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THE WEST
VIRGINIA CHAPTER, AMERICAN ACADEMY OF
PEDIATRICS
RESIDENT RESEARCH CONTEST WINNERS
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2002 RESEARCH CONTEST WINNERS |
First Place:
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Title of
Paper: |
Before
and After Books Reading
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Study: |
The
West Virginia Experience
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Author(s): |
Kreisler, KD; Valentin, HH
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Affiliation: |
West Virginia University SOM, Morgantown, WV
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Objective: |
To evaluate the effectiveness
of a clinic based literacy promotion on parental perceptions of reading
aloud to their children.
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Design: |
Prospective study. Random, convenience sample. Initially parents were read a statement asking
if they would like to answer questions about their child, but no mention
of reading was made. Parents were
then read a 16 question survey. The
first questions on the survey were open-ended without any reference to reading
or books. Surveys were read aloud
in exam rooms to ensure that other families would not hear content of questions.
Then, a three-part intervention was implemented. The three components were: 1. Providers gave
a new book to all children ages 6 months to 5 years presenting for a check-up.
2. Providers gave these same patients anticipatory
guidance regarding reading aloud to children. 3. Volunteers
read aloud in the clinic waiting room. The same survey was repeated one year later
on another random, convenience sample.
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Subjects: |
105 consecutive parents of patients
age 6 months to 5 years presenting for well child care were randomly chosen
by convenience sample prior to implementation of the reading program. One year after implementation of program,
100 consecutive parents were read the same survey. Subjects were matched for gender, birth weight, parental education,
languages spoken at home, number of adults and other children living at
home. Over 85% of parents completed
at least the equivalent of a high school education. Over 90% of families spoke English only in
their home. Three patients were
excluded due to birth weight less than 1500 gm or severe neurodevelopmental
disability. Subjects were also excluded
from the after intervention group if their child had not visited the clinic
for a check up during the previous year.
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Results: |
Prior to the intervention 17% of parents reported receiving
a book from their doctor or encouragement to read aloud versus 70% after
the intervention (p<0.0001). Prior
to the intervention 39% of parents reported reading as one of their three
favorite things to do with their child.
After the intervention 54% of parents reported reading as one of
their three favorite things to do with their child (p-0.05).
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Conclusion: |
Parents remember when they receive books from their provider. This positively influences parental perceptions
of reading aloud to their children even when parents are well-educated and
speak only English at home. While prior studies have shown positive result in low income,
multilingual populations, we propose that all preschool age children may
benefit from this intervention.
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Second Place:
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Title of
Paper: |
Adverse
Outcomes in Hospitalized Neonates Presumed to Be Healthy
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Author(s): |
DiFilippo, M; Edwards, A; Werthammer, J
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Affiliation: |
Marshall University School of Medicine, Huntington
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It
has recently been recommended that neonates requiring resuscitation at
birth, despite appearing normal at 5 minutes of age, be transferred to
an environment where close monitoring can be provided (Textbook of
Neonatal Resuscitation, 4th Ed.)
In order to test this recommendation, we retrospectively reviewed a
one year experience from our delivery service. 2540 term infants delivered over this time
year. 33 infants delivered with
2 minute apgar < 4 (average 3.1 + 0.9) and 5 minute apgar
of >8 (average 8.5+ 0.5).
All infants were breathing spontaneously at 5 minutes of age. Of these 33 depressed infants, 20 were admitted
to our newborn nursery (NBN) and 13 others showed symptoms after 5 minutes
of age, while in the delivery room, requiring admission to our NICU.
Of the 20 infants admitted to NBN, 7 developed complications with
4 requiring subsequent transfer to our NICU.
Of the 13 infants transferred directly to our NICU, 10 were moved
to the NBN after 8 hours and 3 required prolonged NICU hospitalization.
Complications included hypoglycemia 7/33 (21%), transient tachypnea
of the newborn 6/33 (18%), meconium aspiration syndrome 2/33 (6%), hypermagnesemia
with hypotonia 2/33 (6%), hyperbilirubinemia 1/33 (3%), and pneumothorax
1/33 (3%). All complications except
one were detected within 8 hours of birth.
