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1.  SWIFT: Prospective 48-Week Study to Evaluate Efficacy and Safety of Switching to Emtricitabine/Tenofovir From Lamivudine/Abacavir in Virologically Suppressed HIV-1 Infected Patients on a Boosted Protease Inhibitor Containing Antiretroviral Regimen 
Virologic suppression was well maintained when HIV patients receiving 3TC/ABC with a boosted protease inhibitor were switched to emtricitabine/tenofovir disoproxil fumarate (FTC/TDF). Subjects randomized to FTC/TDF) had fewer virologic failures; in addition, improvements in lipids and Framingham risk scores were noted, while slight declines in estimated GFR were observed.
Background. In the United States, emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) is a preferred nucleoside reverse transcriptase inhibitor (NRTI) backbone with lamivudine/abacavir (3TC/ABC) as a commonly used alternative. For patients infected with human immunodeficiency virus (HIV-1) virologically suppressed on a boosted protease inhibitor (PI) + 3TC/ABC regimen, the merits of switching to FTC/TDF as the NRTI backbone are unknown.
Methods. SWIFT was a prospective, randomized, open-label 48-week study to evaluate efficacy and safety of switching to FTC/TDF. Subjects receiving 3TC/ABC + PI + ritonavir (RTV) with HIV-1 RNA < 200 c/mL ≥3 months were randomized to continue 3TC/ABC or switch to FTC/TDF. The primary endpoint was time to loss of virologic response (TLOVR) with noninferiority measured by delta of 12%. Virologic failure (VF) was defined as confirmed rebound or the last HIV-1 RNA measurement on study drug ≥200 c/mL.
Results. In total, 311 subjects were treated in this study (155 to PI + RTV + FTC/TDF, 156 to PI + RTV + 3TC/ABC). Baseline characteristics were similar between the arms: 85% male, 28% black, median age, 46 years; and median CD4 532 cells/mm3. By TLOVR through week 48, switching to FTC/TDF was noninferior compared to continued 3TC/ABC (86.4% vs 83.3%, treatment difference 3.0% (95% confidence interval, −5.1% to 11.2%). Fewer subjects on FTC/TDF experienced VF (3 vs 11; P = .034). FTC/TDF showed greater declines in fasting low-density lipoproteins (LDL), total cholesterol (TC), and triglycerides (TG) with significant declines in LDL and TC beginning at week 12 with no TC/HDL ratio change. Switching to FTC/TDF showed improved NCEP thresholds for TC and TG and improved 10-year Framingham TC calculated scores. Decreased epidermal growth factor receptor (eGFR) was observed in both arms with a larger decrease in the FTC/TDF arm.
Conclusions. Switching to FTC/TDF from 3TC/ABC maintained virologic suppression, had fewer VFs, improved lipid parameters and Framingham scores but decreased eGFR. identifier. NCT00724711.
PMCID: PMC3641864  PMID: 23362296
HIV-1; FTC/TDF; 3TC/ABC; virologic failure; switch
2.  How willing are parents to improve pedestrian safety in their community? 
Study objective: To determine how likely parents would be to contribute to strategies to reduce pedestrian injury risks and how much they valued such interventions.
Design: A single referendum willingness to pay survey. Each parent was randomised to respond to one of five requested contributions towards each of the following activities: constructing speed bumps, volunteering as a crossing guard, attending a neighbourhood meeting, or attending a safety workshop.
Setting: Community survey.
Participants: A sample of 723 Baltimore parents from four neighbourhoods stratified by income and child pedestrian injury risk. Eligible parents had a child enrolled in one of four elementary schools in Baltimore City in May 2001.
Main results: The more parents were asked to contribute, the less likely they were to do so. Parents were more likely to contribute in neighbourhoods with higher ratings of solidarity. The median willingness to pay money for speed bumps was conservatively estimated at $6.43. The median willingness to contribute time was 2.5 hours for attending workshops, 2.8 hours in community discussion groups, and 30 hours as a volunteer crossing guard.
Conclusions: Parents place a high value on physical and social interventions to improve child pedestrian safety.
PMCID: PMC1732358  PMID: 14652260
3.  Injury Control: A Guide to Research and Program Evaluation. 
Injury Prevention  2002;8(4):346.
PMCID: PMC1756564
6.  Measuring the implementation of injury prevention programs in state health agencies. 
Injury Prevention  1997;3(2):94-99.
OBJECTIVE: Injury prevention programs have been implemented with varying degrees of success in the United States. The objective of this study was to identify the variables that influence the successful implementation of injury prevention programs. METHODS: The key indicators of implementation success and its correlates were identified through consultation with a panel of experts. This consultation informed the content of a mail questionnaire sent to all United States state health departments, followed by telephone interviews. Data were analyzed using factor analysis and regression to identify significant relationships between variables. RESULTS: Data were obtained from 64 programs, representing 44 states; these included 24 programs in injury control units, 12 in maternal and child health units, 10 in health promotion/education units; and eight in emergency medical services units. Analysis identified four factors that are associated with an index of successful injury prevention program implementation; (1) participation and advocacy by constituent groups; (2) organizational capacity; (3) administrative control; and (4) attributes of relevant policies. CONCLUSIONS: Findings indicated that constituent participation (the extent and efficacy of constituency support and advocacy) and organizational capacity (a function of program staff and their skill levels) had the greatest influence on successful program implementation. Support from advocacy groups and knowledgeable staff members, whose time is dedicated to the program, are critical for conducting the activities necessary for successful implementation of these programs.
