinfantis’ strain MT15T (CSUR P2276, which were isolated recently from stool samples taken from undernourished children in Niger and Senegal using microbial culturomics.

  3. Evaluation of the impact of a nutritional program for undernourished children in Brazil Avaliação do impacto de um programa de suplementação alimentar para crianças desnutridas no Brasil

    Directory of Open Access Journals (Sweden)

    Iná S. Santos

    2005-06-01

    Full Text Available To assess the effectiveness on child growth and body composition of a supplementary feeding program (Milk Supplement Program, a prospective, controlled study was conducted in Northeast Brazil. When entering the Program, children from 10 municipalities with the highest coverage rates in the Program (intervention group were compared to non-beneficiary children from 10 municipalities with the lowest coverage rates (control group. A total of 219 children aged 6-18 months were enrolled. At entry, both groups were comparable in terms of age, sex, and nutritional status. There were frequent gaps in delivery of the supplement, no extra milk was provided to siblings less than 5 years of age, intra-household redistribution of milk was high, and maternal compliance with recommendations was low. Adjusted analyses by multilevel modelling showed average changes in weight, length, weight-age and length-age Z-scores, and % body water (deuterium method, at 6 months, of 1.53kg, 6.34cm, 0.33, 0.05, and 1.11% respectively among supplemented children as compared to 1.54kg, 6.5cm, 0.26, 0.07, and 4.10% among controls, with no statistically significant difference between groups. Thus, the Program failed to compensate for nutritional deficiencies in undernourished children in Northeast Brazil.Um estudo prospectivo, controlado foi realizado no Nordeste do Brasil para avaliar a efetividade de um programa de suplementação alimentar (Programa do Leite sobre crescimento infantil e composição corporal. Ao ingressar no programa, crianças de dez municípios com as maiores taxas de cobertura do programa (intervenção foram comparadas a crianças não-beneficiárias de dez municípios com as menores taxas de cobertura (controle. Um total de 219 crianças de 6-18 meses de idade foram arroladas. Ao entrar no estudo, ambos os grupos eram comparáveis quanto a sexo, idade e estado nutricional. Houve freqüentes falhas na entrega do suplemento, não foi fornecido leite para os

  4. Zinc treatment ameliorates diarrhea and intestinal inflammation in undernourished rats

    OpenAIRE

    de Queiroz, Camila AA; Fonseca, Said Gonçalves C; Frota, Priscila B; Figueiredo, Ítalo L; Aragão, Karoline S; Magalhães, Carlos Emanuel C; de Carvalho, Cibele BM; Lima, Aldo Ângelo M; Ribeiro, Ronaldo A; Guerrant, Richard L; Moore, Sean R; Oriá, Reinaldo B

    2014-01-01

    Background WHO guidelines recommend zinc supplementation as a key adjunct therapy for childhood diarrhea in developing countries, however zinc’s anti-diarrheal effects remain only partially understood. Recently, it has been recognized that low-grade inflammation may influence stunting. In this study, we examined whether oral zinc supplementation could improve weight, intestinal inflammation, and diarrhea in undernourished weanling rats. Methods Rats were undernourished using a northeastern Br...

  5. Children with intellectual disability and hospice utilization.

    Science.gov (United States)

    Lindley, Lisa C; Colman, Mari Beth; Meadows, John T

    2017-02-01

    Over 42,000 children die each year in the United States, including those with intellectual disability (ID). Survival is often reduced when children with intellectual disability also suffer from significant motor dysfunction, progressive congenital conditions, and comorbidities. Yet, little is known about hospice care for children with intellectual disability. The purpose of this study was to explore the relationship between intellectual disability and hospice utilization. Additionally, we explored whether intellectual disability combined with motor dysfunction, progressive congenital conditions, and comorbidities influenced pediatric hospice utilization. Using a retrospective cohort design and data from the 2009 to 2010 California Medicaid claims files, we conducted a multivariate analysis of hospice utilization. This study shows that intellectual disability was negatively related to hospice enrollment and length of stay. We also found that when children had both intellectual disability and comorbidities, there was a positive association with enrolling in hospice care. A number of clinical implications can be drawn from the study findings that hospice and palliative care nurses use to improve their clinical practice of caring for children with ID and their families at end of life.

  6. Corn-Soy-Blend Fortified with Phosphorus to Prevent Refeeding Hypophosphatemia in Undernourished Piglets

    DEFF Research Database (Denmark)

    Hother, Anne-Louise; Lykke, Mikkel; Martinussen, Torben

    2017-01-01

    Background Phosphorus (P) levels in refeeding diets are very important as undernourished children are at risk of hypophosphatemia during refeeding. For this reason, conventional corn-soyblends (CSB) have been reformulated by the World Food Programme to obtain a mono-calcium-phosphate fortified...... and undernutrition was induced with a nutritionally inadequate pure maize diet for 7 weeks, after which they were refed for 3 weeks with either CSB+ (n = 10), CSB++ (n = 10) or CSB+/wp (n = 10). For reference, a fourth group continued on the maize diet (REF, n = 10). Results Following induction of undernutrition...

  7. Research utilization among children's mental health providers

    Directory of Open Access Journals (Sweden)

    Ferguson H Bruce

    2008-04-01

    Full Text Available Abstract Background Children with emotional and behavioural disorders should be able to count on receiving care that meets their needs and is based on the best scientific evidence available, however, many do not receive these services. Implementation of evidence-based practice (EBP relies, in part, on the research utilization practices of mental health care providers. This study reports on a survey of research utilization practices among 80 children's mental health (CMH service provider organizations in Ontario, Canada. Methods A web-based survey was distributed to 80 CMH service provider organizations, to which 51 executive directors and 483 children's mental health practitioners responded. Research utilization was assessed using questions with Likert-type responses based on the Canadian Health Services Research Foundation's Four-A's approach: access, assess, adapt, apply. Results There was general agreement among executive directors and practitioners regarding the capacity of their organizations to use – access, assess, adapt, and apply – research evidence. Overall, both groups rated their organizations as using research information 'somewhat well.' The low response rate to the practitioner survey should be noted. Conclusion These findings provide a useful benchmark from which changes in reported research utilization in the Ontario CMH sector can be tracked over time, as a function of EBP training and implementation initiatives, for instance. The need to improve access to research evidence should be addressed because it relates to the eventual implementation and uptake of evidence-based practices. Communities of practice are recommended as a strategy that would enable practitioners to build capacity in their adaptation and application of research evidence.

  8. Research utilization among children's mental health providers.

    Science.gov (United States)

    Barwick, Melanie A; Boydell, Katherine M; Stasiulis, Elaine; Ferguson, H Bruce; Blase, Karen; Fixsen, Dean

    2008-04-09

    Children with emotional and behavioural disorders should be able to count on receiving care that meets their needs and is based on the best scientific evidence available, however, many do not receive these services. Implementation of evidence-based practice (EBP) relies, in part, on the research utilization practices of mental health care providers. This study reports on a survey of research utilization practices among 80 children's mental health (CMH) service provider organizations in Ontario, Canada. A web-based survey was distributed to 80 CMH service provider organizations, to which 51 executive directors and 483 children's mental health practitioners responded. Research utilization was assessed using questions with Likert-type responses based on the Canadian Health Services Research Foundation's Four-A's approach: access, assess, adapt, apply. There was general agreement among executive directors and practitioners regarding the capacity of their organizations to use - access, assess, adapt, and apply - research evidence. Overall, both groups rated their organizations as using research information 'somewhat well.' The low response rate to the practitioner survey should be noted. These findings provide a useful benchmark from which changes in reported research utilization in the Ontario CMH sector can be tracked over time, as a function of EBP training and implementation initiatives, for instance. The need to improve access to research evidence should be addressed because it relates to the eventual implementation and uptake of evidence-based practices. Communities of practice are recommended as a strategy that would enable practitioners to build capacity in their adaptation and application of research evidence.

  9. Gut bacteria that prevent growth impairments transmitted by microbiota from malnourished children

    Science.gov (United States)

    Undernourished children exhibit impaired development of their gut microbiota. Transplanting microbiota from 6- and 18-month-old healthy or undernourished Malawian donors into young germ-free mice that were fed a Malawian diet revealed that immature microbiota from undernourished infants and children...

  10. Can prebiotics and probiotics improve therapeutic outcomes for undernourished individuals?

    Science.gov (United States)

    Sheridan, Paul O; Bindels, Laure B; Saulnier, Delphine M; Reid, Gregor; Nova, Esther; Holmgren, Kerstin; O'Toole, Paul W; Bunn, James; Delzenne, Nathalie; Scott, Karen P

    2014-01-01

    It has become clear in recent years that the human intestinal microbiota plays an important role in maintaining health and thus is an attractive target for clinical interventions. Scientists and clinicians have become increasingly interested in assessing the ability of probiotics and prebiotics to enhance the nutritional status of malnourished children, pregnant women, the elderly, and individuals with non-communicable disease-associated malnutrition. A workshop was held by the International Scientific Association for Probiotics and Prebiotics (ISAPP), drawing on the knowledge of experts from industry, medicine, and academia, with the objective to assess the status of our understanding of the link between the microbiome and under-nutrition, specifically in relation to probiotic and prebiotic treatments for under-nourished individuals. These discussions led to four recommendations:   (1) The categories of malnourished individuals need to be differentiated To improve treatment outcomes, subjects should first be categorized based on the cause of malnutrition, additional health-concerns, differences in the gut microbiota, and sociological considerations. (2) Define a baseline "healthy" gut microbiota for each category Altered nutrient requirement (for example, in pregnancy and old age) and individual variation may change what constitutes a healthy gut microbiota for the individual. (3) Perform studies using model systems to test the effectiveness of potential probiotics and prebiotics against these specific categories These should illustrate how certain microbiota profiles can be altered, as members of different categories may respond differently to the same treatment. (4) Perform robust well-designed human studies with probiotics and/or prebiotics, with appropriate, defined primary outcomes and sample size These are critical to show efficacy and understand responder and non-responder outcomes. It is hoped that these recommendations will lead to new approaches that

  11. Zinc treatment ameliorates diarrhea and intestinal inflammation in undernourished rats.

    Science.gov (United States)

    de Queiroz, Camila A A; Fonseca, Said Gonçalves C; Frota, Priscila B; Figueiredo, Italo L; Aragão, Karoline S; Magalhães, Carlos Emanuel C; de Carvalho, Cibele B M; Lima, Aldo Ângelo M; Ribeiro, Ronaldo A; Guerrant, Richard L; Moore, Sean R; Oriá, Reinaldo B

    2014-08-05

    WHO guidelines recommend zinc supplementation as a key adjunct therapy for childhood diarrhea in developing countries, however zinc's anti-diarrheal effects remain only partially understood. Recently, it has been recognized that low-grade inflammation may influence stunting. In this study, we examined whether oral zinc supplementation could improve weight, intestinal inflammation, and diarrhea in undernourished weanling rats. Rats were undernourished using a northeastern Brazil regional diet (RBD) for two weeks, followed by oral gavage with a saturated lactose solution (30 g/kg) in the last 7 days to induce osmotic diarrhea. Animals were checked for diarrhea daily after lactose intake. Blood was drawn in order to measure serum zinc levels by atomic absorption spectroscopy. Rats were euthanized to harvest jejunal tissue for histology and cytokine profiles by ELISA. In a subset of animals, spleen samples were harvested under aseptic conditions to quantify bacterial translocation. Oral zinc supplementation increased serum zinc levels following lactose-induced osmotic diarrhea. In undernourished rats, zinc improved weight gain following osmotic diarrhea and significantly reduced diarrheal scores by the third day of lactose intake (p diarrhea and undernutrition and support the use of zinc to prevent the vicious cycle of malnutrition and diarrhea.

  12. Pediatric Dentist Density and Preventive Care Utilization for Medicaid Children.

    Science.gov (United States)

    Heidenreich, James F; Kim, Amy S; Scott, JoAnna M; Chi, Donald L

    2015-01-01

    The purpose of this study was to evaluate county-level pediatric dentist density and dental care utilization for Medicaid-enrolled children. This was a cross-sectional analysis of 604,885 zero- to 17-year-olds enrolled in the Washington State Medicaid Program for 11-12 months in 2012. The relationship between county-level pediatric dentist density, defined as the number of pediatric dentists per 10,000 Medicaid-enrolled children, and preventive dental care utilization was evaluated using linear regression models. In 2012, 179 pediatric dentists practiced in 16 of the 39 counties in Washington. County-level pediatric dentist density varied from zero to 5.98 pediatric dentists per 10,000 Medicaid-enrolled children. County-level preventive dental care utilization ranged from 32 percent to 81 percent, with 62 percent of Medicaid-enrolled children utilizing preventive dental services. County-level density was significantly associated with county-level dental care utilization (Slope equals 1.67, 95 percent confidence interval equals 0.02, 3.32, Pchildren who utilize preventive dental care services. Policies aimed at improving pediatric oral health disparities should include strategies to increase the number of oral health care providers, including pediatric dentists, in geographic areas with large proportions of Medicaid-enrolled children.

  13. Wealth and under-nourishment among married women in two impoverished nations: evidence from Burkina Faso and Congo Democratic Republic.

    Science.gov (United States)

    Adebowale, Ayo Stephen; Palamuleni, Martin Enoch; Odimegwu, Clifford Obby

    2015-02-08

    Burkina Faso (BF) and Congo Democratic Republic (CDR) are among the top-ten poverty and hunger stricken countries globally. The influence of poverty and hunger on health is enormous. The objectives of the study are to; examine the association between poverty and nutritional status, it also identified socio-demographic and health related mediating factors that contribute to the relationship between poverty and poor nutritional status. The study focused on married or cohabiting women aged 15-49 years and utilized 2010 and 2007 DHS dataset from BF and CDR respectively. Mean age of the women in BF and CDR were 34.4 ± 9.3 and 34.7 ± 9.0 years respectively. About 19.4% and 18.4% of the poor were malnourished as against 7.7% and 9.7% of the rich women in BF and CDR respectively. Obesity and overweight were more prominent among the rich than the poor. Higher prevalence of under-nourish women was found among the older than the younger women in BF. In the countries, the prevalence of malnutrition was significantly higher among women; in the rural areas, with no formal education, anaemic and those who are not working. Multivariate analysis revealed that in the countries, the risk of under-nourishment was significantly higher among poor and middle class than the rich women despite controlling for confounding variables. Undernourished women were more common among the poor and those with no formal education. Programs that target nutrition of women of reproductive age should be strengthened in BF and CDR.

  14. The Link between Nutrition and Cognitive Development in Children.

    Science.gov (United States)

    Tufts Univ., Medford, MA. Center on Hunger, Poverty and Nutrition Policy.

    New findings about child nutrition and cognitive development indicate that undernourished children are typically fatigued and uninterested in their social environments. Such children are less likely to establish relationships or to explore and learn from their surroundings. Undernourished children are also more susceptible to illness and, thus,…

  15. Fluoride toothpaste utilization behaviour among preschool children in Perlis, Malaysia.

    Science.gov (United States)

    Tay, H L; Zainudin, I S; Jaafar, N

    2009-12-01

    Very mild fluorosis is quite prevalent in children and one of the sources may be attributed to poor fluoride toothpaste utilization habits. To investigate the frequency of toothbrushing, parental supervision, the person who usually applied the toothpaste, toothpaste swallowing and spitting habits, size of toothbrush, type of toothpaste used and amount of toothpaste used by shape and weight. Observational cross-sectional study of a representative random sample of 373 children aged 5-6 year-old. The children were interviewed using a structured close ended questionnaire. Direct observations were made on their toothpaste dispensing habit during a toothbrushing exercise. All children reported practising toothbrushing with 90% on a daily basis. Almost all used fluoridated toothpaste (91.4%). About one-half (50.7%) reported that their parents never supervised them. More than one-third of children used adult toothpaste and 60.1% of the toothpaste was flavoured. Most (92%) used toothbrush meant for children. About 40% applied a pea-sized amount of toothpaste. The mean weight of toothpaste applied was 0.43 g (SID + 0.35 g). The majority used the recommended child-sized toothbrush and toothpaste that contained fluoride but less than one-half of the parents supervised their children. Most children used flavoured children's toothpaste but a sizable proportion used toothpastes meant for adults. The amount applied by shape and weight exceeded the amount recommended by experts.

  16. Health care utilization of refugee children after resettlement.

    Science.gov (United States)

    Watts, Delma-Jean; Friedman, Jennifer F; Vivier, Patrick M; Tompkins, Christine E A; Alario, Anthony J

    2012-08-01

    Refugee children can have significant health problems. Our objective was to describe health status and health care utilization of refugee children after resettlement. A retrospective chart review of refugee children was performed. Initial laboratory data was extracted. Primary care visits, emergency room visits, and subspecialty referrals in the first 15 months from arrival were recorded. The sample included 198 refugees, many with positive initial screening tests. After arrival, 21% had an emergency department visit, 40% had a primary care sick visit, and 71% had a primary care follow-up. Mean number of visits ranged from 0.3 for emergency department to 1.9 for follow-up. Fifty-seven percent were referred to at least one subspecialist. Refugee children had substantial disease burden at arrival. Most had primary care follow-up visits and subspecialty referral after resettlement. These visits were largely for problems identified on initial screening and for general pediatric illnesses.

  17. Utility of an Australasian registry for children undergoing radiation treatment

    International Nuclear Information System (INIS)

    Ahern, Verity

    2014-01-01

    The aim of this study was to evaluate the utility of an Australasian registry ('the Registry') for children undergoing radiation treatment (RT). Children under the age of 16years who received a course of radiation between January 1997 and December 2010 and were enrolled on the Registry form the subjects of this study. A total of 2232 courses of RT were delivered, predominantly with radical intent (87%). Registrations fluctuated over time, but around one-half of children diagnosed with cancer undergo a course of RT. The most prevalent age range at time of RT was 10–15years, and the most common diagnoses were central nervous system tumours (34%) and acute lymphoblastic leukaemia (20%). The Registry provides a reflection of the patterns of care of children undergoing RT in Australia and a mechanism for determining the resources necessary to manage children by RT (human, facilities and emerging technologies, such as proton therapy). It lacks the detail to provide information on radiotherapy quality and disease outcomes which should be the subject of separate audit studies. The utility of the Registry has been hampered by its voluntary nature and varying needs for consent. Completion of registry forms is a logical requirement for inclusion in the definition of a subspecialist in paediatric radiation oncology.

  18. Children's utilization of emotion expectancies in moral decision-making.

    Science.gov (United States)

    Hertz, Steven G; Krettenauer, Tobias

    2014-09-01

    This study investigated the relevance of emotion expectancies for children's moral decision-making. The sample included 131 participants from three different grade levels (M = 8.39 years, SD = 2.45, range 4.58-12.42). Participants were presented a set of scenarios that described various emotional outcomes of (im)moral actions and asked to decide what they would do if they were in the protagonists' shoes. Overall, it was found that the anticipation of moral emotions predicted an increased likelihood of moral choices in antisocial and prosocial contexts. In younger children, anticipated moral emotions predicted moral choice for prosocial actions, but not for antisocial actions. Older children showed evidence for the utilization of anticipated emotions in both prosocial and antisocial behaviours. Moreover, for older children, the decision to act prosocially was less likely in the presence of non-moral emotions. Findings suggest that the impact of emotion expectancies on children's moral decision-making increases with age. Contrary to happy victimizer research, the study does not support the notion that young children use moral emotion expectancies for moral decision-making in the context of antisocial actions. © 2014 The British Psychological Society.

  19. Impaired rate of microsomal fatty acid elongation in undernourished neonatal rat brain

    International Nuclear Information System (INIS)

    Yeh, Y.Y.

    1986-01-01

    Hypomyelination caused by undernourishment in characterized by low concentrations of myelin lipids and marked reduction in lignocerate (C/sub 24:0/) and nervonate (C/sub 24:1/) moiety of cerebroside and sulfatide. Since microsomal elongation is the major source of long chain (22 to 24 carbons) fatty acids in the brain, the effect of neonatal undernourishment on acyl elongation was investigated. Undernourishment of suckling rats were induced after birth by restricting maternal dietary intake to 40% of that consumed by dams fed ad libitum. Neonates suckled by the normally fed dams served as controls. Microsomal elongation was measured as nmol from [2- 14 C] malonyl CoA incorporated/h per mg of protein. At 19 days of age, rates of behenoyl CoA (C/sub 22:0/) and erucoyl CoA (C/sub 22:1/) elongation in whole brain of undernourished neonates were 30-40% lower than that of the control, whereas the elongation rates of acyl CoA 16, 18 and 20 carbons in length either saturated or monounsaturated were similar in both groups. Undernourishment had no effect on cytoplasmic de novo fatty acid synthesis from acetyl CoA. If there are multiple elongation factors, the results indicate that the depressed activity of elongating enzyme(s) for C/sub 22:0/ and C/sub 22:1/ is an important contributing factor in lowering S/sub 24:0/ and C/sub 24:1/ content in cerebroside and sulfatide. This impairment may be a specific lesion leading to hypomyelination in undernourished rats

  20. A metabolomics approach to evaluate the effects of shiitake mushroom (Lentinula edodes) treatment in undernourished young rats

    International Nuclear Information System (INIS)

    Molz, Patrícia; Ellwanger, Joel Henrique; Eliete Iochims dos Santos, Carla; Dias, Johnny Ferraz; Campos, Deivis de; Corbellini, Valeriano Antonio; Prá, Daniel; Putzke, Marisa Terezinha Lopes; Franke, Silvia Isabel Rech

    2014-01-01

    Undernourishment is characterized by a decrease of the metabolic rate as a result of lack of nutrients important to life. Shiitake mushroom (Lentinula edodes) can be an alternative to reverse undernourishment. The aim of this study was to explore the metabolic changes and consequent elemental concentrations found in undernourished rats and undernourished rats treated with shiitake mushroom (n = 12 rats each group). To determine the elemental concentration, blood samples were analyzed by Particle Induced X-ray Emission (PIXE). For metabolomics, blood samples were tested under Fourier Transform Infrared Spectroscopy (FT-IR). The results indicated that the supplementation with shiitake mushroom in undernourished rats altered the composition of blood proteins, elements and volume. Several strong correlations were observed between the elemental concentrations and metabolic parameters

  1. A metabolomics approach to evaluate the effects of shiitake mushroom (Lentinula edodes) treatment in undernourished young rats

    Energy Technology Data Exchange (ETDEWEB)

    Molz, Patrícia [Nutrition Course, Department of Physical Education and Health, University of Santa Cruz do Sul, Santa Cruz do Sul, RS (Brazil); Graduate Program in Health Promotion, University of Santa Cruz do Sul, Santa Cruz do Sul, RS (Brazil); Ellwanger, Joel Henrique [Biological Sciences Course, Department of Biology and Pharmacy, University of Santa Cruz do Sul, Santa Cruz do Sul, RS (Brazil); Eliete Iochims dos Santos, Carla; Dias, Johnny Ferraz [Ion Implantation Laboratory, Physics Institute, Federal University of Rio Grande do Sul, Porto Alegre, RS (Brazil); Campos, Deivis de [Biological Sciences Course, Department of Biology and Pharmacy, University of Santa Cruz do Sul, Santa Cruz do Sul, RS (Brazil); Corbellini, Valeriano Antonio [Graduate Program in Health Promotion, University of Santa Cruz do Sul, Santa Cruz do Sul, RS (Brazil); Prá, Daniel [Graduate Program in Health Promotion, University of Santa Cruz do Sul, Santa Cruz do Sul, RS (Brazil); Biological Sciences Course, Department of Biology and Pharmacy, University of Santa Cruz do Sul, Santa Cruz do Sul, RS (Brazil); Putzke, Marisa Terezinha Lopes [Biological Sciences Course, Department of Biology and Pharmacy, University of Santa Cruz do Sul, Santa Cruz do Sul, RS (Brazil); Franke, Silvia Isabel Rech, E-mail: silviafr@unisc.br [Nutrition Course, Department of Physical Education and Health, University of Santa Cruz do Sul, Santa Cruz do Sul, RS (Brazil); Graduate Program in Health Promotion, University of Santa Cruz do Sul, Santa Cruz do Sul, RS (Brazil)

    2014-01-01

    Undernourishment is characterized by a decrease of the metabolic rate as a result of lack of nutrients important to life. Shiitake mushroom (Lentinula edodes) can be an alternative to reverse undernourishment. The aim of this study was to explore the metabolic changes and consequent elemental concentrations found in undernourished rats and undernourished rats treated with shiitake mushroom (n = 12 rats each group). To determine the elemental concentration, blood samples were analyzed by Particle Induced X-ray Emission (PIXE). For metabolomics, blood samples were tested under Fourier Transform Infrared Spectroscopy (FT-IR). The results indicated that the supplementation with shiitake mushroom in undernourished rats altered the composition of blood proteins, elements and volume. Several strong correlations were observed between the elemental concentrations and metabolic parameters.

  2. Resource utilization for observation-status stays at children's hospitals.

    Science.gov (United States)

    Fieldston, Evan S; Shah, Samir S; Hall, Matthew; Hain, Paul D; Alpern, Elizabeth R; Del Beccaro, Mark A; Harding, John; Macy, Michelle L

    2013-06-01

    Observation status, in contrast to inpatient status, is a billing designation for hospital payment. Observation-status stays are presumed to be shorter and less resource-intensive, but utilization for pediatric observation-status stays has not been studied. The goal of this study was to describe resource utilization characteristics for patients in observation and inpatient status in a national cohort of hospitalized children in the Pediatric Health Information System. This study was a retrospective cohort from 2010 of observation- and inpatient-status stays of ≤2 days; all children were admitted from the emergency department. Costs were analyzed and described. Comparison between costs adjusting for age, severity, and length of stay were conducted by using random-effect mixed models to account for clustering of patients within hospitals. Observation status was assigned to 67 230 (33.3%) discharges, but its use varied across hospitals (2%-45%). Observation-status stays had total median costs of $2559, including room costs and $678 excluding room costs. Twenty-five diagnoses accounted for 74% of stays in observation status, 4 of which were used for detailed analyses: asthma (n = 6352), viral gastroenteritis (n = 4043), bronchiolitis (n = 3537), and seizure (n = 3289). On average, after risk adjustment, observation-status stays cost $260 less than inpatient-status stays for these select 4 diagnoses. Large overlaps in costs were demonstrated for both types of stay. Variability in use of observation status with large overlap in costs and potential lower reimbursement compared with inpatient status calls into question the utility of segmenting patients according to billing status and highlights a financial risk for institutions with a high volume of pediatric patients in observation status.

  3. Phototherapy improves healing of cutaneous wounds in nourished and undernourished Wistar rats.

    Science.gov (United States)

    Pinheiro, Antonio Luiz Barbosa; Meireles, Gyselle Cynthia Silva; de Barros Vieira, Alessandro Leonardo; Almeida, Darcy; Carvalho, Carolina Montagn; dos Santos, Jean Nunes

    2004-01-01

    A wound represents the interruption of the continuity of tissue that is followed by damage or cellular death. Wound healing occurs due to a competitive mechanism between the synthesis and lysis of collagen. Any factor that increases collagen lysis or reduces its synthesis may result in changes in the healing process, i.e., nutritional deficiencies. Phototherapies have been suggested as an effective method to improve wound healing. This study evaluated, histologically, the differences in the healing of cutaneous wounds in nourished and undernourished rats following laser therapy or illumination by polarized light. Fifty nourished or undernourished Wistar rats had a standardized wound created on the dorsum and were divided into 6 subgroups: Group 1--Control (Standard diet; n=5); Group 2--Control (DBR; n=5); Group 3--Standard diet + laser therapy (lambda635nm; 20J/cm2, n=5; or 40J/cm2, n=5); Group 4--Standard diet + Bioptron (lambda400-2000nm; 20J/cm2, n=5; or 40 J/cm2, n=5); Group 5--DBR + laser therapy (lambda635nm; 20J/cm2, n=5; or 40J/cm2, n=5); Group 6--DBR + Bioptron (lambda400-2000nm; 20J/cm2, n=5; or 40 J/cm2, n=5). The first application of the treatment was carried out immediately after surgery and repeated every 24 h during 7 days. Specimens were routinely processed (wax, cut and stained with H&E and Picrosirius stain) and analyzed under light microscopy. Analysis included re-epithelization, inflammatory infiltrate, and fibroblastic proliferation. Picrosirius stained slides were used to perform descriptive analysis of the collagen fibers. The results showed the best results for nourished and undernourished groups treated with polarized light at a dose of 20J/cm2 and the undernourished groups irradiated with the laser light. It is concluded that the nutritional status influenced the progression of the healing process as well as the quality of the healed tissue and that the use of both modalities of phototherapy resulted in a positive biomodulatory effect in

  4. The role of parental health care utilization in children's unnecessary utilization in China: evidence from Shaanxi province.

    Science.gov (United States)

    Zhang, Yi; Zhou, Zhongliang; Si, Yafei

    2017-03-09

    China has a large population of children under 18 years of age, whose health is of great concern to the Chinese health care system. However, few studies have been conducted to analyze the factors associated with children's unnecessary health care utilization in China. The objective of this study is to provide some empirical evidence on this issue by investigating the role of parental health care utilization in children's unnecessary health care use. The data were obtained from the fifth Health Service Survey of Shaanxi province in 2013. We employed three dependent variables to measure children's health care utilization: the number of children's outpatient visits during the past 2 weeks, whether or not infusion was used if the child had any outpatient visits during the past 2 weeks, and the number of children's inpatient visits during last year. Based on specific characteristics of these outcome variables, negative binomial models were used for the non-negative numbers of outpatient and inpatient visits, while a probit model was used for the zero-one indicator variable showing whether infusion was used during outpatient visits. Based on a sample of 11,024 children, our results of multivariate analysis showed that children whose parents used outpatient care were estimated to have a larger number of outpatient visits than those whose parents did not have outpatient visits in the past 2 weeks (with a difference of 0.0393 visits). Among children having outpatient visits in the last 2 weeks, the probability of obtaining infusion was 57.01 percentage points higher for children whose parents used infusion in the past 2 weeks than the probability for those whose parents did not use infusion. The predicted number of inpatient visits was higher for children whose parents used inpatient services in the last year, compared with the group whose parents did not use (with a difference of 0.0567 visits). Moreover, we noted that the positive association between parental and

  5. Alterations in proteins of bone marrow extracellular matrix in undernourished mice

    Directory of Open Access Journals (Sweden)

    C.L. Vituri

    2000-08-01

    Full Text Available The objective of the present study was to determine the effect of protein malnutrition on the glycoprotein content of bone marrow extracellular matrix (ECM. Two-month-old male Swiss mice were submitted to protein malnutrition with a low-protein diet containing 4% casein as compared to 20% casein in the control diet. When the experimental group had attained a 20% loss of their original body weight, we extracted the ECM proteins from bone marrow with PBS buffer, and analyzed ECM samples by SDS-PAGE (7.5% and ECL Western blotting. Quantitative differences were observed between control and experimental groups. Bone marrow ECM from undernourished mice had greater amounts of extractable fibronectin (1.6-fold increase and laminin (4.8-fold increase when compared to the control group. These results suggest an association between fluctuations in the composition of the hematopoietic microenvironment and altered hematopoiesis observed in undernourished mice.

  6. Neurodevelopmental outcome after cardiac surgery utilizing cardiopulmonary bypass in children

    Directory of Open Access Journals (Sweden)

    Aymen N Naguib

    2015-01-01

    Full Text Available Introduction: Modulating the stress response and perioperative factors can have a paramount impact on the neurodevelopmental outcome of infants who undergo cardiac surgery utilizing cardiopulmonary bypass. Materials and Methods: In this single center prospective follow-up study, we evaluated the impact of three different anesthetic techniques on the neurodevelopmental outcomes of 19 children who previously underwent congenital cardiac surgery within their 1 st year of life. Cases were done from May 2011 to December 2013. Children were assessed using the Stanford-Binet Intelligence Scales (5 th edition. Multiple regression analysis was used to test different parental and perioperative factors that could significantly predict the different neurodevelopmental outcomes in the entire cohort of patients. Results: When comparing the three groups regarding the major cognitive scores, a high-dose fentanyl (HDF patients scored significantly higher than the low-dose fentanyl (LDF + dexmedetomidine (DEX (LDF + DEX group in the quantitative reasoning scores (106 ± 22 vs. 82 ± 15 P = 0.046. The bispectral index (BIS value at the end of surgery for the -LDF group was significantly higher than that in LDF + DEX group (P = 0.011. For the entire cohort, a strong correlation was seen between the standard verbal intelligence quotient (IQ score and the baseline adrenocorticotropic hormone level, the interleukin-6 level at the end of surgery and the BIS value at the end of the procedure with an R 2 value of 0.67 and P < 0.04. There was an inverse correlation between the cardiac Intensive Care Unit length of stay and the full-scale IQ score (R = 0.4675 and P 0.027. Conclusions: Patients in the HDF group demonstrated overall higher neurodevelopmental scores, although it did not reach statistical significance except in fluid reasoning scores. Our results may point to a possible correlation between blunting the stress response and improvement of the neurodevelopmental

  7. Studies on protein turnover and energy expenditure in chronically undernourished adults during stress of infection

    International Nuclear Information System (INIS)

    Kurpad, A.V.; Shetty, P.S.; Reeds, P.J.

    1994-01-01

    Chronic undernutrition in man leads to adaptive responses which could reduce the requirements for dietary energy and protein. It is also possible that these adaptive responses, which are economical in nature, could lead to a decreased capacity for combating stress. Undernourished people are more susceptible to infections, and during these stresses, show different patterns of protein and energy metabolism from well-nourished subjects. Animal models have clearly shown a diminished response to tissue injury, in terms of the anabolic acute phase response. It is proposed to study the effect of prior nutritional status on the degree to which an infective stress stimulates the acute phase protein synthesis by the liver. In addition, the supply of amino acids to the liver in conditions of stress could come from the breakdown of body tissue proteins, particularly muscle. It is intended to study muscle protein turnover by the use of 13 C-leucine in undernourished subjects under conditions of stress. Since whole body protein turnover can be measured by two methods, using 15 N-glycine and 13 C-leucine, a comparison of these two methods will initially be made in chronically undernourished subjects. It is also intended to study daily energy expenditure in the subject by an isotopic method, i.e. the appearance of 13 CO 2 in the breath after the administration of 13 C-bicarbonate. (author). 8 refs

  8. Utility of the Spelling Sensitivity Score to Analyze Spellings of Children with Specific Language Impairment

    Science.gov (United States)

    Werfel, Krystal L.; Krimm, Hannah

    2015-01-01

    The purpose of this study was to examine the utility of the Spelling Sensitivity Score (SSS) beyond percentage correct scoring in analyzing the spellings of children with specific language impairment (SLI). Participants were 31 children with SLI and 28 children with typical language in grades 2-4. Spellings of individual words were scored using…

  9. Effect of exogenous melatonin on embryo viability and uterine environment in undernourished ewes.

    Science.gov (United States)

    Vázquez, M I; Forcada, F; Sosa, C; Casao, A; Sartore, I; Fernández-Foren, A; Meikle, A; Abecia, J A

    2013-09-01

    The effect of exogenous melatonin on embryo viability in undernourished ewes was investigated. At lambing, 24 ewes were treated (+MEL) or not (-MEL) with a melatonin implant. After 45 days, both groups were fed to provide 1.5 (Control, C) or 0.5 (Low, L) times daily maintenance requirements, so that experimental groups were: C-MEL, C+MEL, L-MEL and L+MEL. Ewes were mated (Day 0) and on Day 5 embryos were recovered and classified according to their developmental stage and morphology. Ovaries were used for in vitro fertilization and uterine horns were processed to study progesterone and oestrogen receptor (PR and ERα) expression by inmunohistochemistry. After 21 days, groups L-MEL and L+MEL had an average weight loss of 10kg (Pmelatonin effect was particularly evident in undernourished ewes, increasing both viability (L+MEL: 65%; L-MEL: 25%; Ppregnancy rates (L+MEL: 66.6%; L-MEL: 16.6%; Pmelatonin nor their interaction had a significant effect on the in vitro oocyte development. Melatonin treatment tended to increase the percentage of positive cells to PR in deep glandular epithelium, independently of diet (P=0.09), and the greatest staining intensity of PR was observed in the luminal and superficial glandular epithelia (Pmelatonin implants at lambing during the breeding season improve the viability of embryos recovered from undernourished ewes, although this effect seems not to be mediated at the oocyte competence level. Copyright © 2013 Elsevier B.V. All rights reserved.

  10. Cyclosporine utilization in Idiopathic Nephrotic Syndrome in children

    International Nuclear Information System (INIS)

    Saeed, B.; Sheriff, S.; Ossman, Mohd Imad

    2006-01-01

    The treatment of steroid-resistant focal segmental glomerulosclerosis (FSGS) imposes one the most perplexing and frustrating problems on nephrologists. Cyclosporine A (CsA) is widely considered as the treatment of choice for steroid-resistant or dependent nephrotic children. We reviewed the clinical outcome in children with idiopathic nephrotic syndrome (INS) under CsA treatment. A total of 22 children presented with either steroid resistant nephrotic syndrome (SRNS) (14 children), or steroid-dependent nephrotic syndrome (SDNS) (8 children) during the period from August 2002 to February 2005; the mean age for both groups was 7.6 years (range: 23 months-15 years). Renal histology showed FSGS in 14 (63%) patients, minimal change disease (MCD) in 4(18%), diffuse mesangial glomerulonphritis (MesGN) in three (13.6%), and membranous glomerulonephritis (MGN) in two (6.8%). Treatment with CsA in combination with alternate-day prednisolone induced remission in 15(68%) patients; 9(60%) patients had complete remission and six (40%) partial remission. Seven (50%) patients in SRNS group responded to CsA treatment; two (14.2%) patients had complete remission and 5 (35.7%) had partial remission. Seven ( 87.5%) children in SDNS group had complete remission and one (13.5%) had partial remission. We conclude that this study demonstrates the efficacy of CsA in inducing remission in the steroid dependent is higher than in the steroid resistant nephrotic children. We believe that CsA is probably a good alternative therapy in this population. (author)

  11. Children with paralytic poliomyelitis: utilization of physiotherapy services in Zamfara State, Nigeria.

    Science.gov (United States)

    Ogwumike, Omoyemi O; Kaka, Bashir; Adeniyi, Ade F

    2013-02-01

    Physiotherapy is usually indicated for health promotion and the rehabilitation of individuals with paralytic poliomyelitis. The endemic nature of this condition in children in Zamfara State, Nigeria necessitated investigation into the utilization of physiotherapy services by parents or primary caregivers of children affected with polio in this sub-region. Parents and primary caregivers of children with paralytic poliomyelitis were recruited using a purposive multi-stage sampling procedure in a cross-sectional survey. Factors associated with the utilization of physiotherapy services were assessed based on questions extracted from a 4-part, 52-item structured questionnaire originally designed for a study which investigated knowledge, attitude, and beliefs of parents of children with paralytic poliomyelitis. A total of 217 participants were included in this study. The mean age was 32.29 ± 9.89 years and the mean knowledge of polio score was 62.0 ± 17.3%. The mean age of the children with paralytic poliomyelitis was 6.41 ± 2.50 years. Only 27.2% of the parents or primary caregivers had utilized physiotherapy service for their children at some point. No association existed between utilization of physiotherapy service and 'knowledge of paralytic poliomyelitis', 'employment status', and 'family income' of respondents. Explanations for low utilization of physiotherapy services for children with paralytic poliomyelitis by parents or primary caregivers are discussed.

  12. Utilization of oral health services by mothers of preschool children in ...

    African Journals Online (AJOL)

    Objective: To determine oral health services utilization by mothers of pre school children in Jos North Local Government Area, Plateau State, Nigeria Design: Cross-sectional study. Setting: Four Primary Health Care (PHC) Clinics in Jos North Local Government Area Participants: 200 mothers of pre school children

  13. Sociodemographic Disparities in Intervention Service Utilization in Families of Children with Autism Spectrum Disorder

    Science.gov (United States)

    Nguyen, Cathina T.; Krakowiak, Paula; Hansen, Robin; Hertz-Picciotto, Irva; Angkustsiri, Kathleen

    2016-01-01

    This study investigates whether sociodemographic factors are associated with utilization of intervention services for children with autism spectrum disorder (ASD) enrolled in the Childhood Autism Risks from Genetics and the Environment Study. Maternal ethnicity, insurance status, and education for 696 families of children with ASD were available.…

  14. Individual and contextual factors influencing dental health care utilization by preschool children: a multilevel analysis

    Science.gov (United States)

    Piovesan, Chaiana; Ardenghi, Thiago Machado; Mendes, Fausto Medeiros; Agostini, Bernardo Antonio; Michel-Crosato, Edgard

    2017-03-30

    The effect of contextual factors on dental care utilization was evaluated after adjustment for individual characteristics of Brazilian preschool children. This cross-sectional study assessed 639 preschool children aged 1 to 5 years from Santa Maria, a town in Rio Grande do Sul State, located in southern Brazil. Participants were randomly selected from children attending the National Children's Vaccination Day and 15 health centers were selected for this research. Visual examinations followed the ICDAS criteria. Parents answered a questionnaire about demographic and socioeconomic characteristics. Contextual influences on children's dental care utilization were obtained from two community-related variables: presence of dentists and presence of workers' associations in the neighborhood. Unadjusted and adjusted multilevel logistic regression models were used to describe the association between outcome and predictor variables. A prevalence of 21.6% was found for regular use of dental services. The unadjusted assessment of the associations of dental health care utilization with individual and contextual factors included children's ages, family income, parents' schooling, mothers' participation in their children's school activities, dental caries, and presence of workers' associations in the neighborhood as the main outcome covariates. Individual variables remained associated with the outcome after adding contextual variables in the model. In conclusion, individual and contextual variables were associated with dental health care utilization by preschool children.

  15. The use of protein hydrolysate improves the protein intestinal absorption in undernourished mice infected with Schistosoma mansoni

    Directory of Open Access Journals (Sweden)

    Coutinho Eridan M.

    2002-01-01

    Full Text Available Patients residing in endemic areas for schistosomiasis in Brazil are usually undernourished and when they develop the hepatosplenic clinical form of the disease should usually receive hospital care, many of them being in need of nutritional rehabilitation before specific treatment can be undertaken. In the mouse model, investigations carried out in our laboratory detected a reduced aminoacid uptake in undernourished animals which is aggravated by a superimposed infection with Schistosoma mansoni. However, in well-nourished infected mice no dysfunction occurs. In this study, we tried to improve the absorptive intestinal performance of undernourished mice infected with S. mansoni by feeding them with hydrolysed casein instead of whole casein. The values obtained for the coefficient of protein intestinal absorption (cpia among well-nourished mice were above 90% (either hydrolysed or whole protein. In undernourished infected mice, however, the cpia improved significantly after feeding them with hydrolysed casein, animals reaching values close to those obtained in well-nourished infected mice.

  16. Understanding the health care utilization of children who require medical technology: A descriptive study of children who require tracheostomies.

    Science.gov (United States)

    Spratling, Regena

    2017-04-01

    Children who require medical technology have complex chronic illnesses. This medical technology, including ventilators, oximeters, tracheostomy tubes, and feeding tubes, allows children and their families to live at home; however, the management of the children's care by informal caregivers is complex with the need for intensive, specialized care. The purpose of this study was to examine the sociodemographic and clinical characteristics that affect health care utilization in a population of children who require medical technology. A retrospective electronic health record (EHR) review was completed on the EHR records on 171 children who require medical technology, specifically tracheostomies, at an outpatient technology dependent pulmonary clinic over a three year period (January 2010-December 2012). Descriptive statistics were used to analyze sociodemographic and clinical characteristics, including medical diagnoses, and emergency department (ED) visits and hospitalizations. Of the 171 children requiring medical technology studied, there were numerous medical diagnoses (n=791), 99% had chronic illnesses affecting two or more body systems, and 88% required two or more technologies, including a tracheostomy and a feeding tube. In addition, 91% of the children had at least one ED visit or hospitalization and were treated in the ED approximately three times over the three year period. The findings from this study noted an increased utilization of health care by these children, and identified common symptoms and medical technologies for which caregivers may need interventions, focusing on education in managing symptoms and medical technology prior to presentation to the ED or hospital. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Programming of intermediate metabolism in young lambs affected by late gestational maternal undernourishment

    DEFF Research Database (Denmark)

    Husted, Sanne; Nielsen, Mette Olaf; Tygesen, Malin Plumhoff

    2007-01-01

    Effects of moderate maternal undernourishment during late gestation on the intermediary metabolism and maturational changes in young lambs were investigated. 20 twin-bearing sheep, bred to two different rams, were randomly allocated the last 6 wk of gestation to either a NORM diet [barley, protein...... supplement, and silage ad libitum ˜ 15 MJ metabolizable energy (ME/day] or a LOW diet (50% of ME intake in NORM, offered exclusively as silage ¨7 MJ ME/day). Post partum, ewes were fed to requirement. After weaning, lambs were fed concentrate and hay ad libitum. At 10 and 19 wk of age, lambs wee subjected...... to an intravenous glucose tolerance test (IGTT) followed by 24 h of fasting. Heat energy (HE) was determined in a respiration chamber at 9 or 20 wk of age. LOW lambs had a lower birth weight and continued to be lighter throughout the experiment. Glucose tolerance did not differ between groups. However, 19-wk...

  18. Secondhand smoke and asthma: what are the effects on healthcare utilization among children?

    Science.gov (United States)

    Jin, Yue; Seiber, Eric E; Ferketich, Amy K

    2013-08-01

    This study aims to examine the associations between asthma, secondhand smoke exposure and healthcare utilization in a nationally representative sample of children. Data from 5686 children aged 0-11 years were analyzed. Healthcare utilization, asthma diagnosis and demographic information came from the 2001 and 2006 Medical Expenditure Panel Surveys. Secondhand smoke exposure was measured during the 2000 and 2005 National Health Interview Surveys. Multivariable regression models were used to determine the association between secondhand smoke exposure, asthma diagnosis and healthcare utilization (hospitalizations, emergency department visits, outpatient visits and prescription medication use). Asthma modified the relationship between secondhand smoke exposure and hospitalizations, as exposure more than doubled the odds of hospitalization among children with asthma but had no effect on children without asthma. Secondhand smoke exposure increased the odds by 37% of emergency room visits (PSecondhand smoke exposure was associated with a greater utilization of hospitals and emergency departments, and the effect on hospitalizations was most pronounced among children with asthma. Reducing secondhand smoke exposure would help to reduce the burden on the healthcare system, especially among children with asthma. Copyright © 2013 Elsevier Inc. All rights reserved.

  19. Healthcare Utilization and Spending for Constipation in Children With Versus Without Complex Chronic Conditions.

    Science.gov (United States)

    Stephens, John R; Steiner, Michael J; DeJong, Neal; Rodean, Jonathan; Hall, Matt; Richardson, Troy; Berry, Jay G

    2017-01-01

    The aim of the study was to examine the prevalence of diagnosis and treatment for constipation among children receiving Medicaid and to compare healthcare utilization and spending for constipation among children based on number of complex chronic conditions (CCCs). Retrospective cohort study of 4.9 million children ages 1 to 17 years enrolled in Medicaid from 2009 to 2011 in 10 states in the Truven Marketscan Database. Constipation was identified using International Classification of Disease, 9th revision codes for constipation (564.0x), intestinal impaction (560.3x), or encopresis (307.7). Outpatient and inpatient utilization and spending for constipation were assessed. CCC status was identified using validated methodology. A total of 267,188 children (5.4%) were diagnosed with constipation. Total constipation spending was $79.5 million. Outpatient constipation spending was $66.8 million (84.1%) during 406,814 visits, mean spending $120/visit. Among children with constipation, 1363 (0.5%) received inpatient treatment, accounting for $12.2 million (15.4%) of constipation spending, mean spending $7815/hospitalization. Of children hospitalized for constipation, 552 (40.5%) did not have an outpatient visit for constipation before admission. Approximately 6.8% of children in the study had ≥1 CCC; these children accounted for 33.5% of total constipation spending, 70.3% of inpatient constipation spending, and 19.8% of emergency department constipation spending. Constipation prevalence was 11.0% for children with 1 CCC, 16.6% with 2 CCCs, and 27.1% with ≥3 CCCs. Although the majority of pediatric constipation treatment occurs in the outpatient setting, inpatient care accounts for a sizable percentage of spending. Children with CCCs have a higher prevalence of constipation and account for a disproportionate amount of constipation healthcare utilization and spending.

  20. Public Health Insurance and Health Care Utilization for Children in Immigrant Families.

    Science.gov (United States)

    Percheski, Christine; Bzostek, Sharon

    2017-12-01

    Objectives To estimate the impacts of public health insurance coverage on health care utilization and unmet health care needs for children in immigrant families. Methods We use survey data from National Health Interview Survey (NHIS) (2001-2005) linked to data from Medical Expenditures Panel Survey (MEPS) (2003-2007) for children with siblings in families headed by at least one immigrant parent. We use logit models with family fixed effects. Results Compared to their siblings with public insurance, uninsured children in immigrant families have higher odds of having no usual source of care, having no health care visits in a 2 year period, having high Emergency Department reliance, and having unmet health care needs. We find no statistically significant difference in the odds of having annual well-child visits. Conclusions for practice Previous research may have underestimated the impact of public health insurance for children in immigrant families. Children in immigrant families would likely benefit considerably from expansions of public health insurance eligibility to cover all children, including children without citizenship. Immigrant families that include both insured and uninsured children may benefit from additional referral and outreach efforts from health care providers to ensure that uninsured children have the same access to health care as their publicly-insured siblings.

  1. Ontogeny of methionine utilization and splanchnic uptake in critically ill children

    Science.gov (United States)

    To determine the rates of methionine splanchnic uptake and utilization in critically ill pediatric patients, we used two kinetic models: the plasma methionine enrichment,and the "intracellular" homocysteine enrichment. Twenty-four patients, eight infants, eight children, and eight adolescents, were ...

  2. Music Therapy with Children: A Review of Clinical Utility and Application to Special Populations.

    Science.gov (United States)

    Yeaw, John David Andrew

    This paper reviews the effectiveness of music therapy in treating children with psychiatric and developmental problems. The clinical utility of music therapy is first evaluated by examining the foundational effects of music on affect and behavior. Next, the two broad approaches to music therapy, active and passive music therapy, are discussed.…

  3. Individual and contextual factors influencing dental health care utilization by preschool children: a multilevel analysis

    Directory of Open Access Journals (Sweden)

    Chaiana PIOVESAN

    2017-03-01

    Full Text Available Abstract The effect of contextual factors on dental care utilization was evaluated after adjustment for individual characteristics of Brazilian preschool children. This cross-sectional study assessed 639 preschool children aged 1 to 5 years from Santa Maria, a town in Rio Grande do Sul State, located in southern Brazil. Participants were randomly selected from children attending the National Children’s Vaccination Day and 15 health centers were selected for this research. Visual examinations followed the ICDAS criteria. Parents answered a questionnaire about demographic and socioeconomic characteristics. Contextual influences on children’s dental care utilization were obtained from two community-related variables: presence of dentists and presence of workers’ associations in the neighborhood. Unadjusted and adjusted multilevel logistic regression models were used to describe the association between outcome and predictor variables. A prevalence of 21.6% was found for regular use of dental services. The unadjusted assessment of the associations of dental health care utilization with individual and contextual factors included children’s ages, family income, parents’ schooling, mothers’ participation in their children’s school activities, dental caries, and presence of workers’ associations in the neighborhood as the main outcome covariates. Individual variables remained associated with the outcome after adding contextual variables in the model. In conclusion, individual and contextual variables were associated with dental health care utilization by preschool children.

  4. Inequalities in dental services utilization among Brazilian low-income children: the role of individual determinants.

    Science.gov (United States)

    Baldani, Marcia Helena; Mendes, Yasmine Bittencourt Emílio; Lawder, Juliana Aparecida de Campos; de Lara, Ana Paula Ingles; Rodrigues, Michelli Marta Azevedo da Silva; Antunes, Jose Leopoldo Ferreira

    2011-01-01

    To assess the role of the individual determinants on the inequalities of dental services utilization among low-income children living in the working area of Brazilian's federal Primary Health Care program, which is called Family Health Program (FHP), in a big city in Southern Brazil. A cross-sectional population-based study was performed. The sample included 350 children, ages 0 to 14 years, whose parents answered a questionnaire about their socioeconomic conditions, perceived needs, oral hygiene habits, and access to dental services. The data analysis was performed according to a conceptual framework based on Andersen's behavioral model of health services use. Multivariate models of logistic regression analysis instructed the hypothesis on covariates for never having had a dental visit. Thirty one percent of the surveyed children had never had a dental visit. In the bivariate analysis, higher proportion of children who had never had a dental visit was found among the very young, those with inadequate oral hygiene habits, those without perceived need of dental care, and those whose family homes were under absent ownership. The mechanisms of social support showed to be important enabling factors: children attending schools/kindergartens and being regularly monitored by the FHP teams had higher odds of having gone to the dentist, even after adjusting for socioeconomic, demographic, and need variables. The conceptual framework has confirmed the presence of social and psychosocial inequalities on the utilization pattern of dental services for low-income children. The individual determinants seem to be important predictors of access.

  5. Melatonin improves placental efficiency and birth weight and increases the placental expression of antioxidant enzymes in undernourished pregnancy.

    Science.gov (United States)

    Richter, Hans G; Hansell, Jeremy A; Raut, Shruti; Giussani, Dino A

    2009-05-01

    Melatonin participates in circadian, seasonal and reproductive physiology. Melatonin also acts as a potent endogenous antioxidant by scavenging free radicals and upregulating antioxidant pathways. The placenta expresses melatonin receptors and melatonin protects against oxidative damage induced in rat placenta by ischemia-reperfusion. One of the most common complications in pregnancy is a reduction in fetal nutrient delivery, which is known to promote oxidative stress. However, whether melatonin protects placental function and fetal development in undernourished pregnancy is unknown. Here, we investigated the effects of maternal treatment with melatonin on placental efficiency, fetal growth, birth weight and protein expression of placental oxidative stress markers in undernourished pregnancy. On day 15 of pregnancy, rats were divided into control and undernourished pregnancy (35% reduction in food intake), with and without melatonin treatment (5 microg/mL drinking water). On day 20 of gestation, fetal biometry was carried out, the placenta was weighed and subsequently analyzed by Western blot for xanthine oxidase, heat shock protein (HSP) 27 and 70, catalase, manganese superoxide dismutase (Mn-SOD) and glutathione peroxidase 1 (GPx-1). A separate cohort was allowed to deliver to assess effects on birth weight. Maternal undernutrition led to a fall in placental efficiency, disproportionate intrauterine growth retardation and a reduction in birth weight. Maternal treatment with melatonin in undernourished pregnancy improved placental efficiency and restored birth weight, and it increased the expression of placental Mn-SOD and catalase. The data show that in pregnancy complicated by undernutrition, melatonin may improve placental efficiency and birth weight by upregulating placental antioxidant enzymes.

  6. Dietary -carbamylglutamate and rumen-protected -arginine supplementation ameliorate fetal growth restriction in undernourished ewes.

    Science.gov (United States)

    Zhang, H; Sun, L W; Wang, Z Y; Deng, M T; Zhang, G M; Guo, R H; Ma, T W; Wang, F

    2016-05-01

    This study was conducted with an ovine intrauterine growth restriction (IUGR) model to test the hypothesis that dietary -carbamylglutamate (NCG) and rumen-protected -Arg (RP-Arg) supplementation are effective in ameliorating fetal growth restriction in undernourished ewes. Beginning on d 35 of gestation, ewes were fed a diet providing 100% of NRC-recommended nutrient requirements, 50% of NRC recommendations (50% NRC), 50% of NRC recommendations supplemented with 20 g/d RP-Arg (providing 10 g/d of Arg), and 50% of NRC recommendations supplemented with 5 g/d NCG product (providing 2.5 g/d of NCG). On d 110, maternal, fetal, and placental tissues and fluids were collected and weighed. Ewe weights were lower ( ewes compared with adequately fed ewes. Maternal RP-Arg or NCG supplementation did not alter ( = 0.26) maternal BW in nutrient-restricted ewes. Weights of most fetal organs were increased ( ewes compared with 50% NRC-fed ewes. Supplementation of RP-Arg or NCG reduced ( ewes but had no effect on concentrations of lactate and GH. Maternal RP-Arg or NCG supplementation markedly improved ( ewes. These novel results indicate that dietary NCG and RP-Arg supplementation to underfed ewes ameliorated fetal growth restriction, at least in part, by increasing the availability of AA in the conceptus and provide support for its clinical use to ameliorate IUGR in humans and sheep industry production.

  7. Characteristics of Hospitalized Children With a Diagnosis of Malnutrition: United States, 2010.

    Science.gov (United States)

    Abdelhadi, Ruba A; Bouma, Sandra; Bairdain, Sigrid; Wolff, Jodi; Legro, Amanda; Plogsted, Steve; Guenter, Peggi; Resnick, Helaine; Slaughter-Acey, Jaime C; Corkins, Mark R

    2016-07-01

    Malnutrition is common in hospitalized patients in the United States. In 2010, 80,710 of 6,280,710 hospitalized children malnutrition (CDM). This report summarizes nationally representative, person-level characteristics of hospitalized children with a CDM. Data are from the 2010 Healthcare Cost and Utilization Project, which contains patient-level data on hospital inpatient stays. When weighted appropriately, estimates from the project represent all U.S. hospitalizations. The data set contains up to 25 ICD-9-CM diagnostic codes for each patient. Children with a CDM listed during hospitalization were identified. In 2010, 1.3% of hospitalized patients malnutrition's true prevalence may be underrepresented. Length of stay among children with a CDM was almost 2.5 times longer than those without a CDM. Hospital costs for children with a CDM were >3 times higher than those without a CDM. Hospitalized children with a CDM were less likely to have routine discharge and almost 3.5 times more likely to require postdischarge home care. Children with a CDM were more likely to have multiple comorbidities. Hospitalized children with a CDM are associated with more comorbidities, longer hospital stay, and higher healthcare costs than those without this diagnosis. These undernourished children may utilize more healthcare resources in the hospital and community. Clinicians and policymakers should factor this into healthcare resource utilization planning. Recognizing and accurately coding malnutrition in hospitalized children may reveal the true prevalence of malnutrition. © 2016 American Society for Parenteral and Enteral Nutrition.

  8. Annual Report on Children's Health Care: Dental and Orthodontic Utilization and Expenditures for Children, 2010-2012.

    Science.gov (United States)

    Berdahl, Terceira; Hudson, Julie; Simpson, Lisa; McCormick, Marie C

    2016-01-01

    To examine general dental and orthodontic utilization and expenditures by health insurance status, public health insurance eligibility, and sociodemographic characteristics among children aged 0 to 17 years using data from 2010-2012. Nationally representative data from the Medical Expenditure Panel Survey (2010-2012) provided data on insurance status, public health insurance eligibility, and visits to dental providers for both general dental care and orthodontic care. Overall, 41.9% of US children reported an annual dental office-based visit for general (nonorthodontic) dental care. Fewer Hispanic (34.7%) and non-Latino black children (34.8%) received dental care compared to non-Hispanic whites (47.3%) and Asians (40.3%). Children living in families with the lowest income were also the least likely to have a visit (32.9%) compared to children in the highest-income families (54.7%). Among children eligible for public coverage, Medicaid-eligible children had the lowest percentage of preventive dental visits (29.2%). Socioeconomic and racial/ethnic disparities in use and expenditures for orthodontic care are much greater than those for general and preventive dental care. Average expenditures for orthodontic care were $1,823, of which 56% ($1,023) was paid out of pocket by families. Our findings provide a baseline assessment for examining trends in the future, especially as coverage patterns for children may change as the Affordable Care Act is implemented and the future of the State Child Health Insurance Program remains uncertain beyond 2017. Published by Elsevier Inc.

  9. Racial Disparities in Orthodontic Service Utilization for Medicaid-Enrolled Children: An Evaluation of the Washington Medicaid Program

    Science.gov (United States)

    Merritt, Jantraveus M.; Greenlee, Geoffrey; Bollen, Anne Marie; Scott, JoAnna M.; Chi, Donald L.

    2016-01-01

    Introduction We assess the relationship between race and orthodontic service utilization for Medicaid-enrolled children. Methods This cross-sectional study focused on 570,364 Washington Medicaid-enrolled children ages 6-19 years. The main predictor variable was self-reported race (White versus non-White). The outcome variable was orthodontic service utilization, defined as children who were pre-authorized for orthodontic treatment by Medicaid in 2012 and subsequently received orthodontic records and initiated treatment. Logistic regression models were used to test the hypothesis that non-Whites would be less likely to utilize orthodontic care than Whites. Results A total of 8,223 children were approved by Medicaid for orthodontic treatment and 7,313 received records and initiated treatment. Non-Whites were significantly more likely to utilize orthodontic care than Whites (Odds Ratio [OR]=1.18; 95% confidence interval [CI]=1.02, 1.36; p=.031). Hispanic non-White children were more likely to utilize orthodontic care than non-Hispanic White children (OR=1.42; 95% CI=1.18, 1.70; porthodontic care than White children. The Washington Medicaid program demonstrates a potential model for addressing racial disparities in orthodontic service utilization. Future research should identify mechanisms underlying these findings and continue to monitor orthodontic service utilization for minority children in Medicaid. PMID:27021456

  10. WISC-III cognitive profiles in children with developmental dyslexia: specific cognitive disability and diagnostic utility.

    Science.gov (United States)

    Moura, Octávio; Simões, Mário R; Pereira, Marcelino

    2014-02-01

    This study analysed the usefulness of the Wechsler Intelligence Scale for Children-Third Edition in identifying specific cognitive impairments that are linked to developmental dyslexia (DD) and the diagnostic utility of the most common profiles in a sample of 100 Portuguese children (50 dyslexic and 50 normal readers) between the ages of 8 and 12 years. Children with DD exhibited significantly lower scores in the Verbal Comprehension Index (except the Vocabulary subtest), Freedom from Distractibility Index (FDI) and Processing Speed Index subtests, with larger effect sizes than normal readers in Information, Arithmetic and Digit Span. The Verbal-Performance IQs discrepancies, Bannatyne pattern and the presence of FDI; Arithmetic, Coding, Information and Digit Span subtests (ACID) and Symbol Search, Coding, Arithmetic and Digit Span subtests (SCAD) profiles (full or partial) in the lowest subtests revealed a low diagnostic utility. However, the receiver operating characteristic curve and the optimal cut-off score analyses of the composite ACID; FDI and SCAD profiles scores showed moderate accuracy in correctly discriminating dyslexic readers from normal ones. These results suggested that in the context of a comprehensive assessment, the Wechsler Intelligence Scale for Children-Third Edition provides some useful information about the presence of specific cognitive disabilities in DD. Practitioner Points. Children with developmental dyslexia revealed significant deficits in the Wechsler Intelligence Scale for Children-Third Edition subtests that rely on verbal abilities, processing speed and working memory. The composite Arithmetic, Coding, Information and Digit Span subtests (ACID); Freedom from Distractibility Index and Symbol Search, Coding, Arithmetic and Digit Span subtests (SCAD) profile scores showed moderate accuracy in correctly discriminating dyslexics from normal readers. Wechsler Intelligence Scale for Children-Third Edition may provide some useful

  11. Measuring Health Utilities in Children and Adolescents: A Systematic Review of the Literature.

    Directory of Open Access Journals (Sweden)

    Dominic Thorrington

    Full Text Available The objective of this review was to evaluate the use of all direct and indirect methods used to estimate health utilities in both children and adolescents. Utilities measured pre- and post-intervention are combined with the time over which health states are experienced to calculate quality-adjusted life years (QALYs. Cost-utility analyses (CUAs estimate the cost-effectiveness of health technologies based on their costs and benefits using QALYs as a measure of benefit. The accurate measurement of QALYs is dependent on using appropriate methods to elicit health utilities.We sought studies that measured health utilities directly from patients or their proxies. We did not exclude those studies that also included adults in the analysis, but excluded those studies focused only on adults.We evaluated 90 studies from a total of 1,780 selected from the databases. 47 (52% studies were CUAs incorporated into randomised clinical trials; 23 (26% were health-state utility assessments; 8 (9% validated methods and 12 (13% compared existing or new methods. 22 unique direct or indirect calculation methods were used a total of 137 times. Direct calculation through standard gamble, time trade-off and visual analogue scale was used 32 times. The EuroQol EQ-5D was the most frequently-used single method, selected for 41 studies. 15 of the methods used were generic methods and the remaining 7 were disease-specific. 48 of the 90 studies (53% used some form of proxy, with 26 (29% using proxies exclusively to estimate health utilities.Several child- and adolescent-specific methods are still being developed and validated, leaving many studies using methods that have not been designed or validated for use in children or adolescents. Several studies failed to justify using proxy respondents rather than administering the methods directly to the patients. Only two studies examined missing responses to the methods administered with respect to the patients' ages.

  12. Children With Intellectual Disability and Hospice Utilization: The Moderating Effect of Residential Care.

    Science.gov (United States)

    Lindley, Lisa C

    2017-01-01

    Children with intellectual disability commonly lack access to pediatric hospice care services. Residential care may be a critical component in providing access to hospice care for children with intellectual disability. This research tested whether residential care intensifies the relationship between intellectual disability and hospice utilization (ie, hospice enrollment, hospice length of stay), while controlling for demographic characteristics. Multivariate regression analyses were conducted using 2008 to 2010 California Medicaid claims data. The odds of children with intellectual disability in residential care enrolling in hospice care were 3 times higher than their counterparts in their last year of life, when controlling for demographics. Residential care promoted hospice enrollment among children with intellectual disability. The interaction between intellectual disability and residential care was not related to hospice length of stay. Residential care did not attenuate or intensify the relationship between intellectual disability and hospice length of stay. The findings highlight the important role of residential care in facilitating hospice enrollment for children with intellectual disability. More research is needed to understand the capability of residential care staff to identify children with intellectual disability earlier in their end-of-life trajectory and initiate longer hospice length of stays.

  13. Payments and Utilization of Immunization Services Among Children Enrolled in Fee-for-Service Medicaid.

    Science.gov (United States)

    Tsai, Yuping

    2018-01-01

    To examine the association between state Medicaid vaccine administration fees and children's receipt of immunization services. The study used the 2008-2012 Medicaid Analytic eXtract data and included children aged 0-17 years and continuously enrolled in a Medicaid fee-for-service plan in each study year. Analyses were restricted to 8 states with a Medicaid managed-care penetration rate Medicaid vaccine administration fees, age group, sex, race/ethnicity, state unemployment rate, state managed-care penetration rate, and state and year-fixed effects. A total of 1,678,288 children were included. In 2008-2012, the average proportion of children making ≥1 vaccination visit per year was 31% and the mean number of vaccination visits was 0.9. State Medicaid reimbursements for vaccine administration was positively associated with immunization service utilization; for every $1 increase in the payment amount, the probability of children making ≥1 vaccination visit increased by 0.72 percentage point (95% confidence interval, 0.23-1.21; P=0.01), representing a 2% increase from the mean and the number of vaccination visits increased by 0.03 (95% confidence interval, -0.00 to 0.06; PMedicaid reimbursements for vaccine administration were associated with increased proportion of children receiving immunization services.

