PMCC PMCC

Search tips
Search criteria

Advanced
Results 1-10 (10)
 

Clipboard (0)
None

Select a Filter Below

Journals
Year of Publication
2.  International Child Health Elective for Pediatric Residents 
Background
There are increasing evidence highlighting the importance of incorporating issues of global health into pre- and post-graduate medical curricula. Medical international cooperation is a fundamental component of strategies to include global health issues in post-graduate medical curricula.
Methods
Here we describe a seven-year cooperation between the Non Governmental Organization (NGO) “Doctors for Africa CUAMM” and the Pediatric Residency Program (PRP) of the University of Padua (Italy) that offers residents a well-articulated personalized international child’s health (ICH) elective in Africa, called “Junior Project Officer”. The elective includes: a careful candidate selection process; pre-departure educational course; preceptorship in Padua and Africa, personalized learning objectives, a personalized job description, a six-month hands-on learning experience in Africa, evaluation of the experience, and formal private and open feed-backs/reports.
Results
Between 2006 and 2012, 14 residents aged from 27 to 31 years, six attending the III, nine the IV and two the V year of residency completed the six-month stage in Africa. All worked in pediatric in-patient units; seven also worked in out-patient clinics, six in emergency rooms and seven in community health centers. Eleven were involved in teaching activities and four in clinical research projects. All residents claimed to have achieved their learning objectives.
Conclusions
A strong partnership between the NGO and the PRP, and well-articulated personalized learning objectives and job description contributed to a successful ICH elective.
doi:10.1186/1824-7288-40-13
PMCID: PMC3922587  PMID: 24499625
Pediatrics; Medical education; International cooperation; Global health
3.  A short questionnaire to assess pediatric resident’s competencies: the validation process 
Background
In order to help assess resident performance during training, the Residency Affair Committee of the Pediatric Residency Program of the University of Padua (Italy) administered a Resident Assessment Questionnaire (ReAQ), which both residents and faculty were asked to complete. The aim of this article is to present the ReAQ and its validation.
Methods
The ReAQ consists of 20 items that assess the six core competencies identified by the Accreditation Council of Graduate Medical Education (ACGME). A many-facet Rasch measurement analysis was used for validating the ReAQ.
Results
Between July 2011 and June 2012, 211 evaluations were collected from residents and faculty. Two items were removed because their functioning changed with the gender of respondents. The step calibrations were ordered. The self evaluations (residents rating themselves) positively correlated with the hetero evaluations (faculty rating residents; Spearman’s ρ = 0.75, p < 0.001). Unfortunately, the observed agreement among faculty was smaller than expected (Exp = 47.1%; Obs = 41%), which indicates that no enough training to faculty for using the tool was provided.
Conclusions
In its final form, the ReAQ provides a valid unidimensional measure of core competences in pediatric residents. It produces reliable measures, distinguishes among groups of residents according to different levels of performance, and provides a resident evaluation that holds an analogous meaning for residents and faculty.
doi:10.1186/1824-7288-39-41
PMCID: PMC3726326  PMID: 23830041
Resident; Pediatrics; Evaluation; Medical residency
4.  Short term efficacy of nebulized beclomethasone in mild-to-moderate wheezing episodes in pre-school children 
Background
Few data are available on the usefulness of short term treatment with low-medium dose of inhaled corticosteroids (ICS) in pre-school children with wheezing exacerbations.
Methods
To compare the efficacy of one week treatment with 400 μg b.i.d. nebulized beclomethasone dipropionate (BDP), plus nebulized 2500 μg prn salbutamol (BDP group), versus nebulized b.i.d. placebo, plus nebulized prn 2500 μg salbutamol (placebo group), a post-hoc analysis was performed on data obtained in 166 pre-school children with multiple-trigger wheezing, recruited during an acute wheezing episode.
Results
The percentage of symptom-free days (SFDs) was significantly higher in the BDP group (54.7%) than in the placebo group (40.5%; p = 0.012), with a 35% relative difference. Day-by-day analysis showed that the percentage of SFDs was already higher in the BDP group after 2 days (7.4%), the difference reaching statistical significance at day 6 (12.3%; p = 0.035). Cough score was also reduced in the BDP group (0.11) as compared with the placebo group (0.39; p = 0.048), the difference reaching statistical significance after 5 days of treatment (0.18 and 0.47 respectively; p = 0.047). The mean number of nebulizations per day of prn salbutamol was lower in the BDP group as compared to the placebo group (0.26 and 0.34, respectively), but the difference was not significant (p = 0.366). There were no differences in positive effects of BDP treatment between children with and without risk factors for asthma.
Conclusions
A 1-week treatment with nebulized BDP and prn salbutamol is effective in increasing SFDs and improving cough in children with wheezing, providing a clinical rationale for the short term use of ICS in episodic wheeze exacerbations in pre-school children.
