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Biomedical subjects

Barry Zuckerman

Publications and source records attributed to Barry Zuckerman.

At least 19 recordsLinked to original sources
PubMed2006

Polymorphism in maternal LRP8 gene is associated with fetal growth.

Fetal growth restriction (FGR) affects >200,000 pregnancies in the United States annually and is associated with increased perinatal mortality and morbidity, as well as poorer long-term health for infants with FGR compared with infants without FGR. FGR appears to be a complex trait, but the role of genetic factors in the development of FGR is largely unknown. We conducted a candidate-gene association study of birth weight and FGR in two independent study samples obtained at the Boston Medical Center. We first investigated the association between maternal genotypes of 68 single-nucleotide polymorphisms (SNPs) from 41 candidate genes and fetal growth in a sample of 204 black women selected for a previous study of preeclampsia, 92 of whom had preeclampsia (characterized by high blood pressure and the presence of protein in the urine). We found significant association between SNP rs2297660 in the LRP8 gene and birth weight. Subsequently, we replicated the association in a larger independent sample of 1,094 black women; similar association between LRP8 and FGR was observed in this sample. The "A" allele at rs2297660 was associated with a higher standardized birth weight and a lower risk of FGR. Under the additive genetic model, each additional copy of the "A" allele reduced the risk of FGR by 33% (P<.05). In conclusion, results from the two independent samples of black women provide consistent evidence that SNP rs2297660 in LRP8 is associated with fetal growth.

Adult↗
PubMed2006

Neighborhood safety and overweight status in children.

OBJECTIVE: To determine if there is a relationship between parental perception of neighborhood safety and overweight at the age of 7 years. DESIGN: Cross-sectional analysis of the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development. SETTING: Ten urban and rural US sites. PARTICIPANTS: A total of 768 children selected via conditional random sampling with complete data at follow-up. MAIN OUTCOME MEASURES: Parents reported demographics and perception of neighborhood safety by standardized questionnaire. Child overweight status was defined as a body mass index greater than or equal to the 95th percentile for age and sex from measured anthropometrics at the age of 7 years. The base model included relationship of the safety reporter to the child, sex, and baseline body mass index z score at the age of 4.5 years. Covariates tested included maternal marital status, education, and depressive symptoms; child race/ethnicity; participation in structured after-school activities; Home Observation for Measurement of the Environment total score; and neighborhood social cohesiveness. RESULTS: The sample was 85% white, and 10% of the children were overweight. Neighborhood safety ratings in the lowest quartile were independently associated with a higher risk of overweight at the age of 7 years compared with safety ratings in the highest quartile (adjusted odds ratio, 4.43; 95% confidence interval, 2.03-9.65). None of the candidate covariates altered the relationship between perception of neighborhood safety and child overweight status. CONCLUSIONS: Perception of the neighborhood as less safe was independently associated with an increased risk of overweight at the age of 7 years. Public health efforts may benefit from policies directed toward improving both actual and perceived neighborhood safety.

Body Mass Index↗
PubMed2006

Sickle cell disease: a question of equity and quality.

Thirty years ago, the first major federal legislation concerning sickle cell disease treatment was passed, resulting in the development of comprehensive sickle cell centers. We are now at another watershed moment in the treatment of this illness with the passage in October 2004 of the Sickle Cell Treatment Act, designed to substantially expand specialized sickle cell treatment programs. This legislation offers a remarkable opportunity to significantly improve health outcomes for individuals with sickle cell disease if it is implemented with a specific focus on the distinct but related issues of equity and quality. Despite major advances in sickle cell disease treatment that have occurred over the past 3 decades, important gaps exist both in the equity of government and private philanthropic support for research and in the uniform provision of high quality clinical care. This article assesses the current gaps in funding support and in the implementation of improvements in clinical care in order to suggest strategies for making optimal use of the opportunity that the new legislation presents to improve the health of all individuals affected by this disease.

Anemia, Sickle Cell↗
PubMed2006

Maternal depression and violence exposure: double jeopardy for child school functioning.

