Psychoeducational characteristics of children with hypohidrotic ectodermal dysplasia.

OBJECTIVE: Hypohidrotic ectodermal dysplasia (HED) is an X-linked hereditary disorder characterized by hypohidrosis, hypotrichosis, and anomalous dentition. Estimates of up to 50% of affected children having intellectual disability are controversial. METHOD: In a cross-sectional study, 45 youth with HED (77% males, mean age 9.75 years) and 59 matched unaffected controls (70% males, mean age 9.79 years) were administered the Kaufman Brief Intelligence Test and the Kaufman Test of Educational Achievement, and their parents completed standardized neurodevelopmental and behavioral measures, educational, and health-related information regarding their child, as well as standardized and nonstandardized data regarding socioeconomic information for their family. RESULTS: There were no statistically significant differences between the two groups in intelligence quotient composite and educational achievement scores, suggesting absence of learning disability in either group. No gender differences within or between groups were found on any performance measures. Among affected youth, parental education level correlated positively with (1) cognitive vocabulary scores and cognitive composite scores; (2) educational achievement for mathematics, reading, and composite scores. CONCLUSION: Youth affected with HED and unaffected matched peers have similar profiles on standardized measures of cognition, educational achievement, and adaptive functioning although children with HED may be at increased risk for ADHD.

Distance from home to hospital and thrombolytic utilization for acute ischemic stroke.

Treatment of acute stroke with thrombolytic therapy has been limited because of the narrow treatment window. Distance from home to hospital may affect arrival time and likelihood of receiving thrombolytic therapy for acute stroke. The present study included stroke subjects seen at Barnes Jewish Hospital in 2006-2007, residing in St Louis City/County, who were at home at the time of the stroke (n = 416). A network distance was calculated by mapping the best route from each subject's home to the hospital on a street network grid. Patients were grouped by distance into quintiles, and the group living the closest (group A, first quintile) was compared with the remainder of the cohort (group B). Outcomes of interest were rate of arrival within 3 hours of stroke onset (timely arrival) and rate of thrombolytic administration. The relative rate (RR) of each outcome was calculated for group A versus group B. A multivariate model of thrombolytic administration was created correcting for potential confounders. There was no difference in timely arrival between groups. The rate of thrombolytic administration was 13/100 for group B and 23/100 for group A, for an RR 0.55 (95% confidence interval [CI], 0.31-0.097) for group B versus group A. In the multivariate model, only National Institutes of Health Stroke Scale score was a significant confounder. The adjusted RR of thrombolytic treatment was 0.59 (95% CI, 0.34-0.99) for group B versus group A. Our data indicate that patients living in close proximity to the hospital are more likely to receive thrombolytic therapy for stroke compared with those living farther away. This finding cannot be explained by earlier arrival time.

Improving the public health workforce: evaluation of a training course to enhance evidence-based decision making.

An evidence-based public health (EBPH) course was developed in 1997 by the Prevention Research Center at Saint Louis University School of Public Health to train the public health workforce to enhance dissemination of EBPH in their public health practice. An on-line evaluation of the course was conducted among participants who attended the course from 2001 to 2004 to determine the impact the course had on the implementation of EBPH within their Respective public health agencies (n = 107). The majority of these individuals were program directors, managers, or coordinators working in state health departments. Results from the evaluation Revealed that 90 percent of participants indicated that the course helped them make more informed decisions in the workplace. Respondents identified improvement in their ability to communicate with their coworkers and Read Reports. When asked to identify potential barriers, participants specified that time constraints were the biggest impediment to using EBPH skills in the workplace. These data suggest the importance of professional training opportunities in EBPH for public health practitioners. Future endeavors should focus on overcoming the barriers to the dissemination of EBPH.

Evaluation of gestational weight gain guidelines for women with normal prepregnancy body mass index.