We conclude that infants depressed at
birth and seemingly recovered at 5 minutes of age have significant morbidity
(42%). Our data support increased
surveillance of these infants for 8 hours after birth.
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Third Place:
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Title of
Paper: |
Tracking
the Emergency of Penicillin Resistance of Streptococcus Pneumoniae By Analysis
of Its Penicillin Binding Protein 2b Gene.
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Author(s): |
Smith, Chadwick; Stanek, Ronald; Mufson, Maurice
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Affiliation: |
Marshall University School of Medicine, Huntington
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| Objective: |
Penicillin resistance in Streptococcus
pneumoniae (pneumococcus) (PRSP) emerged worldwide in the last three
decades, mainly in serotypes 6,9,14,19 and 23. It develops because of alterations in the penicillin binding proteins
(pdp) of the organism. We tracked
penicillin resistance among invasive S. pneumoniae isolated recovered from children in Huntington by
characterization of the pbp 2b gene using restriction fragment length
polymorphism (RFLP). Our goal
was to identify and evaluate mutations in the pbp 2b gene in relation
to penicillin resistance among S.
pneumoniae circulating within the pediatric population. Methods:
We amplified the pbp 2b gene by DNA extraction and PCR amplification
from 68 pneumococcal isolates obtained from children ages 0-4 years with
invasive infections during 1989-2001. 52 isolates were sensitive to penicillin, 11 intermediate resistant,
and 5 resistant, as determined by E-test. The PCR product was cut with two restriction
enzymes, Hinfl and Haefil, and the resulting DNA restriction
fragments were separated using gel electrophoresis.
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| Methods: |
We amplified the pbp 2b gene by DNA extraction and
PCR amplification from 68 pneumococcal isolates obtained from children ages
0-4 years with invasive infections during 1989-2001. 52 isolates were sensitive to penicillin, 11 intermediate resistant,
and 5 resistant, as determined by E-test. The PCR product was cut with two restriction
enzymes, Hinfl and Haefil, and the resulting DNA restriction
fragments were separated using gel electrophoresis.
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| Results: |
Serotypes 6, 14, 18 and 19 comprised 56 (82.4%)
of 68 isolates and 1.3,4,5,7.9,10,16,22 and 23 comprised the remaining isolates. 16 (23.5%) of 68 isolates were PRSP, namely
nine serotype 114, two serotype 19, three serotype 6 and one each of serotype
9 and 23. Sensitive isolates showed
three different RFLP patterns, designated S1, S2 and S3. S2 occurred in all thirteen years, S1 occurred
in eight years and S3 occurred in only one year. Three intermediate PRSP had S1 of S2 RFLP
and three other intermediate PRSP exhibited three unique RFLPs. Five resistant and two intermediate PRSP
exhibited a markedly different RFLP that occurred only in the last three
years.
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| Conclusion: |
Multiple serotypes account for invasive pneumococcal
infection within the pediatric community, but PRSP occurred in only five
serotypes. The RFLP analyses showed that three clones
characterized all penicillin sensitive isolates. Eight clones characterized PRSP and these were sporadic and usually
limited to single isolates. However,
RFLP reliably identified high resistant isolates. These findings show that recent high PRSP
isolates reflect successive changes in the pbp 2b gene.
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Third Place:
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Title of
Paper:
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Comparison of Primary Brain Tumor
Incidence in Childhood in West
Virginia to That of the Neighboring
States and Further with the National
Brain Tumor Incidence: Parallel Data from Charleston Area
Medical Center (CAMC)
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Author:
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Amana
Nasir, M. D.
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Affiliation:
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West
Virginia University, Charleston
Division, Charleston
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Purpose:
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To study the brain tumor
incidence trends in the State of
West Virginia in comparison to the
surrounding states.
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Methods:
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Data from the cancer registries
of Ohio, Pennsylvania, Maryland,
Kentucky and Virginia was obtained
in the form of chronologically
arranged statistics for the years
1990-2000.
Surveillance, Epidemiology and End results (S.E.E.R.) data years
1975-1995,
and web resources for National
Cancer data were also utilized.
