Inequitable health service use in a Canadian paediatric population: A cross-sectional study of individual- and contextual-level factors.

BACKGROUND: Health service use may be influenced by multilevel predisposing, enabling, and need factors but is equitable when driven by need. The study's objectives were as follows: (a) to investigate residential context's effect on child health service use and (b) to examine inequity of child health service use by testing for effect measure modification of need factors. METHODS: The sample of 1,451 children was from a prenatal cohort recruited from London, Ontario, between 2002 and 2004, with follow-up until children were toddler/preschooler-aged. Individual-level data were linked by residential address to neighbourhood contextual-level data sourced from Statistics Canada. Multilevel logistic regression modelled factors associated with child health service use. Interaction terms were included in the model to test for effect measure modification of need factors by predisposing and enabling factors. RESULTS: Contextual-level factors were not associated with child health service use. Maternal parity and nativity to Canada modified the effect of the need factor, paediatric health condition, on health service use. Health condition's effect was lowest in children of Canadian-born mothers with one child only (OR = 1.58, p = .04) and highest in children of Canadian-born mothers with three or more children (OR = 3.52, p < .01). Further, its effect was higher in children of Canadian-born mothers compared to children of mothers who migrated to Canada; however, odds ratios were not statistically significant for the latter. CONCLUSIONS: Results may inform future investigation of the potential inequity of health service use for subgroups of children whose mothers are of lower parity and not Canadian-born. An understanding of these inequities may inform future healthcare policy and care for paediatric populations.

Manifestações clínicas, desfechos e fatores prognósticos da influenza pandêmica A (H1N1) de 2009 em crianças / Clinical manifestations, outcomes and prognostic factors of the 2009 pandemic influenza A (H1N1) in children / Manifestaciones clínicas, desenlaces y factores pronósticos de la influenza pandémica A (H1N1) 2009 en niños

OBJETIVO: Descrever as características clínicas e a letalidade, além de analisar os fatores prognósticos da infecção pela influenza pandêmica A (H1N1), em crianças do estado do Paraná. MÉTODOS: Estudo observacional e retrospectivo. Os dados foram coletados a partir do Sistema Nacional de Agravos de Notificação (Sinan), do Ministério da Saúde, entre março e dezembro de 2010. Foram incluídas as crianças com idade entre zero e 12 anos, com confirmação laboratorial da infecção. As variáveis referentes às características demográficas e clínicas e aos desfechos foram avaliadas estatisticamente a fim de comparar as taxas de letalidade na presença e na ausência desses fatores. Os fatores prognósticos foram identificados por regressão logística. Consideraram-se como significativos os valores de p<0,05. RESULTADOS: Foram incluídas 1.307 crianças, das quais 19 foram a óbito. Os fatores de risco para o óbito foram cardiopatias (OR 7,1; IC95% 1,5 - 32,7), imunodepressão (OR 14,9; IC95% 3,9 - 56,2), dispneia (OR 9,5; IC95% 2,8 - 32,9), pneumonia (OR 23,8; IC95% 2,4 - 239,8), presença de sibilos (OR 11,9; IC95% 1,4 - 103,7) e tempo para o início do tratamento a partir do início dos sintomas (OR 1,3; IC95% 1,2 - 1,5). O tratamento precoce com o antiviral oseltamivir foi um fator de proteção ao óbito (OR 0,012; IC95% 0,003 - 0,05). CONCLUSÕES: Os fatores de risco subjacentes apresentaram papel fundamental na determinação dos desfechos. O diagnóstico e o tratamento precoce foram importantes para a diminuição dos óbitos pela influenza A (H1N1) 2009 em crianças.

OBJECTIVE: To analyze the pandemic influenza A (H1N1) 2009 in children of the state of Paraná, Southern Brazil, in order to identify clinical features, lethality, and prognostic factors for the infection. METHODS: This was a retrospective observational study. Data were collected from the National Notifiable Disease System (Sinan) from the Brazilian Ministry of Health, from March to December, 2010. Children aged between zero and 12 years-old, with laboratorial confirmation of the infection, were included. Variables related to demographic and clinical characteristics and outcomes were evaluated statistically in order to compare the lethality rates in the presence and absence of these factors. The prognostic factors were identified by logistic regression, being significant p<0.05. RESULTS: 1,307 children were included and 19 of them died. Risk factors for death were heart diseases (OR 7.1; 95%CI 1.5 - 32.7), immunosuppression (OR 14.9; 95%CI 3.9 - 56.2), dyspnea (OR 9.5; 95%CI 2.8 - 32.9), pneumonia (OR 23.8; 95%CI 2.4 - 239.8), presence of wheezing (OR 11,9; 95%CI 1.4 - 103.7), and time to start treatment since the onset of symptoms (OR 1.3; 95%CI 1.2 - 1.5). Early treatment with the antiviral drug oseltamivir was a protective factor for death (OR 0.012; 95%CI 0.003 - 0.05). CONCLUSIONS: Underlying risk factors had a major role in determining outcomes. Early diagnosis and treatment were important for the reduction of deaths from influenza A (H1N1) 2009 in children.

