A national survey of parent perspectives on use of patient portals for their children's health care.

OBJECTIVES: To assess parents' current utilization and future willingness to use patient portals to interact with their child's health care provider. METHODS: A cross-sectional survey of a nationally representative sample of US parents was conducted using an established online panel. Bivariate analyses assessed associations between current utilization and future willingness to use patient portals, parental concerns, and demographic variables. RESULTS: Among the 1,420 parent respondents, 40% did not know whether their child's health practice offers the option of setting up a patient portal for their child. Of the 21% of parents who reported being offered the option of setting up a patient portal for their child, 59% had done so. Among parents who had the option but chose not to set up a patient portal for their child, lack of time and low perceived need were the main reasons cited. Current use and likelihood of future use was highest for viewing lab results and immunization records. The most common concern about patient portals was the security of the child portal system. CONCLUSIONS: Current use of patient portals by parents is low. Only about half of parents currently using or likely to use a portal perceive value in using portals for certain tasks, which suggests that providers will need to continue traditional communication mechanisms to reach their entire patient population.

Getting heavier, younger: trajectories of obesity over the life course.

CONTEXT: Although recent trends in obesity have been well documented, generational patterns of obesity from early childhood through adulthood across birth cohorts, which account for the recent epidemic of childhood obesity, have not been well described. Such trends may have implications for the prevalence of obesity-associated conditions among population subgroups, including type 2 diabetes. OBJECTIVE: Our objective was to evaluate trajectories of obesity over the life course for the US population, overall and by gender and race. DESIGN, SETTING AND PARTICIPANTS: We conducted an age, period and birth cohort analysis of obesity for US individuals who participated in the National Health and Nutrition Examination Surveys (NHANES) (1971-2006). MAIN OUTCOME MEASURES: Obesity was defined as a body mass index >or=95th percentile for individuals aged 2-16 years or >or=30 kg m(-2) among individuals older than 16 years. Age was represented by the age of the individual at each NHANES, period was defined by the year midpoint of each survey, and cohort was calculated by subtracting age from period. RESULTS: Recent birth cohorts are becoming obese in greater proportions for a given age, and are experiencing a greater duration of obesity over their lifetime. For example, although the 1966-1975 and 1976-1985 birth cohorts had reached an estimated obesity prevalence of at least 20% by 20-29 years of age, this level was only reached by 30-39 years for the 1946-1955 and 1956-1965 birth cohorts, by 40-49 years for the 1936-1945 birth cohort and by 50-59 years of age for the 1926-1935 birth cohort. Trends are particularly pronounced for female compared with male, and black compared with white cohorts. CONCLUSIONS: The increasing cumulative exposure to excess weight over the lifetime of recent birth cohorts will likely have profound implications for future rates of type 2 diabetes, and mortality within the US population.

Community Case Management improves Use of Treatment for Childhood Diarrhea; Malaria and Pneumonia in a Remote District of Ethiopia

Background: Ethiopia's Health Extension Workers (HEW) deliver preventive interventions and treat childhood diarrhea and malaria; but not pneumonia. Most of Ethiopia's annual estimated 4 million childhood pneumonia cases go untreated. Objective: Evaluate the performance of volunteers in providing Community Case Management (CCM) for diarrhea; fever and pneumonia - in a pre-HEW setting in Liben Woreda; Oromiya Regional State. Methods: Save the Children supported Ministry of Health and communities to deliver child survival interventions from 1997-2006. We obtained permission in 2005 to train 45 volunteers from remote kebeles in CCM. We evaluated the strategy through reviewing registers and supervision records; examining CCM workers; focus group discussions; and three household surveys. Results: The CCM workers treated 4787 cases; mainly: malaria (36); pneumonia (26); conjunctivitis (14); and watery diarrhea with some dehydration (12). They saw 2.5 times more cases of childhood fever; pneumonia; and diarrhea than all the woreda's health facility staff combined. Quality of care was good. Conclusion: The availability; quality; demand; and use of CCM were high. These CCM workers were less educated and less trained than HEWs who perform complicated tasks (Rapid Diagnostic Tests) and dispense expensive antimalarial drugs like Coartemr. They should also treat pneumonia with inexpensive drugs like cotrimoxazole to help achieve Millennium Development Goal 4

Polio outbreak response in Ethiopia.