OBJECTIVE: The goal was to determine how violence exposure affects the relationship between maternal depression, cognitive ability, and child behavior. METHODS: A multivariate regression analysis of data for a nationally representative sample of kindergarten students was performed. Maternal depression and violence exposure were measured with standardized parent interviews. Standardized T scores were derived from direct testing of children in reading, mathematics, and general knowledge; child behavior was reported by teachers. RESULTS: A total of 9360 children had neither maternal depression nor violence exposure, 779 violence only, 1564 depression only, and 380 both. Maternal depression alone was associated with poorer mean T scores for reading, mathematics, and general knowledge. However, this effect was attenuated by nearly 25% for reading and general knowledge with adjustment for violence. Children with concurrent exposure to depression and violence had lower mean T scores for reading, mathematics, and general knowledge, as well as more-concerning behaviors, than did those exposed to either factor alone. Across all outcome measures, boys seemed more affected than girls. CONCLUSIONS: Violence compounds the effect of maternal depression on school functioning and behavior. Research and intervention planning for children affected by maternal depression should consider violence exposure.

Adult↗
PubMed2005

The parent-provider relationship: does race/ethnicity concordance or discordance influence parent reports of the receipt of high quality basic pediatric preventive services?

Recent research among adults suggests that having a provider of the same race/ethnicity may enhance the quality of health care above and beyond just having any regular source of care. It is not known whether such relationships exist in pediatric care. The purpose of this study is to identify the distribution and methods by which families have a race/ethnicity concordant provider of well-child care and examine whether differences exist in the receipt of basic preventive services (BPS) and family-centered care (FCC) among those with concordant, discordant, and no regular providers. Analyses are stratified by geography to assess whether urban versus nonurban setting moderates these differences. This study uses publicly available data from the 2000 National Survey of Early Childhood Health (NSECH), a nationally representative, cross-sectional telephone survey of parents of children ages 4-35 months (n = 1,996). African Americans and Latinos were more likely than whites to lack a regular provider of well-child care (60.9% and 65.7% vs. 50.6%) and less likely to have a concordant provider (9.8% and 5.7% vs. 38.5%) (P < .001). African Americans with a regular provider were about three times more likely to establish a concordant relationship in urban versus nonurban settings (32.4% vs. 12.5%, P < .01). No statistically significant differences in BPS or FCC were found by concordance versus discordance for any group, a finding that held regardless of geographic setting. White children with no regular provider received better BPS than those with a discordant provider (e.g., excellent BPS of 37.2% vs. 27.1%, P < .05), but children with no regular provider were more likely than those with either concordant or discordant providers to have lower FCC in one (Latinos, whites) or three domains (African Americans). Despite racial/ethnic differences in the likelihood of having a concordant regular provider of well-child care, no disparities were found in BPS or FCC associated with discordance, even after stratification by urban/nonurban setting. Lacking a regular provider was associated with lower FCC versus having either a concordant or discordant provider, suggesting that efforts to improve these aspects of well-child care might focus less on linking children with a race/ethnicity concordant provider and more on social, cultural, and linguistic factors that impact having any regular provider.

Child, Preschool↗
PubMed2004

Why pediatricians need lawyers to keep children healthy.

Pediatricians recognize that social and nonmedical factors influence child health and that there are many government programs and laws designed to provide for children's basic needs. However, gaps in implementation result in denials of services, leading to preventable poor health outcomes. Physician advocacy in these arenas is often limited by lack of knowledge, experience, and resources to intervene. The incorporation of on-site lawyers into the health care team facilitates the provision of crucial legal services to vulnerable families. Although social workers and case managers play a critical role in assessing family stability and finding appropriate resources for families, lawyers are trained to identify violations of rights and to take the appropriate legal steps to hold agencies, landlords, schools, and others accountable on behalf of families. The incorporation of lawyers in the clinical setting originated at an urban academic medical center and is being replicated at >30 sites across the country. Lawyers can help enhance a culture of advocacy in pediatrics by providing direct legal assistance and case consultation for providers, as well as jointly addressing systemic issues affecting children and families. Until laws to promote health and safety are consistently applied and enforced, pediatricians will need lawyers to effectively care for vulnerable children.

