Predictors of treatment failure for non-severe childhood pneumonia in developing countries--systematic literature review and expert survey--the first step towards a community focused mHealth risk-assessment tool?

BACKGROUND: Improved referral algorithms for children with non-severe pneumonia at the community level are desirable. We sought to identify predictors of oral antibiotic failure in children who fulfill the case definition of World Health Organization (WHO) non-severe pneumonia. Predictors of greatest interest were those not currently utilized in referral algorithms and feasible to obtain at the community level. METHODS: We systematically reviewed prospective studies reporting independent predictors of oral antibiotic failure for children 2-59 months of age in resource-limited settings with WHO non-severe pneumonia (either fast breathing for age and/or lower chest wall indrawing without danger signs), with an emphasis on predictors not currently utilized for referral and reasonable for community health workers. We searched PubMed, Cochrane, and Embase and qualitatively analyzed publications from 1997-2014. To supplement the limited published evidence in this subject area we also surveyed respiratory experts. RESULTS: Nine studies met criteria, seven of which were performed in south Asia. One eligible study occurred exclusively at the community level. Overall, oral antibiotic failure rates ranged between 7.8-22.9%. Six studies found excess age-adjusted respiratory rate (either WHO-defined very fast breathing for age or 10-15 breaths/min faster than normal WHO age-adjusted thresholds) and four reported young age as predictive for oral antibiotic failure. Of the seven predictors identified by the expert panel, abnormal oxygen saturation and malnutrition were most highly favored per the panel's rankings and comments. CONCLUSIONS: This review identified several candidate predictors of oral antibiotic failure not currently utilized in childhood pneumonia referral algorithms; excess age-specific respiratory rate, young age, abnormal oxygen saturation, and moderate malnutrition. However, the data was limited and there are clear evidence gaps; research in rural, low-resource settings with community health workers is needed.

Content, quality, and readability of website information on dental care for patients with cancer.

OBJECTIVE: This study assessed content, quality, and readability of patient-directed Internet materials about dental care support and oral toxicities/complications of cancer therapy. STUDY DESIGN: A total of 32 websites meeting inclusion criteria from a Google search using terms "cancer>dental>care" were categorized for parameters of content, benchmarks for website quality as defined by JAMA (Journal of the American Medical Association), display of the Health on the Net (HON) seal, and Flesch Reading Ease Score (FRES). RESULTS: Treatment modalities included radiation therapy, chemotherapy, stem cell transplant, and surgery. Dental care was discussed before, during, or after cancer treatment, or a combination of those. The most common oral toxicities/complications discussed were xerostomia, rampant caries, and mucositis. Only 1 site met all 4 JAMA benchmarks; 2 displayed the HON seal; only 9% were written at the 9th-grade FRES reading level; and none were written at the 6th- to 7th-grade level. CONCLUSIONS: Websites addressing dental care for patients with cancer are broad in content yet are limited in quality and are written at difficult reading levels.

Effects of exercise training amount on physical activity energy expenditure.

INTRODUCTION: We examined the effects of three exercise training interventions on total physical activity energy expenditure (PAEE) or nonexercise PAEE in a randomized controlled trial where sedentary, overweight, and obese men and women were assigned to inactive control, low-amount/moderate-intensity, low-amount/vigorous-intensity, or high-amount/vigorous-intensity aerobic exercise. METHODS: To measure PAEE, triaxial RT3 accelerometers were worn by subjects for 7 d at the beginning and end of an 8-month exercise intervention. In total, 50 subjects (control, n = 8; two low-amount groups, n = 28; high-amount group, n = 14) had usable PAEE data collected at both time points. RESULTS: At baseline, subjects had an average age of 53.2 yr, had a body mass index of 29.7 kg x m(-2), and a relative peak VO2 of 28.7 mL x kg(-1) x min(-1). There were no significant differences between groups at baseline. After the intervention, average change in total PAEE was 8.4 +/- 20.9 kJ x h(-1) for controls, 58.6 +/- 20.9 kJ x h(-1) for the two low-amount groups, and 138.1 +/- 33.5 kJ x h(-1) for the high-amount group (means +/- SE). The high-amount group experienced a significantly greater increase in total PAEE compared with the controls (P = 0.02). As expected, total PAEE increased with increasing exercise volume. Average change in nonexercise PAEE was 8.4 +/- 20.9 kJ x h(-1) for control, 25.1 +/- 20.9 kJ x h(-1) for the low-amount groups combined, and 62.8 +/- 29.3 kJ x h(-1) for the high-amount group. There was no statistically significant difference in change of nonexercise PAEE among groups. CONCLUSIONS: We conclude that in middle-aged overweight or obese subjects participating in an extended exercise intervention, total PAEE increased, and there was no compensatory decrease in nonexercise PAEE.

Articaine use in children among dental practitioners.

PURPOSE: The purpose of this study was to examine local anesthetic selection and dentists' use of articaine in children. METHODS: Using a cross-sectional survey design, a questionnaire regarding the use of local anesthetics in children was mailed to a random sample of dentists and all pediatric dentists from North Carolina and Virginia. The 16-item questionnaire included questions regarding the preferred local anesthetic used in children. The association between dental practitioner type and anesthetic use was tested using the chi-square or Fisher's exact test. RESULTS: There was a 30% response rate. Lidocaine with epinephrine was the local anesthetic preferred overall by all practitioners. Approximately 50% of dentists surveyed reported using articaine in children. There were no significant differences in the preference of articaine between provider types with the exception of older, 7- to 10-year-old patients, where general dentists preferred articaine significantly more than pediatric dentists (28% vs 16%). CONCLUSIONS: While lidocaine with epinephrine was still the preferred local anesthetic for use in children, the use of articaine in children was prevalent among both general and pediatric dentists. The use of articaine became more prevalent as the patient's age increased.