PMCID: PMC1067788  PMID: 9213153
7.  An international study of the exposure of children to traffic. 
Injury Prevention  1997;3(2):89-93.
OBJECTIVES: To examine the extent of international differences in children's exposure to traffic as pedestrians or bicyclists. DESIGN: Children's travel patterns were surveyed using a parent-child administered questionnaire. Children were sampled via primary schools, using a probability cluster sampling design. SETTING: Six cities in five countries: Melbourne and Perth (Australia), Montreal (Canada), Auckland (New Zealand), Umeå (Sweden), and Baltimore (USA). SUBJECTS: Children aged 6 and 9 years. MAIN OUTCOME MEASURES: Modes of travel on the school-home journey, total daily time spent walking, and the average daily number of roads crossed. MAIN FINDINGS: Responses were obtained from the parents of 13423 children. There are distinct patterns of children's travel in the six cities studied. Children's travel in the three Australasian cities, Melbourne, Perth and Auckland, is characterised by high car use, low levels of bicycling, and a steep decline in walking with increasing car ownership. In these cities, over a third of the children sampled spent less than five minutes walking per day. In Montreal, walking and public transport were the most common modes of travel. In Umeå, walking and bicycling predominated, with very low use of motorised transport. In comparison with children in the Australasian and North American cities, children in Umeå spend more time walking, with 87% of children walking for more than five minutes per day. CONCLUSIONS: There are large international differences in the extent to which children walk and cycle. These findings would suggest that differences in 'exposure to risk' may be an important contributor to international differences in pedestrian injury rates. There are also substantial differences in pedestrian exposure to risk by levels of car ownership-differences that may explain socioeconomic differentials in pedestrian injury rates.
PMCID: PMC1067787  PMID: 9213152
8.  Determinants of modern health care use by families after a childhood burn in Ghana. 
Injury Prevention  1995;1(1):31-34.
OBJECTIVES: This study examined determinants of modern health care use by families after their child aged 0-5 years sustained a burn injury in the Ashanti Region of Ghana. METHODS: A community based survey of children aged 0-5 years was conducted in 50 enumeration areas in the region. Mothers of all children with scars as evidence of a burn were selected for a follow up interview using a standard questionnaire two to three months later. Determinants of health care use were investigated through a multivariate logistic regression using interview responses from mothers of 617 children for whom report on some treatment was given. RESULTS: Overall, 48% of the burned children were taken to a modern health facility for treatment. Of those taken to a modern health facility, 68% were sent within 24 hours of the burn event. Factors with large adjusted odds ratios for modern health care use included wound infection, burns covering 6% or more of the body surface, and third degree burns. Compared with scalds, children with contact and flame burns were less likely to be taken to a health facility, as were burns to rural children, and those given first aid treatment at home. CONCLUSIONS: It is concluded that families, particularly rural residents, should be educated about appropriate health care seeking practices after a burn.
PMCID: PMC1067538  PMID: 9345990
9.  Deficiencies in current childhood immunization indicators. 
Public Health Reports  1998;113(6):527-532.
OBJECTIVE: To investigate "up-to-date" and "age-appropriate" indicators of preschool vaccination status and their implications for vaccination policy. METHODS: The authors analyzed medical records data from the Baltimore Immunization Study for 525 2-year-olds born from August 1988 through March 1989 to mothers living in low-income Census tracts of the city of Baltimore. RESULTS: While only 54% of 24-month-old children were up-to-date for the primary series, indicators of up-to-date coverage were consistently higher, by 37 or more percentage points, than corresponding age-appropriate indicators. Almost 80% of children who failed to receive the first dose of DTP or OPV age-appropriately failed to be up-to-date by 24 months of age for the primary series. CONCLUSIONS: Age-appropriate immunization indicators more accurately reflect adequacy of protection for preschoolers than up-to-date indicators at both the individual and population levels. Age-appropriate receipt of the first dose of DTP should be monitored to identify children likely to be underimmunized. Age-appropriate indicators should also be incorporated as vaccination coverage estimators in population-based surveys and as quality of care indicators for managed care organizations. These changes would require accurate dates for each vaccination and support the need to develop population-based registries.
PMCID: PMC1308436  PMID: 9847924
10.  Estimating vaccination coverage using parental recall, vaccination cards, and medical records. 
Public Health Reports  1998;113(6):521-526.
