Publications by authors named "James J Burns"

12 Publications

  • Page 1 of 1

The Proximity of Spatial Clusters of Low Birth Weight and Risk Factors: Defining a Neighborhood for Focused Interventions.

Matern Child Health J 2020 Aug;24(8):1065-1072

Department of Mathematics and Statistics, University of West Florida, Building 4, Room 336, 1111 University Parkway, Pensacola, USA.

Background: Low birth weight (LBW) is associated with significant mortality and morbidity and remains a significant preventable problem. Risk factors include socioeconomic, demographics, and characteristics of the environment. Spatial analysis can uncover unusual frequencies of health problems in neighborhoods, eventually leading to insights for targeted interventions.

Objectives: This study's goals were to 1. Evaluate the geographic distribution of spatial clusters of LBW births and maternal risk factors. 2. Determine the spatial relationship between risk factors and LBW.

Methods: This study obtained data on LBW newborns and risk factors from 19,013 births over 5 years (2012-2016) for Escambia County Census Tracts, extracted from Software was used to detect significant spatial clusters; these clusters were then plotted on a map. Poisson regression determined the statistical relationship between Census Tract risk factors and LBW. A separate analysis of the LBW cluster controlling for risk factors was also performed.

Results: All risk factor clusters resided in similar locations as the LBW cluster. The multiple Poisson regression model containing all risk factors fully explained the LBW cluster. On bivariate Poisson regression all risk factors in the Census Tract were significantly related to LBW whereas in multivariable Poisson regression, the proportion of births to African American women in the Census Tract remained significant after adjusting for other risk factors (p < 0.001).

Conclusions For Practice: Clusters of LBW and risk factors were located in the same region of the county, with the proportion of births to African American women in the Census Tract remaining significant on multiple Poisson Regression. Targeted interventions should be directed at the geographic level.
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August 2020

Potential Adverse Consequences of Early Discharge for Newborns Who Meet American Academy of Pediatrics Criteria.

Clin Pediatr (Phila) 2018 03 30;57(3):352-354. Epub 2017 Mar 30.

3 University of Florida, Pensacola, FL, USA.

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March 2018

Household proximity to water and nontuberculous mycobacteria in children with cystic fibrosis.

Pediatr Pulmonol 2017 03 30;52(3):324-330. Epub 2017 Jan 30.

Pediatric Residency Program at Sacred Heart Hospital, University of Florida, Pensacola, Florida.

Background: Nontuberculous mycobacteria (NTM) have a particular affinity for patients with cystic fibrosis (CF). Recent studies suggest a possible relationship between acquiring NTM and the level of environmental water in a given area. We sought to determine if there is an association between household proximity to water and NTM in children with CF.

Materials And Methods: An IRB-approved retrospective chart review was completed on 150 children with CF in Florida. Inclusion criteria required regular follow-up, at least two acid-fast bacilli cultures, and a consistent home address over a 3-year period. The distance from each patient's home to the nearest body of water was measured using ArcMap®, a Geographic Information System, and the mean distance to water for NTM-positive and NTM-negative groups were compared. A stepwise backwards logistic regression was used to evaluate for predictors of NTM-positivity.

Results: Of the 150 CF patients, 65 met inclusion criteria and 21 (32.3%) tested positive for NTM. Comparison of the mean distance to water for NTM-positive versus NTM-negative groups revealed a cutoff of 500 meters. On the logistic regression, CF patients who lived within 500 meters of water were 9.4 times more likely to acquire NTM (P = 0.013). Other significant predictors included a history of Aspergillus fumigatus (OR 7.9, P = 0.011) and recent history of Pseudomonas aeruginosa (OR 2.5, P = 0.007).

Conclusions: In the regions studied, children with CF who live closer to water are more likely to acquire nontuberculous mycobacteria. Future studies in other geographic areas are needed to determine if these results are generalizable. Pediatr Pulmonol. 2017;52:324-330. © 2016 Wiley Periodicals, Inc.
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March 2017

Clusters of adolescent and young adult thyroid cancer in Florida counties.

