Sudden infant death syndrome among extremely preterm infants: United States 1997-1999.

Background: Preterm infants have been reported to be at higher risk than term infants for sudden infant death syndrome (SIDS). Reasons for this higher risk are not clear.

Objective: The objective of this study was to analyze medical and demographic characteristics among infants 24 to 32 weeks gestation to identify characteristics more prevalent among infants dying of SIDS in the postneonatal period than among infants of similar gestation who survived or who died of other causes in the postneonatal period.

Species-specific calls evoke asymmetric activity in the monkey's temporal poles.

It has often been proposed that the vocal calls of monkeys are precursors of human speech, in part because they provide critical information to other members of the species who rely on them for survival and social interactions. Both behavioural and lesion studies suggest that monkeys, like humans, use the auditory system of the left hemisphere preferentially to process vocalizations. To investigate the pattern of neural activity that might underlie this particular form of functional asymmetry in monkeys, we measured local cerebral metabolic activity while the animals listened passively to species-specific calls compared with a variety of other classes of sound.

Technology failure analysis: understanding why a diabetes management tool developed for a Personal Digital Assistant (PDA) didn't work in a randomized controlled trial.

Managing Type 1 Diabetes Mellitus is a challenging feat especially for young patients. It is a tedious and demanding disease which requires painful self-monitoring and injections multiple times per day. Many patients are unable to achieve good blood sugar control, in spite of strong evidence that good control leads to better outcomes.

Completeness of state administrative databases for surveillance of congenital heart disease.

Background: Tracking birth prevalence of cardiac defects is essential to determining time and space clusters, and identifying potential associated factors. Resource limitations on state birth defects surveillance programs sometimes require that databases already available be used for ascertaining such defects. This study evaluated the data quality of state administrative databases for ascertaining congenital heart defects (CHD) and specific diagnoses of CHD.

Antioxidant vitamins C and E improve endothelial function in children with hyperlipidemia: Endothelial Assessment of Risk from Lipids in Youth (EARLY) Trial.

Background: Hyperlipidemia is associated with endothelial dysfunction, an early event in atherosclerosis and predictor of risk for future coronary artery disease. Epidemiological studies suggest that increased dietary intake of antioxidants reduces the risk of coronary artery disease. The purpose of this study was to determine whether antioxidant vitamin therapy improves endothelial function and affects surrogate biomarkers for oxidative stress and inflammation in hyperlipidemic children.

The effects of physical exercise on plasma prebeta-1 high-density lipoprotein.

The impact of physical exercise on high-density lipoprotein (HDL) metabolism is recognized as a major mechanism of coronary artery disease (CAD) risk reduction. Prebeta-1 HDL subparticle species play a pivotal role in initiating reverse cholesterol transport (RCT). We examined the effect of acute physical exercise on plasma prebeta-1 HDL levels.

Genetic analysis of a polymorphism in the human apoA-V gene: effect on plasma lipids.

Recent discovery and characterization of APOAV suggests a role in metabolism of triglyceride (TG)-rich lipoproteins. Previously, variation at the APOAV locus was shown to modestly influence plasma TGs in normolipidemic samples. The aims of this study were to assess the effects of a polymorphism in APOAV (T-1131C) in terms of its frequency among three dyslipidemic populations and a control population, differences of allele frequency across available ethnic groups, and associations with specific lipoprotein TG and cholesterol compartments.

Prevalence of T cell receptor zeta chain deficiency in systemic lupus erythematosus.

T cells from patients with systemic lupus erythematosus (SLE) display antigen receptor-mediated signaling aberrations associated with defective T cell receptor (TCR) zeta chain expression. We determined the prevalence of TCR zeta chain deficiency in SLE from a large cohort of unselected racially diverse patients with different levels of clinical disease activity as determined by SLE Disease Activity Index (SLEDAI). Our data show that the occurrence of TCR zeta chain deficiency is 78% in SLE patients.

Enhanced Web-Based Otitis Study Case vs Simple Paper-Case: Impact on Medical Student Objective Structured Clinical Exam (OSCE) Performance.

Background: Distance education methods have taken on greater importance as medical student education has moved off campus into the community. What the best methods are for conveying information to students at distant sites has not been determined.

Objective: To determine if students at distant community sites who received an otitis media study case by e-mail that was enhanced with a referral to a web-based otitis study case, performed better on otitis OSCE stations than students who received the same case not enhanced with visuals or referrals to a web-based otitis case.

Use of Integra artificial skin is associated with decreased length of stay for severely injured adult burn survivors.

Mortality and length of stay (LOS) of survivors was examined retrospectively in 270 adults with acute burns > or =20% of body surface area to determine the effect of Integra Dermal Regeneration Template treatment on outcome. No difference in mortality was found between patients who received Integra (30%; n = 43) and patients who did not (30%; n = 227). Surviving Integra patients (n = 30) stayed longer, but they were more extensively injured than survivors who did not receive Integra (n = 158), and therefore longer hospitalizations were expected.

Incidence, outcome, and long-term consequences of herpes simplex virus type 1 reactivation presenting as a facial rash in intubated adult burn patients treated with acyclovir.

Background: Increased mortality, extensive visceral involvement, and necrotizing tracheobronchitis associated with herpes viruses have been reported after burns. It is unclear whether herpes presenting as a facial rash results in outcome changes after burns.