OBJECTIVE: To compare estimates based on vaccination cards, parental recall, and medical records of the percentages of children up-to-date on vaccinations for diphtheria, tetanus, and pertussis; polio; and measles, mumps, and rubella. METHOD: The authors analyzed parent interview and medical records data from the Baltimore Immunization Study for 525 2-year-olds born from August 1988 through March 1989 to mothers living in low-income Census tracts of the city of Baltimore. RESULTS: Only one-third of children had vaccination cards; based on medical records, these children had higher up-to-date coverage at 24 months of age than did children without cards. For individual vaccines, only two-thirds of parents could provide information to calculate coverage rates; however, almost all provided enough information to estimate coverage for the primary series. For each vaccine and the series, parental recall estimates were at least 17 percentage points higher than estimates from medical records. For children without vaccination cards whose parents could not provide coverage information, up-to-date rates based on medical records were consistently lower than for children with cards or with parents who provided coverage information. CONCLUSIONS: Population-based vaccine coverage surveys that rely on vaccination cards or parental recall or both may overestimate vaccination coverage.
PMCID: PMC1308435  PMID: 9847923
11.  Risk factors for childhood burns: a case-control study of Ghanaian children. 
STUDY OBJECTIVE--To study risk factors for childhood burns in order to identify possible preventive strategies. DESIGN--Case-control design with pair matching of controls to cases in relation to age, sex, and area of residence. The cases and controls were identified by a community based, multisite survey. The effects of host and socioenvironmental variables reported by mothers were investigated in a multivariate analysis using conditional logistic regression. SETTING--A developing country setting the Ashanti Region in Ghana. PARTICIPANTS--These comprised 610 cases aged 0-5 years who had been burned (as evidenced by a visible scar) and 610 controls with no burn history. MAIN RESULTS--The presence of a pre-existing impairment in a child was the strongest risk factor in this population (OR = 6.71; 95% CI 2.78, 16.16). Other significant risk factor included: sibling death from a burn (OR = 4.41; 95% CI 1.16, 16.68); history of burn in a sibling (OR = 1.79; 95% CI 1.24, 2.58); and storage of a flammable substance in the home (OR = 1.51; 95% CI 1.03; 2.21). Maternal education had a protective effect against childhood burns, although this effect was not strong (OR = 0.76; 95% CI 0.55, 1.05). CONCLUSIONS--Community programmes to ensure adequate child supervision and general child wellbeing, particularly for those with impairments, as well as parental education about burns are recommended, to reduce childhood burns in this region of Ghana. The public should bed advised against storing flammable substances in the home.
PMCID: PMC1060106  PMID: 7798049
12.  Recurrent croup. 
Archives of Disease in Childhood  1985;60(6):585-586.
Thirty one of 486 children followed from birth had recurrent croup in the first four years of life. Twenty one were boys, and 10 girls. Recurrent croup occurred significantly more often in families with a positive history of allergy but was not significantly associated with the initial feeding method.
PMCID: PMC1777364  PMID: 4015178
14.  Clinical manifestations of allergy related to breast and cows' milk feeding. 
Archives of Disease in Childhood  1981;56(3):172-175.
The frequency of allergic manifestations in the first year of life was studied. The prevalence of allergic signs affecting the skin and respiratory tract in infants who had been started on breast feeding was compared with the prevalence of such signs in infants started on cows' milk formulae. The relationship of allergy to family history was investigated. Eczema and rhinitis were found to be present as often in the initially breast-fed group as in the initially cows' milk-fed group. Bottle-fed infants developed asthma and bronchitis more often than their breast-fed counterparts. Infants of allergic parents exhibited more allergy than those from non-allergic families, and this difference was particularly pronounced for asthma or bronchitis. Breast feeding gave some protection against the development of respiratory tract allergies in infants of non-allergic parents. Among the infants with a positive family history of allergy, fewer with eczema or chronic rhinitis were found in the initially breast-fed group group but this did not achieve statistical significance.
PMCID: PMC1627162  PMID: 6894227
15.  Relative activity of beta-blockers. 
British Medical Journal  1978;2(6138):704.
PMCID: PMC1607436  PMID: 29694
16.  Failure to vaccinate children against measles during the second year of life. An analysis of immunization practices in two Tennessee county health departments. 
Public Health Reports  1976;91(2):133-137.
In many Tennessee counties, children under the care of health departments have low measles vaccination levels. An immunization survey and a health department record audit of 2-year-olds were undertaken in two counties to determine the reasons for this situation. The results indicated that faulty clinic procedures played a large part in the failure to vaccinate against measles. Nearly half of the unvaccinated 2-year-olds with health department records had been present in the health department clinic at the appropriate age for measles vaccination; the remainder had dropped out of the well-child program before their first birthday. Emphasis on tuberculin skin testing and delay in the administration of the basic series of DTP immunizations correlated with the failure to vaccinate against measles. For more than half of the children who attended the clinic after their first birthday, no reason was recorded for the failure to vaccinate them against measles. Improved clinic procedures could bring measles vaccination levels within the acceptable range. These procedures would include new methods for correcting immunization delinquency, simultaneous tuberculin skin testing and measles vaccination of children without a history of tuberculosis exposure, emphasis on vaccinating at-risk groups, and more convenient vaccination clinic hours.
PMCID: PMC1438513  PMID: 822461

Results 1-16 (16)