Child↗
PubMed2004

Healthy Steps: a case study of innovation in pediatric practice.

Healthy Steps (HS) represents a significant innovation in the way pediatric primary care can be delivered. Based on the standards and principles of Bright Futures and the American Academy of Pediatrics Health Supervision Guidelines, HS enhances and expands traditional pediatric care by including a child development specialist (Healthy Steps specialist) as part of the pediatric practice team. Services offered by this person, typically a nurse, early childhood educator, or social worker, include more time to spend discussing preventive issues during well-child visits, home visits, a telephone information line exclusively addressing developmental and behavioral concerns, new written materials, and more seamless linkages to community resources and parent support groups. The original HS cohort consisted of 15 pediatric practices in a variety of settings (private practices, health centers, pediatric training programs). Evaluated for the effects of HS on their family were 3737 intervention and comparison families. HS families received significantly more preventive and developmental services, compared to families in the control group. HS families were also less likely to be dissatisfied with their pediatric primary care. Additionally, HS had a positive impact on parenting in many areas including adherence to health visits, nutritional practices, developmental stimulation, appropriate disciplinary techniques, and correct sleeping position. Other outcome measures (such as initiation or duration of breastfeeding, child development knowledge, sense of competence, and reports of child language development at 2 years of age) did not differ between intervention and comparison group. Compared to other early childhood intervention efforts, HS offers a comparable positive impact on parenting at a relatively inexpensive cost: an estimated 400 dollars per family per year (compared to 4500 dollars from Early Head Start). Approximately 3 years after the evaluation of HS ended, 10 of the original 24 sites are still in operation, and an additional 24 sites have started up. Although funding and reimbursement remain an important barrier, continued growth of HS suggests an abiding interest in this approach to expand and enhance preventive and developmental care in pediatric primary care.

Child↗
PubMed2004

Prevalence and correlates of high-quality basic pediatric preventive care.

BACKGROUND: The list of recommended pediatric preventive services has grown considerably in the past decade, and clinician variability, clinician distribution, and other correlates of provision of these basic preventive services (BPS) are not known. OBJECTIVE: To describe the proportion of high-quality basic pediatric preventive services, exclusive of immunizations, reported by parents and to identify sociodemographic and health system predictors and health service correlates of provision of these services. STUDY DESIGN: The study used cross-sectional data on 2041 children, 4 to 35 months of age, in the 2000 National Survey of Early Childhood Health. OUTCOME MEASURES: The BPS measure assesses the receipt of (1) developmental assessment, (2) injury prevention counseling, (3) screening for parental smoking, (4) guidance on reading to the child, and (5) guidance on 14 other topics (assessed as a composite score). The BPS scale categorizes the receipt of services as excellent, good, fair, or poor. RESULTS: Most children received excellent (34.9%) or good (31.5%) care, but many received fair (24.9%) or poor (8.7%) care. Sociodemographic and health care factors such as race/ethnicity, insurance, and practice setting were not associated with BPS levels. Higher BPS scores were associated with parental reports of longer well-child visits, more counseling regarding family and community risk factors, lower rates of delayed or missed care, and greater satisfaction. CONCLUSIONS: Two thirds of children receive good or excellent basic preventive care, as determined with this composite, and no disparities according to race/ethnicity, income, or health insurance status of families (which are often found to be associated with health care access) were found. This equitable distribution of high-quality care suggests a high level of clinician professionalism. Duration of visits may be a key factor to improve quality of care. Because of its association with other services, processes, and outcomes of care, the BPS scale may serve as a useful construct for monitoring quality and stimulating efforts to improve national pediatric preventive care.

Child, Preschool↗
PubMed2003

Errors in medical interpretation and their potential clinical consequences in pediatric encounters.

