Medical Specialties Commons^™

Factors Associated With Blood Lead Levels Of Children In Southern Nevada, Mackenzie Suzanne Burns

UNLV Theses, Dissertations, Professional Papers, and Capstones

Exposure to lead continues to be a public health concern, particularly for young children. The Centers for Disease Control and Prevention report that approximately 250,000 children currently have blood lead levels (BLLs) above the level at which adverse health effects are apparent and intervention is recommended (10μg/dL). National surveillance data on childhood lead exposure has been collected for children under the age of 6 years old since 1995. However, not until 2006 did a program begin in Nevada (limited to Clark County); therefore, statewide data about childhood lead exposure in Nevada remains limited. The goal of this study was to …

Evaluating The Impact Of The Guatemalan Nursing Program On Staff, Organizational, And Clinical Outcomes, Sara Williamson Day

Theses and Dissertations (ETD)

There is great disparity between the outcome of childhood cancer in developed and developing countries. Nurses, who comprise the largest group of health care professionals globally, are essential to successful treatment. Pediatric oncology education is generally unavailable for nurses in developing countries. This lack of education is likely to contribute to the disparity in survival rates, as undereducated nurses are unable to meet the demands of pediatric cancer care. A second critical problem in developing countries is the workload of the nurse, with a patient nurse ratio reported as high as 30 patients per one nurse.

In 2006, the quality …

Effects Of Obesity On The Biomechanics Of Children’S Gait At Different Speeds, Philana-Lee Gouws

UNLV Theses, Dissertations, Professional Papers, and Capstones

The purpose of the study was to investigate the relationship between body mass index (BMI) and spatio-temporal gait characteristics of overweight/obese and non-obese school-aged children (12-14 years) at two different walking speeds. Eighty-four overweight/obese (n=28; age: 13.96 ± 0.79 yrs; mass: 74.8 ± 18.21 kg; height: 159.2 ± 7.1 cm and BMI: 29.28 ± 5.64 kg/m2) and non-obese students (n=56; age: 13.72 ± 0.79 yrs; mass: 51.7 ± 10.2 kg; height: 157.8 ± 8.3 cm and BMI: 20.69 ± 2.74 kg/m2) with no present injuries were recruited. Participants were instructed to walk across an electronic walkway in each of two …

Health Care Access Disparities Among Children Entering Kindergarten In Nevada, Nadia Deashinta

UNLV Theses, Dissertations, Professional Papers, and Capstones

Access to health care is an important factor for the well-being of America's children. The principal goal of this study was examine the 2008-2009 Kindergarten Health Survey data to advance understanding and appreciation of the health status of children in addition to their discrepancies in accessing health care in the state of Nevada (n = 11,073). This dataset serves as a secondary data source to determine whether socio-demographic and medical factors are associated with disparity in accessing health care for children entering kindergarten. This study looked at both independent and combined effects of annual household income, race/ethnicity, primary language spoken …

Teaching Paediatric Critical Care Medicine To Paediatric Residents, Anwarul Haque, Rizwan Haider, Muhammad Sohail Salat

Department of Paediatrics and Child Health

Critical care training during paediatric residency provides an ideal opportunity to learn and refine the skills needed in the early recognition and prompt treatment of the acutely ill paediatric patients. Paediatric critical care medicine is a relatively young sub-specialty in Pakistan. The aim of this study is to describe our experience of teaching paediatric residents in paediatric critical care medicine during paediatric intensive care unit rotation. Our paediatric critical care teaching curriculum for residents is based on the spectrum of our common critical care problems along with basic principal of critical care. The clinical rotation in our paediatric intensive care …

Dyssegemental Dyspalsia; Rolland-Desbuquois Type--A Case Report From Pakistan, Bushra Afroze

Department of Paediatrics and Child Health

Two different forms of dyssegmental dysplasia can be distinguished; the lethal Silverman-Handmaker type and less severe Rolland-Desbuquois type. Patients with Rolland-Desbuquois type often survive beyond neonatal period. The purpose of this paper is to report a rare case of Dyssegmental dysplasia, Rolland-Desbuquois type from Pakistan.