Biomed Res Int 2014 28;2014:832573. Epub 2014 Apr 28.

Florida State University College of Medicine, P.O. Box 33655, Pensacola, FL 32508, USA.

Background: Thyroid cancer is a common cancer in adolescents and young adults ranking 4th in frequency. Thyroid cancer has captured the interest of epidemiologists because of its strong association to environmental factors. The goal of this study is to identify thyroid cancer clusters in Florida for the period 2000-2008. This will guide further discovery of potential risk factors within areas of the cluster compared to areas not in cluster.

Methods: Thyroid cancer cases for ages 15-39 were obtained from the Florida Cancer Data System. Next, using the purely spatial Poisson analysis function in SaTScan, the geographic distribution of thyroid cancer cases by county was assessed for clusters. The reference population was obtained from the Census Bureau 2010, which enabled controlling for population age, sex, and race.

Results: Two statistically significant clusters of thyroid cancer clusters were found in Florida: one in southern Florida (SF) (relative risk of 1.26; P value of <0.001) and the other in northwestern Florida (NWF) (relative risk of 1.71; P value of 0.012). These clusters persisted after controlling for demographics including sex, age, race.

Conclusion: In summary, we found evidence of thyroid cancer clustering in South Florida and North West Florida for adolescents and young adult.
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November 2015

The relationship between local food sources and open space to body mass index in urban children.

Public Health Rep 2011 Nov-Dec;126(6):890-900

Department of Pediatrics, Baystate Children's Hospital, Springfield, MA, USA.

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January 2012

Clinical practice guideline: tonsillectomy in children.

Otolaryngol Head Neck Surg 2011 Jan;144(1 Suppl):S1-30

Department of Surgery, University of Toledo Medical Center, Toledo, Ohio, USA.

Objective: Tonsillectomy is one of the most common surgical procedures in the United States, with more than 530,000 procedures performed annually in children younger than 15 years. Tonsillectomy is defined as a surgical procedure performed with or without adenoidectomy that completely removes the tonsil including its capsule by dissecting the peritonsillar space between the tonsil capsule and the muscular wall. Depending on the context in which it is used, it may indicate tonsillectomy with adenoidectomy, especially in relation to sleep-disordered breathing. This guideline provides evidence-based recommendations on the preoperative, intraoperative, and postoperative care and management of children 1 to 18 years old under consideration for tonsillectomy. In addition, this guideline is intended for all clinicians in any setting who interact with children 1 to 18 years of age who may be candidates for tonsillectomy.

Purpose: The primary purpose of this guideline is to provide clinicians with evidence-based guidance in identifying children who are the best candidates for tonsillectomy. Secondary objectives are to optimize the perioperative management of children undergoing tonsillectomy, emphasize the need for evaluation and intervention in special populations, improve counseling and education of families of children who are considering tonsillectomy for their child, highlight the management options for patients with modifying factors, and reduce inappropriate or unnecessary variations in care.

