Biomedical subjects

Mark H Sawyer

Publications and source records attributed to Mark H Sawyer.

12 recordsLinked to original sources

PubMed2006

Human bocavirus: prevalence and clinical spectrum at a children's hospital.

BACKGROUND: Molecular methods of pathogen discovery have recently led to the description of several new respiratory viruses. Human bocavirus (HBoV), a proposed member of the family Parvoviridae, is one of the most recently described respiratory viruses. Initial reports indicate that HBoV is a common cause of respiratory tract infection in children. METHODS: A total of 1474 nasal scraping specimens collected over a 20-month period were screened by polymerase chain reaction for the presence of HBoV nucleic acid. Positive results were confirmed with a second polymerase chain reaction assay from a different genomic region. The medical records of patients with positive results were reviewed for demographic and clinical data. RESULTS: HBoV DNA was identified in 82 samples (5.6%). The peak rate of HBoV infection occurred during the period of March through May in both 2004 and 2005. Sixty-three percent of infected patients were <12 months of age. The most common symptoms were cough, rhinorrhea, and fever. Other symptoms of interest included diarrhea and a "paroxysmal" cough that was clinically suspected to be caused by Bordetella pertussis. CONCLUSIONS: HBoV DNA is commonly present in children with upper and lower respiratory tract infections. The presence of a pertussis-like cough and diarrhea in association with HBoV infection merits further investigation.

Adolescent↗

PubMed2005

Hepatitis A vaccine uptake in San Diego County: Hispanic children are better immunized.

BACKGROUND: Few studies have examined compliance with hepatitis A vaccination recommendations or factors likely to predict vaccination against hepatitis A virus. OBJECTIVES: To investigate hepatitis A coverage among 3- to 17.9-year-olds in San Diego County and examine predictors of child and adolescent hepatitis A immunization. DESIGN, SETTING, AND PARTICIPANTS: A total of 1455 participants completed a random-digit dial telephone survey that assessed hepatitis A immunization status of 3- to 17.9-year-old children from May 1 to June 24, 2003. Analysis was limited to the 983 respondents with available immunization records or verified immunization histories. MAIN OUTCOME MEASURES: Receipt of at least 1 hepatitis A vaccine administered on or after the child's second birthday and differences in the frequencies of vaccination based on vaccine availability, sex, ethnicity, type of health care provider, mother's highest level of education, and parental knowledge of the hepatitis A vaccine recommendation. RESULTS: Participant response rate was 77.1%. Among all respondents aged 3 to 17.9 years, 59% received at least 1 hepatitis A vaccine and 41% completed the 2-shot regimen. The adjusted odds that a child received at least 1 hepatitis A vaccine was 3.6 times greater among Hispanic children compared with non-Hispanic children. Other predictors of hepatitis A immunization included child's age, having a public health care provider, lower maternal education, and parental knowledge of the vaccine recommendation. CONCLUSIONS: Results challenge historical patterns of underimmunization among Hispanic children compared with white children. Public health education and community awareness should be sustained in Hispanic communities, but interventions are needed in non-Hispanic communities.

Adolescent↗

PubMed2004

Acute disseminated encephalomyelitis in childhood: epidemiologic, clinical and laboratory features.

BACKGROUND: Acute disseminated encephalomyelitis (ADEM) is a central nervous system demyelinating disease that usually follows an apparently benign infection in otherwise healthy young persons. The epidemiology, infectious antecedents and pathogenesis of ADEM are poorly characterized, and some ADEM patients are subsequently diagnosed with multiple sclerosis (MS). METHODS: We retrospectively (1991-1998) and prospectively (1998-2000) studied all persons aged < 20 years diagnosed with ADEM from the 3 principal pediatric hospitals in San Diego County, CA, during 1991-2000. Acute neurologic abnormalities and imaging evidence of demyelination were required for study inclusion. Epidemiologic variables, risk factors, clinical course, laboratory and radiographic findings, neuropathology and treatment data were analyzed. Interleukin (IL)-12, interferon-gamma (IFN-gamma) and IL-10 were assayed in blinded manner on cerebrospinal fluid (CSF) obtained prospectively from a subset of ADEM cases and compared with CSF from patients with enteroviral (EV) meningoencephalitis confirmed by polymerase chain reaction (PCR) and controls without pleocytosis. RESULTS: Data were analyzed on 42 children and adolescents diagnosed with ADEM during 1991-2000, and CSF IL-12, IFN-gamma and IL-10 levels were compared among ADEM (n = 14), EV meningoencephalitis (n = 14) and controls without pleocytosis (n = 28). Overall incidence of ADEM was 0.4/100,000/year; incidence quadrupled during 1998-2000 compared with earlier years. No gender, age stratum, ethnic group or geographic area was disproportionately affected. A total of 4 (9.5%) patients initially diagnosed with ADEM were subsequently diagnosed with MS after multiple episodes of demyelination. Although most children eventually recovered, 2 died, including 1 of the 3 ultimately diagnosed with MS. Magnetic resonance imaging was required for diagnosis among 74% of patients; computerized tomography findings were usually normal. Patients with EV had significantly higher mean CSF IFN-gamma (P = 0.005) and IL-10 (P = 0.05) than patients with ADEM and controls without CSF pleocytosis. CSF from ADEM patients had CSF cytokine values statistically similar to those of 3 patients subsequently diagnosed with MS. CONCLUSIONS: ADEM is a potentially severe demyelinating disorder likely to be increasingly diagnosed as more magnetic resonance imaging studies are performed on patients with acute encephalopathy. Further characterization of the central nervous system inflammatory response will be needed to understand ADEM pathogenesis, to improve diagnostic and treatment strategies and to distinguish ADEM from MS.