Improving Health Outcomes For Children (Ihoc) In Maine Logic Model For Primary Care Practice Improvement, Cutler Institute Of Health And Social Policy

Population Health & Health Policy

Improving Health Outcomes for Children (IHOC) is a 5-year demonstration grant from the Centers for Medicare & Medicaid Services, and authorized by 401 (d) of the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA).

IHOC works with doctors' offices, practices and other agencies who want to improve health care in Maine and Vermont to:

• Collect and report on the use of evidenced-based child health quality measures
• Expand the Health Information Technology to improve the flow of child health data
• Promote a collaborative child health learning environment

New Approaches To Preventing, Diagnosing, And Treating Neonatal Sepsis, Karen Edmond, Anita K. M. Zaidi

Department of Paediatrics and Child Health

No abstract provided.

E-Mail Communication In Paediatrics: Ethical And Clinical Considerations, Susan Albersheim

Paediatrics Publications

E-mail has become a commonplace ‘procedure’ in medical practice because it is efficient and inexpensive. However, there are potential misuses and abuses of this form of written communication, with clinical and ethical implications. Common uses of e-mail in paediatics include general communication with colleagues in a professional setting; electronic formal consultation, in which patient confidentiality is paramount; electronic ‘curbside’ consultation, which may be perceived as a formal consultation; electronic discussion groups, which lack peer review; communication with current patients or their parents, which should be limited to simple, nonurgent issues; and communication with individuals seeking medical advice who are not …

Nutrition And Exercise Prevent Excess Weight Gain In Overweight Pregnant Women, Michelle F. Mottola, Isabelle Giroux, Robert Gratton, Jo Anne Hammond, Anthony Hanley, Stewart Harris, Ruth Mcmanus, Margie H. Davenport, Maggie M. Sopper

Paediatrics Publications

Purpose: To determine the effect of a Nutrition and Exercise Lifestyle Intervention Program (NELIP) for overweight (OW) and obese (OB) pregnant women on pregnancy weight gain, birth weight, and maternal weight retention at 2 months postpartum. Methods: This is a single-arm intervention matched by prepregnant body mass index, age, and parity to a historical cohort (4:1). Women with a prepregnancy body mass index of>25.0 kg•m (N = 65) participated in a NELIP starting at 16-20 wk of pregnancy, continuing until delivery. NELIP consisted of an individualized nutrition plan with total energy intake of approximately 2000 kcal•d (8360 kJ•d) and …

Acute Necrotizing Encephalopathy Of Childhood: A Fatal Complication Of Swine Flu, Muhammad Rehan Khan, Prem Kumar Maheshwari, Syed Asad Ali, Anwarul Haque

Department of Paediatrics and Child Health

Acute necrotizing encephalopathy of childhood (ANEC) is a rare condition characterized by the presence of multifocal symmetrical brain lesions involving mainly thalami, brainstem, cerebellum and white matter. ANEC is a serious and life threatening complication of simple viral infections. We present a case of a young child who developed this condition with classical clinical and radiological findings consistent with ANEC, secondary to swine flu (H1N1). He needed ventilatory support and had profound motor and intellectual deficit on discharge. We report this case with aim of raising awareness about this fatal complication of swine flu which has become a global health …

Familial Hypercholesterolemia: A Decade Of Progress, Samuel S. Gidding, Md

Department of Pediatrics Faculty Papers

Natural history studies of familial hypercholesterolemia (FH), a genetic disorder associated with elevated cholesterol and premature coronary artery disease, and with a frequency of about 1:500 in the general population, were first conducted in the 1970s. 1 Homozygotes, with cholesterol levels in excess of 500 mg/dl experience coronary events as early as adolescence and heterozygotes (with one normal and one abnormal gene) are affected prematurely in middle age. The first major breakthrough in understanding the disease came with the discovery of the low density lipoprotein (LDL) receptor by Brown and Goldstein, work that won the Nobel prize.