OBJETIVO: Describir las características clínicas y la letalidad, además de analizar los factores pronósticos de la infección por la influenza pandémica A (H1N1) en niños de la provincia de Paraná (Brasil). MÉTODOS: Se trató de un estudio observacional y retrospectivo. Los datos fueron recogidos a partir del Sistema Nacional de Agravos de Notificação (Sinan), del Ministerio de Salud, entre marzo y diciembre de 2010. Se incluyeron a los niños con edad entre cero y 12 años, con confirmación laboratorial de la infección. Las variables referentes a las características demográficas y clínicas y a los desenlaces fueron evaluadas estadísticamente, a fin de comparar las tasas de letalidad en la presencia y ausencia de esos factores. Los factores pronósticos fueron identificados por regresión logística. Se consideraron como significativos los valores de p<0,05. RESULTADOS: Se incluyeron a 1.307 niños, de los que 19 fallecieron. Los factores de riesgo para óbito fueron cardiopatías (OR 7,1; IC95% 1,5-32,7), inmunodepresión (OR 14,9; IC95% 3,9-56,2), disnea (OR 9,5; IC95% 2,8-32,9), neumonía (OR 23,8; IC95% 2,4-239,8), presencia de silbidos (OR 11,9; IC95% 1,4-103,7) y tiempo para el inicio del tratamiento a partir del inicio de los síntomas (OR 1,3; IC95% 1,2-1,5). El tratamiento temprano con el antiviral oseltamavir fue un factor de protección al óbito (OR 0,012; IC95% 0,003-0,05). CONCLUSIONES: La tasa de letalidad observada en niños fue menor que la encontrada en el grupo que contrajo la enfermedad. Los factores de riesgo subyacentes presentaron un rol fundamental en la determinación de los desenlaces. El diagnóstico y el tratamiento tempranos fueron importantes para la reducción de los óbitos por influenza A (H1N1) 2009 en niños.

Remifentanil in the horse: identification and detection of its major urinary metabolite.

Remifentanil (4-methoxycarbonyl-4-[(1-oxopropyl)phenylamino]-1-piperidinepropionic acid methyl ester) is a mu-opioid receptor agonist with considerable abuse potential in racing horses. The identification of its major equine urinary metabolite, 4-methoxycarbonyl-4-[(1-oxopropyl)phenylamino]-1-piperidinepropionic+ ++ acid, an ester hydrolysis product of remifentanil is reported. Administration of remifentanil HCl (5 mg, intravenous) produced clear-cut locomotor responses, establishing the clinical efficacy of this dose. ELISA analysis of postadministration urine samples readily detected fentanyl equivalents in these samples. Mass spectrometric analysis, using solid-phase extraction and trimethylsilyl (TMS) derivatization, showed the urine samples contained parent remifentanil in low concentrations, peaking at 1 h. More significantly, a major peak was identified as representing 4-methoxycarbonyl-4-[(1-oxopropyl)phenylamino]-1-piperidinepropionic+ ++ acid, arising from ester hydrolysis of remifentanil. This metabolite reached its maximal urinary concentrations at 1 h and was present at up to 10-fold greater concentrations than parent remifentanil. Base hydrolysis of remifentanil yielded a carboxylic acid with the same mass spectral characteristics as those of the equine metabolite. In summary, these data indicate that remifentanil administration results in the appearance of readily detectable amounts of 4-methoxycarbonyl-4-[(1-oxopropyl)phenylamino]-1-piperidinepropionic+ ++ acid in urine. On this basis, screening and confirmation tests for this equine urinary metabolite should be optimized for forensic control of remifentanil.

Eight novel mutations and consequences on mRNA and protein level in pyruvate kinase-deficient patients with nonspherocytic hemolytic anemia.

Pyruvate kinase (PK) deficiency (PKD) is an autosomal recessive disorder with the typical manifestation of nonspherocytic hemolytic anemia. We analyzed the mutant enzymes of 10 unrelated patients with PKD, whose symptoms ranged from a mild, chronic hemolytic anemia to a severe anemia, by sequence analysis for the presence of alterations in the PKLR gene. In all cases the patients were shown to be compound heterozygous. Eight novel mutations were identified: 458T-->C (Ile153Thr), 656T-->C (Ile219Thr), 877G-->A (Asp293Asn), 991G-->A (Asp331Asn), 1055C-->A (Ala352Asp), 1483G-->A (Ala495Thr), 1649A-->T (Asp550Val), and 183-184ins16bp. This 16 bp duplication produces a frameshift and subsequent stop codon resulting in a drastically reduced mRNA level, and probably in an unstable gene product. Surprisingly, the existence of M2-type PK could be demonstrated in the patient's red blood cells. The study of different polymorphic sites revealed, with one exception, a strict linkage of the 1705C, 1738T, IVS5(+51)T, T(10) polymorphisms and the presence of 14 ATT repeats in intron 11. Our analyses show the consequences of a distorted structure on enzyme function and we discuss the correlations between the mutations identified and the parameters indicative for enzyme function.