Adolescent↗

PubMed2004

Acute disseminated encephalomyelitis associated with enteroviral infection.

A case of acute disseminated encephalomyelitis in 13-year-old boy associated with enterovirus is described. The patient had symptoms of severe headache and photophobia for 2 days. Diagnosis was made on the basis of diffuse high intensity white matter lesions in the left frontoparietal region seen on magnetic resonance imaging, and positive enterovirus polymerase chain reaction in cerebrospinal fluid. His symptoms improved substantially without specific therapy, and he recovered without neurologic sequelae.

Acute Disease↗

PubMed2003

Successful treatment of Balamuthia amoebic encephalitis: presentation of 2 cases.

Case histories are presented of 2 individuals (a 5-year-old girl and 64-year-old man) who developed encephalitis caused by the free-living amoeba Balamuthia mandrillaris. Both individuals survived after diagnosis and initiation of effective antimicrobial therapy. Immunostaining for Balamuthia-specific antibody levels identified the causative agent of the infections. Antimicrobial therapy with flucytosine, pentamidine, fluconazole, sulfadiazine, and a macrolide antibiotic (azithromycin or clarithromycin) was initiated. Phenothiazines (thioridazine and trifluoperazine) were also used. Both patients recovered, and there was no evidence of recrudescence of the disease at 2 and 6 years after onset of symptoms. Awareness of Balamuthia as the causative agent of encephalitis and early initiation of antimicrobial therapy were critical to the recovery of both patients. Although optimal antimicrobial therapy for Balamuthia amoebic encephalitis has yet to be determined, the antimicrobials used in these 2 cases effectively controlled the disease. These 2 individuals are the only known survivors of this otherwise fatal type of amoebic encephalitis.

Amebiasis↗

PubMed2003

A prenatal intervention study to improve timeliness of immunization initiation in Latino infants.

This was a prospective randomized cohort study to assess the effectiveness of an educational immunization intervention with pregnant Latinas on timely initiation of infant immunization. Study participants were recruited from two community clinics in north San Diego County. A total of three hundred and fifty-two Latinas in the third trimester of pregnancy were recruited and randomly assigned to intervention or control groups. Participants received either a culturally and linguistically appropriate session on infant immunization (intervention) or a session on prevention of Sudden Infant Death Syndrome (control). The main outcome measures were pre-post immunization knowledge change and infant immunization status at 92 days. Immunization knowledge increased significantly in the intervention group [p < .0001, 95%CI (1.76, 2.47)]. No difference was found between groups in immunization series initiation: 95 percent of the children in the intervention group were up-to-date by 92 days from birth, and 93 percent of the control group was up-to-date at 92 days. The lack of significant association between receiving immunization education and infant immunization series initiation suggests that parent education may be necessary but not sufficient for timely immunization, particularly in clinics with effective well-child programs. Given the significant increase in immunization knowledge, the broader and perhaps more important implication is that language- and culturally specific infant health education messages in the prenatal period may have a positive long-term impact on the child's health and promote well-child care overall. Future studies should assess the role of prenatal well-child education in the context of clinics with low immunization levels.

Adult↗

PubMed2002

Provider-staff discrepancies in reported immunization knowledge and practices.