BACKGROUND: Ethiopia had been polio-free for almost four years until December 2004. However, between December 2004 and February 2006, 24 children were paralysed as a result of infection with wild poliovirus imported from the neighbouring country of Sudan. In response, the country has attempted to document the impact of various response measures on the containment of wild poliovirus transmission. OBJECTIVES: This study aims at systematic and epidemiological assessment of the extent of the outbreak, its determinants, and the lessons learned as well as the implications for future control strategies to interrupt wild poliovirus transmission. DESIGN: A cross-sectional study design with qualitative and quantitative data collection approaches was used to conduct the epidemiologic assessment. SUBJECTS: All confirmed wild poliovirus cases, and reported acute flaccid paralysis cases in close proximity to the confirmed polio cases were the study subjects. Child caretakers and health service providers were interviewed as part of the investigation. RESULTS: Between December 2004 and February 2006, eight children from Tigray Regional State, nine children from Amhara Regional State and seven children from Oromia Regional State were paralysed as a result of infection with wild poliovirus type 1. Genetic sequencing demonstrated two separate importations to Ethiopia. Risk factors that may have facilitated spread of the outbreak within the country included gaps in vaccination coverage and interruption of the cold chain system, gaps in acute flaccid paralysis surveillance performance, high population mobility, poor environmental sanitation, crowded living conditions and unsafe drinking water. In response to the outbreak, Ethiopia conducted detailed outbreak investigations within two days of confirmation of the index cases. Large-scale, house-to-house vaccination campaigns were also implemented. As a result, the three regions interrupted the wild poliovirus transmission within the regions within one year of confirmation of the index case. CONCLUSION: Outbreak response activities were successful in interrupting the imported wild poliovirus transmission in Tigray, Amhara and Oromia Regional States of Ethiopia within a one-year period of time. In Ethiopia, programme strategies should be intensified to contain further spread and prevent future importation of wild poliovirus. Large-scale immunisation campaigns should reach every child, including those isolated by geography, poverty and security.

Factors predisposing to low birth weight in Jimma Hospital south western Ethiopia.

BACKGROUND: Low birth weight continues to remain a major public health problem in Ethiopia in contrast to what is observed in many developing countries. OBJECTIVES: To assess some of the predisposing factors to low birth weight among deliveries in Jimma hospital. DESIGN: Cross-sectional case referent study. SETTING: Maternal and child health clinic and maternity ward of Jimma University Hospital, Ethiopia. SUBJECTS: One hundred and forty seven mothers who gave birth to low birth weight (LBW) babies between June 1999 and July 2000 were identified. MAIN OUTCOME MEASURES: Normal and low birth weight. RESULTS: The incidence of LBW was found to be 11.02%. Mothers younger than 20 years and > or =35 years, short stature (< or =150 cm), late first antenatal visit and complications during pregnancy were significantly associated with LBW (p<0.001). However, parity showed a negative association with LBW. CONCLUSION: Attention to nutritional education, early antenatal care interventions and strengthening of maternal and child health assists in combating LBW in the area.

Effectiveness of abdominal compression during helical renal CT.

RATIONALE AND OBJECTIVES: The authors performed this study to assess the effect of abdominal compression on opacification and distention of the proximal renal collecting system during helical computed tomography (CT). MATERIALS AND METHODS: Abdominal compression was applied during helical CT in 31 patients who were scanned 150 and 300 seconds after initiating a dynamic bolus injection of contrast material. Two reviewers assessed renal collecting system opacification and measured the maximal short-axis diameter of the collecting system at three locations: the upper pole, the lower pole, and the proximal ureter. A similar evaluation was performed in a control group of 29 patients who underwent CT without compression at 300 seconds after initiating the injection of contrast material. RESULTS: Both reviewers noted collecting system opacification at all locations in 52 of 56 noncompressed collecting systems scanned at 300 seconds, 57 of 59 compressed collecting systems scanned at 300 seconds, but only 26 of 59 compressed collecting systems scanned at 150 seconds. Measured collecting system distention was statistically significantly greater at 300 seconds in patents who received compression than in patients who did not (P = .0013). For patients who received compression, measured collecting system distention was statistically significantly greater on scans obtained at 300 seconds than on scans obtained at 150 seconds (P = .0001). CONCLUSION: Abdominal compression during renal helical CT produces a detectable increase in renal collecting system distention. In patients who receive compression, scanning at 300 seconds rather than at 150 seconds results in greater collecting system distention and more consistent opacification.

Multi--detector row helical CT of the pancreas: effect of contrast-enhanced multiphasic imaging on enhancement of the pancreas, peripancreatic vasculature, and pancreatic adenocarcinoma.