  14. Understanding health-care access and utilization disparities among Latino children in the United States.

    Science.gov (United States)

    Langellier, Brent A; Chen, Jie; Vargas-Bustamante, Arturo; Inkelas, Moira; Ortega, Alexander N

    2016-06-01

    It is important to understand the source of health-care disparities between Latinos and other children in the United States. We examine parent-reported health-care access and utilization among Latino, White, and Black children (≤17 years old) in the United States in the 2006-2011 National Health Interview Survey. Using Blinder-Oaxaca decomposition, we portion health-care disparities into two parts (1) those attributable to differences in the levels of sociodemographic characteristics (e.g., income) and (2) those attributable to differences in group-specific regression coefficients that measure the health-care 'return' Latino, White, and Black children receive on these characteristics. In the United States, Latino children are less likely than Whites to have a usual source of care, receive at least one preventive care visit, and visit a doctor, and are more likely to have delayed care. The return on sociodemographic characteristics explains 20-30% of the disparity between Latino and White children in the usual source of care, delayed care, and doctor visits and 40-50% of the disparity between Latinos and Blacks in emergency department use and preventive care. Much of the health-care disadvantage experienced by Latino children would persist if Latinos had the sociodemographic characteristics as Whites and Blacks. © The Author(s) 2014.

  15. The utility of anaerobic blood culture in detecting facultative anaerobic bacteremia in children.

    Science.gov (United States)

    Shoji, Kensuke; Komuro, Hisako; Watanabe, Yasushi; Miyairi, Isao

    2013-08-01

    Routine anaerobic blood culture is not recommended in children because obligate anaerobic bacteremia is rare in the pediatric population. However, a number of facultative anaerobic bacteria can cause community and hospital acquired infections in children and the utility of anaerobic blood culture for detection of these organisms is still unclear. We conducted a retrospective analysis of all blood culture samples (n = 24,356) at a children's hospital in Japan from October 2009 to June 2012. Among the samples that had paired aerobic and anaerobic blood cultures, 717 samples were considered clinically significant with 418 (58%) organisms detected from both aerobic and anaerobic cultures, 167 (23%) detected only from aerobic culture and 132 (18%) detected only from anaerobic culture. While most facultative anaerobes were detectable by aerobic culture, over 25% of Enterobacteriaceae and 15% of Staphylococcus sp. were detected from anaerobic cultures bottles only, suggesting its potential role in selected settings. Copyright © 2013 Elsevier Inc. All rights reserved.

  16. An assessment of schoolyard features and behavior patterns in children's utilization and physical activity.

    Science.gov (United States)

    Anthamatten, Peter; Brink, Lois; Kingston, Beverly; Kutchman, Eve; Lampe, Sarah; Nigg, Claudio

    2014-03-01

    Careful research that elucidates how behavior relates to design in the context of elementary school grounds can serve to guide cost-efficient design with the goal of encouraging physical activity (PA). This work explores patterns in children's PA behavior within playground spaces with the specific goal of guiding healthy playground design. Data on children's utilization and PA behavior in 6 playgrounds divided into 106 observation zones were collected in 2005 and 2006 at Denver elementary school playgrounds using the System for Observing Play and Leisure Activity in Youth. Analyses of variance and t tests determined whether there were differences in utilization and behavior patterns across observations zones and between genders. This study provides evidence that children prefer to use certain types of playground zones and that they are more likely to practice moderate-to-vigorous physical activity (MVPA) in some zones. The authors observed statistically significant differences between genders. Boys were more likely to engage in MVPA in zones without equipment, girls were more likely to use zones with equipment. This work suggests that the inclusion or omission of specific playground features may have an impact on the way that children use the spaces.

  17. The cost utility and budget impact of adjuvant racecadotril for acute diarrhea in children in Thailand

    Directory of Open Access Journals (Sweden)

    Rautenberg TA

    2017-07-01

    Full Text Available Tamlyn Anne Rautenberg,1,2 Ute Zerwes3 1IGES Institut, Berlin, Germany; 2Health Economics and HIV/AIDS Research Division (HEARD, School of Accounting, Economics and Finance, University of KwaZulu Natal, KwaZulu Natal, South Africa; 3Assessment in Medicine GmbH, Lörrach, Germany Objective: To evaluate the cost utility and the budget impact of adjuvant racecadotril for the treatment of acute diarrhea in children in Thailand. Methods: A cost utility model has been adapted to the context of Thailand to evaluate racecadotril plus oral rehydration solution (R+ORS versus oral rehydration solution (ORS alone for acute diarrhea in children <5 years old. The decision tree Excel model evaluates the costs and effects (quality-adjusted life years over a 6-day time horizon from a public health care payer’s perspective in Thailand. Deterministic sensitivity analysis and budget impact analysis have been undertaken. Results: According to the cost utility model, the intervention (R+ORS is less costly and more effective than the comparator (ORS for the base case with a dominant incremental cost-effectiveness ratio of −2,481,390฿ for the intervention. According to the budget impact analysis (assuming an increase of 5% market share for R+ORS over 5 years, the year-on-year reduction for diarrhea as a percentage of the total health care expenditure is −0.0027%, resulting in potential net cost savings of −35,632,482฿ over 5 years. Conclusion: Subject to the assumptions and limitations of the models, adjuvant racecadotril versus ORS alone is potentially cost-effective for children in Thailand and uptake could translate into savings for the Thailand public health care system. Keywords: economic evaluation, cost utility, decision analysis, health technology assessment

  18. Incremental health care utilization and costs for acute otitis media in children.

    Science.gov (United States)

    Ahmed, Sameer; Shapiro, Nina L; Bhattacharyya, Neil

    2014-01-01

    Determine the incremental health care costs associated with the diagnosis and treatment of acute otitis media (AOM) in children. Cross-sectional analysis of a national health-care cost database. Pediatric patients (age children with and without a diagnosis of AOM, adjusting for age, sex, region, race, ethnicity, insurance coverage, and Charlson comorbidity Index. A total of 8.7 ± 0.4 million children were diagnosed with AOM (10.7 ± 0.4% annually, mean age 5.3 years, 51.3% male) among 81.5 ± 2.3 million children sampled (mean age 8.9 years, 51.3% male). Children with AOM manifested an additional +2.0 office visits, +0.2 emergency department visits, and +1.6 prescription fills (all P <0.001) per year versus those without AOM, adjusting for demographics and medical comorbidities. Similarly, AOM was associated with an incremental increase in outpatient health care costs of $314 per child annually (P <0.001) and an increase of $17 in patient medication costs (P <0.001), but was not associated with an increase in total prescription expenses ($13, P = 0.766). The diagnosis of AOM confers a significant incremental health-care utilization burden on both patients and the health care system. With its high prevalence across the United States, pediatric AOM accounts for approximately $2.88 billion in added health care expense annually and is a significant health-care utilization concern. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

  19. The effect of testosterone and a nutritional supplement on hospital admissions in under-nourished, older people

    Directory of Open Access Journals (Sweden)

    Cameron Ian D

    2011-10-01

    Full Text Available Abstract Background Weight loss and under-nutrition are relatively common in older people, and are associated with poor outcomes including increased rates of hospital admissions and death. In a pilot study of 49 undernourished older, community dwelling people we found that daily treatment for one year with a combination of testosterone tablets and a nutritional supplement produced a significant reduction in hospitalizations. We propose a larger, multicentre study to explore and hopefully confirm this exciting, potentially important finding (NHMRC project grant number 627178. Methods/Design One year randomized control trial where subjects are allocated to either oral testosterone undecanoate and high calorie oral nutritional supplement or placebo medication and low calorie oral nutritional supplementation. 200 older community-dwelling, undernourished people [Mini Nutritional Assessment score 2: 7.5% over 3 months]. Hospital admissions, quality-adjusted life years, functional status, nutritional health, muscle strength, body composition and other variables will be assessed. Discussion The pilot study showed that combined treatment with an oral testosterone and a supplement drink was well tolerated and safe, and reduced the number of people hospitalised and duration of hospital admissions in undernourished, community dwelling older people. This is an exciting finding, as it identifies a treatment which may be of substantial benefit to many older people in our community. We now propose to conduct a multi-centre study to test these findings in a substantially larger subject group, and to determine the cost effectiveness of this treatment. Trial registration Australian Clinical Trial Registry: ACTRN 12610000356066

  20. Correlation between nutritional status and comprehensive physical performance measures among older adults with undernourishment in residential institutions

    Directory of Open Access Journals (Sweden)

    Singh DKA

    2014-08-01

    Full Text Available Devinder KA Singh,1 Zahara A Manaf,2 Noor Aini M Yusoff,3 Nur A Muhammad,2 Mei Fang Phan,1 Suzana Shahar2 1Physiotherapy Program, School of Rehabilitation Sciences, 2Nutrition and Dietetics Program, School of Health Care Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, 3ASIA Metropolitan University, Cheras, Malaysia Purpose: The consequences of combined undernourishment and decreased physical ­performance in older adults are debilitating and increases cost of care. To date, the information regarding the association between nutritional status and physical performance does not provide a complete picture. Most studies used limited or self-reported measures to evaluate physical performance. The objective of this study was to examine the correlation between nutritional status and comprehensive physical performance measures among undernourished older adults who reside in residential institutions.Methods: Forty-seven older adults (26 males, 21 females aged ≥60 (69.23±8.63 years who were identified as undernourished from two residential institutions participated in this study. A battery of physical performance tests (10 m gait speed test, dominant hand grip strength test, timed five-repetition sit-to-stand test, ten step test, arm curl test, scratch test, and respiratory muscle strength test, biochemical profiles (serum albumin, hemoglobin, serum ferritin, and prealbumin levels, and falls risk using the short-form Physiological Profile Approach were performed. The Functional Ability Questionnaire and Geriatric Depression Scale were also administered.Results: The results demonstrated that generally older adults with undernourishment scored poorly on the physical performance tests, had depression, and a high risk of falls. Biochemical results demonstrated that 10.9% of the participants were anemic, 63% had hypoalbuminemia (<3.5 g/dL, and 21.7% were at risk of protein energy malnutrition with prealbumin level (100–170 mg/L. A significant

  1. Children's orthodontic utilization in the United States: Socioeconomic and surveillance considerations.

    Science.gov (United States)

    Laniado, Nadia; Oliva, Stephanie; Matthews, Gregory J

    2017-11-01

    There has been no epidemiologic study of malocclusion prevalence and treatment need in the United States since the Third National Health and Nutrition Examination Survey, conducted from 1988 to 1991. In this descriptive study, the authors sought to estimate orthodontic treatment prevalence by examining a nationally representative survey to assess current pediatric dental and orthodontic utilization. The 2009 and 2013 Medical Expenditure Panel Surveys were used to categorize and compare all types of pediatric dental and orthodontic procedures in children and adolescents up to 20 years old. Descriptive variables included dental insurance, poverty level, and racial/ethnic background. Visits for orthodontic procedures constituted the third largest treatment category (14.5%) and were greatest among the uninsured and higher income populations. Children with public insurance had the fewest orthodontic visits (9.4%). Racial/ethnic disparities were most pronounced among orthodontic visits, with black and Hispanic children receiving the fewest orthodontic procedures (8.89% and 10.56%, respectively). Orthodontic treatment prevalence data suggest that significant disparities exist in orthodontic utilization based on race/ethnicity, poverty level, and insurance status. To establish the burden of malocclusion, describe populations in greatest need of interventions, and craft appropriate programs and policies, an active orthodontic surveillance system is essential. Copyright © 2017 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

  2. Potential utility of MRI in the evaluation of children at risk of renal scarring

    International Nuclear Information System (INIS)

    Chan Yuleung; Chan Kamwing; Roebuck, D.J.; Chu, W.C.W.; Metreweli, C.; Yeung Chungkwong; Lee Kimhung

    1999-01-01

    Background. Gadolinium-enhanced MRI has recently been employed in the diagnosis of acute pyelonephritis. Its potential utility in the diagnosis of renal scars in children is unknown. Objective. To evaluate the potential utility of MRI using fat-saturated T1-weighted (T1-W) and post-gadolinium, short-tau inversion-recovery (STIR) sequences in detecting renal scarring by comparison with technetium dimercaptosuccinic acid ( 99 m Tc-DMSA) renal scintigraphy in children at risk of renal scarring. Materials and methods. A group of 24 children with spina bifida and neurogenic bladder or anorectal anomaly was studied. No patient had a history of acute pyelonephritis. Documented urinary tract infection (UTI) was present in 10 children (42 %). The remaining 14 (58 %) children had a history of asymptomatic bacteriuria. None had clinical signs or symptoms of acute UTI at the time of the study. 99 m Tc-DMSA and MRI were performed to detect renal scarring. 99 m Tc-DMSA scans were supplemented with pinhole imaging. MRI of the kidneys employed a fat-saturated T1-W sequence and a post-gadolinium STIR sequence employing a short echo time. Results. Of the kidneys studied, 33 % (n = 16) had evidence of a renal parenchymal defect suggestive of scarring on 99 m Tc-DMSA. The concordance in the detection of a scarred kidney by post-gadolinium STIR sequence and 99 m Tc-DMSA is 94 %; that by fat-saturated T1-W sequence and 99 m Tc-DMSA is 82 %; that by both sequences (positive result on either sequence) and 99 m Tc-DMSA is 100 %. Using 99 m Tc-DMSA as the gold standard, MRI had a sensitivity of 100 % and a specificity of 78 % in the diagnosis of a scarred kidney. The concordance in the detection of a scarred zone by post-gadolinium STIR sequence and 99 m Tc-DMSA is 68 %; that by fat-saturated T1-W sequence and DMSA is 44 %; that by both sequences (positive result on either sequence) and 99 m Tc-DMSA is 84 %. MRI had a sensitivity of 84 % and a specificity of 86 % in the diagnosis of a

  3. Health care access and utilization among children of single working and nonworking mothers in the United States.

    Science.gov (United States)

    Clarke, Tainya C; Arheart, Kristopher L; Muennig, Peter; Fleming, Lora E; Caban-Martinez, Alberto J; Dietz, Noella; Lee, David J

    2011-01-01

    To examine indicators of health care access and utilization among children of working and nonworking single mothers in the United States, the authors used data on unmarried women participating in the 1997-2008 National Health Interview Survey who financially supported children under 18 years of age (n = 21,842). Stratified by maternal employment, the analyses assessed health care access and utilization for all children. Outcome variables included delayed care, unmet care, lack of prescription medication, no usual place of care, no well-child visit, and no doctor's visit. The analyses reveal that maternal employment status was not associated with health care access and utilization. The strongest predictors of low access/utilization included no health insurance and intermittent health insurance in the previous 12 months, relative to those with continuous private health insurance coverage (odds ratio ranges 3.2-13.5 and 1.3-10.3, respectively). Children with continuous public health insurance compared favorably with those having continuous private health insurance on three of six access/utilization indicators (odds ratio range 0.63-0.85). As these results show, health care access and utilization for the children of single mothers are not optimal. Passage of the U.S. Healthcare Reform Bill (HR 3590) will probably increase the number of children with health insurance and improve these indicators.

  4. Acute health care utilization and outcomes for outpatient-treated urinary tract infections in children.

    Science.gov (United States)

    Copp, Hillary L; Hanley, Janet; Saigal, Christopher S; Saperston, Kara

    2016-08-01

    The majority of urinary tract infections (UTIs) in children are treated in the ambulatory setting. The goal of this study is to describe the course of outpatient UTI management, including health services utilization, antibiotic switching (change from empirically prescribed antibiotic to another antibiotic), and antibiotic side effects. Using a large claims database, Truven Health MarketScan Research Database, we analyzed all children younger than 18 years old who had an antibiotic prescribed for an outpatient UTI from 2002 to 2010. We evaluated health services utilization and antibiotic switching in the 21-day period after UTI diagnosis. We compared side effects with rates in patients receiving narrow versus broad-spectrum antibiotic treatment. Chi-square analysis was used for descriptive statistics. We identified 242,819 outpatient, antibiotic-treated, UTI episodes. During the 21-day period after presentation, 26% required more than one visit for UTI management and children did not have imaging within 21 days of UTI: renal bladder ultrasound in 6%, VCUG in 2.6%, and DMSA in 0.05%. Broad-spectrum antibiotics were empirically prescribed to 34% of patients. Antibiotic switching occurred in only 8% of UTI episodes, indicating that empiric prescription covered the offending uropathogen the majority of the time. Antibiotic side effects occurred in 8% of UTI episodes. The most common side effects were gastrointestinal (∼3% of UTI episodes). All other side effects occurred in UTI episodes. Although there were statistically significant differences in side effects between broad- and narrow-spectrum antibiotics, these differences were not clinically relevant. Most outpatient UTIs in children do not require more than one healthcare visit, hospital admission, or change in empiric antibiotic therapy. This study supports the fact that pediatric UTIs can be effectively treated in the ambulatory setting. Copyright © 2016. Published by Elsevier Ltd.

  5. Failure to establish and maintain a pregnancy in undernourished recipient ewes is associated with a poor endocrine milieu in the early luteal phase.

    Science.gov (United States)

    de Brun, Victoria; Meikle, Ana; Fernández-Foren, Andrea; Forcada, Fernando; Palacín, Inmaculada; Menchaca, Alejo; Sosa, Cecilia; Abecia, José-Alfonso

    2016-10-01

    Embryos from undernourished and control donor ewes were transferred to undernourished and control recipient ewes. Progesterone and metabolic hormones were investigated in recipient ewes to determine their association with pregnancy success. Forty-five donor and 52 recipient Rasa Aragonesa ewes were fed 1.5 (control group; donor n=20; recipient n=25) or 0.5 (low group; donor n=25; recipient n=27) times the daily requirements for maintenance from the onset of estrous synchronization treatment to embryo collection and transfer. The embryos were collected 7days after the onset of estrus (day 0), and two good-quality embryos were transferred into each recipient ewe. The percentage of pregnant ewes on day 18 and 40 did not differ between the two groups, although the recipient undernourished ewes tended to have greater late embryonic mortality (from days 18-40) than the control recipient ewes (P=0.11). No effect of the nutrition of the donor was found. Recipients that became pregnant had a higher ovulation rate than non-pregnant ewes (P=0.02). Undernourished ewes had lower plasma insulin concentrations than control ewes (P=0.03), and those that suffered late embryo mortality (from days 18-40) tended to have lower insulin and progesterone concentrations than their counterparts that remained pregnant (P=0.06 and P=0.07, respectively). In this study, pregnancy in control and undernourished recipient ewes was not associated with the origin of the embryo (undernourished and control donors). In conclusion, failure to establish and maintain a pregnancy was associated with lower progesterone and insulin levels one week after estrus in recipient ewes. Copyright © 2016 Elsevier B.V. All rights reserved.

  6. The Predictive Utility of Narcissism among Children and Adolescents: Evidence for a Distinction between Adaptive and Maladaptive Narcissism

    Science.gov (United States)

    Barry, Christopher T.; Frick, Paul J.; Adler, Kristy K.; Grafeman, Sarah J.

    2007-01-01

    We examined the predictive utility of narcissism among a community sample of children and adolescents (N=98) longitudinally. Analyses focused on the differential utility between maladaptive and adaptive narcissism for predicting later delinquency. Maladaptive narcissism significantly predicted self-reported delinquency at one-, two-, and…

  7. Utility of positron emission tomography for tumour surveillance in children with neurofibromatosis type 1

    International Nuclear Information System (INIS)

    Moharir, Mahendranath; London, Kevin; Howman-Giles, Robert; North, Kathryn

    2010-01-01

    There is little consensus regarding optimal surveillance of optic pathway glioma (OPG) and plexiform neurofibroma (PNF) in childhood neurofibromatosis type 1 (NF1). 18 F-2-Fluoro-2-deoxy-D-glucose (FDG) positron emission tomography and computed tomography (PET/CT) is employed in the surveillance of adult PNFs; but its utility has neither been specifically studied in children with PNFs nor in children with OPG. Review of PET/CT studies was performed in NF1 children with OPG or PNF. FDG-avidity of tumours was semi-quantitatively analysed and graded by calculating the maximum standardised uptake value (SUV max ) [grade 1: 3- 4 (intense)]. Eighteen children (ten girls; median age: 8.5-years) had PET/CT. Nineteen OPGs were imaged. The SUV max could be measured in 16. Ten were grade 1 and three each were grade 2 and grade 3. FDG-avidity reduced from grade 3 to grade 1 in two symptomatic OPGs following chemotherapy and this was associated with clinical improvement. PET/CT diagnosed symptomatic OPGs with a sensitivity of 0.625 [95% confidence interval (CI): 0.259-0.897] and specificity of 0.875 (95% CI: 0.466-0.993). Sixteen PNFs were imaged. Twelve were grade 1 and two each were grade 2 and grade 3. The two grade 3 PNFs were confirmed malignant peripheral nerve sheath tumours. PET/CT diagnosed malignant transformation with a sensitivity of 1.0 (95% CI: 0.197-1.0) and specificity of 0.857 (95% CI: 0.561-0.974). PET/CT may contribute useful information to the surveillance of OPG in childhood NF1 - particularly to identify progressive, symptomatic tumours. As in adults, PET/CT is useful for the detection of malignant transformation in PNFs in children with NF1. (orig.)

  8. Utility of positron emission tomography for tumour surveillance in children with neurofibromatosis type 1

    Energy Technology Data Exchange (ETDEWEB)

    Moharir, Mahendranath [Hospital for Sick Children, Division of Neurology, Ontario (Canada); London, Kevin [Children' s Hospital at Westmead, Department of Nuclear Medicine, Sydney (Australia); Howman-Giles, Robert [University of Sydney, Discipline of Imaging, Faculty of Medicine, Sydney (Australia); North, Kathryn [Children' s Hospital at Westmead, Institute for Neuroscience and Muscle Research, Sydney, NSW (Australia)

    2010-07-15

    There is little consensus regarding optimal surveillance of optic pathway glioma (OPG) and plexiform neurofibroma (PNF) in childhood neurofibromatosis type 1 (NF1). {sup 18}F-2-Fluoro-2-deoxy-D-glucose (FDG) positron emission tomography and computed tomography (PET/CT) is employed in the surveillance of adult PNFs; but its utility has neither been specifically studied in children with PNFs nor in children with OPG. Review of PET/CT studies was performed in NF1 children with OPG or PNF. FDG-avidity of tumours was semi-quantitatively analysed and graded by calculating the maximum standardised uptake value (SUV{sub max}) [grade 1: <3 (low), grade 2: >3-<4 (intermediate), grade 3: >4 (intense)]. Eighteen children (ten girls; median age: 8.5-years) had PET/CT. Nineteen OPGs were imaged. The SUV{sub max} could be measured in 16. Ten were grade 1 and three each were grade 2 and grade 3. FDG-avidity reduced from grade 3 to grade 1 in two symptomatic OPGs following chemotherapy and this was associated with clinical improvement. PET/CT diagnosed symptomatic OPGs with a sensitivity of 0.625 [95% confidence interval (CI): 0.259-0.897] and specificity of 0.875 (95% CI: 0.466-0.993). Sixteen PNFs were imaged. Twelve were grade 1 and two each were grade 2 and grade 3. The two grade 3 PNFs were confirmed malignant peripheral nerve sheath tumours. PET/CT diagnosed malignant transformation with a sensitivity of 1.0 (95% CI: 0.197-1.0) and specificity of 0.857 (95% CI: 0.561-0.974). PET/CT may contribute useful information to the surveillance of OPG in childhood NF1 - particularly to identify progressive, symptomatic tumours. As in adults, PET/CT is useful for the detection of malignant transformation in PNFs in children with NF1. (orig.)

  9. Outcomes and healthcare utilization in children and young adults with aplastic anemia: A multiinstitutional analysis.

    Science.gov (United States)

    Gupta, Ashish; Fu, Pingfu; Hashem, Hasan; Vatsayan, Anant; Shein, Steven; Dalal, Jignesh

    2017-12-01

    Aplastic anemia is a bone marrow failure syndrome with high mortality affecting children and young adults. Although current treatment guidelines recommend hematopoietic stem cell transplant (HCT) for patients with matched sibling donors, outcomes with alternate donor options have been improving. We analyzed a validated multiinstitutional pediatric cohort using one of the largest pediatric and young adult database, the Pediatric Health Information System, for patients diagnosed with aplastic anemia (AA) from 2006 to 2015. Outcomes with upfront and salvage transplants were analyzed along with healthcare utilization. Among 2,169 patients in the study period, almost 20% underwent HCT, while others received immunosuppressive therapy. In a multivariate model, there was no significant difference in mortality with upfront or salvage transplants (odds ratio [OR] 1.24, 95% confidence interval [CI] 0.6-2.58, P = 0.567), while every platelet transfusion was associated with higher mortality (OR 1.37, 95% CI 1.12-1.67, P = 0.002). Healthcare utilization was significantly higher in salvage transplants requiring frequent hospitalization and transfusion requirements. Treatment mortality and graft failure rates were significantly reduced in the salvage transplant group in recent years (2011-2015 as compared to 2006-2010). As outcomes with HCT continue to improve in severe AA, transplant with good alternate donors should be considered upfront in children and young adults. © 2017 Wiley Periodicals, Inc.

  10. Contextual factors associated with health care service utilization for children with acute childhood illnesses in Nigeria.

    Directory of Open Access Journals (Sweden)

    Sulaimon T Adedokun

    Full Text Available To examine the independent contribution of individual, community and state-level factors to health care service utilization for children with acute childhood illnesses in Nigeria.The study was based on secondary analyses of cross-sectional population-based data from the 2013 Nigeria Demographic and Health Survey (DHS. Multilevel logistic regression models were applied to the data on 6,427 under-five children who used or did not use health care service when they were sick (level 1, nested within 896 communities (level 2 from 37 states (level 3.About one-quarter of the mothers were between 15 and 24 years old and almost half of them did not have formal education (47%. While only 30% of the children utilized health service when they were sick, close to 67% lived in the rural area. In the fully adjusted model, mothers with higher education attainment (Adjusted odds ratio [aOR] = 1.63; 95% credible interval [CrI] = 1.31-2.03, from rich households (aOR = 1.76; 95% CrI = 1.35-2.25, with access to media (radio, television or magazine (aOR = 1.18; 95% CrI = 1.08-1.29, and engaging in employment (aOR = 1.18; 95% CrI = 1.02-1.37 were significantly more likely to have used healthcare services for acute childhood illnesses. On the other hand, women who experienced difficulty getting to health facilities (aOR = 0.87; 95% CrI = 0.75-0.99 were less likely to have used health service for their children.Our findings highlight that utilization of healthcare service for acute childhood illnesses was influenced by not only maternal factors but also community-level factors, suggesting that public health strategies should recognise this complex web of individual composition and contextual composition factors to guide provision of healthcare services. Such interventions could include: increase in female school enrolment, provision of interest-free loans for small and medium scale enterprises, introduction of mobile clinics and establishment of more primary health care

  11. Mental Health Services Utilization and Expenditures Among Children Enrolled in Employer-Sponsored Health Plans.

    Science.gov (United States)

    Walter, Angela Wangari; Yuan, Yiyang; Cabral, Howard J

    2017-05-01

    Mental illness in children increases the risk of developing mental health disorders in adulthood, and reduces physical and emotional well-being across the life course. The Mental Health Parity and Addiction Equity Act (MHPAEA, 2008) aimed to improve access to mental health treatment by requiring employer-sponsored health plans to include insurance coverage for behavioral health services. Investigators used IBM Watson/Truven Analytics MarketScan claims data (2007-2013) to examine: (1) the distribution of mental illness; (2) trends in utilization and out-of-pocket expenditures; and (3) the overall effect of the MHPAEA on mental health services utilization and out-of-pocket expenditures among privately-insured children aged 3 to 17 with mental health disorders. Multivariate Poisson regression and linear regression modeling techniques were used. Mental health services use for outpatient behavioral health therapy (BHT) was higher in the years after the implementation of the MHPAEA (2010-2013). Specifically, before the MHPAEA implementation, the annual total visits for BHT provided by mental health physicians were 17.1% lower and 2.5% lower for BHT by mental health professionals, compared to years when MHPAEA was in effect. Children covered by consumer-driven and high-deductible plans had significantly higher out-of-pocket expenditures for BHT compared to those enrolled PPOs. Our findings demonstrate increased mental health services use and higher out-of-pocket costs per outpatient visit after implementation of the MHPAEA. As consumer-driven and high-deductible health plans continue to grow, enrollees need to be cognizant of the impact of health insurance benefit designs on health services offered in these plans. Copyright © 2017 by the American Academy of Pediatrics.

  12. Utilization of Preventive Health Care in Adults and Children With Eczema.

    Science.gov (United States)

    Strom, Mark A; Silverberg, Jonathan I

    2016-02-01

    Chronic disease is a barrier to delivery of preventive health care and health maintenance. However, health behaviors of adults and children with eczema, a chronic skin disorder, have not been examined. This study examined associations of eczema with vaccination, disease screening, health maintenance, and healthcare utilization. This study investigated 34,613 adults and 13,298 children from the 2012 National Health Interview Survey, a prospective questionnaire-based study. Data were analyzed between August 2014 and January 2015. Adult eczema was associated with higher odds of vaccination for tetanus (OR [95% CI]=1.37 [1.22, 1.54]); influenza (1.23 [1.10, 1.37]); hepatitis A (1.21 [1.04, 1.41]) and B (1.21 [1.07, 1.35]); human papilloma virus (1.66 [1.32, 2.08]); and pneumonia (1.35 [1.19, 1.54]), but not herpes zoster virus (1.07 [0.87, 1.31]). Adult eczema was associated with increased measurement of blood glucose (1.29 [1.16, 1.44]); cholesterol (1.19 [1.06, 1.34]); blood pressure (1.84 [1.56, 2.08]); and HIV infection (1.50 [1.34, 1.70]), but not Pap smears (1.11 [0.95, 1.30]); colon cancer screening (p=0.17); or mammograms (p=0.63). Adults with eczema were more likely to interact with general doctors, mid-level providers, mental health professionals, eye doctors, podiatrists, chiropractors, therapists, obstetrician/gynecologists, and other specialists (p≤0.01). Childhood eczema was associated with higher rates of vaccination for influenza (pEczema in adults and children is associated with greater utilization of preventive health care and health maintenance, but not cancer screening. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  13. Utility of a routine urinalysis in children who require clean intermittent catheterization.

    Science.gov (United States)

    Forster, C S; Haslam, D B; Jackson, E; Goldstein, S L

    2017-10-01

    Children who require clean intermittent catheterization (CIC) frequently have positive urine cultures. However, diagnosing a urinary tract infection (UTI) can be difficult, as there are no standardized criteria. Routine urinalysis (UA) has good predictive accuracy for UTI in the general pediatric population, but data are limited on the utility of routine UA in the population of children who require CIC. To determine the utility of UA parameters (e.g. leukocyte esterase, nitrites, and pyuria) to predict UTI in children who require CIC, and identify a composite UA that has maximal predictive accuracy for UTI. A cross-sectional study of 133 children who required CIC, and had a UA and urine culture sent as part of standard of care. Patients in the no-UTI group all had UA and urine cultures sent as part of routine urodynamics, and were asymptomatic. Patients included in the UTI group had growth of ≥50,000 colony-forming units/ml of a known uropathogen on urine culture, in addition to two or more of the following symptoms: fever, abdominal pain, back pain, foul-smelling urine, new or worse incontinence, and pain with catheterization. Categorical data were compared using Chi-squared test, and continuous data were compared with Student's t-test. Sensitivity, specificity, and positive and negative predictive values were calculated for individual UA parameters, as well as the composite UA. Logistic regression was performed on potential composite UA models to identify the model that best fit the data. There was a higher proportion of patients in the no-UTI group with negative leukocyte esterase compared with the UTI group. There was a higher proportion of patients with UTI who had large leukocyte esterase and positive nitrites compared with the no-UTI group (Summary Figure). There was no between-group difference in urinary white blood cells. Positive nitrites were the most specific (84.4%) for UTI. None of the parameters had a high positive predictive value, while all had

  14. Constipation-Related Health Care Utilization in Children Before and After Hospitalization for Constipation.

    Science.gov (United States)

    Stephens, John R; Steiner, Michael J; DeJong, Neal; Rodean, Jonathan; Hall, Matt; Richardson, Troy; Berry, Jay G

    2018-01-01

    We studied constipation-related health care among children before and after constipation admission. Index admissions for constipation in 2010-2011 were identified in the Truven Marketscan Database, which includes children receiving Medicaid in 10 states. We measured number of and spending for outpatient constipation visits 12 months before and after index hospitalizations. We also measured spending for constipation hospitalizations and rehospitalization rate. There were 780 index constipation admissions. The median number of outpatient constipation visits was 1 (interquartile range [IQR] = 0, 3) in the 12 months before and 2 (IQR [0, 4]) after admission ( P = .001). Median outpatient spending for constipation was $110 (IQR [0, 429]) before and $132 (IQR [0, 431]) after admission ( P = .2). Median spending for index constipation admissions was $5295 (IQR [2756, 8267]); 78 children (10%) were rehospitalized for constipation within 12 months. Constipation-related health care utilization increased after constipation admission. Median spending for one constipation admission was 50 times the median spending for 12 months of outpatient constipation visits.

  15. Resource utilization in children with tuberous sclerosis complex and associated seizures: a retrospective chart review study.

    Science.gov (United States)

    Lennert, Barb; Farrelly, Eileen; Sacco, Patricia; Pira, Geraldine; Frost, Michael

    2013-04-01

    Seizures are a hallmark manifestation of tuberous sclerosis complex, yet data characterizing resource utilization are lacking. This retrospective chart review was performed to assess the economic burden of tuberous sclerosis complex with neurologic manifestations. Demographic and resource utilization data were collected for 95 patients for up to 5 years after tuberous sclerosis complex diagnosis. Mean age at diagnosis was 3.1 years, with complex partial and infantile spasms as the most common seizure types. In the first 5 years post-diagnosis, 83.2% required hospitalization, 30.5% underwent surgery, and the majority of patients (90.5%) underwent ≥3 testing procedures. In 79 patients with a full 5 years of data, hospitalizations, intensive care unit stays, diagnostic testing, and rehabilitation services decreased over the 5-year period. Resource utilization is cost-intensive in children with tuberous sclerosis complex and associated seizures during the first few years following diagnosis. Improving seizure control and reducing health care costs in this population remain unmet needs.

  16. Health service utilization and access to medicines among Syrian refugee children in Jordan.

    Science.gov (United States)

    Doocy, Shannon; Lyles, Emily; Akhu-Zaheya, Laila; Burton, Ann; Weiss, William

    2016-01-01

    With over one million Syrian refugee children in the region, we undertook this study to characterize care-seeking behaviors and health service utilization for child refugees with the aim of informing humanitarian programming for non-camp settings in Jordan. A survey of Syrian refugees living outside of camps in Jordan was conducted using a 125 × 12 cluster design with probability proportional to size sampling to obtain a representative sample. The questionnaire focused on access to health services, including a module on care seeking for children. Care seeking was high with 90.9% of households with a child less than 18 years seeking medical care the last time it was needed. Households most often sought care for children in the public sector (54.6%), followed by private (36.5%) and charity sectors (8.9%). Among child care seekers, 88.6% were prescribed medication during the most recent visit, 90.6% of which obtained the medication. Overall, 49.4% of households reported out-of-pocket expenditures for either the consultation or prescribed medications at the most recent visit (mean $US21.1 and median $US0). Syrian refugees had good access to care for their sick children at the time of the survey; however, this has likely deteriorated since the survey because of the withdrawal of free access for refugees. The number of refugees in Jordan and relative accessibility of care has resulted in a large burden on the health system; the Jordanian government will require additional support if current levels of health access are to be maintained for Syrian refugees. © 2016 The Authors. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd.

  17. Potential utility of MRI in the evaluation of children at risk of renal scarring

    Energy Technology Data Exchange (ETDEWEB)

    Chan Yuleung; Chan Kamwing; Roebuck, D.J.; Chu, W.C.W.; Metreweli, C. [Dept. of Diagnostic Radiology and Organ Imaging, Chinese Univ. of Hong Kong, Shatin (China); Yeung Chungkwong; Lee Kimhung [Dept. of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong (China)

    1999-11-01

    Background. Gadolinium-enhanced MRI has recently been employed in the diagnosis of acute pyelonephritis. Its potential utility in the diagnosis of renal scars in children is unknown. Objective. To evaluate the potential utility of MRI using fat-saturated T1-weighted (T1-W) and post-gadolinium, short-tau inversion-recovery (STIR) sequences in detecting renal scarring by comparison with technetium dimercaptosuccinic acid ({sup 99} {sup m}Tc-DMSA) renal scintigraphy in children at risk of renal scarring. Materials and methods. A group of 24 children with spina bifida and neurogenic bladder or anorectal anomaly was studied. No patient had a history of acute pyelonephritis. Documented urinary tract infection (UTI) was present in 10 children (42 %). The remaining 14 (58 %) children had a history of asymptomatic bacteriuria. None had clinical signs or symptoms of acute UTI at the time of the study. {sup 99} {sup m}Tc-DMSA and MRI were performed to detect renal scarring. {sup 99} {sup m}Tc-DMSA scans were supplemented with pinhole imaging. MRI of the kidneys employed a fat-saturated T1-W sequence and a post-gadolinium STIR sequence employing a short echo time. Results. Of the kidneys studied, 33 % (n = 16) had evidence of a renal parenchymal defect suggestive of scarring on {sup 99} {sup m}Tc-DMSA. The concordance in the detection of a scarred kidney by post-gadolinium STIR sequence and {sup 99} {sup m}Tc-DMSA is 94 %; that by fat-saturated T1-W sequence and {sup 99} {sup m}Tc-DMSA is 82 %; that by both sequences (positive result on either sequence) and {sup 99} {sup m}Tc-DMSA is 100 %. Using {sup 99} {sup m}Tc-DMSA as the gold standard, MRI had a sensitivity of 100 % and a specificity of 78 % in the diagnosis of a scarred kidney. The concordance in the detection of a scarred zone by post-gadolinium STIR sequence and {sup 99} {sup m}Tc-DMSA is 68 %; that by fat-saturated T1-W sequence and DMSA is 44 %; that by both sequences (positive result on either sequence) and {sup 99

  18. Measuring growth in bilingual and monolingual children's english productive vocabulary development: the utility of combining parent and teacher report.

    Science.gov (United States)

    Vagh, Shaher Banu; Pan, Barbara Alexander; Mancilla-Martinez, Jeannette

    2009-01-01

    This longitudinal study examined growth in the English productive vocabularies of bilingual and monolingual children between ages 24 and 36 months and explored the utility and validity of supplementing parent reports with teacher reports to improve the estimation of children's vocabulary. Low-income, English-speaking and English/Spanish-speaking parents and Early Head Start and Head Start program teachers completed the MacArthur-Bates Communicative Development Inventory, Words and Sentences for 85 children. Results indicate faster growth rates for monolingual than for bilingual children and larger vocabularies for bilingual children who spoke mostly English than mostly Spanish at home. Parent-teacher composite reports, like parent reports, significantly related to children's directly assessed productive vocabulary at ages 30 and 36 months, but parent reports fit the model better. Implications for vocabulary assessment are discussed.

  19. Utility of large spot binocular indirect laser delivery for peripheral photocoagulation therapy in children.

    Science.gov (United States)

    Balasubramaniam, Saranya C; Mohney, Brian G; Bang, Genie M; Link, Thomas P; Pulido, Jose S

    2012-09-01

    The purpose of this article is to demonstrate the utility of the large spot size (LSS) setting using a binocular laser indirect delivery system for peripheral ablation in children. One patient with bilateral retinopathy of prematurity received photocoagulation with standard spot size burns placed adjacently to LSS burns. Using a pixel analysis program called Image J on the Retcam picture, the areas of each retinal spot size were determined in units of pixels, giving a standard spot range of 805 to 1294 pixels and LSS range of 1699 to 2311 pixels. Additionally, fluence was calculated using theoretical retinal areas produced by each spot size: the standard spot setting was 462 mJ/mm2 and the LSS setting was 104 mJ/mm2. For eyes with retinopathy of prematurity, our study shows that LSS laser indirect delivery halves the number of spots required for treatment and reduces fluence by almost one-quarter, producing more uniform spots.

  20. The difference in medical utilization and associated factors between children and adolescents with and without autism spectrum disorders.

    Science.gov (United States)

    Wu, Ching-Mien; Kung, Pei-Tseng; Li, Chia-Ing; Tsai, Wen-Chen

    2014-10-18

    This study determined differences in health care utilization and health care expenditures between children with and without autism spectrum disorder (ASD) and examined possible reasons for these differences. A retrospective longitudinal study of children aged younger than 18 years both with and without ASD was conducted using the 2008 database of the Ministry of the Interior registry of the disabled persons in tandem with the National Health Insurance Research Database. Propensity score matching for the covariates of age, sex, and parental monthly salary was used to match children at a ratio of 1:3 for observing health care utilization among children with and without ASD from 2008 to 2011. Generalized estimating equation analysis was performed to determine factors that affect health care utilization, such as physician visits, emergency room (ER) visits, hospitalizations, and health care expenditures. After matching was completed, the sample size comprised 3280 children with ASD and 9840 children without ASD. Among the children in the sample, most were boys (86.68%) between the ages of 6-11 years, and the average age of both samples was 9.8 years. After relevant factors were controlled for, the children with ASD yielded an average of 14.2 more annual physician visits and were more likely to visit the ER (OR=1.12, Pchildren without ASD. Compared with the children without ASD, the children with ASD exhibited higher annual physician visit expenditures (NT$26,580 more), higher ER visit expenditures (NT$50 more), higher hospitalization expenditures (NT$5830 more), and NT$32,460 more total health care expenditures (all Pchildren with ASD were age, parental monthly salary, and severity of comorbidity. The most common reasons for physician visits or hospitalizations among the children with ASD were psychiatric illnesses, respiratory illnesses, and digestive illnesses. The children without ASD most commonly experienced respiratory, digestive, and nervous system or sense

  1. Danish evidence-based clinical guideline for use of nutritional support in pulmonary rehabilitation of undernourished patients with stable COPD

    DEFF Research Database (Denmark)

    Beck, Anne Marie; Iepsen, Ulrik Winning; Topperup, Randi

    2015-01-01

    Background and aims Disease-related under-nutrition is a common problem in individuals with COPD. The rationale for nutritional support in pulmonary rehabilitation therefore seems obvious. However there is limited evidence regarding the patient-relevant outcomes i.e. activities of daily living (ADL......) or quality of life. Therefore the topic was included in The Danish Health and Medicines Authority's development of an evidence-based clinical guideline for rehabilitation of patients with stable COPD. Methods The methods were specified by The Danish Health and Medicines Authority as part of a standardized...... studies had been published. There were evidence of moderate quality that nutritional support for undernourished patients with COPD lead to a weight gain of 1.7 kg (95% confidence interval: 1.3 to 2.2 kg), but the effect was quantified as a mean change from baseline, which is less reliable. There were...

  2. Trends in the utilization of computed tomography and cardiac catheterization among children with congenital heart disease.

    Science.gov (United States)

    Yang, Justin Cheng-Ta; Lin, Ming-Tai; Jaw, Fu-Shan; Chen, Shyh-Jye; Wang, Jou-Kou; Shih, Tiffany Ting-Fang; Wu, Mei-Hwan; Li, Yiu-Wah

    2015-11-01

    Pediatric cardiac computed tomography (CT) is a noninvasive imaging modality used to clearly demonstrate the anatomical detail of congenital heart diseases. We investigated the impact of cardiac CT on the utilization of cardiac catheterization among children with congenital heart disease. The study sample consisted of 2648 cardiac CT and 3814 cardiac catheterization from 1999 to 2009 for congenital heart diseases. Diagnoses were categorized into 11 disease groups. The numbers of examination, according to the different modalities, were compared using temporal trend analyses. The estimated effective radiation doses (mSv) of CT and catheterization were calculated and compared. The number of CT scans and interventional catheterizations had a slight annual increase of 1.2% and 2.7%, respectively, whereas that of diagnostic catheterization decreased by 6.2% per year. Disease groups fell into two categories according to utilization trend differences between CT and diagnostic catheterization. The increased use of CT reduces the need for diagnostic catheterization in patients with atrioventricular connection disorder, coronary arterial disorder, great vessel disorder, septal disorder, tetralogy of Fallot, and ventriculoarterial connection disorder. Clinicians choose either catheterization or CT, or both examinations, depending on clinical conditions, in patients with semilunar valvular disorder, heterotaxy, myocardial disorder, pericardial disorder, and pulmonary vein disorder. The radiation dose of CT was lower than that of diagnostic cardiac catheterization in all age groups. The use of noninvasive CT in children with selected heart conditions might reduce the use of diagnostic cardiac catheterization. This may release time and facilities within the catheterization laboratory to meet the increasing demand for cardiac interventions. Copyright © 2014. Published by Elsevier B.V.

  3. Evaluation of protein undernourishment on the condylar process of the Wistar rat mandible correlation with insulin receptor expression

    Directory of Open Access Journals (Sweden)

    Marcelo Arthur CAVALLI

    2015-04-01

    Full Text Available The mandible condylar process cartilage (CP of Wistar rats is a secondary cartilage and acts as a mandibular growth site. This phenomenon depends on adequate proteins intake and hormone actions, including insulin. Objectives The present study evaluated the morphological aspects and the expression of the insulin receptor (IR in the cartilage of the condylar process (CP of rats subjected to protein undernourishment. Material and Methods The nourished group received a 20% casein diet, while the undernourished group (U received a 5% casein diet. The re-nourished groups, R and RR, were used to assess the effects of re-nutrition during puberty and adulthood, respectively. CPs were processed and stained with picro-sirius red, safranin-O and azocarmine. Scanning electron microscopy and immunohistochemistry were also performed. Results The area of the CP cartilage and the number of cells in the chondroblastic layer decreased in the U group, as did the thickness of the CP layer in the joint and hypertrophic layer. Renourishment during the pubertal stage, but not during the adult phase, restored these parameters. The cell number was restored when re-nutrition occurred in the pubertal stage, but not in the adult phase. The extracellular matrix also decreased in the U group, but was restored by re-nutrition during the pubertal stage and further increased in the adult phase. IR expression was observed in all CPs, being higher in the chondroblastic and hypertrophic cartilage layers. The lowest expression was found in the U and RR groups. Conclusions Protein malnutrition altered the cellularity, the area, and the fibrous cartilage complex, as well as the expression of the IRs.

  4. Low-dose CT colonography in children: initial experience, technical feasibility and utility

    International Nuclear Information System (INIS)

    Anupindi, Sudha; Perumpillichira, James; Zalis, Michael E.; Jaramillo, Diego; Israel, Esther J.

    2005-01-01

    CT colonography (CTC) is utilized as a diagnostic tool in the detection of colon polyps and early colorectal cancer in adults. Large studies in the literature, although focused on adult populations, have shown CTC to be a safe, accurate, non-invasive technique. We evaluated the technical feasibility of CTC in children using a low-dose technique. From November 2001 to April 2004 we evaluated eight patients (3-17 years) with non-contrast CTC. Seven of the patients had CTC, followed by standard colonoscopy (SC) the same day; in one patient, CTC followed a failed SC. CTC results were compared to results of SC. The estimated effective dose from each CTC was calculated and compared to that of standard barium enema. CTC results were consistent with those of SC. Sensitivity for polyps 5-10 mm was 100%, and sensitivity for polyps 10 mm and larger was 66.7%. The estimated mean effective dose was 2.17 mSv for CTC, compared to the 5-6 mSv for a standard air-contrast barium enema in a small child. Our initial experience shows CTC in children is well-tolerated, safe, and useful. The procedure can be performed successfully with a low radiation dose, and preliminary results compare well with SC. (orig.)

  5. Pediatric cancer gone viral. Part I: strategies for utilizing oncolytic herpes simplex virus-1 in children

    Science.gov (United States)

    Cripe, Timothy P; Chen, Chun-Yu; Denton, Nicholas L; Haworth, Kellie B; Hutzen, Brian; Leddon, Jennifer L; Streby, Keri A; Wang, Pin-Yi; Markert, James M; Waters, Alicia M; Gillespie, George Yancey; Beierle, Elizabeth A; Friedman, Gregory K

    2015-01-01

    Progress for improving outcomes in pediatric patients with solid tumors remains slow. In addition, currently available therapies are fraught with numerous side effects, often causing significant life-long morbidity for long-term survivors. The use of viruses to kill tumor cells based on their increased vulnerability to infection is gaining traction, with several viruses moving through early and advanced phase clinical testing. The prospect of increased efficacy and decreased toxicity with these agents is thus attractive for pediatric cancer. In part I of this two-part review, we focus on strategies for utilizing oncolytic engineered herpes simplex virus (HSV) to target pediatric malignancies. We discuss mechanisms of action, routes of delivery, and the role of preexisting immunity on antitumor efficacy. Challenges to maximizing oncolytic HSV in children are examined, and we highlight how these may be overcome through various arming strategies. We review the preclinical and clinical evidence demonstrating safety of a variety of oncolytic HSVs. In Part II, we focus on the antitumor efficacy of oncolytic HSV in pediatric tumor types, pediatric clinical advances made to date, and future prospects for utilizing HSV in pediatric patients with solid tumors. PMID:26436135

  6. Pediatric cancer gone viral. Part I: strategies for utilizing oncolytic herpes simplex virus-1 in children

    Directory of Open Access Journals (Sweden)

    Timothy P Cripe

    Full Text Available Progress for improving outcomes in pediatric patients with solid tumors remains slow. In addition, currently available therapies are fraught with numerous side effects, often causing significant life-long morbidity for long-term survivors. The use of viruses to kill tumor cells based on their increased vulnerability to infection is gaining traction, with several viruses moving through early and advanced phase clinical testing. The prospect of increased efficacy and decreased toxicity with these agents is thus attractive for pediatric cancer. In part I of this two-part review, we focus on strategies for utilizing oncolytic engineered herpes simplex virus (HSV to target pediatric malignancies. We discuss mechanisms of action, routes of delivery, and the role of preexisting immunity on antitumor efficacy. Challenges to maximizing oncolytic HSV in children are examined, and we highlight how these may be overcome through various arming strategies. We review the preclinical and clinical evidence demonstrating safety of a variety of oncolytic HSVs. In Part II, we focus on the antitumor efficacy of oncolytic HSV in pediatric tumor types, pediatric clinical advances made to date, and future prospects for utilizing HSV in pediatric patients with solid tumors.

  7. Utilization of free dental health care services provided to the perinatally infected human immunodeficiency virus children in Bangalore: Longitudinal study

    OpenAIRE

    Beena Javaregowda Parvathy

    2014-01-01

    Background: Use of Highly active anti-retroviral therapy have increased the life expectancy of human immunodeficiency virus (HIV) infected patients and hence it is imperative that all efforts have to be made by Pediatric dentists to provide a better oral health for these children. Aim: The aim of this study was to evaluate the rate of utilization of free dental treatment provided to these perinatally infected HIV positive children who were previously screened as a part of oral health survey. ...

  8. User-fee-removal improves equity of children's health care utilization and reduces families' financial burden: evidence from Jamaica.

    Science.gov (United States)

    Li, Zhihui; Li, Mingqiang; Fink, Günther; Bourne, Paul; Bärnighausen, Till; Atun, Rifat

    2017-06-01

    The impact of user-fee policies on the equity of health care utilization and households' financial burdens has remained largely unexplored in Latin American and the Caribbean, as well as in upper-middle-income countries. This paper assesses the short- and long-term impacts of Jamaica's user-fee-removal for children in 2007. This study utilizes 14 rounds of data from the Jamaica Survey of Living Conditions (JSLC) for the periods 1996 to 2012. JSLC is a national household survey, which collects data on health care utilization and among other purposes for planning. Interrupted time series (ITS) analysis was used to examine the immediate impact of the user-fee-removal policy on children's health care utilization and households' financial burdens, as well as the impact in the medium- to long-term. Immediately following the implementation of user-fee-removal, the odds of seeking for health care if the children fell ill in the past 4 weeks increased by 97% (odds ratio 2.0, 95% confidence interval (CI) 1.1 to 3.5, P  = 0.018). In the short-term (2007-2008), health care utilization increased at a faster rate among children not in poverty than children in poverty; while this gap narrowed after 2008. There was minimal difference in health care utilization across wealth groups in the medium- to long-term. The household's financial burden (health expenditure as a share of household's non-food expenditures) reduced by 6 percentage points (95% CI: -11 to -1, P  = 0.020) right after the policy was implemented and kept at a low level. The difference in financial burden between children in poverty and children not in poverty shrunk rapidly after 2007 and remained small in subsequent years. User-fee-removal had a positive impact on promoting health care utilization among children and reducing their household health expenditures in Jamaica. The short-term and the medium- to long-term results have different indications: In the short-term, the policy deteriorated the equity of

  9. Utilization of Integrated Child Development Services (ICDS Scheme by child beneficiaries in Coastal Karnataka, India

    Directory of Open Access Journals (Sweden)

    Saranya Sivanesan

    2016-06-01

    Full Text Available Background: India’s main early childhood development intervention the ICDS Scheme has been sustained for 40 years and has been successful in some ways. However, nearly half of the children under six years are still under nourished. The program in reducing the proportion of undernourished children over the past decade has been modest and slower in India than what has been achieved in other countries with comparable socio-economic indicators. Aims & Objectives: 1. To study the utilization of services offered to children under ICDS, 2. To assess the perception about the services. Materials & Methods: A community based cross sectional study was done among mothers of 271 children in the age group three to six years registered in anganwadis. Results: Median duration of absenteeism to anganwadi was five months during the last six months enquired. About 95.9% of registered child beneficiaries utilized supplementary nutrition services and only 48.7% mothers of child beneficiaries were attending nutrition and health education sessions. Among mothers who were aware of growth monitoring, only 73.6% of their children’s weight was checked regularly.  About 60% of mothers were not happy with the quality of food served to their children in the anganwadi. Among children adherent to anganwadi, 72.5% children’s weight remained normal. Conclusion: Only 75% children were regularly attending. Median duration of adherence to anganwadi services was only 12 months and the most common reason for not adhering to the services is due to their simultaneous enrollment in other private nursery school.

  10. Patterns of hospital resource utilization of children with leukemia and CNS tumors: a comparison of children who survive and those who die within 3 years of diagnosis.

    Science.gov (United States)

    Hendrickson, Karrie Cummings; Rimar, Joan

    2009-01-01

    Hospital admissions for children with cancer tend to be longer than admissions for adults with cancer and longer, more frequent, and more costly than other pediatric admissions. The two childhood cancers most commonly requiring hospitalization are leukemia and tumors of the central nervous system (CNS tumors). Determining the best use of limited financial resources and preparing children and their parents for what to expect requires a better understanding of the patterns and cost of hospital resource utilization by children with cancer. Both hospital administrators and third-party payers can use this understanding to better allocate resources and plan the care of children with cancer in the future. Because many parents of children with cancer struggle financially due to the high cost of treatments, time off of work, and other non-medical expenses, more education in this area may help parents to prepare, thus alleviating some of the uncertainty and unexpected financial costs associated with childhood cancer.

  11. Utility of the serum C-reactive protein for detection of occult bacterial infection in children.

    Science.gov (United States)

    Isaacman, Daniel J; Burke, Bonnie L

    2002-09-01

    To assess the utility of serum C-reactive protein (CRP) as a screen for occult bacterial infection in children. Febrile children ages 3 to 36 months who visited an urban children's hospital emergency department and received a complete blood cell count and blood culture as part of their evaluation were prospectively enrolled from February 2, 2000, through May 30, 2001. Informed consent was obtained for the withdrawal of an additional 1-mL aliquot of blood for use in CRP evaluation. Logistic regression and receiver operator characteristic (ROC) curves were modeled for each predictor to identify optimal test values, and were compared using likelihood ratio tests. Two hundred fifty-six patients were included in the analysis, with a median age of 15.3 months (range, 3.1-35.2 months) and median temperature at triage 40.0 degrees C (range, 39.0 degrees C-41.3 degrees C). Twenty-nine (11.3%) cases of occult bacterial infection (OBI) were identified, including 17 cases of pneumonia, 9 cases of urinary tract infection, and 3 cases of bacteremia. The median white blood cell count in this data set was 12.9 x 10(3)/ micro L [corrected] (range, 3.6-39.1 x10(3)/ micro L) [corrected], the median absolute neutrophil count (ANC) was 7.12 x 10(3)/L [corrected] (range, 0.56-28.16 x10(3)/L) [corrected], and the median CRP level was 1.7 mg/dL (range, 0.2-43.3 mg/dL). The optimal cut-off point for CRP in this data set (4.4 mg/dL) achieved a sensitivity of 63% and a specificity of 81% for detection of OBI in this population. Comparing models using cut-off values from individual laboratory predictors (ANC, white blood cell count, and CRP) that maximized sensitivity and specificity revealed that a model using an ANC of 10.6 x10(3)/L [corrected] (sensitivity, 69%; specificity, 79%) was the best predictive model. Adding CRP to the model insignificantly increased sensitivity to 79%, while significantly decreasing specificity to 50%. Active monitoring of emergency department blood cultures

  12. Variables associated with emergency department and/or unplanned hospital utilization for children with epilepsy.

    Science.gov (United States)

    Patel, Anup D

    2014-02-01

    In the United States, approximately one million people are evaluated annually in an emergency department (ED) for the diagnosis of a seizure or epilepsy. The highest percentages of these patients are less than five years of age. No studies have been performed on assessing potential variables associated with recurrent ED visits and/or unplanned hospitalizations for children with epilepsy. Institutional review board approval from Nationwide Children's Hospital was obtained prior to study initiation. An accountable care organization (ACO), Partner for Kids (PFK), database was searched for patients with the highest and the lowest number of ED visits and/or unplanned hospitalizations from 2007 through 2011 using ICD-9 codes of 345.xx and 780.39. The patients were stratified into a high and a low utilizer group. The total number of visits and their associated health care costs were noted for each patient. In total, 120 patients were included for review. Information on the total number of no-shows to outpatient neurology clinic visits and telephone calls to neurology triage nursing was noted. A chart review was performed by a pediatric epileptologist to determine if each individual patient was an appropriate candidate for an emergency seizure treatment. The dose of emergency seizure medication was cross-checked to the patient's actual dose during the time of ED or hospital presentation to determine if the dose given was high, low, or accurate based on dosing recommendations. Multivariable logistic regression was used to test the effects of factors. When controlling for other factors, patients who were given an incorrect or no emergency seizure dosing had a high probability of having multiple ED visits/unplanned hospitalizations compared with patients who were given correct dosing (odds ratio=11.28, 95% CI of odds ratio=(2.42, 52.63), p valuechildren with epilepsy. Copyright © 2013 Elsevier Inc. All rights reserved.

  13. Utility of screening questionnaire and polysomnography to predict postoperative outcomes in children.

    Science.gov (United States)

    Kako, Hiromi; Tripi, Jennifer; Walia, Hina; Tumin, Dmitry; Splaingard, Mark; Jatana, Kris R; Tobias, Joseph D; Raman, Vidya T

    2017-11-01

    The prevalence of pediatric obstructive sleep apnea (OSA) has increased concurrently with the increasing prevalence of obesity. We have previously validated a short questionnaire predicting the occurrence of OSA on polysomnography (PSG). This follow-up study assessed the utility of the questionnaire in predicting postoperative outcomes. Children undergoing surgery and completing a sleep study were prospectively screened for OSA using a short questionnaire. Procedures within 1 year of PSG were included in the analysis. Questionnaires were scored according to a cutoff previously deemed optimal for predicting OSA (apnea-hypopnea index ≥ 5) on the sleep study. Postoperative outcomes included prolonged (>60 min) length of stay (LOS) in the post-anesthesia care unit (PACU) and oxygen requirement in the PACU. The study cohort included 185 patients (100/85 male/female) age 8 ± 4 years, undergoing adenotonsillectomy (n = 109), other ear, nose, and throat (ENT) procedures (n = 18), or non-ENT procedures (n = 58). There were 45 patients with OSA documented by PSG and 122 patients identified as likely to have OSA according to questionnaire responses (89% sensitivity, 41% specificity). PACU LOS was prolonged in 55/181 (30%) cases and supplemental oxygen was used in the PACU in 29/181 (16%) cases. In separate multivariable models, supplemental oxygen use in the PACU was more common if a patient scored ≥2/6 points on the short questionnaire scale (OR = 5.0; 95% CI: 1.3, 19.9; p = 0.023) or if the patient was diagnosed with OSA on PSG (OR = 4.6; 95% CI: 1.6, 13.5; p = 0.005). Neither OSA on PSG nor questionnaire score ≥2/6 were associated with prolonged PACU stay. Both OSA diagnosis based on the AHI and the questionnaire scale achieved comparable predictive value for the need for oxygen use in the PACU. The utility of the questionnaire in predicting rare adverse events (e.g., unplanned admission or rapid response team activation) remains to be determined

  14. Service utilization by children with conduct disorders: findings from the 2004 Great Britain child mental health survey.

    Science.gov (United States)

    Shivram, Raghuram; Bankart, John; Meltzer, Howard; Ford, Tamsin; Vostanis, Panos; Goodman, Robert

    2009-09-01

    Children with conduct disorders (CD) and their families are in contact with multiple agencies, but there is limited evidence on their patterns of service utilization. The aim of this study was to establish the patterns, barriers and correlates of service use by analysing the cohort of the 2004 Great Britain child mental health survey (N = 7,977). Use of social services was significantly higher by children with CD than emotional disorders (ED) in the absence of co-morbidity, while use of specialist child mental health and paediatric was significantly higher by children with hyperkinetic disorders (HD) than CD. Children who had comorbid physical disorders used more primary healthcare services compared to those without physical disorders. Utilization of specialist child mental heath and social services was significantly higher among children with unsocialized CD than socialized CD and oppositional defiant disorders. Services utilization and its correlates varied with the type of service. Overall, specialist services use was associated with co-morbidity with learning disabilities, physical and psychiatric disorders. Several correlates of services use in CD appeared non-specific, i.e. associated with use of different services indicating the possibility of indiscriminate use of different types of services. The findings led to the conclusion that there is the need for effective organization and co-ordination of services, and clear care pathways. Involvement of specialist child mental health services should be requested in the presence of mental health co-morbidity.

  15. Social and emotional difficulties in children with ADHD and the impact on school attendance and healthcare utilization

    Directory of Open Access Journals (Sweden)

    Classi Peter

    2012-10-01

    Full Text Available Abstract Background The objective of this study was to examine the impact of co-occurring social and emotional difficulties on missed school days and healthcare utilization among children with attention deficit/hyperactivity disorder (ADHD. Methods Data were from the 2007 U.S. National Health Interview Survey (NHIS and were based on parental proxy responses to questions in the Sample Child Core, which includes questions on demographics, health, healthcare treatment, and social and emotional status as measured by questions about depression, anxiety, and phobias, as well as items from the brief version of the Strength and Difficulties Questionnaire (SDQ. Logistic regression was used to assess the association between co-occurring social and emotional difficulties with missed school days and healthcare utilization, adjusting for demographics. Results Of the 5896 children aged 6–17 years in the 2007 NHIS, 432 (7.3% had ADHD, based on parental report. Children with ADHD and comorbid depression, anxiety, or phobias had significantly greater odds of experiencing > 2 weeks of missed school days, ≥ 6 visits to a healthcare provider (HCP, and ≥ 2 visits to the ER, compared with ADHD children without those comorbidities (OR range: 2.1 to 10.4. Significantly greater odds of missed school days, HCP visits, and ER visits were also experienced by children with ADHD who were worried, unhappy/depressed, or having emotional difficulties as assessed by the SDQ, compared with ADHD children without those difficulties (OR range: 2.2 to 4.4. Conclusions In children with ADHD, the presence of social and emotional problems resulted in greater odds of missed school days and healthcare utilization. These findings should be viewed in light of the limited nature of the parent-report measures used to assess social and emotional problems.

  16. Assistive technology needs, functional difficulties, and services utilization and coordination of children with developmental disabilities in the United States.

    Science.gov (United States)

    Lin, Sue C; Gold, Robert S

    2018-01-01

    Assistive technology (AT) enhances the ability of individuals with disabilities to be fully engaged in activities at home, at school, and within their communities-especially for children with developmental disabilities (DD) with physical, sensory, learning, and/or communication impairments. The prevalence of children with DD in the United States has risen from 12.84% in 1997 to 15.04% in 2008. Thus, it is important to monitor the status of their AT needs, functional difficulties, services utilization, and coordination. Using data from the 2009-2010 National Survey on Children with Special Health Care Needs (NS-CSHCN), we conducted bivariate and multivariate statistical analysis, which found that 90% or more of parents of both children with DD and other CSHCN reported that their child's AT needs were met for vision, hearing, mobility, communication, and durable medical equipment; furthermore, children with DD had lower odds of AT needs met for vision and hearing and increased odds for meeting AT needs in mobility and communication. Our findings outline the current AT needs of children with DD nationally. Fulfilling these needs has the potential to engender positive lifelong effects on the child's disabilities, sense of independence, self-confidence, and productivity.

  17. A Cost-Utility Analysis of 5 Strategies for the Management of Acute Otitis Media in Children.

    Science.gov (United States)

    Shaikh, Nader; Dando, Emily E; Dunleavy, Mark L; Curran, Dorothy L; Martin, Judith M; Hoberman, Alejandro; Smith, Kenneth J

    2017-10-01

    To assess whether antimicrobial therapy in young children with acute otitis media reduces time to resolution of symptoms, overall symptom burden, and persistence of otoscopic evidence of infection. We used a cost-utility model to evaluate whether immediate antimicrobial treatment seems to be worthwhile, and if so, which antimicrobial agent is most cost effective. We compared the cost per quality-adjusted life-day of 5 treatment regimens in children younger than 2 years of age with acute otitis media: immediate amoxicillin/clavulanate, immediate amoxicillin, immediate cefdinir, watchful waiting, and delayed prescription (DP) for antibiotic. The 5 treatment regimens, listed in order from least effective to most effective were DP, watchful waiting, immediate cefdinir, immediate amoxicillin, and immediate amoxicillin/clavulanate. Listed in order from least costly to most costly, the regimens were DP, immediate amoxicillin, watchful waiting, immediate amoxicillin/clavulanate, and immediate cefdinir. The incremental cost-utility ratio of immediate amoxicillin compared with DP was $101.07 per quality-adjusted life-day gained. The incremental cost-utility ratio of immediate amoxicillin/clavulanate compared with amoxicillin was $2331.28 per quality-adjusted life-day gained. In children younger than 2 years of age with acute otitis media and no recent antibiotic exposure, immediate amoxicillin seems to be the most cost-effective initial treatment. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Utilization of Illustrations during Learning of Science Textbook Passages among Low- and High-Ability Children.