Partial And Transitional Atrioventricular Septal Defect Outcomes., L Luann Minich, Andrew M. Atz, Steven D. Colan, Lynn A. Sleeper, Seema Mital, James Jaggers, Renee Margossian, Ashwin Prakash, Jennifer S. Li, Meryl S. Cohen, Ronald V. Lacro, Gloria L. Klein, John A. Hawkins, Pediatric Heart Network Investigators, Girish S. Shirali

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Surgical and perioperative improvements permit earlier repair of partial and transitional atrioventricular septal defects (AVSD). We sought to describe contemporary outcomes in a multicenter cohort.

METHODS: We studied 87 patients undergoing primary biventricular repair of partial or transitional AVSD between June 2004 and February 2006 across seven North American centers. One-month and 6-month postoperative data included weight-for-age z-scores, left atrioventricular valve regurgitation (LAVVR) grade, residual shunts, and left ventricular ejection fraction. Paired methods were used to assess 6-month change.

RESULTS: Median age at surgery was 1.8 years; median weight z-score was -0.88. Median days for ventilation were 1, intensive …

Efficacy And Safety Of Procedural Sedation And Analgesia By Paediatric Intensivist In Paediatric Oncology Unit, Anwarul Haque, Zahra Fadoo

Department of Paediatrics and Child Health

Children with cancer especially acute leukaemia undergo multiple painful procedures like bone marrow biopsy (BM) and lumber puncture (LP) for intrathecal chemotherapy during their first year of treatment. The purpose of this study is to report safety and efficacy of Procedural Sedation and Analgesia (PSA) by paediatric intensivist for oncology procedures in controlled setting in paediatric oncology unit. During 20 months, 124 children received PSA for 499 procedures. 324 LP alone, 175 BM alone and 40 combined LP and BM were done. The most common diagnosis was acute leukaemia and lymphoma. All procedures were in compliance with American Society of …

Clinical Profile And Treatment Of Infantile Spasms Using Vigabatrin And Acth - A Developing Country Perspective, S. H. Ibrahim, Shamshad Gulab, Sidra Ishaque, Taimur Saleem

Department of Paediatrics and Child Health

Background: Infantile spasms represent a serious epileptic syndrome that occurs in the early infantile age. ACTH and Vigabatrin are actively investigated drugs in its treatment. This study describes the comparison of their efficacy in a large series of Patients with infantile spasms from Pakistan. Methods: All Patients with infantile spasms who presented to Aga Khan University Hospital, Karachi, Pakistan from January, 2006 to April, 2008 were included in this study. Inclusion criteria were clinical symptoms of infantile spasms, hypsarrythmia or modified hyparrythmia on electroencephalography, at least six months of follow-up period and receipt of any of the two drugs mentioned …

A Comprehensive Approach To Obesity, Hypertension, And Mental Health Evaluation, Stefan G. Kiessling, Kimberly K. Mcclanahan, Hatim A. Omar

Pediatrics Faculty Publications

The global epidemic of childhood and adolescent obesity in developing and developed countries has become a major public health concern. Given the relationship between obesity and hypertension as documented in several landmark studies, it is no surprise that, as the prevalence of obesity has increased in the pediatric population, rates of hypertension have also increased substantially. Hypertension is one of the most important risk factors for cardiovascular diseases and stroke; therefore, evaluation and initiation of appropriate treatment are extremely important in the pediatric population. Evaluation for secondary causes of hypertension, including renovascular, renoparenchymal, and endocrine disease, is the approach most …

Substance Abuse Among Adolescents, Abdel Salous, Hatim A. Omar

Pediatrics Faculty Publications

This chapter aims to provide a global perspective on substance abuse among adolescents across different cultures, and to review appropriate strategies in communicating with the adolescent population about substance abuse. Drug abuse continues to be a major public health issue in the United States, especially among adolescents. The attitude toward and involvement in drug abuse among adolescents is a complex problem shaped by multiple psychosocial parameters. Psychosocial variables such as ethnicity, and religion, and group dynamics, while deeply intertwined in shaping the cultural identity of adolescents, also deliver their impact to substance abuse in this patient population. In a society …

2010 Cancer Care Annual Report, Children's Mercy Hospital

Cancer Center Annual Reports

Annual report of cancer care and oncology services at the Children's Mercy Hospital, Kansas City MO, a pediatric medical center.

