Childrens Clinic

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Childrens Clinic

United States
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Lachance L.,University of Michigan | Benedict M.B.,MediCaid | Doctor L.J.,Wk Kellogg Foundation | Gilmore L.A.,FHI 360 | And 11 more authors.
Journal of Asthma | Year: 2014

Objective: To examine the impact of Allies Against Asthma, community-based coalitions working to improve asthma outcomes, on vulnerable children: those with the most urgent health care use and those of youngest age. Methods: Allies zip codes were matched with comparison communities on demographic factors. Five years of Medicaid data (n=26,836) for significant health care events: hospitalizations, ED and urgent care facility visits, were analyzed. Longitudinal analyses using generalized estimating equations and proportional hazards models compared Allies and comparison group children. Results: In the two start-up years of Allies, odds of having a significant event were greater for Allies children than for comparison children (p<0.05). During the third and fourth years when Allies activities were fully implemented, for frequent health care users at baseline, odds of an asthma event were the same for both Allies and comparison children, yet in the less frequent users, odds of an event were lower in Allies children (p<0.0001). In the initial year of Allies efforts, among the youngest, the Allies children had greater odds than comparison children of an event (p<0.01), but by the fourth year the Allies group had lower odds (p=0.02) of an event. Hazard ratios over all years of the study for the youngest Allies children and most frequent baseline users of urgent care were lower than for comparison children (p=0.01 and p=0.0004). Conclusion: Mobilizing a coalition of diverse stakeholders focused on policy and system change generated community-wide reductions over the long-term in health care use for vulnerable children. © 2014 Informa Healthcare USA, Inc.


Tatishvili N.,Iashvili Childrens Central Hospital | Gabunia M.,Aversi Clinic | Laliani N.,Childrens Clinic
European Journal of Paediatric Neurology | Year: 2010

Three hundred-forty-eight out of a regional population of 1272 newborn infants were randomly chosen and followed neurologically until age of two years to study the epidemiology of neurodevelopmental disorders, and to reveal the main factors influencing outcome. The most frequent neonatal pathologies were low Apgar scores - 45 (3.5%), neonatal sepsis - 28 (2.2%), neonatal seizures - 26 (2.0%), neonatal sepsis complicated with bacterial meningitis - 13 (1.0%), traumatic injury of peripheral nerves - 7 (0.6%), intracranial hemorrhages - 4 (0.3%) and CNS malformations - 3 (0.2%). At the age of 24 months abnormal development was identified in 29 cases (8.5%) of children, comprising global developmental delay in five (1.5%), unclassified motor problems (hypotonia without ataxia) in four (1.2%), cerebral palsy in three (0.9%), behavioral/sleep disorders in 12 (3.5%) and epilepsy in five (1.5%). The most significant single risk factors for abnormal neurodevelopmental outcome were maternal age, chorioamnionitis, gestational age <37 weeks, pathological delivery, and a low (<5) Apgar score at 5 min after birth. Coexistence of several risk factors increased the probability of an adverse outcome. © 2009 European Paediatric Neurology Society.


PubMed | Federal University of Campina Grande, Childrens Hospital Albert Sabin, Childrens Hospital Juvencio Mattos, Federal University of São Carlos and 5 more.
Type: Journal Article | Journal: European journal of medical research | Year: 2016

Pycnodysostosis is an autosomal recessive skeletal dysplasia, the prevalence of which is estimated to be low (1 per million). Nevertheless, in recent years we have found 27 affected individuals from 22 families in Cear State, a region of the Brazilian Northeast, giving a local prevalence of 3 per million. This local prevalence associated with a high parental consanguinity, suggesting a possible founder effect, prompted us to perform a molecular investigation of these families to test this hypothesis.The CTSK gene was sequenced by the Sanger method in the patients and their parents. In addition to 18 families from Cear, this study also included 15 families from other Brazilian regions. We also investigated the origin of each family from the birthplace of the parents and/or grandparents.We have studied 39 patients, including 33 probands and 6 sibs, from 33 families with pycnodysostosis and identified six mutations, five previously described (c.436G>C, c.580G>A, c.721C>T, c.830C>T and c.953G>A) and one novel frameshift (c.83dupT). This frameshift variant seems to have a single origin in Cear State, since the haplotype study using the polymorphic markers D1S2344, D1S442, D1S498 and D1S2715 suggested a common origin. Most of the mutations were found in homozygosity in the patients from Cear (83.3%) while in other states the mutations were found in homozygosity in half of patients. We have also shown that most of the families currently living outside of Cear have northeastern ancestors, suggesting a dispersion of these mutations from the Brazilian Northeast.The high frequency of pycnodysostosis in Cear State is the consequence of the high inbreeding in that region. Several mutations, probably introduced a long time ago in Cear, must have spread due to consanguineous marriages and internal population migration. However, the novel mutation seems to have a single origin in Cear, suggestive of a founder effect.