    Science.gov (United States)

    Hannus; Hyönä

    1999-04-01

    Effects of illustrations on learning authentic textbook materials were studied among 10-year-old elementary school children of high and low intellectual ability. Experiment 1 showed that the presence of illustrations improved learning of illustrated text content, but not that of nonillustrated text content. Comprehension scores were improved by the presence of illustrations for high-ability children, but not for low-ability children. In Experiment 2, children's eye movements were measured during learning of illustrated textbook passages to study how children divide their attention between text and illustrations. The results suggest that learning is heavily driven by the text and that children inspect illustrations only minimally. High-ability students were more strategic in processing in the sense that they spent relatively more time on pertinent segments of text and illustrations. It is concluded that the learning of illustrated science textbook materials involves requirements that may be more readily met by more intellectually capable students. Copyright 1999 Academic Press.

  19. The Role of Strategy Utility Knowledge in Children's Strategy Decision Making.

    Science.gov (United States)

    Pressley, Michael; And Others

    1984-01-01

    Ten- to thirteen-year-old children selected either the objectively more effective keyword method or the naturalistic context method for learning vocabulary meanings. Concludes that, even in the absence of explicit performance feedback, children can be induced to reflect on their use of strategies and their outcomes on subsequent cognitive actions.…

  20. Gestational Undernourishment Modifies the Composition of Skeletal Muscle Transverse Tubule Membranes and the Mechanical Properties of Muscles in Newborn Rats

    Directory of Open Access Journals (Sweden)

    Ricardo Tonathiu Ramírez-Oseguera

    2013-10-01

    Full Text Available Backgroud/Aims: Skeletal muscle (SM constitutes more than 40% of the body weight in adulthood. Transports dietary glucose mainly through the insulin-dependent glucose transporter (Glut-4 located in the Transverse tubule membrane system (TT. The TT development ends shortly after birth. The TT membrane hosts the proteins involved in excitation-contraction coupling and glucose uptake. Glycaemic regulation through movement is a key function of fully developed skeletal muscle. In this study, we aimed to characterize the effect of gestational undernourishment (GUN in rats GLUT-4 expression and on the protein/lipid content of the TT membranes. We also examined the effect of GUN on the mechanical properties of muscles as an indication of the metabolic condition of the SM at birth. Methods: Isolated TT membrane from SM of GUN rats were used to study lipid/protein content and protein stability by differential scanning calorimetry. The effect of GUN on the SM mechanical properties was determined in isolated Extensor Digitorum Longus (EDL muscle. Results: We demonstrate that compared to control, GUN in the new-born produces; i decreases body weight; ii diminution in SM mass; iii decreases the formation of TT membranes; iv expresses TT membrane proteins with higher thermal stability. The TT membrane expression of GLUT-4 in GUN offspring was twice that of controls. The isolated EDL of GUN offspring was 20% stronger as measured by contractile force and more resistant to fatigue relative to controls. Conclusion; These results provide the first evidence of adaptive changes of the SM in new-borns exposed to severe gestational food restriction. The effects of GUN on muscle at birth are the first step toward detrimental SM metabolic function, contributing to the physiopathology of metabolic diseases in adulthood.

  1. Gestational undernourishment modifies the composition of skeletal muscle transverse tubule membranes and the mechanical properties of muscles in newborn rats.

    Science.gov (United States)

    Ramírez-Oseguera, Ricardo Tonathiu; Jiménez-Garduño, Aura Matilde; Alvarez, Rocío; Heine, Katharina; Pinzón-Estrada, Enrique; Torres-Saldaña, Ismael; Ortega, Alicia

    2013-01-01

    [corrected] Skeletal muscle (SM) constitutes more than 40% of the body weight in adulthood. Transports dietary glucose mainly through the insulin-dependent glucose transporter (Glut-4) located in the Transverse tubule membrane system (TT). The TT development ends shortly after birth. The TT membrane hosts the proteins involved in excitation-contraction coupling and glucose uptake. Glycaemic regulation through movement is a key function of fully developed skeletal muscle. In this study, we aimed to characterize the effect of gestational undernourishment (GUN) in rats GLUT-4 expression and on the protein/lipid content of the TT membranes. We also examined the effect of GUN on the mechanical properties of muscles as an indication of the metabolic condition of the SM at birth. Isolated TT membrane from SM of GUN rats were used to study lipid/protein content and protein stability by differential scanning calorimetry. The effect of GUN on the SM mechanical properties was determined in isolated Extensor Digitorum Longus (EDL) muscle. We demonstrate that compared to control, GUN in the new-born produces; i) decreases body weight; ii) diminution in SM mass; iii) decreases the formation of TT membranes; iv) expresses TT membrane proteins with higher thermal stability. The TT membrane expression of GLUT-4 in GUN offspring was twice that of controls. The isolated EDL of GUN offspring was 20% stronger as measured by contractile force and more resistant to fatigue relative to controls. These results provide the first evidence of adaptive changes of the SM in new-borns exposed to severe gestational food restriction. The effects of GUN on muscle at birth are the first step toward detrimental SM metabolic function, contributing to the physiopathology of metabolic diseases in adulthood. © 2013 S. Karger AG, Basel

  2. Utilization of free dental health care services provided to the perinatally infected human immunodeficiency virus children in Bangalore: longitudinal study.

    Science.gov (United States)

    Parvathy, Beena Javaregowda

    2014-01-01

    Use of Highly active anti-retroviral therapy have increased the life expectancy of human immunodeficiency virus (HIV) infected patients and hence it is imperative that all efforts have to be made by Pediatric dentists to provide a better oral health for these children. The aim of this study was to evaluate the rate of utilization of free dental treatment provided to these perinatally infected HIV positive children who were previously screened as a part of oral health survey. Purposive sampling was used. Perinatally infected HIV children screened for oral health status. Patients not screened during the oral health survey. Attendance records of 319 perinatally HIV infected children consisting of 178 males and 141 females attending a specialized pediatric outpatient clinic at Indira Gandhi Institute of Child Health were examined to compare treatment compliance rates. The number of patients in the severe category who completed treatment was significantly less compared with mild and advanced categories (P 0.05). The results show that children with HIV have significantly lower compliance. Even though all dental treatment provided to them was free of the cost it still had no impetus to encourage them to go through with the treatment.

  3. Utilization of free dental health care services provided to the perinatally infected human immunodeficiency virus children in Bangalore: Longitudinal study

    Directory of Open Access Journals (Sweden)

    Beena Javaregowda Parvathy

    2014-01-01

    Full Text Available Background: Use of Highly active anti-retroviral therapy have increased the life expectancy of human immunodeficiency virus (HIV infected patients and hence it is imperative that all efforts have to be made by Pediatric dentists to provide a better oral health for these children. Aim: The aim of this study was to evaluate the rate of utilization of free dental treatment provided to these perinatally infected HIV positive children who were previously screened as a part of oral health survey. Design: Purposive sampling was used. Inclusion criteria: Perinatally infected HIV children screened for oral health status. Exclusion criteria: Patients not screened during the oral health survey. Materials and Methods: Attendance records of 319 perinatally HIV infected children consisting of 178 males and 141 females attending a specialized pediatric outpatient clinic at Indira Gandhi Institute of Child Health were examined to compare treatment compliance rates. Results: The number of patients in the severe category who completed treatment was significantly less compared with mild and advanced categories (P 0.05. Conclusion: The results show that children with HIV have significantly lower compliance. Even though all dental treatment provided to them was free of the cost it still had no impetus to encourage them to go through with the treatment.

  4. Children with mental versus physical health problems: differences in perceived disease severity, health care service utilization and parental health literacy.

    Science.gov (United States)

    Dey, Michelle; Wang, Jen; Jorm, Anthony Francis; Mohler-Kuo, Meichun

    2015-03-01

    To compare children with mental and physical health problems regarding (1) perceived disease severity; (2) the impact of their condition on their families; (3) their utilization of health care services (including satisfaction with care); and (4) parents' health literacy about their child's condition and its treatment. Furthermore, we examined whether parents' health literacy differs between types of mental health condition. Parental reports about their 9- to 14-year-old children with mental (n = 785) or physical health problems (n = 475) were analyzed from the population-based National Survey of Children with Special Health Care Needs in Switzerland. Mental health problems were perceived as being more severe (p mental health problem mentioned having a particular person or place to contact if they needed information or advice regarding the child's condition (p = 0.004) and were satisfied with the health care services their child received (p mental health problems vs. parents of children with physical health problems (OR in the adjusted model = 1.92; 95 % CI 1.47-2.50; p mental health problem (although only a trend was observable for internalizing problems). The large impact of children's mental health conditions on themselves and their families might be reduced by adapting the provision of health care and by increasing parents' health literacy.

  5. The Diagnostic Utility of Behavioral Checklists in Identifying Children with ADHD and Children with Working Memory Deficits

    Science.gov (United States)

    Alloway, Tracy Packiam; Gathercole, Susan E.; Holmes, Joni; Place, Maurice; Elliott, Julian G.; Hilton, Kerry

    2009-01-01

    The present study investigated whether children with ADHD and those with working memory impairments have a common behavioral profile in the classroom. Three teacher checklists were used: the Conners' teacher rating scale (CTRS), the behavior rating inventory of executive function (BRIEF), and the working memory rating scale. The Conners'…

  6. Trends in the utilization of computed tomography and cardiac catheterization among children with congenital heart disease

    Directory of Open Access Journals (Sweden)

    Justin Cheng-Ta Yang

    2015-11-01

    Conclusion: The use of noninvasive CT in children with selected heart conditions might reduce the use of diagnostic cardiac catheterization. This may release time and facilities within the catheterization laboratory to meet the increasing demand for cardiac interventions.

  7. Validation and clinical utility of a bowel habit questionnaire in school-age children.

    Science.gov (United States)

    Wald, Ellen R; Jagodzinski, Tanya D; Moyer, Stacey C L; Wald, Arnold; Eickhoff, Jens C; Edmonson, M Bruce

    2011-11-01

    The aim of the study was to validate a brief Bowel Habit Questionnaire (BHQ) with prospectively obtained data from a 14-day diary and to determine whether the BHQ predicts the development of medically significant constipation (MSC) during the following year. The BHQ was distributed to parents of children ages 5 to 8 years during health supervision visits. Both the BHQ and subsequent diary were scored to indicate constipation if at least 2 of the following were reported: infrequent bowel movements, stool accidents, straining, avoidance, discomfort with defecation, or passing large stools >25% of the time. One year later, the BHQ was repeated to assess for MSC, defined as medical encounters about constipation or use of enemas, suppositories, laxatives, or stool softeners. MSC was reported for 57 (13.7%) of 416 children on the first BHQ. Paired BHQ and diary data were obtained for 269 children; 54 (20.1%) had diary scores indicating constipation. BHQ had a sensitivity of 59.6% (95% confidence interval [CI] 46.7%-71.4%) and a specificity of 82.6% (95% CI 77.0%-87.1%). One year later, 11 children (5.2%) had developed new-onset MSC; 7 (63.6%) of these children had initial BHQ scores of at least 2. Positive and negative predictive values for MSC were 19.4% (95% CI 9.8%-35.0%) and 97.7% (94.2%-99.1%), respectively. Parents often do not recognize constipation in young school-age children and most constipated children remain untreated. A brief screening questionnaire in this population proved to be valid but only moderately sensitive; efforts to improve sensitivity are needed before recommending it for routine use.

  8. Differences in utilization of dental procedures by children enrolled in Wisconsin Medicaid and Delta Dental insurance plans.

    Science.gov (United States)

    Bhagavatula, Pradeep; Xiang, Qun; Szabo, Aniko; Eichmiller, Fredrick; Okunseri, Christopher

    2017-12-01

    Few studies have directly compared dental procedures provided in public and private insurance plans for enrollees living in dental health professional shortage areas (DHPSAs). We examined the rates for the different types of dental procedures received by 0-18-year-old children living in DHPSAs and non-DHPSAs who were enrolled in Medicaid and those enrolled under Delta Dental of Wisconsin (DDW) for years 2002 to 2008. Medicaid and DDW dental claims data for 2002 to 2008 was analyzed. Enrollees were divided into DDW-DHPSA and non-DHPSA and Medicaid-DHPSA and non-DHPSA groups. Descriptive and multivariable analyses using over-dispersed Poisson regression were performed to examine the effect of living in DHPSAs and insurance type in relation to the number of procedures received. Approximately 49 and 65 percent of children living in non-DHPSAs that were enrolled in Medicaid and DDW received at least one preventive dental procedure annually, respectively. Children in DDW non-DHPSA group had 1.79 times as many preventive, 0.27 times fewer complex restorative and 0.51 times fewer endodontic procedures respectively, compared to those in Medicaid non-DHPSA group. Children enrolled in DDW-DHPSA group had 1.53 times as many preventive and 0.25 times fewer complex restorative procedures, compared to children in Medicaid-DHPSA group. DDW enrollees had significantly higher utilization rates for preventive procedures than children in Medicaid. There were significant differences across Medicaid and DDW between non-DHPSA and DHPSA for most dental procedures received by enrollees. © 2016 American Association of Public Health Dentistry.

  9. Utility of CT-compatible EEG electrodes in critically ill children

    International Nuclear Information System (INIS)

    Abend, Nicholas S.; Dlugos, Dennis J.; Zhu, Xiaowei; Schwartz, Erin S.

    2015-01-01

    Electroencephalographic monitoring is being used with increasing frequency in critically ill children who may require frequent and sometimes urgent brain CT scans. Standard metallic disk EEG electrodes commonly produce substantial imaging artifact, and they must be removed and later reapplied when CT scans are indicated. To determine whether conductive plastic electrodes caused artifact that limited CT interpretation. We describe a retrospective cohort of 13 consecutive critically ill children who underwent 17 CT scans with conductive plastic electrodes during 1 year. CT images were evaluated by a pediatric neuroradiologist for artifact presence, type and severity. All CT scans had excellent quality images without artifact that impaired CT interpretation except for one scan in which improper wire placement resulted in artifact. Conductive plastic electrodes do not cause artifact limiting CT scan interpretation and may be used in critically ill children to permit concurrent electroencephalographic monitoring and CT imaging. (orig.)

  10. Utility of CT-compatible EEG electrodes in critically ill children

    Energy Technology Data Exchange (ETDEWEB)

    Abend, Nicholas S. [Perelman School of Medicine at the University of Pennsylvania, Departments of Neurology and Pediatrics, The Children' s Hospital of Philadelphia, Philadelphia, PA (United States); CHOP Neurology, Philadelphia, PA (United States); Dlugos, Dennis J. [Perelman School of Medicine at the University of Pennsylvania, Departments of Neurology and Pediatrics, The Children' s Hospital of Philadelphia, Philadelphia, PA (United States); Zhu, Xiaowei; Schwartz, Erin S. [Perelman School of Medicine at the University of Pennsylvania, Department of Radiology, The Children' s Hospital of Philadelphia, Philadelphia, PA (United States)

    2015-05-01

    Electroencephalographic monitoring is being used with increasing frequency in critically ill children who may require frequent and sometimes urgent brain CT scans. Standard metallic disk EEG electrodes commonly produce substantial imaging artifact, and they must be removed and later reapplied when CT scans are indicated. To determine whether conductive plastic electrodes caused artifact that limited CT interpretation. We describe a retrospective cohort of 13 consecutive critically ill children who underwent 17 CT scans with conductive plastic electrodes during 1 year. CT images were evaluated by a pediatric neuroradiologist for artifact presence, type and severity. All CT scans had excellent quality images without artifact that impaired CT interpretation except for one scan in which improper wire placement resulted in artifact. Conductive plastic electrodes do not cause artifact limiting CT scan interpretation and may be used in critically ill children to permit concurrent electroencephalographic monitoring and CT imaging. (orig.)

  11. Growth patterns reflect response to antiretroviral therapy in HIV-positive infants: potential utility in resource-poor settings.

    Science.gov (United States)

    Benjamin, D K; Miller, W C; Ryder, R W; Weber, D J; Walter, E; McKinney, R E

    2004-01-01

    Laboratory monitoring of HIV-infected children is the current standard of care in the United States to guide the appropriate use of antiretroviral therapy (ART). Although ART is becoming a reality in some developing countries, laboratory monitoring of ART is costly, necessitating creative approaches to monitoring. As an initial step to guide monitoring of HIV progression in low resource settings, we assessed the utility of the physical examination to predict clinical progression of HIV. We conducted a retrospective cohort study of HIV-infected children using data from Pediatric AIDS Clinical Trials Group Protocol 300. We developed a clinical predictive model, and compared the utility of the clinical model to the change in HIV RNA viral load as diagnostic tests of ART failure. The clinical model incorporated treatment regimen, age, and height velocity: a three-level clinical predictive model provided likelihood ratios of 0.3, 3.9, and 14. For decline in RNA the likelihood ratios were 0.2 (> 1 log decline), 1.4, and 3.5 (> log increase). We developed a simple clinical predictive model that was able to predict clinical progression of HIV after initiation of new ART. The clinical model performed similarly to using changes in HIV RNA viral load. These data should be validated internationally and prospectively, because the test subjects were from a resource rich environment and growth patterns in undernourished children may be impacted differently by HIV and its treatment. The model was most pertinent to children 36 months of age or younger, and was conducted in children receiving monotherapy and dual therapy.

  12. Danish evidence-based clinical guideline for use of nutritional support in pulmonary rehabilitation of undernourished patients with stable COPD.

    Science.gov (United States)

    Beck, Anne Marie; Iepsen, Ulrik Winning; Tobberup, Randi; Jørgensen, Karsten Juhl

    2015-02-01

    Disease-related under-nutrition is a common problem in individuals with COPD. The rationale for nutritional support in pulmonary rehabilitation therefore seems obvious. However there is limited evidence regarding the patient-relevant outcomes i.e. activities of daily living (ADL) or quality of life. Therefore the topic was included in The Danish Health and Medicines Authority's development of an evidence-based clinical guideline for rehabilitation of patients with stable COPD. The methods were specified by The Danish Health and Medicines Authority as part of a standardized approach to evidence-based national clinical practice guidelines. They included formulation of a PICO with pre-defined criteria for the Population, Intervention, Control and Outcomes. Existing guidelines or systematic reviews were used after assessment using the AGREE II tool or AMSTAR, if possible. We identified primary studies by means of a systematic literature search (July to December 2013), and any identified studies were then quality assessed using the Cochrane risk of bias tool and the GRADE approach. The extracted data on our pre-defined outcomes were summarized in meta-analyses when possible, or meta-analyses from existing guidelines or systematic reviews were adapted. The results were used for labeling and wording of the recommendations. Data from 12 randomized controlled trials were included in a systematic review, which formed the basis for our recommendations as no new primary studies had been published. There were evidence of moderate quality that nutritional support for undernourished patients with COPD lead to a weight gain of 1.7kg (95% confidence interval: 1.3 to 2.2kg), but the effect was quantified as a mean change from baseline, which is less reliable. There were evidence of moderate quality that nutritional therapy does not increase in the 6 minute walking distance of 13 m (95% confidence interval: -27 to 54 m) when results in the intervention and control groups were

  13. The effect of health and dental insurance on US children's dental care utilization for urgent and non-urgent dental problems - 2008.

    Science.gov (United States)

    Naavaal, Shillpa; Barker, Laurie K; Griffin, Susan O

    2017-12-01

    We examined the association between utilization of care for a dental problem (utilization-DP) and parent-reported dental problem (DP) urgency among children with DP by type of health care insurance coverage. We used weighted 2008 National Health Interview Survey data from 2,834 children, aged 2-17 years with at least one DP within the 6 months preceding survey. Explanatory variables were selected based on Andersen's model of healthcare utilization. Need was considered urgent if DP included toothache, bleeding gums, broken or missing teeth, broken or missing filling, or decayed teeth and otherwise as non-urgent. The primary enabling variable, insurance, had four categories: none, private health no dental coverage (PHND), private health and dental (PHD), or Medicaid/State Children's Health Insurance Program (SCHIP). Predisposing variables included sociodemographic characteristics. We used bivariate and multivariate analyses to identify explanatory variables' association with utilization-DP. Using logistic regression, we obtained adjusted estimates of utilization-DP by urgency for each insurance category. In bivariate analyses, utilization-DP was associated with both insurance and urgency. In multivariate analyses, the difference in percent utilizing care for an urgent versus non-urgent DP among children covered by Medicaid/SCHIP was 32 percentage points; PHD, 25 percentage points; PHND, 12 percentage points; and no insurance, 14 percentage points. The difference in utilization by DP urgency was higher for children with Medicaid/SCHIP compared with either PHND or uninsured children. Expansion of Medicaid/SCHIP may permit children to receive care for urgent DPs who otherwise may not, due to lack of dental insurance. © 2016 American Association of Public Health Dentistry.

  14. Lower respiratory tract illness in young children: predictors of disease and health care utilization

    NARCIS (Netherlands)

    Jong, B.M. de

    2008-01-01

    Lower respiratory tract illness (LRTI) is an important health problem in early childhood. More than half of all infants develop LRTI in the first years of life. LRTI is an important risk factor for asthma. At the age of six, 10-15% still has symptoms of LRTI. Most of the children grow over the

  15. Examining the Utility of the Stimulus Pairing Observation Procedure with Preschool Children Learning a Second Language

    Science.gov (United States)

    Rosales, Rocio; Rehfeldt, Ruth Anne; Huffman, Nancy

    2012-01-01

    We evaluated the effectiveness of a stimulus pairing observation procedure to facilitate tact and listener relations in preschool children learning a second language. This procedure resulted in the establishment of most listener relations as well as some tact relations. Multiple-exemplar training resulted in the establishment of most of the…

  16. Utilization of School Nurses during the Evaluation and Identification of Children with Autism Spectrum Disorders

    Science.gov (United States)

    Mcintosh, Constance E.; Thomas, Cynthia M.

    2015-01-01

    This study explored school nurses' involvement during the identification and treatment of children with autism spectrum disorder (ASD). The extent of school nurses' collaboration with school psychologists and other educators also was studied. Participants included 100 school nurses, representing 18 states, who completed a survey on ASD. The…

  17. Lessons from healthcare utilization in children with obstructive sleep apnoea syndrome.

    Science.gov (United States)

    Martinez-Beneyto, Paz; Soria Checa, Cristina E; Botella-Rocamora, Paloma; Rincon-Piedrahita, Inés; Garcia Callejo, Francisco J; Algarra, Jaime Marco

    Paediatric Obstructive Sleep Apnoea-Hypopnoea Syndrome (OSAS) is a multisystemic condition affecting child's health status that may be investigated analyzing demand for healthcare. to quantify the frequency of medical consultations in children with OSAS over a 5-year period, compared to a healthy population. A longitudinal, case-control, ambispective study was conducted at a hospital pertaining to the national public health system. 69 consecutive children referred for OSAS were recruited with no diseases other than OSAS so that healthcare demand was purely attributed to this condition. Matched healthy control children were selected to compare these data. Data regarding frequency of the medical consultations were obtained over 5 years: the year of the treatment ("Year0"), 1 and 2 years before ("Year -1" and "Year -2" respectively), and 1 and 2 years after treatment ("Year+1" and "Year+2") RESULTS: Frequentation Index (FI), as ratio between the use of health services by OSAS children and healthy controls was 1.89 during Year-2, and 2.15 during Year-1 (Pde Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

  18. Fluoroscopic and CT enteroclysis in children: initial experience, technical feasibility, and utility

    International Nuclear Information System (INIS)

    Brown, Shanaree; Applegate, Kimberly E.; Sandrasegaran, Kumar; Jennings, S.G.; Garrett, Joshua; Maglinte, Dean T.; Skantharajah, Arunan

    2008-01-01

    Partial small-bowel obstruction can be difficult to diagnose on clinical examination. These obstructions might not be detected on routine abdominal/pelvic CT. To evaluate the feasibility, safety, and techniques of fluoroscopic enteroclysis (FE) and CT enteroclysis (CTE), and to review their indications and findings in children. We retrospectively reviewed all enteroclysis studies in children younger than 18 years performed between January 2002 and March 2007. We correlated the results with other abdominal imaging and surgical and pathological findings. The review revealed 112 FE and 74 CTE studies performed in 175 children (mean age 14 years, range 3-18 years). FE and CTE studies were performed most commonly for evaluation of known Crohn disease (FE 38%, CTE 29%) and abdominal pain (FE 26%, CTE 26%). One FE study was terminated because of patient anxiety, and one CTE study was terminated because of patient discomfort. No complications of FE or CTE were reported. The findings were normal in 54% of the FE studies and 46% of the CTE studies. The most common small bowel diagnoses were Crohn disease (FE 34%, CTE 28%) and partial small bowel obstruction (FE 3%, CTE 10%). Two FE studies (2%) and 14 CTE studies (19%) showed abnormalities outside the small bowel. In 54 patients with inflammatory bowel disease, 11 FE studies and 25 CTE studies showed additional bowel abnormalities. Overall, 14 and 21 patients had surgery as a result of the findings of FE and CTE, respectively. FE and CTE are safe, feasible, and accurate in depicting small-bowel pathology in children. These techniques can be particularly useful in children with Crohn disease involving the small bowel. (orig.)

  19. Profile of children with urinary tract infection and the utility of urine dipstick as a diagnostic tool.

    Science.gov (United States)

    Ojha, A R; Aryal, U R

    2014-01-01

    Urinary tract infection is a common problem in children and its early diagnosis and treatment is important to prevent long-term complications. Urine dipstick can be an important tool in this respect. The aim of this study is to look at the utility of urine dipstick as a diagnostic tool for UTI and will also see the clinical profile of children with UTI and sensitivity pattern of antibiotics among the isolates of urine culture. Urine samples of all children below 14 years of age who were suspected of urinary tract infection were sent for routine microscopic examination and dipstick testing. Urine culture and sensitivity were sent for those samples that were tested positive for nitrite, leucocyte esterase activity or both. For every fifth sample, which is dipstick negative, a culture and sensitivity testing was done. Among 110 children enrolled, 32(29%) cases had significant bacteriuria. Out of 32 culture positive cases 18(56%) were female. Fever was the main complaint (62.5%)). Escherichia Coli was isolated in 81.25% of cases. Amikacin was sensitive in 93% and amoxicillinwas resistant in 82%. The sensitivity, specificity, positive predictive value, negative predictive value of nitrite test was 65%, 80%, 58%, 85% respectively; those of leucocyte esterase are 84%, 55%, 43%, 89% respectively; those for significant microscopic pyuria >10/hpf were 65%, 74%, 51%, 84% respectively. E. Coli is the commonest uropathogen in children with UTI. Amikacin is the most sensitive antibiotic against all the isolates. A positive dipstick both for nitrite and leucocyte esterase is associated with high sensitivity and specificity for urinary tract infection as compared to either of them positive alone. In addition, urine WBC ≥10/hpf is associated with high probability of UTI.

  20. Mothers of children diagnosed with attention-deficit/hyperactivity disorder: health conditions and medical care utilization in periods before and after birth of the child.

    Science.gov (United States)

    Ray, G Thomas; Croen, Lisa A; Habel, Laurel A

    2009-01-01

    Analyzing health conditions and medical utilization of mothers of children with attention-deficit/hyperactivity disorder (ADHD) can shed light on biologic, environmental, and psychosocial factors relating to ADHD. To examine health conditions, health care utilization, and costs of mothers of children with ADHD in periods before the child was diagnosed. Using automated data from Northern California Kaiser Permanente we identified mothers of children with ADHD, mothers of children without ADHD, and mothers of children with asthma. Mothers' diagnostic clusters, health care utilization, and costs were compared. Mothers of children with ADHD were compared with mothers of children without ADHD and, separately, to mothers of children with asthma. Compared with mothers of children without ADHD, mothers of children with ADHD were more likely to be diagnosed with numerous medical and mental health problems in the 2 years after birth of their child, including depression [odds ratio (OR): 1.88], anxiety neuroses (OR: 1.64), obesity (OR: 1.70), and musculoskeletal symptoms (OR: 1.51). Results were similar for the year before delivery. Mothers of children with ADHD also had higher total health care costs per person in the year before ($1,003) and the 2 years after ($953) the birth of their child. Mothers of children with ADHD also were diagnosed with more health conditions and had higher health care costs than mothers of children with asthma. Our findings suggest that the likelihood of being diagnosed with ADHD is related to maternal conditions and use of health services that precede the child's diagnosis. Future studies are needed to clarify whether this is due to biologic, psychosocial, or environmental factors, or a combination.

  1. Managed Care for Children: Effect on Access to Care and Utilization of Health Services.

    Science.gov (United States)

    Szilagyi, Peter G.

    1998-01-01

    Reviews what is known about the effect of managed care on access to health services, as well as utilization of hospital care, emergency department visits, primary care services, and specialty pediatric services. The effect of managed care appears dependent on several factors and, thus, is likely to vary according to the population served. (SLD)

  2. Utilization of genetic testing among children with developmental disabilities in the United States

    Directory of Open Access Journals (Sweden)

    Kiely B

    2016-07-01

    Full Text Available Bridget Kiely, Sujit Vettam, Andrew Adesman Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Steven and Alexandra Cohen Children’s Medical Center of New York, New Hyde Park, NY, USA Purpose: Several professional societies recommend that genetic testing be routinely included in the etiologic workup of children with developmental disabilities. The aim of this study was to determine the rate at which genetic testing is performed in this population, based on data from a nationally representative survey.Methods: Data were analyzed from the Survey of Pathways to Diagnosis and Services, a telephone-based survey of parents and guardians of US school-age children with current or past developmental conditions. This study included 3,371 respondents who indicated that their child had an autism spectrum disorder (ASD, intellectual disability (ID, and/or developmental delay (DD at the time of survey administration. History of genetic testing was assessed based on report by the parent/s. Children were divided into the following five mutually exclusive condition groups: ASD with ID; ASD with DD, without ID; ASD only, without ID or DD; ID without ASD; and DD only, without ID or ASD. Logistic regression was used to assess the demographic correlates of genetic testing, to compare the rates of genetic testing across groups, and to examine associations between genetic testing and use of other health-care services.Results: Overall, 32% of this sample had a history of genetic testing, including 34% of all children with ASD and 43% of those with ID. After adjusting for demographics, children with ASD + ID were more than seven times as likely as those with ASD only, and more than twice as likely as those who had ID without ASD, to have undergone genetic testing. Prior specialist care (developmental pediatrician or neurologist and access to all needed providers within the previous year were associated with higher odds of genetic testing

  3. Morphological aspects of Schistosoma mansoni adult worms isolated from nourished and undernourished mice: a comparative analysis by confocal laser scanning microscopy

    Directory of Open Access Journals (Sweden)

    Neves Renata Heisler

    2001-01-01

    Full Text Available Malnutrition hampers the course of schistosomiasis mansoni infection just as normal growth of adult worms. A comparative morphometric study on adult specimens (male and female recovered from undernourished (fed with a low protein diet - regional basic diet and nourished (rodent commercial laboratory food, NUVILAB white mice was performed. Tomographic images and morphometric analysis of the oral and ventral suckers, reproductive system and tegument were obtained by means of confocal laser scanning microscopy. Undernourished male specimens presented smaller morphometric values (length and width of the reproductive system (first, third and last testicular lobes and thickness of the tegument than controls. Besides that, it was demonstrated that the dorsal surface of the male worms bears large tubercles unevenly distributed, but kept grouped and flat. At the subtegumental region, vacuolated areas were detected. It was concluded that the inadequate nutritional status of the vertebrate host has a negative influence mainly in the reproductive system and topographical somatic development of male adult Schistosoma mansoni, inducing some alterations on the structure of the parasite.

  4. ROLE OF MATERNAL EDUCATION & OCCUPATION IN THE NUTRITIONAL STATUS OF UNDER THREE CHILDREN

    Directory of Open Access Journals (Sweden)

    Shaili Vyas

    2011-06-01

    Full Text Available Research question: To determine the role of  Maternal  Education & Occupation in the nutritional status of  <3yrs children. Objectives: To assess the role of  maternal education & occupation in the nutritional status of  <3yrs children.  Study design: Cross sectional study. Settings:In the field practice area of Department of Community Medicine, Dehradun. Participants:500 children between 0-3years. Statistical Analysis:Chi Square . Results:  Majority of mothers (41.20% were found to be illiterate & of these majority had undernourished children (73.30%. In our study, most (92.20% of the mothers were housewives or were unemployed ,whereas maximum undernutrition (88.46% was found in children whose mothers were unskilled labourer by occupation, whereas children of housewives were found to be only 59.22%  undernourished.

  5. Utilizing Social Stories to Increase Prosocial Behavior and Reduce Problem Behavior in Young Children with Autism

    Directory of Open Access Journals (Sweden)

    Lisa A. Wright

    2012-01-01

    Full Text Available The purpose of this paper was to evaluate the effects of a Social Story intervention on the behavior rates of 4 young children with autism using a multiple-baseline across participants design. The results of this paper indicate that the Social Story was modestly effective in increasing prosocial behavior rates in 3 of the 4 participants, though none of the participants reached the prosocial behavior rates of age and gender-matched peers. The problem behaviors of the participants modestly decreased with the intervention. Maintenance of skills over a 1-month period was demonstrated for all of the participants. The variable and inconsistent results of the research add to the current literature base in support of the use of Social Stories for some children with autism.

  6. [Utilization of Occupational Therapy in Children - Results from the KiGGS Basis Survey].

    Science.gov (United States)

    Weber, A; Karch, D; Thyen, U; Rommel, A; Schlack, R; Hölling, H; von Kries, R

    2016-03-01

    A population-based analysis on use of occupational therapy by child's parentally reported health restrictions and socio-demographic determinants is missing. The basis KiGGS survey (2003 to 2006) reports on health in 17 641 children aged 0 to 17 years. The use of occupational therapy in the last 12 months could be ticked as other therapies with a free text field to name occupational therapy or others. Health restrictions potentially relevant for the use of occupational therapy and sociodemographic factors were assessed. The proportion of use of occupational therapy explained by the health restrictions was estimated by the population attributable risk fraction. The average use of occupational therapy for 3 to 13-year-olds was 2.4%. There was no association with the socioeconomic status; Children with immigration background used occupational therapy less often (e. g. age group 3 to 6 years: ORadjusted 0.2 [95-% KI: 0.1-1.0]). The proportion of occupational therapy explainable by the health restrictions considered ranged from 45% (3 to 6 years) to 65% (11 to 13 years). The lower use of occupational therapy in the KiGGS survey compared to health insurance reports may be explained by the ascertainment method. A lower use of occupational therapy related to immigration background matches lower use for physician visits. The causes for the low proportion of explained occupational therapy in young children and the lower use in children with immigration background warrant further research. © Georg Thieme Verlag KG Stuttgart · New York.

  7. Utility of MRI in the follow-up of pyogenic spinal infection in children

    International Nuclear Information System (INIS)

    Wang, Qiuyan; Babyn, Paul; Branson, Helen; Davila, Jorge; Mueller, Edrise L.; Tran, Dat

    2010-01-01

    MRI is used at an increasing rate in evaluation of pediatric spinal infections both at the time of diagnosis and in follow-up. However, the impact of MRI in follow-up has been rarely evaluated to date. To evaluate serial follow-up spinal MRI changes compared to clinical outcome and assess their impact on clinical management. All pediatric (<18 years) patients with pyogenic spinal infection over a 9-year period with at least one follow-up after treatment were included. Atypical infections were excluded. We examined 35 whole-spine and 16 localized spinal scans from 17 patients (2 months to 16 years, 9F:8 M) who had 51 follow-ups done 2 weeks to 4.75 years after baseline. Seven children (41%) younger than 3 years underwent 33 follow-ups (65%); most required GA or sedation. Short-term follow-up scans demonstrated epidural and/or paraspinal soft-tissue changes correlating with clinical status and laboratory findings in all cases. However, MRI showed that bone and/or disc abnormalities continued and progressed in some cases despite clinical improvement. Long-term follow-up scans showed bone, disc and soft-tissue changes 1-3 years after baseline, despite children being symptom free. Extension of antibiotics occurred in 47% of children partly based on follow-up MRI. Epidural and paraspinal soft-tissue changes correlated with children's clinical symptoms. Progression of bone and disc changes can manifest despite adequate clinical response. Long-term or serial routine follow-ups were not necessary. Management should be made based on clinical response. (orig.)

  8. The clinical utility of testicular prosthesis placement in children with genital and testicular disorders

    Science.gov (United States)

    2014-01-01

    Testicular prosthesis placement is a useful important adjunctive reconstructive therapy for managing children with testicular loss or absence. Though these prostheses are functionless, experience has shown that they are extremely helpful in creating a more normal male body image and in preventing/relieving psychological stress in males with a missing testicle. With attention to details of implant technique, excellent cosmetic results can be anticipated in simulating a normal appearing scrotum. PMID:26816795

  9. Cognitive Modules Utilized for Narrative Comprehension in Children: A Functional Magnetic Resonance Imaging Study

    OpenAIRE

    Schmithorst, Vincent J.; Holland, Scott K.; Plante, Elena

    2005-01-01

    The ability to comprehend narratives constitutes an important component of human development and experience. The neural correlates of auditory narrative comprehension in children were investigated in a large-scale functional magnetic resonance imaging (fMRI) study involving 313 subjects ages 5–18. Using group Independent Component Analysis (ICA), bilateral task-related components were found comprising the primary auditory cortex, the mid-superior temporal gyrus, the hippocampus, the angular g...

  10. Clinical utility of PPPM and FPS-R to quantify post-tonsillectomy pain in children.

    Science.gov (United States)

    de Azevedo, Carolina Brotto; Carenzi, Lucas Rodrigues; de Queiroz, Danielle Leite Cunha; Anselmo-Lima, Wilma T; Valera, Fabiana Cardoso Pereira; Tamashiro, Edwin

    2014-02-01

    As pain is a subjective and difficult parameter to assess in children, we aimed to evaluate the correspondence of two pain scales - parents' post-operative pain measure (PPPM) and faces pain scale-revised (FPS-R) with analgesic intake in the assessment of post-tonsillectomy pain in a pediatric population. Children aged 4-10 years (n=174) undergoing tonsillectomy with or without adenoidectomy had their pain monitored by PPPM and FPS-R over 7 days following surgery. The amount of analgesic (acetaminophen or dipyrone) intake was also recorded each day. Linear regression and correlation analysis were performed for pain scales and Poisson regression model for analgesic administration. To evaluate influence of gender linear regression and logistic regression with random effects were performed. PPPM and FPS-R presented a significant positive correlation (τ=0.5; R(2)=0.36; pFPS-R also showed a significant correlation with analgesic use over the 7 post-operative days (pFPS-R are equivalent pain scales to quantify post-tonsillectomy pain in children and are useful tools in post-tonsillectomy clinical research. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  11. The utilization of health care services by children with Foetal Alcohol Syndrome in the Western Cape, South Africa.

    Science.gov (United States)

    Credé, Sarah; Sinanovic, Edina; Adnams, Colleen; London, Leslie

    2011-06-01

    The rates of Foetal Alcohol Syndrome (FAS) and Partial Foetal Alcohol Spectrum (PFAS) in South Africa are the highest reported worldwide. There is a paucity of research examining the health care costs of caring for children with FAS or PFAS in this country. A cross-sectional analytical study was conducted using an interviewer-administered questionnaire amongst caregivers of children (0-12 years) with FAS/PFAS in the Western Cape to estimate the utilization of health care services; the annual direct and indirect health care costs per child as well as the total cost to society for providing health care services to children with FAS/PFAS. It was found that the median number of annual visits to public health care facilities per child was 8 (IQR 4 to 14). The total average annual cost per child was $1039.38 (95% CI: $808.68; $1270.07) and the total annual societal cost for the Western Cape was $70,960,053.68 (95% CI: $5,528,895.48; $86,709,971.13). Caregivers in receipt of a social support grant reported spending significantly less on health care for a child with FAS/PFAS (Fisher's exact p=0.004). These study results confirm the significant burden of FAS/PFAS on the Western Cape economy and the health care system which has significant implications for FAS prevention. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  12. Clinical utility of valsartan in the treatment of hypertension in children and adolescents

    Directory of Open Access Journals (Sweden)

    Rossana Baracco

    2011-03-01

    Full Text Available Rossana Baracco, Gaurav KapurChildren’s Hospital of Michigan/Wayne State University, Detroit, MI, USAAbstract: Valsartan is a potent antagonist of the type 1 angiotensin receptor (AT1. By blocking the actions of angiotensin II on the AT1, it inhibits vasoconstriction and synthesis of aldosterone thus lowering systemic blood pressure. Valsartan has been approved by the FDA for the treatment of hypertension in children aged 6 years and older. Valsartan can be dosed once a day with a sustained 24-hour effect on blood pressure reduction. The starting dose recommended in children is 1.3 mg/kg once daily (maximum 40 mg which needs adjustment according to blood pressure response (dose range 1.3–2.7 mg/kg daily; up to 160 mg. A suspension form (4 mg/mL is available for children who cannot swallow tablets. In patients aged 6 to 16 years, valsartan treatment (from a low dose of 10–20 mg to a high dose of 80–160 mg resulted in dose-dependent reductions of 7.9–11.5 mmHg in systolic blood pressure and 4.6–7.4 mmHg in diastolic blood pressure. In 1- to 5-year-olds, valsartan (from a low dose of 5–10 mg to a high dose of 40–80 mg reduced the systolic blood pressure by 8.4–8.6 mmHg and the diastolic blood pressure by 5.5 mmHg. Similar to adults and other antihypertensive medications, the most frequent side effect in children subsequent to valsartan use is headache. Current studies have not shown adverse effects on linear growth, weight gain, head growth, or development in children aged 1 to 5 years subsequent to valsartan use. Based on limited pediatric data, valsartan appears to be well tolerated and efficacious in reducing elevated blood pressure.Keywords: valsartan, hypertension, angiotensin receptor blockers

  13. Combining psychological and engineering approaches to utilizing social robots with children with autism.

    Science.gov (United States)

    Dickstein-Fischer, Laurie; Fischer, Gregory S

    2014-01-01

    It is estimated that Autism Spectrum Disorder (ASD) affects 1 in 68 children. Early identification of an ASD is exceedingly important to the introduction of an intervention. We are developing a robot-assisted approach that will serve as an improved diagnostic and early intervention tool for children with autism. The robot, named PABI® (Penguin for Autism Behavioral Interventions), is a compact humanoid robot taking on an expressive cartoon-like embodiment. The robot is affordable, durable, and portable so that it can be used in various settings including schools, clinics, and the home. Thus enabling significantly enhanced and more readily available diagnosis and continuation of care. Through facial expressions, body motion, verbal cues, stereo vision-based tracking, and a tablet computer, the robot is capable of interacting meaningfully with an autistic child. Initial implementations of the robot, as part of a comprehensive treatment model (CTM), include Applied Behavioral Analysis (ABA) therapy where the child interacts with a tablet computer wirelessly interfaced with the robot. At the same time, the robot makes meaningful expressions and utterances and uses stereo cameras in eyes to track the child, maintain eye contact, and collect data such as affect and gaze direction for charting of progress. In this paper we present the clinical justification, anticipated usage with corresponding requirements, prototype development of the robotic system, and demonstration of a sample application for robot-assisted ABA therapy.

  14. Utilization of Facebook by School Children in the Apprenticeship Seeking Process

    Directory of Open Access Journals (Sweden)

    Tom Sander

    2016-12-01

    Full Text Available The search for a practical apprenticeship place can be the first step in the business world for German students. The students have to apply for this placement, as Companies require applicants. Facebook is one of the most often used social networks among the younger generation in Germany, which can provide a direct communication channel between businesses and candidates. The research evaluates the reasons to use Facebook to identify a solid apprenticeship training platform for German students. Research methods applied: scientific publication analysis, survey (by paper-based questionnaire of German students of the ninth and tenth grade. Analysis of survey data by main indicators of descriptive statistics: arithmetic mean, mode, median, and standard deviations to get an impression of evaluations on analysed aspects by survey respondents. Analysis of variance – ANOVA – is applied to study the difference of the assessments between female and male school children and the differences between the ninth and tenth classes. The existence of correlations between the intensity of use of social network sites (SNS and the apprenticeship seeking process have been investigated. The results of the research have shown that there are differences in evaluations, on analysed aspects, between female and male school children in the analysed classes on the occasion career entry by the apprenticeship.

  15. [Utilization of Physiotherapy Services by Children and Adolescents - Results of the KiGGS- Baseline Survey].

    Science.gov (United States)

    Weber, A; Karch, D; Thyen, U; Rommel, A; Schlack, R; Hölling, H; von Kries, R

    2017-03-01

    Aim of the study: The use of physical therapy in German children and adolescents has so far solely been analyzed on the basis of health insurance data, which can neither consider case history nor social factors. Using the KiGGS-baseline survey it is possible to examine the use of physical therapy on the basis of parental reported health problems and social factors. Methodology: Identifiable determinants for the use of physical therapy in the last 12 months in the KiGGS-baseline survey were examined bivariate and multivariate in logistic regression models with mutual adjustment. The following determinants were considered: social factors, somatic disorders and psychological abnormalities. The proportion of the use of physical therapy, which can be explained by these determinants, was estimated using population-attributable risk fraction. Results: The frequency of the use of physical therapy in the last 12 months in the 0 to 17-year-olds in the KiGGS-baseline survey was 6,4% with higher use during infancy and adolescence. The socio-economic status of parents was not associated with the use of physical therapy. A migration background decreased the probability of the use of physical therapy, for example, among children aged 0 to 2 years (OR adjusted : 0,5 [95% CI: 0,2-1,0]). In those with scoliosis, the use of physical therapy was almost twice as frequent in infancy as in adolescence (58,4 vs. 34,4%). A maximum of 15% of all children and adolescents with back pain reported the use of physical therapy. When ADHD was diagnosed at preschool age, the probability of using physical therapy was increased (OR adjusted : 5,1 [95% CI: 1,4-18,6]). The health problems, which were assessed in the KiGGS-baseline survey and considered for this analysis could explain 37% of the use of physical therapy in the 0 to 2-year-olds. In the other age groups, 59 to 62% could be explained. Conclusion: Comparison of the KiGGS-baseline survey with health insurance data shows similar frequencies

  16. Insecticide-Treated Nets Utilization and Associated Factors among under-5 Years Old Children in Mirab-Abaya District, Gamo-Gofa Zone, Ethiopia.

    Science.gov (United States)

    Admasie, Amha; Zemba, Amanuel; Paulos, Wondimagegn

    2018-01-01

    Malaria can be prevented using cost-effective interventions. It can be prevented at large via the use of insecticide-treated mosquito nets (ITNs). The use of ITNs decreases malaria mortality rates by 55% in under-5 years old children in Africa, Ethiopia, realizing the effectiveness, scaling up distribution and utilization of ITNs to cover 100% of children less than 5 years of age. However, little is known about ITNs utilization and factors associated with the utilization in under-5 years old children in the study area yet. The purpose of this study was to assess the level and associated factors of ITNs utilization in under-5 years old children among households with under-5 years old children of Mirab Abaya District, Gamo Gofa Zone, Ethiopia. A community-based cross-sectional study was conducted during August-September, 2016. Six study Kebeles were identified by simple random sampling technique and 398 households with at least one under-5 years old children were selected by random sampling technique using computer generated random numbers from health post family folders. Structured, interviewer questionnaire was administered to mothers or care givers of the children. Data were entered to Epi Info Version 3.5 and analyzed in SPSS version 21 statistical software. Bivariate and multivariate logistic regression analysis was done. P -value used for the determination of associations between dependent and predictor variables. Results were presented in narrations, tables, and graph. Among 398 under-5 years old children assessed, the majority, 362 (91.0%) of them had access to ITN, but only 137 (37.2%) of the child had ITNs utilization during the previous night prior to the survey. Households with age of mothers or caretakers 31-44 years, AOR = 0.03, 95% CI (0.01-0.07) and ≥45 years of age; AOR = 0.05, 95% CI (0.01-0.58); households with family size ≤5 members, AOR = 11.23, 95% CI (4.31-29.24); and households with sleeping space ≥2, AOR

  17. The role of mother's education in the nutritional status of children in Serbia.

    Science.gov (United States)

    Stamenkovic, Zeljka; Djikanovic, Bosiljka; Laaser, Ulrich; Bjegovic-Mikanovic, Vesna

    2016-10-01

    The present study aimed to identify the role of mother's education in the nutritional status of children aged 2-5 years in Serbia. Nationally representative population-based study. Age- and gender-specific BMI percentiles of children were analysed. In accordance with the WHO growth reference, children with BMI less than the 5th percentile were considered undernourished. Logistic regression was used to calculate the association between mother's education and other socio-economic determinants as possible confounders. UNICEF's fourth Multiple Indicator Cluster Survey, conducted in both Roma and non-Roma settlements in Serbia. Children (n 2603) aged 2-5 years (mean age 3·05 years). Less than 5 % of children aged 2-5 years were undernourished. There were significantly more undernourished children among the Roma population, in the capital of Serbia and among those whose mothers were less educated. There were statistically significant differences according to mother's education in all socio-economic characteristics (ethnicity, area, region of living and wealth index). Mother's level of education proved to be the most important factor for child's nutritional status; place of living (region) was also associated. Mother's education is the most significant predictor of children's undernutrition. It confirms that investment in females' education will bring benefits and progress not only for women and their children, but also for society as a whole.

  18. Dental Caries Experience and Utilization of Oral Health Services Among Tibetan Refugee-Background Children in Paonta Sahib, Himachal Pradesh, India.

    Science.gov (United States)

    Bhatt, Sumeet; Gaur, Ambika

    2018-06-04

    The study was done to describe the dental caries experience and dental care utilization among Tibetan refugee-background children in Paonta Sahib, India. The study was conducted on 254 school children in a Tibetan settlement in Paonta Sahib. Examination was done as per World Health Organization Oral Health Assessment criteria (2013). Data on dental services utilization was obtained from the parents of children using a structured questionnaire. Oral examination of 254 school children aged 6-18 years revealed an overall dental caries prevalence of 79.5%. The dental caries experience was greater in the mixed dentition (84%) than secondary dentition (77.3%). The mean DMFT was associated with sex and dental visiting patterns. About 60% children had never visited a dentist before. The main reason for dental visit was tooth removal (43%). The prevalence of dental caries among Tibetan refugee-background school children was high and utilization of dental care was low. A comprehensive oral health program focusing on preventive care and oral health education is recommended.

  19. Clinical utility of guanfacine extended release in the treatment of ADHD in children and adolescents

    Directory of Open Access Journals (Sweden)

    Bello NT

    2015-06-01

    Full Text Available Nicholas T Bello Department of Animal Sciences, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA Abstract: Attention deficit hyperactivity disorder (ADHD is the most common psychiatric illness in children and adolescents. Several stimulant medications, such as methylphenidate and amphetamine derivatives, are available to treat ADHD in pediatric patients. Nonstimulant medications are more preferred by some parents, other caregivers, and patients because they lack the abuse potential of stimulant medications. In the US, one available nonstimulant option is guanfacine extended release (XR. As a selective α2A adrenergic receptor, guanfacine acts on the central noradrenergic pathways and cortical noradrenergic targets to improve working memory and attention. The XR formulation of guanfacine, compared with the immediate-release formulation, is more effective for the long-term management of ADHD and is associated with fewer adverse effects. Available data also indicate that guanfacine XR is superior to atomoxetine and is as effective as the nonselective α2 adrenergic receptor agonist, clonidine XR. The most common adverse effects associated with guanfacine XR are somnolence, fatigue, bradycardia, and hypotension. Somnolence is the most often cited reason for discontinuation. Guanfacine XR is also labeled for use as an adjuvant to stimulant treatment for ADHD. A similar profile of adverse effects as reported with monotherapy is reported when guanfacine XR is “added on” to stimulant therapy with somnolence as the most commonly reported adverse event. This review discusses the clinical efficacy and patient preference of guanfacine XR based on available published data on the safety, relative effectiveness, and tolerance of this medication to treat ADHD. Keywords: Intuniv, norepinephrine, prefrontal cortex, locus coeruleus, impulsivity, inattentive

  20. Utility of three anthropometric indices in assessing the cardiometabolic risk profile in children.

    Science.gov (United States)

    Buchan, Duncan S; Boddy, Lynne M; Grace, Fergal M; Brown, Elise; Sculthorpe, Nicholas; Cunningham, Conor; Murphy, Marie H; Dagger, Rebecca; Foweather, Lawrence; Graves, Lee E F; Hopkins, Nicola D; Stratton, Gareth; Baker, Julien S

    2017-05-06

    To evaluate the ability of BMI, WC, and WHtR to identify increased cardiometabolic risk in pre-adolescents. This is a cross-sectional study involving 192 children (10.92 ± 0.58 years, 56% female) from the United Kingdom between 2010 and 2013. Receiver operating characteristic curves determined the discriminatory ability of BMI, WC and WHtR to identify individuals with increased cardiometabolic risk (increased clustered triglycerides, HDL-cholesterol, systolic blood pressure, cardiorespiratory fitness, and glucose). A WHtR ≥ 0.5 increased the odds by 5.2 (95% confidence interval 2.6 - 10.3) of having increased cardiometabolic risk. Similar associations were observed for BMI and WC. Both BMI-z and WHtR were fair predictors of increased cardiometabolic risk, although BMI-z demonstrated the best trade-off between sensitivity and specificity, 76.1% and 63.6%, compared with 68.1% and 65.5% for WHtR. Cross-validation analysis revealed that BMI-z and WHtR correctly classified 84% of individuals (kappa score = 0.671, 95% CI 0.55, 0.79). The sensitivity of the cut-points suggests that 89.3% of individuals were correctly classified as being at risk with only 10.7% misdiagnosed whereas the specificity of the cut-points indicated that 77.8% of individuals were correctly identified as being healthy with 22.2% of individuals incorrectly diagnosed as being at risk. Findings suggest that WHtR provides similar cardiometabolic risk estimates to age and sex adjusted BMI. © 2016 Wiley Periodicals, Inc.

  1. Transcriptional, translational, and physiological signatures of undernourished honey bees (Apis mellifera) suggest a role for hormonal factors in hypopharyngeal gland degradation.

    Science.gov (United States)

    Corby-Harris, Vanessa; Meador, Charlotte A D; Snyder, Lucy A; Schwan, Melissa R; Maes, Patrick; Jones, Beryl M; Walton, Alexander; Anderson, Kirk E

    2016-02-01

    Honey bee colonies function as a superorganism, where facultatively sterile female workers perform various tasks that support the hive. Nurse workers undergo numerous anatomical and physiological changes in preparation for brood rearing, including the growth of hypopharyngeal glands (HGs). These glands produce the major protein fraction of a protein- and lipid-rich jelly used to sustain developing larvae. Pollen intake is positively correlated with HG growth, but growth in the first three days is similar regardless of diet, suggesting that initial growth is a pre-determined process while later HG development depends on nutrient availability during a critical window in early adulthood (>3 d). It is unclear whether the resultant size differences in nurse HG are simply due to growth arrest or active degradation of the tissue. To determine what processes cause such differences in HG size, we catalogued the differential expression of both gene transcripts and proteins in the HGs of 8 d old bees that were fed diets containing pollen or no pollen. 3438 genes and 367 proteins were differentially regulated due to nutrition. Of the genes and proteins differentially expressed, undernourished bees exhibited more gene and protein up-regulation compared to well-nourished bees, with the affected processes including salivary gland apoptosis, oogenesis, and hormone signaling. Protein secretion was virtually the only process up-regulated in well-nourished bees. Further assays demonstrated that inhibition of ultraspiracle, one component of the ecdysteroid receptor, in the fat body caused larger HGs. Undernourished bees also had higher acid phosphatase activity, a physiological marker of cell death, compared to well-nourished bees. These results support a connection between poor nutrition, hormonal signaling, and HG degradation. Published by Elsevier Ltd.

  2. Effects of exogenous melatonin on in vivo embryo viability and oocyte competence of undernourished ewes after weaning during the seasonal anestrus.

    Science.gov (United States)

    Vázquez, M I; Abecia, J A; Forcada, F; Casao, A

    2010-09-01

    This study investigated the effects of exogenous melatonin on embryo viability and oocyte competence in post-partum undernourished ewes during the seasonal anestrus. At parturition (mid-Feb), 36 adult Rasa Aragonesa ewes were assigned to one of two groups: treated (+MEL) or not treated (-MEL) with a subcutaneous implant of melatonin (Melovine(R), CEVA) on the day of lambing. After 45 d of suckling, lambs were weaned, ewes were synchronized using intravaginal pessaries, and fed to provide 1.5x (Control, C) or 0.5x (Low, L) times daily maintenance requirements. Thus, ewes were divided into four groups: C-MEL, C+MEL, L-MEL, and L+MEL. At estrus (Day=0), ewes were mated. At Day 5 after estrus, embryos were recovered by mid-ventral laparotomy and classified based on their developmental stage and morphology. After embryo collection, ovaries were recovered and oocytes were classified and selected for use in in vitro fertilization (IVF). Neither diet nor melatonin treatment had a significant effect on ovulation rate and on the number of ova recovered per ewe. Melatonin treatment significantly improved the number of fertilized embryos/corpus luteum (CL) (-MEL: 0.35 +/- 0.1, +MEL: 0.62 +/- 0.1; P = 0.08), number of viable embryos/CL (-MEL: 0.23 +/- 0.1, +MEL: 0.62 +/- 0.1; P competence of oocytes during IVF. Treatment groups did not differ significantly in the number of healthy oocytes used for IVF, number of cleaved embryos, or number of blastocysts and, consequently, the groups had similar cleavage and blastocyst rates. In conclusion, melatonin treatments improved ovine embryo viability during anestrus, particularly in undernourished post-partum ewes, although the effects of melatonin did not appear to be mediated at the oocyte competence level. Copyright 2010 Elsevier Inc. All rights reserved.

  3. Evaluating the cost utility of racecadotril for the treatment of acute watery diarrhea in children: the RAWD model

    Directory of Open Access Journals (Sweden)

    Rautenberg TA

    2012-04-01

    Full Text Available Tamlyn Anne Rautenberg1,2, Ute Zerwes1, Douglas Foerster3,4, Rick Aultman51Assessment in Medicine GmbH, Lörrach, Germany; 2Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; 3Abbott Products Operations AG, Allschwil, Switzerland; 4University of Bielefeld, School of Public Health, Bielefeld, Germany; 5Semalytics, Arizona, United States of AmericaBackground: The safety and efficacy of racecadotril to treat acute watery diarrhea (AWD in children is well established, however its cost effectiveness for infants and children in Europe has not yet been determined.Objective: To evaluate the cost utility of racecadotril adjuvant with oral rehydration solution (ORS compared to ORS alone for the treatment of AWD in children younger than 5 years old. The analysis is performed from a United Kingdom National Health Service (NHS perspective.Methods: A decision tree model has been developed in Microsoft® Excel. The model is populated with the best available evidence. Deterministic and probabilistic sensitivity analyses (PSA have been performed. Health effects are measured as quality-adjusted life years (QALYs and the model output is cost (2011 GBP per QALY. The uncertainty in the primary outcome is explored by probabilistic analysis using 1000 iterations of a Monte Carlo simulation.Results: Deterministic analysis results in a total incremental cost of –£379 in favor of racecadotril and a total incremental QALY gain in favor of racecadotril of +0.0008. The observed cost savings with racecadotril arise from the reduction in primary care reconsultation and secondary referral. The difference in QALYs is largely attributable to the timely resolution of symptoms in the racecadotril arm. Racecadotril remains dominant when base case parameters are varied. Monte Carlo simulation and PSA confirm that racecadotril is the dominant treatment strategy and is almost certainly cost effective, under the central assumptions of the model, at a

  4. Trends in resource utilization by children with neurological impairment in the United States inpatient health care system: a repeat cross-sectional study.

    Directory of Open Access Journals (Sweden)

    Jay G Berry

    2012-01-01

    Full Text Available Care advances in the United States (US have led to improved survival of children with neurological impairment (NI. Children with NI may account for an increasing proportion of hospital resources. However, this assumption has not been tested at a national level.We conducted a study of 25,747,016 US hospitalizations of children recorded in the Kids' Inpatient Database (years 1997, 2000, 2003, and 2006. Children with NI were identified with International Classification of Diseases, 9th Revision, Clinical Modification diagnoses resulting in functional and/or intellectual impairment. We assessed trends in inpatient resource utilization for children with NI with a Mantel-Haenszel chi-square test using all 4 y of data combined. Across the 4 y combined, children with NI accounted for 5.2% (1,338,590 of all hospitalizations. Epilepsy (52.2% [n = 538,978] and cerebral palsy (15.9% [n = 164,665] were the most prevalent NI diagnoses. The proportion of hospitalizations attributable to children with NI did not change significantly (p = 0.32 over time. In 2006, children with NI accounted for 5.3% (n = 345,621 of all hospitalizations, 13.9% (n = 3.4 million of bed days, and 21.6% (US$17.7 billion of all hospital charges within all hospitals. Over time, the proportion of hospitalizations attributable to children with NI decreased within non-children's hospitals (3.0% [n = 146,324] in 1997 to 2.5% [n = 113,097] in 2006, p<.001 and increased within children's hospitals (11.7% [n = 179,324] in 1997 to 13.5% [n = 209,708] in 2006, p<0.001. In 2006, children with NI accounted for 24.7% (2.1 million of bed days and 29.0% (US$12.0 billion of hospital charges within children's hospitals.Children with NI account for a substantial proportion of inpatient resources utilized in the US. Their impact is growing within children's hospitals. We must ensure that the current health care system is staffed, educated, and equipped to serve this growing segment of vulnerable children.

  5. Psychometrics and utility of Psycho-Educational Profile-Revised as a developmental quotient measure among children with the dual disability of intellectual disability and autism.

    Science.gov (United States)

    Alwinesh, Merlin Thanka Jemi; Joseph, Rachel Beulah Jansirani; Daniel, Anna; Abel, Julie Sandra; Shankar, Satya Raj; Mammen, Priya; Russell, Sushila; Russell, Paul Swamidhas Sudhakar

    2012-09-01

    There is no agreement about the measure to quantify the intellectual/developmental level in children with the dual disability of intellectual disability and autism. Therefore, we studied the psychometric properties and utility of Psycho-Educational Profile-Revised (PEP-R) as a developmental test in this population. We identified 116 children with dual disability from the day care and inpatient database of a specialised Autism Clinic. Scale and domain level scores of PEP-R were collected and analyzed. We examined the internal consistency, domain-total correlation of PEP-R and concurrent validity of PEP-R against Gesell's Developmental Schedule, inter-rater and test-retest reliability and utility of PEP-R among children with dual disability in different ages, functional level and severity of autism. Besides the adequate face and content validity, PEP-R demonstrates a good internal consistency (Cronbach's α ranging from 0.91 to 0.93) and domain-total correlation (ranging from 0.75 to 0.90). The inter-rater reliability (intraclass correlation coefficient, ICC = 0.96) and test-retest reliability (ICC = 0.87) for PEP-R is good. There is moderate-to-high concurrent validity with GDS (r ranging from 0.61 to 0.82; all Ps = 0.001). The utility of PEP-R as a developmental measure was good with infants, toddlers, pre-school and primary school children. The ability of PEP-R to measure the developmental age was good, irrespective of the severity of autism but was better with high-functioning children. The PEP-R as an intellectual/developmental test has strong psychometric properties in children with dual disability. It could be used in children with different age groups and severity of autism. PEP-R should be used with caution as a developmental test in children with dual disability who are low functioning.

  6. The utility of screen for child anxiety related emotional disorders (SCARED) as a tool for identifying children at high risk for prevalent anxiety disorders

    NARCIS (Netherlands)

    Muris, P.; Merckelbach, H.; Kindt, M.; Bögels, S.; Dreessen, L.; van Dorp, C.; Habets, A.; Rosmuller, S.; Snieder, N.

    2001-01-01

    The current study examined the utility of the Screen for Child Anxiety Related Emotional Disorders (SCARED) as a screening tool for the identification of children at high risk for prevalent childhood anxiety disorders. The child version of the Structured Clinical Interview for DSM (KSCID) was used

  7. The Impact of Head Start on Children, Families and Communities. Final Report of the Head Start Evaluation, Synthesis and Utilization Project.

    Science.gov (United States)

    McKey, Ruth Hubbell; And Others

    Including all Head Start research (both published and unpublished) and using, when possible, the statistical technique of meta-analysis, this final report of the Head Start Evaluation, Synthesis, and Utilization Project presents findings on the impact of Head Start on children's cognitive and socioemotional development, on child health and health…

  8. Quantifying Morbidity Burdens and Medical Utilization of Children with Intellectual Disabilities in Taiwan: A Nationwide Study Using the ACG Case-Mix Adjustment System

    Science.gov (United States)

    Lee, Wui-Chiang; Chen, Tzeng-Ji

    2012-01-01

    The purpose of this study was to quantify morbidity burdens of children with intellectual disability (ID) and to examine its association with total medical utilization and expenditure on a national basis in Taiwan. People under 18 years of age that had been continuously enrolled in the National Health Insurance (NHI) between year 2008 and 2010…

  9. Nasal Obstruction in Children With Cleft Lip and Palate: Results of a Cross-Sectional Study Utilizing the NOSE Scale.

    Science.gov (United States)

    Zhang, Rosaline S; Lin, Lawrence O; Hoppe, Ian C; Jackson, Oksana A; Low, David W; Bartlett, Scott P; Swanson, Jordan W; Taylor, Jesse A

    2018-01-01

    To characterize the epidemiology and risk factors for nasal obstruction among subjects with cleft lip and/or cleft palate (CL/P) utilizing the well-validated Nasal Obstruction Symptom Evaluation (NOSE) survey. Retrospective cross-sectional study. Cleft Lip and Palate Program, Children's Hospital of Philadelphia. Patients, Subjects: One thousand twenty-eight surveys obtained from 456 subjects (mean age: 10.10 (4.48) years) with CL/P evaluated between January 2015 and August 2017 with at least 1 completed NOSE survey. Nasal Obstruction Symptom Evaluation surveys completed at each annual visit. Composite NOSE and individual symptom scores. Sixty-seven percent of subjects had nasal obstruction at some point during the study period, with 49% reporting nasal obstruction at latest follow-up. subjects aged 14 years and older reported the most severe symptoms ( P = .002). Subjects with cleft lip and alveolus (CL+A) and unilateral cleft lip and palate (CLP) reported more severe nasal blockage than other phenotypes ( P = .021). subjects with a history of either posterior pharyngeal flap (PPF) or sphincter pharyngoplasty (SP) had significantly higher NOSE scores than subjects with no history of speech surgery ( P = .006). There was no significant difference ( P > .050) in NOSE scores with regard to history of primary tip rhinoplasty, nasal stent use, or nasoalveolar molding. There are more severe nasal obstructive symptoms among subjects older than 14 years of age, with CL+A or unilateral CLP, and with a history of PPF or SP. Future studies utilizing the NOSE are needed to evaluate and address this prevalent morbidity in the CLP population.