Trial Registration
ClinicalTrials.gov (NCT00497523)
doi:10.1186/1824-7288-37-39
PMCID: PMC3170583  PMID: 21859484
5.  Systems medicine and integrated care to combat chronic noncommunicable diseases 
Genome Medicine  2011;3(7):43.
We propose an innovative, integrated, cost-effective health system to combat major non-communicable diseases (NCDs), including cardiovascular, chronic respiratory, metabolic, rheumatologic and neurologic disorders and cancers, which together are the predominant health problem of the 21st century. This proposed holistic strategy involves comprehensive patient-centered integrated care and multi-scale, multi-modal and multi-level systems approaches to tackle NCDs as a common group of diseases. Rather than studying each disease individually, it will take into account their intertwined gene-environment, socio-economic interactions and co-morbidities that lead to individual-specific complex phenotypes. It will implement a road map for predictive, preventive, personalized and participatory (P4) medicine based on a robust and extensive knowledge management infrastructure that contains individual patient information. It will be supported by strategic partnerships involving all stakeholders, including general practitioners associated with patient-centered care. This systems medicine strategy, which will take a holistic approach to disease, is designed to allow the results to be used globally, taking into account the needs and specificities of local economies and health systems.
doi:10.1186/gm259
PMCID: PMC3221551  PMID: 21745417
6.  Assessment of Pediatric asthma drug use in three European countries; a TEDDY study 
European Journal of Pediatrics  2010;170(1):81-92.
Asthma drugs are amongst the most frequently used drugs in childhood, but international comparisons on type and indication of use are lacking. The aim of this study was to describe asthma drug use in children with and without asthma in the Netherlands (NL), Italy (IT), and the United Kingdom (UK). We conducted a retrospective analysis of outpatient medical records of children 0–18 years from 1 January 2000 until 31 December 2005. For all children, prescription rates of asthma drugs were studied by country, age, asthma diagnosis, and off-label status. One-year prevalence rates were calculated per 100 children per patient-year (PY). The cohort consisted of 671,831 children of whom 49,442 had been diagnosed with asthma at any time during follow-up. ß2-mimetics and inhaled steroids were the most frequently prescribed asthma drug classes in NL (4.9 and 4.1/100 PY), the UK (8.7 and 5.3/100 PY) and IT (7.2 and 16.2/100 PY), respectively. Xanthines, anticholinergics, leukotriene receptor antagonists, and anti-allergics were prescribed in less than one child per 100 per year. In patients without asthma, ß2-mimetics were used most frequently. Country differences were highest for steroids, (Italy highest), and for ß2-mimetics (the UK highest). Off-label use was low, and most pronounced for ß2-mimetics in children <18 months (IT) and combined ß2-mimetics + anticholinergics in children <6 years (NL). Conclusion: This study shows that among all asthma drugs, ß2-mimetics and inhaled steroids are most often used, also in children without asthma, and with large variability between countries. Linking multi-country databases allows us to study country specific pediatric drug use in a systematic manner without being hampered by methodological differences. This study underlines the potency of healthcare databases in rapidly providing data on pediatric drug use and possibly safety.
doi:10.1007/s00431-010-1275-7
PMCID: PMC3016194  PMID: 20811908
Pediatric asthma; Drug utilization
7.  Metabolomics: moving towards personalized medicine 
In many fields of medicine there is a growing interest in characterizing diseases at molecular level with a view to developing an individually tailored therapeutic approach. Metabolomics is a novel area that promises to contribute significantly to the characterization of various disease phenotypes and to the identification of personal metabolic features that can predict response to therapies. Based on analytical platforms such as mass spectrometry or NMR-based spectroscopy, the metabolomic approach enables a comprehensive overview of the metabolites, leading to the characterization of the metabolic fingerprint of a given sample. These metabolic fingerprints can then be used to distinguish between different disease phenotypes and to predict a drug's effectiveness and/or toxicity.
Several studies published in the last few years applied the metabolomic approach in the field of pediatric medicine. Being a highly informative technique that can be used on samples collected non-invasively (e.g. urine or exhaled breath condensate), metabolomics has appeal for the study of pediatric diseases. Here we present and discuss the pediatric clinical studies that have taken the metabolomic approach.
doi:10.1186/1824-7288-35-30
PMCID: PMC2773773  PMID: 19852788
8.  Childhood Asthma and Environmental Exposures at Swimming Pools: State of the Science and Research Recommendations 
Environmental Health Perspectives  2008;117(4):500-507.
Objectives
Recent studies have explored the potential for swimming pool disinfection by-products (DBPs), which are respiratory irritants, to cause asthma in young children. Here we describe the state of the science on methods for understanding children’s exposure to DBPs and biologics at swimming pools and associations with new-onset childhood asthma and recommend a research agenda to improve our understanding of this issue.