PURPOSE: To determine the optimal phase for enhancement of the normal pancreas and peripancreatic vasculature and the maximal tumor-to-pancreatic parenchymal enhancement difference by using multiphase, contrast material-enhanced, multi-detector row helical computed tomography (CT). MATERIALS AND METHODS: Forty-nine patients with a normal-appearing pancreas but suspected of having pancreatic abnormality and 28 patients with proved pancreatic adenocarcinoma underwent multiphase, contrast-enhanced, multi-detector row CT during the arterial phase (AP), pancreatic parenchymal phase (PPP), and portal venous phase (PVP). Attenuation values of the normal pancreas, pancreatic adenocarcinoma, celiac and superior mesenteric arteries, and superior mesenteric and portal veins were measured during all three imaging phases. Quantitative analysis of these measurements and subjective qualitative analysis of tumor conspicuity were performed. RESULTS: Maximal enhancement of the normal pancreatic parenchyma occurred during the PPP. Maximal tumor-to-parenchyma attenuation differences during the PPP and PVP were equivalent but greater than that during the AP. Subjective analysis revealed that tumor conspicuity during the PPP and PVP was equivalent but superior to that during the AP. Maximal arterial enhancement was seen during the PPP, and maximal venous enhancement was seen during the PVP. CONCLUSION: A combination of PPP and PVP imaging is sufficient for detection of pancreatic adenocarcinoma, because it provides maximal pancreatic parenchymal and peripancreatic vascular enhancement. AP imaging can be reserved for patients in whom CT angiography is required.

Evaluation of competence in the interpretation of chest radiographs.

RATIONALE AND OBJECTIVES: The purpose of this study was to determine relative rates of missed diagnoses for radiologists as a measure of competence in interpreting chest radiographs. MATERIALS AND METHODS: Cases involving differing interpretations of chest radiographs were collected from January 1994 through December 1999 by faculty (chest and nonchest radiology specialists) in an academic radiology department. A quarterly peer-review process designated cases months after the fact, and anonymously, as no miss or as class I (nondiagnosable), class II (very difficult diagnosis), class III (should be diagnosed most of time), or class IV (should almost always be diagnosed) missed diagnoses. The rates and classes of missed diagnoses were compared among chest faculty and for the nonchest radiology specialists as a group. RESULTS: Chest radiologists read 184,977 studies, and nonchest radiologists read 300,684 studies. Of these, 243 missed diagnoses were classified (classes I and II, 184 cases; class III, 50; and class IV, nine). No difference was detected in the rate of class III and IV misses among chest faculty, but nonchest faculty had significantly more class III (P = .022) and class IV misses (P = .016). CONCLUSION: Random sampling of differing interpretations can yield a relative rate of missed diagnoses for radiologists. No difference was detected in clinically important misses (ie, classes III and IV) among chest radiologists, but a statistically significantly higher rate of seemingly obvious misdiagnoses was found for nonchest specialty radiologists. Potential biases may have influenced this analysis, including disease prevalence, sampling, clinical factors, observer variability, and truth-in-diagnosis.

Subgaleal haemorrhage: risk factors and neurological and developmental outcome in survivors.

To identify the risk factors associated with subgaleal haemorrhage and to assess the long-term neurological and developmental morbidity in survivors, data were prospectively collected over 5 years on 69 newborns with subgaleal haemorrhage from a cohort of 23,353 live and term deliveries, giving an incidence of subgaleal haemorrhage of 3.0 per 1000 live and term births. Multivariate analysis of risk factors associated with subgaleal haemorrhage on univariate analysis showed that prolonged second stage of labour (OR = 9.02; 95% CI 6.15-17.51), fetal distress (OR = 5.05; 95% CI 2.67-11.12), vacuum delivery (OR = 7.17; 95% CI 5.43-10.25), forceps delivery (OR = 2.66; 95% CI 1.78-5.18), and birthweight (OR = 2.20; 95% CI 1.54-6.56) significantly influenced the occurrence of subgaleal haemorrhage. When the effects of prolonged second stage of labour, fetal distress, birthweight and gestational age were controlled for, the odds of harbouring subgaleal bleed following vacuum delivery were, respectively, OR = 7.80 (95% CI 5.45-11.61), OR = 6.15 (95% CI 3.71-10.84), OR = 5.01 (95% CI 2.78-9.63) and OR = 7.65 (95% CI 4.73-16.65). Among the 69 newborns with subgaleal haemorrhage, ten (14%) died and twelve (20%) of the 59 survivors were lost to follow-up. Of the remaining 47 survivors, three (6%) died during follow-up of diseases unrelated to the bleed, leaving 44 survivors, none of whom had either neurological deficit or developmental delay. The study concludes that subgaleal haemorrhage in neonates is the result of birth trauma associated with difficult instrumental delivery. Newborns with subgaleal haemorrhage who survive the acute episode of the bleed show no evidence of subsequent long-term neurological deficit or developmental delay.