  10. Insecticide-treated nets ownership and utilization among under-five children following the 2010 mass distribution in Burkina Faso.

    Science.gov (United States)

    Diabaté, Souleymane; Druetz, Thomas; Bonnet, Emmanuel; Kouanda, Seni; Ridde, Valéry; Haddad, Slim

    2014-09-04

    Periodic mass distributions contribute significantly to universal access to insecticide-treated nets (ITNs). However, due to the limited number of nets distributed, needs remain unsatisfied, particularly in large households. This study was conducted in Kaya health district following the 2010 mass distribution of ITNs in Burkina Faso. Data were collected on the socio-economic and geo-spatial characteristics and ITN possession and utilization levels of 2,004 households. The study explored: 1) ITN access, in terms of intra-household saturation with ITNs (households with at least one ITN for every two members) correctly installed and in very good physical condition; and 2) factors influencing the decision to place under-five children under a net. Particular attention was given to vector control activities undertaken by mothers. Of the 2,004 households, 90% possessed at least one ITN. However, intra-household saturation with ITNs was below 60% in small households and below 20% in large ones (>6 members). Crude proportion ratios comparing possession and levels of intra-household saturation with ITNs varied between 1.5 (small households) and 7.8 (large households). The proportions of households with ITNs for every two members that were correctly hung or in very good physical condition ranged from 0% to 6.5% in large households and 27.8% to 40.7% in small ones. ITN use to protect under-five children was lower in large households; it was significantly higher when there was at least one ITN for every two members. In large households, it was significantly higher when a child had experienced an episode of any illness in the previous two weeks and when the mother had taken actions to control vector proliferation. In small households, ITN use was significantly higher in families with agricultural land and children aged 12-23 months. Ownership rates were high, but real access to bed nets remained limited. The allocation process disadvantages large families. Real access to bed

  11. Parental immigration status is associated with children's health care utilization: findings from the 2003 new immigrant survey of US legal permanent residents.

    Science.gov (United States)

    Yun, Katherine; Fuentes-Afflick, Elena; Curry, Leslie A; Krumholz, Harlan M; Desai, Mayur M

    2013-12-01

    Our objective was to examine the association between parental immigration status and child health and health care utilization. Using data from a national sample of immigrant adults who had recently become legal permanent residents (LPR), children (n = 2,170) were categorized according to their parents' immigration status prior to LPR: legalized, mixed-status, refugee, temporary resident, or undocumented. Logistic regression with generalized estimating equations was used to compare child health and health care utilization by parental immigration status over the prior 12 months. Nearly all children in the sample were reported to be in good to excellent health. Children whose parents had been undocumented were least likely to have had an illness that was reported to have required medical attention (5.4 %). Children whose parents had been either undocumented or temporary residents were most likely to have a delayed preventive annual exam (18.2 and 18.7 %, respectively). Delayed dental care was most common among children whose parents had come to the US as refugees (29.1 %). Differences in the preventive annual exam remained significant after adjusting for socioeconomic characteristics. Parental immigration status before LPR was not associated with large differences in reported child health status. Parental immigration status before LPR was associated with the use of preventive annual exams and dental services. However, no group of children was consistently disadvantaged with respect to all measures.

  12. Utilization of formal health services for children aged 1-5 in Aceh after the 2004 tsunami: Which children did not receive the health care they needed? Implications for other natural disaster relief efforts.

    Science.gov (United States)

    Rassekh, Bahie Mary; Santosham, Mathuram

    2014-01-01

    Aceh, Indonesia, was the hardest-hit area in the December 26, 2004 Indian Ocean earthquake and tsunami, with more than 500,000 people displaced, 120,000 people dead, and total damages and losses estimated at $4.5 billion. The relief effort following the tsunami was also immense, with billions of dollars of aid pledged to this province alone. Since then, there have been several natural disasters, including Typhoon Haiyan, which have caused great loss of life and displacement and for which these results are applicable. This study aimed to determine and assess utilization patterns of health services for children under the age of five with diarrhea, cough and difficulty breathing, fever, or skin disease and to identify determinants of formal and non-formal healthcare usage. A household survey of 1439 households was administered to caretakers of children aged 1-5 years. A sample of clusters within Banda Aceh and Aceh Besar were selected and those caretakers within the cluster who fit the inclusion criteria were interviewed. In the two weeks prior to the survey, 78.3% of respondents utilized formal health services as the first line of care for their child's illness episode. Factors significantly associated with decreased formal healthcare usage for the sick children were if the children were living in a displaced household, if the children's mother or father were not living, and if the children's caretaker was not the mother. Although utilization of formal health services for children was quite high after the tsunami, there were certain children who received significantly less care, including those who were displaced, those who were being cared for by someone other than their mother, and those for whom one or both parents had died. Among the recommendations are suggestions to target these children to ensure that they receive the health care they need.

  13. The Clinical and Classroom Utility of the Inventory of Reading Occupations: An Assessment Tool of Children ’s Reading Participation

    Directory of Open Access Journals (Sweden)

    Lenin Grajo

    2018-04-01

    Full Text Available Background: The aim of this study was to determine the initial clinical and classroom utility of the Inventory of Reading Occupations (IRO, a new tool to assess children’s reading participation. Method: The study used phenomenological qualitative and descriptive methods. The participants included 38 occupational therapists, speech-language pathologists, classroom teachers, and parents who completed or reviewed responses of children on the IRO. To provide triangulation, 20 of the children who completed the IRO were interviewed. Data were thematically analyzed and then categorized using a central StrengthsWeaknesses-Opportunities-Threats premise. Results: The majority of the participants indicated favorable response to the clinical and classroom utility of the tool. Common themes were (a the IRO is a user-friendly and engaging assessment that allows students to reflect on their reading participation; (b the IRO is more suitable for children who engage in more structured reading; (c the IRO can be adapted for older children; and (d there is a need to identify whether the IRO is better as a screening or a full assessment tool. Conclusion: The study provided useful perspectives on how the tool can be further improved as a measure of the reading participation of school-aged children.

  14. Recent and lifetime utilization of health care services by children and adolescent suicide victims: a case-control study.

    Science.gov (United States)

    Renaud, Johanne; Berlim, Marcelo T; Séguin, Monique; McGirr, Alexander; Tousignant, Michel; Turecki, Gustavo

    2009-10-01

    In the present paper we describe a case-control study on the utilization of health care services prior to suicide (across different time periods) among children and adolescents aged 11 to 18 years in the Province of Quebec, Canada and matched healthy controls. Utilization of services (i.e., contact with general practitioners, mental health professionals, psychiatrists and/or youth protection groups) was examined at different time periods in 55 child and adolescent suicide victims and 54 matched community controls using proxy-based interviews and questionnaires. In addition, we examined the rates of detection of psychopathology by health care professionals, the use of psychotropic medications and the subjects' compliance with treatment. Although more than 90% of child and adolescent suicide completers in our sample suffered from mental disorders, a significant proportion of them were left without appropriate healthcare support (including psychiatric consultation) in the period preceding their suicide. Also, 20% of suicide completers and no control subject made prior suicide attempts. More specifically, over two-thirds of suicide completers had no treatment contact within the month prior to the completion, while only 12.7% (n=7) of them were in contact with psychiatric services during that same period. Moreover, 56.4% (n=31) of the suicide completers had not been diagnosed as having a mental disorder at the time of their death, and 54.5% of the subjects' that received treatment (12 out of 22) were considered poorly compliant or not compliant at all according to their medical/psychosocial records. Finally, we also found that females seemed to have more psychiatric and mental health service contacts in the past month, that subjects with depressive and anxious disorders received more psychiatric and general mental health services in the past year, and that past month hospitalization was more often associated with alcohol abuse and psychosis. Relatively small sample size

  15. The Utility of the Social Communication Questionnaire in Screening for Autism in Children Referred for Early Intervention

    Science.gov (United States)

    Wiggins, Lisa D.; Bakeman, Roger; Adamson, Lauren B.; Robins, Diana L.

    2007-01-01

    The Social Communication Questionnaire (SCQ) is a brief parental screening instrument used to identify children with autism spectrum disorders (ASD). Screening validity for the SCQ has been supported in children 4 years of age and older, but ongoing studies indicate that the SCQ may not be effective in identifying very young children with ASD. The…

  16. Factors associated with utilization of long-acting and permanent contraceptive methods among women who have decided not to have more children in Gondar city.

    Science.gov (United States)

    Zenebe, Chernet Baye; Adefris, Mulat; Yenit, Melaku Kindie; Gelaw, Yalemzewod Assefa

    2017-09-06

    Despite the fact that long acting family planning methods reduce population growth and improve maternal health, their utilization remains poor. Therefore, this study assessed the prevalence of long acting and permanent family planning method utilization and associated factors among women in reproductive age groups who have decided not to have more children in Gondar city, northwest Ethiopia. An institution based cross-sectional study was conducted from August to October, 2015. Three hundred seventeen women who have decided not to have more children were selected consecutively into the study. A structured and pretested questionnaire was used to collect data. Both bivariate and multi-variable logistic regressions analyses were used to identify factors associated with utilization of long acting and permanent family planning methods. The multi-variable logistic regression analysis was used to investigate factors associated with the utilization of long acting and permanent family planning methods. The Adjusted Odds Ratio (AOR) with the corresponding 95% Confidence Interval (CI) was used to show the strength of associations, and variables with a P-value of <0.05 were considered statistically significant. In this study, the overall prevalence of long acting and permanent contraceptive (LAPCM) method utilization was 34.7% (95% CI: 29.5-39.9). According to the multi-variable logistic regression analysis, utilization of long acting and permanent contraceptive methods was significantly associated with women who had secondary school, (AOR: 2279, 95% CI: 1.17, 4.44), college, and above education (AOR: 2.91, 95% CI: 1.36, 6.24), history of previous utilization (AOR: 3.02, 95% CI: 1.69, 5.38), and information about LAPCM (AOR: 8.85, 95% CI: 2.04, 38.41). In this study the prevalence of long acting and permanent family planning method utilization among women who have decided not to have more children was high compared with previous studies conducted elsewhere. Advanced educational

  17. Utilization of Children with Special Health Care Needs (CSHCN) Screener© by O'ahu's pediatricians.

    Science.gov (United States)

    Guo, Mary; Chock, Galen; Parlin, Leolinda; Yamashiroya, Vince; Rudoy, Raul

    2013-05-01

    O'ahu's primary care physicians are in the process of implementing the Patient-Centered Medical Home (PCMH) model. The Medical Home Task Force recommends the implementation of the Children with Special Health Care Needs (CSHCN) Screener© as one of the two quality improvement programs that must be completed by each participating physician. This study sought to find how many pediatricians practice population health management and to determine barriers for incorporating population health management and care registries into practices. An online survey of 55 pediatricians in Hawai'i was conducted between January 10, 2012 and March 10, 2012. The survey contained questions regarding knowledge and use of population health management and investigated the utilization rate of the Screener©. This survey provides baseline data on the implementation of this recommended screener, and informs the process that will be necessary to ensure maximal adoption of recommendations. Sixty percent of the survey participants have not incorporated population health management into their routine practice. Twenty three percent did not have knowledge of population health management and 85% did not use a chronic disease registry. As of August 2011, 95% had not screened their patients with the Screener©. Reasons included not having heard of the Screener© and never having considered using a systematic process to ask patients to assess their health. Based on results, there are important educational goals that need to be accomplished in order for Hawai'i's physicians to transform their practices into effective PCMHs. Physicians will likely need instructional and monetary support to effectively change their practices into PCMHs.

  18. Nutritional Status And Its Association With Diabetes Mellitus In School Children, India

    Directory of Open Access Journals (Sweden)

    Muninarayana C

    2012-03-01

    Full Text Available Background: Poor health and nutrition may impair both the growth and intellectual development of school children. Incidence of malnutrition related childhood diabetes mellitus has increased and continues to be on the rise.Objectives: To assess the nutritional status by anthropometry and to screen for diabetes by capillary blood examination of school children. Design: Longitudinal study Setting: The study was carried out at Sri R.L.Jalappa Central School, Kolar from August 2008 to December 2009. Methods: All the school children were interviewed with pre-designed and pre-tested proforma. Height, Weight was measured by standard procedures. The nutritional status was analysed by Body Mass Index (BMI for age. The school children were also screened for diabetes mellitus by Finger stick capillary random plasma glucose testing. The children were followed up for any major medical problems during the study period.Participants: All the students studying in the school during study period.Results: Mean height and weight of children were found comparable to the ICMR pooled data. However, compared to NCHS standards and affluent Indian children the mean height and weight were found to be much inferior at all ages. According to BMI for age as per NCHS most of the children were undernourished (79.2% and 3 children (0.6% were overweight. Out of 495 children screened for diabetes 14 children had hyperglycaemia (>160mg/dl. These 14 children were further tested by oral glucose tolerance test and found to have normal blood sugars levels. During the follow up two undernourished children developed diabetes mellitus. Conclusion: The magnitude of malnutrition among school going children was found to be 79%. During the follow up two undernourished children developed diabetes mellitus, hence under nutrition was associated with diabetes mellitus.

  19. A study of acute phase and transport protein synthesis in undernourished men using simulated infection and uniformly 15N-labelled Spirulina Platenses

    International Nuclear Information System (INIS)

    Kurpad, A.V.; Soares, M.J.; Sekhar, R.V.; Reeds, P.J.; Fjeld, C.R.

    1994-01-01

    This study was conducted to test the hypothesis that acute phase protein synthesis is accelerated and transport protein synthesis is decelerated in adult men in whom the stress of infection is superimposed upon undernutrition. As a pilot study, four chronically undernourished men and two well-nourished controls were studied on two occasions separated by four days; the second session was conducted 24 hours after the administration of typhoid vaccine. Basal urine and blood samples were collected and then subjects were given priming oral doses of 15 N-Spirulina (13.5mg/kg body weight) and oral doses (3.5mg/kg body weight) every 30 min for the next six hours. Meals were aliquoted during the dosing period. Blood samples were collected at four, five and six hours. 15 N enrichment in different fractions of plasma i.e., albumin, non-albumin and amino acids, was measured by combustion GC-IRMS. Total urinary nitrogen was measured by Kjeldahl. 5 refs, 2 figs, 3 tabs

  20. Low transformation growth factor-β1 production and collagen synthesis correlate with the lack of hepatic periportal fibrosis development in undernourished mice infected with Schistosoma mansoni

    Directory of Open Access Journals (Sweden)

    Andreia Ferreira Barros

    2014-04-01

    Full Text Available Undernourished mice infected (UI submitted to low and long-lasting infections by Schistosoma mansoni are unable to develop the hepatic periportal fibrosis that is equivalent to Symmers’ fibrosis in humans. In this report, the effects of the host’s nutritional status on parasite (worm load, egg viability and maturation and host (growth curves, biology, collagen synthesis and characteristics of the immunological response were studied and these are considered as interdependent factors influencing the amount and distribution of fibrous tissue in hepatic periovular granulomas and portal spaces. The nutritional status of the host influenced the low body weight and low parasite burden detected in UI mice as well as the number, viability and maturation of released eggs. The reduced oviposition and increased number of degenerated or dead eggs were associated with low protein synthesis detected in deficient hosts, which likely induced the observed decrease in transformation growth factor (TGF-β1 and liver collagen. Despite the reduced number of mature eggs in UI mice, the activation of TGF-β1 and hepatic stellate cells occurred regardless of the unviability of most miracidia, due to stimulation by fibrogenic proteins and eggshell glycoproteins. However, changes in the repair mechanisms influenced by the nutritional status in deficient animals may account for the decreased liver collagen detected in the present study.

  1. Temporal Changes in Prescription of Neuropharmacologic Drugs and Utilization of Resources Related to Neurologic Morbidity in Mechanically Ventilated Children With Bronchiolitis.

    Science.gov (United States)

    Shein, Steven L; Slain, Katherine; Wilson-Costello, Deanne; McKee, Bryan; Rotta, Alexandre T

    2017-12-01

    Critically ill children with bronchiolitis may require neuropharmacologic medications and support for neuro-functional sequelae, but current practices are not well described. We aimed to describe recent trends in neuropharmacology and utilization of neuro-rehabilitation resources in mechanically ventilated children with bronchiolitis. Analysis of the multicenter Pediatric Health Information System database. Forty-seven U.S. children's hospitals. PICU patients less than 2 years old with bronchiolitis undergoing mechanical ventilation between 2006 and 2015. None. Annual rates of utilization of neuropharmacologic medications (sedatives, analgesics, etc) and of neuro-rehabilitation services (physical therapy, neurologic consultation, etc) over the 10-year study period were compared. Neuropharmacologic medications prescribed on greater than or equal to 2 days were extracted. Utilization of MRI of the brain, neurologic consultation, swallow evaluation, occupational therapy, and physical therapy was also extracted. Among 12,508 subjects, the median age was 2.8 months, ~50% had comorbid conditions, and the median duration of mechanical ventilation was 7 days. The percentage of children prescribed greater than or equal to five drugs/drug classes increased over the study period from 36.5% to 55.8% (p use of greater than or equal to one service (36.3% in 2006 to 59.6% in 2015; p use of greater than or equal to two services (20.8% to 34.8%; p use of vasoactive medications and mortality did not. Prescription of neuropharmacologic agents increased over time using metrics of both overall drug burden and specific drug usage. Concurrently, the utilization of services that evaluate and/or treat neurologic morbidity was common and also increased over time.

  2. Breeding of a leopard gecko in a kindergarden and it's utilization for awakening and intensifying children's interest in nature

    OpenAIRE

    Kovalová, Marie

    2016-01-01

    This thesis is focused on the theme of the reciprocal action of animals and pre-school children. It introduces us to the breeding of leopard geckos in kindergartens (with its benefits and disadvantages). Based on case studies, it describes a leopard gecko's influence on preschool children's personalities in kindergarten. The main method of research involves observing individual children as well as a group of children in a one- room kindergarten, Lísteček. Kindergarten Lísteček enrolls childre...

  3. Supportive care utilization and treatment toxicity in children with Down syndrome and acute lymphoid leukaemia at free-standing paediatric hospitals in the United States.

    Science.gov (United States)

    Salazar, Elizabeth G; Li, Yimei; Fisher, Brian T; Rheingold, Susan R; Fitzgerald, Julie; Seif, Alix E; Huang, Yuan-Shung; Bagatell, Rochelle; Aplenc, Richard

    2016-08-01

    Although inferior outcomes of children with Down syndrome (DS) and acute lymphoid leukaemia (ALL) are established, national supportive care patterns for these patients are unknown. A validated retrospective cohort of paediatric patients diagnosed with ALL from 1999 to 2011 was assembled from the US Pediatric Health Information System (PHIS) database to examine organ toxicity, sepsis, and resource utilization in children with and without DS. Among 10699 ALL patients, 298 had DS-ALL (2·8%). In a multivariate model, DS was associated with increased risk of cardiovascular (odds ratio [OR] 2·0, 95% confidence interval [CI] 1·6-2·7), respiratory (OR 2·1, 95% CI: 1·6-2·9), neurologic (OR 3·4, 95% CI 1·9-6·2), and hepatic (OR 1·4, 95% CI 1·0-1·9) dysfunction and sepsis (OR 1·8, 95% CI: 1·4-2·4). Children with DS-ALL used significantly more respiratory support, insulin, and anti-infectives, including broad-spectrum Gram-positive agents, quinolones, and azoles. They used significantly fewer analgesics and antiemetics compared to non-DS-ALL children. Ultimately, this study confirms the increased risk of infectious and end-organ toxicity in children with DS-ALL and quantifies important differences in resource utilization between children with DS and non-DS ALL. These findings highlight the importance of investigating the impact of these care variations and developing specific supportive care guidelines for this population. © 2016 John Wiley & Sons Ltd.

  4. A NATIONAL DEMONSTRATION PROJECT UTILIZING TELEVISED MATERIALS FOR THE FORMAL EDUCATION OF CULTURALLY DISADVANTAGED PRESCHOOL CHILDREN. FINAL REPORT.

    Science.gov (United States)

    MUKERJI, ROSE; AND OTHERS

    TO SUPPLY DISADVANTAGED PRESCHOOL CHILDREN WITH CULTURALLY STIMULATING EXPERIENCES, A TV SERIES, "ROUNDABOUT," WAS DESIGNED TO BE USED IN WASHINGTON, D.C. INNER-CITY PRESCHOOL AND DAY CARE CENTERS. THE 15-MINUTE PROGRAMS WERE TO INTRODUCE NEW EXPERIENCES AND SUPPLEMENT REGULAR ACTIVITIES. IT WAS HOPED THAT THE CHILDREN WOULD IDENTIFY…

  5. Exploring the utility of cardiorespiratory fitness as a population health surveillance indicator for children and youth: An international analysis of results from the 20-m shuttle run test.

    Science.gov (United States)

    Lang, Justin J

    2018-02-01

    Emerging evidence has demonstrated the strong link between cardiorespiratory fitness and multiple aspects of health (i.e., physiological, physical, psychosocial, cognitive), independent of physical activity, among school-aged children and youth. Cardiorespiratory fitness is a trait that does not vary substantially from day-to-day, and provides an indication of recent physical activity levels, making it an important possible indicator of population health. Thus, the objective of this dissertation was to investigate the utility of cardiorespiratory fitness, measured using the 20-m shuttle run test, as a broad, holistic health indicator for population health surveillance among children and youth. To achieve this objective we completed 7 manuscripts, all prepared for submission to peer-reviewed, scientific journals: (1) Systematic review of the relationship between 20-m shuttle run performance and health indicators among children and youth. (2) Review of criterion-referenced standards for cardiorespiratory fitness: what percentage of 1 142 026 international children and youth are apparently healthy? (3) Cardiorespiratory fitness is associated with physical literacy in a large sample of Canadian children aged 8 to 12 years. (4) International variability in 20-m shuttle run performance in children and youth: Who are the fittest from a 50-country comparison? A systematic review with pooling of aggregate results. (5) Making a case for cardiorespiratory fitness surveillance among children and youth. (6) International normative 20-m shuttle run values from 1 142 026 children and youth representing 50 countries. (7) Temporal trends in the cardiorespiratory fitness of children and adolescents representing 19 high-income and upper middle-income countries between 1981 and 2014. Combined, this dissertation provides support for the importance of cardiorespiratory fitness for health surveillance among school-aged children and youth. Results from the international analysis

  6. Prevalence of vaccine preventable diseases and utilization of routine immunizations services by parents of under‐one children in a semi‐urban community of Sokoto State, Nigeria

    Directory of Open Access Journals (Sweden)

    Kaoje AU

    2017-01-01

    Full Text Available Introduction Vaccine preventable diseases are categories of diseases that could be prevented by immunization. They affect children of less than five years of age. This study was conducted to determine the prevalence of vaccine preventable diseases and utilization of routine immunization services among parents/caregivers of under‐one children in Bodinga town of Sokoto State, Nigeria. Methods The study was community based and a descriptive cross sectional epidemiological study design was used. Four hundred households participated in the survey and were selected using a two stage sampling technique. A structured interviewer administered questionnaire with closed and some open‐ ended questions was used to collect the survey data through face‐to‐face interview. Data collected were entered into computer and analyzed using the SPSS version 23. Results were presented in simple tables for clarity. Results Measles was found to be the most prevalent vaccine preventable diseases in the community, while Hepatitis B has the least prevalence and mortality from these diseases was found to be 3%. Majority of the respondent were aware of Poliomyelitis as vaccine preventable disease and only few were aware of Hepatitis B vaccination. The percentage of fully vaccinated children was very low (4.75% while about one‐third of the children were not immunized at all. The socio‐cultural factors found to affect the utilization of routine immunization services includes: place of delivery (more for the hospital delivery, educational level and occupation of child’s parent affect positively more especially the mother. The major reason for not taking the children for immunization was Father’s refusal. Conclusion The study revealed that measles is the most prevalent vaccine preventable disease in the study area. The awareness of vaccine preventable diseases was found to be low except for poliomyelitis. Strengthening routine immunization including demand creation

  7. Health care utilization and cost among children with asthma who were enrolled in a health maintenance organization.

    Science.gov (United States)

    Lozano, P; Fishman, P; VonKorff, M; Hecht, J

    1997-06-01

    To measure the impact of asthma on the use and cost of health care by children in a managed care organization. Population-based historical cohort study. A medium-sized staff model health maintenance organization in western Washington state. All 71 818 children, between age 1 to 17 years, who were enrolled and used services during 1992. Children were identified with one or more asthma diagnoses during 1992 using automated encounter data. Nonurgent outpatient visits, pharmacy fills, urgent care visits, and hospital days, as well as associated costs were measured. All services were categorized as asthma care or nonasthma care. Multivariate regression analysis was used to compute marginal cost for asthma (difference in total cost between children with asthma and other children using services, adjusted for covariates). Treated prevalence of asthma was 4.9%. Children with asthma incurred 88% more costs ($1060.32 vs $563. 81/yr), filled 2.77 times as many prescriptions (11.59 vs 4.19/yr), made 65% more nonurgent outpatient visits (5.75 vs 3.48/yr), and had twice as many inpatient days (.23 vs .11/yr) compared with the general population of children using services. Asthma care represented 37% of all health care received by children with asthma, while the remaining 63% were for nonasthma services. Almost two-thirds of asthma-related costs were attributable to nonurgent outpatient care and prescriptions; only one third was attributable to urgent care and hospitalizations. Controlling for age, sex, and comorbidities, the marginal cost of asthma was $615.17/yr (95% confidence interval $502.73, $727.61), which includes asthma as well as nonasthma services. This marginal cost represents 58% of all health care costs for children with asthma. Children with asthma use significantly more health services (and incur significantly more costs) than other children using services, attributable largely to asthma care. The majority of all health care costs for children with asthma were for

  8. Access, acceptability and utilization of community health workers using diagnostics for case management of fever in Ugandan children: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Mukanga David

    2012-05-01

    Full Text Available Abstract Background Use of diagnostics in integrated community case management (iCCM of fever is recognized as an important step in improving rational use of drugs and quality of care for febrile under-five children. This study assessed household access, acceptability and utilization of community health workers (CHWs trained and provided with malaria rapid diagnostic tests (RDTs and respiratory rate timers (RRTs to practice iCCM. Methods A total of 423 households with under-five children were enrolled into the study in Iganga district, Uganda. Households were selected from seven villages in Namungalwe sub-county using probability proportionate to size sampling. A semi-structured questionnaire was administered to caregivers in selected households. Data were entered into Epidata statistical software, and analysed using SPSS Statistics 17.0, and STATA version 10. Results Most (86%, 365/423 households resided within a kilometre of a CHW’s home, compared to 26% (111/423 residing within 1 km of a health facility (p  Fifty-seven percent (243/423 of caregivers took their febrile children to a CHW at least once in the three month period preceding the survey. Households located 1–3 km from a health facility were 72% (AOR 1.72; 95% CI 1.11–2.68 more likely to utilize CHW services compared to households within 1 km of a health facility. Households located 1–3 km from a CHW were 81% (AOR 0.19; 95% CI 0.10–0.36 less likely to utilize CHW services compared to those households residing within 1 km of a CHW. A majority (79%, 336/423 of respondents thought CHWs services were better with RDTs, and 89% (375/423 approved CHWs’ continued use of RDTs. Eighty-six percent (209/243 of respondents who visited a CHW thought RRTs were useful. Conclusion ICCM with diagnostics is acceptable, increases access, and is the first choice for caregivers of febrile children. More than half of caregivers of febrile children utilized CHW services over a three

  9. Dopamine receptor genetic polymorphisms and body composition in undernourished pastoralists: An exploration of nutrition indices among nomadic and recently settled Ariaal men of northern Kenya

    Directory of Open Access Journals (Sweden)

    Gray Peter B

    2008-06-01

    Full Text Available Abstract Background Minor alleles of the human dopamine receptor polymorphisms, DRD2/TaqI A and DRD4/48 bp, are related to decreased functioning and/or numbers of their respective receptors and have been shown to be correlated with body mass, height and food craving. In addition, the 7R minor allele of the DRD4 gene is at a higher frequency in nomadic compared to sedentary populations. Here we examine polymorphisms in the DRD2 and DRD4 genes with respect to body mass index (BMI and height among men in two populations of Ariaal pastoralists, one recently settled (n = 87 and the other still nomadic (n = 65. The Ariaal live in northern Kenya, are chronically undernourished and are divided socially among age-sets. Results Frequencies of the DRD4/7R and DRD2/A1 alleles were 19.4% and 28.2%, respectively and did not differ between the nomadic and settled populations. BMI was higher in those with one or two DRD4/7R alleles in the nomadic population, but lower among the settled. Post-hoc analysis suggests that the DRD4 differences in BMI were due primarily to differences in fat free body mass. Height was unrelated to either DRD2/TaqI A or DRD4/48 bp genotypes. Conclusion Our results indicate that the DRD4/7R allele may be more advantageous among nomadic than settled Ariaal men. This result suggests that a selective advantage mediated through behaviour may be responsible for the higher frequency of the 7R alleles in nomadic relative to sedentary populations around the world. In contrast to previous work, we did not find an association between DRD2 genotypes and height. Our results support the idea that human phenotypic expression of genotypes should be rigorously evaluated in diverse environments and genetic backgrounds.

  10. Diagnostic Utility of the ADI-R and DSM-5 in the Assessment of Latino Children and Adolescents.

    Science.gov (United States)

    Magaña, Sandy; Vanegas, Sandra B

    2017-05-01

    Latino children in the US are systematically underdiagnosed with Autism Spectrum Disorder (ASD); therefore, it is important that recent changes to the diagnostic process do not exacerbate this pattern of under-identification. Previous research has found that the Autism Diagnostic Interview-Revised (ADI-R) algorithm, based on the Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition, Text Revision (DSM-IV-TR), has limitations with Latino children of Spanish speaking parents. We evaluated whether an ADI-R algorithm based on the new DSM-5 classification for ASD would be more sensitive in identifying Latino children of Spanish speaking parents who have a clinical diagnosis of ASD. Findings suggest that the DSM-5 algorithm shows better sensitivity than the DSM-IV-TR algorithm for Latino children.

  11. An evaluation of nutritional status of children in Anganwadi Centre of Hyderabad district of Andhra Pradesh stateusing WHO z- score technique

    Directory of Open Access Journals (Sweden)

    Shanawaz

    2013-01-01

    Full Text Available BACKGROUND In India the nationwide Integrated Child Development Services (ICDS uses the I.A.P criteria to grade under nutrition. The current WHO recommendation is to use Z score or the standard deviation system to grade under nutrition. Although widely recommended the z scores have not been widely used in India, especially in community based studies. AIMS & OBJECTIVES 1. To assess the socio-demographic profile of 0-72 months age group of children. 2. To find out the nutritional status of children using WHO z- score technique. METHODOLOGY A cross sectional, community-based was done in ICDS Anganwadi centers among the 400 ICDS children (0-6 years RESULTS There are (47.5% undernourished and (16.5% severely malnourished children according to WHO z score technique. Males (49.5% are comparatively more under nourished than females (45.5%. Female infants (31.2% are less undernourished when compared to male infants (50%. Literacy of mother had significance over the nutritional status of their children (p˂0.05. CONCLUSION The present study shows that there are still many children who are undernourished and severely malnourished in our country, even after 36 years of ICDS services. There is need to use WHO standards at the grass route levels to correctly identify the burden of under nutrition. Z score technique is simple to use, reliable and easy to understand at grass route level by health workers.

  12. Expected utility without utility

    OpenAIRE

    Castagnoli, E.; Licalzi, M.

    1996-01-01

    This paper advances an interpretation of Von Neumann–Morgenstern’s expected utility model for preferences over lotteries which does not require the notion of a cardinal utility over prizes and can be phrased entirely in the language of probability. According to it, the expected utility of a lottery can be read as the probability that this lottery outperforms another given independent lottery. The implications of this interpretation for some topics and models in decision theory are considered....

  13. Utilization of complementary and alternative medicine (CAM) among children from a German birth cohort (GINIplus): patterns, costs, and trends of use.

    Science.gov (United States)

    Italia, Salvatore; Brand, Helmut; Heinrich, Joachim; Berdel, Dietrich; von Berg, Andrea; Wolfenstetter, Silke Britta

    2015-03-10

    The use of complementary and alternative medicine (CAM) is widespread among children in Germany and other European countries. Only a few studies are available on trends in pediatric CAM use over time. The study's objective was to present updated results for prevalence, predictors, and costs of CAM use among German children and a comparison with findings from a previous follow-up of the same birth cohort. Data were collected for 3013 children on their utilization of medicinal products (during the last 4 weeks) and consultation with CAM providers (in the preceding year) from a German birth cohort study (GINIplus, 15-year follow-up) using a self-administered questionnaire. The reported medicinal CAMs were classified into six categories (homeopathy, herbal drugs, nutritionals, minerals and trace elements, microorganisms, further CAM). Drug prices were traced using pharmaceutical identification numbers (PZNs), or otherwise conservatively estimated. Finally, the results were compared with data obtained from the 10-year follow-up of the same birth cohort study by adopting the identical methodology. In all, 26% of the reported 2489 drugs were medicinal CAM. The 4-week prevalence for homeopathy and herbal drug use was 7.5% and 5.6%, respectively. Some 13.9% of the children used at least one type of medicinal CAM in the preceding 4 weeks. The 1-year prevalence for consultation with CAM providers was 10.8%. From the drugs identified as CAM, 53.7% were homeopathic remedies, and 30.8% were herbal drugs. Factors associated with higher medicinal CAM use were female gender, residing in Munich, and higher maternal education. A homeopathy user utilized on average homeopathic remedies worth EUR 15.28. The corresponding figure for herbal drug users was EUR 16.02, and EUR 18.72 for overall medicinal CAM users. Compared with the 10-year follow-up, the prevalence of homeopathy use was more than halved (-52%) and dropped substantially for herbal drug use (-36%) and overall CAM use (-38

  14. Utility of an abbreviated version of the stanford-binet intelligence scales (5th ed.) in estimating 'full scale' IQ for young children with autism spectrum disorder.

    Science.gov (United States)

    Twomey, Conal; O'Connell, Helen; Lillis, Mary; Tarpey, Sarah Louise; O'Reilly, Gary

    2018-03-01

    The fifth edition of the Stanford-Binet Intelligence scales allows 'full scale' IQ (FSIQ) to be estimated using an abridged version of the test-the abbreviated battery IQ (ABIQ). Set within a public early intervention team service, the current cross-sectional study investigated the utility of the ABIQ in estimating FSIQ for 40 children with autism spectrum disorder (ASD) aged 3-5 years. A strong ABIQ-FSIQ association was yielded (r = 0.89; r 2  = 0.808) and the ABIQ did not over-estimate mean FSIQ above a clinically-relevant threshold; however, clinically significant over-estimation occurred in 17.5% of individual cases. While the findings provide support for the utility of the ABIQ in estimating FSIQ for young children with ASD, caution relating to the over-estimation of FSIQ is warranted. Careful clinical judgment-ideally based on examination of previous cognitive assessment results (if available), thorough interactional observations, and close multi-disciplinary consultation-is necessary to determine the applicability of the ABIQ to individual cases. Autism Res 2018, 11: 503-508. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. We investigated the utility of a shortened version of the Stanford-Binet Intelligence Scales in estimating IQ for 40 young children with autism spectrum disorder (ASD). The findings provide qualified support for the instrument: acceptably accurate IQ estimation was achieved for most cases; but not so for a sizeable minority (17.5%). Careful clinical judgment is necessary to determine the applicability of the ABIQ to individual cases. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.

  15. Drawing on resilience: piloting the utility of the Kinetic Family Drawing to measure resilience in children of HIV-positive mothers

    Directory of Open Access Journals (Sweden)

    L Ebersöhn

    2012-01-01

    Full Text Available In this article we describe how using a visual, child-friendly measure of resilience in a randomised control trial (RCT, the Kgolo Mmogo (KM project, resulted in representative insights on resilience in a mother-child relationship where the mother is HIV-positive. We used the existing psychological method Kinetic Family Drawing (KFD to measure resilience of young children in the qualitative phase of the concurrent mixed method RCT as the children represent cultural groups for whom standardized measures have not been developed. We use the case example of baseline KM assessment data of 6 year olds (n = 11; 3 female, 8 male. The results of the study demonstrate that the visual and qualitative data from children (KFD added to quantitative information obtained from mothers (Vineland Adaptive Behavior Scale, VABS. Additional information from the KFD had interpretation value for VABS scores and provided a child's perspective regarding resilience. Contrasting information from the KFD problematized mothers' perspectives as indicated in the VABS. The absence of significant information in KFD results regarding VABS sub-domains indicates differences in the cultural/contextual conceptualization of resilience. This exploratory study indicates initial support for the cross-cultural utility of the KFD to measure resilience in young children faced with adversity.

  16. Utility of a summative scale based on the Children with Special Health Care Needs (CSHCN) Screener to identify CSHCN with special dental care needs.

    Science.gov (United States)

    Iida, Hiroko; Lewis, Charlotte W

    2012-08-01

    Our objective was to determine if a summative scale reflecting the number of positive criteria on the Children with Special Health Care Needs (CSHCN) Screener is useful in identifying subgroups of CSHCN at risk for poorer oral health and unmet dental care needs and who should be considered to have special dental care needs. Data were analyzed for a population-based sample of 91,642 US children needs in the past 12 months. Descriptive and multivariable logistic regression analyses were performed for each outcome using the survey command in Stata to account for the sampling design. A summative scale based on the number of positive CSHCN Screener criteria was independently associated with various parent-perceived poorer oral health outcomes in children. CSHCN who met 4 or 5 screener criteria had 4 and 4.5 times, respectively, the odds of having fair-poor condition of teeth and bleeding gums relative to non-CSHCN. They also had 87% higher odds for parent-perceived toothache and 2 and 2.5 times the odds of having recent broken teeth and unmet dental care needs relative to non-CSHCN, respectively. There was no dose-dependent association between summative number of positive CSHCN Screener criteria and reported cavities in children. Application of a summative score based on the CSHCN Screener has utility in identifying the CSHCN subgroup with special dental care needs.

  17. Utility of adjunctive macrolide therapy in treatment of children with asthma: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Mikailov A

    2013-01-01

    Full Text Available Anar Mikailov,1 Ilona Kane,2 Stephen C Aronoff,3 Raemma Luck,3,† Michael T DelVecchio31Beth Israel Deaconess Medical Center, Boston, MA, 2St Christopher's Hospital for Children, Philadelphia, PA, 3Department of Pediatrics, Temple University School of Medicine, Philadelphia, PA, USA†Raemma Luck is now deceasedBackground: The purpose of this study was to investigate macrolides as an adjunct to an asthma controller regimen in children with asthma.Methods: Prospective clinical trials of macrolide therapy in children with asthma using outcome measures of change in forced expiratory volume in one second (FEV1 and/or oral corticosteroid requirement were searched for in PubMed up to December 2009. The reference lists of studies were also included in the analysis, as well as those listed in published meta-analyses.Results: The literature search yielded 116 studies, six of which were included in this meta-analysis. The change in FEV1 from baseline with adjunctive use of macrolide therapy in all children was not significant (0.25% predicted; 95% confidence interval [CI] −0.37, 0.86 predicted, P = 0.43; however, the change in FEV1 among children receiving daily oral corticosteroids was significant (3.89% predicted; 95% CI −0.01, 7.79, P = 0.05. Addition of macrolide therapy to the treatment of children with oral corticosteroid-dependent asthma resulted in a statistically significant decrease in daily corticosteroid dosage (−3.45 mg/day; 95% CI −5.79, −1.09 mg/day, P = 0.004. This reduction in daily corticosteroid dosage was directly proportional to the duration of macrolide therapy (−0.17 mg methylprednisolone per week of macrolide therapy; 95% CI −0.33, −0.021, P = 0.025.Conclusion: Addition of macrolides to the treatment regimen of children with oral corticosteroid-dependent asthma improves FEV1 and decreases the daily dosage of corticosteroids required for control in these children. The degree of dose reduction is directly related to

  18. Mullen scales of early learning: the utility in assessing children diagnosed with autism spectrum disorders, cerebral palsy, and epilepsy.

    Science.gov (United States)

    Burns, Thomas G; King, Tricia Z; Spencer, Katherine S

    2013-01-01

    A group of 47 patients diagnosed with neurodevelopmental disorders were compared to 47 age-, gender-, and racially matched typically developing children to examine the frequency of impairment across domains of the Mullen Scales of Early Learning (MSEL). The MSEL is a comprehensive measure of cognitive functioning designed to assess infants and preschool children between the ages of birth to 68 months. In the neurodevelopmental group, the sample was composed of children 2 to 4 years of age who were diagnosed with autism spectrum disorders (ASD; n = 19), cerebral palsy (CP; n = 14), and epilepsy (EPI; n = 14). A sample of 47 matched controls, taken from the normative sample of the MSEL, was used as a comparison group. Each one of the clinical groups comprising the neurodevelopmental sample demonstrated statistically significant delays across domains relative to the respective matched control group (p Children failed to demonstrate a "signature" profile for a diagnosis of ASD, CP, or EPI. The clinical sensitivity of the MSEL and the need for obtaining specific intervention services for children diagnosed with these conditions are presented. Finally, these results are discussed within the context of the clinical sensitivity of the MSEL in working with these clinical populations.

  19. Differences in the prevalence of hospitalizations and utilization of emergency outpatient services for ambulatory care sensitive conditions between asylum-seeking children and children of the general population: a cross-sectional medical records study (2015

    Directory of Open Access Journals (Sweden)

    Célina Lichtl

    2017-11-01

    Full Text Available Abstract Background Hospitalizations for ambulatory care sensitive (ACS conditions are established indicators for the availability and quality of ambulatory care. We aimed to assess the differences between asylum-seeking children and children of the general population in a German city with respect to (i the prevalence of ACS hospitalizations, and (ii the utilization of emergency outpatient services for ACS conditions. Methods Using anonymous account data, all children admitted to the University Hospital Heidelberg in 2015 were included in our study. A unique cost unit distinguished asylum seekers residing in a nearby reception center (exposed from the children of the general population. We adapted international lists of ACS conditions and calculated the prevalence of ACS hospitalizations and the utilization of emergency outpatient services for ACS conditions, attributable fractions among the exposed (Afe and the population attributable fraction among total admissions (PAF for each outcome. Differences in the prevalence of each outcome between exposed and controls were analyzed in logistic regression models adjusted for sex, age group and quarterly admission. Results Of the 32,015 admissions in 2015, 19.9% (6287 were from inpatient and 80.1% (25,638 from outpatient care. In inpatient care, 9.8% (622 of all admissions were hospitalizations for ACS conditions. The Afe of ACS hospitalizations was 46.57%, the PAF was 1.12%. Emergency service use for ACS conditions could be identified in 8.3% (3088 of all admissions (Afe: 79.57%, PAF: 5.08%. The odds ratio (OR of asylum-seeking children being hospitalized for ACS conditions in comparison to the control group was 1.81 [95% confidence interval, CI: 1.02; 3.2]. The OR of the asylumseeking population compared to the general population for the utilization of emergency service use for ACS conditions was 4.93 [95% CI: 4.11; 5.91]. Conclusions Asylum-seeking children had significantly higher odds of ACS

  20. Utilization of Stimulants and Atomoxetine for Attention-Deficit/Hyperactivity Disorder among 5.4 Million Children Using Population-Based Longitudinal Data

    DEFF Research Database (Denmark)

    Furu, Kari; Karlstad, Øystein; Zoëga, Helga

    2017-01-01

    Use of stimulants to treat attention-deficit/hyperactivity disorder (ADHD) has increased over the past two decades and varies substantially between countries. The objective of this multinational population-based study was to examine utilization of ADHD drugs (stimulants and atomoxetine) including...... the importance of close monitoring of treatment for ADHD among children.......Use of stimulants to treat attention-deficit/hyperactivity disorder (ADHD) has increased over the past two decades and varies substantially between countries. The objective of this multinational population-based study was to examine utilization of ADHD drugs (stimulants and atomoxetine) including...... comedication with other psychotropic drugs in the entire child population in the five Nordic countries. We included longitudinal data on dispensed ADHD drugs from five Nordic prescription registers during 2008-2012, which in 2012 comprised 48,296 individuals among 5.42 million inhabitants aged 0-17 years...

  1. Assessing the Quality of Life Using the Health Utilities Index Questionnaire in Children With Severe Persistent Asthma During the Treatment With Omalizumab

    Directory of Open Access Journals (Sweden)

    Leyla S. Namazova-Baranova

    2017-01-01

    Full Text Available Background. Quality of life (QoL is an important parameter that provides additional information about changes in health status. Objective. Our aim was to study the change in QoL of patients with severe persistent bronchial asthma (BA during the treatment with genetically engineered biological preparation (GIBP omalizumab in addition to daily background therapy. Methods. The QoL assessment was conducted using the Health Utilities Index Mark 3 and Mark 2 (HUI3, HUI2 questionnaires at two points (1st point and 2nd point — in 6 months in 47 children with severe BA at the age of 13 (7; 17 years, 72% of them are boys. At the same points, QoL was evaluated using the PAQLQ (S specialized pediatric questionnaire (Standardized Pediatric Asthma Quality of Life Questionnaire. Results. Depending on the duration of omalizumab therapy, all children were divided into 5 groups: 1st group — children who did not receive treatment with monoclonal antibodies at the 1st point; in 2, 3, 4, 5-th groups, the QoL assessment was performed on GIBP treatment for different time. In children of the 1st group whose QoL was evaluated before starting GIBP therapy and in 6 months, a statistically significant change in scores on the Health Utilities Index questionnaire was noted: the multi-attribute indices HUI2 and HUI3 improved, respectively, by 21.3 and 10.71% (p = 0.041 and 0.086. According to the HUI2 classification system, a significant improvement in the emotion attribute was revealed, which positively correlated with the overall indicator and the emotion indicator of the PAQLQ (S questionnaire. In the remaining groups, the indicators of the Health Utilities Index questionnaire did not change significantly. Conclusion. The study results showed that the dynamics of the quality of life in children with severe persistent BA is an important additional criterion in a comprehensive assessment of the efficacy of targeted bioengineering therapy. 

  2. Lack of utility of repeat monitoring of hemoglobin and hematocrit following blunt solid organ injury in children.

    Science.gov (United States)

    Acker, Shannon N; Petrun, Branden; Partrick, David A; Roosevelt, Genie E; Bensard, Denis D

    2015-12-01

    Current management protocols for children with blunt solid organ injury to the liver and spleen call for serial monitoring of the child's hemoglobin and hematocrit every 6, 12, or 24 hours, depending on the injury grade. We hypothesized that children who require emergent intervention in the form of laparotomy, angioembolization, or packed red blood cell (PRBC) transfusion because of bleeding from a solid organ injury will have changes in their vital signs that alert the clinician to the need for intervention, making scheduled laboratory evaluation unnecessary. We performed a retrospective review of all children admitted to either of two pediatric trauma centers following blunt trauma with any grade liver or spleen injury from January 2009 to December 2013. Data evaluated include a need for intervention, indication for intervention, and timing of intervention. A total of 245 children were admitted with blunt liver or spleen injury. Six patients (2.5%) underwent emergent exploratory laparotomy for hypotension a median of 4 hours after injury (range, 2-4 hours), four of who required splenectomy. No child required laparotomy for delayed bleeding from a solid organ injury. One child (0.4%) underwent angioembolization for blunt splenic injury. Forty-one children (16.7%) received a PRBC transfusion during hospitalization, 32 of whom did not undergo laparotomy or angioembolization. Children who underwent an intervention had a lower nadir hematocrit (median, 22.9 vs. 32.8; p hematocrit (median, 35.5 vs. 16 hours; p hemoglobin and hematocrit monitoring (median, 20 vs. 5; p hemoglobin and hematocrit values may not be necessary. Retrospective study with no negative criteria, prognostic study, level III.

  3. The utility of ultrasonography in the the diagnostics and monitoring of treatment of acute abdominal pain in children with neoplasms

    International Nuclear Information System (INIS)

    Zaleska-Dorobisz, U.; Jankowski, B.; Maciaszek, A.; Moron, K.

    2005-01-01

    The aim of this study was to estimate the results of the diagnostic imaging modalities, especially ultrasonography (US) in children during the oncological therapy with the acute abdominal symptoms. Acute abdominal symptoms in children with neoplasms causing a very difficult clinical and diagnostic problems and can occur in any stage of disease. The high-resolution ultrasound has a very important role in diagnosis in all patients with acute abdominal pain and with neoplasms. The authors consider that the US should be the first imaging method in the differential diagnosis of the abdominal changes in children with neutropenia and oncological disease. Proper diagnosis should be established only with clinical information. We analyzed 249 ultrasounds examinations of the abdominal cavity in 144 girls and 105 boys aged from 1 to 18 years (mean age 10, 3 years). The more important indication for the US exam in 133 cases was acute abdominal symptoms. We took exams during pre- and postoperative chemotherapy, radiotherapy and after the hematopoietic stem cell transplantation. All the patients were under routine hematological control. Based on the clinical symptoms and the laboratory tests we analysed two groups of children with oncological disease and acute abdomen: I group - 111 children with neutropenia, II group - 22 children without neutropenia. In the patients who underwent operation procedure the final diagnosis was established on histopathology. In the other cases diagnosis was based on clinical, laboratory and radiological exams, especially ultrasonography. We analyzed clinical picture of disease, the results of therapy and the US changes in examined patients using statistic parameters as: sensitivity, specificity and efficiency. In the group of 133 children with acute abdominal symptoms the most (92- 69,1%) patients suffer from ALL (acute lymphoblastic leukaemia) and 16(12%) - from AML (acute lymphoblastic leukaemia), Ewing sarcoma-3(2,2%), osteosarcoma - 3(2,2%), NHL

  4. The effect of balanced protein energy supplementation in undernourished pregnant women and child physical growth in low- and middle-income countries: a systematic review and meta-analysis.

    Science.gov (United States)

    Stevens, Briony; Buettner, Petra; Watt, Kerrianne; Clough, Alan; Brimblecombe, Julie; Judd, Jenni

    2015-10-01

    The beneficial effect of balanced protein energy supplementation during pregnancy on subsequent child growth is unclear and may depend upon the mother entering pregnancy adequately nourished or undernourished. Systematic reviews to-date have included studies from high-, middle- and low-income countries. However, the effect of balanced protein energy supplementation should not be generalised. This review assesses the effect of balanced protein energy supplementation in undernourished pregnant women from low- and middle-income countries on child growth. A systematic review of articles published in English (1970-2015) was conducted via MEDLINE, Scopus, the Cochrane Register and hand searching. Only peer-reviewed experimental studies analysing the effects of balanced protein energy supplementation in undernourished pregnant women from low- and middle-income countries with measures of physical growth as the primary outcome were included. Two reviewers independently assessed full-text articles against inclusion criteria. Validity of eligible studies was ascertained using the Quality Assessment Tool for Quantitative Studies (EPHPP QAT). In total, seven studies met the inclusion criteria. All studies reported on birthweight, five on birth length, three on birth head circumference, and one on longer-term growth. Standardised mean differences were calculated using a random-effects meta-analysis. Balanced protein energy supplementation significantly improved birthweight (seven randomised controlled trials, n = 2367; d = 0.20, 95% confidence interval, 0.03-0.38, P = 0.02). No significant benefit was observed on birth length or birth head circumference. Impact of intervention could not be determined for longer-term physical growth due to limited evidence. Additional research is required in low- and middle-income countries to identify impacts on longer-term infant growth. © 2015 John Wiley & Sons Ltd.

  5. Utilizing Storytelling to Promote Emotional Well-Being of Children With a Distinct Physical Appearance: The Case of Children Who Wear Eyeglasses

    Directory of Open Access Journals (Sweden)

    Andreas Brouzos

    2016-03-01

    Full Text Available This study explored the effectiveness of storytelling in supporting children with unusual physical traits. Participants were forty-eight children, aged 9 – 12 who, due to various eye diseases, wear eyeglasses. They completed various standardized self-report measures, both before and after participation, in one of the six intervention groups. The measures assessed shyness and social anxiety symptoms, loneliness and social dissatisfaction, perception of negative evaluation, satisfaction with one’s appearance, and anxiety regarding physical appearance. The intervention consisted of six 90-min group sessions and included both individual and group activities. The results lend support to the hypothesis that storytelling can significantly contribute to the emotional well-being of children, with a distinct physical appearance.

  6. Children's tooth decay in a public health program to encourage low-income pregnant women to utilize dental care

    Directory of Open Access Journals (Sweden)

    Shirtcliff R Mike

    2010-02-01

    Full Text Available Abstract Background A community-based public health program to provide a dental home for women covered by the Oregon Health Plan (Medicaid in Klamath County, Oregon USA was instituted with the long-term goal to promote preventive oral care for both mothers and their new infants provided by dental managed care companies. Methods As part of the evaluation of the program, children in Klamath and comparable non-program counties were examined in their 2nd year of life to begin to determine if benefits accrued to the offspring of the mothers in Klamath County. Results Eighty-five and 58.9% of the children were caries free in the Klamath and comparison county samples, respectively (RR = 1.48, 95% CI 1.13, 1.93. The mean (SD number of teeth with any decay was .75 (2.5 in the test population and 1.6 (2.5 in the comparison population (t = 2.08, p = .04. Conclusions The assessment showed that children of mothers in the Klamath County program were about one and a half times more likely to be caries free than children in the comparison counties. Additional controlled studies are being undertaken.

  7. Children's tooth decay in a public health program to encourage low-income pregnant women to utilize dental care.

    Science.gov (United States)

    Milgrom, Peter; Sutherland, Marilynn; Shirtcliff, R Mike; Ludwig, Sharity; Smolen, Darlene

    2010-02-18

    A community-based public health program to provide a dental home for women covered by the Oregon Health Plan (Medicaid) in Klamath County, Oregon USA was instituted with the long-term goal to promote preventive oral care for both mothers and their new infants provided by dental managed care companies. As part of the evaluation of the program, children in Klamath and comparable non-program counties were examined in their 2nd year of life to begin to determine if benefits accrued to the offspring of the mothers in Klamath County. Eighty-five and 58.9% of the children were caries free in the Klamath and comparison county samples, respectively (RR = 1.48, 95% CI 1.13, 1.93). The mean (SD) number of teeth with any decay was .75 (2.5) in the test population and 1.6 (2.5) in the comparison population (t = 2.08, p = .04). The assessment showed that children of mothers in the Klamath County program were about one and a half times more likely to be caries free than children in the comparison counties. Additional controlled studies are being undertaken.

  8. Let's Draw: Utilizing Interactive White Board to Support Kindergarten Children's Visual Art Learning Practice

    Science.gov (United States)

    Chou, Pao-Nan; Chang, Chi-Cheng; Chen, Mei-Yin

    2017-01-01

    Compared to other academic disciplines, interactive white board (IWB) research in early childhood education is still in its infancy. To add more knowledge base regarding the instructional effectiveness of IWB for young children, this study aimed to investigate educational phenomenon of using an IWB to teach visual art to kindergarten students. The…

  9. Chest health surveillance utility in the early detection of bronchiolitis obliterans syndrome in children after allo-SCT.

    Science.gov (United States)

    Gassas, A; Craig-Barnes, H; Dell, S; Doyle, J; Schechter, T; Sung, L; Egeler, M; Palaniyar, N

    2013-06-01

    To prospectively assess whether periodic chest health surveillance is beneficial for the early detection of bronchiolitis obliterans syndrome (BOS) in children after allo-SCT. Children up to 18 years of age receiving allo-SCT from September 2009 to September 2011 were included. Surveillance consisted of the following: a 7-item respiratory system questionnaire of cough, wheeze and shortness of breath; focused physical examination; and pulmonary function test (PFT) conducted before SCT and at 1, 3, 6, 9, 12, 18 and 24 months after SCT. Thirty-nine patients were enrolled. Five children developed BOS at a median time of 192 days (range 94-282). Positive response comparisons between the BOS group vs the non-BOS group were NS for history questionnaire (P=0.2), heart rate (P=0.3), respiratory rate (P=0.3) and oxygen saturation monitoring (P=0.8). Differences between the two groups for chest auscultation and PFT were statistically significant (P=0.03 and P=0.01, respectively). However, chest auscultation in the BOS group was only positive after BOS diagnosis. PFT reduction was evident in the asymptomatic phase (BOS group 33%; non-BOS group 4.5%, P=0.01). Changes in PFT, but not history/physical examination, allow the early detection of BOS in children after SCT. Our study is limited by the small sample size.

  10. A Look at the Memory Performance of Retarded and Normal Children Utilizing the Levels of Processing Framework.

    Science.gov (United States)

    Lupart, Judy L.; Mulcahy, Robert F.

    Memory performance differences of mental age matched (9-12 years) educable mentally retarded (EMR) (n=56) and normal (n=56) children were examined in two experiments using the F. Craik and R. Lockhart levels of processing framework. In experiment 1, Ss were randomly assigned to an incidental, intentional, or planned intentional learning condition,…

  11. Utility of the Psychoeducational Profile-3 for Assessing Cognitive and Language Skills of Children with Autism Spectrum Disorders

    Science.gov (United States)

    Fulton, Mandy L.; D'Entremont, Barbara

    2013-01-01

    The Psychoeducational Profile-3's (PEP-3) ability to estimate cognitive and language skills of 136 children (20-75 months) with autism spectrum disorders (ASDs) across a range of functioning, and the association between the PEP-3 and ASD symptomatology was examined using retrospective data. PEP-3 cognitive and language measures were positively…

  12. Diagnostic Utility of the ADI-R and DSM-5 in the Assessment of Latino Children and Adolescents

    Science.gov (United States)

    Magaña, Sandy; Vanegas, Sandra B.

    2017-01-01

    Latino children in the US are systematically underdiagnosed with Autism Spectrum Disorder (ASD); therefore, it is important that recent changes to the diagnostic process do not exacerbate this pattern of under-identification. Previous research has found that the Autism Diagnostic Interview-Revised (ADI-R) algorithm, based on the Diagnostic and…

  13. Single and Cumulative Relations of Social Risk Factors with Children's Dental Health and Care-Utilization Within Regions of the United States.

    Science.gov (United States)

    Yang, Alyssa J; Gromoske, Andrea N; Olson, Melissa A; Chaffin, Jeffrey G

    2016-03-01

    The purpose is to examine the relation of social risk factors, and the cumulative burden of social risk factors, on parent-reported dental health and dental care-seeking behavior. National Survey of Children's Health data (2011-2012) were analyzed for US children by Title V Block Grant regions. Multivariate logistic regressions were estimated for ten social risk factors, as well as a cumulative risk index, to find any associations with poor condition of teeth, presence of dental caries, and no dental care visits. Almost all of the risk factors were significantly associated with poor condition of teeth and presence of dental caries for the US. Models associating no dental care visits suggested that low family income (OR 1.58), poor maternal mental health (OR 1.54), high school education or less (OR 1.34), and multi-racial/other race (OR 1.18) were significant factors for the US. Regional variation existed for those risk factors and their association with the outcomes, but income, education, and poor maternal mental health consistently played a significant role in adverse outcomes. The cumulative risk index was strongly related to poor oral health outcomes, with a weaker relationship to dental care utilization. US children experiencing certain social risk factors, such as low family income, high school education or less, and poor maternal mental health, are likely to be at greater risk for poor dental health and low levels of dental-care seeking behavior. Children experiencing multiple social risks are at greater risk for poor oral outcomes than children who experience fewer social risks. An approach that involves the social determinants of health is needed to address these issues.

  14. A Developmental Examination of the Psychometric Properties and Predictive Utility of a Revised Psychological Self-Concept Measure for Preschool-Aged Children

    Science.gov (United States)

    Jia, Rongfang; Lang, Sarah N.; Schoppe-Sullivan, Sarah J.

    2015-01-01

    Accurate assessment of psychological self-concept in early childhood relies on the development of psychometrically sound instruments. From a developmental perspective, the current study revised an existing measure of young children's psychological self-concepts, the Child Self-View Questionnaire (CSVQ, Eder, 1990), and examined its psychometric properties using a sample of preschool-aged children assessed at approximately 4 years old with a follow-up at age 5 (N = 111). The item compositions of lower-order dimensions were revised, leading to improved internal consistency. Factor Analysis revealed three latent psychological self-concept factors (i.e., Sociability, Control, and Assurance) from the lower-order dimensions. Measurement invariance by gender was supported for Sociability and Assurance, not for Control. Test-retest reliability was supported by stability of the psychological self-concept measurement model during the preschool years, although some evidence of increasing differentiation was obtained. Validity of children's scores on the three latent psychological self-concept factors was tested by investigating their concurrent associations with teacher-reported behavioral adjustment on the Social Competence and Behavior Evaluation Scale – Short Form (SCBE-SF, LaFreniere & Dumas, 1996). Children who perceived themselves as higher in Sociability at 5 years old displayed less internalizing behavior and more social competence; boys who perceived themselves as higher in Control at age 4 exhibited lower externalizing behavior; children higher in Assurance had greater social competence at age 4, but displayed more externalizing behavior at age 5. Implications relevant to the utility of the revised psychological self-concept measure are discussed. PMID:26098231

  15. A developmental examination of the psychometric properties and predictive utility of a revised psychological self-concept measure for preschool-age children.

    Science.gov (United States)

    Jia, Rongfang; Lang, Sarah N; Schoppe-Sullivan, Sarah J

    2016-02-01

    Accurate assessment of psychological self-concept in early childhood relies on the development of psychometrically sound instruments. From a developmental perspective, the current study revised an existing measure of young children's psychological self-concepts, the Child Self-View Questionnaire (CSVQ; Eder, 1990), and examined its psychometric properties using a sample of preschool-age children assessed at approximately 4 years old with a follow-up at age 5 (N = 111). The item compositions of lower order dimensions were revised, leading to improved internal consistency. Factor analysis revealed 3 latent psychological self-concept factors (i.e., sociability, control, and assurance) from the lower order dimensions. Measurement invariance by gender was supported for sociability and assurance, not for control. Test-retest reliability was supported by stability of the psychological self-concept measurement model during the preschool years, although some evidence of increasing differentiation was obtained. Validity of children's scores on the 3 latent psychological self-concept factors was tested by investigating their concurrent associations with teacher-reported behavioral adjustment on the Social Competence and Behavior Evaluation Scale-Short Form (SCBE-SF; LaFreniere & Dumas, 1996). Children who perceived themselves as higher in sociability at 5 years old displayed less internalizing behavior and more social competence; boys who perceived themselves as higher in control at age 4 exhibited lower externalizing behavior; children higher in assurance had greater social competence at age 4, but displayed more externalizing behavior at age 5. Implications relevant to the utility of the revised psychological self-concept measure are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  16. Utilization of low-dose multidetector CT and virtual bronchoscopy in children with suspected foreign body aspiration

    International Nuclear Information System (INIS)

    Adaletli, Ibrahim; Kurugoglu, Sebuh; Ulus, Sila; Ozer, Harun; Kantarci, Fatih; Mihmanli, Ismail; Akman, Canan; Elicevik, Mehmet

    2007-01-01

    Foreign body aspiration is common in children, especially those under 3 years of age. Chest radiography and CT are the main imaging modalities for the evaluation of these children. Management of children with suspected foreign body aspiration (SFBA) mainly depends on radiological findings. To investigate the potential use of low-dose multidetector CT (MDCT) and virtual bronchoscopy (VB) in the evaluation and management of SFBA in children. Included in the study were 37 children (17 girls, 20 boys; age 4 months to 10 years, mean 32 months) with SFBA. Chest radiographs were obtained prior to MDCT in all patients. MDCT was performed using a low-dose technique. VB images were obtained in the same session. Conventional bronchoscopy (CB) was performed within 24 h on patients in whom an obstructive abnormality had been found by MDCT and VB. Obstructive pathology was found in 16 (43.25%) of the 37 patients using MDCT and VB. In 13 of these patients, foreign bodies were detected and removed via CB. The foreign bodies were located in the right main bronchus (n = 5), in the bronchus intermedius (n = 6), in the medial segment of the middle lobe bronchus (n = 1), and in the left main bronchus (n = 1). In the remaining three patients, the diagnosis was false-positive for an obstructive pathology by MDCT and VB; the final diagnoses were secretions (n = 2) and schwannoma (n = 1), as demonstrated by CB. In 21 patients in whom no obstructive pathology was detected by MDCT and VB, CB was not performed. These patients were followed for 5-20 months without any recurrent obstructive symptomatology. Low-dose MDCT and VB are non-invasive radiological modalities that can be used easily in the investigation of SFBA in children. MDCT and VB provide the exact location of the obstructive pathology prior to CB. If obstructive pathology is depicted with MDCT and VB, CB should be performed either for confirmation of the diagnosis or for the diagnosis of an alternative cause for the obstruction

  17. Utility of the modified ATP III defined metabolic syndrome and severe obesity as predictors of insulin resistance in overweight children and adolescents: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Agarwalla Vipin

    2007-02-01

    Full Text Available Abstract Background The rising prevalence of obesity and metabolic syndrome (MetS has received increased attention since both place individuals at risk for Type II diabetes and cardiovascular disease. Insulin resistance (IR has been implicated in the pathogenesis of obesity and MetS in both children and adults and is a known independent cardiovascular risk factor. However measures of IR are not routinely performed in children while MetS or severe obesity when present, are considered as clinical markers for IR. Objective The study was undertaken to assess the utility of ATPIII defined metabolic syndrome (MetS and severe obesity as predictors of insulin resistance (IR in a group of 576 overweight children and adolescents attending a pediatric obesity clinic in Brooklyn. Methods Inclusion criteria were children ages 3–19, and body mass index > 95th percentile for age. MetS was defined using ATP III criteria, modified for age. IR was defined as upper tertile of homeostasis model assessment (HOMA within 3 age groups (3–8, n = 122; 9–11, n = 164; 12–19, n = 290. Sensitivity, specificity, positive predictive values and odds ratios (OR with 95% confidence intervals (CI were calculated within age groups for predicting IR using MetS and severe obesity respectively. Results MetS was present in 45%, 48% and 42% of the respective age groups and significantly predicted IR only in the oldest group (OR = 2.0, 95% CI 1.2, 3.4; p = .006. Sensitivities were Conclusion The expression of IR in overweight children and adolescents is heterogeneous and MetS or severe obesity may not be sufficiently sensitive and specific indicators of insulin resistance. In addition to screening for MetS in overweight children markers for IR should be routinely performed. Further research is needed to establish threshold values of insulin measures in overweight children who may be at greater associated risk of adverse outcomes whether or not MetS is present.

  18. Cross-Sectional Study of Unmet Mental Health Need in 5- to 7-Year Old Latino Children in the United States: Do Teachers and Parents Make a Difference in Service Utilization?