Methods: A retrospective study characterizing the incidence, presentation, and outcome of 14 patients with facial herpes rashes out of 95 severely burned intubated adults was performed.

Trends and characteristics of induced labour in the United States, 1989-98.

Induction of labour is one of the fastest growing medical procedures in the United States. In 1998, 19.2% of all US births were a product of induced labour, more than twice the 9.

Enforcing prompt-payment regulations: the Texas approach.

To ensure that insurance carriers pay providers in a timely manner, Texas has adopted strict payment regulations. Enforcement of the regulations has led to restitution payments for many providers. However, issues such as clean claims, underpayment, discrepancies in payment dates, and self-funded claims continue to present challenges.

Human cholesterol 7alpha-hydroxylase (CYP7A1) deficiency has a hypercholesterolemic phenotype.

Bile acid synthesis plays a critical role in the maintenance of mammalian cholesterol homeostasis. The CYP7A1 gene encodes the enzyme cholesterol 7alpha-hydroxylase, which catalyzes the initial step in cholesterol catabolism and bile acid synthesis. We report here a new metabolic disorder presenting with hyperlipidemia caused by a homozygous deletion mutation in CYP7A1.

Trends in postneonatal aspiration deaths and reclassification of sudden infant death syndrome: impact of the "Back to Sleep" program.

Objective: The introduction of the "Back to Sleep" campaign for the prevention of sudden infant death syndrome (SIDS) brought with it concern that there might be an increase in the incidence of aspiration-related deaths. The objective of this analysis was to describe the trends in postneonatal mortality and proportionate mortality ratios for the United States for the years 1991 to 1996 for aspiration-related deaths and other causes to which a SIDS death could conceivably be reclassified.

Methods: Linked birth and infant death vital statistic files for the United States were used for the years 1991, 1995, and 1996.

A risk factor for atherosclerosis: triglyceride-rich lipoproteins.

Compelling evidence from meta-analysis of a number of clinical studies on a large aggregate of patients has established an increased level of triglycerides as an independent risk factor for atherosclerotic heart disease. The finding of triglyceride-rich lipoproteins in human atheromata has provided substantial pathophysiologic evidence for a direct role in atherogenesis. Hypertriglyceridemia is commonly embedded in the context of a metabolic syndrome that includes central obesity, insulin resistance, low levels of HDL cholesterol, and often hypertension.

Impact of Generalist Physician Initiatives on Residency Selection.

Objective: To compare the residency selection choices of students who experienced courses resulting from generalist physician initiatives to choices made by students prior to the implementation of those courses and to describe the characteristics of students selecting primary care residencies.

Background: In the fall of 1994 a first year Community Continuity Experience course was initiated and in the summer of 1995 a third year Multidisciplinary Ambulatory Clerkship was begun at the University of Texas Medical Branch in Galveston. These courses were inserted into the curriculum to enhance and promote primary care education.

Urban Wisconsin pediatric patients using an after-hours telephone triage service: outcomes and compliance.

Objective: Evaluate the ability of a telephone triage service (TTS) to assess illness acuity of and patient compliance with advice given.

Design: Retrospective, observational study.

Patients: Patients of an urban, academic, pediatric clinic whose parents or caregivers called the TTS between July 23, 1997 and August 23, 1997.

Elevated baseline triglyceride levels modulate effects of HMGCoA reductase inhibitors on plasma lipoproteins.

Background: The response in levels of very-low-density (VLDL) and low-density (LDL) lipoproteins varies substantially among hyperlipidemic patients during treatment with HMGCoA reductase inhibitors. Apolipoprotein E genotype and gender are known to contribute to the regulation of steady state levels of plasma lipoproteins. This study explores the effect of these and other potential determinants of the response of VLDL and LDL to treatment with reductase inhibitors.

Haplotypes of the human renin gene associated with essential hypertension and stroke.

The human renin gene (REN) is a good candidate in studies aimed at unravelling the genetic basis of essential hypertension and stroke. We previously established that both a BglI and an MboI dimorphisms (located respectively in the first and ninth introns of the REN gene) were associated with essential hypertension in a population of hyperlipidaemic US subjects. In this association (retrospective case-control) study, we investigated the haplotype distribution of alleles defined by the combination of REN BglI and MboI dimorphic sites in 329 hyperlipidaemic US Caucasian subjects referred to UCSF Medical Center (140 hypertensives, 141 normotensives, and 48 hypertensive patients who had suffered a stroke).

Risk factors for pediatric asthma emergency visits. Milwaukee Childhood Asthma Project Team.

The purpose of this study was to identify risk factors for pediatric asthma emergency department (ED) visits. A cross-sectional sample of 307 families (24%) responded to a mailed survey. Respondents were similar to the target population of 2487 children with asthma.

A 6.9-Mb high-resolution BAC/PAC contig of human 4p15.3-p16.1, a candidate region for bipolar affective disorder.

Bipolar affective disorder (BPAD) is a complex disease with a significant genetic component and a population lifetime risk of 1%. Our previous work identified a region of human chromosome 4p that showed significant linkage to BPAD in a large pedigree. Here, we report the construction of an accurate, high-resolution physical map of 6.