Arch Pediat Adol Med
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Arch Pediat Adol Med · Oct 1996
Comparative StudyRethinking the threshold for an abnormal capillary blood lead screening test.
To examine the test characteristics of the capillary blood lead screening test as a predictor of elevated venous blood lead levels, using receiver operating characteristic (ROC) curves. To consider a rational capillary blood lead cutoff value in the context of what has been learned about the screening test and what is understood about the clinical course of children with elevated blood lead levels in the mild range (0.48-0.92 mumol/L [10-19 micrograms/dL]). ⋯ In this sample of children, capillary blood lead measurement performed well as a screening test for elevated venous blood lead levels. Altering the capillary specimen contamination rate has little effect on the rest characteristics because much of the misclassification error resulted from random analytic error in the analysis of blood lead levels, which is high compared with the threshold of concern (0.48 mumol/L [10 micrograms/dL]). Because of lack of data on clinical outcomes for children with elevated blood lead levels in the 0.48- to 0.92-mumol/L (10- to 19-micrograms/dL) range, we suggest that the greatest utility be placed on avoiding false-positive misclassification. A clinical capillary screening cutoff value of 0.72 mumol/L (15 micrograms/dL) would avoid most false-positive results and would permit 100% sensitivity in detecting children with blood lead levels of 0.97 mumol/L (20 micrograms/dL) or higher.
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Arch Pediat Adol Med · Oct 1996
Mortality from intentional and unintentional injury among infants of young mothers in Colorado, 1986 to 1992.
To investigate the association between maternal age and other risk factors and infant injury deaths in the state of Colorado from 1986 to 1992. ⋯ Maternal age and marital status significantly affect the rate of both unintentional and intentional infant injury mortality. These results suggest that child abuse prevention strategies should be targeted to teenaged mothers, and that strategies designed to prevent unintentional injuries should focus particularly on parents or caretakers of infants born to unmarried mothers in their early 20s as well as married teenagers.
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To quantify the content and setting of injury prevention training provided to pediatric residents and to identify aspects of residency programs associated with this training. ⋯ Injury prevention is less frequently taught than disease prevention in pediatric residency training. Injury prevention is most often taught in continuity clinics, the setting most consistent with ongoing primary patient care. A gap exists between the leading causes of injury death and injury prevention topics taught to pediatric residents. Residency programs must better recognize and adapt to the epidemiology of trauma in their communities, better enabling new pediatricians to meet their patient's needs.
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Arch Pediat Adol Med · Oct 1996
Randomized Controlled Trial Comparative Study Clinical TrialLidocaine for lumbar punctures. A help not a hindrance.
To determine whether premedication for lumbar puncture (LP) with lidocaine hinders collection of cerebrospinal fluid (CSF) through either increased number of attempts or increased incidence of traumatic punctures. ⋯ Premedication with lidocaine for an LP does not binder the ease of obtaining CSF. The clinical relevance of a greater number of traumatic LPs in the lidocaine-treated group is questionable because this finding is negated when traumatic is defined as more than 10,000 x 10(6)/L CSF red blood cells. Based on these results, we advocate premedication with a local anesthetic when an LP is performed in the pediatric emergency department.
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Arch Pediat Adol Med · Sep 1996
Pediatric Research. National Institutes of Health support in the 'steady-state' decade, 1983-1993.
To examine the trend in the US Public Health Service's National Institutes of Health (NIH) funding for pediatric research over the last 10 years in terms of dollars expended, grants awarded to pediatrics departments vs other medical school departments, NIH Clinical Research Center support, and the distribution of NIH grants to all medical schools and children's hospitals in the United States. ⋯ Pediatric research has increased its absolute and relative NIH grant support in the last 10 years to a greater degree than all other clinical departments except for psychiatry, neurology, and anesthesiology. The distribution of grants favors a small number of departments and children's hospitals. Clinical pediatric research supported by the NIH has fallen dramatically. In the era of stable NIH funding, pediatric investigators must develop other sources (private funding and industry) for expanding their research activities.