How adult specialists deal with the principles of a successful transition

OBJECTIVES: To evaluate whether adult specialists comply with the basic principles for a successful transition of adolescents with chronic disorders, and to determine whether the characteristics of the adult specialists have an influence on applying these principles. METHODS: Out of 299 adult specialists in four French-speaking Swiss cantons, 209 (70%) answered a paper-and-pencil mailed questionnaire between May and July 2007. Only those having received the transfer of at least one adolescent in the previous 2 years (N=102) were included in the analysis. We analyzed four dependent variables: discussing common concerns of adolescent patients, seeing the patient alone, having a transition protocol, and having a previous contact with the pediatric specialist. A logistic regression was performed for each dependent variable controlling for the physicians' characteristics (number of transfers, age, gender, workplace, and perceived experience). RESULTS: Fifty-four percent of the physicians did not spend time alone with their patients, and sensitive issues such as sexuality or substance use were not widely discussed with their young patients. Most respondents (59%) did not have an established protocol, and 54% did not have any contact with the pediatric specialist. In the multivariate analyses, the adult specialists' characteristics had little impact. CONCLUSIONS: For many adolescents with chronic disorders the transition from pediatric to adult healthcare seems to be limited to a simple transfer, often lacking adequate communication between physicians. Applying simple but basic principles such as a good coordination between providers would probably improve the quality of healthcare of adolescents with chronic illness

Synchronization Analysis of Networks of Self- Sampled All-Digital Phase-Locked Loops

Abstract — This paper analyses the stability of the synchronized state in Cartesian networks of identical all-digital phase-locked loops (ADPLLs) for clock distribution applications. Such networks consist in Cartesian grids of digitally-controlled oscillator nodes, where each node communicates only with its nearest neighbors. Under certain conditions, we show that the whole network may synchronize both in phase and frequency. A key aspect of this study lies in the fact that, in the absence of an absolute reference clock, the loop-filter in each ADPLL is operated on the irregular rising edges of the local oscillator and consequently, does not use the same operands depending on whether the local clock is leading or lagging. Under simple assumptions, these networks of so-called “self-sampled ” all-digital phase-locked-loops (SS-ADPLLs) can be described as piecewiselinear systems, the stability of which is notoriously difficult to establish, The main contribution of this paper is a simple design rule that must be met by the coefficients of each loop-filter in order to achieve synchronization in a Cartesian network of arbitrary size. Transient simulations indicate that this necessary synchronization condition may also be sufficient for a specific (but important) class of SS-ADPLLs. A synthesis of the different approaches that have been conducted in the study of the synchronization of SS-ADPLLs is also done. I I

Consumo de leite de vaca e anemia na infância no Município de São Paulo Cow's milk consumption and childhood anemia in the city of São Paulo, southern Brazil

OBJETIVO: Avaliar a influência de consumo de leite de vaca sobre o risco de anemia em menores de cinco anos. MÉTODOS: Estudou-se amostra domiciliar de menores de cinco anos do Município de São Paulo (n=584) em 1995 e 1996. O diagnóstico de anemia (hemoglobina <11g/dl) foi feito a partir de sangue capilar obtido por punctura digital. O teor de leite de vaca e a densidade da dieta em ferro heme e ferro não heme foram obtidos a partir de inquéritos alimentares recordatórios de 24 horas. Modelos múltiplos de regressão linear e logística foram empregados para se estudar a associação entre teor de leite de vaca na dieta e concentração de hemoglobina ou risco de anemia, com o controle estatístico de possíveis variáveis de confundimento (idade, gênero, peso ao nascer, parasitas intestinais, renda familiar e escolaridade materna). RESULTADOS: A prevalência de anemia foi 45,2% e a contribuição média do leite no valor calórico total da dieta foi 22,0%. A associação entre consumo de leite e o risco de anemia manteve-se (p=0,041) significativa, mesmo após levar em conta o efeito diluidor do consumo de leite sobre a densidade de ferro da dieta. Evidenciou-se um possível efeito inibidor do leite sobre a absorção do ferro presente nos demais alimentos ingeridos pelas crianças. CONCLUSÕES: A participação relativa do leite de vaca na dieta infantil associa-se positiva e significativamente ao risco de anemia em crianças entre seis e 60 meses de idade, independentemente da densidade de ferro na dieta.<br>OBJECTIVE: To evaluate the influence of the consumption of cow's milk on the risk of anemia during childhood in the city of São Paulo. METHODS: We have studied a probabilistic sample (n=584) of underfive children living in the city of São Paulo, southeastern Brazil, between 1995 and 1996. Anemia (hemoglobin <11g/dl) was diagnosed using capillary blood obtained by fingertip puncture. The cow's milk content and the density of heme and nonheme iron in the child's diet were obtained using 24-hour recall questionnaires. Multiple linear and logistic regression models were used to study the association between cow's milk content in the diet and hemoglobin concentration or risk of anemia, and included statistical control for potential confounders (age, sex, birthweight, presence of intestinal parasites, family income, and mother's schooling). RESULTS: The prevalence of anemia was 45.2% and the mean contribution of milk to the total caloric content of the children's diets was 22.0%. The association between milk consumption and risk of anemia remained significant, even after considering the dilutive effect of milk consumption on the density of iron in the diet, thus indicating a possible inhibitor effect of milk on the absorption of the iron present in the other foods ingested by the child. CONCLUSIONS: The relative participation of cow's milk in the child's diet showed a significant positive association with risk of anemia in children between ages six and 60 months, regardless of the density of iron in the diet