Results: The panel made a strong recommendation that clinicians should administer a single, intraoperative dose of intravenous dexamethasone to children undergoing tonsillectomy. The panel made a strong recommendation against clinicians routinely administering or prescribing perioperative antibiotics to children undergoing tonsillectomy. The panel made recommendations for (1) watchful waiting for recurrent throat infection if there have been fewer than 7 episodes in the past year or fewer than 5 episodes per year in the past 2 years or fewer than 3 episodes per year in the past 3 years; (2) assessing the child with recurrent throat infection who does not meet criteria in statement 2 for modifying factors that may nonetheless favor tonsillectomy, which may include but are not limited to multiple antibiotic allergy/intolerance, periodic fever, aphthous stomatitis, pharyngitis and adenitis, or history of peritonsillar abscess; (3) asking caregivers of children with sleep-disordered breathing and tonsil hypertrophy about comorbid conditions that might improve after tonsillectomy, including growth retardation, poor school performance, enuresis, and behavioral problems; (4) counseling caregivers about tonsillectomy as a means to improve health in children with abnormal polysomnography who also have tonsil hypertrophy and sleep-disordered breathing; (5) counseling caregivers that sleep-disordered breathing may persist or recur after tonsillectomy and may require further management; (6) advocating for pain management after tonsillectomy and educating caregivers about the importance of managing and reassessing pain; and (7) clinicians who perform tonsillectomy should determine their rate of primary and secondary posttonsillectomy hemorrhage at least annually. The panel offered options to recommend tonsillectomy for recurrent throat infection with a frequency of at least 7 episodes in the past year or at least 5 episodes per year for 2 years or at least 3 episodes per year for 3 years with documentation in the medical record for each episode of sore throat and 1 or more of the following: temperature >38.3°C, cervical adenopathy, tonsillar exudate, or positive test for group A β-hemolytic streptococcus.
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January 2011

The adolescent with a chronic illness.

Pediatr Ann 2006 Mar;35(3):206-10, 214-6

Tufts University School of Medicine, Baystate Children's Hospital, 140 High Street, Springfield, MA 01199, USA.

The primary care clinician can play an important role in enhancing the quality of life for the adolescent with chronic illness through developmentally appropriate, individualized and compassionate coordination of care (Sidebar 2). Special attention to the process of adolescence, family, and psychological issues are required for successful management. Transition of care to adult services should be planned carefully with a multidisciplinary team.
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March 2006

Index of suspicion.

Pediatr Rev 2005 Oct;26(10):377-82

The Hospital for Sick Children, Toronto, Ontario, Canada.

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October 2005

Influence of prior sexual risk experience on response to intervention targeting multiple risk behaviors among adolescents.

J Adolesc Health 2005 Jan;36(1):56-63

Department of Pediatrics, West Virginia University, Morgantown, West Virginia, USA.

Purpose: To identify correlates of sexual risk variations among African-American adolescents, and to examine the influence of prior sexual experience on response to a HIV risk-reduction intervention.

Methods: Eight hundred seventeen African-American youth aged 13 to 16 years living in and around urban public housing in Baltimore were recruited to participate in a HIV risk-reduction intervention targeting multiple risk behaviors. An instrument designed to measure three levels of sexual risk ("abstinent," "protected sex" [having sex with a condom], and "unprotected sex" [having sex without a condom]) was administered at baseline, 6 months and 12 months postintervention. Multiple regression analyses were conducted to identify predictors of the degree of sexual risk using longitudinal data. Repeated measure analyses were conducted to assess behavioral changes over time among the three groups.

Results: Data confirmed the co-variation of sexual risk behavior and other problem behaviors among adolescents, cross-sectionally and longitudinally. After exposure to an 8-session risk-reduction intervention, youth engaging in the highest degree of sexual risk demonstrated the greatest reduction in both sexual risk and other risks. These improvements were seen at both 6 months and 12 months postintervention. Youth who were abstinent at baseline maintained the lowest levels in risk involvement throughout the study period when compared with sexually active youth. However, abstinent youth risk involvement significantly increased at 6 months and 12 months after baseline. Youth engaging in protected sex at baseline demonstrated a significant increase in non-condom use and a significant decrease in multiple risk involvement over time.

Conclusions: Results support HIV risk-reduction intervention efforts that target multiple risk behaviors. Response of adolescents to the intervention is directly related to the sexual risk behavior at baseline. These data may suggest that the response to risk behavior intervention depends in part on the risk behavior profile of the population to which it is being applied.
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January 2005

Depressive symptoms and health risk among rural adolescents.

Pediatrics 2004 May;113(5):1313-20

Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia 26506-9214, USA.