    Science.gov (United States)

    Toppelberg, Claudio O; Hollinshead, Marisa O; Collins, Brian A; Nieto-Castañon, Alfonso

    2013-06-01

    The aim of the study is to examine the rates of mental health service utilization in young Latino children of immigrants in relation to maternal and teacher reports of child mental health need. Specific knowledge is lacking about gaps in service utilization among young Latino children, the fastest growing and possibly the most underserved segment of the US child population. The associations of mental health service utilization (Service Assessment for Children and Adolescents) and mental health need (clinical levels of internalizing, externalizing, or total problems reported by mothers [Child Behavior Checklist] and teachers [Teacher's Report Form]) were examined in a community sample of young Latino children of immigrants ( n = 228; mean age = 6) and compared across mothers' and teachers' responses. Mother-teacher agreement was also studied. Sixty-five children (28.5 %) had a mental health need; most (76.9 %) of these received no services. For all types of mental health need, service utilization was more likely when need was reported by mothers rather than teachers ( p = .03). Teachers' reports were not associated with service utilization. Mother-teacher agreement was low for externalizing ( r = .23; p ≤ 0.01) and total problems ( r = .21; p ≤ 0.05), and nonsignificant for internalizing problems. This study is the first in the United States to document, in such a young Latino group, high rates of unmet need comparable to those among older Latino youth; low or no mother-teacher agreement on which children had a mental health need; low utilization of school-based services; and a lack of association between service utilization and teacher-reported mental health need-both for externalizing and internalizing problems. These findings suggest that schools are not effectively leveraging mental health services for young Latino children. Potential factors responsible for the findings are discussed.

  19. Clinical utility of spot urine protein-to-creatinine ratio modified by estimated daily creatinine excretion in children.

    Science.gov (United States)

    Yang, Eun Mi; Yoon, Bo Ae; Kim, Soo Wan; Kim, Chan Jong

    2017-06-01

    The spot urine protein-to-creatinine ratio (UPCR) is widely used to predict 24-h urine protein (24-h UP) excretion. In patients with low daily urine creatinine excretion (UCr), however, the UPCR may overestimate 24-h UP. The aim of this study was to predict 24-h UP using UPCR adjusted by estimated 24-h UCr in children. This study included 442 children whose 24-h UP and spot UPCR were measured concomitantly. Estimated 24-h UCr was calculated using three previously existing equations. We estimated the 24-h UP excretion from UPCR by multiplying the estimated UCr. The results were compared with the measured 24-h UP. There was a strong correlation between UPCR and 24-h UP (r = 0.801, P < 0.001), and the correlation improved after multiplying the UPCR by the measured UCr (r = 0.847, P < 0.001). Using the estimated UCr rather than the measured UCr, there was high accuracy and strong correlation between the estimated UPCR weighted by the Cockcroft-Gault equation and 24-h UP. Improvement was also observed in the subgroup (proteinuria vs. non-proteinuria) analysis, particularly in the proteinuria group. The spot UPCR multiplied by the estimated UCr improved the accuracy of prediction of the 24-h UP in children.

  20. Immediate and sustained effects of user fee exemption on healthcare utilization among children under five in Burkina Faso: A controlled interrupted time-series analysis.

    Science.gov (United States)

    Zombré, David; De Allegri, Manuela; Ridde, Valéry

    2017-04-01

    Little is known about the long-term effects of user fee exemption policies on health care use in developing countries. We examined the association between user fee exemption and health care use among children under five in Burkina Faso. We also examined how factors related to characteristics of health facilities and their environment moderate this association. We used a multilevel controlled interrupted time-series design to examine the strength of effect and long term effects of user fee exemption policy on the rate of health service utilization in children under five between January 2004 and December 2014. The initiation of the intervention more than doubled the utilization rate with an immediate 132.596% increase in intervention facilities (IRR: 2.326; 95% CI: 1.980 to 2.672). The effect of the intervention was 32.766% higher in facilities with higher workforce density (IRR: 1.328; 95% CI (1.209-1.446)) and during the rainy season (IRR:1.2001; 95% CI: 1.0953-1.3149), but not significant in facilities with higher dispersed populations (IRR: 1.075; 95% CI: (0.942-1.207)). Although the intervention effect was substantially significant immediately following its inception, the pace of growth, while positive over a first phase, decelerated to stabilize itself three years and 7 months later before starting to decrease slowly towards the end of the study period. This study provides additional evidence to support user fee exemption policies complemented by improvements in health care quality. Future work should include an assessment of the impact of user fee exemption on infant morbidity and mortality and better discuss factors that could explain the slowdown in this upward trend of utilization rates three and a half years after the intervention onset. Copyright © 2017. Published by Elsevier Ltd.

  1. Cost-utility analysis of different treatments for post-traumatic stress disorder in sexually abused children

    Directory of Open Access Journals (Sweden)

    Gospodarevskaya Elena

    2012-04-01

    Full Text Available Abstract Background Post-traumatic stress disorder (PTSD is diagnosed in 20% to 53% of sexually abused children and adolescents. Living with PTSD is associated with a loss of health-related quality of life. Based on the best available evidence, the NICE Guideline for PTSD in children and adolescents recommends cognitive behavioural therapy (TF-CBT over non-directive counselling as a more efficacious treatment. Methods A modelled economic evaluation conducted from the Australian mental health care system perspective estimates incremental costs and Quality Adjusted Life Years (QALYs of TF-CBT, TF-CBT combined with selective serotonin reuptake inhibitor (SSRI, and non-directive counselling. The "no treatment" alternative is included as a comparator. The first part of the model consists of a decision tree corresponding to 12 month follow-up outcomes observed in clinical trials. The second part consists of a 30 year Markov model representing the slow process of recovery in non-respondents and the untreated population yielding estimates of long-term quality-adjusted survival and costs. Data from the 2007 Australian Mental Health Survey was used to populate the decision analytic model. Results In the base-case and sensitivity analyses, incremental cost-effectiveness ratios (ICERs for all three active treatment alternatives remained less than A$7,000 per QALY gained. The base-case results indicated that non-directive counselling is dominated by TF-CBT and TF-CBT + SSRI, and that efficiency gain can be achieved by allocating more resources toward these therapies. However, this result was sensitive to variation in the clinical effectiveness parameters with non-directive counselling dominating TF-CBT and TF-CBT + SSRI under certain assumptions. The base-case results also suggest that TF-CBT + SSRI is more cost-effective than TF-CBT. Conclusion Even after accounting for uncertainty in parameter estimates, the results of the modelled economic evaluation

  2. Utility of CT after sonography for suspected appendicitis in children: integration of a clinical scoring system with a staged imaging protocol.

    Science.gov (United States)

    Srinivasan, Abhay; Servaes, Sabah; Peña, Andrès; Darge, Kassa

    2015-02-01

    To improve diagnosis of pediatric appendicitis, many institutions have implemented a staged imaging protocol utilizing ultrasonography (US) first and then computed tomography (CT). A substantial number of children with suspected appendicitis undergo CT after US, and the efficient and accurate diagnosis of pediatric appendicitis continues to be challenging. The objective of the study is to characterize the utility of CT following US for diagnosis of pediatric appendicitis, in conjunction with a clinical appendicitis score (AS). Imaging studies of children with suspected appendicitis who underwent CT after US in an imaging protocol were retrospectively reviewed by three radiologists in consensus. Chart review derived the AS (range 0-10) and obtained the patient diagnosis and disposition, and an AS was applied to each patient. Clinical and radiologic data were analyzed to assess the yield of CT after US. Studies of 211 children (mean age 11.3 years) were included. The positive threshold for AS was determined to be 6 out of 10. When AS and US were concordant (N = 140), the sensitivity and specificity of US were similar to CT. When AS and US were discordant (N = 71) and also when AS ≥ 6 (N = 84), subsequent CT showed superior sensitivity and specificity to US alone. In the subset where US showed neither the appendix nor inflammatory change in the right lower quadrant (126/211, 60 % of scans), when AS 6 (kg/year, P < 0.001) and after-hours (1700 -0730 hours) performance of US (P < 0.001). Results suggest that the appendicitis score has utility in guiding an imaging protocol and support the contention that non-visualization of the appendix on US is not intrinsically non-diagnostic. There was little benefit to additional CT when AS < 6 and US did not show the appendix or evidence of inflammation; this would have avoided CT in 140/211 (66 %) patients. CT demonstrated benefit when AS ≥ 6, suggesting that cases with AS ≥ 6 and

  3. Impact of standardized clinical assessment and management plans on resource utilization and costs in children after the arterial switch operation.

    Science.gov (United States)

    Rathod, Rahul H; Jurgen, Brittney; Hamershock, Rose A; Friedman, Kevin G; Marshall, Audrey C; Samnaliev, Mihail; Graham, Dionne A; Jenkins, Kathy; Lock, James E; Powell, Andrew J

    2017-12-01

    Standardized Clinical Assessment and Management Plans (SCAMPs) are a quality improvement initiative designed to reduce unnecessary utilization, decrease practice variation, and improve patient outcomes. We created a novel methodology, the SCAMP managed episode of care (SMEOC), which encompasses multiple encounters to assess the impact of the arterial switch operation (ASO) SCAMP on total costs. All ASO SCAMP patients (dates March 2009 to July 2015) were compared to a control group of ASO patients (January 2001 to February 2009). Patients were divided into "younger" (operation while maintaining quality of care. © 2017 Wiley Periodicals, Inc.

  4. The utility of bispectral index monitoring for prevention of rocuronium-induced withdrawal movement in children: A randomized controlled trial.

    Science.gov (United States)

    Lim, Byung Gun; Lee, Il Ok; Kim, Young Sung; Won, Young Ju; Kim, Heezoo; Kong, Myoung Hoon

    2017-01-01

    This study was designed to determine whether a deep hypnotic state with a bispectral index (BIS) value less than 40 could alleviate withdrawal movement (WM) upon rocuronium injection during anesthesia induction in children. Finally, 135 healthy children (3-12 years) scheduled for minor elective surgery were studied. Without premedication, anesthesia was induced with thiopental sodium 5 mg/kg. Patients were randomized into 2 groups (control vs experimental) and then by virtue of rocuronium injection time, patients in the experimental group were allocated into 2 groups, as follows: in the control group (group C; n = 45), rocuronium 0.6 mg/kg was administered at the loss of eyelash reflex; in the 1st experimental group, rocuronium 0.6 mg/kg was administered when BIS fell to less than 40 (group T; n = 45); however, if BIS did not fall below 40 after thiopental sodium administration, manual ventilation was provided with oxygen 6 L/minute using sevoflurane 8% and then rocuronium was administered when BIS fell below 40 (the 2nd experimental group, group S; n = 45). Rocuronium-induced WM was evaluated using a 4-point scale (no movement; movement/withdrawal involving the arm only; generalized response, with movement/withdrawal of more than 1 extremity, but no requirement for restraint of the body; and generalized response which required restraint of the body and caused coughing or breath-holding). No significant differences were found among the groups for patient characteristics including age, sex, height, and location of venous cannula. However, body weight, height, and body mass index in group S were all smaller than those in group T. The incidence of WM caused by rocuronium was 100% in group C, 95.6% in group T, and 80% in group S, and was significantly lower in group S than in group C. The grade of WM was 3.7 ± 0.6 in group C, 3.2 ± 0.9 in group T, and 2.6 ± 1.0 in group S. It was significantly lower in group T than in group C and

  5. Clinical utility of N-isopropyl-p-[123I] iodoamphetamine (123I-IMP) for SPECT in epileptic children

    International Nuclear Information System (INIS)

    Taki, Kuniyasu; Seto, Hikaru; Futatsuya, Ryusuke; Kakishita, Masao; Seki, Hiroyasu.

    1989-01-01

    A regional cerebral perfusion study was performed in epileptic children using single photon emission computed tomography (SPECT) and N-isopropyl-p-[ 123 I] iodoamphetamine ( 123 I-IMP). A total of 22 patients with epilepsy underwent both a 123 I-IMP brain perfusion study and X-ray CT. Eighteen had positive and four had negative perfusion study results. Of the eighteen patients with positive perfusion study results, two were positive on X-ray CT. In these two patients, the areas of perfusion defects were larger than those of low density on X-ray CT. In only four patients did the areas of perfusion defects correspond to the sites of abnormal EEG. In conclusion, 123 I-IMP perfusion study is of great clinical value in pediatric epileptic cases. (author)

  6. Utility of Exercise Testing and Adenosine Response for Risk Assessment in Children with Wolff-Parkinson-White Syndrome.

    Science.gov (United States)

    Ergul, Yakup; Ozturk, Erkut; Ozyilmaz, Isa; Unsal, Serkan; Carus, Hayat; Tola, Hasan Tahsin; Tanidir, Ibrahim Cansaran; Guzeltas, Alper

    2015-01-01

    We aimed to determine the correlation between noninvasive testing (exercise stress testing [EST] and adenosine responsiveness of accessory pathway [AP] ) and invasive electrophysiology study (EPS) for assessment antegrade conduction of the AP in Wolff-Parkinson-White syndrome. This prospective, observational study enrolled 40 children (58% male children, median age of 13 years, and median weight of 47.5 kg) with Wolff-Parkinson-White syndrome. Conduction through the AP to a cycle length of ≤250 ms was considered rapid or high-risk; otherwise, patients were nonrapid or low-risk. The sudden disappearance of the delta-wave was seen in 10 cases (25%) during EST. Accessory pathway was found to be high-risk in 13 cases (13/40, 32.5%) while the accessory path was identified as low-risk in 27 cases; however, six patients (15%) had blocked AP conduction with adenosine during EPS. Low-risk classification by EST alone to identify patients with nonrapid conduction in baseline EPS had a specificity of 93% and a positive predictive value of 90% (accuracy 54%). Blocked AP conduction with adenosine as a marker of nonrapid baseline AP conduction had a specificity of 93% and a positive predictive value of 84%. Finally, AP was adenosine nonresponsive in the majority of patients (28/30, 93%) with persistent delta-waves, 40% of those who had a sudden disappearance of delta-waves had an adenosine-responsive AP (P value: .028). Abrupt loss of preexcitation during EST and blocked AP conduction with adenosine had high specificity and positive predictive value for nonrapid and low-risk antegrade conduction during baseline invasive EPS. Successful risk stratification of pediatric patients with Wolff-Parkinson-White is possible through the use of EST and the adenosine responsiveness of AP. © 2015 Wiley Periodicals, Inc.

  7. Identifying Low pH Active and Lactate-Utilizing Taxa within Oral Microbiome Communities from Healthy Children Using Stable Isotope Probing Techniques

    Energy Technology Data Exchange (ETDEWEB)

    McLean, Jeffrey S.; Fansler, Sarah J.; Majors, Paul D.; Mcateer, Kathleen; Allen, Lisa Z.; Shirtliff, Mark E.; Lux, Renate; Shi, Wenyuan

    2012-03-05

    Many human microbial infectious diseases including dental caries are polymicrobial in nature and how these complex multi-species communities evolve from a healthy to a diseased state is not well understood. Although many health- or disease-associated oral microbes have been characterized in vitro, their physiology in vivo in the presence of the complex oral microbiome is difficult to determine with current approaches. In addition, about half of these oral species remain uncultivated to date and little is known except their 16S rRNA sequence. Lacking culture-based physiological analyses, the functional roles of uncultivated microorganisms will remain enigmatic despite their apparent disease correlation. To start addressing these knowledge gaps, we applied a novel combination of in vivo Magnetic Resonance Spectroscopy (MRS) with RNA and DNA based Stable Isotope Probing (SIP) to oral plaque communities from healthy children for temporal monitoring of carbohydrate utilization, organic acid production and identification of metabolically active and inactive bacterial species.

  8. Comparing Trauma Exposure, Mental Health Needs, and Service Utilization Across Clinical Samples of Refugee, Immigrant, and U.S.-Origin Children.

    Science.gov (United States)

    Betancourt, Theresa S; Newnham, Elizabeth A; Birman, Dina; Lee, Robert; Ellis, B Heidi; Layne, Christopher M

    2017-06-01

    Most mental health services for trauma-exposed children and adolescents were not originally developed for refugees. Information is needed to help clinicians design services to address the consequences of trauma in refugee populations. We compared trauma exposure, psychological distress, and mental health service utilization among children and adolescents of refugee-origin, immigrant-origin, and U.S.-origin referred for assessment and treatment by U.S. providers in the National Child Traumatic Stress Network (NCTSN). We used propensity score matching to compare trauma profiles, mental health needs, and service use across three groups. Our sample comprised refugee-origin youth (n = 60, 48.3% female, mean age = 13.07 years) and propensity-matched samples of immigrant-origin youth (n = 143, 60.8% female, mean age = 13.26 years), and U.S.-origin youth (n = 140, 56.1% female, mean age = 12.11 years). On average, there were significantly more types of trauma exposure among refugee youth than either U.S.-origin youth (p refugee youth had higher rates of community violence exposure, dissociative symptoms, traumatic grief, somatization, and phobic disorder.  In contrast, the refugee group had comparably lower rates of substance abuse and oppositional defiant disorder (ps ranging from .030 to refugee-origin youth presented with distinct patterns of trauma exposure, distress symptoms, and service needs that merit consideration in services planning. Copyright © 2017 International Society for Traumatic Stress Studies.

  9. Enrollment in Private Medical Insurance and Utilization of Medical Services Among Children and Adolescents: Data From the 2009-2012 Korea Health Panel Surveys

    Directory of Open Access Journals (Sweden)

    Dong Hee Ryu

    2016-03-01

    Full Text Available Objectives: The purposes of this study were to examine the status of children and adolescents with regard to enrollment in private medical insurance (PMI and to investigate its influence on their utilization of medical services. Methods: The present study assessed 2973 subjects younger than 19 years of age who participated in five consecutive Korea Health Panel surveys from 2009 to 2012. Results: At the initial assessment, less than 20% of the study population had not enrolled in any PMI program, but this proportion decreased over time. Additionally, the number of subjects with more than two policies increased, the proportions of holders of indemnity-type only (‘I’-only and of fixed amount+indemnity-type (‘F+I’ increased, whereas the proportion of holders with fixed amount-type only (‘F’-only decreased. Compared with subjects without private insurance, PMI policyholders were more likely to use outpatient and emergency services, and the number of policies was proportionately related to inpatient service utilization. Regarding out-patient care, subjects with ‘F’-only PMI used these services more often than did uninsured subjects (odds ratio [OR], 1.69, whereas subjects with ‘I’-only PMI or ‘F+I’ PMI utilized a broad range of inpatient, outpatient, and emergency services relative to uninsured subjects (ORs for ‘I’-only: 1.39, 1.63, and 1.38, respectively; ORs for ‘F+I’: 1.67, 2.09, and 1.37, respectively. Conclusions: The findings suggest public policy approaches to standardizing PMI contracts, reform in calculation of premiums in PMI, re-examination regarding indemnity insurance products, and mutual control mechanisms to mediate between national health insurance services and private insurers are required.

  10. Cost utility, budget impact, and scenario analysis of racecadotril in addition to oral rehydration for acute diarrhea in children in Malaysia

    Directory of Open Access Journals (Sweden)

    Rautenberg TA

    2018-03-01

    Full Text Available Tamlyn Anne Rautenberg,1,2 Ute Zerwes,3 Way Seah Lee4 1IGES Institut GmbH, Berlin, Germany; 2Health Economics and HIV/AIDS Research Division (HEARD, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa; 3Assessment in Medicine GmbH, Lörrach, Germany; 4Department of Pediatrics, University Malaya, Kuala Lumpur, Malaysia Objective: To perform cost utility (CU and budget impact (BI analyses augmented by scenario analyses of critical model structure components to evaluate racecadotril as adjuvant to oral rehydration solution (ORS for children under 5 years with acute diarrhea in Malaysia.Methods: A CU model was adapted to evaluate racecadotril plus ORS vs ORS alone for acute diarrhea in children younger than 5 years from a Malaysian public payer’s perspective. A bespoke BI analysis was undertaken in addition to detailed scenario analyses with respect to critical model structure components.Results: According to the CU model, the intervention is less costly and more effective than comparator for the base case with a dominant incremental cost-effectiveness ratio of –RM 1,272,833/quality-adjusted life year (USD –312,726/quality-adjusted life year in favor of the intervention. According to the BI analysis (assuming an increase of 5% market share per year for racecadotril+ORS for 5 years, the total cumulative incremental percentage reduction in health care expenditure for diarrhea in children is 0.136578%, resulting in a total potential cumulative cost savings of –RM 73,193,603 (USD –17,983,595 over a 5-year period. Results hold true across a range of plausible scenarios focused on critical model components.Conclusion: Adjuvant racecadotril vs ORS alone is potentially cost-effective from a Malaysian public payer perspective subject to the assumptions and limitations of the model. BI analysis shows that this translates into potential cost savings for the Malaysian public health care system. Results hold true at evidence-based base

  11. Utilization of health facilities and predictors of health-seeking behavior for under-five children with acute diarrhea in slums of Addis Ababa, Ethiopia: a community-based cross-sectional study

    OpenAIRE

    Adane, Metadel; Mengistie, Bezatu; Mulat, Worku; Kloos, Helmut; Medhin, Girmay

    2017-01-01

    Background Information on health-seeking behavior and utilization of health facilities in slums of Addis Ababa is scarce, impeding the implementation of effective interventions. The purpose of this study is to assess the status of health facilities utilization and predictors for health-seeking behavior of mothers/caregivers of under-five children with acute diarrhea in slums of Addis Ababa, Ethiopia. Methods A community-based cross-sectional study design was employed in five rounds of surveys...

  12. Pareto utility

    NARCIS (Netherlands)

    Ikefuji, M.; Laeven, R.J.A.; Magnus, J.R.; Muris, C.H.M.

    2013-01-01

    In searching for an appropriate utility function in the expected utility framework, we formulate four properties that we want the utility function to satisfy. We conduct a search for such a function, and we identify Pareto utility as a function satisfying all four desired properties. Pareto utility

  13. Utility of a multiplex reverse transcriptasepolymerase chain reaction assay (HemaVision in the evaluation of genetic abnormalities in Korean children with acute leukemia: a single institution study

    Directory of Open Access Journals (Sweden)

    Hye-Jin kim

    2013-06-01

    Full Text Available &lt;b&gt;Purpose:&lt;/b&gt; In children with acute leukemia, bone marrow genetic abnormalities (GA have prognostic significance, and may be the basis for minimal residual disease monitoring. Since April 2007, we have used a multiplex reverse transcriptase-polymerase chain reaction tool (HemaVision to detect of GA. &lt;b&gt;Methods:&lt;/b&gt; In this study, we reviewed the results of HemaVision screening in 270 children with acute leukemia, newly diagnosed at The Catholic University of Korea from April 2007 to December 2011, and compared the results with those of fluorescence in situ hybridization (FISH, and G-band karyotyping. &lt;b&gt;Results:&lt;/b&gt; Among the 270 children (153 males, 117 females, 187 acute lymphoblastic leukemia and 74 acute myeloid leukemia patients were identified. Overall, GA was detected in 230 patients (85.2%. HemaVision, FISH, and G-band karyotyping identified GA in 125 (46.3%, 126 (46.7%, and 215 patients (79.6%, respectively. TEL-AML1 (20.9%, 39/187 and AML1-ETO (27%, 20/74 were the most common GA in ALL and AML, respectively. Overall sensitivity of HemaVision was 98.4%, with false-negative results in 2 instances: 1 each for TEL-AML1 and MLL-AF4 . An aggregate of diseasesspecific FISH showed 100% sensitivity in detection of GA covered by HemaVision for actual probes utilized. G-band karyotype revealed GA other than those covered by HemaVison screening in 133 patients (49.3%. Except for hyperdiplody and hypodiploidy, recurrent GA as defined by the World Health Organizationthat were not screened by HemaVision, were absent in the karyotype. &lt;b&gt;Conclusion:&lt;/b&gt; HemaVision, supported by an aggregate of FISH tests for important translocations, may allow for accurate diagnosis of GA in Korean children with acute leukemia.

  14. Profiles of the Most Preferred and the Most Effective Music Therapy Approaches Being Utilized with Children with Autism Spectrum Disorders According to the Opinions of Music Therapists in the U.S.

    Science.gov (United States)

    Eren, Bilgehan

    2017-01-01

    The purpose of this study was to identify and analyze opinions of music therapists practicing in the United States, regarding various music therapy approaches currently being utilized with children diagnosed with Autism Spectrum Disorder. Music therapy approaches were analyzed for possible correlations between music therapists' preferences, and…

  15. Astronomy4Kids: Utilizing online video forums to teach basic planetary concepts to children (pre-K to 2nd-grade)

    Science.gov (United States)

    Pearson, Richard L.

    2016-10-01

    We have developed Astronomy4Kids to help cultivate the next generation of scientists by using technology to reach every interested child in both formal and informal learning environments. This online video series fills the void of effective STEM education tools for children under the age of 8. Our first collection of videos discuss many planetary topics, including the following: planet and moon formation theories, solar and lunar eclipses, and the seasonal effect of the Earth's tilt. As education and outreach become a larger focus of groups such as AAS and NASA, it is imperative to include programs such as Astronomy4Kids to extend these initiatives to younger age groups.Traditionally, this age group has been viewed as too young to be introduced to physics and astronomy concepts. However, child development research is consistently demonstrating the amazing plasticity of a young child's mind: the younger one is introduced to a complex concept, the easier it is to grasp later on. Following the philosophies of Fred Rogers, we present children with a real, relatable, instructor allowing them to focus on the concepts being presented.The format of Astronomy4Kids includes short instruction video clips that usually include a hands-on activity that is easily reproduced at home or in the classroom. This permits flexibility in how the video series is utilized. Within formal classroom or after-school situations, teachers and instructors can lead the discussion and activity with help from the video and supplemental materials (e.g. worksheets, concept outlines, etc.). Informal environments permit the viewer to complete the tasks on their own or simply enjoy the presentation. The video series can be found on YouTube (under "Astronomy 4 Kids") or Facebook (at www.facebook.com/astronomy4kids); we have also expanded to Instagram (www.instragram.com/astronomy4kids) and Pinterest (www.pinterest.com/astronomy4kids).

  16. Growth and nutritional status of preschool children in India: a study of two recent time periods.

    Science.gov (United States)

    Sen, Pronab; Bharati, Susmita; Som, Suparna; Pal, Manoranjan; Bharati, Premananda

    2011-06-01

    Preschool children call for focused attention in India because India has the highest percentage of undernourished children in the world. To compare the growth and nutritional status of Indian preschool children for the periods 1998/99 and 2005/06, Using data on weight and length/height as well as the sociodemographic background of preschool children from the National Family Health Surveys (NFHS) from 1998/99 and 2005/06, we determined the distribution of weight and length/height and their association with sociodemographic variables. The distributions of weight and length/height around the mean remained remarkably stable over age but were much greater in India than the international norms. The rates of growth of mean weight and length/ height were far lower in India than the international norms up to the age of 2 years. The temporal trend indicates declines in the percentages of undernourished (low weight-for-age) and stunted (low height-for-age) children over the 7-year period, although the degree of improvement was far better for stunting than for underweight. Mother's educational status is the only variable that has been found to influence child nutrition. The level of mothers' education needs urgent attention with top priority to reduce the prevalence of underweight and stunting of children. This also implies that, for future benefit, girls should be given more facilities for better education. Breastfeeding and weaning practices also need special attention.

  17. Video self-modeling in children with autism: a pilot study validating prerequisite skills and extending the utilization of VSM across skill sets.

    Science.gov (United States)

    Williamson, Robert L; Casey, Laura B; Robertson, Janna Siegel; Buggey, Tom

    2013-01-01

    Given the recent interest in the use of video self-modeling (VSM) to provide instruction within iPod apps and other pieces of handheld mobile assistive technologies, investigating appropriate prerequisite skills for effective use of this intervention is particularly timely and relevant. To provide additional information regarding the efficacy of VSM for students with autism and to provide insights into any possible prerequisite skills students may require for such efficacy, the authors investigated the use of VSM in increasing the instances of effective initiations of interpersonal greetings for three students with autism that exhibited different pre-intervention abilities. Results showed that only one of the three participants showed an increase in self-initiated greetings following the viewing of videos edited to show each participant self-modeling a greeting when entering his or her classroom. Due to the differences in initial skill sets between the three children, this finding supports anecdotally observed student prerequisite abilities mentioned in previous studies that may be required to effectively utilize video based teaching methods.

  18. Undernutrition in children with profound intellectual and multiple disabilities (PIMD): its prevalence and influence on quality of life.

    Science.gov (United States)

    Holenweg-Gross, C; Newman, C J; Faouzi, M; Poirot-Hodgkinson, I; Bérard, C; Roulet-Perez, E

    2014-07-01

    To estimate the prevalence of undernutrition among children with profound intellectual and multiple disabilities (PIMD) and to explore its influence on quality of life. Seventy-two children with PIMD (47 male; 25 female; age range 2 to 15 years 4 months; mean age 8.6, SD 3.6) underwent an anthropometric assessment, including body weight, triceps skinfold thickness, segmental measures and recumbent length. Undernutrition was determined using tricipital skinfold percentile and z-scores of weight-for-height and height-for-age. The quality of life of each child was evaluated using the QUALIN questionnaire adapted for profoundly disabled children. Twenty-five children (34.7%) were undernourished and seven (9.7%) were obese. Among undernourished children only eight (32 %) were receiving food supplements and two (8%) had a gastrostomy, of which one was still on a refeeding programme. On multivariate analysis, undernutrition was one of the independent predictors of lower quality of life. Undernutrition remains a matter of concern in children with PIMD. There is a need to better train professionals in systematically assessing the nutritional status of profoundly disabled children in order to start nutritional management when necessary. © 2013 John Wiley & Sons Ltd.

  19. Utility of waist-to-height ratio in assessing the status of central obesity and related cardiometabolic risk profile among normal weight and overweight/obese children: The Bogalusa Heart Study

    Directory of Open Access Journals (Sweden)

    Xu Jihua

    2010-10-01

    Full Text Available Abstract Background Body Mass Index (BMI is widely used to assess the impact of obesity on cardiometabolic risk in children but it does not always relate to central obesity and varies with growth and maturation. Waist-to-Height Ratio (WHtR is a relatively constant anthropometric index of abdominal obesity across different age, sex or racial groups. However, information is scant on the utility of WHtR in assessing the status of abdominal obesity and related cardiometabolic risk profile among normal weight and overweight/obese children, categorized according to the accepted BMI threshold values. Methods Cross-sectional cardiometabolic risk factor variables on 3091 black and white children (56% white, 50% male, 4-18 years of age were used. Based on the age-, race- and sex-specific percentiles of BMI, the children were classified as normal weight (5th - 85th percentiles and overweight/obese (≥ 85th percentile. The risk profiles of each group based on the WHtR ( Results 9.2% of the children in the normal weight group were centrally obese (WHtR ≥0.5 and 19.8% among the overweight/obese were not (WHtR Conclusion WHtR not only detects central obesity and related adverse cardiometabolic risk among normal weight children, but also identifies those without such conditions among the overweight/obese children, which has implications for pediatric primary care practice.

  20. Comparative treatment patterns, healthcare resource utilization and costs of atomoxetine and long-acting methylphenidate among children and adolescents with attention-deficit/hyperactivity disorder in Germany.

    Science.gov (United States)

    Greven, Peter; Sikirica, Vanja; Chen, Yaozhu J; Curtice, Tammy G; Makin, Charles

    2017-09-01

    Attention-deficit/hyperactivity disorder (ADHD) imposes a substantial burden on patients and their families. A retrospective, propensity score-matched cohort study compared treatment patterns, healthcare resource utilization (HRU) and costs among children/adolescents with ADHD aged 6-17 years at treatment initiation (index) in Germany who received atomoxetine (ATX) or long-acting methylphenidate (LA-MPH) monotherapy. Patients received at least one prescription for their index medication (ATX/LA-MPH) during 2006-2010; the first prescription marked the index date. ATX- and LA-MPH-indexed cohorts were matched 1:1 (n = 737); a patient subset was identified that had not received ADHD-indicated medications in 12 months prior to index (novel initiators: ATX, n = 486; LA-MPH, n = 488). Treatment patterns were evaluated among novel initiators, and HRU and costs among the matched cohorts in the 12 months after index. No significant differences in baseline characteristics were found between the novel initiator patient subsets. ATX-indexed novel initiators had significantly longer persistence to index medication [mean (standard deviation; SD) days: 222.0 (133.9) vs 203.2 (135.0), P = 0.029) but higher switching rates (8.8 vs 5.5 %, P = 0.045) than LA-MPH-indexed novel initiators. The total ATX-indexed cohort required more prescriptions [any medication; mean (SD): 20.9 (11.5) vs 15.7 (9.0), P < 0.001] and outpatient visits [mean (SD): 10.1 (6.3) vs 8.3 (5.3), P < 0.001], and incurred significantly higher total median healthcare costs (€1144 vs €541, P < 0.001) versus matched LA-MPH patients. These real-world data indicate that, among children/adolescents with ADHD in Germany, ATX-indexed patients may require more prescriptions and physician visits, and incur higher total healthcare costs, than matched LA-MPH patients.

  1. Utilization of medical and health-related services among school-age children and adolescents with special health care needs (1994 National Health Interview Survey on Disability [NHIS-D] Baseline Data).

    Science.gov (United States)

    Weller, Wendy E; Minkovitz, Cynthia S; Anderson, Gerard F

    2003-09-01

    To determine how sociodemographic factors and type of insurance influence use of medical and health-related services by children with special health care needs (CSHCN), after controlling for need. A cross-sectional analysis of 1994 National Health Interview Disability Survey was conducted. Children between 5 and 17 years were identified as chronically ill according to the Questionnaire for Identifying Children with Chronic Conditions (n = 3061). Independent variables included child and family characteristics categorized as predisposing, enabling, and need. Dependent variables included use of 4 medical or 7 health-related services. Most children (88.7%) had seen a physician; 23.9% had an emergency department visit, 11.4% had a mental health outpatient visit, and 6.4% were hospitalized. Health-related service use ranged from <5.0% (transportation and social work) to 65.1% (medical care coordination); 20% to 30% of children used the remaining services (therapeutic, assistive devices, nonmedical care coordination, housing modifications). In fully adjusted logistic models, children with public insurance were significantly more likely than privately insured children to use 2 of the 4 medical services and 5 of the 7 health-related services. Non-Hispanic black children and children from less educated families were significantly less likely to use many of the services examined. In 1994, factors in addition to need influenced medical and health-related service use by CSHCN. Differences in the scope of benefits covered by public insurance compared with private insurance may influence utilization of medical and especially health-related services. Attention is needed to ensure that CSHCN who are racial/ethnic minorities or are from less educated families have access to needed services. Future studies should determine whether these patterns have changed over time.

  2. Cross-Sectional Relationships Between Household Food Insecurity and Child BMI, Feeding Behaviors, and Public Assistance Utilization Among Head Start Children From Predominantly Hispanic and American Indian Communities in the CHILE Study

    OpenAIRE

    Trappmann, Jessica L.; Jimenez, Elizabeth Yakes; Keane, Patricia C.; Cohen, Deborah A.; Davis, Sally M.

    2015-01-01

    Associations between food insecurity and overweight/obesity, feeding behaviors, and public food assistance utilization have been explored to a greater extent among adults and adolescents than among young children. This cross-sectional study examines a subset of pre-intervention implementation data (n = 347) among families participating in the Child Health Initiative for Lifelong Eating and Exercise (CHILE) study conducted in rural New Mexico among predominantly Hispanic and American Indian He...

  3. Disparities in Healthcare Access and Utilization among Children with Autism Spectrum Disorder from Immigrant Non-English Primary Language Households in the United States

    Directory of Open Access Journals (Sweden)

    Sue C. Lin, MS

    2015-09-01

    Full Text Available Background: The prevalence of autism spectrum disorder (ASD in United State (US has surged from 1 in 150 children in 2007 to 1 in 88 children in 2012 with substantial increase in immigrant minority groups including Hispanic and Somali children. Our study objective is to examine the associations between household language among children with ASD and national health quality indicators attainment. Methods: We conducted bivariate and multivariate logistic regression analyses using cross-sectional data from the publicly-available 2009-2010 National Survey of Children with Special Health Care Needs (NS-CSHCN to investigate the association between household language use and quality indicators of medical home, adequate insurance, and early and continuous screening. Results: Approximately, 28% of parents of children with ASD from non-English primary language (NEPL households reported their child having severe ASD as compared with 13% of parents from English primary language (EPL households. Older children were more likely to have care that met the early and continuous screening quality indicator, while lower income children and uninsured children were less likely to have met this indicator. Conclusions and Global Health Implications: Despite the lack of differences in the attainment of quality indicators by household language, the higher severity found in children in NEPL households suggests that they are exceptionally vulnerable. Enhanced early screening and identification for these children and supporting their parents in navigating the complex US health care delivery system would increase their participation in early intervention services. Immigration of children with special health care needs from around the world to the US has been increasing from countries with diverse healthcare systems. Our findings will help to inform policies and interventions to reduce health disparities for children with ASD from immigrant populations. As the prevalence of

  4. Describing normal development in an African setting : The utility of the Kilifi Developmental Inventory among young children at the Kenyan coast

    NARCIS (Netherlands)

    Kitsao-Wekulo, Patricia; Holding, Penny; Abubakar, Amina; Kvalsvig, Jane; Taylor, H. Gerry; King, Christopher L.

    The Kilifi Developmental Inventory (KDI) is a tool developed in Kenya for the assessment of psychomotor development in infants and young children. We developed age-appropriate standards against which the developmental progress of individual children could be tracked. The current report is based on

  5. Street children of India -- a glimpse.

    Science.gov (United States)

    Nigam, S

    1994-01-01

    In India, 90% of street children are working children with regular family ties who live with their families, but are on the streets due to poverty and their parents' unemployment. The remaining 10% are either working children with few family ties who view the streets as their homes or abandoned and neglected children with no family ties. The National Policy for Children established in 1974 emphasizes the provision of equal opportunities for the development to all children during their growing years. Policy stresses programs to maintain, educate, and train destitute children and orphans. Policy is also to protect children against neglect, cruelty, and exploitation, but this is only on paper. An UNICEF study found that almost 40,000 children die every day in developing countries, 25% of whom are in India. Studies in some major cities indicate that the street children in India are of moderate health status, suffering from various chronic diseases and undernourishment. They are deprived of all health programs, but seem to prefer government hospitals in case of dire need. Street children often have to pay for water. Almost 97% in Calcutta, 99% in Bangalore, and 90% in Madras reported having no access to toilet and bathing facilities; 83% in Kanpur, however, had access to such facilities. Nothing has been heard in recent years of the National Children's Board established in 1975. Apparently the board has gradually waned. Various schemes were planned in 1992 by the Union Welfare Ministry in association with UNICEF. Extending extra health facilities, establishing nutrition programs, providing vocational training, protecting children from abuse, distributing dry-food polypacks, providing night shelters, providing ration cards, and creating bathing and toilet facilities would go far in improving the quality of life and the future of street children in India.

  6. Estimating Utility

    DEFF Research Database (Denmark)

    Arndt, Channing; Simler, Kenneth R.

    2010-01-01

    A fundamental premise of absolute poverty lines is that they represent the same level of utility through time and space. Disturbingly, a series of recent studies in middle- and low-income economies show that even carefully derived poverty lines rarely satisfy this premise. This article proposes a......, with the current approach tending to systematically overestimate (underestimate) poverty in urban (rural) zones.......A fundamental premise of absolute poverty lines is that they represent the same level of utility through time and space. Disturbingly, a series of recent studies in middle- and low-income economies show that even carefully derived poverty lines rarely satisfy this premise. This article proposes...... an information-theoretic approach to estimating cost-of-basic-needs (CBN) poverty lines that are utility consistent. Applications to date illustrate that utility-consistent poverty measurements derived from the proposed approach and those derived from current CBN best practices often differ substantially...

  7. Utility of unenhanced fat-suppressed T1-weighted MRI in children with sickle cell disease -- can it differentiate bone infarcts from acute osteomyelitis?

    Science.gov (United States)

    Delgado, Jorge; Bedoya, Maria A; Green, Abby M; Jaramillo, Diego; Ho-Fung, Victor

    2015-12-01

    Children with sickle cell disease (SCD) are at risk of bone infarcts and acute osteomyelitis. The clinical differentiation between a bone infarct and acute osteomyelitis is a diagnostic challenge. Unenhanced T1-W fat-saturated MR images have been proposed as a potential tool to differentiate bone infarcts from osteomyelitis. To evaluate the reliability of unenhanced T1-W fat-saturated MRI for differentiation between bone infarcts and acute osteomyelitis in children with SCD. We retrospectively reviewed the records of 31 children (20 boys, 11 girls; mean age 10.6 years, range 1.1-17.9 years) with SCD and acute bone pain who underwent MR imaging including unenhanced T1-W fat-saturated images from 2005 to 2010. Complete clinical charts were reviewed by a pediatric hematologist with training in infectious diseases to determine a clinical standard to define the presence or absence of osteomyelitis. A pediatric radiologist reviewed all MR imaging and was blinded to clinical information. Based on the signal intensity in T1-W fat-saturated images, the children were further classified as positive for osteomyelitis (low bone marrow signal intensity) or positive for bone infarct (high bone marrow signal intensity). Based on the clinical standard, 5 children were classified as positive for osteomyelitis and 26 children as positive for bone infarct (negative for osteomyelitis). The bone marrow signal intensity on T1-W fat-saturated imaging was not significant for the differentiation between bone infarct and osteomyelitis (P = 0.56). None of the additional evaluated imaging parameters on unenhanced MRI proved reliable in differentiating these diagnoses. The bone marrow signal intensity on unenhanced T1-W fat-saturated MR images is not a reliable criterion to differentiate bone infarcts from osteomyelitis in children.

  8. Utility of unenhanced fat-suppressed T1-weighted MRI in children with sickle cell disease - can it differentiate bone infarcts from acute osteomyelitis?

    International Nuclear Information System (INIS)

    Delgado, Jorge; Bedoya, Maria A.; Green, Abby M.; Jaramillo, Diego; Ho-Fung, Victor

    2015-01-01

    Children with sickle cell disease (SCD) are at risk of bone infarcts and acute osteomyelitis. The clinical differentiation between a bone infarct and acute osteomyelitis is a diagnostic challenge. Unenhanced T1-W fat-saturated MR images have been proposed as a potential tool to differentiate bone infarcts from osteomyelitis. To evaluate the reliability of unenhanced T1-W fat-saturated MRI for differentiation between bone infarcts and acute osteomyelitis in children with SCD. We retrospectively reviewed the records of 31 children (20 boys, 11 girls; mean age 10.6 years, range 1.1-17.9 years) with SCD and acute bone pain who underwent MR imaging including unenhanced T1-W fat-saturated images from 2005 to 2010. Complete clinical charts were reviewed by a pediatric hematologist with training in infectious diseases to determine a clinical standard to define the presence or absence of osteomyelitis. A pediatric radiologist reviewed all MR imaging and was blinded to clinical information. Based on the signal intensity in T1-W fat-saturated images, the children were further classified as positive for osteomyelitis (low bone marrow signal intensity) or positive for bone infarct (high bone marrow signal intensity). Based on the clinical standard, 5 children were classified as positive for osteomyelitis and 26 children as positive for bone infarct (negative for osteomyelitis). The bone marrow signal intensity on T1-W fat-saturated imaging was not significant for the differentiation between bone infarct and osteomyelitis (P = 0.56). None of the additional evaluated imaging parameters on unenhanced MRI proved reliable in differentiating these diagnoses. The bone marrow signal intensity on unenhanced T1-W fat-saturated MR images is not a reliable criterion to differentiate bone infarcts from osteomyelitis in children. (orig.)

  9. Utility of unenhanced fat-suppressed T1-weighted MRI in children with sickle cell disease - can it differentiate bone infarcts from acute osteomyelitis?

    Energy Technology Data Exchange (ETDEWEB)

    Delgado, Jorge; Bedoya, Maria A. [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Green, Abby M. [The Children' s Hospital of Philadelphia, Division of Oncology, Philadelphia, PA (United States); Jaramillo, Diego; Ho-Fung, Victor [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (United States)

    2015-12-15

    Children with sickle cell disease (SCD) are at risk of bone infarcts and acute osteomyelitis. The clinical differentiation between a bone infarct and acute osteomyelitis is a diagnostic challenge. Unenhanced T1-W fat-saturated MR images have been proposed as a potential tool to differentiate bone infarcts from osteomyelitis. To evaluate the reliability of unenhanced T1-W fat-saturated MRI for differentiation between bone infarcts and acute osteomyelitis in children with SCD. We retrospectively reviewed the records of 31 children (20 boys, 11 girls; mean age 10.6 years, range 1.1-17.9 years) with SCD and acute bone pain who underwent MR imaging including unenhanced T1-W fat-saturated images from 2005 to 2010. Complete clinical charts were reviewed by a pediatric hematologist with training in infectious diseases to determine a clinical standard to define the presence or absence of osteomyelitis. A pediatric radiologist reviewed all MR imaging and was blinded to clinical information. Based on the signal intensity in T1-W fat-saturated images, the children were further classified as positive for osteomyelitis (low bone marrow signal intensity) or positive for bone infarct (high bone marrow signal intensity). Based on the clinical standard, 5 children were classified as positive for osteomyelitis and 26 children as positive for bone infarct (negative for osteomyelitis). The bone marrow signal intensity on T1-W fat-saturated imaging was not significant for the differentiation between bone infarct and osteomyelitis (P = 0.56). None of the additional evaluated imaging parameters on unenhanced MRI proved reliable in differentiating these diagnoses. The bone marrow signal intensity on unenhanced T1-W fat-saturated MR images is not a reliable criterion to differentiate bone infarcts from osteomyelitis in children. (orig.)

  10. Does school breakfast benefit children's educational performance?

    Science.gov (United States)

    Fernald, L; Ani, C C; Grantham-mcgregor, S

    1997-09-01

    This article reviews several research studies on the impact of the lack of breakfast among students. Recent data reveal that about 20% of Nigerian children were wasted or had weight-for-height measurements under the 5th percentile of the US National Center for Health Statistics (NCHS) standard. In Ghana, 41% of children were underweight or had a weight-for-age under -2 standard deviations of the NCHS standards. In Tanzania, about 34% of children were underweight. Many more students in Africa are attending school, but many are leaving primary school early or failing secondary school examinations. It is argued that poor nutritional status affects children's ability to learn. Research reveals several hypotheses about how breakfast affects children's cognition, behavior, and school performance. Children may not attend school at all due to the inability to purchase food to eat at school, or insufficient food resources at home to provide sufficient energy to walk long distances to school. In four studies, two in the USA and the others in Peru and Jamaica, findings reveal that when undernourished children missed breakfast, they performed worse in tests of cognition. Adequately nourished children's performance was unaffected by missing breakfast. A study in four Jamaican schools found that children had more creative ideas when they received a breakfast for 2 weeks than when they did not receive breakfast. Two Swedish studies found that children with a high-calorie breakfast improved in cognition compared to those receiving a low-calorie breakfast. One study found that children in well-equipped classrooms paid more attention in class after having breakfast. Children in overcrowded classes and poorly equipped schools were less likely to pay attention after breakfast. Long-term effects are less well studied, but findings clearly support the benefits of breakfast.

  11. Asthma-Like Symptoms in Homeless Children in the Greater Paris Area in 2013: Prevalence, Associated Factors and Utilization of Healthcare Services in the ENFAMS Survey.

    Directory of Open Access Journals (Sweden)

    Delphine Lefeuvre

    Full Text Available Asthma remains poorly studied in homeless children. We sought to estimate the prevalence of asthma-like symptoms (ALS and to identify the factors associated with ALS and healthcare service utilisation.A cross-sectional survey of a random sample of sheltered homeless families was conducted by interviewing 801 parents of children (0-12 years in 17 languages. ALS were defined as wheezing or night cough without fever during the previous year. Poisson regression models with robust error variance were used to compute prevalence ratios (PR for factors associated with ALS and healthcare service utilisation for ALS.The prevalence of ALS among the children was 19.9%. Poor housing sanitation was significantly associated with ALS, as being born in the European Union. Most of the children with ALS had used healthcare services (85.4%. The main barriers to accessing such services were having lived in France for less than 49 months, having difficulties in French and living in poor housing conditions.ALS prevalence seemed lower than in the general child population, possibly because of the children's origins. Environmental factors associated with ALS point to the need to improve the indoor environment of family shelters. The relatively high rate of healthcare service utilisation should not overshadow existing barriers.

  12. Utility of knowledge, attitude, and practice survey, and prevalence of dental caries among 11- to 13-year-old children in an urban community in India

    Directory of Open Access Journals (Sweden)

    Sanskriti Khanal

    2013-04-01

    Full Text Available Background: The school oral health education program is believed to be a cost-effective method for promoting oral health. The KAP (knowledge–attitude–practice model of oral health education is often the foundation of most health education programs. Objectives: To assess the existing knowledge, attitude, and oral health care practices among 11- to 13-year-old children and the association of knowledge with attitude, oral health care practices, and dental caries prevalence. Design: Cross-sectional design, involving 858 children studying in class seven at various schools in the city of Mangalore, India. The children were selected using stratified random sampling method. Prevalence of dental caries was determined using decayed, missing, and filled permanent teeth (DMFT index. A self-administered questionnaire on self-care practices in oral health, knowledge, and attitude toward oral health care was filled by children. The association of different variables with knowledge was analyzed using binary logistic regression analysis. Results: The dental caries prevalence was 59.4%, and 54.5% had low knowledge. They lacked knowledge regarding use of fluoridated toothpaste and did not use them. Children with low knowledge had significantly higher odds of having DMFT ≥ 1, not using fluoridated toothpaste, and being afraid of going to the dentist due to possible pain. There was no association of other oral health care practices and attitudes with knowledge. Conclusion: Oral health care practices and attitudes are not fully explained by knowledge, and other models of health education need to be considered.

  13. Impaired health-related quality of life in children and adolescents with chronic conditions: a comparative analysis of 10 disease clusters and 33 disease categories/severities utilizing the PedsQL™ 4.0 Generic Core Scales

    Directory of Open Access Journals (Sweden)

    Burwinkle Tasha M

    2007-07-01

    Full Text Available Abstract Background Advances in biomedical science and technology have resulted in dramatic improvements in the healthcare of pediatric chronic conditions. With enhanced survival, health-related quality of life (HRQOL issues have become more salient. The objectives of this study were to compare generic HRQOL across ten chronic disease clusters and 33 disease categories/severities from the perspectives of patients and parents. Comparisons were also benchmarked with healthy children data. Methods The analyses were based on over 2,500 pediatric patients from 10 physician-diagnosed disease clusters and 33 disease categories/severities and over 9,500 healthy children utilizing the PedsQL™ 4.0 Generic Core Scales. Patients were recruited from general pediatric clinics, subspecialty clinics, and hospitals. Results Pediatric patients with diabetes, gastrointestinal conditions, cardiac conditions, asthma, obesity, end stage renal disease, psychiatric disorders, cancer, rheumatologic conditions, and cerebral palsy self-reported progressively more impaired overall HRQOL than healthy children, respectively, with medium to large effect sizes. Patients with cerebral palsy self-reported the most impaired HRQOL, while patients with diabetes self-reported the best HRQOL. Parent proxy-reports generally paralleled patient self-report, with several notable differences. Conclusion The results demonstrate differential effects of pediatric chronic conditions on patient HRQOL across diseases clusters, categories, and severities utilizing the PedsQL™ 4.0 Generic Core Scales from the perspectives of pediatric patients and parents. The data contained within this study represents a larger and more diverse population of pediatric patients with chronic conditions than previously reported in the extant literature. The findings contribute important information on the differential effects of pediatric chronic conditions on generic HRQOL from the perspectives of children and

  14. Impaired health-related quality of life in children and adolescents with chronic conditions: a comparative analysis of 10 disease clusters and 33 disease categories/severities utilizing the PedsQL 4.0 Generic Core Scales.

    Science.gov (United States)

    Varni, James W; Limbers, Christine A; Burwinkle, Tasha M

    2007-07-16

    Advances in biomedical science and technology have resulted in dramatic improvements in the healthcare of pediatric chronic conditions. With enhanced survival, health-related quality of life (HRQOL) issues have become more salient. The objectives of this study were to compare generic HRQOL across ten chronic disease clusters and 33 disease categories/severities from the perspectives of patients and parents. Comparisons were also benchmarked with healthy children data. The analyses were based on over 2,500 pediatric patients from 10 physician-diagnosed disease clusters and 33 disease categories/severities and over 9,500 healthy children utilizing the PedsQL 4.0 Generic Core Scales. Patients were recruited from general pediatric clinics, subspecialty clinics, and hospitals. Pediatric patients with diabetes, gastrointestinal conditions, cardiac conditions, asthma, obesity, end stage renal disease, psychiatric disorders, cancer, rheumatologic conditions, and cerebral palsy self-reported progressively more impaired overall HRQOL than healthy children, respectively, with medium to large effect sizes. Patients with cerebral palsy self-reported the most impaired HRQOL, while patients with diabetes self-reported the best HRQOL. Parent proxy-reports generally paralleled patient self-report, with several notable differences. The results demonstrate differential effects of pediatric chronic conditions on patient HRQOL across diseases clusters, categories, and severities utilizing the PedsQL 4.0 Generic Core Scales from the perspectives of pediatric patients and parents. The data contained within this study represents a larger and more diverse population of pediatric patients with chronic conditions than previously reported in the extant literature. The findings contribute important information on the differential effects of pediatric chronic conditions on generic HRQOL from the perspectives of children and parents utilizing the PedsQL 4.0 Generic Core Scales. These findings

  15. Utilization of Mental Health Services and Mental Health Status Among Children Placed in Out-of-Home Care: A Parallel Process Latent Growth Modeling Approach.

    Science.gov (United States)

    Yampolskaya, Svetlana; Sharrock, Patty J; Clark, Colleen; Hanson, Ardis

    2017-10-01

    This longitudinal study examined the parallel trajectories of mental health service use and mental health status among children placed in Florida out-of-home care. The results of growth curve modeling suggested that children with greater mental health problems initially received more mental health services. Initial child mental health status, however, had no effect on subsequent service provision when all outpatient mental health services were included. When specific types of mental health services, such as basic outpatient, targeted case management, and intensive mental health services were examined, results suggested that children with compromised functioning during the baseline period received more intensive mental health services over time. However, this increased provision of intensive mental health services did not improve mental health status, rather it was significantly associated with progressively worse mental health functioning. These findings underscore the need for regular comprehensive mental health assessments focusing on specific needs of the child.

  16. Multiattribute Utility Theory without Expected Utility Foundations

    NARCIS (Netherlands)

    Stiggelbout, A.M.; Wakker, P.P.

    1995-01-01

    Methods for determining the form of utilities are needed for the implementation of utility theory in specific decisions. An important step forward was achieved when utility theorists characterized useful parametric families of utilities, and simplifying decompositions of multiattribute utilities.

  17. Multiattribute utility theory without expected utility foundations

    NARCIS (Netherlands)

    Wakker, P.P.; Miyamoto, J.

    1996-01-01

    Methods for determining the form of utilities are needed for the implementation of utility theory in specific decisions. An important step forward was achieved when utility theorists characterized useful parametric families of utilities, and simplifying decompositions of multiattribute utilities.

  18. Health-Related Quality of Life and Cognitive Functioning from the Perspective of Parents of School-Aged Children with Asperger's Syndrome Utilizing the PedsQL[TM

    Science.gov (United States)

    Limbers, Christine A.; Heffer, Robert W.; Varni, James W.

    2009-01-01

    HRQOL as a multidimensional construct has not been previously investigated in children with Asperger's Syndrome. The objective of the present study was to examine the initial feasibility, reliability, and validity of the PedsQL[TM] 4.0 Generic Core Scales and PedsQL[TM] Cognitive Functioning Scale parent proxy-report versions in school-aged…

  19. Children and Their Families in Two Counties of New York State: An Exploration of the Ecological Utility of the DIPOV Index.

    Science.gov (United States)

    Kogan, Leonard S.; And Others

    The DIPOV Index as an indicator of "the state of the child" in various ecological settings is examined in a study based on extensive interviews with mothers or mother-surrogates of children aged 1 to 10. Several hundred households were sampled in two upstate New York counties with strongly contrasting DIPOV Indices. Developed as an…

  20. Availability and utilization of the WHO recommended priority lifesaving medicines for under five-year old children in public health facilities in Uganda

    DEFF Research Database (Denmark)

    Nsabagasani, Xavier; Ogwal-Okeng, Jasper; Mbonye, Anthony

    2015-01-01

    priority medicines for diarrhea, sepsis, pneumonia and malaria. 81 health workers from the facilities reported what they prescribed for children with the above diseases. RESULTS: Oral rehydration salt (ORS) and zinc sulphate dispersible tablets for diarrhea were available in all HC IIs and IIIs and in only...

  1. The Impact of Head Start on Children, Families and Communities. Final Report of the Head Start Evaluation, Synthesis and Utilization Project. Executive Summary.

    Science.gov (United States)

    McKey, Ruth Hubbell; And Others

    This report summarizes the results of a study on the impact of Head Start on children's cognitive and socioemotional development, on child health and health institutions in the community, on enrollees' families, and on communities where Head Start programs operate. After discussing the background and methodology of the study, the report concludes…

  2. The Discriminative Ability and Diagnostic Utility of the ADOS-G, ADI-R, and GARS for Children in a Clinical Setting

    Science.gov (United States)

    Mazefsky, Carla A.; Oswald, Donald P.

    2006-01-01

    Recent years have seen a surge of interest in assessment instruments for diagnosing autism in children. Instruments have generally been developed and evaluated from a research perspective. The Autism Diagnostic Observation Schedule-Generic (ADOS-G), Autism Diagnostic Interview-Revised (ADI-R), and Gilliam Autism Rating Scale (GARS) have received…

  3. A Study of the Relationship between Virtual Reality (Perceived Realism) and the Ability of Children To Create, Manipulate and Utilize Mental Images for Spatially Related Problem Solving.

    Science.gov (United States)

    Merickel, Mark L.

    The premise of the Creative Technology Project, a collaboration by Autodesk, Inc., the School of Education at Oregon State University, and Novato Unified School District in the San Francisco Bay Area, was that children's cognitive abilities could be enhanced by having them develop, displace, transform, and interact with 2D and 3D…

  4. Environmental correlates of undernutrition among children of 3–6 years of age, Rajkot, Gujarat, India

    Directory of Open Access Journals (Sweden)

    Zalak Rameshbhai Matariya

    2016-01-01

    Full Text Available Introduction: There are lots of studies focusing on the role of reproductive and child health factors and dietary factors on the nutrition status of the child. The present study is an attempt to highlight the role of macro- and micro-environmental factors in predicting the occurrence of undernutrition in children. Methods: This was a cross-sectional study conducted in field practice area of Community Medicine Department, PDU Medical College, Rajkot. The nutrition status of children was assessed using the weight for age WHO reference standards, 2006. Children below two standard deviation of the reference median (weight for age were considered as malnourished. Data were collected for sociodemographic factors, sanitation, hygiene, and attitude of mother toward her child, etc., Data were entered in MS excel, and logistic regression was used. Results: Analysis of 495 selected children showed 24% prevalence of undernutrition. Employment status of mothers (adjusted odds ratio [AOR] 1.65, drinking water quality (AOR 1.53, and cleanliness of mother's hands and clothes (AOR 1.91 significantly affected the nutrition status of the child. Children classified in fair or poor category for Briscoe's sanitation scale had 1.34 and1.92 times higher odds of being undernourished (P > 0.05, respectively. Children classified in fair or poor category for Elizabeth's microenvironment scale had 2.05 and 2.41 times higher odds of being undernourished (P < 0.05, respectively. Conclusions: Water, sanitation, and hygiene-related factors, as well as microenvironmental factors, significantly affected the nutrition status of the children.

  5. Prevalence of severe acute malnutrition and associated sociodemographic factors among children aged 6 months–5 years in rural population of Northern India: A population-based survey

    Directory of Open Access Journals (Sweden)

    Ajeet Singh Bhadoria

    2017-01-01

    Full Text Available Introduction: National Family Health Survey (NFHS-3 documented that nearly 57 million children are undernourished in India, which is one-third of the world's share. We planned a study to identify the prevalence of severe acute malnutrition (SAM among children aged <5 years in a rural population of Northern India. Materials and Methods: A cross-sectional study was conducted at 2 blocks of District Meerut during 2012–2014. A total of 70 villages were identified and all children in the age group 6–60 months were approached through house-to-house visits. Data on sociodemographic profile and anthropometry were collected utilizing standards methods and equipment. The Z-scores for weight-for-age, height-for-age, and weight-for-height (WHZ were calculated using the World Health Organization (WHO reference data as standard. SAM (severe wasting was defined as per the WHO criteria (WHZ score −3 standard deviation or severe visible wasting or bipedal edema. Results: A total of 19,449 children were screened and 18,463 children (age, 32.6 ± 15.4 years, and 53.4% males were enrolled, and 466 were excluded due to erroneous age estimation and physical deformities. The prevalence of SAM was 2.2%, 95% confidence interval (CI 2.02–2.44%, (409/18,463. Multivariate logistic regression documented age (odds ratio [OR]: 0.97, 95% CI 0.96–0.98, nuclear family (OR: 1.25, 95% CI 1.01–1.54, lower occupation of head of family (OR: 1.29, 95% CI 1.05–1.59, and lower paternal education (OR: 1.49, 95% CI 1.16–1.91 as independent predictor of SAM. Conclusion: The prevalence of SAM was lower (2.2% in this Northern district of India as compared to national prevalence (7.9%. Younger age, nuclear family, lower parental education, and poor occupation of the head of the family predispose a child to SAM.

  6. Simplifying the Evaluation of Children With New Onset Diabetes: Utility of Pancreatic Autoantibodies for Diabetes Type Classification and Use of Serum Bicarbonate to Diagnose and Classify Diabetic Ketoacidosis.

    OpenAIRE

    Von Oettingen, Julia Elisabeth

    2015-01-01

    Objectives: To assess whether routinely measuring pancreatic autoantibodies (PAA) in pediatric new onset diabetes (NODM) is necessary, and to evaluate serum bicarbonate (HCO3) as a substitute for venous pH (vpH) in the diagnosis of diabetic ketoacidosis (DKA). Methods: Retrospective analysis of all patients with NODM admitted to Boston Children's Hospital from 10/1/07-7/1/13. Logistic regression was used to develop a clinical score to classify diabetes type. Linear and logistic regression...

  7. Utilities objectives

    International Nuclear Information System (INIS)

    Cousin, Y.; Fabian, H.U.

    1996-01-01

    The policy of French and german utilities is to make use of nuclear energy as a long term, competitive and environmentally friendly power supply. The world electricity generation is due to double within the next 30 years. In the next 20 to 30 years the necessity of nuclear energy will be broadly recognized. More than for most industries, to deal properly with nuclear energy requires the combination of a consistent political will, of a proper institutional framework, of strong and legitimate control authorities, of a sophisticated industry and of operators with skilled management and human resources. One of the major risk facing nuclear energy is the loss of competitiveness. This can be achieved only through the combination of an optimized design, a consistent standardization, a proper industrial partnership and a stable long term strategy. Although the existing plants in Western Europe are already very safe, the policy is clearly to enhance the safety of the next generation of nuclear plants which are designing today. The French and German utilities have chosen an evolutionary approach based on experience and proven technologies, with an enhanced defense in depth and an objective of easier operation and maintenance. The cost objective is to maintain and improve what has been achieved in the best existing power plants in both countries. This calls for rational choices and optimized design to meet the safety objectives, a strong standardization policy, short construction times, high availability and enough flexibility to enable optimization of the fuel cycle throughout the lifetime of the plants. The conceptual design phase has proven that the French and German teams from industry and from the utilities are able to pursue both the safety and the cost objectives, basing their decision on a rational approach which could be accepted by the safety authorities. (J.S.)

  8. Thorium utilization

    Energy Technology Data Exchange (ETDEWEB)

    Trauger, D B [Oak Ridge National Lab., TN (USA)

    1978-01-01

    Some of the factors that provide incentive for the utilization of thorium in specific reactor types are explored and the constraints that stand in the way are pointed out. The properties of thorium and derived fuels are discussed, and test and reactor operating experience is reviewed. In addition, symbiotic systems of breeder and converter reactor are suggested as being particularly attractive systems for energy production. Throughout the discussion, the High-Temperature Gas-Cooled Reactor and Molten Salt Reactor are treated in some detail because they have been developed primarily for use with thorium fuel cycles.

  9. Japanese utilities' plutonium utilization program

    International Nuclear Information System (INIS)

    Matsuo, Yuichiro.

    1996-01-01

    Japan's 10 utility companies are working and will continue to work towards establishing a fully closed nuclear fuel cycle. The key goals of which are: (1) reprocessing spent fuel; (2) recycling recovered uranium and plutonium; and (3) commercializing fast breeder technology by around the year 2030. This course of action by the Japanese electric power industry is in full accordance with Japan's national policy outlined in the government's report ''The Long-Term Program for Research, Development, and Nuclear Energy,'' which was published in June 1994. The Japanese civilian nuclear program is a long-term program that looks into the 21st century and beyond. It is quite true that sustaining the recycling option for energy security and the global environment demands a large investment. For it to be accepted by the public, safety must be the highest priority and will be pursued at a great cost if necessary. In its history, Japan has learned that as technology advances, costs will come down. The Japanese utility industry will continue investment in technology without compromising safety until the recycling option becomes more competitive with other options. This effort will be equally applied to the development of the commercial FBRs. The Japanese utility industry is confident that Japan's stable policy and strong objective to develop competitive and peaceful technology will contribute to the global economy and the environment without increasing the threat of plutonium proliferation

  10. Multiattribute Utility Theory without Expected Utility Foundations

    NARCIS (Netherlands)

    J. Miyamoto (John); P.P. Wakker (Peter)

    1996-01-01

    textabstractMethods for determining the form of utilities are needed for the implementation of utility theory in specific decisions. An important step forward was achieved when utility theorists characterized useful parametric families of utilities and simplifying decompositions of multiattribute

  11. Dyslipidaemia and Undernutrition in Children from Impoverished Areas of Maceió, State of Alagoas, Brazil

    Directory of Open Access Journals (Sweden)

    Telma M. M. T. Florêncio

    2010-11-01

    Full Text Available Chronic undernutrition causes reduced growth and endocrine adaptations in order to maintain basic life processes. In the present study, the biochemical profiles of chronically undernourished children were determined in order to test the hypothesis that chronic undernutrition also causes changes in lipid profile in pre-school children. The study population comprised 80 children aged between 12 and 71 months, including 60 with moderate undernutrition [height-for-age Z (HAZ scores ≤ −2 and > −3] and 20 with severe undernutrition (HAZ scores ≤ −3. Socioeconomic, demographic and environmental data were obtained by application of a questionnaire, and anthropometric measurements and information relating to sex, age and feeding habits were collected by a trained nutritionist. Blood samples were analysed for haemoglobin, vitamin A, insulin-like growth factor 1 (IGF-1 and serum lipids, while cortisol was assayed in the saliva. Faecal samples were submitted to parasitological investigation. Analysis of variance and χ2 methods were employed in order to select the variables that participated in the multivariate logistic regression analysis. The study population was socioeconomically homogeneous, while the lack of a treated water supply was clearly associated with the degree of malnutrition. Most children were parasitised and anaemia was significantly more prevalent among the severely undernourished. Levels of IGF-1 decreased significantly with increasing severity of undernutrition. Lipid analysis revealed that almost all of the children had dyslipidemia, while low levels of high-density lipoprotein were associated with the degree of undernutrition. It is concluded that chronic malnutrition causes endocrine changes that give rise to alterations in the metabolic profile of pre-school children.