BACKGROUND: About 19 million people in the United States are limited in English proficiency, but little is known about the frequency and potential clinical consequences of errors in medical interpretation. OBJECTIVES: To determine the frequency, categories, and potential clinical consequences of errors in medical interpretation. METHODS: During a 7-month period, we audiotaped and transcribed pediatric encounters in a hospital outpatient clinic in which a Spanish interpreter was used. For each transcript, we categorized each error in medical interpretation and determined whether errors had a potential clinical consequence. RESULTS: Thirteen encounters yielded 474 pages of transcripts. Professional hospital interpreters were present for 6 encounters; ad hoc interpreters included nurses, social workers, and an 11-year-old sibling. Three hundred ninety-six interpreter errors were noted, with a mean of 31 per encounter. The most common error type was omission (52%), followed by false fluency (16%), substitution (13%), editorialization (10%), and addition (8%). Sixty-three percent of all errors had potential clinical consequences, with a mean of 19 per encounter. Errors committed by ad hoc interpreters were significantly more likely to be errors of potential clinical consequence than those committed by hospital interpreters (77% vs 53%). Errors of clinical consequence included: 1) omitting questions about drug allergies; 2) omitting instructions on the dose, frequency, and duration of antibiotics and rehydration fluids; 3) adding that hydrocortisone cream must be applied to the entire body, instead of only to facial rash; 4) instructing a mother not to answer personal questions; 5) omitting that a child was already swabbed for a stool culture; and 6) instructing a mother to put amoxicillin in both ears for treatment of otitis media. CONCLUSIONS: Errors in medical interpretation are common, averaging 31 per clinical encounter, and omissions are the most frequent type. Most errors have potential clinical consequences, and those committed by ad hoc interpreters are significantly more likely to have potential clinical consequences than those committed by hospital interpreters. Because errors by ad hoc interpreters are more likely to have potential clinical consequences, third-party reimbursement for trained interpreter services should be considered for patients with limited English proficiency.

Ambulatory Care Facilities↗
PubMed2003

Association between clinically meaningful behavior problems and overweight in children.

OBJECTIVE: To determine whether there is a relationship between clinically meaningful behavior problems and concurrent and future overweight in 8- to 11-year-old children. METHODS: 1998 National Longitudinal Survey of Youth interview data for 8- to 11-year-old children and their mothers were analyzed. A Behavior Problems Index score >90th percentile was considered clinically meaningful. Child overweight was defined as a body mass index (BMI) >or=95th percentile for age and sex. Multiple logistic regression was used to control for potential confounders (selected a priori): child's sex, race, use of behavior-modifying medication, history of academic retention, and hours of television per day; maternal obesity, smoking status, marital status, education, and depressive symptoms; family poverty status; and Home Observation for Measurement of the Environment-Short Form (HOME-SF) cognitive stimulation score. In an attempt to elucidate temporal sequence, a second analysis was conducted with a subsample of normal-weight children who became overweight between 1996 and 1998 while controlling for BMI z score in 1996. RESULTS: The sample included 755 mother-child pairs. Of the potential confounding variables, race, maternal obesity, academic grade retention, maternal education, poverty status, and HOME-SF cognitive stimulation score acted as joint confounders, altering the relationship between behavior problems and overweight in the multiple logistic regression model. With these covariates in the final model, behavior problems were independently associated with concurrent child overweight (adjusted odds ratio: 2.95; 95% confidence interval: 1.34-6.49). The relationship was strengthened in the subsample of previously normal-weight children, with race, maternal obesity, HOME-SF cognitive stimulation score, and 1996 BMI z score acting as confounders (adjusted odds ratio: 5.23; 95% confidence interval: 1.37-19.9). CONCLUSIONS: Clinically meaningful behavior problems in 8- to 11-year-old children were independently associated with an increased risk of concurrent overweight and becoming overweight in previously normal-weight children.

Body Mass Index↗
PubMed2002

Maternal cigarette smoking, metabolic gene polymorphism, and infant birth weight.