Objective: To determine the stability of depression and its relationship with health risk factors among rural adolescents.

Methods: A clinic-based longitudinal study was conducted to test for depression and risk factors in 64 participants who attended a rural, primary care, adolescent medicine clinic. The primary measure of risk and depression was the Perkins Adolescent Risk Screen (PARS). Adolescent patients who were aged 12 to 18 years and had PARS assessments during a previous visit to the adolescent clinic were invited to complete a follow-up PARS assessment.

Results: The mean age of adolescents at baseline was 12.79 years; 14.59 years at follow-up. With age and gender being controlled, adolescent depression and various adolescent risk indices were significantly related at baseline. Longitudinally, baseline depression score on PARS were related to follow-up: depression, school problems, substance abuse, tobacco use, sexual activity, and violent behavior scores and a history of physical/sexual abuse. On multivariate analysis controlling for other significantly associated variables, the relationship persisted for baseline depression and follow-up: tobacco, substance abuse, depression, and history of physical/sexual abuse.

Conclusion: This study confirms a strong longitudinal relationship between baseline depressive symptoms and several important risk behaviors/factors measured at follow-up in a clinic population of rural adolescents. Also, longitudinal stability of depression over time is supported.
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May 2004

Validation of the Perkins Adolescent Risk Screen (PARS).

J Adolesc Health 2003 Dec;33(6):462-70

Department of Psychology, West Virginia University, Morgantown, West Virginia, USA.

Purpose: To examine the initial psychometric properties for the PARS, a brief interview used to screen for 16 items of adolescent risk and protective factors.

Methods: Participants included 193 adolescents, attending public middle and high schools or a university-based Adolescent Clinic. Participants completed a PARS interview, as well as a battery of questionnaires. Approximately 31% of participants received a second PARS interview from an independent rater to assess inter-rater consistency.

Results: Descriptive statistics revealed that participants, on average, were rated as low to moderate risk for health-related difficulties across all PARS items. Descriptive statistics also showed important risk patterns in this sample of adolescents (e.g., 1/5 of sample not exercising at all). Factor analysis yielded a total of five factors (Risk Factors, Protection Factors, Relationships/Mood, Motivation Issues, Weight Issues), accounting for 58% of the variance in PARS item scores. Satisfactory levels of internal consistency and inter-rater agreement for the PARS score were found. Convergent and divergent validity of PARS scores were supported by correlations obtained with similar and dissimilar measures, respectively. A significant age group difference was obtained in the total PARS score, with adolescents aged 17-19 years obtaining higher scores than did adolescents aged 14-16 years. No significant gender differences were found.

Conclusions: Our results support the initial psychometric properties (i.e., reliability, validity) of the PARS as a measure of health risk and protective factors in adolescents. The PARS is a brief, efficient means of obtaining important health risk information from adolescents throughout periodic routine health care visits.
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December 2003

Eating disorders in adolescents.

W V Med J 2003 Mar-Apr;99(2):60-6

Department of Pediatrics, Head, Division of Ambulatory Pediatrics, West Virginia University School of Medicine, Morgantown, USA.

Eating disorders including anorexia nervosa and bulimia are commonly seen in adolescent patients. There are many medical complications including disturbances in cardiac, endocrine, bone, gastrointestinal, hematological, neurological, metabolic, and renal function. There are characteristic dermatological and dental findings. Attention to key elements of the history and characteristic findings on physical exam can help the primary care provider in timely diagnosis. Although there is a wide differential diagnosis for these patients, the presence of alteration in body image and fear of being overweight are key features that help distinguish eating disorders from other disease states. Management requires a multi-disciplinary team that can provide psychological, nutritional and medical services. Adequate nutritional rehabilitation is critical and should occur concurrently with the mental health interventions. With early detection and adequate treatment, prognosis for recovery can be quite good, although mortality rates in long-term studies are surprisingly high.
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August 2003