Jan E. Drutz

Blood Lead Levels in a Continuity Clinic Population

INTRODUCTION Lead toxicity is well recognized as a significant cause of morbidity in children, especially those under the age of six years. While lead toxicity has not been recognized as a public health problem in Houston, it is possible that children in the area suffer from low-level lead effects on the central nervous system. OBJECTIVES To detect asymptomatic cases of lead toxicity in one population of Houston children and to assess the effectiveness of the lead risk questionnaire. DESIGN Venous blood samples for quantitative lead were analyzed utilizing the Anodic Stripping Voltameter. The Centers for Disease Controls lead risk assessment questionnaire was administered to each patient. SETTING Baylor College of Medicine Continuity Clinic at Texas Childrens Hospital. SUBJECTS All patients, ages 9-72 months, seen for routine care between December 1992 and June 1994 were screened once. RESULTS Blood lead levels were obtained on 801 children; all but 47 completed lead risk questionnaires. The mean age of the study group was 2.37 years (SD 1.84) and they were 54% male. They were 39% Hispanic, 39% Black, and 18% White. Eighty-eight percent reported an annual income of <

Improving Return Visits In Private Provider Offices Through Immunization Reminder/Recall. † 649

20,000. They lived in 127 separate zip codes. Twenty-five (3.1%) patients had elevated blood lead, 21 between 10-14 micrograms/dL and 4 between 15-19 micrograms/dL. No patients had blood lead levels of > or = 20 micrograms/dL. No statistically significant differences were found between patients with blood lead < 10 micrograms/dL and those with > or = 10 micrograms/dL when comparing for age, sex, ethnicity, income, and zip code. Only those children living in or regularly visiting a pre-1960 home with peeling or chipping paint were significantly more likely to have elevated blood lead (p = .045). CONCLUSION Although the majority of children in our setting were poor and urban, the prevalence of blood lead > or = 10 micrograms/dL was 3.1%, well below the estimated 17% quoted by the Centers for Disease Control in recommending stringent screening guidelines. The lead risk assessment questionnaire failed to identify 32% of children with elevated blood lead levels. Since this questionnaire is critical to screening populations at low risk for lead toxicity, it is important to determine whether a revised questionnaire or a more careful elicitation of parental responses will improve identification of those children at risk.

Brucellosis of the Central Nervous System A Case Report of an Infected Infant

Improving Return Visits In Private Provider Offices Through Immunization Reminder/Recall. † 649

Use of Health Care Services by Pediatrics Residents: A CORNET Study

Brucellosis in early infancy is unusual and reports of congenitally acquired infection are extremely rare. The patient presented at the age of 8 months with high fever and signs of meningitis. He had a previous history of hydrocephalus undergoing shunt alleviation at I month of age. A diagnosis of central nervous system (CNS) brucellosis was subsequently made. Trans-placental transmission is offered as a possible explanation for the acquisition of this childs brucellosis infection.

The prevalence and practice of academies of medical educators: a survey of U.S. medical schools.

BACKGROUND The personal health practices of residents and their access to health care has not been well explored. Suboptimal personal health care habits and practices among many physicians may evolve during residency. OBJECTIVE To identify the nature and extent of pediatrics resident health care use and the factors that restrict or facilitate use. METHODS A web-based survey was sent to pediatrics residents from 19 continuity practice sites enrolled in the nationwide Continuity Research Network (CORNET) during April through June 2010. Outcome measures included self-report of health care use, involvement in an established care relationship with a primary care provider, and barriers residents encountered in receiving care. RESULTS Of 1210 eligible residents, 766 (63%) completed the survey. Respondents were 73% women; each postgraduate training year was equally represented. More than one-half of residents (54%) stated they had an established care relationship (ECR) with a primary care provider. Interns were less likely to have an ECR when compared with upper level residents; female residents were twice as likely to have an ECR compared with male residents. Although 22% (172 of 766) of the respondents reported they had a chronic health condition, only 69% (118 of 172) of those individuals had an established care provider. The most significant barrier to obtaining health care was resident concern for time away from work and the potential increased workload for colleagues. CONCLUSIONS A slight majority of pediatrics residents stated they had an established relationship with a primary care provider. The most common barriers to seeking routine and acute care were work related.