CONTEXT: Little is known about genetic susceptibility to cigarette smoke in relation to adverse pregnancy outcomes. OBJECTIVE: To investigate whether the association between maternal cigarette smoking and infant birth weight differs by polymorphisms of 2 maternal metabolic genes: CYP1A1 and GSTT1. DESIGN, SETTING, AND PARTICIPANTS: Case-control study conducted in 1998-2000 among 741 mothers (174 ever smokers and 567 never smokers) who delivered singleton live births at Boston Medical Center. A total of 207 cases were preterm or low-birth-weight infants and 534 were non-low-birth-weight, full-term infants (control). MAIN OUTCOME MEASURE: Birth weight, gestation, fetal growth by smoking status and CYP1A1 MspI (AA vs Aa and aa, where Aa and aa were combined because of small numbers of aa and similar results), and GSTT1 (present vs absent) genotypes. RESULTS: Without consideration of genotype, continuous maternal smoking during pregnancy was associated with a mean reduction of 377 g (SE, 89 g) in birth weight (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.2-3.7). When CYP1A1 genotype was considered, the estimated reduction in birth weight was 252 g (SE, 111 g) for the AA genotype group (n = 75; OR, 1.3; 95% CI, 0.6-2.6), but was 520 g (SE, 124 g) for the Aa/aa genotype group (n = 43 for Aa, n = 6 for aa; OR, 3.2; 95% CI, 1.6-6.4). When GSTT1 genotype was considered, the estimated reduction in birth weight was 285 g (SE, 99 g) (OR, 1.7; 95% CI, 0.9-3.2) and 642 g (SE, 154 g) (OR, 3.5; 95% CI, 1.5-8.3) for the present and absent genotype groups, respectively. When both CYP1A1 and GSTT1 genotypes were considered, the greatest reduction in birth weight was found among smoking mothers with the CYP1A1 Aa/aa and GSTT1 absent genotypes (-1285 g; SE, 234 g; P<.001). Among never smokers, genotype did not independently confer an adverse effect. A similar pattern emerged in analyses stratified by maternal ethnicity and in analyses for gestation. CONCLUSIONS: In our study, maternal CYP1A1 and GSTT1 genotypes modified the association between maternal cigarette smoking and infant birth weight, suggesting an interaction between metabolic genes and cigarette smoking.

Adult↗
PubMed2002

Children who witness violence, and parent report of children's behavior.

OBJECTIVES: To examine how much distress children report in response to violence that they have witnessed and how this is associated with parental reports of children's behavior. METHODS: As part of a study of in utero exposure to cocaine, children completed the Levonn interview for assessing children's symptoms of distress in response to witnessing violence. The children's caregivers completed the Exposure to Violence Interview (EVI), a caretaker-report measure of the child's exposure to violent events during the last 12 months. The EVI was analyzed as a 3-level variable: no exposure, low exposure, and high exposure. The caregivers also completed the Children's Behavior Checklist (CBCL). RESULTS: Of 94 six-year-old children, 58% had no exposure to violence, 36% had low exposure to violence, and 6% had high exposure to violence, according to caretaker reports. The children's median+/-SD Levonn score was 64 (SD +/- 19.3). The mean SD +/- CBCL total T-score was 53 (SD +/- 10.2). In multiple regression analyses with gender, low and high exposure on EVI, Levonn, and prenatal cocaine exposure status as predictors, the Levonn score explained 4.8% of total variance in children's CBCL internalizing scores, 9.1% of the total variance in CBCL externalizing score, and 12.2% of the total variance in CBCL total score (P =.04, P =.004, and P<.001, respectively). CONCLUSIONS: After accounting for the caretaker's report of the level of the child's exposure to violence, the child's own report significantly increased the amount of variance in predicting child behavior problems with the CBCL. These findings indicate that clinicians and researchers should elicit children's own accounts of exposure to violence in addition to the caretakers' when attempting to understand children's behavior.

Child↗