Data sources
A workshop was held in Leuven, Belgium, 21–23 August 2007, to evaluate the literature and to develop a research agenda to better understand children’s exposures in the swimming pool environment and their potential associations with new-onset asthma. Participants, including clinicians, epidemiologists, exposure scientists, pool operations experts, and chemists, reviewed the literature, prepared background summaries, and held extensive discussions on the relevant published studies, knowledge of asthma characterization and exposures at swimming pools, and epidemiologic study designs.
Synthesis
Childhood swimming and new-onset childhood asthma have clear implications for public health. If attendance at indoor pools increases risk of childhood asthma, then concerns are warranted and action is necessary. If there is no such relationship, these concerns could unnecessarily deter children from indoor swimming and/or compromise water disinfection.
Conclusions
Current evidence of an association between childhood swimming and new-onset asthma is suggestive but not conclusive. Important data gaps need to be filled, particularly in exposure assessment and characterization of asthma in the very young. Participants recommended that additional evaluations using a multidisciplinary approach are needed to determine whether a clear association exists.
doi:10.1289/ehp.11513
PMCID: PMC2679591  PMID: 19440486
aerosols; biologics; childhood asthma; DBPs; disinfection by-products; epidemiology; study design; swimming pools
9.  Longitudinal monitoring of lung injury in children following chlorine exposure in a swimming pool 
Rationale: Acute exposure to chlorine gas results in respiratory impairment, but few data are available on the pathobiology of the underlying lung damage. Objectives: To assess lung function and potential lung damage pathways in the acute phase and longitudinally over a 15-month follow-up after chlorine exposure. Methods: Ten previously-healthy children were accidentally exposed to chlorine gas at a swimming pool due an erroneous servicing procedure. Exhaled nitric oxide (FENO), exhaled breath condensate (EBC) compounds and serum Clara cell protein (CC16) were repeatedly measured. Main results: In the acute phase, all patients had respiratory distress (one child required mechanical ventilation) and reduced lung function (median and IQR: FVC 51% pred. [43-60], FEV1 51% pred. [46-60]). This was accompanied by low FENO (4.7 [3.9-7.9] ppb), high EBC leukotriene B4 (LTB-4) levels (24.4 [22.5-24.9] pg/mL) and increased serum CC16 levels (mean ± SE 23.4 ± 2.5 μg/L). Lung function returned to normal in 15 days (FVC 97% pred. [82-108] and FEV1 92% pred. [77-102]). FENO reached normal values after 2 months (12.6 [11.4-15] ppb), while LTB-4 levels were still increased (12 [9.3-17.1] pg/mL). Conclusion: Children acutely exposed to chlorine in a swimming pool presented a substantial lung function impairment associated with biochemical exhaled breath alterations, mainly represented by an increase in LTB-4 and a reduction in FENO. While lung function and FENO improved within a few weeks, the increased levels of exhaled LTB-4 persisted for several months.
doi:10.1164/rccm.200509-1392OC
PMCID: PMC1555620  PMID: 16763216
Chlorine inhalation; Pulmonary function; Exhaled nitric oxide; Exhaled breath condensate; Pneumoproteinemia
10.  Longitudinal Monitoring of Lung Injury in Children after Acute Chlorine Exposure in a Swimming Pool 
Rationale: Acute exposure to chlorine gas results in respiratory impairment, but few data are available on the pathobiology of the underlying lung damage.
Objectives: To assess lung function and potential lung damage pathways in the acute phase and longitudinally over a 15-mo follow-up after acute chlorine exposure.
Methods: Ten previously healthy children were accidentally exposed to chlorine gas at a swimming pool because of an erroneous servicing procedure. The fraction of nitric oxide in exhaled air (FeNO), exhaled breath condensate compounds, and serum Clara cell–specific protein CC16 were repeatedly measured.
Main results: In the acute phase, all patients had respiratory distress (one child required mechanical ventilation) and reduced lung function (median and interquartile range: FVC, 51 [43–60]% predicted; FEV1, 51 [46–60]% predicted). This was accompanied by low FeNO (4.7 [3.9–7.9] ppb), high exhaled breath condensate leukotriene B4 (LTB4) levels (24.4 [22.5–24.9] pg/ml), and increased serum CC16 levels (mean ± SEM, 23.4 ± 2.5 μg/L). Lung function returned to normal in 15 d (FVC, 97% predicted [82–108], and FEV1, 92% predicted [77–102]). FeNO reached normal values after 2 mo (12.6 [11.4–15] ppb), whereas LTB4 levels were still increased (12 [9.3–17.1] pg/ml).
Conclusion: Children acutely exposed to chlorine in a swimming pool presented a substantial lung function impairment associated with biochemical exhaled breath alterations, represented mainly by an increase in LTB4 and a reduction in FeNO. Although lung function and FeNO improved within a few weeks, the increased levels of exhaled LTB4 persisted for several months.
doi:10.1164/rccm.200509-1392OC
PMCID: PMC1555620  PMID: 16763216
chlorine inhalation; exhaled breath condensate; exhaled nitric oxide; pneumoproteinemia; pulmonary function

Results 1-10 (10)