Clark N.M.,University of Michigan | Lachance L.L.,University of Michigan | Benedict M.B.,MediCaid | Doctor L.J.,W K Kellogg Foundation | And 12 more authors.
American Journal of Public Health | Year: 2013

Objectives. We assessed changes in asthma-related health care use by lowincome children in communities across the country where 6 Allies Against Asthma coalitions (Hampton Roads, VA; Washington, DC; Milwaukee, WI; King County/Seattle, WA; Long Beach, CA; and Philadelphia, PA) mobilized stakeholders to bring about policy changes conducive to asthma control. Methods. Allies intervention zip codes were matched with comparison communities by median household income, asthma prevalence, total population size, and race/ethnicity. Five years of data provided by the Center for Medicare and Medicaid Services on hospitalizations, emergency department (ED) use, and physician urgent care visits for children were analyzed. Intervention and comparison sites were compared with a stratified recurrent event analysis using a Cox proportional hazard model. Results. In most of the assessment years, children in Allies communities were significantly less likely (P < .04) to have an asthma-related hospitalization, ED visit, or urgent care visit than children in comparison communities. During the entire period, children in Allies communities were significantly less likely (P < .02) to have such health care use. Conclusions. Mobilizing a diverse group of stakeholders, and focusing on policy and system changes generated significant reductions in health care use for asthma in vulnerable communities.


Birkebaek N.H.,Aarhus University Hospital | Wolthers O.D.,Childrens Clinic | Heuch C.,Aarhus University Hospital | Balslev T.,Viborg Regional Hospital | And 2 more authors.
Journal of Pediatric Endocrinology and Metabolism | Year: 2011

Objective: To report on the effect of growth hormone (GH) treatment on final height (FH) and to describe the insulin-like growth factor (IGF) system, ghrelin, and adiponectin (ADPN) in children with Seckel syndrome. Subjects and results: Four severely growth-retarded Iraqi siblings (two girls and two boys) with Seckel syndrome were referred at ages 16.5, 14.4, 12.4, and 10.4 years. They were born at term, but their growth was retarded and birth weight ranged between 1 and 1.5 kg. The children were healthy and had a normal response to GH provocative test. Long-term GH treatment of the youngest brother and sister increased the FH by 7.2 and 3.4 cm, respectively, compared with their older brother and sister. At FH, body mass index standard deviation scores (BMISDS) ranged from-3.0 to-3.9. Serum levels of immunoreactive IGF-1, bioactive IGF-1, and IGF-binding protein 3 were all within normal to high range before GH treatment and increased after GH treatment. Fasting plasma ghrelin remained severely reduced. Despite low BMISDS, plasma ADPN was moderately reduced and showed an almost complete absence of the low-molecular-weight subform. Conclusion: This is the first report on the effect of GH treatment on FH in children with Seckel syndrome. GH may have increased FH. In addition to growth defects and reduced BMISDS, patients with Seckel syndrome are characterized by low fasting ghrelin levels, low total ADPN, and near deficiency of the low-molecular-weight ADPN subform. The possible significance of the hormonal changes requires further investigations. © 2011 by Walter de Gruyter Berlin Boston.


Vals M.-A.,University of Tartu | Kahre T.,University of Tartu | Mee P.,University of Tartu | Muru K.,University of Tartu | And 4 more authors.
Molecular Syndromology | Year: 2015

Silver-Russell syndrome (SRS) and Beckwith-Wiedemann syndrome (BWS) are 2 opposite growth-Affecting disorders. The common molecular cause for both syndromes is an abnormal regulation of genes in chromosomal region 11p15, where 2 imprinting control regions (ICR) control fetal and postnatal growth. Also, many submicroscopic chromosomal disturbances like duplications in 11p15 have been described among SRS and BWS patients. Duplications involving both ICRs cause SRS or BWS, depending on which parent the aberration is inherited from. We describe to our knowledge the smallest familial pure 1.3-Mb duplication in chromosomal region 11p15.5p15.4 that involves both ICRs and is present in 3 generations causing an SRS or BWS phenotype. © 2015 S. Karger AG, Basel.


Arnold R.W.,Alaska Blind Child Discovery | Arnold A.W.,Alaska Blind Child Discovery | Armitage M.D.,Alaska Blind Child Discovery | Shen J.M.,Childrens Clinic | And 2 more authors.
Binocular Vision and Strabology Quarterly | Year: 2013

Background: New photoscreening models promise to detect amblyopia risk factors early in hopes of reducing permanent pediatric monocular and binocular vision impairment. The 3 commercially available interpreted photoscreeners had not yet been compared. Methods: This is a prospective, observational screening study following AAPOS guidelines on pediatric patients with and without developmental delays. 270 patients in a pediatric eye practice aged 4.7 +/- 4 years with 7% special needs. From December 2011 through March 2012, the Plusoptix, the iScreen, and the Pediavision SPOT were applied before confirmatory exam in a clinical pediatric eye practice. Results: The inconclusive rate ranged from 1-4% (iScreen) to 12% (Plusoptix). Sensitivity ranged from 72% (iScreen) to 84% (Plusoptix) and specificity ranged from 68% (SPOT) to 94% (Plusoptix). The iScreen can provide results in 99% of high risk patients.. Conclusions: In this cohort with high pre-screening prevalence, the 2011 photoscreeners had favorable validation that is expected to improve with further clinical study. Pediatricians have practical technology with a recognized procedure code to assist in amblyopia reduction. © A Medical Scientific ePeriodical.


Wald E.R.,University of Wisconsin - Madison | Jagodzinski T.D.,Childrens Clinic | Moyer S.C.L.,University of Wisconsin - Madison | Wald A.,University of Wisconsin - Madison | And 2 more authors.
Journal of Pediatric Gastroenterology and Nutrition | Year: 2011

OBJECTIVES: 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. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. Copyright © 2011 by ESPGHAN and NASPGHAN.

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