2009 Cancer Care Annual Report, Children's Mercy Hospital

Cancer Center Annual Reports

Annual report of cancer care and oncology services at the Children's Mercy Hospital, Kansas City MO, a pediatric medical center. This report has a focus on acute lymphoblastic leukemia.

A Bland–Altman Comparison Of The Lead Care® System And Inductively Coupled Plasma Mass Spectrometry For Detecting Low-Level Lead In Child Whole Blood Samples, Christina Sobin, Tanner Schaub, Natali Parisi, Eva De La Riva

Selected Works Temporary Series

Chronic childhood lead exposure, yielding blood lead levels consistently below 10 μg/dL, remains a major public health concern. Low neurotoxic effect thresholds have not yet been established. Progress requires accurate, efficient, and cost-effective methods for testing large numbers of children. The LeadCare® System (LCS) may provide one ready option. The comparability of this system to the “gold standard” method of inductively coupled plasma mass spectrometry (ICP-MS) for the purpose of detecting blood lead levels below 10 μg/dL has not yet been examined. Paired blood samples from 177 children ages 5.2–12.8 years were tested with LCS and ICP-MS. Triplicate repeat tests …

A Program To Promote Physical Activity And Healthy Body Weight In An Adolescent Female: A Case Study, Katie Stoddard

Kinesiology and Public Health

A case study of an obese 14-year-old female was conducted to assess her body weight and dietary and physical activity habits. The purpose of this study was to promote weight loss through improved dietary practices and an increase in energy expenditure. This was done by monitoring and altering caloric intake and engaging in regular, vigorous physical activity. Furthermore, the subject increased health-related knowledge, developed new skills, and ultimately attempted behavior modification. From April to September 2009, the subject participated in a minimum of two supervised exercise sessions per week to increase her energy expenditure and to teach her strategies for …

Pharmacokinetics Of Cefuroxime Are Not Significantly Altered By Cardiopulmonary Bypass In Children, Chad A. Knoderer, Sarah A. Saft, Scott G. Walker, Daniel P. Healy, Kevin M. Sowinski

Scholarship and Professional Work – COPHS

Poster presented at: SPA/AAP PEDIATRIC ANESTHESIOLOGY 2010 - Winter Meeting; April 2010; San Antonio, TX.

Continuous Infusion Of Nafcillin For Sternal Osteomyelitis In An Infant After Cardiac Surgery, Chad A. Knoderer, Jennifer L. Morris, Elaine G. Cox

Scholarship and Professional Work – COPHS

We report the use of the continuous infusion of nafcillin for the treatment of an infant who had methicillinsusceptible Staphylococcus aureus sternal osteomyelitis not responsive to traditional nafcillin dosing. The patient was successfully treated with surgical debridement and the continuous infusion of nafcillin. To our knowledge, this is the first report describing the successful use of the continuous infusion of nafcillin to treat an infant who had sternal osteomyelitis after cardiac surgery.

Pulmonary Embolism Presenting With Sudden Respiratory Failure In Two Previously Stable Neonates, Joseph Werthammer, Audra Pritt, Laura Reechi, Linda Brown, Mahmood Heydarian

Pediatrics

Pulmonary artery embolism (PE) is a rare and life-threatening complication in the neonate. We describe two previously stable infants who incurred respiratory failure from PE. The first case is a late preterm infant with gastroschisis with autopsy confirmation of PE presumably as a result of a central venous line (CVL) with thromboembolism. The second case is an extreme low birth weight infant with sudden onset of respiratory failure, abnormal chest x-ray, disseminated intravascular coagulation (DIC), and echocardiographic confirmation of a thrombus at the junction of the superior vena cava and right atrium (SVC/RA) at the site of a previous CVL. …

Chronic Renal Disease Is More Prevalent In Patients With Hemolytic Uremic Syndrome Who Had A Positive History Of Diarrhea, Ajay P. Sharma, Guido Filler, Prabo Dwight, William F. Clark