  12. Utilization of teledentistry as a tool to screen for dental caries among 12-year-old school children in a rural region of India.

    Science.gov (United States)

    Purohit, Bharathi M; Singh, Abhinav; Dwivedi, Ashish

    2017-03-01

    The study aims to assess the reliability of video-graphic method as a tool to screen the dental caries among 12-year-old school children in a rural region of India. A total of 139 school children participated in the study. Visual tactile examinations were conducted using the Decayed, Missing, and Filled Teeth (DMFT) index. Simultaneously, standardized video recording of the oral cavity was performed. Sensitivity and specificity values were calculated for video-graphic assessment of dental caries. Bland-Altman plot was used to assess agreement between the two methods of caries assessment. Likelihood ratio (LR) and receiver-operating characteristic (ROC) curve were used to assess the predictive accuracy of the video-graphic method. Mean DMFT for the study population was 2.47 ± 2.01 and 2.46 ± 1.91 by visual tactile and video-graphic assessment (P = 0.76; > 0.05). Sensitivity and specificity values of 0.86 and 0.58 were established for video-graphic assessment. A fair degree of agreement was noted between the two methods with Intraclass correlation coefficient (ICC) value of 0.56. LR for video-graphic assessment was 2.05. Bland-Altman plot confirmed the level of agreement between the two assessment methods. The area under curve was 0.69 (CI 0.57, 0.80, P = 0.001). Teledentistry examination is comparable to clinical examination when screening for dental caries among school children. This study provides evidence that teledentistry may be used as an alternative screening tool for assessment of dental caries and is viable for remote consultation and treatment planning. Teledentistry offers to change the dynamics of dental care delivery and may effectively bridge the rural-urban oral health divide. © 2016 American Association of Public Health Dentistry.

  13. Acute Dehydrating Gastro-enteritis Undernourished Infants

    African Journals Online (AJOL)

    1974-08-03

    Aug 3, 1974 ... of intravenous fluid therapy are seen annually, one such method has been ... medical, nursing and laboratory personnel; and a simple standardised ..... to improvement in fluid balance and metabolism, but the absence of a ...

  14. A Tale of Smoking Cessation Promotion: The Utilization of a Children's Book to Increase Screening and Counseling in the Pediatric Clinic.

    Science.gov (United States)

    Thomas, Katharine E H; Kisely, Steve; Urrego, Fernando

    2017-10-01

    The rate at which pediatricians promote smoking cessation in clinical settings is low. The literature demonstrates that interventions paired with tangible health promotion materials may significantly increase screening rates to the pediatric office. The aim of this study was to investigate whether the addition of a children's book in the pediatric clinic could result in an increase in the rate in which pediatricians screened for secondhand smoke exposure (SHSe) and counseled caregivers to stop smoking. This randomized controlled study was performed at 7 pediatric clinics. Seven pediatric clinic sites were randomly assigned to either an intervention or control group. Pediatricians in the intervention group were given children's books about SHSe to distribute to their patients while the control group did not receive any materials. At baseline, there was no difference between the control group and intervention group in rates at which pediatricians screened for SHSe ( P = .8728) and counseled caregivers to stop smoking ( P = .29). After the intervention, screening for SHSe and counseling caregivers to stop smoking were statistically significantly greater in the intervention group, when compared to controls ( P book in the pediatric setting can increase the rate at which pediatricians screen for SHSe and counsel caregivers to stop smoking. Future research should examine the effect of the storybook on various parameters of smoking cessation and future smoking behaviors.

  15. Utility of gastric aspirates for diagnosing tuberculosis in children in a low prevalence area: predictors of positive cultures and significance of non-tuberculous mycobacteria.

    Science.gov (United States)

    Kordy, Faisal; Richardson, Susan E; Stephens, Derek; Lam, Ray; Jamieson, Frances; Kitai, Ian

    2015-01-01

    In countries with low rates of tuberculosis (TB), yields of gastric aspirates (GAs) for Mycobacterium tuberculosis (MTB) culture are low. The significance of non-tuberculous mycobacteria (NTM) isolated from GA is uncertain. We reviewed clinical, microbiologic and radiologic data for children who underwent GA between 1999 and 2011 at Sick Kids, Toronto. Radiologic features of cases were compared with those of age matched controls. 785 GAs were obtained from 285 patients of whom 20 (7%) had positive MTB cultures: in 15 patients the GA was the only positive culture for MTB. Of 15 culture-positive patients who underwent exactly 3 GAs, MTB was isolated from the first lavage in 10 (67%), only from the second in 3 (20%) and only from the third in 2 (13%). On univariate analysis, miliary disease and intrathoracic lymphadenopathy were associated with a positive GA MTB culture. On multiple conditional logistic regression analysis, adenopathy remained significant (OR 10.2 [95% CI 2.0-51.4] p =0.005). Twelve patients had NTM isolated, most commonly M. avium complex: none had evidence of invasive NTM disease during a median duration of 12 months of follow-up. Causal pathogens different from the GA NTM culture were isolated from biopsies or bronchoalveolar lavage in 3. GAs continue to be important for TB diagnosis in children. Three GAs have a yield better than 1. Those with miliary or disseminated TB and intrathoracic lymphadenopathy have highest yields. NTM isolates from GA are likely unimportant and can be clinically misleading.

  16. Morbilidad bucal: Su relación con el estado nutricional en niños de 2 a 5 años de la Consulta de Nutrición del Hospital Pediátrico Docente de Centro Habana Oral morbidity and its relationship with the nutritional status of 2-5 years-old children

    Directory of Open Access Journals (Sweden)

    María Elena Quiñónez Ybarra

    2004-04-01

    Full Text Available En el presente trabajo se describe la morbilidad de las principales afecciones bucales y su relación con el estado nutricional y peso al nacer en niños de 2 a 5 años de edad. Se realizó un estudio descriptivo transversal donde se evaluaron 230 niños, de ellos 115 eutróficos y 115 desnutridos, según tablas de referencia cubana de peso y talla, exámenes bioquímicos y exámenes clínicos, utilizándose como variables: estado nutricional, peso al nacer, índice coe-d, retardo del brote dentario, lesiones de esmalte, maloclusión e índice PMA. Para su procesamiento estadístico se aplicaron pruebas Chi cuadrado con un nivel de confiabilidad del 95 % (alfa 0,05. Se concluye que el índice coe-d fue de 0,14 para los eutróficos y de 0,71 para los desnutridos. El brote dentario estuvo retardado en el 2,63 % en los eutróficos, mientras que los desnutridos fue del 39,4 % y estuvo más retardado en los bajo peso al nacer, desnutridos, con el 75 %. Solo aparecieron lesiones de esmalte en el grupo de desnutridos (22,60 % y se incrementó en los bajo peso de este grupo (34,61 %. El porcentaje de maloclusión en el grupo eutrófico fue de 36,52 %, en los desnutridos 62,6 % y aumentó en los de bajo peso, con el 84,61 %. Se apreció como trastorno periodontal el 26,92 % de gingivitis moderada en niños desnutridos de bajo peso.The present paper describes the morbidity of the main oral diseases and their relationship with nutritional status and low birthweight in 2-5 years-old children. A cross-sectional descriptive study was conducted to evaluate 230 children - 115 eutrophic and 115 undernourished- according to the Cuban weight-size reference tables, biochemical and clinical examinations, using variables such as nutritional status, birthweight, coe-d index, dental eruption retardation, dental enamel lesions, malocclusion, and PMA index. For statistical processing, Chi-square test with a 95% confidence interval (alpha 0,05 was applied. It was

  17. Clinical utility of the Chinese version of the Pediatric Daytime Sleepiness Scale in children with obstructive sleep apnea syndrome and narcolepsy.

    Science.gov (United States)

    Yang, Chien-Ming; Huang, Yu-Shu; Song, Yu-Chen

    2010-04-01

    The present study examined the psychometric properties of the Chinese version of the Pediatric Daytime Sleepiness Scale (PDSS) and the utility of the PDSS as a screening tool for pathological daytime sleepiness in teenagers with obstructive sleep apnea (OSA) and narcolepsy. The PDSS was first administered to 238 middle and high school students to assess the reliability of the scale, and then administered to 28 teenagers with OSA, 31 teenagers with narcolepsy, and 34 normal controls to evaluate its clinical utility. Test-retest reliability and internal consistency were acceptable. The PDSS scores were significantly higher in narcoleptic subjects than in subjects with OSA, and higher in OSA syndrome (OSAS) subjects than normal controls. Furthermore, the scores decreased in narcoleptic subjects after medical treatment. Both reliability and validity were proven to be good. As a screening tool for narcolepsy, receiver operator characteristic (ROC) curve analysis showed that the PDSS, with a cut-off score of 16/17, had good sensitivity (87.1%) and fair specificity (74.3%) for identifying individuals with narcolepsy. When used for screening OSA, however, the differentiating power was not as good. The PDSS is a reliable and valid tool for the measurement of sleepiness in clinical youth populations. When used as a screening tool, it is useful for sleep disorders involving more severe pathological sleepiness, as in narcolepsy.

  18. Functioning and disability in patients with Angelman syndrome: utility of the International Classification of functioning disability and health, children and youth adaptation framework.

    Science.gov (United States)

    Bonanni, Paolo; Gobbo, Annamaria; Nappi, Sara; Moret, Ornella; Nogarol, Anita; Santin, Michela; Randazzo, Giovanna; Martinuzzi, Andrea

    2009-01-01

    Angelman syndrome (AS) accounts for upto 6% of all cases with severe mental retardation and epilepsy. Clinical findings include developmental delay, severely impaired expressive language, ataxic gait, tremulousness of limbs and a typical behavioral profile including a happy demeanour, hyperactive behavior and low attention span. Seizures, abnormal electroencephalogram, microcephaly and scoliosis are observed in >80% of patients. Cognitive, language and orthopedic problems must be addressed with vigorous rehabilitation programs. Classification of functioning disability and health, children and youth adaptation (ICF-CY) can provide the most adequate framework to describe the condition of the persons towards whom rehabilitative efforts are concentrated. The aim of the study is to test whether the ICF-CY framework is effectively able to capture the various dimensions of health in AS. We applied the ICF-CY, to the detail of second level codes, to a cohort of 11 patients with AS of various ages. The coding was obtained by the multi-professional team following these children for the rehabilitation program. The functional profile obtained applying the ICF-CY is complete and comparable with the characteristics of the syndrome described in literature. The possibility of highlighting not only the problems but also the points of strength appears as very helpful. The second level codes may be too broad to provide insight in the clinical and rehabilitative peculiarities, and the use of the full power of the classification may be more advisable for clinical use. This prelimiary study shows that ICF-CY is a valid tool to frame the clinical characteristics of a complex syndrome as AS, and may give a strong foundation for the rehabilitation programming.

  19. Utility of Cardiovascular Magnetic Resonance-Derived Wave Intensity Analysis As a Marker of Ventricular Function in Children with Heart Failure and Normal Ejection Fraction.

    Science.gov (United States)

    Ntsinjana, Hopewell N; Chung, Robin; Ciliberti, Paolo; Muthurangu, Vivek; Schievano, Silvia; Marek, Jan; Parker, Kim H; Taylor, Andrew M; Biglino, Giovanni

    2017-01-01

    This study sought to explore the diagnostic insight of cardiovascular magnetic resonance (CMR)-derived wave intensity analysis to better study systolic dysfunction in young patients with chronic diastolic dysfunction and preserved ejection fraction (EF), comparing it against other echocardiographic and CMR parameters. Evaluating systolic and diastolic dysfunctions in children is challenging, and a gold standard method is currently lacking. Patients with presumed diastolic dysfunction [ n  = 18; nine aortic stenosis (AS), five hypertrophic, and four restrictive cardiomyopathies] were compared with age-matched control subjects ( n  = 18). All patients had no mitral or aortic incompetence, significant AS, or reduced systolic EF. E / A ratio, E / E ' ratio, deceleration time, and isovolumetric contraction time were assessed on echocardiography, and indexed left atrial volume (LAVi), acceleration time (AT), ejection time (ET), and wave intensity analyses were calculated from CMR. The latter was performed on CMR phase-contrast flow sequences, defining a ratio of the peaks of the early systolic forward compression wave (FCW) and the end-systolic forward expansion wave (FEW). Significant differences between patients and controls were seen in the E / E ' ratio (8.7 ± 4.0 vs. 5.1 ± 1.3, p  = 0.001) and FCW/FEW ratio (2.5 ± 1.6 vs. 7.2 ± 4.2 × 10 -5 m/s, p  wave intensity-derived ratio summarizing systolic and diastolic function could provide insight into ventricular function in children, on top of CMR and echocardiography, and it was here able to identify an element of ventricular dysfunction with preserved EF in a small group of young patients.

  20. Utility training

    International Nuclear Information System (INIS)

    Villaros, P.E.; Luxo, Armando; Bruant, Jacques

    1977-01-01

    The study of operational training systems for electro-nuclear utilities may be conducted through two different approaches. A first analytical approach consists of determining, for each position of a given organization chart, the necessary qualifications required and the corresponding complementary training to be provided. This approach applies preferentially to existing classical systems which are converted to nuclear operation with objectives of minimum structural changes and conservation of maximum efficiency. A second synthetical approach consists of determining the specific characteristics of nuclear plant operation, then, of deducting the training contingencies and the optimized organization chart of the plant, while taking into account, at each step, the parameters linked to local conditions. This last approach is studied in some detail in the present paper, taking advantage of its better suitability to the problems raised at the first stage of an electro-nuclear program development. In this respect, the possibility offered by this apprach to coordinate the training system of a given nuclear power station personnel with the overall problem of developing a skilled industrial labor force in the country, may lead to reconsideration of some usual priorities in the economy of operation of the nuclear power plant

  1. The effects of breakfast on behavior and academic performance in children and adolescents.

    Science.gov (United States)

    Adolphus, Katie; Lawton, Clare L; Dye, Louise

    2013-01-01

    Breakfast consumption is associated with positive outcomes for diet quality, micronutrient intake, weight status and lifestyle factors. Breakfast has been suggested to positively affect learning in children in terms of behavior, cognitive, and school performance. However, these assertions are largely based on evidence which demonstrates acute effects of breakfast on cognitive performance. Less research which examines the effects of breakfast on the ecologically valid outcomes of academic performance or in-class behavior is available. The literature was searched for articles published between 1950-2013 indexed in Ovid MEDLINE, Pubmed, Web of Science, the Cochrane Library, EMBASE databases, and PsychINFO. Thirty-six articles examining the effects of breakfast on in-class behavior and academic performance in children and adolescents were included. The effects of breakfast in different populations were considered, including undernourished or well-nourished children and adolescents from differing socio-economic status (SES) backgrounds. The habitual and acute effects of breakfast and the effects of school breakfast programs (SBPs) were considered. The evidence indicated a mainly positive effect of breakfast on on-task behavior in the classroom. There was suggestive evidence that habitual breakfast (frequency and quality) and SBPs have a positive effect on children's academic performance with clearest effects on mathematic and arithmetic grades in undernourished children. Increased frequency of habitual breakfast was consistently positively associated with academic performance. Some evidence suggested that quality of habitual breakfast, in terms of providing a greater variety of food groups and adequate energy, was positively related to school performance. However, these associations can be attributed, in part, to confounders such as SES and to methodological weaknesses such as the subjective nature of the observations of behavior in class.

  2. The global pediatric antiretroviral market: analyses of product availability and utilization reveal challenges for development of pediatric formulations and HIV/AIDS treatment in children

    Directory of Open Access Journals (Sweden)

    Jambert Elodie

    2010-10-01

    Full Text Available Abstract Background Important advances in the development and production of quality-certified pediatric antiretroviral (ARV formulations have recently been made despite significant market disincentives for manufacturers. This progress resulted from lobbying and innovative interventions from HIV/AIDS activists, civil society organizations, and international organizations. Research on uptake and dispersion of these improved products across countries and international organizations has not been conducted but is needed to inform next steps towards improving child health. Methods We used information from the World Health Organization Prequalification Programme and the United States Food and Drug Administration to describe trends in quality-certification of pediatric formulations and used 7,989 donor-funded, pediatric ARV purchase transactions from 2002-2009 to measure uptake and dispersion of new pediatric ARV formulations across countries and programs. Prices for new pediatric ARV formulations were compared to alternative dosage forms. Results Fewer ARV options exist for HIV/AIDS treatment in children than adults. Before 2005, most pediatric ARVs were produced by innovator companies in single-component solid and liquid forms. Five 2-in1 and four 3-in-1 generic pediatric fixed-dose combinations (FDCs in solid and dispersible forms have been quality-certified since 2005. Most (67% of these were produced by one quality-certified manufacturer. Uptake of new pediatric FDCs outside of UNITAID is low. UNITAID accounted for 97-100% of 2008-2009 market volume. In total, 33 and 34 countries reported solid or dispersible FDC purchases in 2008 and 2009, respectively, but most purchases were made through UNITAID. Only three Global Fund country recipients reported purchase of these FDCs in 2008. Prices for pediatric FDCs were considerably lower than liquids but typically higher than half of an adult FDC. Conclusion Pediatric ARV markets are more fragile than

  3. The global pediatric antiretroviral market: analyses of product availability and utilization reveal challenges for development of pediatric formulations and HIV/AIDS treatment in children.

    Science.gov (United States)

    Waning, Brenda; Diedrichsen, Ellen; Jambert, Elodie; Bärnighausen, Till; Li, Yun; Pouw, Mieke; Moon, Suerie

    2010-10-17

    Important advances in the development and production of quality-certified pediatric antiretroviral (ARV) formulations have recently been made despite significant market disincentives for manufacturers. This progress resulted from lobbying and innovative interventions from HIV/AIDS activists, civil society organizations, and international organizations. Research on uptake and dispersion of these improved products across countries and international organizations has not been conducted but is needed to inform next steps towards improving child health. We used information from the World Health Organization Prequalification Programme and the United States Food and Drug Administration to describe trends in quality-certification of pediatric formulations and used 7,989 donor-funded, pediatric ARV purchase transactions from 2002-2009 to measure uptake and dispersion of new pediatric ARV formulations across countries and programs. Prices for new pediatric ARV formulations were compared to alternative dosage forms. Fewer ARV options exist for HIV/AIDS treatment in children than adults. Before 2005, most pediatric ARVs were produced by innovator companies in single-component solid and liquid forms. Five 2-in1 and four 3-in-1 generic pediatric fixed-dose combinations (FDCs) in solid and dispersible forms have been quality-certified since 2005. Most (67%) of these were produced by one quality-certified manufacturer. Uptake of new pediatric FDCs outside of UNITAID is low. UNITAID accounted for 97-100% of 2008-2009 market volume. In total, 33 and 34 countries reported solid or dispersible FDC purchases in 2008 and 2009, respectively, but most purchases were made through UNITAID. Only three Global Fund country recipients reported purchase of these FDCs in 2008. Prices for pediatric FDCs were considerably lower than liquids but typically higher than half of an adult FDC. Pediatric ARV markets are more fragile than adult markets. Ensuring a long-term supply of quality, well

  4. Gastrointestinal and nutritional problems in neurologically impaired children.

    Science.gov (United States)

    Quitadamo, Paolo; Thapar, Nikhil; Staiano, Annamaria; Borrelli, Osvaldo

    2016-11-01

    The current increasing survival of children with severe central nervous system damage has created a major challenge for medical care. Gastrointestinal and nutritional problems in neurologically impaired children have been recently recognized as an integral part of their disease, often leading to growth failure and worsened quality of life for both children and caregivers. Nutritional support is essential for the optimal care of these children. Undernourished handicapped children might not respond properly to intercurrent diseases and suffer unnecessarily. On the other hand, restoring a normal nutritional status results in a better quality of life in many. The easiest and least invasive method to increase energy intake is to improve oral intake. However, oral intake can be maintained as long as there is no risk of aspiration, the child is growing well and the time required to feed the child remains within acceptable limits. When oral intake is unsafe, insufficient or too time consuming, enteral nutrition should be initiated. Damage to the developing central nervous system may result in significant dysfunction in the gastrointestinal tract and is reflected in impairment in oral-motor function, rumination, gastro-oesophageal reflux (GER), with or without aspiration, delayed gastric emptying and constipation. These problems can all potentially contribute to feeding difficulty in disabled children, carrying further challenging long-term management issues. Copyright © 2016 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

  5. Compensatory lung growth: protein, DNA and RNA lung contents in undernourished trilobectomized rats Crescimento pulmonar compensatório: conteúdos pulmonares de proteína, DNA e RNA em ratos subnutridos trilobectomizados

    Directory of Open Access Journals (Sweden)

    Raul Lopes Ruiz Júnior

    2005-06-01

    Full Text Available PURPOSE: To demonstrate compensatory lung growth (CLG by lung contents of proteins, DNA, and RNA in undernourished young adult rats, submitted to pulmonary trilobectomy. METHODS: We used 137 male Wistar rats, randomly distributed into 9 groups; they were submitted to three treatments (control, thoracotomy, and trilobectomy, and sacrificed at three different times (7, 30, and 90 days. In trilobectomy we removed the right median, accessory, and caudal lobes. We studied lung proteins, DNA, and RNA contents. RESULTS: In the cranial lobe and left lung, protein content was higher in trilobectomized rats however there was insufficient CLG to make up for the loss. The increase of DNA in the cranial lobe and left lung of trilobectomized rats was sufficient to compensate for this loss, resulting in a similar content to controls. RNA content in trilobectomized rats, was higher in the cranial lobe and left lung, more efficient in the cranial lobe, but less than in the other groups. CONCLUSION: CLG occurred in trilobectomized rats, probably with cell hyperplasia and little hypertrophy, due to the large DNA compensation and small RNA compensation. This was markedly different to well-nourished animals, who had pronounced hypertrophy.OBJETIVO: demonstrar se ocorre crescimento pulmonar compensatório (CPC representado pelos conteúdos de proteínas, DNA e RNA no rato adulto jovem, subnutrido, submetido à trilobectomia pulmonar. MÉTODOS: Utilizamos 137 ratos "Wistar", machos, distribuídos por sorteio, em 9 grupos, submetidos a três tratamentos (controle, toracotomia, trilobectomia, sacrificados em três momentos (7, 30 e 90 dias. Na trilobectomia foram extirpados os lobos médio, acessório e caudal direitos. Variáveis estudadas: conteúdos pulmonares de proteínas, DNA e RNA. RESULTADOS: No lobo cranial e pulmão esquerdo o conteúdo protéico foi maior nos trilobectomizados. Ocorreu CPC insuficiente para suprir a perda desta variável, sendo menor nos pulm

  6. Efficacy of supplementation in filipino children.

    Science.gov (United States)

    Tayao, Charisse Marie S

    2015-01-01

    At present, in the absence of an anemia prevention and screening program in Barangay Vasra, this will aid in the formation of programs that would teach about this health related issue, with an intervention that could be used efficiently by the health workers at the non-government organization run center. The aim of the following study is to establish the efficacy of iron supplementation alone versus iron and ascorbic acid supplementation in improving the hemoglobin (Hgb), hematocrit (Hct), reticulocyte count and red cell indices of anemic undernourished children 5-10 years of age at Lingap Center, Barangay Vasra, Quezon City. Anemic undernourished male and female children 5-10 years of age enrolled in the Supplementary Feeding Program of Lingap Center, Barangay Vasra, Quezon City. Prospective, experimental trial comparing two interventions-iron supplementation alone versus iron and ascorbic acid supplementation. A total of 25 children participated in this study, with a majority being female at 52% (13/25) of the total. Those who received iron supplementation alone for 6 months, while there were 50% (6/12) of either sex, whereas subjects who took iron and ascorbic acid supplementation for 6 months were predominantly female at 53.85% (7/13). Data obtained before and after iron supplementation alone revealed that there was an increase among the levels of Hgb, Hct, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC) and reticulocyte count, with the rise statistically significant. Hematological values gained before and after iron and ascorbic acid supplementation uncovered that there was an augmentation among the levels of Hct, MCV, MCH, MCHC and reticulocyte count, with the improvement statistically significant. Encompassing both interventions, the differences in findings were statistically significant in red blood cell (RBC) count, with the level progression statistically significant. Overall, the results

  7. Efficacy of supplementation in Filipino children

    Directory of Open Access Journals (Sweden)

    Charisse Marie S Tayao

    2015-01-01

    Full Text Available Introduction: At present, in the absence of an anemia prevention and screening program in Barangay Vasra, this will aid in the formation of programs that would teach about this health related issue, with an intervention that could be used efficiently by the health workers at the non-government organization run center. Objective: The aim of the following study is to establish the efficacy of iron supplementation alone versus iron and ascorbic acid supplementation in improving the hemoglobin (Hgb, hematocrit (Hct, reticulocyte count and red cell indices of anemic undernourished children 5-10 years of age at Lingap Center, Barangay Vasra, Quezon City. Methodology: Anemic undernourished male and female children 5-10 years of age enrolled in the Supplementary Feeding Program of Lingap Center, Barangay Vasra, Quezon City. Study Design: Prospective, experimental trial comparing two interventions-iron supplementation alone versus iron and ascorbic acid supplementation. Results: A total of 25 children participated in this study, with a majority being female at 52% (13/25 of the total. Those who received iron supplementation alone for 6 months, while there were 50% (6/12 of either sex, whereas subjects who took iron and ascorbic acid supplementation for 6 months were predominantly female at 53.85% (7/13. Data obtained before and after iron supplementation alone revealed that there was an increase among the levels of Hgb, Hct, mean corpuscular volume (MCV, mean corpuscular hemoglobin (MCH, mean corpuscular hemoglobin concentration (MCHC and reticulocyte count, with the rise statistically significant. Hematological values gained before and after iron and ascorbic acid supplementation uncovered that there was an augmentation among the levels of Hct, MCV, MCH, MCHC and reticulocyte count, with the improvement statistically significant. Encompassing both interventions, the differences in findings were statistically significant in red blood cell (RBC count

  8. The effects of breakfast on behaviour and academic performance in children and adolescents

    Directory of Open Access Journals (Sweden)

    Katie eAdolphus

    2013-08-01

    Full Text Available Breakfast consumption is associated with positive outcomes for diet quality, micronutrient intake, weight status and lifestyle factors. Breakfast has been suggested to positively affect learning in children in terms of behaviour, cognitive and school performance. However, these assertions are largely based on evidence which demonstrates acute effects of breakfast on cognitive performance. Less research which examines the effects of breakfast on the ecologically valid outcomes of academic performance or in-class behaviour is available. The literature was searched for articles published between 1950-2013 indexed in Ovid MEDLINE, Pubmed, Web of Science, the Cochrane Library, EMBASE databases and PsychINFO. Thirty-six articles examining the effects of breakfast on in-class behaviour and academic performance in children and adolescents were included. The effects of breakfast in different populations were considered, including undernourished or well-nourished children and adolescents from differing socio-economic status (SES backgrounds. The habitual and acute effects of breakfast and the effects of school breakfast programs (SBPs were considered. The evidence indicated a mainly positive effect of breakfast on on-task behaviour in the classroom. There was suggestive evidence that habitual breakfast (frequency and quality and SBPs have a positive effect on children’s academic performance with clearest effects on mathematic and arithmetic grades in undernourished children. Increased frequency of habitual breakfast was consistently positively associated with academic performance. Some evidence suggested that quality of habitual breakfast, in terms of providing a greater variety of food groups and adequate energy, was positively related to school performance. However, these associations can be attributed, in part, to confounders such as SES and to methodological weaknesses such as the subjective nature of the observations of behaviour in class.

  9. Differences in Health Care Needs, Health Care Utilization, and Health Care Outcomes Among Children With Special Health Care Needs in Ohio: A Comparative Analysis Between Medicaid and Private Insurance.

    Science.gov (United States)

    Sarkar, Madhurima; Earley, Elizabeth R; Asti, Lindsey; Chisolm, Deena J

    This study explores comparative differentials in health care needs, health care utilization, and health status between Medicaid and private/employer-sponsored insurance (ESI) among a statewide population of children with special health care needs (CSHCN) in Ohio. We used data from the 2012 Ohio Medicaid Assessment Survey to examine CSHCN's health care needs, utilization, status, and health outcomes by insurance type. Adjusted multivariable logistic regression models were used to explore associations between public and private health insurance, as well as the utilization and health outcome variables. Bivariate analyses indicate that the Medicaid population had higher care coordination needs (odds ratio [OR] = 1.6; 95% confidence interval [CI], 1.1-2.2) as well as need for mental/educational health care services (OR = 1.5; 95% CI; 1.1-2.0). They also reported higher unmet dental care needs (OR = 2.2; 95% CI, 1.2-4.0), higher emergency department (ED) utilization (OR = 2.3; 95% CI, 1.7-3.2), and worse overall health (OR = 0.6; 95% CI, 0.4-0.7), oral health (OR = 0.4; 95% CI, 0.3-0.5), and vision health (OR = 0.4; 95% CI, 0.2-0.6). After controlling for demographic variables, CSHCN with Medicaid insurance coverage were more likely to need mental health and education services (adjusted odds ratio [AOR] = 1.8; 95% CI; 1.2-2.6), had significantly more ED visits (AOR = 2.3; 95% CI, 1.5-3.5), and were less likely to have excellent overall health (AOR = 0.64; 95% CI, 0.4-0.9), oral health (AOR = 0.43; 95% CI, 0.3-0.7), and vision health (AOR = 0.38; 95% CI, 0.2-0.6) than those with private insurance/ESI. The CSHCN population is a highly vulnerable population. While Ohio's Medicaid provides greater coverage to CSHCN, disparities continue to exist within access and services that Medicaid provides versus the ones provided by private insurance/ESI.

  10. On the incidence of diarrhoea among young Indian children.

    Science.gov (United States)

    Borooah, Vani K

    2004-03-01

    Diarrhoea, claiming over three million young lives in the world every year, is the second biggest killer of children in developing countries. Using data for over 13,000 children in rural India, under the age of 3 years, this paper examines the relative effects of the different factors--inter alia the quality of the water supply, mother's literacy, housing conditions, and the level of development of the villages in which the children lived--contributing to diarrhoea. The paper highlights the importance of two factors: that children born to undernourished mothers may be more susceptible to infection than children whose mothers are well nourished, and that good hygienic practices within the home, such as washing hands with soap before feeding a child, can reduce the incidence of diarrhoea. The paper also quantifies the relative strength of the factors that determine whether mothers do so. The results emphasize the importance of mothers being literate, of household affluence and of institutional support (through the availability of trained midwives and mother and child centres in villages) in promoting domestic hygiene.

  11. Neuropathological research at the "Deutsche Forschungsanstalt fuer Psychiatrie" (German Institute for Psychiatric Research) in Munich (Kaiser-Wilhelm-Institute). Scientific utilization of children's organs from the "Kinderfachabteilungen" (Children's Special Departments) at Bavarian State Hospitals.

    Science.gov (United States)

    Steger, Florian

    2006-09-01

    During National Socialism, the politically motivated interest in psychiatric genetic research lead to the founding of research departments specialized in pathological-anatomical brain research, the two Kaiser Wilhelm-Institutes (KWI) in Berlin and Munich. The latter was indirectly provided with brain material by Bavarian State Hospitals, to three of which "Kinderfachabteilungen" (Special Pediatric Units) were affiliated. As children became victims of the systematically conducted child "euthanasia" in these Special Pediatric Units, this paper will address the question whether and to which extent the organs from victims of child "euthanasia" were used for (neuro-) pathological research at the KWI in Munich. By means of case studies and medical histories (with focus on the situation in Kaufbeuren-Irsee), I will argue that pediatric departments on a regular base delivered slide preparations, that the child "euthanasia" conduced in these departments systematically contributed to neuropathological research and that slide preparations from victims of child "euthanasia" were used in scientific publications after 1945.

  12. A Comparative Analysis of Health-Related Quality of Life and Family Impact between Children with ADHD Treated in a General Pediatric Clinic and a Psychiatric Clinic Utilizing the PedsQL

    Science.gov (United States)

    Limbers, Christine A.; Ripperger-Suhler, Jane; Boutton, Kelly; Ransom, Daniel; Varni, James W.

    2011-01-01

    Objective: To evaluate health-related quality of life (HRQOL) from the perspective of children with ADHD and their parents being seen in a Pediatric Clinic in comparison to healthy children and children with ADHD being seen in a Psychiatric Clinic. Method: Participants were children with a physician diagnosis of ADHD ages 5-18 years and their…

  13. [Classification of Colombian children with malnutrition according to NCHS reference or WHO standard].

    Science.gov (United States)

    Velásquez, Claudia; Bermúdez, Juliana; Echeverri, Claudia; Estrada, Alejandro

    2011-12-01

    A descriptive study was conducted to evaluate the concordance of National Center for Health Statistics reference (NCHS) used to classify undernourished children from Colombia with the WHO Child Growth Standards. We used data from children aged 6 to 59 months with acute malnutrition (Z Infantil" nutrition program in Colombia. Indicators height-for-age, weight for-height were analyzed when they were admitted to the hospital and weight for-height leaving the hospital. A statistical method used to compare means was T-student. Correlation coefficient intraclass (CCI) and Kappa index evaluated the concordance between NCHS and OMS; McNemar method evaluated the changes on the nutritional classification for children according to growth devices used. Of the total number of children classified as normal by NCHS, 10.4% were classified as stunted by WHO. 64% of the children admitted to the hospital presented acute malnutrition according to NCHS, of these 44,8% presented severe emaciation according to OMS, indeed severe emaciation increased of 36,0% to 63,3% using OMS. 5% of children leaving the hospital could need to stay more days if they had been evaluated with OMS. Growth devices shown high concordance in height-for-age (CCI = 0,988; k= 0,866) and weight for-height (CCI = 0,901; k = 0,578). Concluded that OMS growth standards classified more malnourished children and more severe states, in addition more malnourished children could be hospitalized and they could stay more days.

  14. Fatores associados à realização de consultas médicas de crianças menores de 5 anos Factors associated to outpatient care utilization by children (under five years of age

    Directory of Open Access Journals (Sweden)

    Antônio Augusto Moura da Silva

    1999-08-01

    Full Text Available A utilização de consultas médicas por crianças foi estimada por inquérito domiciliar transversal, em amostra aleatória por conglomerados em múltiplos estágios, no município de São Luís, Maranhão, Brasil, em 1994. Foi aplicado questionário padronizado em entrevistas com 711 mães ou responsáveis por crianças de 3 a 59 meses de idade. Pretendeu-se identificar demanda reprimida, estudar alguns fatores associados à não realização de consultas e verificar se a implantação do SUS (Sistema Único de Saúde e a expansão da rede de ambulatórios públicos reduziram a desigualdade na utilização dos serviços de saúde. Mais de dois terços, 67,2% das crianças realizaram consulta médica com finalidade curativa no último trimestre. Destas, 74,9% foram atendidas no SUS. Um percentual muito reduzido, 0,7%, procurou e não obteve consultas, caracterizando baixa repressão à demanda. Após o ajuste para fatores de confusão, pela regressão de Cox adaptada para estudos transversais, os fatores predisponentes, como escolaridade materna, sexo e idade da criança, idade materna, número de irmãos e ocupação do chefe de família explicaram pouco a não realização de consultas. Os fatores facilitadores, como renda familiar e posse de seguro-saúde, não foram preditores. O preditor mais importante da não realização de consultas foi a não necessidade, pois as crianças cujas mães referiram não estar doentes apresentaram maior risco de não serem consultadas. A expansão do atendimento público contribuiu para reduzir ou anular o peso das diferenças sociais na utilização de consultas curativas.Children outpatient health care utilization was estimated by a cross-sectional household survey using multi-stage cluster sampling in the city of São Luís, in the State of Maranhão, Brazil. 711 mothers or caretakers of children aged from 3 to 59 months answered a standardized questionnaire. The aim was to study factors associated with

  15. Clinical Utility of Cancellation on the WISC-IV

    Science.gov (United States)

    Zhu, Jianjun; Chen, Hsinyi

    2013-01-01

    This study examined empirical evidence for clinical utility of the Wechsler Intelligence Scale for Children, fourth edition (WISC-IV) cancellation subtest by comparing data from 597 clinical and 597 matched control children. The results of dependent t and sequential logistic regression analyses demonstrated that (a) children with intellectual…

  16. Endocarditis - children

    Science.gov (United States)

    Valve infection - children; Staphylococcus aureus - endocarditis - children; Enterococcus - endocarditis- children; Streptococcus viridians - endocarditis - children; Candida - endocarditis - children; Bacterial endocarditis - children; Infective ...

  17. Desnutrición infantil, coeficiente de desarrollo y su relación con el medio ambiente: un estudio piloto Desnutrição infantil, coeficiente do desenvolvimento e sua relação com o meio ambiente: um estudo piloto Infant undernourishment, the development coefficient and its relation to the environment: a pilot study

    Directory of Open Access Journals (Sweden)

    M. de la Luz Alvarez

    1991-08-01

    Full Text Available Fueron estudiados los factores socioculturales que podrían estar influyendo en el desarrollo psicomotor normal del lactante desnutrido. La muestra consistió en 32 díadas madrelactante: 16 tenían CD normal (Grupo A y 16 CD bajo lo normal (Grupo B según el Test de Bailey aplicado a los lactantes recién ingresados a un Centro de Recuperación Nutricional. Los resultados muestran que había algunas diferencias en los antecedentes de los lactantes: Los lactantes del Grupo A eran producto de un embarazo deseado (pEstudam-se os fatores sócio-culturais que poderiam estar influenciando no desenvolvimento psicomotor normal do lactente desnutrido. A amostra consistiu de 32 pares mãe-criança: 16 com coeficiente de desenvolvimento (CD normal (grupo A e 16 com CD abaixo do normal (grupo B de acordo com o teste de Bailey aplicado a lactentes que ingressavam a um centro de recuperação nutricional. Havia diferenças nos antecedentes das crianças: os lactentes do grupo A eram fruto de gravidez desejada (p The socio-cultural factors that might be influencing the normal psychomotor development of the undernourished infant are studied. The sample consisted of 32 mother-infant dyads: 16 having normal DQ (Group A and 16 having a below normal DQ (Group B according to Bailey's Test applied to infants who entered a Nutritional Recuperation Center. Results showed that there were some differences in the infants' backgrounds: infants of Group A were the product of a wished-for pregnancy (p < .05, and were separated less from their mother's side (p < .007 than was the case in Group B. No differences were found in the socio-cultural and demographic background of the mothers. The infants' external environment was different in aspects observed within the neighborhood: there were fewer negative aspects in Group A than in Group B (p < .003 and more positive in Group A than in B (p < .001. The infant's internal environment as related to the mother was also different

  18. An epidemiological study of urban and rural children in Pakistan: examining the relationship between delayed psychomotor development, low birth weight and postnatal growth failure.

    Science.gov (United States)

    Avan, Bilal I; Raza, Syed A; Kirkwood, Betty R

    2015-03-01

    Low birth weight is known to be associated with postnatal growth failure. It is not yet established that both conditions are determinants of psychomotor development. The study investigated whether or not low birth weight leads to delayed psychomotor development of a child, and whether it can be mitigated by adequate postnatal growth. A cross-sectional study was conducted in 2002 in 15 rural and 11 urban communities of Sindh province, Pakistan. Assessment of 1234 children less than 3 years of age included Bayley's Scale of Infant Development II, socioeconomic questionnaire and anthropometry; WHO standards were used to calculate z-scores of height-for-age, weight-for-height and weight-for-age. The underlying study hypotheses were tested through multiple regression modelling. Out of 1219 children, 283 (23.2%) had delayed psychomotor development and 639 (52.4%) were undernourished according to the composite index of anthropometric failure. Strong negative associations with the psychomotor development index were detected between stunting and being underweight, with a larger magnitude of effect for stunting (pchildren. The psychomotor index increased by 2.07 points with every unit increase in height-for-age z-score. The relationship between low birth weight and psychomotor development appears to be mediated largely by postnatal growth and nutritional status. This association suggests that among undernourished children there is significant likelihood of a group that is developmentally delayed. It is important to emphasize developmental needs in programmes that target underprivileged children. © The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  19. Adaptive Calibration of Children's Physiological Responses to Family Stress: The Utility of Evolutionary Developmental Theory--Comment on Del Giudice et al. (2012) and Sturge-Apple et al. (2012)

    Science.gov (United States)

    Bugental, Daphne Blunt

    2012-01-01

    Children's physiological reactions to stress are presented from the broader theoretical perspective of adaptive calibration to the environment, as rooted in life history theory. Del Giudice, Hinnant, Ellis, and El-Sheikh (2012) focus on children's physiological responses to a stressful task as a consequence of their history of family stress.…

  20. Entrez Programming Utilities

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Entrez Programming Utilities (E-utilities) are a set of eight server-side programs that provide a stable interface into the Entrez query and database system at...

  1. Imaging utilization commentary: a radiology perspective

    International Nuclear Information System (INIS)

    Reed, Martin H.

    2008-01-01

    To adhere to the ALARA concept, imaging should be limited to studies that actually contribute to the management of the patient. For example, by applying the Ottawa Ankle Rule and the Ottawa Knee Rule, fewer radiographs are required to evaluate ankle and knee trauma in children. Chest radiographs usually do not contribute to the management of children presenting with typical acute bronchiolitis or asthma, and they can be detrimental because consolidation resulting from retained secretions is interpreted as pneumonia and the child is started on antibiotics unnecessarily. Moreover, a radiograph of the abdomen has poor validity and reproducibility for the diagnosis of constipation. The Pediatric Emergency Care Applied Research Network (PECARN) and the Pediatric Emergency Research in Canada (PERC) are currently developing decision rules for the use of CT in the assessment of minor head injuries in children, which should reduce its utilization in this condition. PECARN is also developing a decision rule for the use of CT in the assessment of abdominal trauma in children. CT is frequently used for the diagnosis of appendicitis in children, but appendicitis can be diagnosed clinically. If imaging is required, appendicitis can often be diagnosed with US, and CT need only be used in the minority of cases where the diagnosis is still in doubt. Utilization guidelines for pediatric imaging studies obtained in children in the emergency setting can improve yield and help in the more efficient management of often scarce health care resources. (orig.)

  2. Imaging utilization commentary: a radiology perspective

    Energy Technology Data Exchange (ETDEWEB)

    Reed, Martin H. [University of Manitoba, Diagnostic Imaging, Children' s Hospital, Health Sciences Centre, Winnipeg (Canada); Children' s Hospital, Department of Radiology, Winnipeg, Manitoba (Canada)

    2008-11-15

    To adhere to the ALARA concept, imaging should be limited to studies that actually contribute to the management of the patient. For example, by applying the Ottawa Ankle Rule and the Ottawa Knee Rule, fewer radiographs are required to evaluate ankle and knee trauma in children. Chest radiographs usually do not contribute to the management of children presenting with typical acute bronchiolitis or asthma, and they can be detrimental because consolidation resulting from retained secretions is interpreted as pneumonia and the child is started on antibiotics unnecessarily. Moreover, a radiograph of the abdomen has poor validity and reproducibility for the diagnosis of constipation. The Pediatric Emergency Care Applied Research Network (PECARN) and the Pediatric Emergency Research in Canada (PERC) are currently developing decision rules for the use of CT in the assessment of minor head injuries in children, which should reduce its utilization in this condition. PECARN is also developing a decision rule for the use of CT in the assessment of abdominal trauma in children. CT is frequently used for the diagnosis of appendicitis in children, but appendicitis can be diagnosed clinically. If imaging is required, appendicitis can often be diagnosed with US, and CT need only be used in the minority of cases where the diagnosis is still in doubt. Utilization guidelines for pediatric imaging studies obtained in children in the emergency setting can improve yield and help in the more efficient management of often scarce health care resources. (orig.)

  3. The prevalence of undernutrition upon hospitalization in children in a developing country: A single hospital study from Malaysia.

    Science.gov (United States)

    Lee, Way-Seah; Ahmad, Zulfadly

    2017-10-01

    Undernourished children who require hospital care have a longer duration of hospitalization and respond poorly to modern medical therapy. The objective of the present study was to ascertain the nutritional status of children admitted to a pediatric tertiary center in Malaysia and the risk factors leading to undernutrition upon admission. In this cross-sectional, hospital-based study, anthropometric measurements [weight, length/height, mid-upper arm circumference (MUAC), triceps skinfold thickness were performed in 285 children aged from 3 months to 15 years who were admitted to University Malaya Medical Centre, Kuala Lumpur in November 2013. Acute (wasting) and chronic (stunting) undernutrition were defined as weight-for-height (WFH) and height-for-age (HFA) standard deviation (S.D.), respectively. Underweight was defined as weight-for-age definition for acute undernutrition (HFA definition of acute undernutrition, an additional eight patients were noted to have acute undernutrition (n = 40, 14%). No significant risk factors associated with undernutrition were identified. The prevalence of undernutrition among children admitted to a tertiary hospital in Malaysia was 14%. Strategies for systematic screening and provision of nutritional support in children at risk of undernutrition as well as treatment of undernutrition in children requiring hospitalization are needed. Copyright © 2017. Published by Elsevier B.V.

  4. US utility partnerships

    International Nuclear Information System (INIS)

    Worthington, B.

    1995-01-01

    Activities of the United States Energy Association were reviewed, as well as the manner in which its members are benefitting from the Association's programs. The principal cooperative program set up is the Utility Partnership Program, which was described. Through this program the Association is matching US companies, both electric utilities and gas utilities, with counterparts in Eastern Europe or the former Soviet Union. So far, about 25 partnerships were signed, e.g. in the Czech Republic, in Kazakhstan, in Poland, and in Slovakia. It was estimated that the return to the United States from the investments made by the American government in these Utility Partnership Programs has been well over 100-fold

  5. X-rays utilization

    International Nuclear Information System (INIS)

    Rebigan, F.

    1979-03-01

    The modality of X-ray utilization in different activities and economy is given. One presents firstly quantities and units used in radiation dosimetry and other fields. One gives the generation of X-rays, their properties as well as the elements of radiation protection. The utilization characteristics of these radiations in different fields are finally given. (author)

  6. Dor na criança desnutrida: percepção da mãe Dolor en el niño malnutrido: percepción de la madre Pain in undenourished children: the mother's perception

    Directory of Open Access Journals (Sweden)

    Larissa Coelho Barbosa

    2005-08-01

    Full Text Available O objetivo foi identificar a percepção da mãe quanto a dor no seu filho desnutrido. Pesquisa de natureza qualitativa, utilizando entrevistas semi-estruturadas no Instituto de Prevenção à Desnutrição e a Excepcionalidade - IPREDE (Fortaleza-Ceará. As informantes foram mães que acompanhavam seus filhos desnutridos. De acordo com a análise surgiram as categorias: Busca à Instituição; Descrição da dor e Como cuidar da dor. Conclui-se, a necessidade de um trabalho da sociedade, respeitando os direitos do cidadão e sua cultura, com o intuito de reverter a dor na criança desnutrida.El objetivo de esa investigación cualitativa era identificar la opinión de madres respecto al dolor de su hijo malnutrido. Se realizó entrevistas semiestructuradas en el Instituto para la Prevención a la Desnutrición y Excepcionalidad - IPREDE (Fortaleza-Ceará-Brasil. Los participantes fueron las madres que acompañaban a sus hijos malnutridos. El análisis reveló las siguientes categorías: Búsqueda de la institución; Descripción del dolor y Cómo cuidar del dolor. Se concluye que es necesario un trabajo de la sociedad, respetando los derechos del ciudadano y su cultura, con objeto de revertir el dolor del niño malnutrido.This qualitative study aimed to identify how mothers perceive pain in their undernourished children. Semistructured interviews were realized at the Institute for the Prevention of Malnutrition and Exceptionality - IPREDE (Fortaleza-Ceará-Brazil. Participants were mothers who accompanied their undernourished children. Data analysis revealed the following categories: Coming to the Institution; Pain description and How to take care of the pain. Society needs to take actions, in respect of citizens' rights and culture, with a view to reverting this picture of pain in undernourished children.

  7. Malnutrition is associated with worse health-related quality of life in children with cancer.

    Science.gov (United States)

    Brinksma, Aeltsje; Sanderman, Robbert; Roodbol, Petrie F; Sulkers, Esther; Burgerhof, Johannes G M; de Bont, Eveline S J M; Tissing, Wim J E

    2015-10-01

    Malnutrition in childhood cancer patients has been associated with lower health-related quality of life (HRQOL). However, this association has never actually been tested. Therefore, we aimed to determine the association between nutritional status and HRQOL in children with cancer. In 104 children, aged 2-18 years and diagnosed with hematological, solid, or brain malignancies, nutritional status and HRQOL were assessed at diagnosis and at 3, 6, and 12 months using the child- and parent-report versions of the PedsQL 4.0 Generic scale and the PedsQL 3.0 Cancer Module. Scores on both scales range from 0 to 100. Undernourished children (body mass index (BMI) or fat-free mass children on the domains physical functioning (-13.3), social functioning (-7.0), cancer summary scale (-5.9), and nausea (-14.7). Overnourished children (BMI or fat mass >2 SDS) reported lower scores on emotional (-8.0) and cognitive functioning (-9.2) and on the cancer summary scale (-6.6), whereas parent-report scores were lower on social functioning (-7.5). Weight loss (>0.5 SDS) was associated with lower scores on physical functioning (-13.9 child-report and -10.7 parent-report), emotional (-7.4) and social functioning (-6.0) (child-report), pain (-11.6), and nausea (-7.8) (parent-report). Parents reported worse social functioning and more pain in children with weight gain (>0.5 SDS) compared with children with stable weight status. Undernutrition and weight loss were associated with worse physical and social functioning, whereas overnutrition and weight gain affected the emotional and social domains of HRQL. Interventions that improve nutritional status may contribute to enhanced health outcomes in children with cancer.

  8. Utility portfolio diversification

    International Nuclear Information System (INIS)

    Griffes, P.H.

    1990-01-01

    This paper discusses portfolio analysis as a method to evaluate utility supply decisions. Specifically a utility is assumed to increase the value of its portfolio of assets whenever it invests in a new supply technology. This increase in value occurs because the new asset either enhances the return or diversifies the risks of the firm's portfolio of assets. This evaluation method is applied to two supply innovations in the electric utility industry: jointly-owned generating plants and supply contracts with independent power producers (IPPs)

  9. MSIS Drug Utilization Datamart

    Data.gov (United States)

    U.S. Department of Health & Human Services — This page provides background needed to take advantage of the capabilities of the MSIS Drug Utilization Datamart. This mart allows the user to develop high-level...

  10. Utility franchises reconsidered

    Energy Technology Data Exchange (ETDEWEB)

    Weidner, B.

    1981-11-01

    It is easier to obtain a public utility franchise than one for a fast food store because companies like Burger King value the profit share and control available with a franchise arrangement. The investor-owned utilities (IOUs) in Chicago and elsewhere gets little financial or regulatory benefit, although they do have an alternative because the franchise can be taken over by the city with a one-year notice. As IOUs evolved, the annual franchise fee has been incorporated into the rate in a move that taxes ratepayers and maximizes profits. Cities that found franchising unsatisfactory are looking for ways to terminate the franchise and finance a takeover, but limited-term and indeterminate franchises may offer a better mechanism when public needs and utility aims diverge. A directory lists franchised utilities by state and comments on their legal status. (DCK)

  11. Chemical Search Web Utility

    Data.gov (United States)

    U.S. Environmental Protection Agency — The Chemical Search Web Utility is an intuitive web application that allows the public to easily find the chemical that they are interested in using, and which...

  12. Utility requirements for HTGRs

    International Nuclear Information System (INIS)

    Nicholls, D.R.

    1997-01-01

    Eskom, the state utility of South Africa, is currently evaluating the technical and economic feasibility of the helium cooled Pebble Bed Modular Reactor with a closed cycle gas turbine power conversion system for future power generating additions to its electric system. This paper provides an overview of the Eskom system including the needs of the utility for future generation capacity and the key performance requirements necessary for incorporation of this gas cooled reactor plant. (author)

  13. Utility, games, and narratives

    OpenAIRE

    Fioretti, Guido

    2009-01-01

    This paper provides a general overview of theories and tools to model individual and collective decision-making. In particular, stress is laid on the interaction of several decision-makers. A substantial part of this paper is devoted to utility maximization and its application to collective decision-making, Game Theory. However, the pitfalls of utility maximization are thoroughly discussed, and the radically alternative approach of viewing decision-making as constructing narratives is pre...

  14. The Effects of Breakfast and Breakfast Composition on Cognition in Children and Adolescents: A Systematic Review.

    Science.gov (United States)

    Adolphus, Katie; Lawton, Clare L; Champ, Claire L; Dye, Louise

    2016-05-01

    Breakfast is thought to be beneficial for cognitive and academic performance in school children. However, breakfast is the most frequently skipped meal, especially among adolescents. The aim of the current article was to systematically review the evidence from intervention studies for the effects of breakfast on cognitive performance in children and adolescents. The effects of breakfast were evaluated by cognitive domain and breakfast manipulation. A total of 45 studies reported in 43 articles were included in the review. Most studies considered the acute effect of a single breakfast (n = 34). The acute studies looked at breakfast compared with no breakfast (n = 24) and/or comparisons of breakfast type (n = 15). The effects of chronic school breakfast program interventions were evaluated in 11 studies. The findings suggest that breakfast consumption relative to fasting has a short-term (same morning) positive domain-specific effect on cognition. Tasks requiring attention, executive function, and memory were facilitated more reliably by breakfast consumption relative to fasting, with effects more apparent in undernourished children. Firm conclusions cannot be made about the acute effects of breakfast composition and the effects of chronic breakfast interventions because there are too few studies and these largely report inconsistent findings. This review also highlights methodologic limitations of the existing research. These include a lack of research on adolescents, few naturalistic breakfast manipulations or testing environments, small samples, and insensitive cognitive tests. © 2016 American Society for Nutrition.

  15. Utility requirements for fusion

    International Nuclear Information System (INIS)

    Vondrasek, R.J.

    1982-02-01

    This report describes work done and results obtained during performance of Task 1 of a study of Utility Requirements and Criteria for Fusion Options. The work consisted of developing a list of utility requirements for fusion optics containing definition of the requirements and showing their relative importance to the utility industry. The project team members developed a preliminary list which was refined by discussions and literature searches. The refined list was recast as a questionnaire which was sent to a substantial portion of the utility industry in this country. Forty-three questionnaire recipients responded including thirty-two utilities. A workshop was held to develop a revised requirements list using the survey responses as a major input. The list prepared by the workshop was further refined by a panel consisting of vice presidents of the three project team firms. The results of the study indicate that in addition to considering the cost of energy for a power plant, utilities consider twenty-three other requirements. Four of the requirements were judged to be vital to plant acceptability: Plant Capital Cost, Financial Liability, Plant Safety and Licensability

  16. Treatment of children with Helicobacter pylori infection and malabsorption syndrome with probiotics: Comparison with conventional method

    Energy Technology Data Exchange (ETDEWEB)

    Ndiaye, M F; Mbengue, M; Mbaye, P S; Diouf, S [Societe Senegalaise de Gasto-enterologie et d' hepatologie, Dakar (Senegal); Ghoos, Y [Labo. Digestie Absorptie, Leuven (Belgium); Brunser, O [Institute of Nutrition and Food Technology, Santiago (Chile)

    2004-07-01

    Helicobacter pylori infection is one of the most common bacterial infection (82 %) in Senegal where malnutrition is common in children (25 %). Our aims were to definite prevalence of H. pylori, to determine the relationship between Hp infection and undernourishment and to verify the efficiency of treatment with probiotic. In some studies a positive effect of Saccharomyces boulardii has been demonstrated against H. pylori. We have included healthy children 7 to 10 years of age. 108 out of 129 (84%) were H. pylori-positive by breath-test. Two groups were randomised. Group A was treated with ten days' standard triple therapy (Omeprazole 1 mg Kg/day in single day gift, Amoxycillin 50 mg/kg/two times per day and Clarithromycin 250 mg two times per day). Group B received probiotic (250 mg of Saccharomyces boulardii with 5g Inulin three times per day) for 3 months. Evaluation of treatment was done one month after the end of therapy. Seventy one children out of 110 (64.5%) had digestive symptoms in their medical history. The main signs were recurrent abdominal pain in 64 cases. BMI were less than 18.50 in all the children with H. pylori infection without other nutritional abnormaly. Eight children were eradicated after treatment seven in the group under conventional treatment (58%) and one in the group under probiotics (6%). We concluded that prevalence of H. pylori infection is very high in young children as of the 7 years' age in urban as in rural environments. Symptoms are not specific. No significant difference in the nutritional state is observed between H. pylori-positive and H. pylori-negative children. Treatment by probiotics does not seem to give efficient results for eradication of H. pylori. (author)

  17. Measurement of utility.

    Science.gov (United States)

    Thavorncharoensap, Montarat

    2014-05-01

    The Quality Adjusted Life Year (QALY) is the most widely recommended health outcome measure for use in economic evaluations. The QALY gives a value to the effect of a given health intervention in terms of both quantity and quality. QALYs are calculated by multiplying the duration of time spent in a given health state, in years, by the quality of life weighted, known as utility. Utility can range from 0 (the worst health state-the equivalent of death) to 1 (the best health state-full health). This paper provides an overview of the various methods that can be used to measure utility and outlines the recommended protocol for measuring utility, as described in the Guidelines for Health Technology Assessment in Thailand (second edition). The recommendations are as follows: Wherever possible, primary data collection using EQ-5D-3L in patients using Thai value sets generated from the general public should be used. Where the EQ-5D-3L is considered inappropriate, other methods such as Standard gamble (SG), Time-trade-off (TTO), Visual analogue scale (VAS), Health Utilities Index (HUI), SF-6D, or Quality of well being (QWB) can be used. However, justification and full details on the chosen instrument should always be provided.

  18. Electric utility report '80

    International Nuclear Information System (INIS)

    Anon.

    1980-01-01

    A collection of brief atricles describes the trends and developments in Canada's electric utilities for the 1980's. Generating stations planned or under construction are listed. The trends in technology discused at a recent Canadian Electrical Association meeting are summarized in such areas as turbine stability control, power line vibration control, system reliability, substations and transformer specifications. Developments in nuclear generation are discussed and compared on the world scale where Japan, for example, has the world's largest nuclear program. Progress on fusion is discussed. In Canada the electric utilities are receiving the support of the comprehensive nuclear R and D program of Atomic Energy of Canada Ltd. New innovations in utility technology such as street lighting contactors, superconductive fault limiters and demand profile analyzers are discussed. (T.I.)

  19. Utility planning for decommissioning

    International Nuclear Information System (INIS)

    Williams, D.H.

    1982-01-01

    Though the biggest impact on a utility of nuclear power plant decommissioning may occur many years from now, procrastination of efforts to be prepared for that time is unwarranted. Foresight put into action through planning can significantly affect that impact. Financial planning can assure the recovery of decommissioning costs in a manner equitable to customers. Decision-making planning can minimize adverse affects of current decisions on later decommissioning impacts and prepare a utility to be equipped to make later decommissioning decisions. Technological knowledge base planning can support all other planning aspects for decommissioning and prepare a utility for decommissioning decisions. Informed project planning can ward off potentially significant pitfalls during decommissioning and optimize the effectiveness of the actual decommissioning efforts

  20. Markets: green utilities

    International Nuclear Information System (INIS)

    Wood, Elisa

    2006-01-01

    Publicly owned utilities have consistently led the United States in the rate of customer participation in green power programmes. The US has about 2000 community and state-owned utilities, which serve 43 million customers and account for about 16.6% of kilowatt-hour sales to consumers. In all, public power is responsible for about 10% of the nation's installed electric capacity. Investor owned utilities account for 39%, with the remainder of the nation's power mostly from independent power generators. Although IOUs have almost four times as much electric capacity as public power, they edge out public power by only a small margin when it comes to renewable capacity. IOUs are responsible for 24,577.5 MW of renewable capacity, compared to the 21,338 MW installed by public power. The reasons discussed by the author range from small town advantage to clean and cheap power. (Author)

  1. Octopus: LLL's computing utility

    International Nuclear Information System (INIS)

    Anon.

    1978-01-01

    The Laboratory's Octopus network constitutes one of the greatest concentrations of computing power in the world. This power derives from the network's organization as well as from the size and capability of its computers, storage media, input/output devices, and communication channels. Being in a network enables these facilities to work together to form a unified computing utility that is accessible on demand directly from the users' offices. This computing utility has made a major contribution to the pace of research and development at the Laboratory; an adequate rate of progress in research could not be achieved without it. 4 figures

  2. Growth & development of Indian children adopted in Sweden.

    Science.gov (United States)

    Proos, Lemm A

    2009-11-01

    More than 6800 children from India have been adopted in Sweden over the last four decades. At arrival many were undernourished and suffered from infectious diseases. Catch-up growth was common. Unexpectedly, cases of early pubertal development were subsequently reported. In order to investigate the growth and development of adopted children more in detail we studied 114 children adopted from India prospectively during two years. The majority were stunted at arrival and caught up in height and weight after two years. Psychomotor retardation and common infections diminished fairly soon. Those that were stunted did not attain the higher catch-up levels of those not stunted at arrival. Low birthweight also limited the degree of catch-up growth. 107 girls were analysed retrospectively in another study. The median menarcheal age was 11.6 yr (range 7.3-14.6 yr) which is significantly earlier than the mean in Swedish and privileged Indian girls (13.0 and 12.4-12.9 yr, respectively). The pubertal linear growth component was normal in duration and magnitude but likewise started 1.5 yr earlier. The final height/age was 154 cm (-1.4 SDS) and the weight/age 46.9 kg (-1.1 SDS) 8 per cent were 145 cm or shorter. Stunting limited catch-up growth and final height. Those that were most stunted at arrival, and had the fastest catch-up growth, had the earliest menarche. Good maternal and child nutrition is necessary for full expression of a child's growth potential. What is lost in growth early in life can only partially be recovered by catch-up growth. Such growth is associated with risk for early pubertal development which abbreviates the childhood growth period and limits final height. The mechanism underlying the early pubertal development, and the optimal management of nutrition rehabilitation after chronic malnutrition, need to be clarified by further studies.

  3. Moderated Mediation Effect of Self-esteem on the Relationship Between Parenting Stress and Depression According to Employment Status in Married Women: A Longitudinal Study Utilizing Data from Panel Study on Korean Children.

    Science.gov (United States)

    Han, Jeong-Won; Kim, Ju Hee

    2017-06-01

    This study was to examined the moderated mediation effect of self-esteem on the relationship between parenting stress and depression among married women with children using longitudinal data from the 3rd to 6th Panel Studies on Korean. The data from the Panel Study of Korean Children (Korea Institute of Child Care and Education) was collected as part of a longitudinal inquiry of babies born in 2008, their parents and their community environments. Only the data collected from the married women over the age of 20 who participated in the maternal survey was used for this study. The initial level of married women's parenting stress affects the initial level and the rate of change in self-esteem; the initial level of self-esteem, the initial level and rate of change in depression; and the initial level of parenting stress, the initial level of depression. However, the impact of the rate of change in parenting stress on that of self-esteem was significant only in employed women while the impact of the rate of change in self-esteem on that of depression was significant only in unemployed women. It is necessary to manage parenting stress among married women through various programs and education that increase self-esteem in order to reduce their level of depression. Copyright © 2017. Published by Elsevier B.V.

  4. [Children and bankers in Bangladesh].

    Science.gov (United States)

    Hartmann, B

    1991-06-01

    This critique of the World Bank's role in developing country population programs begins with a description of a 1987 case in which an 80-year- old Bangladeshi man was persuaded to undergo vasectomy and then robbed of his incentive payment by the health agent. For over 20 years, the World Bank has pressured 3rd World governments to implement population control programs. Although there are divergent opinions within the World Bank, the most dominant is the neomalthusian view that the poor through their high fertility help perpetuate their own poverty. This view hides the real source of poverty in the Third World: the unequal distribution of resources within these countries and between the developed and developing countries. The World Bank has always been blind to the inequalities, and has associated with the elites of developing countries who monopolize the resources of their countries and thereby impede authentic development. Furthermore, the emphasis on population control distorts social policy and hinders the implementation of safe and voluntary family planning services. In many countries the World Bank has required governments to give greater priority to population control than to basic health services. It has pressured them to relax contraceptive prescription norms and has promoted the more effective methods without regard to proper use or side effects. In Bangladesh the World Bank has sponsored sterilization programs that rely on coercion and incentives. In that country of enormous inequities, 10% of landowners control over 50% of lands, while nearly half the population is landless and chronically underemployed. Political power is concentrated in the military government, which annually receives over 1.5 billion dollars in external aid. External aid primarily benefits the wealthy. 3/4 of the population are undernourished and less than 1/3 are literate or have access to basic health care. The poor of Bangladesh, as in many other countries, feel that their only

  5. Electric utilities in Illinois

    Energy Technology Data Exchange (ETDEWEB)

    1978-01-01

    Although the conference dealt specifically with concerns of the electric utilities in Illinois, the issues were dealt with in the national context as well. A separate abstract was prepared for each of the 5 sections of this proceeding. A total of 25 papers were presented. Section titles are: Forecasting, Planning and Siting, Reliability, Rates and Financing, and Future Developments.

  6. Male Adolescent Contraceptive Utilization.

    Science.gov (United States)

    Finkel, Madelon Lubin; Finkel, David J.

    1978-01-01

    The contraceptive utilization of a sample of sexually active, urban, high school males (Black, Hispanic, and White) was examined by anonymous questionnaire. Contraceptive use was haphazard, but White males tended to be more effective contraceptors than the other two groups. Reasons for nonuse were also studied. (Author/SJL)

  7. "Utilizing" signal detection theory.

    Science.gov (United States)

    Lynn, Spencer K; Barrett, Lisa Feldman

    2014-09-01

    What do inferring what a person is thinking or feeling, judging a defendant's guilt, and navigating a dimly lit room have in common? They involve perceptual uncertainty (e.g., a scowling face might indicate anger or concentration, for which different responses are appropriate) and behavioral risk (e.g., a cost to making the wrong response). Signal detection theory describes these types of decisions. In this tutorial, we show how incorporating the economic concept of utility allows signal detection theory to serve as a model of optimal decision making, going beyond its common use as an analytic method. This utility approach to signal detection theory clarifies otherwise enigmatic influences of perceptual uncertainty on measures of decision-making performance (accuracy and optimality) and on behavior (an inverse relationship between bias magnitude and sensitivity optimizes utility). A "utilized" signal detection theory offers the possibility of expanding the phenomena that can be understood within a decision-making framework. © The Author(s) 2014.