Childhood obesity.

Childhood obesity has become one of the more alarming nutritional problems plaguing the American population, with estimates as high as 25% of all children being obese. Aside from obesity's associated risks, there are psychosocial and emotional burdens carried by obese children as well. Clinicians are encountering many of these children in their clinics everyday for other reasons and yet are failing to address the issue of obesity. The problem is not so much that physicians are not recognizing it, but rather that they are ignoring it, especially if the parent or child is unaware that there is a problem. Unfortunately, much controversy exists regarding the treatment of childhood obesity. This article attempts to sort through the myriad issues surrounding childhood obesity and to dispel some of the rumors and myths surrounding this subject.

Correlation between sex hormones and magnetic resonance imaging lesions in multiple sclerosis.

OBJECTIVE: To determine if sex hormones play a role in the pathogenesis of multiple sclerosis (MS) by correlating serum estradiol and progesterone levels with gadolinium (Gd) enhancing lesions on magnetic resonance imaging (MRI) in MS. METHODS: Thirty patients with MS were studied with Gd enhanced brain MRI and simultaneous serum estradiol and progesterone levels either during the early follicular, late follicular or luteal phases of their menstrual cycle. Correlation between hormone levels and number of Gd enhancing lesions was determined. RESULTS: Patients with high estradiol and low progesterone levels had a significantly greater number of Gd enhancing lesions than those with low levels of both these hormones. Patients with a high estrogen to progesterone ratio had a significantly greater number of active MRI lesions than those with a low ratio. CONCLUSION: Estradiol and progesterone may influence disease activity in MS. If further studies confirm these results, it may be possible to develop therapy by altering levels of these hormones.

Serum sAPO-1/Fas levels in multiple sclerosis.

UNLABELLED: Soluble APO-1 (sAPO-1) may prevent apoptosis of lymphocytes induced by activation of the APO-1/Fas receptor. OBJECTIVES: To determine sAPO-1 levels in the serum of multiple sclerosis (MS) patients and controls in order to investigate if abnormal lymphocyte apoptosis occurs in this disease. METHODS: Serum samples from patients with MS, other neurological diseases, systemic lupus erythematosus and healthy controls were determined by enzyme-linked immunosorbent assay. RESULTS: We did not detect differences in mean serum sAPO-1 levels between patients with multiple sclerosis and controls. CONCLUSIONS: This preliminary study suggests that resistance of peripheral blood lymphocytes to apoptosis mediated by sAPO-1 is not likely to be a major factor in the development of autoreactive cells in MS.

The culturally diverse student: a model for empowerment.

The student who is at a disadvantage due to race, educational background, or cultural background is often unsuccessful in higher education. Specific programs designed to assist the culturally diverse student can make a significant difference in the successful completion of a program of nursing and passing of the National Council Licensure Examination (NCLEX). The authors discuss a model that assists culturally diverse students' success in a program of nursing.

Production and properties of xylanases from thermophilic actinomycetes.

30 strains of xylanolytic thermophilic actinomycetes were isolated from composted grass and cattle manure and identified as members of the genera Thermomonospora, Saccharomonospora, Microbispora, Streptomyces and Actinomadura. Screening of these strains for extracellular xylanase indicated that strains of Saccharomonospora and Microbispora generally were poor xylanase producers (0.5-1.5 U/ml) whereas relatively high activities were observed in cultures of Streptomyces and Actinomadura (4-12 U/ml). A preliminary characterization of the enzymes of strains of the latter genera suggested that xylanases of all the strains of Actinomadura exhibited higher thermostabilities than those of Streptomyces. To evaluate the potential of thermophilic Actinomadura for industrial applications, xylanases of three strains were studied in more detail. The highest activity levels for xylanases were observed in cultures grown on xylan and wheat bran. The optimal pH and temperature for xylanase activities ranged from 6.0 to 7.0 and 70 to 80 degrees C. The enzymes exhibited considerable thermostability at their optimum temperature. The half-lives at 75 degrees C were in the range from 6.5 to 17 h. Hydrolysis of xylan by extracellular xylanases yielded xylobiose, xylose and arabinose as principal products. Estimated by the amount of reducing sugars liberated the degree of hydrolysis was 55 to 65%. Complete utilization of xylan is presumably achieved by beta-xylosidase activities which could be shown to be largely cell-associated in the 3 Actinomadura strains.