Paediatrics Publications

Many uncontrolled studies and a subsequent meta-analysis suggest that hemolytic uremic syndrome (HUS) with a positive history for diarrhea is associated with a significant increase in chronic renal disease. Two recent controlled studies that followed children with this type of HUS after Escherichia coli O157:H7 outbreaks, and where the controls were selected from a group exposed in the outbreak, gave conflicting results. To clarify this apparent difference, we retrospectively compared a cohort of 30 children with sporadic diarrhea-positive HUS with 30 healthy controls who had no history of bloody diarrhea or HUS and who had similar age and gender. Significantly …

Ppar_2 Expression In Growth Plate Chondrocytes Is Regulated By P38 And Gsk-3, Lee-Anne Stanton, Jennifer Ruizhe Li, Frank Beier

Paediatrics Publications

Although peroxisome proliferator activated receptor (PPAR)_ remains a critical regulator of preadipocyte differentiation, new roles have been discovered in inflammation, bone morphogenesis, endothelial function, cancer, longevity and atherosclerosis. Despite the demonstration of PPAR expression in chondrocytes, its role and the pathways affecting its expression and activity in chondrocytes remain largely unknown. We investigated the effects of PPAR activation on chondrocyte differentiation and its participation in chondrocyte lipid metabolism. PPAR2 expression is highly regulated during chondrocyte differentiation in vivo and in vitro PPAR activation with troglitazone resulted in increased Indian hedgehog expression and reduced collagen X expression, confirming previously described roles …

Children's Mercy Hospital Annual Report 2009, Children's Mercy Hospital

Children's Mercy Annual Reports

Annual report for The Children's Mercy Hospital in Kansas City MO, a pediatric medical center.

Hyperandrogenism And Obesity, Amit M. Deokar, Shawn J. Smith, Amanda J. Goodwin, Hatim A. Omar

Pediatrics Faculty Publications

This chapter has a two-fold objective. One, ti addresses the association of hyperandrogenism and obesity and the complex metabolic derangements that are part of the problem. Clinical management of these co-morbidities is challenging and complex. Second, this chapter will aid health care providers with the key features to an early diagnosis and intervention to decrease the morbidities in the short as well as long term. Method: Systematic review of articles and information on the topic of interest that were published in the last 15 years. Conclusion: Obesity and hyperandrogenism are integral parts of Metabolic Syndrome/Polycystic Ovarian Syndrome (PCOS)/Hyperandrogenism, Insulin resistance, …

The Global Pediatrician: Is There Such A Person, Or Can There Be?, Robert Armstrong

Paediatrics and Child Health, East Africa

As pediatricians, our concern for the health of children and youth starts with our individual encounters with patients and their families and extends to the community in which they live and the broader systems of society that influence their health. This concept of a pediatrician is captured in one of the “bibles” of our profession and in the words of Richard Behrman when he defines pediatrics as being “concerned with the health of infants, children, and adolescents, their growth and development, and their opportunity to achieve full potential as adults.”¹ Health, growth and development, and opportunity as adults encompass …

Predictors Of Emotional Problems And Physical Aggression Among Children Of Hong Kong Chinese, Mainland Chinese And Filipino Immigrants To Canada, Morton Beiser, Hayley Hamilton, Joanna Anneke Rummens, Jacqueline Oxman-Martinez, Linda Ogilvie, Chuck Humphrey, Robert Armstrong

Paediatrics and Child Health, East Africa

Background and study aims: Data from the New Canadian Children and Youth Study (NCCYS), a national study of immigrant children and youth in Canada, are used to examine the mental health salience of putatively universal determinants, as well as of immigration-specific factors. Universal factors (UF) include age, gender, family and neighbourhood characteristics. Migration-specific (MS) factors include ethnic background, acculturative stress, prejudice, and the impact of region of resettlement within Canada.

Methods: In a sample of children from Hong Kong, the Philippines and Mainland China, the study examined the determinants of emotional problems (EP), and physical aggression (PA). A two-step regression …