Discontinuing anti-epileptic medication(s) in epileptic children: 18 versus 24 months.

For a period of slightly over 4 years, 80 children who had been seizure-free for at least 18 months while on anti-convulsant medication were prospectively collected. These 80 children were randomly assigned to either the 18-months seizure-free group (n = 41) or to the group where anti-convulsant medications were continued for another 6 months before they were gradually tapered off and stopped, i.e. the 24-months seizure-free group (n = 39). Twelve (29%) of the 41 children who had been seizure-free for 18 months and 14 (36%) of the 39 children who had been seizure-free for 24 months had seizure recurrence during the follow-up period. Log-rank test of the recurrence experience of the two groups of patients showed no statistically significant difference between the groups (p > 0.50). Similarly, when both groups were combined and other risk variables likely to influence the rate of seizure recurrence were tested, only EEG abnormality at discontinuation of anti-convulsant medication had a significant association with the risk of seizure recurrence (p < 0.001).

Sydenham's chorea: risk factors and the role of prophylactic benzathine penicillin G in preventing recurrence.

To determine the effect of prophylactic long-acting penicillin G in preventing recurrence of Sydenham's chorea and to discover the risk factors associated with occurrence of symptoms, 18 children with symptoms over a 5-year period were prospectively identified. Of these, ten were boys and eight were girls. The majority occurred between the ages of 8 and 10 years [mean (SD) 9.10 (2.62) years]. Sydenham's chorea was generalized in 14 children and one-sided in four. There was no difference in the incidence of right- and left-sided hemichorea. Among the risk factors examined, only a history of chorea in relatives had a significant association with the occurrence of Sydenham's chorea (OR = 6.39; 95% CI 1.30-31.3). A comparison of recurrence between those given prophylactic long-acting penicillin G and those who had none showed a statistically significant difference in the recurrence experience between the two groups (p < 0.02).

Neonatal meningitis in Addis Ababa: a 10-year review.

In a hospital population-based retrospective study of neonatal meningitis, 55 cases were identified over a period of 10 years. The prevalences of meningitis for preterm and term newborns were 3.66 and 0.97 per 1000, respectively (22/6465 vs 33/36638; p < 0.01). The overall prevalence was 1.37 per 1000 live births. Twenty-two (40%) babies with meningitis died, more preterm than term (13/22 vs 9/33; p < 0.05). Known maternal risk factors for neonatal meningitis were observed in 15 (27%) babies. The risk factors were more common in preterm than in term newborns (10/22 vs 5/33; p < 0.05). The common causative organisms were Klebsiella pneumoniae, Escherichia coli and Enterobacter spp. which together accounted for 67% of all CSF isolates. These organisms were evenly distributed between early- and late-onset meningitis, and among term and preterm newborns. Seven of 33 (21%) of the surviving newborns developed neurological complications. The short-term sequelae were hydrocephalus, spastic paresis and seizures.

Predictors of mortality in childhood neurotuberculosis: a retrospective study of 84 cases.

In our institute neurotuberculosis now forms (0.6%) of an average of 2000 total admission per year. Our mortality rate was 38%. Young age patients who present themselves late and delay in the initiation of anti-tuberculous therapy correlated significantly with poor outcome.

Migrane in childhood and adolescence in Ethiopia.

Thirty children and adolescents with migrane were reviewed. The male to female ratio was 1.7:1.0. Migrane was more common in males below the age of 10 years and in the females above the age of 12 years. Classical migrane occurred in equal numbers in both males and females. Common migrane was more common in males. The other forms of migrane were pretty rare. There was a high incidence of migrane in parents of patients with classical and complicated migrane.

Subacute sclerosing panencephalitis (SSPE) in an adolescent Ethiopian girl.

Some 50 years have elapsed since Dawson first described a 16-year-old girl with an inclusion encephalitis. Since then, numerous publications on subacute sclerosing panencephalitis (SSPE) have appeared in the world literature. However, most of these reports are from the developed world. There have been few reports from Africa. One of them was from Kenya, where a retrospective analysis of EEGs of patients with epilepsy over a 5-year period identified 53 probable cases of subacute sclerosing panencephalitis (1). The other one was from South Africa where an incidence of 1.2 per million per year was reported on the basis of 15 cases collected from two hospitals in the Cape Province (2). No case, as yet, has been reported from Ethiopia. This paper reports SSPE presenting in an adolescent Ethiopian girl who had measles at the age of 18 months.