Statistical analyses were performed
using the Chi-Square, Odds Ratio and
P-value. Inclusion and exclusion criteria were based on
establishment of Cancer registry for
the period of time from 1990-2000
and timely availability of data on
request from the registry, i.e., if
the registry responded in time with
the required figures they were
included in the comparison.
Correspondence was a limiting factor due to the study duration
being only one month.
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Results: |
West Virginia has a higher than
average malignant brain tumor
incidence in the 0-19 year
population when statistics were
studied from 1990-2000, with a
P-value being of significance at
<0.0001. Neighboring states had rates
comparable to the nation, and
considerably lower than West
Virginia. There was no evidence that this
disparity was narrowing over the
years.
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Conclusion:
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Higher incidence of pediatric
malignant brain tumors in West
Virginia needs to be further
evaluated by looking into the risk
factors, and then strategies to
lower this incidence should be
implemented.
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2001 RESEARCH CONTEST WINNERS |
First Place:
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Title of Paper: |
Successful
Short Term Treatment of Obesity in School-Age Children
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Author(s): |
Misty
Trent Strow, James R. Bailes, Adrian R. McGinnis, Lewis Spangler, Jr and
Isabel Pino
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Affiliation: |
Marshall
University School of Medicine, Huntington
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Background: |
Obesity
is a major health problem among children in the United States leading to
increased morbidity and mortality later in life. We have previously shown
an incidence of 23% obesity in our patient population.
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Objective: |
To
compare two dietary interventions in the management of childhood obesity.
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Methods: |
Seventy
obese school-age children were enrolled in this study. Obesity was defined
as greater than the 95th percentile for body mass index (BMI). Height, weight,
BMI, blood pressure, lipid profile, and renal function were assessed in
all children. Each child was seen by a pediatric endocrinologist and a nutritionist.
Group A was assigned to a hypocaloric, low fat diet (55% CHO, 15-20% protein,
<30% fat). Group B was assigned to a high protein, low carbohydrate diet
without caloric restriction (7% CHO, 49% protein, 44% fat). The changes
in weight and BMI were compared between the groups.
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Results: |
A
total of 47 children (67%) completed the study with a minimum of 2 months
follow up. Obese children treated with high protein, low CHO diet (Group
B) lost a mean of 6 kg + 4.6 with a mean decrease in BMI of 2.8 kg/m2 +
1.7 when compared to obese children on a hypocaloric, low fat diet (Group
A) who gained a mean of 4.6 kg + 5.8 with an increase in BMI of 0.8 kg/m2
+2 (p-value 0.001).
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Conclusions: |
A
high protein, low carbohydrate diet is an effective method for weight reduction
in obese children.
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Third Place:
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Title of Paper: |
Postnatal
Growth in Very Low Birth Weight (VLBW) Infants
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Author(s): |
S.
Alexander, M. Williams, J. Werthammer
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Affiliation: |
Marshall
University School of Medicine, Huntington
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Background: |
The
literature is unclear regarding appropriate growth rate of VLBW infants
in the first 2 years of life.
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Objective: |
The
purpose of this study is to generate growth curves for VLBW infants seen
in our NICU follow-up clinic.
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Method: |
167
infants from our NICU follow-up clinic who were born January 1995 to December
1999, birth weight 500-1500 grams, considered appropriate for gestational
age, and seen on a minimum of two clinic visits were selected for our study.
The infants were divided into 4 cohorts based on birth weight by 250 gram
increments. Anthropometric data were collected and plotted verses corrected
age. Linear regression was used to interpolate standard data points.
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Results: |
We
constructed growth curves for weight (Wt), length (L), and head circumference
(HC) plotted against corrected age for 4 cohorts weighing 500-749, 750-949,
1000-1249, and 1250-1499 grams at birth. The curves showed convergence at
24 months corrected age of all 4 birth weight cohorts for WT, L and HC.
These premature infants at 24 months corrected age "caught up" with term
infants at 24 months but lagged behind this group when age was not corrected.
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Conclusion: |
We
have constructed growth curves for premature infants that can be used as
a guide for future VLBW infant graduates from our NICU.
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