OBJECTIVE: To investigate the relationship between gestational weight gain and adverse pregnancy outcomes among women with normal prepregnancy body mass index. METHODS: We conducted a population-based cohort study of women with normal prepregnancy body mass index who delivered full-term singletons using Missouri birth certificate data for 1999-2001. The cohort was divided into three groups (less than recommended [less than 25 lb], n=16,852; recommended [25-35 lb], n=37,292; more than recommended [more than 35 lb], n=40,552) based on Institute of Medicine gestational weight gain guidelines. Logistic regression was used to adjust for known confounders. RESULTS: Compared with women gaining 25-35 lb, women gaining less than 25 lb during pregnancy had lower odds for preeclampsia (adjusted odds ratio [aOR] 0.56, 95% confidence interval [CI] 0.49-0.64), cephalopelvic disproportion (aOR 0.64, 95% CI 0.55-0.75), failed induction (aOR 0.68, 95% CI 0.59-0.78), cesarean delivery (aOR 0.82, 95% CI 0.78-0.87), and large for gestational age infants (aOR 0.40, 95% CI 0.37-0.44) and increased odds for small for gestational age infants (aOR 2.14, 95% CI 2.01-2.27). Likewise, women gaining more than 35 lb had lower odds for small for gestational age infants (aOR 0.48, 95% CI 0.45-0.50) and increased odds for preeclampsia (aOR 1.88, 95% CI 1.74-2.04), failed induction (aOR 1.51, 95% CI 1.39-1.64), cesarean delivery (aOR 1.35, 95% CI 1.29-1.40), and large for gestational age infants (aOR 2.43, 95% CI 2.30-2.56). CONCLUSION: Our study shows that adherence to the current Institute of Medicine guidelines results in lower risks for adverse pregnancy, labor, and delivery outcomes when comparing all outcomes collectively.

Gestational weight gain and pregnancy outcomes in obese women: how much is enough?

OBJECTIVE: To examine the effect of gestational weight change on pregnancy outcomes in obese women. METHODS: A population-based cohort study of 120,251 pregnant, obese women delivering full-term, liveborn, singleton infants was examined to assess the risk of four pregnancy outcomes (preeclampsia, cesarean delivery, small for gestational age births, and large for gestational age births) by obesity class and total gestational weight gain. RESULTS: Gestational weight gain incidence for overweight or obese pregnant women, less than the currently recommended 15 lb, was associated with a significantly lower risk of preeclampsia, cesarean delivery, and large for gestational age birth and higher risk of small for gestational age birth. These results were similar for each National Institutes of Health obesity class (30-34.9, 35-35.9, and 40.0 kg/m(2)), but at different amounts of gestational weight gain. CONCLUSION: Limited or no weight gain in obese pregnant women has favorable pregnancy outcomes.

Training practitioners in evidence-based chronic disease prevention for global health.

Too often, public health decisions are based on short-term demands rather than long-term research and objectives. Policies and programmes are sometimes developed around anecdotal evidence. The Evidence-Based Public Health (EBPH) programme trains public health practitioners to use a comprehensive, scientific approach when developing and evaluating chronic disease programmes. Begun in 2002, the EBPH programme is an international collaboration. The course is organized in seven parts to teach skills in: 1) assessing a community's needs; 2) quantifying the issue; 3) developing a concise statement of the issue; 4) determining what is known about the issue by reviewing the scientific literature; 5) developing and prioritizing programme and policy options; 6) developing an action plan and implementing interventions; and 7) evaluating the programme or policy. The course takes an applied approach and emphasizes information that is readily available to busy practitioners, relying on experiential learning and includes lectures, practice exercises, and case studies. It focuses n using evidence-based tools and encourages participants to add to the evidence base in areas where intervention knowledge is sparse. Through this training programme, we educated practitioners from 38 countries in 4 continents. This article describes the evolution of the parent course and describes experiences implementing the course in the Russian Federation, Lithuania, and Chile. Lessons learned from replication of the course include the need to build a "critical mass" of public health officials trained in EBPH within each country and the importance of international, collaborative networks. Scientific and technologic advances provide unprecedented opportunities for public health professionals to enhance the practice of EBPH. To take full advantage of new technology and tools and to combat new health challenges, public health practitioners must continually improve their skills.