BACKGROUND: The purpose of the study was to compare immunization-relevant knowledge, certainty about knowledge, self-efficacy, vested interest, and reported practices of providers and clinical staff in the same clinics. METHODS: A valid and reliable instrument measuring the aforementioned issues was developed and administered to a sample of 50 providers and 60 members of the clinical staff. RESULTS: Providers were significantly more knowledgeable than staff (P < 0.001); however, they were not more certain about their knowledge (P = 0.52) nor were they more confident in their capability to properly immunize all children in their practice (P = 0.10). Providers reported lower vested interest in immunizations than clinical staff (P < 0.05). Both groups were equally likely to immunize a child with a cold. Providers were less likely to defer needed immunizations for a 15-month-old child, and they were more likely to administer multiple injections to an 18-month-old (both P < 0.05). Providers were more likely than staff to immunize during acute and chronic illness visits (both P < 0.001), and both groups were equally likely to immunize during preventive visits. CONCLUSIONS: Discrepancies in reported immunization practices between providers and staff may be a barrier to full immunization.

Attitude of Health Personnel↗

PubMed2002

Missed opportunities to immunize: psychosocial and practice correlates.

BACKGROUND: The goal of this pilot study was to correlate missed opportunities to immunize young children with providers' psychosocial characteristics and self-reported immunization practices. METHODS: In a population of children aged 0 to 36 months, missed opportunities to immunize were established for a sample of 28 providers, who also responded to a valid and reliable instrument measuring the aforementioned variables. RESULTS: Missed opportunities were significantly lower among providers with higher vested interest (r=-0.45, p=0.02) and tended to be lower among providers with more positive attitudes toward having all children properly immunized at every healthcare visit (r=-0.33, p =0.09). Neither knowledge nor perceived barriers correlated significantly with missed opportunities. Providers missed opportunities to immunize in over half of the visits studied (mean, 0.58), yet all of them reported always immunizing at preventive and follow-up visits, almost all (96.3%) at chronic illness visits, and a majority (78.6%) at acute care visits. As a result, none of the self-reported immunization practices was significantly correlated with missed opportunities. CONCLUSIONS: Missed opportunities appear to be best predicted by motivational psychosocial factors and not by knowledge or perceived barriers. Self-reported immunization practices do not correspond to actual immunization behavior.

Child, Preschool↗

PubMed2002

Enterovirus infections: diagnosis and treatment.

Enteroviruses cause infections that present in diverse ways and affect people of all ages. Infections peak during summer and fall epidemics and cause 10 to 15 million symptomatic infections annually in the United States. The 70 enteroviral serotypes cause illness that ranges from nonspecific fevers and rashes to life-threatening myocarditis or central nervous system disease. These common infections create a significant burden on our society and healthcare system. New developments in rapid diagnosis of enterovirus infections using polymerase chain reaction (PCR) positively affect patient management and have the potential to reduce the healthcare impact of enterovirus infection. The future holds promise for effective antiviral drugs that can treat enterovirus infections and decrease their significant morbidity and mortality.

Adult↗

PubMed2002

The forms that bind: multiple data forms result in internal disaggregation of immunization information.

To examine how forms encountered during routine clinical activities impact a provider's immunization activity, workflow analysis was performed in nine community clinics and small private practices. Data gathered included the number, source, and nature of forms. A total of 200 forms were used by the nine clinics just for children under 35 months of age. These represent a real labor cost as well as an opportunity cost. Use of a single summary sheet, yearly review of the forms, and coordination of agency documentation efforts are recommended.

California↗

PubMedDate not supplied

Non-punctual patients: planning for variability in appointment arrival times.

Tighter competition and rationed resources place a premium on health clinic management of patient arrival times to maximize smooth workflow dynamics and consistency in patient processes. Early efforts to analyze patient arrival characteristics relied on assumptions that may have been too simplistic. For instance, it was assumed that a scheduled patient's arrival was likely to fit a bell-shaped curve in terms of being early, late, or on time and that any one patient's likelihood of being "on time" was purely a random event. However, our analysis of patient arrival times, obtained from detailed workflow observations in nine community clinics, indicates that the likelihood of a patient arriving early, late, or on time is neither entirely random nor does the pattern of arrivals fit a bell-shaped curve. Rather, patients tend to arrive in "clumps," possibly due to factors such as traffic patterns and parking availability. These findings are important with respect to 1) clinic practice management, 2) scheduling optimization strategies, and 3) computer simulation and analysis of clinic processes.

Appointments and Schedules↗

PubMedDate not supplied

Can the doctor still see me? What happens when patients arrive late?

Demands to optimize productivity and quality require a patient scheduling system that can balance patient demand and clinic resources. The consequences of unscheduled and late patient arrivals on operational efficiencies have been documented. Less understood is the impact of unscheduled and late arrivals on the quality of service each receives. This article examines the impact of unscheduled and late patient arrivals on operational, clinical and administrative outcomes that affect quality of care of children potentially eligible for immunizations. An unexpected finding was the generally better and faster levels of service for late arrivals.

Ambulatory Care↗