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Biomedical subjects

D R Neuspiel

Publications and source records attributed to D R Neuspiel.

At least 19 recordsLinked to original sources
PubMed2001

The role of race in the clinical presentation.

What role, if any, should race play in clinical presentations? While race is widely used as a way of identifying patients, this practice has been challenged as conceptually flawed, potentially misleading, and possibly prejudicial to the patient. There are, however; important reasons for not excluding information about race. This article includes a set of guidelines for the inclusion of racial data in presentations: (1) Race is a social construct and, if used, should be recorded in the social history, not the opening sentence of the presentation. (2) Patients should self-identity their race or races. (3) Race should not be used as a proxy for genetic variation, social class, or other elements of the social history. (4) Clinicians should be mindful of the potential influence of racism in the clinical encounter.

Attitude of Health Personnel↗
PubMed1994

Behavior in cocaine-exposed infants and children: association versus causality.

The effects of prenatal cocaine exposure on infant and child development and behavior are uncertain. This ambiguity has been enhanced by the early nature of human research and suboptimal study designs. Methodological difficulty in this research, particularly in the consideration of confounding effects, has made it difficult to ascribe causal relationships. Future research must consider more precise measures of confounding.

Child Behavior Disorders↗
PubMed1994

Intrauterine cocaine, lead, and nicotine exposure and fetal growth.

Intrauterine tobacco, lead, and cocaine exposure often co-occur and may affect fetal growth and development, yet studies of gestational cocaine effects have not adequately measured lead or tobacco. In this anonymous survey, blood lead and urine cotinine levels were determined and mothers were queried about tobacco use. Eighteen cocaine-exposed mother-infant dyads had higher lead and cotinine levels than 46 random nonexposed dyads, regardless of reported cigarette smoking. Crude growth decrements in cocaine-exposed newborns were attenuated after control for lead and cotinine. Future studies of gestational cocaine effects should measure other toxic exposures with more precision.

Adult↗
PubMed1993

Custody of cocaine-exposed newborns: determinants of discharge decisions.

OBJECTIVES: Maternal cocaine use is a leading grounds for newborn foster placement. This study was initiated to investigate the factors that predict custody status of infants born to substance-abusing women. METHODS: A retrospective cohort design was used to study the correlates of discharge custody decisions for 99 consecutive infants testing positive for cocaine in a public hospital. RESULTS: The population was 49% Black, 40% Hispanic, and 11% other or unknown. Custody at discharge was to mothers (38%), other family members (25%), or agency foster care (36%). Placement outside the family was greater when mothers had prior child welfare records, in Blacks vs others, with no prenatal care, and when mothers were younger at their first delivery or older at the index birth. Denial of custody to the mother was higher with prior child welfare involvement, in Blacks, and when the mother did not live in her own home. Both models also controlled for parity, child sex, and birthweight. CONCLUSIONS: Earlier involvement with child welfare authorities, race, and other factors predict continued separation of mothers and children at newborn discharge, suggesting the need to reexamine current policies and practices.

Birth Weight↗
PubMed1992

Cocaine use and post partum psychiatric symptoms.

The association of mental health symptoms with cocaine use was studied among post partum women. Gestational cocaine use was determined by confidential interview or urine assay. A structured Psychiatric Symptom Index was used to measure mental health symptoms. Among 155 women, 24 (15%) used cocaine. Cocaine-using women had less education, higher parity, less weight gain during pregnancy, and used more cigarettes, marijuana, and opiates in pregnancy than nonusers. High frequency of symptoms (standardized Psychiatric Symptom Index score greater than or equal to 20) was found in 71% of women for the Total Index score, 81% on depression, 61% on anxiety, 36% on cognitive disturbance, and 75% on anger. No differences in Psychiatric Symptom Index Total or factor scores were associated with cocaine use.

Adult↗
PubMed1991

Cocaine and infant behavior.

Prenatal and early postnatal cocaine exposure may have lasting effects on brain development. Whereas adverse behavioral outcomes in exposed infants are plausible, they have not yet been well defined, due to methodological limitations of published studies. Improved research and clinical programs are needed to serve drug-exposed infants and their families.

Animals↗
PubMed1989

Parental smoking and post-infancy wheezing in children: a prospective cohort study.

The contribution of parental smoking to wheezing in children was studied in a subset of all British births between April 5 and 11, 1970 (N = 9,670). Children of smoking mothers had an 18.0 per cent cumulative incidence of post-infancy wheezing through 10 years of age, compared with 16.2 per cent among children of nonsmoking mothers (risk ratio 1.11, 95% CI: 1.02, 1.21). This difference was confined to wheezing attributed to wheezy bronchitis, of which children of smokers had 7.4 per cent, and those of nonsmokers had 5.2 per cent (risk ratio 1.44, 95% CI: 1.24, 1.68). The incidence of wheezy bronchitis increased as mothers smoked more cigarettes. After multiple logistic regression analysis was used to control for paternal smoking, social status, sex, family allergy, crowding, breast-feeding, gas cooking and heating, and bedroom dampness, the association of maternal smoking with childhood wheezy bronchitis persisted. Some of this effect was explained by maternal respiratory symptoms and maternal depression, but not by neonatal problems, the child's allergic symptoms, or paternal respiratory symptoms. There was a 14 per cent increase in childhood wheezy bronchitis when mothers smoked over four cigarettes per day, and a 49 per cent increase when mothers smoked over 14 cigarettes daily.

Bronchitis↗
PubMed1987

Sudden nontraumatic death in adolescence. Deaths at school.

Sudden and unexpected nontraumatic death of adolescents in a school setting was studied in a defined population. All deaths of Allegheny County, Pennsylvania, residents between 12 and 21 years of age for a nine-year period were reviewed. One hundred twenty-four sudden, nontraumatic events were identified. Fourteen events (11.3%) were school related, of which seven were associated with physical exertion. Of the four events occurring during organized school sports, no subject had a condition that would have been easily detectable by preathletic screening. Further evaluation of preventive measures, such as identification and treatment of individuals at high risk for sudden death, and improved cardiopulmonary resuscitation by trained personnel, is recommended.

Adolescent↗
PubMed1987

Fatalities from undetected appendicitis in early childhood.

A survey of unexpected death in children 1 to 5 years of age in a defined community over a 9-year period revealed three deaths, representing 4.5 deaths per million at risk per year. These cases were preceded by recognized prodromal symptoms, yet proper diagnosis did not occur and prompt therapy was not instituted. A higher index of suspicion, improved attention to early symptoms, and decreased therapeutic delay are suggested to prevent these deaths.

Appendicitis↗
PubMed1985

Sudden and unexpected natural death in childhood and adolescence.

The descriptive epidemiology of sudden nontraumatic death from persons aged 1 to 21 years was studied in a defined population. In nine years, the 207 deaths in this group (4.6/100,000 population/per year) comprised 22% of nontraumatic mortality. Age-specific rates were highest between 1 and 4 years (mainly infections and undetermined causes) and 14 and 21 years (mainly cardiovascular, epilepsy, intracranial hemorrhage, and asthma). Nonwhite rates were higher than whites, and white males had higher rates than white females. Referral for medicolegal evaluation was inconsistent. Only 18% died at university hospitals. Infections included lower respiratory tract and septic shock. The main cardiac diagnosis was myocarditis. Most epilepsy deaths were unwitnessed and had absent or low anticonvulsant levels. Eighty-five cases had a known associated chronic illness and 111 reported prodromal symptoms. Prevention of these events requires improved identification and management of antecedent conditions.

Adolescent↗