Correlates of physical activity among pregnant women in the United States.

INTRODUCTION: Physical activity recommendations for pregnant and nonpregnant women have been issued, but little data exist to compare the extent that these women are meeting the recommendation levels. METHODS: A population-based, cross-sectional study using data from the 1994, 1996, 1998, and 2000 Behavioral Risk Factor Surveillance System evaluated the physical activity recommendations met by pregnant and nonpregnant women. The study population included women who were 18-44 yr of age. Random digit dialing, telephone surveys were used to assess all information. Pregnant and nonpregnant women were categorized into five mutually exclusive groups based upon their level of physical activity in the past month: vigorous activity (meeting guidelines) moderate activity (meeting guidelines), moderate or vigorous activity (not meeting guidelines), irregular activity, or no physical activity. RESULTS: Nonpregnant women were more likely than pregnant women to meet the vigorous or moderate physical activity recommendations. Walking was the most common activity among pregnant and nonpregnant women (52 and 45%, respectively). Pregnant women meeting the moderate or vigorous physical activity recommendations were more likely to be younger, nonhispanic white, more educated, not married, nonsmokers, and to have higher incomes. CONCLUSION: Many pregnant women do not appear to be meeting the physical activity recommendations. Healthcare providers should further encourage the promotion of physical activity during uncomplicated pregnancies.

Socioeconomic factors and adolescent pregnancy outcomes: distinctions between neonatal and post-neonatal deaths?

BACKGROUND: Young maternal age has long been associated with higher infant mortality rates, but the role of socioeconomic factors in this association has been controversial. We sought to investigate the relationships between infant mortality (distinguishing neonatal from post-neonatal deaths), socioeconomic status and maternal age in a large, retrospective cohort study. METHODS: We conducted a population-based cohort study using linked birth-death certificate data for Missouri residents during 1997-1999. Infant mortality rates for all singleton births to adolescent women (12-17 years, n = 10,131; 18-19 years, n = 18,954) were compared to those for older women (20-35 years, n = 28,899). Logistic regression was used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI) for all potential associations. RESULTS: The risk of infant (OR 1.95, CI 1.54-2.48), neonatal (1.69, 1.24-2.31) and post-neonatal mortality (2.47, 1.70-3.59) were significantly higher for younger adolescent (12-17 years) than older (20-34 years) mothers. After adjusting for race, marital status, age-appropriate education level, parity, smoking status, prenatal care utilization, and poverty status (indicated by participation in WIC, food stamps or Medicaid), the risk of post-neonatal mortality (1.73, 1.14-2.64) but not neonatal mortality (1.43, 0.98-2.08) remained significant for younger adolescent mothers. There were no differences in neonatal or post-neonatal mortality risks for older adolescent (18-19 years) mothers. CONCLUSION: Socioeconomic factors may largely explain the increased neonatal mortality risk among younger adolescent mothers but not the increase in post-neonatal mortality risk.

Prevention Research Centers: contributions to updating the public health workforce through training.

Because public health is a continually evolving field, it is essential to provide ample training opportunities for public health professionals. As a natural outgrowth of the Centers for Disease Control and Prevention's Prevention Research Centers Program, training courses of many types have been developed for public health practitioners working in the field. This article describes three of the Prevention Research Center training program offerings: Evidence-Based Public Health, Physical Activity and Public Health for Practitioners, and Social Marketing. These courses illustrate the commitment of the Prevention Research Centers Program to helping create a better trained public health workforce, thereby enhancing the likelihood of improving public health.

Early mobilization of patients hospitalized with community-acquired pneumonia.

