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Compares the Missouri State Department of Health linked birth-infant death certificate database and medical records with respect to recording hyaline membrane disease in very low-birthweight infants. Percentage of the birth certificates and medical records with documented hyaline membrane disease; Sensitivity and specificity of documents.

Objective: We examined the hypothesis that black race independent of other factors increases the risk for extreme preterm birth and its frequency of recurrence at a similar gestational age., Study Design: We conducted a population-based cohort study using the Missouri Department of Health's maternally linked database of all births in Missouri between 1989 and 1997 for factors associated with recurrent preterm delivery., Results: Recurrent black preterm births occurred at increased frequency (adjusted odds ratio 4.11 [95% confidence interval 3.78 to 4.4.47]) and earlier gestations (31 versus 33 weeks' median age) than white births. Black siblingships also had higher multiplicity of prematurity (odds ratio 2.14 [95% confidence interval 1.49 to 3.07] and 5.09 [95% confidence interval 1.26 to 20.51] for 3 and 4 preterm births). Additionally, 47% of women delivered recurrent preterm infants within 2 weeks of the gestational age of their initial preterm infant., Conclusion: Overrepresentation of preterm births in blacks occurs independently of maternal medical and socioeconomic factors. Furthermore, the grouping of timing for preterm birth in different pregnancies of the same mother implicates important genetic contributors to the timing of birth.

Background: Little is known about the temporal relationship between an asthma exacerbation and a painful episode in a child with sickle cell disease (SCD). We tested the hypothesis that respiratory symptoms either immediately precede or occur concomitantly with painful episodes more frequently in children with SCD and asthma when compared with children with SCD without asthma., Methods: A cohort study was conducted. As part of standard care, the primary hematologist referred all children with SCD for evaluation by a pulmonologist. The definition of asthma was based on the National Heart Lung and Blood Institute's guidelines. All painful episodes during a 25-month sampling frame were reviewed. Events that were diagnosed as asthma exacerbations were excluded from analysis. Respiratory symptoms (cough, wheeze, tachypnea, retractions, or grunting) were included if they occurred up to 96 hours before a painful episode., Results: A total of 74 children were evaluated for a painful episode. Of these patients, 36 were diagnosed with asthma (mean age 9.8 y; range 2.4 to 19.4) and 38 were determined not to have asthma (mean age, 9.8 y; range 2.4 to 19.5). Among the children with pain and asthma, the odds ratio of having antecedent or concurrent respiratory symptoms was 4.9 (95% confidence intervals, 2.2-10.7) when compared with children with pain and without asthma., Conclusions: In children with both SCD and asthma, respiratory symptoms are a risk factor for painful episodes within 96 hours.

The primary objective of this study was to improve the educational success of children with sickle-cell disease (SCD) and cerebral infarcts. A prospective intervention trial was conducted; a multidisciplinary team was created to maximize educational resources for children with SCD and cerebral infarcts. Students were evaluated systematically before and after the intervention. A baseline evaluation was completed assessing the presence of an Individualized Education Plan (IEP), grade retention in school, and days absent from school in the year preceding the intervention. A postintervention assessment occurred 2 years later for these same measurements. At baseline, 74% (17 of 23) of the students were receiving IEPs. Two years later, 87% (20 of 23) students received IEPs (p = .34). Despite the intervention, the rate of children retained in their school grade increased from 0.6 per 100 years in school at baseline to 1.7 per 100 years, 95% CI (-3.86, 1.49). The school absenteeism rate did not significantly change after the intervention; the average days absent per student rose from 15.5 to 22.5, (p = .05). The multidisciplinary team effort alone was insufficient to decrease grade retention and absenteeism rate. Further support, from either the parents or school administration, is needed to increase education attainment of students with cerebral infarcts.

This program evaluated the effectiveness of a sickle cell disease (SCD) education program for teachers of students with SCD in their classroom. Teachers with students in a remediation program for students participated in an educational program consisting of four domains: Inheritance and Prevalence, Common Complications, Strokes, and Individual Education Plans (IEP). A 30- to 45-minute presentation was given with a pretest and posttest. Eighty-one teachers who taught grades K-12 completed the program. Most teachers understood the complications of fever and pain, risks of strokes occurring at any age, and the purpose of IEPs. Overall the rate of correct answers increased from 72.5% to 83.1%, p = 0.0001. Teachers improved their understanding of heredity (32% vs. 66%, p = 0.0001), prevalence (81% vs. 94%, p = 0.039), silent stroke diagnosis (21% vs. 80%, p = 0.0001) and overt stroke therapy (40% vs. 75%, p = 0.0001). No significant impact on teacher knowledge occurred for the contents of IEPs (80% vs. 87%, p = 0.227). Teachers of students with SCD increased knowledge about SCD following the program.