  8. Children's (Pediatric) Magnetic Resonance Imaging

    Medline Plus

    Full Text Available ... work? Unlike conventional x-ray examinations and computed tomography (CT) scans, MRI does not utilize ionizing radiation. Instead, ... Angiography Magnetic Resonance, Functional (fMRI) - Brain Children's (Pediatric) CT (Computed Tomography) Magnetic Resonance Imaging (MRI) Safety Contrast Materials Children ...

  9. Relationship between anthropometric indicators and cognitive performance in Southeast Asian school-aged children.

    Science.gov (United States)

    Sandjaja; Poh, Bee Koon; Rojroonwasinkul, Nipa; Le Nyugen, Bao Khanh; Budiman, Basuki; Ng, Lai Oon; Soonthorndhada, Kusol; Xuyen, Hoang Thi; Deurenberg, Paul; Parikh, Panam

    2013-09-01

    Nutrition is an important factor in mental development and, as a consequence, in cognitive performance. Malnutrition is reflected in children's weight, height and BMI curves. The present cross-sectional study aimed to evaluate the association between anthropometric indices and cognitive performance in 6746 school-aged children (aged 6-12 years) of four Southeast Asian countries: Indonesia; Malaysia; Thailand; Vietnam. Cognitive performance (non-verbal intelligence quotient (IQ)) was measured using Raven's Progressive Matrices test or Test of Non-Verbal Intelligence, third edition (TONI-3). Height-for-age z-scores (HAZ), weight-for-age z-scores (WAZ) and BMI-for-age z-scores (BAZ) were used as anthropometric nutritional status indices. Data were weighted using age, sex and urban/rural weight factors to resemble the total primary school-aged population per country. Overall, 21% of the children in the four countries were underweight and 19% were stunted. Children with low WAZ were 3·5 times more likely to have a non-verbal IQ < 89 (OR 3·53 and 95% CI 3·52, 3·54). The chance of having a non-verbal IQ < 89 was also doubled with low BAZ and HAZ. In contrast, except for severe obesity, the relationship between high BAZ and IQ was less clear and differed per country. The odds of having non-verbal IQ levels < 89 also increased with severe obesity. In conclusion, undernourishment and non-verbal IQ are significantly associated in 6-12-year-old children. Effective strategies to improve nutrition in preschoolers and school-aged children can have a pronounced effect on cognition and, in the longer term, help in positively contributing to individual and national development.

  10. Passive stiffness of rat skeletal muscle undernourished during fetal development

    Directory of Open Access Journals (Sweden)

    Ana Elisa Toscano

    2010-01-01

    Full Text Available OBJECTIVES: The aim of the study was to investigate the effect of fetal undernutrition on the passive mechanical properties of skeletal muscle of weaned and young adult rats. INTRODUCTION: A poor nutrition supply during fetal development affects physiological functions of the fetus. From a mechanical point of view, skeletal muscle can be also characterized by its resistance to passive stretch. METHODS: Male Wistar rats were divided into two groups according to their mother's diet during pregnancy: a control group (mothers fed a 17% protein diet and an isocaloric low-protein group (mothers fed a 7.8% protein diet. At birth, all mothers received a standardized meal ad libitum. At the age of 25 and 90 days, the soleus muscle and extensor digitorum longus (EDL muscles were removed in order to test the passive mechanical properties. A first mechanical test consisted of an incremental stepwise extension test using fast velocity stretching (500 mm/s enabling us to measure, for each extension stepwise, the dynamic stress (σd and the steady stress (σs. A second test consisted of a slow velocity stretch in order to calculate normalized stiffness and tangent modulus from the stress-strain relationship. RESULTS: The results for the mechanical properties showed an important increase in passive stiffness in both the soleus and EDL muscles in weaned rat. In contrast, no modification was observed in young adult rats. CONCLUSIONS: The increase in passive stiffness in skeletal muscle of weaned rat submitted to intrauterine undernutrition it is most likely due to changes in muscle passive stiffness.

  11. Altered placental development in undernourished rats: role of maternal glucocorticoids

    Directory of Open Access Journals (Sweden)

    Chen Chun-Hung

    2011-08-01

    Full Text Available Abstract Maternal undernutrition (MUN during pregnancy may lead to fetal intrauterine growth restriction (IUGR, which itself predisposes to adult risk of obesity, hypertension, and diabetes. IUGR may stem from insufficient maternal nutrient supply or reduced placental nutrient transfer. In addition, a critical role for maternal stress-induced glucocorticoids (GCs has been suggested to contribute to both IUGR and the ensuing risk of adult metabolic syndrome. While GC-induced fetal organ defects have been examined, there have been few studies on placental responses to MUN-induced maternal stress. Therefore, we hypothesize that 50% MUN associates with increased maternal GC levels and decreased placental HSD11B. This in turn leads to decreased placental and fetal growth, hence the need to investigate nutrient transporters. We measured maternal serum levels of corticosterone, and the placental basal and labyrinth zone expression of glucocorticoid receptor (NR3C1, 11-hydroxysteroid dehydrogenase B 1 (HSD11B-1 predominantly activates cortisone to cortisol and 11-dehydrocorticosterone (11-DHC to corticosterone, although can sometimes drive the opposing (inactivating reaction, and HSD11B-2 (only inactivates and converts corticosterone to 11-DHC in rodents in control and MUN rats at embryonic day 20 (E20. Moreover, we evaluated the expression of nutrient transporters for glucose (SLC2A1, SLC2A3 and amino acids (SLC38A1, 2, and 4. Our results show that MUN dams displayed significantly increased plasma corticosterone levels compared to control dams. Further, a reduction in fetal and placental weights was observed in both the mid-horn and proximal-horn positions. Notably, the placental labyrinth zone, the site of feto-maternal exchange, showed decreased expression of HSD11B1-2 in both horns, and increased HSD11B-1 in proximal-horn placentas, but no change in NR3C1. The reduced placental GCs catabolic capacity was accompanied by downregulation of SLC2A3, SLC38A1, and SLC38A2 expression, and by increased SLC38A4 expression, in labyrinth zones from the mid- and proximal-horns. In marked contrast to the labyrinth zone, the basal zone, which is the site of hormone production, did not show significant changes in any of these enzymes or transporters. These results suggest that dysregulation of the labyrinth zone GC "barrier", and more importantly decreased nutrient supply resulting from downregulation of some of the amino acid system A transporters, may contribute to suboptimal fetal growth under MUN.

  12. Acute dehydrating gastro-enteritis in undernourished infants | Beatty ...

    African Journals Online (AJOL)

    The use of half-strength Oarrow's solution in 2;5% dextrose water, with supplementary intravenous sodium bicarbonate and oral potassium, rapidly corrected the electrolyte and acid-base disturbances. No significant difference resulted when this regimen was modified by variations in the rate, volume or type of intravenous ...

  13. Undernourishment and Public Policy in India | IDRC - International ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    ... underlying the development of India's proposed National Food Security Act. As ... the delivery of social welfare programs that affect food and nutritional security. ... 2017 call for proposals to establish Cyber Policy Centres in the Global South.

  14. Treatment of children with Helicobacter pylori infection and malabsorption syndromes with probiotics: Comparison with conventional methods

    International Nuclear Information System (INIS)

    Ghoos, Y.; Brunser, O.; Lawson, F.; Muzeke, A.; Ndjaye, M.F.

    2000-01-01

    It is stated that in developing countries a high rate of Helicobacter pylori infection among newborns and young children occurs. It is further assumed that this incidence may lead to inhibition of defense mechanism (inhibition of acid secretion) against bacteria, per orally ingested. This may result in excessive colonisation of the small intestine by bacteria. This situation may become a major cause for chronic malnutrition and diarrhoea syndrome with failure to thrive. This project aims at determining the occurrence of Helicobacter pylori infection in children at young age. It is aimed also at tracing the relationship between the Helicobacter pylori infection and the state of undernourishment. Finally it is aimed at comparing the usefulness of pre-/probiotics as anti-infection treatment. The methods used to demonstrate above mentioned parameters are based on stable isotopes, 13 CO 2 and H 2 breath tests mainly. To assess nutritional status and progress in growth conventional anthropometric techniques will be used, complementary to the results obtained by stable isotopes. It is put forward that the use of pre-/probiotics, instead of antibiotics, will suppress upper gastrointestinal infection and restore the intestinal cell capacity to assimilate all food ingredients. (author)

  15. Treatment of children with Helicobacter pylori infection and malabsorption syndromes with probiotics: Comparison with conventional methods

    Energy Technology Data Exchange (ETDEWEB)

    Ghoos, Y [UZ Gasthuisberg, Gastrointestinal Pathophysiology, Leuven (Belgium); Brunser, O [Institute of Nutrition and Food Technology, Santiago (Chile); Lawson, F [Clinique Padre Pio, Cotonou (Benin); Muzeke, A [Faculte de Medicine, University of Kinshasa, Kinshasa (Congo); Ndjaye, M F [Cercle Senegalais Gastroenterologie, Dakar (Senegal)

    2000-07-01

    It is stated that in developing countries a high rate of Helicobacter pylori infection among newborns and young children occurs. It is further assumed that this incidence may lead to inhibition of defense mechanism (inhibition of acid secretion) against bacteria, per orally ingested. This may result in excessive colonisation of the small intestine by bacteria. This situation may become a major cause for chronic malnutrition and diarrhoea syndrome with failure to thrive. This project aims at determining the occurrence of Helicobacter pylori infection in children at young age. It is aimed also at tracing the relationship between the Helicobacter pylori infection and the state of undernourishment. Finally it is aimed at comparing the usefulness of pre-/probiotics as anti-infection treatment. The methods used to demonstrate above mentioned parameters are based on stable isotopes, {sup 13}CO{sub 2} and H{sub 2} breath tests mainly. To assess nutritional status and progress in growth conventional anthropometric techniques will be used, complementary to the results obtained by stable isotopes. It is put forward that the use of pre-/probiotics, instead of antibiotics, will suppress upper gastrointestinal infection and restore the intestinal cell capacity to assimilate all food ingredients. (author)

  16. Measuring the Readability of Children's Trade Books.

    Science.gov (United States)

    Popp, Helen M.; Porter, Douglas

    In order to utilize interesting children's trade books in a systematic reading program, two readability formulas were devised based on a selection of children's trade books. Children's scores on selections from these books and judges' rankings were compared. The judges' decisions were considered to be highly credible and were used as the criterion…

  17. Biomass ash utilization

    Energy Technology Data Exchange (ETDEWEB)

    Bristol, D.R.; Noel, D.J.; O`Brien, B. [HYDRA-CO Operations, Inc., Syracuse, NY (United States); Parker, B. [US Energy Corp., Fort Fairfield, ME (United States)

    1993-12-31

    This paper demonstrates that with careful analysis of ash from multiple biomass and waste wood fired power plants that most of the ash can serve a useful purpose. Some applications require higher levels of consistency than others. Examples of ash spreading for agricultural purposes as a lime supplement for soil enhancement in Maine and North Carolina, as well as a roadbase material in Maine are discussed. Use of ash as a horticultural additive is explored, as well as in composting as a filtering media and as cover material for landfills. The ash utilization is evaluated in a framework of environmental responsibility, regulations, handling and cost. Depending on the chemical and physical properties of the biomass derived fly ash and bottom ash, it can be used in one or more applications. Developing a program that utilizes ash produced in biomass facilities is environmentally and socially sound and can be financially attractive.

  18. Utilization of research reactors

    International Nuclear Information System (INIS)

    1962-01-01

    About 200 research reactors are now in operation in different parts of the world, and at least 70 such facilities, which are in advanced stages of planning and construction, should be critical within the next two or three years. In the process of this development a multitude of problems are being encountered in formulating and carrying out programs for the proper utilization of these facilities, especially in countries which have just begun or are starting their atomic energy work. An opportunity for scientific personnel from different Member States to discuss research reactor problems was given at an international symposium on the Programing and Utilization of Research Reactors organized by the Agency almost immediately after the General Conference session. Two hundred scientists from 35 countries, as well as from the European Nuclear Energy Agency and EURATOM, attended the meeting which was held in Vienna from 16 to 21 October 1961

  19. Health care utilization

    DEFF Research Database (Denmark)

    Jacobsen, Christian Bøtcher; Andersen, Lotte Bøgh; Serritzlew, Søren

    An important task in governing health services is to control costs. The literatures on both costcontainment and supplier induced demand focus on the effects of economic incentives on health care costs, but insights from these literatures have never been integrated. This paper asks how economic cost...... containment measures affect the utilization of health services, and how these measures interact with the number of patients per provider. Based on very valid register data, this is investigated for 9.556 Danish physiotherapists between 2001 and 2008. We find that higher (relative) fees for a given service...... make health professionals provide more of this service to each patient, but that lower user payment (unexpectedly) does not necessarily mean higher total cost or a stronger association between the number of patients per supplier and the health care utilization. This implies that incentives...

  20. Industrial coal utilization

    Energy Technology Data Exchange (ETDEWEB)

    None

    1979-01-01

    The effects of the National Energy Act on the use of coal in US industrial and utility power plants are considered. Innovative methods of using coal in an environmentally acceptable way are discussed: furnace types, fluidized-bed combustion, coal-oil-mixtures, coal firing in kilns and combustion of synthetic gas and liquid fuels. Fuel use in various industries is discussed with trends brought about by uncertain availability and price of natural gas and fuel oils: steel, chemical, cement, pulp and paper, glass and bricks. The symposium on Industrial Coal Utilization was sponsored by the US DOE, Pittsburgh Energy Technology Center, April 3 to 4, 1979. Twenty-one papers have been entered individually into the EDB. (LTN)

  1. Utility customer issues

    International Nuclear Information System (INIS)

    Downey, W.H.

    1997-01-01

    Customer issues affected by the restructuring of the $250 billion US electric power industry were discussed. In the past the industry's vertically integrated utilities conducted their business in protected geographic markets. With deregulation and greater competition, that industry structure will change. This presentation highlighted the strategies that Unicom is using to react to the restructuring of the electric power industry. The underlying principle is for the utility to reinvent itself to change its market orientation and focus on customer services, such as reliability, responsiveness, custom tailored solutions, and guaranteed savings over time. Attempting to become total energy providers and delivering integrated solutions to meet the needs of large industrial and commercial consumers, intensive market research, improved service and installation, and sophisticated customer retention initiatives will also have to be high on the agenda

  2. Role of the utility

    International Nuclear Information System (INIS)

    Bellin, A.

    1986-03-01

    It is common to say that a nuclear programme needs basic infrastructures such as an appropriate educational system, governmental organizations for regulation, decision and inspection, engineering organizations for design and implementation, industrial infrastructures for manufacturing, erection and commissioning, operation organizations for running and maintaining power plants. This schematic organization is not sufficient to succeed in a nuclear programme: one has to consider very carefully the attribution of responsibilities. It appears, that, among all the different systems which exist in the world for the organization of a nuclear project, it is always the utility which bears the overall responsibility for the implementation of the project. It defines objectives such as production capacity, schedule, price; it takes part in the definition of a national policy for energy supply, for the choice of a type of reactor, for the implementation of a national nuclear industry; it selects sites and conducts feasibility studies including a preliminary project; it participates in the definition of organization charts and selects contractors; it calls for and obtains authorizations from regulatory bodies; it manages the project, coordinates contractors and permanently ensures that goals are attained as regards safety, quality, schedule, costs. The French utility has directly taken charge of all these basic responsibilities and this is commonly considered as a major reason of the success of the French nuclear programme. Depending on its capacities, the utility may delegate some of these responsibilities - mainly concerning engineering and project management - to experienced firms. Nevertheless, one has to remember that the utility bears the final responsibility and that it is probably the organization most fully aware of the fact that the final goal is not the construction of a nuclear power station but the production of nuclear electricity in the best and safest conditions

  3. Reactor utilization, Annex A

    International Nuclear Information System (INIS)

    Martinc, R.; Stanic, A.

    1984-01-01

    Reactor was operated until August 1984 due to prohibition issued by the Ministry since the reactor does not have the emergency cooling system nor special filters in the ventilation system yet. This means that the operation plan was fulfilled by 69%. This annex includes detailed tables containing data about utilization of reactor experimental channels, irradiated samples, as well as interruptions of operation. Detailed data about reactor power during this period are shown as well

  4. Electric utilities in 2007

    Energy Technology Data Exchange (ETDEWEB)

    Hyman, L.S. [Smith Barney Inc., New York, NY (United States)

    1998-10-01

    A century ago--in the year J.J. Thomson discovered the electron--electricity, gas and traction companies battled for markets, and corrupt city councils demanded their fair share of the take. One tycoon became so disgusted with the confusion and dishonesty that he decided to bribe the legislature to set up an honest, state-run regulatory agency that would bring order to chaos. But he was found out. The scandal set back the cause of regulation until 1907, the year in which the electric washing machine and the vacuum cleaner were invented. By then, electricity sales had septupled from 1897 levels, and three states had established utility regulation. In the coming decade, 1997 to 2007, the utility business could undergo similar dramatic change, but it will move toward less regulation and more competition during a period of slow growth. Management will have to work harder to achieve success, however, because much of the profits will have to come not from a growing market but from the pockets of competitors. By 2007, electricity will constitute a component of a larger energy and utility services industry that sells electricity, natural gas and possibly water, propane and telecommunications. Customized service will meet the needs of consumers of all sizes. The dominant firm in the industry, the virtual utility, may look more like a financial organization or a mass marketer than the traditional converter of raw material to energy. Emphasis on market-based pricing should lead to more efficient use of resources. If the process works right, the consumer wins.

  5. Utilization of biogas

    Energy Technology Data Exchange (ETDEWEB)

    Walsh, J L; Ross, C C; Smith, M S; Harper, S R [Georgia Tech Research Corp., Atlanta, GA (USA)

    1989-01-01

    A comprehensive study of the systems and equipment required to convert biogas into useful thermal and/or electrical energy was conducted, and the results published in the Handbook on Biogas Utilization (Walsh et al., Georgia Institute of Technology, Atlanta, GA, 1988). The physical, chemical and combustion characteristics of biogas, and the impact of these characteristics on both new and modified combustion equipment, were considered. The study also included consideration of auxiliary equipment for biogas collection, clean-up, compression and storage. (author).

  6. UTILITY OF SIMPLIFIED LABANOTATION

    Directory of Open Access Journals (Sweden)

    Maria del Pilar Naranjo

    2016-02-01

    Full Text Available After using simplified Labanotation as a didactic tool for some years, the author can conclude that it accomplishes at least three main functions: efficiency of rehearsing time, social recognition and broadening of the choreographic consciousness of the dancer. The doubts of the dancing community about the issue of ‘to write or not to write’ are highly determined by the contexts and their own choreographic evolution, but the utility of Labanotation, as a tool for knowledge, is undeniable.

  7. Clean energy utilization technology

    International Nuclear Information System (INIS)

    Honma, Takuya

    1992-01-01

    The technical development of clean energy including the utilization of solar energy was begun in 1973 at the time of the oil crisis, and about 20 years elapsed. Also in Japan, the electric power buying system by electric power companies for solar light electric power and wind electric power has been started in 1992, namely their value as a merchandise was recognized. As for these two technologies, the works of making the international standards and JIS were begun. The range of clean energy or natural energy is wide, and its kinds are many. The utilization of solar heat and the electric power generation utilizing waves, tide and geotherm already reached the stage of practical use. Generally in order to practically use new energy, the problem of price must be solved, but the price is largely dependent on the degree of spread. Also the reliability, durability and safety must be ensured, and the easiness of use, effectiveness and trouble-saving maintenance and operation are required. For the purpose, it is important to packaging those skillfully in a system. The cases of intelligent natural energy systems are shown. Solar light and wind electric power generation systems and the technology of transporting clean energy are described. (K.I.)

  8. Protocol investigating the clinical utility of an objective measure of attention, impulsivity and activity (QbTest) for optimising medication management in children and young people with ADHD 'QbTest Utility for Optimising Treatment in ADHD' (QUOTA): a feasibility randomised controlled trial.

    Science.gov (United States)

    Hall, Charlotte L; James, Marilyn; Brown, Sue; Martin, Jennifer L; Brown, Nikki; Selby, Kim; Clarke, Julie; Vijayan, Hena; Guo, Boliang; Sayal, Kapil; Hollis, Chris; Groom, Madeleine J

    2018-02-15

    Attention-deficit hyperactivity disorder (ADHD) is characterised by symptoms of inattention, hyperactivity and impulsivity. To improve outcomes, the National Institute for Health and Care Excellence ADHD guidelines recommend regular monitoring of symptoms when children commence medication. However, research suggests that routine monitoring rarely happens, and clinicians often rely on subjective information such as reports from parents and teachers to ascertain improvement. These sources can be unreliable and difficult to obtain. The addition of an objective test of attention and activity (QbTest) may improve the objectivity, reliability and speed of clinical decision-making and so reduce the time to identify the optimal medication dose. This study aims to assess the feasibility and acceptability of a QbTest medication management protocol delivered in routine healthcare services for children with ADHD. This multisite feasibility randomised controlled trial (RCT) will recruit 60 young people (aged 6-17 years old), diagnosed with ADHD, and starting stimulant medication who are seen by Child and Adolescent Mental Health Services or Community Paediatric services. Participants will be randomised into one of two arms. In the experimental arm (QbTest protocol), the participant will complete a QbTest at baseline (prior to medication initiation), and two follow-up QbTests on medication (2-4 weeks and 8-10 weeks later). In the control arm, participants will receive treatment as usual, with at least two follow-up consultations. Measures of parent-, teacher- and clinician-rated symptoms and global functioning will be completed at each time point. Health economic measures will be completed. Clinicians will record treatment decision-making. Acceptability and feasibility of the protocol will be assessed alongside outcome measure completion rates. Qualitative interviews will be conducted. The findings will be used to inform the development of a fully powered RCT. The results will

  9. Determinants of anemia among women and children in Nepal and Pakistan: An analysis of recent national survey data.

    Science.gov (United States)

    Harding, Kassandra L; Aguayo, Victor M; Namirembe, Grace; Webb, Patrick

    2017-08-31

    Anemia remains one of the most intractable public health challenges in South Asia. This paper analyzes individual-level and household-level determinants of anemia among children and women in Nepal and Pakistan. Applying multivariate modified Poisson models to recent national survey data, we find that the prevalence of anemia was significantly higher among women from the poorest households in Pakistan (adjusted prevalence ratio [95% CI]: 1.10 [1.04-1.17]), women lacking sanitation facilities in Nepal (1.22 [1.12-1.33]), and among undernourished women (BMI Pakistan: 1.07 [1.02-1.13]). Similarly, children in both countries were more likely to be anemic if stunted (Nepal: 1.19 [1.09-1.30] and Pakistan: 1.10 [1.07-1.14]) and having an anemic mother (Nepal: 1.31 [1.20-1.42] and Pakistan: 1.21 [1.17-1.26]). Policies and programs need to target vulnerable and hard-to-reach subpopulations who continue to bear a disproportionate burden of anemia. Covariates of poverty underpin rates of anemia among children and their mothers, but income growth alone will not suffice to resolve such deeply entrenched problems. Greater understanding of the relative role of various diet, health, sanitation, and educational factors by local context should guide investments to resolve anemia in tandem with stunting and maternal underweight. © 2017 The Authors. Maternal and Child Nutrition Published by John Wiley & Sons, Ltd.

  10. The Effects of Breakfast and Breakfast Composition on Cognition in Children and Adolescents: A Systematic Review123

    Science.gov (United States)

    Champ, Claire L

    2016-01-01

    Breakfast is thought to be beneficial for cognitive and academic performance in school children. However, breakfast is the most frequently skipped meal, especially among adolescents. The aim of the current article was to systematically review the evidence from intervention studies for the effects of breakfast on cognitive performance in children and adolescents. The effects of breakfast were evaluated by cognitive domain and breakfast manipulation. A total of 45 studies reported in 43 articles were included in the review. Most studies considered the acute effect of a single breakfast (n = 34). The acute studies looked at breakfast compared with no breakfast (n = 24) and/or comparisons of breakfast type (n = 15). The effects of chronic school breakfast program interventions were evaluated in 11 studies. The findings suggest that breakfast consumption relative to fasting has a short-term (same morning) positive domain-specific effect on cognition. Tasks requiring attention, executive function, and memory were facilitated more reliably by breakfast consumption relative to fasting, with effects more apparent in undernourished children. Firm conclusions cannot be made about the acute effects of breakfast composition and the effects of chronic breakfast interventions because there are too few studies and these largely report inconsistent findings. This review also highlights methodologic limitations of the existing research. These include a lack of research on adolescents, few naturalistic breakfast manipulations or testing environments, small samples, and insensitive cognitive tests. PMID:27184287

  11. Market research for electric utilities

    International Nuclear Information System (INIS)

    Shippee, G.

    1999-01-01

    Marketing research is increasing in importance as utilities become more marketing oriented. Marketing research managers need to maintain autonomy from the marketing director or ad agency and make sure their work is relevant to the utility's operation. This article will outline a model marketing research program for an electric utility. While a utility may not conduct each and every type of research described, the programs presented offer a smorgasbord of activities which successful electric utility marketers often use or have access to

  12. Development of norms for executive functions in typically-developing Indian urban preschool children and its association with nutritional status.

    Science.gov (United States)

    Selvam, Sumithra; Thomas, Tinku; Shetty, Priya; Thennarasu, K; Raman, Vijaya; Khanna, Deepti; Mehra, Ruchika; Kurpad, Anura V; Srinivasan, Krishnamachari

    2018-02-01

    Executive functions (EFs) are essential and important for achieving success in children's everyday lives and play a fundamental role in children's cognitive, academic, social, emotional and behavioral functioning. A cross-sectional study was carried out to develop age- and sex-specific norms for EFs using the Behavior Rating Inventory of Executive Function - Preschool Version (BRIEF-P) among 2- to 5-year-olds from urban Bangalore, India. In addition, the association between EFs and anthropometric measures, a marker of nutritional status, is also examined. Primary caregivers of 412 children, equally distributed by age and sex, participated. Raw scores for each domain and indices were converted to standard t-scores and percentiles were computed. A t-score at or above 63 corresponding to the 90th percentile was considered as the cutoff for executive dysfunction in this sample. The prevalence of executive dysfunction is 10% based on the Global Executive Composite score of the BRIEF-P. The cutoff score for identifying executive dysfunction using existing United States (US) norms is higher compared to the cutoff score obtained in the current study. Therefore, using US norms for Indian children could result in the prevalence of executive dysfunction been underestimated. Multiple linear regression analysis revealed that stunted and underweight children have significantly elevated EF scores after adjusting for age, sex and socioeconomic status (SES; p < .01). A greater understanding of EFs in preschool children is important for the early identification of executive dysfunction and implementing interventions to improve their future prospects. This study also shows that undernourished children are more likely to have executive dysfunction.

  13. Growth in Children with Cerebral Palsy during five years after Selective Dorsal Rhizotomy: a practice-based study

    Directory of Open Access Journals (Sweden)

    Wagner Philippe

    2010-07-01

    Full Text Available Abstract Background Overweight is reported as a side effect of SDR. The aims were to study the development of weight, height and body mass index (BMI during five years after SDR. Methods This prospective, longitudinal and practice-based study included all 56 children with CP spastic diplegia undergoing SDR from the start in March 1993 to April 2003 in our hospital. The preoperative Gross Motor Function Classification System (GMFCS levels were I-II in 17, III in 15, IV-V in 24 children. Median age at SDR was 4.3 years (range 2.4-7.4 years. Weight and height/recumbent length were measured. Swedish growth charts for typically developing children generated weight, height and BMI z-scores for age and gender. Results The preoperative median z-scores were for height -1.92 and for body mass index (BMI -0.22. Five years later, the median BMI z-score was increased by + 0.57 (p + 2 SD increased (p The individual growth was highly variable, but a tendency towards increasing stunting with age was seen in severe gross motor dysfunction (GMFCS levels IV-V and the opposite, a slight catch-up of height in children with walking ability (GMFCS levels I-III. Conclusions These are the first available subtype- and GMFCS-specific longitudinal growth data for children with CP spastic diplegia. Their growth potential according to these data should be regarded as a minimum, as some children were undernourished. It is unknown whether the spasticity reduction through SDR increased the weight gain velocity, or if the relative weight increase was part of the general "obesity epidemic". For some children the weight increase was highly desirable. In others, it resulted in overweight and obesity with risk of negative health effects. Weight and height should be monitored to enable early prevention of weight aberrations also causing problems with mobility, activity and participation.

  14. Time Functions as Utilities

    Science.gov (United States)

    Minguzzi, E.

    2010-09-01

    Every time function on spacetime gives a (continuous) total preordering of the spacetime events which respects the notion of causal precedence. The problem of the existence of a (semi-)time function on spacetime and the problem of recovering the causal structure starting from the set of time functions are studied. It is pointed out that these problems have an analog in the field of microeconomics known as utility theory. In a chronological spacetime the semi-time functions correspond to the utilities for the chronological relation, while in a K-causal (stably causal) spacetime the time functions correspond to the utilities for the K + relation (Seifert’s relation). By exploiting this analogy, we are able to import some mathematical results, most notably Peleg’s and Levin’s theorems, to the spacetime framework. As a consequence, we prove that a K-causal (i.e. stably causal) spacetime admits a time function and that the time or temporal functions can be used to recover the K + (or Seifert) relation which indeed turns out to be the intersection of the time or temporal orderings. This result tells us in which circumstances it is possible to recover the chronological or causal relation starting from the set of time or temporal functions allowed by the spacetime. Moreover, it is proved that a chronological spacetime in which the closure of the causal relation is transitive (for instance a reflective spacetime) admits a semi-time function. Along the way a new proof avoiding smoothing techniques is given that the existence of a time function implies stable causality, and a new short proof of the equivalence between K-causality and stable causality is given which takes advantage of Levin’s theorem and smoothing techniques.

  15. Electricity utilities: Nuclear sector

    International Nuclear Information System (INIS)

    Brosche, D.

    1992-01-01

    The safe and economic operation of nuclear power plants requires an appropriate infrastructure on the part of the operator as well as a high level of technical quality of the plants and of qualification of the personnel. Added to this are a variety of services rendered by specialist firms. The Bayernwerk utility, with plants of its own, has played a major role in the development of nuclear power in the Federal Republic of Germany. The importance of nuclear power to this firm is reflected in the pattern of its electricity sources and in the composition of its power plants. (orig.) [de

  16. Reactor utilization, Part 1

    International Nuclear Information System (INIS)

    Martinc, R.; Stanic, A.

    1981-01-01

    The reactor operating plan for 1981 was subject to the needs of testing operation with the 80% enriched fuel and was fulfilled on the whole. This annex includes data about reactor operation, review of shorter interruptions due to demands of the experiments, data about safety shutdowns caused by power cuts. Period of operation at low power levels was used mostly for activation analyses, and the operation at higher power levels were used for testing and regular isotope production. Detailed data about samples activation are included as well as utilization of the reactor as neutron source and the operating plan for 1982 [sr

  17. Energy utilization in Canada

    International Nuclear Information System (INIS)

    Klassen, J.

    1976-04-01

    The situation of the energy supply of Canada is characterized by its geographic location and by the dispersal of the energy consumers over a wide area. At present, the energy supply leaving the successful CANDU nuclear energy programme out of account, is based mainly on crude oil, natural gas, and electricity as well as on coal imported from the USA. The targets of Canadian enery policies and energy research are stated as follows: a) Reducing and optimizing energy consumption, b) introducing district heating, and c) utilizing the extensive local coal deposits. (GG) [de

  18. Managing the nuclear utility

    International Nuclear Information System (INIS)

    Williams, J.W. Jr.

    1985-01-01

    The Florida Power and Light Company (FP and L) is the fifth largest investor-owned utility in the country. The success of nuclear power generation at the St. Lucie Units 1 and 2 and Turkey Point Units 3 and 4 has resulted from a continuing management commitment to the nuclear program. The management of the power plants rely strongly on teamwork for most large projects and activities whether they entail plant operation, construction, or maintenance. Various examples of how teamwork has been used to realize the successful completion of projects or solutions to problems are given

  19. Tribal Utility Feasibility Study

    Energy Technology Data Exchange (ETDEWEB)

    Engel, R. A.; Zoellick, J. J.

    2007-06-30

    The Schatz Energy Research Center (SERC) assisted the Yurok Tribe in investigating the feasibility of creating a permanent energy services program for the Tribe. The original purpose of the DOE grant that funded this project was to determine the feasibility of creating a full-blown Yurok Tribal electric utility to buy and sell electric power and own and maintain all electric power infrastructure on the Reservation. The original project consultant found this opportunity to be infeasible for the Tribe. When SERC took over as project consultant, we took a different approach. We explored opportunities for the Tribe to develop its own renewable energy resources for use on the Reservation and/or off-Reservation sales as a means of generating revenue for the Tribe. We also looked at ways the Tribe can provide energy services to its members and how to fund such efforts. We identified opportunities for the development of renewable energy resources and energy services on the Yurok Reservation that fall into five basic categories: • Demand-side management – This refers to efforts to reduce energy use through energy efficiency and conservation measures. • Off-grid, facility and household scale renewable energy systems – These systems can provide electricity to individual homes and Tribal facilities in areas of the Reservation that do not currently have access to the electric utility grid. • Village scale, micro-grid renewable energy systems - These are larger scale systems that can provide electricity to interconnected groups of homes and Tribal facilities in areas of the Reservation that do not have access to the conventional electric grid. This will require the development of miniature electric grids to serve these interconnected facilities. • Medium to large scale renewable energy development for sale to the grid – In areas where viable renewable energy resources exist and there is access to the conventional electric utility grid, these resources can be

  20. Social group utility maximization

    CERN Document Server

    Gong, Xiaowen; Yang, Lei; Zhang, Junshan

    2014-01-01

    This SpringerBrief explains how to leverage mobile users' social relationships to improve the interactions of mobile devices in mobile networks. It develops a social group utility maximization (SGUM) framework that captures diverse social ties of mobile users and diverse physical coupling of mobile devices. Key topics include random access control, power control, spectrum access, and location privacy.This brief also investigates SGUM-based power control game and random access control game, for which it establishes the socially-aware Nash equilibrium (SNE). It then examines the critical SGUM-b

  1. A review of health utilities across conditions common in paediatric and adult populations

    Directory of Open Access Journals (Sweden)

    Hopkins Robert B

    2010-01-01

    Full Text Available Abstract Background Cost-utility analyses are commonly used in economic evaluations of interventions or conditions that have an impact on health-related quality of life. However, evaluating utilities in children presents several challenges since young children may not have the cognitive ability to complete measurement tasks and thus utility values must be estimated by proxy assessors. Another solution is to use utilities derived from an adult population. To better inform the future conduct of cost-utility analyses in paediatric populations, we reviewed the published literature reporting utilities among children and adults across selected conditions common to paediatric and adult populations. Methods An electronic search of Ovid MEDLINE, EMBASE, and the Cochrane Library up to November 2008 was conducted to identify studies presenting utility values derived from the Health Utilities Index (HUI or EuroQoL-5Dimensions (EQ-5D questionnaires or using time trade off (TTO or standard gamble (SG techniques in children and/or adult populations from randomized controlled trials, comparative or non-comparative observational studies, or cross-sectional studies. The search was targeted to four chronic diseases/conditions common to both children and adults and known to have a negative impact on health-related quality of life (HRQoL. Results After screening 951 citations identified from the literature search, 77 unique studies included in our review evaluated utilities in patients with asthma (n = 25, cancer (n = 23, diabetes mellitus (n = 11, skin diseases (n = 19 or chronic diseases (n = 2, with some studies evaluating multiple conditions. Utility values were estimated using HUI (n = 33, EQ-5D (n = 26, TTO (n = 12, and SG (n = 14, with some studies applying more than one technique to estimate utility values. 21% of studies evaluated utilities in children, of those the majority being in the area of oncology. No utility values for children were reported in skin

  2. Geothermal Resource Utilization

    Energy Technology Data Exchange (ETDEWEB)

    Lienau, Paul J.

    1998-01-03

    Man has utilized the natural heat of the earth for centuries. Worldwide direct use of geothermal currently amounts to about 7,000 MWt, as compared to 1,500 MWe, now being used for the generation of electricity. Since the early 1970s, dwindling domestic reservoirs of oil and gas, continued price escalation of oil on the world market and environmental concerns associated with coal and nuclear energy have created a growing interest in the use of geothermal energy in the United States. The Department of Energy goals for hydrothermal resources utilization in the United States, expressed in barrels of oil equivalent, is 50 to 90 million bbl/yr by 1985 and 350 to 900 million bbl/yr by the year 2000. This relatively clean and highly versatile resource is now being used in a multitude of diverse applications (e.g., space heating and cooling, vegetable dehydration, agriculture, aquaculture, light manufacturing), and other applications requiring a reliable and economic source of heat.

  3. Utilization of coalbed methane

    Energy Technology Data Exchange (ETDEWEB)

    Gustavson, J.B. [Gustavson Associates Inc., Boulder, CO (United States)

    1996-02-01

    Substantial progress has been made in capturing coalbed methane (CBM gas), which constitutes a valuable source of clean burning energy. It is of importance to study the various potential uses of coalbed methane and to understand the various technologies required, as well as their economics and any institutional constraints. In industrialised countries, the uses of coalbed methane are almost solely dependent on microeconomics; coalbed methane must compete for a market against natural gas and other energy sources - and frequently, coalbed methane is not competitive against other energy sources. In developing countries, on the other hand, particularly where other sources of energy are in short supply, coalbed methane economics yield positive results. Here, constraints to development of CBM utilization are mainly lack of technology and investment capital. Sociological aspects such as attitude and cultural habits, may also have a strong negative influence. This paper outlines the economics of coalbed methane utilization, particularly its competition with natural gas, and touches upon the many different uses to which coalbed methane may be applied. 24 refs., 4 figs.

  4. Protocol investigating the clinical utility of an objective measure of activity and attention (QbTest) on diagnostic and treatment decision-making in children and young people with ADHD-'Assessing QbTest Utility in ADHD' (AQUA): a randomised controlled trial.

    Science.gov (United States)

    Hall, Charlotte L; Walker, Gemma M; Valentine, Althea Z; Guo, Boliang; Kaylor-Hughes, Catherine; James, Marilyn; Daley, David; Sayal, Kapil; Hollis, Chris

    2014-12-01

    The National Institute for Health and Care Excellence (NICE) guidelines for attention deficit/hyperactivity disorder (ADHD) state that young people need to have access to the best evidence-based care to improve outcome. The current 'gold standard' ADHD diagnostic assessment combines clinical observation with subjective parent, teacher and self-reports. In routine practice, reports from multiple informants may be unavailable or contradictory, leading to diagnostic uncertainty and delay. The addition of objective tests of attention and activity may help reduce diagnostic uncertainty and delays in initiating treatment leading to improved outcomes. This trial investigates whether providing clinicians with an objective report of levels of attention, impulsivity and activity can lead to an earlier, and more accurate, clinical diagnosis and improved patient outcome. This multisite randomised controlled trial will recruit young people (aged 6-17 years old) who have been referred for an ADHD diagnostic assessment at Child and Adolescent Mental Health Services (CAMHS) and Community Paediatric clinics across England. Routine clinical assessment will be augmented by the QbTest, incorporating a continuous performance test (CPT) and infrared motion tracking of activity. The participant will be randomised into one of two study arms: QbOpen (clinician has immediate access to a QbTest report): QbBlind (report is withheld until the study end). Primary outcomes are time to diagnosis and diagnostic accuracy. Secondary outcomes include clinician's diagnostic confidence and routine clinical outcome measures. Cost-effective analysis will be conducted, alongside a qualitative assessment of the feasibility and acceptability of incorporating QbTest in routine practice. The findings from the study will inform commissioners, clinicians and managers about the feasibility, acceptability, clinical utility and cost-effectiveness of incorporating QbTest into routine diagnostic assessment of young

  5. Utilities in UNIX

    International Nuclear Information System (INIS)

    Perez, L.

    2002-01-01

    This manual goes to the users with some or much experience in the unix operating system. In such manner that they can get more efficiency using the unix of the most vendors. Include the majority of UNIX commands, shell built-in functions to create scripts, and a brief explication of the variables in several environments. In addition, other products are included, more and more integrated in the most of the unix operating systems. For example: the scanning and processing language awk, the print server LPRng, GNU Utilities, batch subsystem, etc. The manual was initially based in an specific unix. But it and been written for use of the most unix that exist: Tru64 unix, aix, iris, hpux. solaris y linux. In this way, many examples in the chapter had been included. The purpose of this manual is to provide an UNIX reference for advanced users in any of the unix operating systems family. (Author)

  6. Hydrogen and energy utilities

    Energy Technology Data Exchange (ETDEWEB)

    Hustadt, Daniel [Vattenfall Europe Innovation GmbH (Germany)

    2010-07-01

    Renewable electricity generation plays one major role with the biggest share being wind energy. At the end of the year 2009 a wind power plant capacity of around 26 GW was installed in Germany. Several outlooks come to the conclusion that this capacity can be doubled in ten years (compare Figure 1). Additionally the German government has set a target of 26 GW installed off-shore capacity in North and Baltic Sea until 2030. At Vattenfall only a minor percentage of the electricity production comes from wind power today. This share will be increased up to 12% until 2030 following Vattenfall's strategy 'Making Electricity Clean'. This rapid development of wind power offers several opportunities but also means some challenges to Utilities. (orig.)

  7. Utility prudency issues

    International Nuclear Information System (INIS)

    Charnoff, G.

    1986-01-01

    The conventional legal standard of prudence found in the common law of public utility regulation precludes a judgment about past decisions based on present knowledge of whether the decisions proved in time to have been right or wrong. The proper inquiry is not whether every management decision proved to be correct. Rather, the proper inquiry as stated by the New York Public Service Commission in Re Consolidated Edison Co. of New York, Inc. is ...whether the company's conduct was reasonable at the time, under all of the circumstances, considering that the company had to solve its problems prospectively.... The exercise of prudence does not guarantee performance on schedule or within budget, or the making of correct decisions, when judged after the fact. But it does require or involve the exercise of reasoned decision making within a framework of reasonably available alternatives

  8. Energy utilities and the Internet

    International Nuclear Information System (INIS)

    2000-01-01

    The chances for energy utilities in the Netherlands to present themselves on the Internet are briefly outlined. It appears that other businesses are ahead of the Dutch utilities in offering electronic services with respect to energy

  9. [Health services' utilization patterns in Catalonia, Spain].

    Science.gov (United States)

    Medina, Carmen; Salvador, Xavier; Faixedas, M Teresa; Gallo, Pedro

    2011-12-01

    The purpose of this article is disclose services utilization patterns among the Catalan population with particular emphasis on primary care, specialised care, hospital care and emergency care. A number of logistic regression models were used to explain the utilization of the various types of services. Variables in the analysis included self-perceived need, lifestyles, and sociodemographic variables. Separate analyses were performed for male, female, adults, and children as well as for the general population. Women use all types of services more often than men. Children and people over 64 are more frequent users of primary care. Primary care is also associated to lower socioeconomic conditions. Young adults and the migrant population in general are found to be under users of services, except of emergency care services. The use of specialised care is associated to the better-off, to those with university level education attainment, individual private insurance, and those living in the city of Barcelona. Hospital care is largely associated to need variables. The use of health services is explained by self-perceived need as well as by demographic, socioeconomic and geographical factors. Copyright © 2011 Elsevier España S.L. All rights reserved.

  10. Promoting the Utilization of Science in Healthcare (PUSH) Project: A Description of the Perceived Barriers and Facilitators to Research Utilization Among Pediatric Nurses.

    Science.gov (United States)

    Cline, Genieveve J; Burger, Kristina J; Amankwah, Ernest K; Goldenberg, Neil A; Ghazarian, Sharon R

    The purpose of this descriptive study was to identify the perceived barriers and facilitators to research utilization and evidence-based practice among nurses employed in a tertiary care children's hospital. Results revealed seven facilitator and six barrier themes that contribute to the understanding of the problem. The themes can be utilized by nursing professional development specialists to customize organizational infrastructure and educational programs.

  11. YEAR 2 BIOMASS UTILIZATION

    Energy Technology Data Exchange (ETDEWEB)

    Christopher J. Zygarlicke

    2004-11-01

    This Energy & Environmental Research Center (EERC) Year 2 Biomass Utilization Final Technical Report summarizes multiple projects in biopower or bioenergy, transportation biofuels, and bioproducts. A prototype of a novel advanced power system, termed the high-temperature air furnace (HITAF), was tested for performance while converting biomass and coal blends to energy. Three biomass fuels--wood residue or hog fuel, corn stover, and switchgrass--and Wyoming subbituminous coal were acquired for combustion tests in the 3-million-Btu/hr system. Blend levels were 20% biomass--80% coal on a heat basis. Hog fuel was prepared for the upcoming combustion test by air-drying and processing through a hammer mill and screen. A K-Tron biomass feeder capable of operating in both gravimetric and volumetric modes was selected as the HITAF feed system. Two oxide dispersion-strengthened (ODS) alloys that would be used in the HITAF high-temperature heat exchanger were tested for slag corrosion rates. An alumina layer formed on one particular alloy, which was more corrosion-resistant than a chromia layer that formed on the other alloy. Research activities were completed in the development of an atmospheric pressure, fluidized-bed pyrolysis-type system called the controlled spontaneous reactor (CSR), which is used to process and condition biomass. Tree trimmings were physically and chemically altered by the CSR process, resulting in a fuel that was very suitable for feeding into a coal combustion or gasification system with little or no feed system modifications required. Experimental procedures were successful for producing hydrogen from biomass using the bacteria Thermotoga, a deep-ocean thermal vent organism. Analytical procedures for hydrogen were evaluated, a gas chromatography (GC) method was derived for measuring hydrogen yields, and adaptation culturing and protocols for mutagenesis were initiated to better develop strains that can use biomass cellulose. Fly ash derived from

  12. Comparison of measles complications in well nourished and mal-nourished children

    International Nuclear Information System (INIS)

    Qaisar, I.; Ahmad, A.; Ahmad, A.

    2009-01-01

    Measles is the most common and the most infectious of the viral infections of childhood. It can cause severe pneumonia, diarrhoea, encephalitis, and death. A significant proportion of deaths due to measles in young children worldwide are attributable to low weight for age. To compare the measles complications in well-nourished and mal-nourished children, this cross-sectional study was conducted at Paediatric out-patient department and paediatric unit 1 Bahawal Victoria Hospital Bahawalpur. Total 120 patients were included in the study. All patients presented with signs and symptoms suggestive of measles according to WHO criteria. These patients were divided into well nourished and malnourished according to the modified Gomez classification. Both groups were evaluated for measles complications like pneumonia, diarrhoea, encephalitis, corneal ulceration, thrombocytopenia, otitis media and myocarditis by detailed history and complete physical examination, and statistically analysed. In the studied patients, 75 were males and 45 were females. Mean age was 23 months. Fifty-nine (49.2%) patients were well-nourished and 61 (50.8%) were undernourished. Fifty-two (43.3%) patients were having pneumonia. Fifty-three (44.2%) patients were having diarrhoea. Twenty-six (21.7%) patients were having encephalitis. Corneal ulceration was found in 9 (7.5%) patients. Thrombocytopenia and otitis media was present in 1 patient in each group. Fourteen patients expired. Measles is a global epidemic problem having many serious complications, including pneumonia, diarrhoea, encephalitis, corneal ulcerations etc. Moreover these complications are more frequent in under nourished children. Efforts should be made to improve the nutritional status of the children and to eradicate this disease by effective vaccination. (author)

  13. Mortality after Inpatient Treatment for Severe Pneumonia in Children: a Cohort Study.

    Science.gov (United States)

    Ngari, Moses M; Fegan, Greg; Mwangome, Martha K; Ngama, Mwanajuma J; Mturi, Neema; Scott, John Anthony Gerard; Bauni, Evasius; Nokes, David James; Berkley, James A

    2017-05-01

    Although pneumonia is a leading cause of inpatient mortality, deaths may also occur after discharge from hospital. However, prior studies have been small, in selected groups or did not fully evaluate risk factors, particularly malnutrition and HIV. We determined 1-year post-discharge mortality and risk factors among children diagnosed with severe pneumonia. A cohort study of children aged 1-59 months admitted to Kilifi County Hospital with severe pneumonia (2007-12). The primary outcome was death pneumonia, 1041 (25%) had severe acute malnutrition (SAM), 267 (6.4%) had a positive HIV antibody test, and 364 (8.7%) died in hospital. After discharge, 2279 KHDSS-resident children were followed up; 70 (3.1%) died during 2163 child-years: 32 (95% confidence interval (CI) 26, 41) deaths per 1000 child years. Post-discharge mortality was greater after admission for severe pneumonia than for other diagnoses, hazard ratio 2.5 (95% CI 1.2, 5.3). Malnutrition, HIV status, age and prolonged hospitalisation, but not signs of pneumonia severity, were associated with post-discharge mortality. Fifty-two per cent (95% CI 37%, 63%) of post-discharge deaths were attributable to low mid-upper arm circumference and 11% (95% CI 3.3%, 18%) to a positive HIV test. Admission with severe pneumonia is an important marker of vulnerability. Risk stratification and better understanding of the mechanisms underlying post-discharge mortality, especially for undernourished children, are needed to reduce mortality after treatment for pneumonia. © 2017 The Authors. Paediatric and Perinatal Epidemiology Published by John Wiley & Sons Ltd.

  14. Washington state foster care: dental utilization and expenditures.

    Science.gov (United States)

    Melbye, Molly L R; Chi, Donald L; Milgrom, Peter; Huebner, Colleen E; Grembowski, David

    2014-01-01

    To identify factors associated with dental utilization and expenditures for children enrolled in Washington State (WA) foster care (FC). This cross-sectional study used 2008 Medicaid enrollment and claims files for children ages WA FC program for ≥11 months (N = 10,177). Regression models were used to examine associations between utilization and expenditures and sex, race, age group, Supplemental Security Income (SSI) (i.e., disability), substance abuse, behavior problems, placement setting (Foster Home Care, Kinship Care, Group Care, Other), and urbanicity. Only 43 percent of the children utilized any dental care; the adjusted mean expenditure was $198.35 [95% confidence interval (CI) $181.35, $215.36]. Fewer utilized diagnostic (41 percent), preventive (39 percent), restorative (11 percent), or complex (5 percent) services. Associated with utilization (P ≤ 0.01) were: female [ARR = 1.05, 95% CI(1.01, 1.10)]; 0-2 years [ARR = 0.18, 95% CI(0.15, 0.21)], [3-5 years ARR = 0.78, 95% CI(0.74, 0.83)]; Native American [ARR = 0.85, 95% CI(0.80, 0.91)]; SSI [ARR = 1.10, 95% CI(1.04, 1.17)]; Kinship Care [ARR = 0.94, 95% CI(0.90, 0.98)]; Group Care [ARR = 1.25 95% CI(1.15, 1.37)]; and urban/rural urbanicity with population WA FC for ≥11 months during 2008 did not receive dental care. Research is needed to determine the level of unmet need among children in FC and interventions to improve access to oral health of the children. Enforcement of existing federal legislation is needed. © 2013 American Association of Public Health Dentistry.

  15. National Utility Rate Database: Preprint

    Energy Technology Data Exchange (ETDEWEB)

    Ong, S.; McKeel, R.

    2012-08-01

    When modeling solar energy technologies and other distributed energy systems, using high-quality expansive electricity rates is essential. The National Renewable Energy Laboratory (NREL) developed a utility rate platform for entering, storing, updating, and accessing a large collection of utility rates from around the United States. This utility rate platform lives on the Open Energy Information (OpenEI) website, OpenEI.org, allowing the data to be programmatically accessed from a web browser, using an application programming interface (API). The semantic-based utility rate platform currently has record of 1,885 utility rates and covers over 85% of the electricity consumption in the United States.

  16. Utility service entrance in boreholes

    International Nuclear Information System (INIS)

    1987-08-01

    This study evaluates alternatives for utility service entrances to the repository. We determined the requirements for a repository utility supply. These requirements were defined as safety, maintainability, flexibility, reliability, cost efficiency, voltage regulation, and simplicity of operation. The study showed that repository shafts can best satisfy all requirements for location of the utility supply without the use of borehole penetrations into the repository. It is recommended that the shafts be utilized for utility distribution to the repository, and that the current NWTS program position to minimize the number of boreholes penetrating the repository horizon be maintained. 42 refs., 2 figs., 3 tabs

  17. Utility application of simulation software

    International Nuclear Information System (INIS)

    Sudduth, A.L.

    1986-01-01

    The purpose of this paper is to discuss dynamic system simulation from the perspective of a successful utility user. In it, four aspects of the issue of utility use of simulation will be addressed: (1) What simulation software is available to utilities which can be of practical assistance with a modest investment in staff and training. (2) To what specific problems can utilities apply the technique of simulation and achieve reasonably cost effective results. (3) What the advantages are of in-house dynamic simulation capability, as opposed to depending on NSSS vendors or consultants. (4) What the prospects are for wider use of dynamic simulation in the utility industry

  18. Market research for electric utilities

    Energy Technology Data Exchange (ETDEWEB)

    Shippee, G.

    1999-12-01

    Marketing research is increasing in importance as utilities become more marketing oriented. Marketing research managers need to maintain autonomy from the marketing director or ad agency and make sure their work is relevant to the utility's operation. This article will outline a model marketing research program for an electric utility. While a utility may not conduct each and every type of research described, the programs presented offer a smorgasbord of activities which successful electric utility marketers often use or have access to.

  19. Utilization management in anatomic pathology.

    Science.gov (United States)

    Lewandrowski, Kent; Black-Schaffer, Steven

    2014-01-01

    There is relatively little published literature concerning utilization management in anatomic pathology. Nonetheless there are many utilization management opportunities that currently exist and are well recognized. Some of these impact only the cost structure within the pathology department itself whereas others reduce charges for third party payers. Utilization management may result in medical legal liabilities for breaching the standard of care. For this reason it will be important for pathology professional societies to develop national utilization guidelines to assist individual practices in implementing a medically sound approach to utilization management. © 2013.

  20. SYMPAL: utilities guide

    International Nuclear Information System (INIS)

    Simpson, J.A.; Sublet, J.-Ch.

    1997-02-01

    The processing code SYMPAL is used to perform the data treatment for creating a new version of the European Activation File (EAF). The entire process is handled by different modules of the code in a sequential and orderly manner. The modular code system accesses, translates and processes cross section data from a wide variety of libraries and calculations with nuclear model codes. Two major data bases are accessed and merged so as to create a new library version. The Master Data File (MDF) contains the original cross section data extracted, unmodified but reformatted, from numerous sources. The Master Parameter File (MPF) contains a compilation of all physical information necessary to renormalise, split and internally validate any particular type of cross section. The combination of these two files generates a new activation library in pointwise and various groupwise formats. The SYMPAL utilities guide describes a set of programs developed to handle certain aspects of the procedure done outside of the main processing tasks. These include counting, translating, selecting and plotting data streams. Special printing and plotting procedures have been written to handle the large amounts of information present in activation libraries. (author)

  1. Gnuastro: GNU Astronomy Utilities

    Science.gov (United States)

    Akhlaghi, Mohammad

    2018-01-01

    Gnuastro (GNU Astronomy Utilities) manipulates and analyzes astronomical data. It is an official GNU package of a large collection of programs and C/C++ library functions. Command-line programs perform arithmetic operations on images, convert FITS images to common types like JPG or PDF, convolve an image with a given kernel or matching of kernels, perform cosmological calculations, crop parts of large images (possibly in multiple files), manipulate FITS extensions and keywords, and perform statistical operations. In addition, it contains programs to make catalogs from detection maps, add noise, make mock profiles with a variety of radial functions using monte-carlo integration for their centers, match catalogs, and detect objects in an image among many other operations. The command-line programs share the same basic command-line user interface for the comfort of both the users and developers. Gnuastro is written to comply fully with the GNU coding standards and integrates well with all Unix-like operating systems. This enables astronomers to expect a fully familiar experience in the source code, building, installing and command-line user interaction that they have seen in all the other GNU software that they use. Gnuastro's extensive library is included for users who want to build their own unique programs.

  2. Knowledge-based utility

    International Nuclear Information System (INIS)

    Chwalowski, M.

    1997-01-01

    This presentation provides industry examples of successful marketing practices by companies facing deregulation and competition. The common thread through the examples is that long term survival of today's utility structure is dependent on the strategic role of knowledge. As opposed to regulated monopolies which usually own huge physical assets and have very little intelligence about their customers, unregulated enterprises tend to be knowledge-based, characterized by higher market value than book value. A knowledge-based enterprise gathers data, creates information and develops knowledge by leveraging it as a competitive weapon. It institutionalizes human knowledge as a corporate asset for use over and over again by the use of databases, computer networks, patents, billing, collection and customer services (BCCS), branded interfaces and management capabilities. Activities to become knowledge-based such as replacing inventory/fixed assets with information about material usage to reduce expenditure and achieve more efficient operations, and by focusing on integration and value-adding delivery capabilities, were reviewed

  3. Gas utilization technologies

    International Nuclear Information System (INIS)

    Biljetina, R.

    1994-01-01

    One of the constant challenges facing the research community is the identification of technology needs 5 to 15 years from now. A look back into history indicates that the forces driving natural gas research have changed from decade to decade. In the 1970s research was driven by concerns for adequate supply; in the 1980s research was aimed at creating new markets for natural gas. What then are the driving forces for the 1990s? Recent reports from the natural gas industry have helped define a new direction driven primarily by market demand for natural gas. A study prepared by the Interstate Natural Gas Association of America Foundation entitled ''Survey of Natural Research, Development, and Demonstration RD ampersand D Priorities'' indicated that in the 1990s the highest research priority should be for natural gas utilization and that technology development efforts should not only address efficiency and cost, but environmental and regulatory issues as well. This study and others, such as the report by the American Gas Association (A.G.A.) entitled ''Strategic Vision for Natural Gas Through the Year 2000,'' clearly identify the market sectors driving today's technology development needs. The biggest driver is the power generation market followed by the industrial, transportation, appliance, and gas cooling markets. This is best illustrated by the GRI 1994 Baseline Projection on market growth in various sectors between the year 1992 and 2010. This paper highlights some of the recent technology developments in each one of these sectors

  4. Automated ISS Flight Utilities

    Science.gov (United States)

    Offermann, Jan Tuzlic

    2016-01-01

    During my internship at NASA Johnson Space Center, I worked in the Space Radiation Analysis Group (SRAG), where I was tasked with a number of projects focused on the automation of tasks and activities related to the operation of the International Space Station (ISS). As I worked on a number of projects, I have written short sections below to give a description for each, followed by more general remarks on the internship experience. My first project is titled "General Exposure Representation EVADOSE", also known as "GEnEVADOSE". This project involved the design and development of a C++/ ROOT framework focused on radiation exposure for extravehicular activity (EVA) planning for the ISS. The utility helps mission managers plan EVAs by displaying information on the cumulative radiation doses that crew will receive during an EVA as a function of the egress time and duration of the activity. SRAG uses a utility called EVADOSE, employing a model of the space radiation environment in low Earth orbit to predict these doses, as while outside the ISS the astronauts will have less shielding from charged particles such as electrons and protons. However, EVADOSE output is cumbersome to work with, and prior to GEnEVADOSE, querying data and producing graphs of ISS trajectories and cumulative doses versus egress time required manual work in Microsoft Excel. GEnEVADOSE automates all this work, reading in EVADOSE output file(s) along with a plaintext file input by the user providing input parameters. GEnEVADOSE will output a text file containing all the necessary dosimetry for each proposed EVA egress time, for each specified EVADOSE file. It also plots cumulative dose versus egress time and the ISS trajectory, and displays all of this information in an auto-generated presentation made in LaTeX. New features have also been added, such as best-case scenarios (egress times corresponding to the least dose), interpolated curves for trajectories, and the ability to query any time in the

  5. Fuel manufacturing and utilization

    International Nuclear Information System (INIS)

    2005-01-01

    The efficient utilisation of nuclear fuel requires manufacturing facilities capable of making advanced fuel types, with appropriate quality control. Once made, the use of such fuels requires a proper understanding of their behaviour in the reactor environment, so that safe operation for the design life can be achieved. The International Atomic Energy Agency supports Member States to improve in-pile fuel performance and management of materials; and to develop advanced fuel technologies for ensuring reliability and economic efficiency of the nuclear fuel cycle. It provides assistance to Member States to support fuel-manufacturing capability, including quality assurance techniques, optimization of manufacturing parameters and radiation protection. The IAEA supports the development fuel modelling expertise in Member States, covering both normal operation and postulated and severe accident conditions. It provides information and support for the operation of Nuclear Power Plant to ensure that the environment and water chemistry is appropriate for fuel operation. The IAEA supports fuel failure investigations, including equipment for failed fuel detection and for post-irradiation examination and inspection, as well as fuel repair, it provides information and support research into the basic properties of fuel materials, including UO 2 , MOX and zirconium alloys. It further offers guidance on the relationship with back-end requirement (interim storage, transport, reprocessing, disposal), fuel utilization and management, MOX fuels, alternative fuels and advanced fuel technology

  6. The Utility and Consequences of Using Impressed Child Soldiers in Africa's Contemporary Wars

    National Research Council Canada - National Science Library

    Woguwale, Jasom

    2000-01-01

    .... The purpose of this paper titled, "The Utility and Consequences of Using Impressed Child Soldiers in Africa's Contemporary Wars," is to examine the practice of using children as soldiers by various...

  7. Facility Utilization Reports - FAA Aviation Information Utilization Reports

    Data.gov (United States)

    Department of Transportation — Provides: (1) Space management and planning, including area calculations, tracking space by organization and employee, and monitoring space utilization information....

  8. Utility Computing: Reality and Beyond

    Science.gov (United States)

    Ivanov, Ivan I.

    Utility Computing is not a new concept. It involves organizing and providing a wide range of computing-related services as public utilities. Much like water, gas, electricity and telecommunications, the concept of computing as public utility was announced in 1955. Utility Computing remained a concept for near 50 years. Now some models and forms of Utility Computing are emerging such as storage and server virtualization, grid computing, and automated provisioning. Recent trends in Utility Computing as a complex technology involve business procedures that could profoundly transform the nature of companies' IT services, organizational IT strategies and technology infrastructure, and business models. In the ultimate Utility Computing models, organizations will be able to acquire as much IT services as they need, whenever and wherever they need them. Based on networked businesses and new secure online applications, Utility Computing would facilitate "agility-integration" of IT resources and services within and between virtual companies. With the application of Utility Computing there could be concealment of the complexity of IT, reduction of operational expenses, and converting of IT costs to variable `on-demand' services. How far should technology, business and society go to adopt Utility Computing forms, modes and models?

  9. Children's Learning

    Science.gov (United States)

    Siegler, Robert S.

    2005-01-01

    A new field of children's learning is emerging. This new field differs from the old in recognizing that children's learning includes active as well as passive mechanisms and qualitative as well as quantitative changes. Children's learning involves substantial variability of representations and strategies within individual children as well as…

  10. Children's Places

    DEFF Research Database (Denmark)

    Using a cross-cultural approach the book investigates children's places in different societies. "Children's Places" examines the ways in which children and adults, from their different vantage-points in society, negotiate proper places of children in both social and spatial terms. It looks at some...

  11. Privatization of municipal electrical utilities

    International Nuclear Information System (INIS)

    Carr, J.

    1998-01-01

    The challenges and special issues which arise through the sale of a municipal electric utility were discussed. The recent sales of two utilities, the Kentville Electric Commission in Nova Scotia and Cornwall Electric in Ontario, were used as examples to show how the sale of an electric utility differs from the sale of most business enterprises. Municipal utilities are integral parts of the communities they serve which introduces several complexities into the sale. Factors that require special attention in the sale of the utilities, including electricity rates, local accountability, treatment of employees and local economic development, and the need for a comprehensive communication program to deal with the substantial public interest that sale of a municipal utility will engender, were reviewed

  12. Factors that influence the selection and utilization of children’s medical insurance

    Directory of Open Access Journals (Sweden)

    Shishu Zhang

    2015-12-01

    Full Text Available The researchers analyzed how different regions in the USA, family structure, ethnicity, and family income levels influenced the selection and utilization of medical care programs and services by American children. To prevent any possible bias in the analysis and to produce reliable results, an endogenous switching model was utilized in the study. The researchers found no statistically significant differences in the number of doctor visits and hospital stays between children with insurance and children without insurance. However, significant differences were determined regarding family structure, family income, geographic regions, and ethnicity. Children from single-parent families with insurance coverage (private, Medicaid, or SCHIP had statistically higher rates of doctor visits and hospital stays than children from two-parent families with insurance coverage. Family income, region, and ethnicity variables all had significant impacts on the type of health insurance coverage that was reported for children.

  13. Mox fuel utilization in ATR

    OpenAIRE

    下村 和生; 川太 徳夫

    1987-01-01

    ATR, a heavy-water moderated boiling-light-water cooled reactor developed in Japan, is a unique reactor with out-standing flexibility regarding nuclear fuel utilization, because it has superior properties concerning the utilization of plutonium, recovered uranium and depleted uranium. The development of this type of reactor is expected to contribute both to the stable supply of energy and to the establishment of plutonium utilization in Japan. Much effort has been and will be made on the deve...

  14. Utility deregulation and AMR technology

    International Nuclear Information System (INIS)

    Moore, G.

    1991-01-01

    This article reviews the effects of deregulation on other utilities and services and examines how the electric utilities can avoid the worst of these effects and capitalize of the best aspects of competition in achieving marketing excellence. The article presents deregulation as a customer service and underscores the need for utilities to learn to compete aggressively and intelligently and provide additional services available through technology such as automated meter reading

  15. Subjective expected utility without preferences

    OpenAIRE

    Bouyssou , Denis; Marchant , Thierry

    2011-01-01

    This paper proposes a theory of subjective expected utility based on primitives only involving the fact that an act can be judged either "attractive" or "unattractive". We give conditions implying that there are a utility function on the set of consequences and a probability distribution on the set of states such that attractive acts have a subjective expected utility above some threshold. The numerical representation that is obtained has strong uniqueness properties.

  16. Medical Service Utilization among Youth with School-Identified Disabilities in Residential Care

    Science.gov (United States)

    Lambert, Matthew C.; Trout, Alexandra L.; Nelson, Timothy D.; Epstein, Michael H.; W. Thompson, Ronald

    2016-01-01

    Background: Behavioral, social, emotional, and educational risks among children and youth with school identified disabilities served in residential care have been well documented. However, the health care needs and medical service utilization of this high-risk population are less well known. Given the risks associated with children with…

  17. VT Electric Utility Franchise Areas

    Data.gov (United States)

    Vermont Center for Geographic Information — (Link to Metadata) ELCFRANCHISE includes Vermont's Electric Utility Franchise boundaries. It is a compilation of many data sources. The boundaries are approximate...