STUDY OBJECTIVE: To determine if early mobilization (EM) of hospitalized adults with community-acquired pneumonia (CAP) reduces hospital length of stay. DESIGN: Group randomized trial. SETTING: Three Midwestern hospitals. PARTICIPANTS: Four hundred fifty-eight patients with CAP admitted to 17 general medical units between November 1997 and April 1998. INTERVENTION: EM was defined as sitting out of bed or ambulating for at least 20 min during the first 24 h of hospitalization. Progressive mobilization occurred each subsequent day during hospitalization. MEASUREMENTS AND RESULTS: Intervention (n = 227) and usual-care patients (n = 231) were similar in age, gender, disease severity, door-to-drug delivery time, and IV-to-po switchover time. Hospital length of stay for EM vs usual care was significantly less (mean, 5.8 vs 6.9 days; adjusted absolute difference, 1.1 days; 95% confidence interval, 0.0 to 2.2 days). There were no differences in adverse events or other secondary outcomes between treatment groups. CONCLUSIONS: Like patients hospitalized with acute myocardial infarction and total knee replacements, EM of hospitalized patients with CAP reduces overall hospital length of stay and institutional resources without increasing the risk of adverse outcomes.

An intervention to improve antibiotic delivery and sputum procurement in patients hospitalized with community-acquired pneumonia.

STUDY OBJECTIVES: To determine if an educational intervention targeting emergency department (ED) and medicine staff could successfully decrease the time to antibiotic delivery (door-to-drug delivery time [DDD]) for patients admitted through the ED with community-acquired pneumonia (CAP). DESIGN: Prospective, multidisciplinary team-based educational project. Demographics, outcomes, and processes of care including DDD and sputum procurement for patients with CAP were determined during a baseline period and compared to the same parameters for patients with CAP presenting after the educational intervention was administered to ED and medicine staff. SETTING: Barnes-Jewish Hospital, a large Midwest teaching institution affiliated with the Washington University School of Medicine. PATIENTS: Consecutive adult patients admitted through the ED with CAP. INTERVENTION: Multidisciplinary in-service education administered to ED physicians and nurses, and medicine housestaff, which emphasized the importance of rapid antibiotic delivery and procurement of preantibiotic expectorated sputum. RESULTS: Mean DDD improved from 413 to 291 min (p = 0.02), with more patients receiving antibiotics in the ED (46% vs 69%; adjusted odds ratio [OR], 2.3; 95% confidence interval [CI], 1.0 to 4.9). Sputum procurement improved from 11.5 to 25.4% (adjusted OR, 3.3; 95% CI, 1.1 to 9.9). There were no observed differences for inpatient mortality or length of stay. CONCLUSION: This multidisciplinary team intervention significantly improved the time to initiation of antibiotics and procurement of sputum for patients with CAP.

Assessing the competencies and training needs for public health professionals managing chronic disease prevention programs.

The purpose of this study was to assess the competencies and training needs for public health professionals managing chronic disease prevention programs. Focus groups were conducted among representatives from 12 state health departments across the United States, and data from the interviews were analyzed. The findings support additional training to enhance specific competencies for management/leadership, epidemiology/biostatistics, chronic disease prevention/policy development, and evaluation. Commonly reported competencies were knowledge of public health and chronic diseases, communication, and diversity. The findings can be used to design future competency-based training programs to build the capacity for chronic disease programs in state and territorial health departments.

Microcephaly: an epidemiologic analysis.

OBJECTIVE: This study was conducted to identify all risk factors that are associated with microcephaly and to quantify the magnitude of risk that is associated with these factors. STUDY DESIGN: This population-based case-control study used the Missouri Birth Defects Registry to identify 360 microcephaly cases and 3600 control cases during 1993 through 1999. Logistic regression was used to calculate adjusted odds ratios and 95% CIs. RESULTS: Significant risk factors for isolated microcephaly include alcohol use, inadequate weight gain during pregnancy, inadequate prenatal care, black race, and low education. Mothers with one previous live birth were protected against isolated microcephaly compared with nulliparous women. CONCLUSION: Our results suggest that microcephaly may arise from some preventable factors. These findings may be useful in aiding clinicians, patients, and policymakers in reducing the risk of microcephaly, a source of high perinatal mortality and morbidity rates.