  18. Multiattribute Utility Theory, Intertemporal Utility and Correlation Aversion

    DEFF Research Database (Denmark)

    Andersen, Steffen; Harrison, Glenn W.; Lau, Morten

    2018-01-01

    Convenient assumptions about qualitative properties of the intertemporal utility function have generated counterintuitive implications for the relationship between atemporal risk aversion and the intertemporal elasticity of substitution. If the intertemporal utility function is additively separable...... aversion. Our results show that subjects are correlation averse over lotteries with intertemporal income profiles....

  19. The changing utility workforce and the evolution of utility design

    Energy Technology Data Exchange (ETDEWEB)

    Saunders, A. [Autodesk Inc., (United States); Zeiss, G. [Autodesk Inc., (Canada)

    2008-07-01

    Electric utilities are experiencing an unprecedented workforce turnover as a wave of retirement approaches. The challenge for the industry is to mitigate the loss of industry knowledge and attract talented new designers and engineers. Utilities need to effectively transfer knowledge from an existing workforce with up to three decades of experience to their new hires who have very different skill levels as well as different expectations regarding design tools compared to their predecessors. Knowledge transfer from the retiring workforce to the new hires can be facilitated with rules-based design software. Easy-to-use design software with built-in validations can accelerate training. By investing in utility design software that incorporates the best elements of design processes from other industries, utilities can attract the new generation of engineers and designers to help utilities define new processes to upgrade existing infrastructure, bring online new distributed and renewable generation facilities, implement smart devices and meters, and improve customer service. 3 refs.

  20. Utility of spinal MRI in children with anorectal malformation

    Energy Technology Data Exchange (ETDEWEB)

    Miyasaka, Mikiko; Nosaka, Shunsuke; Tsutsumi, Yoshiyuki [National Centre for Child Health and Development, Radiology, Tokyo (Japan); Kitano, Yoshihiro [Saitama Children' s Medical Centre, Paediatric Surgery, Saitama (Japan); Ueoka, Katsuhiko [National Centre for Child Health and Development, Paediatric Urology, Tokyo (Japan); Kuroda, Tatsuo; Honna, Toshiroh [National Centre for Child Health and Development, Paediatric Surgery, Tokyo (Japan)

    2009-08-15

    The association between spinal cord anomalies and imperforate anus is well recognized. Until now, the incidence of tethered cord has been assumed to be higher in patients with high-type imperforate anus. However, recent reports suggest that tethered cord is as common in patients with a low lesion as in those with a high lesion. To review the incidence of spinal cord anomalies in those with a low lesion and those with a high (including intermediate) anorectal malformation (ARM), and to determine the best diagnostic imaging strategy. A group of 50 consecutive patients with postoperative ARM and in whom spinal MRI had been performed were identified retrospectively. We reviewed and compared the following factors between those with a high lesion and those with a low lesion: (1) clinical symptoms, (2) spinal cord anomalies, and (3) vertebral anomalies. The incidence of spinal cord anomalies was no different between those with a high lesion and those with a low lesion, and spinal cord anomalies were present regardless of the presence of vertebral anomalies or symptoms. Owing to the high incidence of spinal cord anomalies in patients with imperforate anus, MRI is the best imaging tool for detecting such anomalies regardless of the level of the lesion. (orig.)

  1. Concept Maps: An Alternative Methodology to Assess Young Children

    Science.gov (United States)

    Atiles, Julia T.; Dominique-Maikell, Nikole; McKean, Kathleen

    2014-01-01

    The authors investigated the utility and efficacy of using concepts maps as a research tool to assess young children. Pre- and post- concept maps have been used as an assessment and evaluation tool with teachers and with older students, typically children who can read and write; this article summarizes an investigation into the utility of using…

  2. The utility target market model

    International Nuclear Information System (INIS)

    Leng, G.J.; Martin, J.

    1994-01-01

    A new model (the Utility Target Market Model) is used to evaluate the economic benefits of photovoltaic (PV) power systems located at the electrical utility customer site. These distributed PV demand-side generation systems can be evaluated in a similar manner to other demand-side management technologies. The energy and capacity values of an actual PV system located in the service area of the New England Electrical System (NEES) are the two utility benefits evaluated. The annual stream of energy and capacity benefits calculated for the utility are converted to the installed cost per watt that the utility should be willing to invest to receive this benefit stream. Different discount rates are used to show the sensitivity of the allowable installed cost of the PV systems to a utility's average cost of capital. Capturing both the energy and capacity benefits of these relatively environmentally friendly distributed generators, NEES should be willing to invest in this technology when the installed cost per watt declines to ca $2.40 using NEES' rated cost of capital (8.78%). If a social discount rate of 3% is used, installation should be considered when installed cost approaches $4.70/W. Since recent installations in the Sacramento Municipal Utility District have cost between $7-8/W, cost-effective utility applications of PV are close. 22 refs., 1 fig., 2 tabs

  3. Empirical Specification of Utility Functions.

    Science.gov (United States)

    Mellenbergh, Gideon J.

    Decision theory can be applied to four types of decision situations in education and psychology: (1) selection; (2) placement; (3) classification; and (4) mastery. For the application of the theory, a utility function must be specified. Usually the utility function is chosen on a priori grounds. In this paper methods for the empirical assessment…

  4. Xylose utilization in recombinant zymomonas

    Science.gov (United States)

    Caimi, Perry G; McCole, Laura; Tao, Luan; Tomb, Jean-Francois; Viitanen, Paul V

    2014-03-25

    Xylose-utilizing Zymomonas strains studied were found to accumulate ribulose when grown in xylose-containing media. Engineering these strains to increase ribose-5-phosphate isomerase activity led to reduced ribulose accumulation, improved growth, improved xylose utilization, and increased ethanol production.

  5. Rising utilization of inpatient pediatric asthma pathways.

    Science.gov (United States)

    Kaiser, Sunitha V; Rodean, Jonathan; Bekmezian, Arpi; Hall, Matt; Shah, Samir S; Mahant, Sanjay; Parikh, Kavita; Morse, Rustin; Puls, Henry; Cabana, Michael D

    2018-02-01

    Clinical pathways are detailed care plans that operationalize evidence-based guidelines into an accessible format for health providers. Their goal is to link evidence to practice to optimize patient outcomes and delivery efficiency. It is unknown to what extent inpatient pediatric asthma pathways are being utilized nationally. (1) Describe inpatient pediatric asthma pathway design and implementation across a large hospital network. (2) Compare characteristics of hospitals with and without pathways. We conducted a descriptive, cross-sectional, survey study of hospitals in the Pediatric Research in Inpatient Settings Network (75% children's hospitals, 25% community hospitals). Our survey determined if each hospital used a pathway and pathway characteristics (e.g. pathway elements, implementation methods). Hospitals with and without pathways were compared using Chi-square tests (categorical variables) and Student's t-tests (continuous variables). Surveys were distributed to 3-5 potential participants from each hospital and 302 (74%) participants responded, representing 86% (106/123) of surveyed hospitals. From 2005-2015, the proportion of hospitals utilizing inpatient asthma pathways increased from 27% to 86%. We found variation in pathway elements, implementation strategies, electronic medical record integration, and compliance monitoring across hospitals. Hospitals with pathways had larger inpatient pediatric programs [mean 12.1 versus 6.1 full-time equivalents, p = 0.04] and were more commonly free-standing children's hospitals (52% versus 23%, p = 0.05). From 2005-2015, there was a dramatic rise in implementation of inpatient pediatric asthma pathways. We found variation in many aspects of pathway design and implementation. Future studies should determine optimal implementation strategies to better support hospital-level efforts in improving pediatric asthma care and outcomes.

  6. Low Fertility Preservation Utilization Among Transgender Youth.

    Science.gov (United States)

    Nahata, Leena; Tishelman, Amy C; Caltabellotta, Nicole M; Quinn, Gwendolyn P

    2017-07-01

    Research demonstrates a negative psychosocial impact of infertility among otherwise healthy adults, and distress among adolescents facing the prospect of future infertility due to various medical conditions and treatments that impair reproductive health. Guidelines state that providers should counsel transgender youth about potential infertility and fertility preservation (FP) options prior to initiation of hormone therapy. The purpose of this study was to examine the rates of fertility counseling and utilization of FP among a cohort of adolescents with gender dysphoria seen at a large gender clinic. An Institutional Review Board-approved retrospective review of electronic medical records was conducted of all patients with ICD-9/10 codes for gender dysphoria referred to Pediatric Endocrinology for hormone therapy (puberty suppression and/or cross-sex hormones) from January 2014 to August 2016. Seventy-eight patients met inclusion criteria. Five children were prepubertal, no hormone therapy was considered, and they were therefore excluded. Of the remaining 73 patients, 72 had documented fertility counseling prior to initiation of hormone therapy and 2 subjects attempted FP; 45% of subjects mentioned a desire or plan to adopt, and 21% said they had never wanted to have children. Utilization rates of FP are low among transgender adolescents. More research is needed to understand parenthood goals among transgender youth at different ages and developmental stages and to explore the impact of gender dysphoria on decision-making about FP and parenthood. Discussions about infertility risk, FP, and other family building options should be prioritized in this vulnerable adolescent population. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  7. Fears of American Children Following Terrorism

    Science.gov (United States)

    Burnham, Joy J.; Hooper, Lisa M.

    2008-01-01

    Two months after 9/11, the fears of children and adolescents in Grades 2-12 were examined utilizing the American Fear Survey Schedule for Children and Adolescents (FSSC-AM). Fear intensity scores and age and gender differences are reported. Terrorist-related content on the FSSC-AM (e.g., terrorist attacks, our country being invading by enemies)…

  8. Underdiagnosis of malnutrition in infants and young children in Rwanda: implications for attainment of the Millennium Development Goal to end poverty and hunger.

    Science.gov (United States)

    Binagwaho, Agnès; Agbonyitor, Mawuena; Rukundo, Alphonse; Ratnayake, Niloo; Ngabo, Fidel; Kayumba, Josephine; Dowdle, Bridget; Chopyak, Elena; Smith Fawzi, Mary C

    2011-12-29

    Progress towards the first Millennium Development Goal (MDG1) to end poverty and hunger has lagged behind attainment of other MDGs due to chronic poverty and worldwide inequity in access to adequate health care, food, clean water, and sanitation. Despite ongoing challenges, Rwanda has experienced economic progress and the expansion of the national public health system during the past 20 years. However, protein-energy malnutrition in children under five is still a major concern for physicians and government officials in Rwanda. Approximately 45% of children under the age of five in Rwanda suffer from chronic malnutrition, and one in four is undernourished. For years, health facilities in Rwanda have used incorrect growth references for measuring nutritional status of children despite the adoption of new standards by the World Health Organization in 2006. Under incorrect growth references used in Rwanda, a number of children under five who were severely underweight were not identified, and therefore were not treated for malnutrition, thus potentially contributing to the under five mortality rate. Given that one in ten children suffer from malnutrition worldwide, it is imperative that all countries with a burden of malnutrition adopt the most up-to-date international standards for measuring malnutrition, and that the problem is brought to the forefront of international public health initiatives. For low income countries in the process of improving economic conditions, as Rwanda is, increasing the identification and treatment of malnutrition can promote the advancement of MDG1 as well as physical and cognitive development in children, which is imperative for advancing future economic progress.

  9. Underdiagnosis of malnutrition in infants and young children in Rwanda: implications for attainment of the Millennium Development Goal to end poverty and hunger

    Directory of Open Access Journals (Sweden)

    Binagwaho Agnès

    2011-12-01

    Full Text Available Abstract Progress towards the first Millennium Development Goal (MDG1 to end poverty and hunger has lagged behind attainment of other MDGs due to chronic poverty and worldwide inequity in access to adequate health care, food, clean water, and sanitation. Despite ongoing challenges, Rwanda has experienced economic progress and the expansion of the national public health system during the past 20 years. However, protein-energy malnutrition in children under five is still a major concern for physicians and government officials in Rwanda. Approximately 45% of children under the age of five in Rwanda suffer from chronic malnutrition, and one in four is undernourished. For years, health facilities in Rwanda have used incorrect growth references for measuring nutritional status of children despite the adoption of new standards by the World Health Organization in 2006. Under incorrect growth references used in Rwanda, a number of children under five who were severely underweight were not identified, and therefore were not treated for malnutrition, thus potentially contributing to the under five mortality rate. Given that one in ten children suffer from malnutrition worldwide, it is imperative that all countries with a burden of malnutrition adopt the most up-to-date international standards for measuring malnutrition, and that the problem is brought to the forefront of international public health initiatives. For low income countries in the process of improving economic conditions, as Rwanda is, increasing the identification and treatment of malnutrition can promote the advancement of MDG1 as well as physical and cognitive development in children, which is imperative for advancing future economic progress.

  10. Hualapai Tribal Utility Development Project

    Energy Technology Data Exchange (ETDEWEB)

    Hualapai Tribal Nation

    2008-05-25

    The first phase of the Hualapai Tribal Utility Development Project (Project) studied the feasibility of establishing a tribally operated utility to provide electric service to tribal customers at Grand Canyon West (see objective 1 below). The project was successful in completing the analysis of the energy production from the solar power systems at Grand Canyon West and developing a financial model, based on rates to be charged to Grand Canyon West customers connected to the solar systems, that would provide sufficient revenue for a Tribal Utility Authority to operate and maintain those systems. The objective to establish a central power grid over which the TUA would have authority and responsibility had to be modified because the construction schedule of GCW facilities, specifically the new air terminal, did not match up with the construction schedule for the solar power system. Therefore, two distributed systems were constructed instead of one central system with a high voltage distribution network. The Hualapai Tribal Council has not taken the action necessary to establish the Tribal Utility Authority that could be responsible for the electric service at GCW. The creation of a Tribal Utility Authority (TUA) was the subject of the second objective of the project. The second phase of the project examined the feasibility and strategy for establishing a tribal utility to serve the remainder of the Hualapai Reservation and the feasibility of including wind energy from a tribal wind generator in the energy resource portfolio of the tribal utility (see objective 2 below). It is currently unknown when the Tribal Council will consider the implementation of the results of the study. Objective 1 - Develop the basic organizational structure and operational strategy for a tribally controlled utility to operate at the Tribe’s tourism enterprise district, Grand Canyon West. Coordinate the development of the Tribal Utility structure with the development of the Grand Canyon

  11. Improving Care for Children With Complex Needs

    Science.gov (United States)

    2017-10-10

    Medically Complex Children; Care Coordination; Case Manager; Care Manager; Collaborative Care; Disease Management; Patient Care Team or Organization; Managed Care; Children With Chronic Conditions; Children With Special Health Care Needs; Shared Care Plan; Patient Care Plan; Health Care and Resource Utilization; Adherence to Care; Functional Status and Productivity; Health Related Quality of Life; Satisfaction With Care; Care Coordinator; Family Experience of Care; Quality Health Care

  12. Likeable children, uneasy children

    DEFF Research Database (Denmark)

    Anderson, Sally Dean

    2014-01-01

    Drawing on fieldwork in small-town schools with children of Muslim background whose families came to Denmark as United Nation refugees, the chapter explores how pedagogical ideologies of school-based peer sociability inflect children’s experiences of ‘being Muslim.’ Danish provincial schools, wit...... a child’s personal religiosity, whereas not participating conjures up images of really religious families....

  13. Analysis of Macronutrients Intake and Body Mass Index in Preschool Children in the Western Region of the Republic of Srpska.

    Science.gov (United States)

    Djermanović, Mirjana; Miletić, Ivanka; Pavlović, Zoran

    2015-01-01

    Childhood obesity is currently considered to be one of the most prevailing and challenging public health issues in industrialized countries and some developing countries, including the Republic of Srpska. Our objective was to determine macronutrients intake in collective diet of preschool children and to estimate the rate of obesity in this population. Samples of food intended for preschool children diet were collected in a preschool facility in the western region of the Republic of Srpska. In daily portions, the content of proteins, fats, carbohydrates, water and mineral matter were determined using standard methods. The body mass index was determined on the basis of anthropometric measurements. RESULTS An average daily meal contained 17.5 g of fats, 19.1 g of proteins and 101.5 g of carbohydrates. The energy value was 676 Kcal. The analysis of the data from the menu showed that the number of consumed servings of fruits, vegetables, legumes, milk and dairy products was less than one portion per day. However, the amount of consumed meat and meat products exceeded one portion per day. Out of the total number of children, 10.0% were undernourished, 16.7% were overweight and 13.3% were obese. Daily portions in the preschool facility are not in accordance with the recommended dietary allowance for energy and carbohydrates intake, and the composition of meals is inadequate. Parents and caregivers should be encouraged to expose young children to a wide variety of fruit and vegetables, whole grains, low-fat dairy products, and to balance food intake with the requirements.

  14. Essential fats: how do they affect growth and development of infants and young children in developing countries? A literature review.

    Science.gov (United States)

    Huffman, Sandra L; Harika, Rajwinder K; Eilander, Ans; Osendarp, Saskia J M

    2011-10-01

    Omega-3 and omega-6 fatty acids, particularly docosahexaenoic acid (DHA), are known to play an essential role in the development of the brain and retina. Intakes in pregnancy and early life affect growth and cognitive performance later in childhood. However, total fat intake, alpha-linolenic acid (ALA) and DHA intakes are often low among pregnant and lactating women, infants and young children in developing countries. As breast milk is one of the best sources of ALA and DHA, breastfed infants are less likely to be at risk of insufficient intakes than those not breastfed. Enhancing intake of ALA through plant food products (soy beans and oil, canola oil, and foods containing these products such as lipid-based nutrient supplements) has been shown to be feasible. However, because of the low conversion rates of ALA to DHA, it may be more efficient to increase DHA status through increasing fish consumption or DHA fortification, but these approaches may be more costly. In addition, breastfeeding up to 2 years and beyond is recommended to ensure an adequate essential fat intake in early life. Data from developing countries have shown that a higher omega-3 fatty acid intake or supplementation during pregnancy may result in small improvements in birthweight, length and gestational age based on two randomized controlled trials and one cross-sectional study. More rigorous randomized controlled trials are needed to confirm this effect. Limited data from developing countries suggest that ALA or DHA supplementation during lactation and in infants may be beneficial for growth and development of young children 6-24 months of age in these settings. These benefits are more pronounced in undernourished children. However, there is no evidence for improvements in growth following omega-3 fatty acid supplementation in children >2 years of age. © 2011 Blackwell Publishing Ltd.

  15. Analysis of macronutrients intake and body mass index in preschool children in the western region of the Republic of Srpska

    Directory of Open Access Journals (Sweden)

    Đermanović Mirjana

    2015-01-01

    Full Text Available Introduction. Childhood obesity is currently considered to be one of the most prevailing and challenging public health issues in industrialized countries and some developing countries, including the Republic of Srpska. Objective. Our objective was to determine macronutrients intake in collective diet of preschool children and to estimate the rate of obesity in this population. Methods. Samples of food intended for preschool children diet were collected in a preschool facility in the western region of the Republic of Srpska. In daily portions, the content of proteins, fats, carbohydrates, water and mineral matter were determined using standard methods. The body mass index was determined on the basis of anthropometric measurements. Results. An average daily meal contained 17.5 g of fats, 19.1 g of proteins and 101.5 g of carbohydrates. The energy value was 676 Kcal. The analysis of the data from the menu showed that the number of consumed servings of fruits, vegetables, legumes, milk and dairy products was less than one portion per day. However, the amount of consumed meat and meat products exceeded one portion per day. Out of the total number of children, 10.0% were undernourished, 16.7% were overweight and 13.3% were obese. Conclusion. Daily portions in the preschool facility are not in accordance with the recommended dietary allowance for energy and carbohydrates intake, and the composition of meals is inadequate. Parents and caregivers should be encouraged to expose young children to a wide variety of fruit and vegetables, whole grains, low-fat dairy products, and to balance food intake with the requirements.

  16. Dealing with the difficult utility

    International Nuclear Information System (INIS)

    Keats, D.E.; Sundquist, M.J.; Cross, J.P.

    1991-01-01

    STS HydroPower, Ltd. (STS) is an independent hydroelectric power developer involved in the full scope of hydroelectric activities. This includes the permitting, design, financing, turbine design and manufacturing, site construction and operation of small to mid-sized hydroelectric sites across the United States. At the present time, STS owns and operates nine sites in four states with a combined capacity of 20 megawatts. In dealing with the implementation of these sites, STS has dealt with five different utilities. In addition, in pursuing additional development opportunities throughout the United States, STS has had contact with numerous other utilities. During this time it would be fair to conclude that each of these utilities has exhibited its own personality with respect to dealing with independent developers. To the credit of the utility industry, the majority of these utilities have been helpful and supportive of independent projects, but a small number of utilities have approached projects from an initial and continuing adversarial position. The purpose of this paper is to examine those options and procedures available to the developer when a utility is encountered with a negative predisposition

  17. Neighborhood Poverty and Maternal Fears of Children's Outdoor Play

    Science.gov (United States)

    Kimbro, Rachel Tolbert; Schachter, Ariela

    2011-01-01

    Investigating children's outdoor play unites scholarship on neighborhoods, parental perceptions of safety, and children's health. Utilizing the Fragile Families and Child Well-being Study (N = 3,448), we examine mothers' fear of their 5-year-old children playing outdoors, testing associations with neighborhood social characteristics, city-level…

  18. A Study on Gross Motor Skills of Preschool Children

    Science.gov (United States)

    Wang, Joanne Hui-Tzu

    2004-01-01

    The purpose of this study was to investigate the effects of a creative movement program on gross motor skills of preschool children. Sixty children between the ages of 3 to 5 were drawn from the population of a preschool in Taichung, Taiwan. An experimental pretest-posttest control-group design was utilized. The children enrolled in the…

  19. A utility perspective on BRC

    International Nuclear Information System (INIS)

    Farrell, B.

    1988-01-01

    The author is program manager for low-level radioactive waste (LLW) for the Utility Nuclear Waste Management Group (UNWMG), an activity funded by 45 utilities with nuclear power programs. The UNWMG represents the utility industry on high-level and low-level radioactive waste issues in legislative, regulatory, and technical proceedings, and therefore has a strong interest in the progress of below-regulatory-concern (BRC) regulations. The author addresses waste disposal volumes prior to discussing recent developments and status of BRC regulations

  20. Children's Health

    Science.gov (United States)

    Your child's health includes physical, mental and social well-being. Most parents know the basics of keeping children healthy, like offering ... for children to get regular checkups with their health care provider. These visits are a chance to ...

  1. Epilepsy - children

    Science.gov (United States)

    ... the one before it. Some children have a strange sensation before a seizure. Sensations may be tingling, ... Prognosis) Most children with epilepsy live a normal life. Certain types of childhood epilepsy go away or ...

  2. Medicare Utilization for Part B

    Data.gov (United States)

    U.S. Department of Health & Human Services — This link takes you to the Medicare utilization statistics for Part B (Supplementary Medical Insurance SMI) which includes the Medicare Part B Physician and Supplier...

  3. State Drug Utilization Data 2003

    Data.gov (United States)

    U.S. Department of Health & Human Services — Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate...

  4. Decentralized method for utility regulation

    Energy Technology Data Exchange (ETDEWEB)

    Loeb, M. (North Carolina State Univ., Raleigh); Magat, W.A.

    1979-10-01

    A new institutional arrangement for regulating utilities is suggested that minimizes the costs of natural monopolies. A mixture of regulation and franchising, the plan draws on the advantages of each and eliminates many of the problems. The proposal allows utilities to set their own price on the basis of demand and marginal-cost projections. Subsidies are provided by the regulatory agency if there is a consumer surplus. The system encourages the utility to select a competitive price and to produce only the amount of service needed. Operating efficiency is encouraged by rewarding cost reductions and discouraging cost overstatement at the rate review. The regulatory agency would not need to take action to bring price and marginal costs into equality. The franchise sale can be made by competitive bidding, in which the bidders would capitalize part or all of the subsidy or the regulatory agency could recover the subsidy in a lump-sum tax on the utility.

  5. State Drug Utilization Data 2011

    Data.gov (United States)

    U.S. Department of Health & Human Services — Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate...

  6. Medicare Utilization for Part A

    Data.gov (United States)

    U.S. Department of Health & Human Services — This link takes you to the Medicare utilization statistics for Part A (Hospital Insurance HI) which include the Medicare Ranking for all Short-Stay Hospitals by...

  7. Build Resilience at Your Utility

    Science.gov (United States)

    CREAT allows users to evaluate potential impacts of climate change on their utility and to evaluate adaptation options to address them using both traditional risk assessment and scenario-based decision making.

  8. State Drug Utilization Data 2009

    Data.gov (United States)

    U.S. Department of Health & Human Services — Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate...

  9. State Drug Utilization Data 2016

    Data.gov (United States)

    U.S. Department of Health & Human Services — Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate...

  10. Growth of hydrocarbon utilizing microorganisms

    Digital Repository Service at National Institute of Oceanography (India)

    Bhosle, N.B.; Mavinkurve, S.

    Two isolates from marine mud having broad spectrum hydrocarbon utilizing profile were identified as Arthrobacter simplex and Candida tropicalis.Both the organisms grew exponentially on crude oil. The cell yield of the organisms was influenced...

  11. State Drug Utilization Data 2017

    Data.gov (United States)

    U.S. Department of Health & Human Services — Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate...

  12. State Drug Utilization Data 1996

    Data.gov (United States)

    U.S. Department of Health & Human Services — Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate...

  13. State Drug Utilization Data 2008

    Data.gov (United States)

    U.S. Department of Health & Human Services — Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate...

  14. State Drug Utilization Data 1992

    Data.gov (United States)

    U.S. Department of Health & Human Services — Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate...

  15. State Drug Utilization Data 1995

    Data.gov (United States)

    U.S. Department of Health & Human Services — Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate...

  16. State Drug Utilization Data 1998

    Data.gov (United States)

    U.S. Department of Health & Human Services — Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate...

  17. State Drug Utilization Data 2014

    Data.gov (United States)

    U.S. Department of Health & Human Services — Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate...

  18. State Drug Utilization Data 2005

    Data.gov (United States)

    U.S. Department of Health & Human Services — Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate...

  19. State Drug Utilization Data 2002

    Data.gov (United States)

    U.S. Department of Health & Human Services — Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate...

  20. State Drug Utilization Data 2004

    Data.gov (United States)

    U.S. Department of Health & Human Services — Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate...

  1. State Drug Utilization Data 1993

    Data.gov (United States)

    U.S. Department of Health & Human Services — Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate...

  2. State Drug Utilization Data 2006

    Data.gov (United States)

    U.S. Department of Health & Human Services — Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate...

  3. State Drug Utilization Data 2012

    Data.gov (United States)

    U.S. Department of Health & Human Services — Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate...

  4. State Drug Utilization Data 1999

    Data.gov (United States)

    U.S. Department of Health & Human Services — Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate...

  5. State Drug Utilization Data 2015

    Data.gov (United States)

    U.S. Department of Health & Human Services — Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate...

  6. State Drug Utilization Data 1997

    Data.gov (United States)

    U.S. Department of Health & Human Services — Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate...

  7. State Drug Utilization Data 1991

    Data.gov (United States)

    U.S. Department of Health & Human Services — Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate...

  8. State Drug Utilization Data 2001

    Data.gov (United States)

    U.S. Department of Health & Human Services — Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate...

  9. State Drug Utilization Data 2007

    Data.gov (United States)

    U.S. Department of Health & Human Services — Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate...

  10. State Drug Utilization Data 2013

    Data.gov (United States)

    U.S. Department of Health & Human Services — Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate...

  11. HUG - the Hydrogen Utility Group

    International Nuclear Information System (INIS)

    Tinkler, M.

    2006-01-01

    The Hydrogen Utility Group (HUG) was formally established in October 2005 by a group of leading electric utilities with a common interest in sharing hydrogen experiences and lessons learned. HUG's Mission Statement is: 'To accelerate utility integration of promising hydrogen energy related business applications through the coordinated efforts and actions of its members in collaboration with key stakeholders, including government agencies and utility support organizations.' In February 2006, HUG members presented a briefing to the US Senate Hydrogen and Fuel Cell Caucus in Washington, DC, outlining the significant role that the power industry should play in an emerging hydrogen economy. This presentation provides an overview of that briefing, summarizing the HUG's ongoing interests and activities

  12. State Drug Utilization Data 1994

    Data.gov (United States)

    U.S. Department of Health & Human Services — Drug utilization data are reported by states for covered outpatient drugs that are paid for by state Medicaid agencies since the start of the Medicaid Drug Rebate...

  13. Critical paths to coal utilization

    Energy Technology Data Exchange (ETDEWEB)

    Hill, G R

    1977-01-01

    The present dilemma of energy producers, converters, and policy decision makers is presented. The consequences of environmental control regulations, coupled with the need for conservation and energy, and of energy resources on the increased utilization of coal, are discussed. Several recent technical accomplishments that make possible increased utilization of coal for power generation are described. Groundwork is laid for discussion of the technical development that must occur if the United States is to retain its energy viability.

  14. The 1990 utility tax conference

    International Nuclear Information System (INIS)

    Norris, J.E.

    1990-01-01

    This article reports on the Sixth Annual Utility Tax Conference held in Washington, D.C. in October. Topics of the conference concerned tax issues associated with depreciable assets, employee benefits plans, valuation on utility property, pollution control, and restructuring and reorganization. Also discussed briefly were the tax changes being considered at that time as part of the negotiation of the details of the Omnibus Budget Reconciliation Act

  15. Strategies for the plutonium utilization

    International Nuclear Information System (INIS)

    Zouain, D.M.; Lima, J.O.V.; Sakamoto, L.H.

    1981-11-01

    A review of the activities involving plutonium (its recycle, utilization and technological status and perspectives) is done. These informations are useful for an economic viability study for the plutonium utilization in thermal reactors (recycling) and in fast breeders reactor (FBR), trying to collect the major number of informations about these subjects. The initial phase describes the present status and projections of plutonium accumulation and requirements. Then, the technological process are described and some strategies are analyzed. (E.G.) [pt

  16. Utility requirements for fusion power

    International Nuclear Information System (INIS)

    DeBellis, R.J.

    1977-03-01

    A four-man month study was undertaken to identify utility requirements of fusion power and define a role for the utilities in the fusion development process during the 1980s. This report, preliminary in nature, serves mainly as a planning document for future requirements analyses. A requirements organization was defined to consist of three major chronological phases: research and development, plant installation, and plant operation. Thirty-seven requirements were identified, covering all categories. In addition, training, environment, safety, licensing, and utility model were identified as five matrix-type requirements. As the requirement definition process continued during the study period, comments received from utility representatives revealed a consistency of key issues in the fusion development process. These issues form the basis for the eventual establishment of definitive roles for the utilities during the 1980s. The issues are not meant to reflect a negative view of fusion, but are items that must be solved before fusion can be introduced commercially as an electrical power source. As a result of this requirements study, preliminary candidate roles for the utilities in the fusion development process during the 1980s were identified as public education, commercialization studies, industry investment analyses, training plan implementation, alternate reactor concept development, ERDA concept design review, and requirements refinement

  17. Utility requirements for fusion power

    International Nuclear Information System (INIS)

    DeBellis, R.J.

    1977-03-01

    A four-man-month study, jointly funded by EPRI and McDonnell Douglas Astronautics Company-EAST, was undertaken to identify the utility requirements of fusion power and define a role for the utilities in the fusion development process during the 1980's. This report, preliminary in nature, serves mainly as a planning document for future requirements analyses. A requirements organization was defined to consist of three major chronological phases: research and development, plant installation, and plant operation. Thirty-seven requirements were identified, covering all categories. In addition, training, environment, safety, licensing, and utility model were identified as five matrix-type requirements. As the requirement definition process continued during the study period, comments received from utility representatives revealed a consistency of key issues in the fusion development process. These issues form the basis for the eventual establishment of definitive roles for the utilities during the 1980's. The issues are not meant to reflect a negative view of fusion, but are items which must be solved before fusion can be introduced commercially as an electrical power source. As a result of this requirements study, preliminary candidate roles for the utilities in the fusion development process during the 1980's were identified as public education, commercialization studies, industry investment analyses, training plan implementation, alternate reactor concept development, ERDA concept design review, and requirements refinement

  18. Uso de medicamentos em crianças de zero a seis anos matriculadas em creches de Tubarão, Santa Catarina Drug utilization among children aged zero to six enrolled in day care centers of Tubarão, Santa Catarina, Brazil

    Directory of Open Access Journals (Sweden)

    Diélly Cunha de Carvalho

    2008-09-01

    Full Text Available OBJETIVO: Identificar o padrão de utilização de medicamentos, nos últimos seis meses, em crianças entre zero e seis anos, em quatro creches de Tubarão, Santa Catarina, no ano de 2007. MÉTODOS: Estudo transversal realizado por meio de questionário semi-estruturado, aplicado aos pais ou responsáveis pelas 413 crianças incluídas na pesquisa, após consentimento informado. Foram coletados dados sobre utilização de medicamentos e informações de saúde. A análise estatística foi feita com auxílio do programa Statistical Package for the Social Sciences 15.0. RESULTADOS: A média de idade das crianças foi 3,7±1,3 anos, sendo 195 (47% meninas e 218 (53% meninos. Dentre os adultos que responderam ao questionário, 75% eram mães e 43% tinham oito anos de estudo. Diante de situação de doença, 47% forneciam os medicamentos que tinham em casa. Das crianças pesquisadas, 82 (20% apresentavam doença crônica e 75 (18% portavam doença aguda no momento da pesquisa. Houve histórico de reações adversas aos medicamentos em 82 (20% crianças, sendo a mais freqüente a alergia. A classe de medicamentos mais utilizada foi a dos analgésicos e antitérmicos (45% e o motivo de uso principal foi febre (32%. Nos últimos seis meses, haviam sido utilizados 763 medicamentos, com média de 1,8 medicamentos por criança, sendo 41% com prescrição médica e 59% por automedicação. CONCLUSÕES: A prática freqüente de automedicação em crianças é um fenômeno potencialmente nocivo à saúde. Esse estudo mostrou que a maioria dos pais ou responsáveis segue essa prática, podendo mascarar doenças graves, gerar quadros de reações adversas e desenvolver resistência bacteriana, além de outras complicações.OBJECTIVE: Identify the pattern of drug utilization in a six-month period among children aged zero to six years old, in Tubarão, Santa Catarina, Brazil, during 2007. METHODS: This cross-sectional study was carried out using a semi

  19. O estado de nutrição de crianças internadas por tôdas as causas em hospital assistencial do município de S. Paulo The nutritional status in children interned irrespective of diagnosis in an assistencial Hospital in the city of S. Paulo - Brazil

    Directory of Open Access Journals (Sweden)

    Ondina Rosenburg

    1971-06-01

    Full Text Available Um estudo sôbre o estado de nutrição de 2.007 crianças entre 0 e 24 meses de idade, internadas num Hospital Assistencial do Município de São Paulo, revela que o percentual total de desnutridos corresponde a cêrca de 3/4 da população observada. O percentual total de distróficos foi menor em 1963 do que em 1961, mas em 1969 ultrapassou o de 1963. O maior percentual de desnutridos em grau mais avançado (D³, que se encontrava, em 1961 e 1963, no primeiro semestre do segundo ano de vida, deslocou-se em 1969, para o segundo semestre do primeiro ano de vida.The nutritional status of 2.007 children, between zero to 24 months, admitted to an Assistential Hospital of S. Paulo City irrespective of diagnosis, was studied. The total percentage of distrophics in all grades reached almost 3/4 of the supervisioned children. The percentual decrease of undernourished children observed in 1963 did not persist in 1969. The greatest percentage of children in D3 which in 1961 and 1963 was found in the first semester of the 2nd year of life, displaced itself in 1969 to the 2nd semester of the first year of life.

  20. Urinary tract infection - children

    Science.gov (United States)

    UTI - children; Cystitis - children; Bladder infection - children; Kidney infection - children; Pyelonephritis - children ... Craig JC. Long-term antibiotics for preventing recurrent urinary tract infection in children. Cochrane Database Syst Rev . 2011;(3):CD001534. PMID: ...

  1. Gastroesophageal reflux disease - children

    Science.gov (United States)

    Peptic esophagitis - children; Reflux esophagitis - children; GERD - children; Heartburn - chronic - children; Dyspepsia - GERD - children ... GERD. Certain factors can lead to GERD in children, including: Birth defects, such as hiatal hernia , a ...

  2. Inter-utility trade review

    International Nuclear Information System (INIS)

    Warnes, E.M.; Vaahedi, E.

    1991-01-01

    The National Energy Board was requested by the Minister of Energy, Mines and Resources to identify possible measures to improve cooperation among Canadian electrical utilities and to enhance access for buyers and sellers of electricity to available transmission capacity through intervening systems for wheeling purposes. To identify measures to improve cooperation, a questionnaire was sent to electric utilities and other interested parties on the present extent and future possibilities for inter-utility cooperation. The questionnaire and its results are presented. It was found that there already exists a significant amount of inter-utility cooperation in Canada. Such cooperation generally involves interchanges of economy energy, non-economic capacity and energy, coordinated operation, resource sharing, maintenance scheduling, emergency supports, etc. There is a very limited degree of integrated generation expansion planning. Typically, these agreements are carried out under interconnection agreements negotiated on a bi-lateral basis. The highest current degree of cooperation exists under the auspices of the Alberta interconnected power system pool. Wheeling is limited and generally restricted to cases where the sender and receiver are the same entity or where power is wheeled to a utility purchasing it from the wheeler's system. 2 figs., 3 tabs

  3. Life-Cycle Consumption and Children

    DEFF Research Database (Denmark)

    Jørgensen, Thomas Høgholm

    2017-01-01

    I estimate by maximum likelihood a dynamic model of optimal intertemporal allocation of consumption in the presence of children using high-quality Danish longitudinal data. The number and age of all children can affect the marginal utility of consumption while income uncertainty, credit constraints...... and postretirement motives also influence household behaviour. While I estimate that children have a surprisingly small effect on the marginal utility of non-durable consumption, data simulated from the estimated model replicates similar correlations between log consumption growth and changing household composition...... as found in the Danish data and typically found in UK and US data. To reconcile the results with existing studies, I illustrate how ignoring precautionary motives increases the estimated importance of children. The results indicate that precautionary motives might play a larger role than children...

  4. Thinness among preschool children residing in rural area: A cross-sectional study

    Directory of Open Access Journals (Sweden)

    Rakesh K Nayak

    2015-01-01

    Full Text Available Introduction: The legacy of malnutrition especially among preschool children is a huge obstacle to overall national development. India is home to more than one-third of the world′s under-nourished children. While there is global acceptance that body mass index (BMI should be used for assessment of obesity/adiposity in children, there has not been a similar consensus regarding use of BMI for assessment of under-nutrition in children. Materials and Methods: The present study was a community-based cross-sectional study carried out in a primary health center between January and December 2011. Study population comprised of 697 children aged between 2 and 5 years. Weight (kg and height (cm measurements were taken on each subject, and BMI was computed. Nutritional status was evaluated using the Cole′s age- and sex-specific cut-off points of BMI. One-way ANOVA (F-test was performed to test for age differences in means of weight, height, and BMI using SPSS statistical package. Results: A total of 339 boys and 358 females were studied. Result showed that age-combined prevalence of under-nutrition (Grades I, II, and III combined among boys and girls was 63.4% and 58.6% respectively with an overall prevalence of 61.7%. There were significant mean differences between ages among boys in weight (F = 4.160; P < 0.001 and height (F = 6.502; P < 0.001. However, no significant mean differences between ages for BMI (F = 1.098; P = 0.295. Similar findings were seen among girls where in significant differences were observed in weight (F = 3.125, P < 0.001 and height (F = 6.895; P < 0.001 but not with BMI (F = 1.091; P = 0.311. Conclusion: Our study provided evidence that these children were under acute and chronic nutritional stress in the form of thinness.

  5. Utilization trend of wood species utilized in furniture industry in ...

    African Journals Online (AJOL)

    The utilization trend of four commonly used wood species and two lesser used wood species that are used for furniture making was examined. The wood species are Mansonia altissima (Mansonia), Khaya ivorensis (Khaya), Cordia millenii (Cordia) and Tectona grandis (Teak) as commonly used wood species; Aningeria ...

  6. The NRC and utility finances

    International Nuclear Information System (INIS)

    Byus, L.C.

    1992-01-01

    In a speech before the National Association of Regulatory Utility Commissioners in November 1991, Nuclear Regulatory Commission Chairman Ivan Selin presented what he called an open-quotes expansion of the concept of safety beyond our previous narrow bounds.close quotes He went on to explain, open-quotes To be seen as successful and safe operators of nuclear facilities, utilities must have safe and predictable cash flows.close quotes While there is little disagreement that the concepts of successful plant operations and financial strength go hand in hand, the relationship between the two is not clear. Which came first, successful operation of generating plants or financial strength? Selin's views on NRC involvement in financial aspects of utility operation in the United States are sure to stimulate debate on the issue

  7. The European Utility Requirement Document

    International Nuclear Information System (INIS)

    Roche, I.I.

    1999-01-01

    The major European electricity producers work on a common requirement document for future LWR plants since 1992. They aim at requirements acceptable together by the owners, the public and the authorities. Thus the designers can develop standard LWR designs acceptable everywhere in Europe and the utilities can open their consultations to vendors on common bases. Such a standardisation promotes an improvement of generation costs and of safety : public and authorities acceptance should be improved as well ; significant savings are expected in development and construction costs. Since the early stages of the project, the EUR group has grown significantly. It now includes utilities from nine European countries. Utilities from two other European countries are joining the group. Specific cooperation agreements are also in progress with a few extra-European partners

  8. Calculating utility prudency issue costs

    International Nuclear Information System (INIS)

    Nielsen, K.R.

    1985-01-01

    The nuclear industry, particularly utilities and their construction, engineering and vendor agents, is faced with a surging increase in prudency management audits. What started as primarily a nuclear project-oriented requirement has spread to encompass most significant utility capital construction projects. Such audits are often a precedent condition to commencement of rate hearings. The cost engineer, a primary major capital construction project participant, is required to develop or critique ''prudency issue'' costs as part of such audits. Although utility costs in the broadest sense are potentially at issue, this paper concentrates on the typical project/construction management costs. The costs of design, procurement and construction are all subject to the calculation process

  9. Utility applications and broadband networks

    Energy Technology Data Exchange (ETDEWEB)

    Chebra, R.; Taylor, P.

    2003-02-01

    A detailed analytical model of a cable network that would be capable of providing utilities with such services as automatic meter reading, on-line ability to remotely connect and disconnect commodity service, outage notification, tamper detection, direct utility-initiated load control, indirect user prescribed load control, and user access to energy consumption information, is described. The paper provides an overview of of the zones of focus that must be addressed -- market assessment, competitive analysis, product identification, economic model development, assessment of skill set requirements, performance monitoring and tracking, and various technical issues -- to identify any gaps in the organisation's ability to fully develop such a plan. Developers of the model field tested it in 1995 using some benchmarks that were available at that time, and found that the benefit afforded by direct labor saving was not sufficient to cover the capital expenditure of the advanced utility gateway connected to the cable network. However, since 1995 the unanticipated shift in the derived consumer value from a host of cable-based communications services has rendered these original projections irrelevant. Since national communications organizations concentrate on 'tier one' or at best 'tier two' cities (roughly corresponding to the NFL franchise cities and baseball farm team cities), the uncovered rural and suburban areas of the country create a significant digital divide within the population. The developers of the model contend that these unserviced areas provide utilities, especially municipal utilities, with an excellent opportunity to step into the gap and provide a full range of services that includes water, electricity and communications. The proposed model provides the foundation for utilities upon which to base their ultimate implementation decisions.

  10. 24 CFR 5.632 - Utility reimbursements.

    Science.gov (United States)

    2010-04-01

    ... Section 8 Project-Based Assistance Family Payment § 5.632 Utility reimbursements. (a) Applicability. This... the utility supplier to pay the utility bill on behalf of the family. If the PHA elects to pay the utility supplier, the PHA must notify the family of the amount paid to the utility supplier. (3) In the...

  11. 'Utility marketing' as an oxymoron

    International Nuclear Information System (INIS)

    Gedge, P.

    1996-01-01

    Electricity industry restructuring through the elimination of monopolies and the introduction of competition was examined. A distinction was made between marketing a product and brand marketing, emphasizing the customer loyalty, customer confidence and high profitability associated with brand names. The meaning of 'brand' in general and particularly in relation to electric power was explained. The old and the new utilities world were contrasted, and the place and importance of marketing in the deregulated, customer choice-based, market-driven new utilities world was described

  12. Environmental issues: I - Energy utilization

    International Nuclear Information System (INIS)

    Dincer, I.

    2001-01-01

    In this article, energy utilization and its major environmental impacts are discussed from the standpoint of sustainable development, including anticipated patterns of future energy use and consequent environmental issues and policies. Overall, the paper also examines several issues related to energy utilization, environment, sustainable development from both current and future perspectives, and energy use and its environmental impacts in the transportation sector. Finally, the conclusions and recommendations are presented in the form to be beneficial to energy scientists, engineers and energy policy makers. (author)

  13. Electric energy utilization and conservation

    International Nuclear Information System (INIS)

    Tripathy, S.C.

    1991-01-01

    Various aspects of electric energy utilization and conservation are discussed. First chapter reviews thermodynamic aspects of energy conservation. Subsequent chapters describe possibilities and methods of energy conservation in thermal power plants, airconditioning and ventilation systems, electric lighting systems, electric heating systems in industries, and railway electrification. Chapter 8 describes various modes of energy storage and compares their economies. The next chapter discusses various facets of energy economics and the last chapter discusses the practical aspects of energy conservation in different industries and power utilities. (M.G.B.). 100 refs

  14. E-Commerce for utilities

    Energy Technology Data Exchange (ETDEWEB)

    Malicky, M. [Metzler and Associates, Deerfield, IL (United States)

    1999-07-01

    The use of E-Commerce by energy utility and service companies was discussed. E-Commerce was described as being all communication via the web including Internet, Intranet and Extranet. E-Commerce communication includes the exchange of information, data, money services, products, ideas, conversations, knowledge, inventory and events. E-Commerce can be applied to electric and gas utilities to enhance energy marketing, delivery, retail energy, energy services, retail services and customer satisfaction. This means of communication is quickly becoming an essential part of customer care strategy. It reduces costs and improves performance. It was forecasted that E-Commerce will more than double from 1998 to 2001. 15 refs.

  15. `Utility marketing` as an oxymoron

    Energy Technology Data Exchange (ETDEWEB)

    Gedge, P. [TransAlta Utilities Corp., Calgary, AB (Canada)

    1996-12-31

    Electricity industry restructuring through the elimination of monopolies and the introduction of competition was examined. A distinction was made between marketing a product and brand marketing, emphasizing the customer loyalty, customer confidence and high profitability associated with brand names. The meaning of `brand` in general and particularly in relation to electric power was explained. The old and the new utilities world were contrasted, and the place and importance of marketing in the deregulated, customer choice-based, market-driven new utilities world was described.

  16. Bereaved children.

    OpenAIRE

    Schultz, K.

    1999-01-01

    OBJECTIVE: To describe the unique aspects of childhood grief. To provide a framework for family physicians to use in assisting children to grieve. QUALITY OF EVIDENCE: A MEDLINE search from 1966 to 1999 using the key words children, childhood, grief, mourning, and bereavement revealed mainly expert opinion articles, some non-randomized observational studies, and retrospective case-control studies. MAIN MESSAGE: Although children are influenced by similar factors and need to work through the s...

  17. Thorium utilization in power reactors

    International Nuclear Information System (INIS)

    Saraceno; Marcos.

    1978-10-01

    In this work the recent (prior to Aug, 1976) literature on thorium utilization is reviewed briefly and the available information is updated. After reviewing the nuclear properties relevant to the thorium fuel cycle we describe briefly the reactor systems that have been proposed using thorium as a fertile material. (author) [es

  18. Breaking into the utility market

    International Nuclear Information System (INIS)

    Argue, D.; Rubinoff, M.

    1992-01-01

    The wind energy industry in Canada must displace competition from government protected conventional energy industries if it is to gain a market position. This hypothesis is discussed for the case of Ontario, where the provincial utility has historically focused on nuclear, large hydro, and coal-fired sources. It is alleged that the utility has consistently underestimated costs for conventional energy sources and overestimated those for renewable sources such as wind power. Research by a coalition of environmental groups is cited to show that avoided generation costs in Ontario range from 8 cents/kWh for off-peak periods to a high of 12 cents/kWh during peak periods. At these values, even the utility's high cost estimates of $1,890-$2,600/kW for wind turbines and wind farms indicates cost effectiveness. Estimates of the added costs of conventional energy developments (the costs of environmental impacts not taken into account in conventional utility accounting) range from 1.1 cents/kWh for gas combined cycle cogeneration to 4.4 cents/kWh for existing coal-fired plants. By taking this kind of information to public hearings on energy developments, the wind energy industry can help establish new standards for evaluating conventional energy technology

  19. Natural gas for utility generation

    International Nuclear Information System (INIS)

    Moore, T.

    1992-01-01

    Forecasters predict that natural gas will be the dominant fuel choice for utility capacity additions in the coming decade and that power generation will be by far the largest growth market for gas sales. While gas's low emissions, high efficiency potential, and present low cost argue persuasively for a surge in gas-fired generation, many utilities have been slow to commit to a gas future, citing reasoned concern about long-term price trends and the ability of gas suppliers to deliver the fuel where and when it will be needed. Meanwhile, the relatively low cost of gas-fired units is providing an opportunity for independent power producers to compete strongly with utilities for generation contracts. EPRI studies suggest that a sound, competitive strategy will be based not on how much gas a utility burns, but rather on how this capacity fits into its overall generating mix at various fuel price levels. Gas suppliers will need to pay special attention to the operating needs of power generators if they are to solidify this important market

  20. Utilities practices toward sustainable development

    International Nuclear Information System (INIS)

    2008-01-01

    The strategy toward a Sustainable Development is not standardised and it is useful to compare approaches of companies. WG C3.03 analysed a number of Sustainability Reports or Environmental Reports, published by Utilities, exposing their current approaches to the three 'Pillars': environmental aspects, society development and economical performances. Case studies, relevant to the three 'Pillars', show examples of practices

  1. Utility of spoken dialog systems

    CSIR Research Space (South Africa)

    Barnard, E

    2008-12-01

    Full Text Available the evolution of poken dialog system research in the developed world, and show that the utility of speech is based on user factors and application factors (among others). After adjusting the factors for the developing world context, and plotting...

  2. Utility impact on STARFIRE design

    International Nuclear Information System (INIS)

    DeFreece, D.A.; Waganer, L.M.; Woklenhauer, W.C.

    1981-01-01

    A primary objective of STARFIRE has been to design a tokamak fusion power plant that was attractive to the utilities. To achieve this goal, several utility representatives were directly involved in the decision-making processes as the design evolved. An initial step was to establish the relative importance to the utilities for an extensive list of economic, performance, safety and environmental issues. The top twenty issues were ranked. Cost of electricity was clearly most important with very little spread in the ratings of individual evaluators. Licensing is a go/no-go factor and must be accomplished for the other factors to have meaning. The top nine factors were judged to be very important by all evaluators, as was shown by the spread of ratings from 5 to 10. There is considerably more spread in the bottom eleven, which reflects a lack of consensus as to the relative importance of the evaluation factors. This evaluation was utilized in establishing the initial design concept

  3. Solar energy storage and utilization

    Science.gov (United States)

    Yuan, S. W.; Bloom, A. M.

    1976-01-01

    A method of storing solar energy in the ground for heating residential buildings is described. The method would utilize heat exchanger pipes with a circulating fluid to transfer the energy beneath the surface as well as to extract the stored energy.

  4. Wind energy utilization: A bibliography

    Science.gov (United States)

    1975-01-01

    Bibliography cites documents published to and including 1974 with abstracts and references, and is indexed by topic, author, organization, title, and keywords. Topics include: Wind Energy Potential and Economic Feasibility, Utilization, Wind Power Plants and Generators, Wind Machines, Wind Data and Properties, Energy Storage, and related topics.

  5. Utilizing Twitter for Concept Learning

    Science.gov (United States)

    Buzzelli, Armand; Holdan, E. Gregory; Rota, Daniel; McCarthy, John

    2016-01-01

    Despite the perception that face-to-face classrooms provide speaking opportunities, studies by Fassinger (1995), Nunn (1996), and Weimer (2013) have conveyed that there is limited interaction in a traditional college lecture setting. Social media networks such as Twitter provide an opportunity for instructors to utilize popular mobile technology…

  6. Expected utility with lower probabilities

    DEFF Research Database (Denmark)

    Hendon, Ebbe; Jacobsen, Hans Jørgen; Sloth, Birgitte

    1994-01-01

    An uncertain and not just risky situation may be modeled using so-called belief functions assigning lower probabilities to subsets of outcomes. In this article we extend the von Neumann-Morgenstern expected utility theory from probability measures to belief functions. We use this theory...

  7. Utilization technology on slurried ash

    Energy Technology Data Exchange (ETDEWEB)

    Kanbe, Yoshio; Yasuda, Minoru; Furuki, Yasuhiko [The Coal Mining Research Centre, Japan, Tokyo, Japan; Electric Power Development Co., Ltd., Tokyo (Japan))

    1987-08-01

    Three research results of the utilization technology on slurried ash were reported. As for the utilization as the fly ash quick setting (FQS) backfill grout for tail void in shield works of tunneling, grout blending was simplified, the blended solution of cement, clay, additives and water was stabilized, and a favorable workability and long term durability were obtained. As for the utilization as the material of a SMW (soil mixing wall) method for continuous walls in long shaft digging, a fly ash-gypsum-cement (FGC) stabilizer showed an excellent workability and remarkably high water-tightness as compared with conventional cement bentonite. As for the utilization as the material of an injection method of overlay mats in foundation works of light weight structures on the sea bed mud foundation, since a FGC concrete weight in water was remarkably light as 0.7t/m{sup 3}, no both large mold form strength and vibration compacting were required. 10 figs., 8 tabs.

  8. Production and utilization of radioisotopes

    International Nuclear Information System (INIS)

    Sekine, Toshiaki; Matsuoka, Hiromitsu

    1999-01-01

    A plan of developing radioisotopes with a high power proton accelerator of the Neutron Science Project is presented. The status of production and utilization of radioisotopes in Japan is briefly discussed. The radioisotopes to be produced for biomedical use are discussed together with the facility for production of those radioisotopes and for research with the products. (author)

  9. Waste heat utilization in agriculture

    International Nuclear Information System (INIS)

    Horacek, P.

    1983-01-01

    The Proceedings contain 17 papers presented at meetings of the Working Group for Waste Heat Utilization of the Committee of the European Society of Nuclear Methods in Agriculture of which 7 fall under the INIS scope. The working group met in May 1980 in Brno, Czechoslovakia, in October 1981 in Aberdeen, Scotland and in September 1982 in Brno. (Z.M.)

  10. Utilization and management of alder.

    Science.gov (United States)

    David G. Briggs; Dean S. DeBell; William A. Atkinson

    1978-01-01

    In the Pacific Northwest and British Columbia, red alder often grows on forest lands following natural or man-caused disturbances. Frequently ignored as a pest or weed, many alder stands have developed to the point where important utilization and management questions are being asked. It is recognized that alder is a fast growing species, and that its rapid early growth...

  11. TWRS LDUA utilization study report

    International Nuclear Information System (INIS)

    Rieck, R.H.

    1994-01-01

    Tank Waste Remediation Systems functional requirements were reviewed. The Light Duty Utility Arm capabilities were considered as a means to support completion of these functional requirements. The recommendation is made to continue to develop the LDUA, integrating TWRS functional needs into the design to better support completion of TWRS mission needs

  12. Utility Energy Services Contracts: Enabling Documents

    Energy Technology Data Exchange (ETDEWEB)

    None

    2009-05-01

    Utility Energy Services Contracts: Enabling Documents provides materials that clarify the authority for Federal agencies to enter into utility energy services contracts (UESCs), as well as sample documents and resources to ease utility partnership contracting.

  13. The evolution of utility functions and psychological altruism.

    Science.gov (United States)

    Clavien, Christine; Chapuisat, Michel

    2016-04-01

    Numerous studies show that humans tend to be more cooperative than expected given the assumption that they are rational maximizers of personal gain. As a result, theoreticians have proposed elaborated formal representations of human decision-making, in which utility functions including "altruistic" or "moral" preferences replace the purely self-oriented "Homo economicus" function. Here we review mathematical approaches that provide insights into the mathematical stability of alternative utility functions. Candidate utility functions may be evaluated with help of game theory, classical modeling of social evolution that focuses on behavioral strategies, and modeling of social evolution that focuses directly on utility functions. We present the advantages of the latter form of investigation and discuss one surprisingly precise result: "Homo economicus" as well as "altruistic" utility functions are less stable than a function containing a preference for the common welfare that is only expressed in social contexts composed of individuals with similar preferences. We discuss the contribution of mathematical models to our understanding of human other-oriented behavior, with a focus on the classical debate over psychological altruism. We conclude that human can be psychologically altruistic, but that psychological altruism evolved because it was generally expressed towards individuals that contributed to the actor's fitness, such as own children, romantic partners and long term reciprocators. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. [The utility of the interrupter technique in pediatric asthma].

    Science.gov (United States)

    Iimura, Akiko; Yoshihara, Shigemi; Arisaka, Osamu

    2002-11-01

    Interrupter respiratory resistance (Rint) is a new lung function test for measuring airway resistance. We investigated the utility of the Rint lung function test in pediatric patients with asthma. Thirty seven asthmatic patients with mild or moderate asthma attack (asthma group) and 9 healthy children (control group) were enrolled in the study, and the utility of the Ring test was compared with that of the PEF lung function test. Rint and PEF were measured after the inhalation of saline or beta(2) stimulant, and the values for the asthma and control groups were compared. The rint and PEF values did not change after the inhalation of saline, but both values improved after the inhalation of beta(2) stimulant in the asthma group. In the control group, the PEF and Rint values measured after saline or beta(2) stimulant were not significantly different. Rint measurements may be more useful than PEF tests for evaluating therapeutic responses to mild asthma attacks in children. These findings suggest that Rint is a useful respiratory function test for evaluating children with asthma.

  15. Health Care Utilization and Costs Associated with Pediatric Chronic Pain.

    Science.gov (United States)

    Tumin, Dmitry; Drees, David; Miller, Rebecca; Wrona, Sharon; Hayes, Don; Tobias, Joseph D; Bhalla, Tarun

    2018-03-30

    The population prevalence of pediatric chronic pain is not well characterized, in part due to lack of nationally representative data. Previous research suggests that pediatric chronic pain prolongs inpatient stay and increases costs, but the population-level association between pediatric chronic pain and health care utilization is unclear. We use the 2016 National Survey of Children's Health to describe the prevalence of pediatric chronic pain, and compare health care utilization among children ages 0-17 years according to the presence of chronic pain. Using a sample of 43,712 children, we estimate the population prevalence of chronic pain to be 6%. On multivariable analysis, chronic pain was not associated with increased odds of primary care or mental health care use, but was associated with greater odds of using other specialty care (OR=2.01, 95% CI: 1.62, 2.47; pcomplementary and alternative medicine (OR=2.32, 95% CI: 1.79, 3.03; pchronic pain were more likely to use specialty care but not mental health care. The higher likelihood of emergency care use in this group raises the question of whether better management of pediatric chronic pain could reduce emergency department use. Copyright © 2018. Published by Elsevier Inc.

  16. Power Sales to Electric Utilities

    Energy Technology Data Exchange (ETDEWEB)

    None

    1989-02-01

    The Public Utilities Regulatory Policies Act (PURPA) of 1979 requires that electrical utilities interconnect with qualifying facilities and purchase electricity at a rate based upon their full avoided costs (i.e., costs of providing both capacity and energy). Qualifying facilities (QF) include solar or geothermal electric units, hydropower, municipal solid waste or biomass-fired power plants, and cogeneration projects that satisfy maximum size, fuel use, ownership, location, and/or efficiency criteria. In Washington State, neither standard power purchase prices based upon a proxy ''avoided plant'', standard contracts, or a standard offer process have been used. Instead, a variety of power purchase contracts have been negotiated by developers of qualifying facilities with investor-owned utilities, public utility districts, and municipally-owned and operated utilities. With a hydro-based system, benefits associated with resource acquisition are determined in large part by how compatible the resource is with a utility's existing generation mix. Power purchase rates are negotiated and vary according to firm energy production, guarantees, ability to schedule maintenance or downtime, rights of refusal, power plant purchase options, project start date and length of contract; front-loading or levelization provisions; and the ability of the project to provide ''demonstrated'' capacity. Legislation was also enacted which allows PURPA to work effectively. Initial laws established ownership rights and provided irrigation districts, PUDs, and municipalities with expanded enabling powers. Financial processes were streamlined and, in some cases, simplified. Finally, laws were passed which are designed to ensure that development proceeds in an environmentally acceptable manner. In retrospect, PURPA has worked well within Washington. In the state of Washington, 20 small-scale hydroelectric projects with a combined generating capacity of

  17. The Diagnostic Utility of the Child Sexual Behavior Inventory for Sexual Abuse: A Systematic Review.

    Science.gov (United States)

    Vrolijk-Bosschaart, Thekla F; Verlinden, Eva; Langendam, Miranda W; De Smet, Vivienne; Teeuw, Arianne H; Brilleslijper-Kater, Sonja N; Benninga, Marc A; Lindauer, Ramón J L

    2018-06-11

    Children with alleged child sexual abuse (CSA) need to be assessed systematically. The use of validated instruments during the assessment, like the Child Sexual Behavior Inventory (CSBI), could add diagnostic value. We aim to assess the diagnostic utility of the CSBI to differentiate between sexually abused and non-abused children. We conducted a systematic review. We searched the electronic databases MEDLINE and PsychInfo for studies comparing CSBI scores in sexually abused children and non-abused children (2-12 years old). Two independent reviewers extracted data and assessed the methodological quality. We included 7 (out of 1048) articles. The CSBI total scores were significantly higher in CSA-victims compared with non-abused children (in case-control settings). However, in children with suspected CSA, the results were ambiguous. One study reported significant differences. Another study reported weak diagnostic ability for the CSBI-3 in children with suspected CSA (a sensitivity and specificity of 0.50, with a positive predictive value of 0.28, and a negative predictive value of 0.72). Research on the diagnostic utility of the CSBI for suspected CSA is limited and shows disappointing results. Until more research is done, the CSBI should not be used on its own to differentiate between sexually abused and non-abused children.

  18. Comparative study of paediatric prescription drug utilization between the spanish and immigrant population

    Science.gov (United States)

    2009-01-01

    Background The immigrant population has increased greatly in Spain in recent years to the point where immigrants made up 12% of the infant population in 2008. There is little information available on the profile of this group with regard to prescription drug utilization in universal public health care systems such as that operating in Spain. This work studies the overall and specific differences in prescription drug utilization between the immigrant and Spanish population. Methods Use was made of the Aragonese Health Service databases for 2006. The studied population comprises 159,908 children aged 0-14 years, 13.6% of whom are foreign nationals. Different utilization variables were calculated for each group. Prescription-drug consumption is measured in Defined Daily Doses (DDD) and DDD/1000 persons/day/(DID). Results A total of 833,223 prescriptions were studied. Utilization is lower for immigrant children than in Spanish children for both DID (66.27 v. 113.67) and average annual expense (€21.55 v. €41.14). Immigrant children consume fewer prescription drugs than Spanish children in all of the therapy groups, with the most prescribed (in DID) being: respiratory system, anti-infectives for systemic use, nervous system, sensory organs. Significant differences were observed in relation to the type of drugs and the geographical background of immigrants. Conclusion Prescription drug utilization is much greater in Spanish children than in immigrant children, particularly with reference to bronchodilators (montelukast and terbutaline) and attention-disorder hyperactivity drugs such as methylphenidate. There are important differences regarding drug type and depending on immigrants' geographical backgrounds that suggest there are social, cultural and access factors underlying these disparities. PMID:19995453

  19. Comparative study of paediatric prescription drug utilization between the spanish and immigrant population

    Directory of Open Access Journals (Sweden)

    Macipe-Costa Rosa

    2009-12-01

    Full Text Available Abstract Background The immigrant population has increased greatly in Spain in recent years to the point where immigrants made up 12% of the infant population in 2008. There is little information available on the profile of this group with regard to prescription drug utilization in universal public health care systems such as that operating in Spain. This work studies the overall and specific differences in prescription drug utilization between the immigrant and Spanish population. Methods Use was made of the Aragonese Health Service databases for 2006. The studied population comprises 159,908 children aged 0-14 years, 13.6% of whom are foreign nationals. Different utilization variables were calculated for each group. Prescription-drug consumption is measured in Defined Daily Doses (DDD and DDD/1000 persons/day/(DID. Results A total of 833,223 prescriptions were studied. Utilization is lower for immigrant children than in Spanish children for both DID (66.27 v. 113.67 and average annual expense (€21.55 v. €41.14. Immigrant children consume fewer prescription drugs than Spanish children in all of the therapy groups, with the most prescribed (in DID being: respiratory system, anti-infectives for systemic use, nervous system, sensory organs. Significant differences were observed in relation to the type of drugs and the geographical background of immigrants. Conclusion Prescription drug utilization is much greater in Spanish children than in immigrant children, particularly with reference to bronchodilators (montelukast and terbutaline and attention-disorder hyperactivity drugs such as methylphenidate. There are important differences regarding drug type and depending on immigrants' geographical backgrounds that suggest there are social, cultural and access factors underlying these disparities.

  20. Children neglected: Where cumulative risk theory fails.

    Science.gov (United States)

    O'Hara, Mandy; Legano, Lori; Homel, Peter; Walker-Descartes, Ingrid; Rojas, Mary; Laraque, Danielle

    2015-07-01

    Neglected children, by far the majority of children maltreated, experience an environment most deficient in cognitive stimulation and language exchange. When physical abuse co-occurs with neglect, there is more stimulation through negative parent-child interaction, which may lead to better cognitive outcomes, contrary to Cumulative Risk Theory. The purpose of the current study was to assess whether children only neglected perform worse on cognitive tasks than children neglected and physically abused. Utilizing LONGSCAN archived data, 271 children only neglected and 101 children neglected and physically abused in the first four years of life were compared. The two groups were assessed at age 6 on the WPPSI-R vocabulary and block design subtests, correlates of cognitive intelligence. Regression analyses were performed, controlling for additional predictors of poor cognitive outcome, including socioeconomic variables and caregiver depression. Children only neglected scored significantly worse than children neglected and abused on the WPPSI-R vocabulary subtest (p=0.03). The groups did not differ on the block design subtest (p=0.4). This study shows that for neglected children, additional abuse may not additively accumulate risk when considering intelligence outcomes. Children experiencing only neglect may need to be referred for services that address cognitive development, with emphasis on the linguistic environment, in order to best support the developmental challenges of neglected children. Copyright © 2015 Elsevier Ltd. All rights reserved.