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Biomedical subjects

Donald A Brand

Publications and source records attributed to Donald A Brand.

13 recordsLinked to original sources
PubMed2006

Parents' perceptions of neighborhood safety and children's physical activity.

OBJECTIVE: The obesity epidemic disproportionately affects minority and poor children. Negative perceptions of neighborhood safety in poor communities may affect overweight by inhibiting children's physical activity. This study investigates the degree to which parents in a poor inner city vs. a middle-class suburban community limit their children's outdoor activity because of neighborhood safety concerns. METHOD: Parents of children aged 5-10 years from an inner city family practice in a poor community and from a suburban pediatric practice in a middle-class community completed a 20-item questionnaire. Parents estimated the amount of their child's activity in various situations and indicated their level of anxiety concerning gangs, child aggression, crime, traffic, and personal safety in their neighborhood. RESULTS: Inner city children (n = 204) engaged in less physical activity than suburban children (N = 103) (P < 0.001). Inner city parents expressed much greater anxiety about neighborhood safety than suburban parents (P < 0.0001). In the inner city population, children's physical activity levels were negatively correlated with parental anxiety about neighborhood safety (r = -0.18, P < 0.05). CONCLUSIONS: Inner city parents have high levels of anxiety about neighborhood safety. While these concerns may not entirely explain the discrepancy in activity levels between inner city and suburban children, a safe environment is crucial to increasing opportunities for physical activity.

Child↗
PubMed2006

Parental beliefs about autism: implications for the treating physician.

This study investigated parental beliefs about the etiology, diagnosis, and treatment of autism spectrum disorders. Sixty-two families of affected children completed a questionnaire asking when the parent first noticed developmental or behavioral problems, when they were told the diagnosis, how confident they were about the ability of their child's physician to recognize autism, whether they believed anything specific might have caused their child's autism, and what medications and complementary or alternative therapies they had tried. Two-thirds of parents suspected a specific cause, and three-quarters questioned their physician's ability. Parents who perceived a greater delay in diagnosis or who had tried more different therapies both tended to have less confidence in their physician (p = 0.20 and p = 0.07, respectively). Physicians should inquire about parental beliefs concerning etiology, learn what treatments the children are receiving, perform screening at the 18 month visit, and make referrals for further evaluation as soon as a child begins to exhibit signs suggestive of autism.

Adolescent↗
PubMed2005

Predictors of death within six months in patients with advanced AIDS.

OBJECTIVES: This study sought to identify potential predictive variables of death within 6 months in patients with advanced AIDS. METHODS: Investigators enrolled a consecutive series of patients with advanced AIDS admitted to a skilled nursing facility in New York City over a 1-year period. Demographic, clinical, laboratory, and outcome data were abstracted from medical records using a standardized data collection instrument. RESULTS: Of the 152 patients enrolled during the study period, 61 patients (40%) died within 6 months from date of admission. Serum albumin, percent deviation from ideal body weight, and number of comorbidities at the time of admission proved to be the best combination of predictors of death within 6 months. SIGNIFICANCE OF RESULTS: The decrease in AIDS mortality over the past decade, along with an increase in prevalence due to longer survival, has been attributed primarily to the successful use of highly active antiretroviral therapy (HAART). HAART regimens, however, can also produce both short-term adverse effects and long-term complications. The prognostic model developed by this study may be useful in guiding treatment decisions in patients with advanced AIDS for whom a more palliative care plan may be sought.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Yield of diagnostic testing in infants who have had an apparent life-threatening event.

OBJECTIVE: Many infants who have experienced an apparent life-threatening event (ALTE) seem normal by the time they reach the hospital. Nevertheless, they typically undergo an extensive evaluation to rule out serious underlying conditions. The purpose of the present investigation was to determine the yield of different diagnostic tests in helping to identify the cause of the ALTE. METHODS: We reviewed test results from a consecutive series of infants who were younger than 12 months and admitted to a tertiary care academic medical center between November 1996 and June 1999 after having experienced a sudden breathing irregularity, color change, or alteration in mental status or muscle tone. For each patient, we noted whether a given test was performed, whether the result was positive, and, if so, whether the test contributed to the diagnosis, that is, suggested or helped establish the cause. We also noted whether the initial history and physical examination contributed information that eventually led to the final diagnosis. RESULTS: A total of 243 patients met the enrollment criteria. Of the 3776 tests ordered, 669 (17.7%) were positive and 224 (5.9%) contributed to the diagnosis. Prompted by findings from the initial clinical assessment, the following tests proved useful in patients who had a contributory history and physical examination: blood counts, chemistries, and cultures; cerebrospinal fluid analysis and cultures; metabolic screening; screening for respiratory pathogens; screening for gastroesophageal reflux; chest radiograph; brain neuroimaging; skeletal survey; electroencephalogram; echocardiogram; and pneumogram. In the remaining patients, who had a noncontributory history and physical examination, only the following tests proved useful: screening for gastroesophageal reflux, urine analysis and culture, brain neuroimaging, chest radiograph, pneumogram, and white blood cell count. Broad evaluations for systemic infections, metabolic diseases, and blood chemistry abnormalities were not productive in these patients. CONCLUSIONS: For many tests used in the evaluation of an ALTE, the likelihood of a positive result is low and the likelihood of a contributory result is even lower. Estimates of diagnostic yield derived from the present investigation can help clinicians maximize the productivity and efficiency of their evaluation.

Apnea↗
PubMed2004

Waiting for a liver--hidden costs of the organ shortage.

Discussion about the economics of end-stage liver disease has typically focused on the high cost of liver transplantation, but the management of complications in patients waiting for an organ can also be very expensive. Our research considered the hypothesis that an increase in the number of organ grafts would decrease health care costs in patients with liver disease by eliminating the cost of waiting for an organ. We examined treatment costs for a consecutive series of liver transplant candidates listed at our institution between November 1, 1996 and December 31, 1997. Costs were estimated for inpatient stays, outpatient visits, and posttransplant medications for 2 1/2 years from the date of listing. Of the 58 study patients, 26 (45%) received transplants, 7 of whom died within 2 1/2 years. A total of 11 patients (19%) died while waiting for an organ, and another 21 patients (36%) were still waiting after 2 1/2 years. Pretransplantation costs accounted for 41% of the total cost. Transplanting all 58 candidates without delay through a hypothetical increase in the supply of organs to meet demand would have more than doubled the number of transplantations while increasing costs in this cohort by only 37% (from 123,000 dollars to 169,000 dollars per patient). In conclusion, although an adequate supply of donor organs would not decrease total health care spending for patients with end-stage liver disease, so much money is currently spent on medical management during the waiting period that the savings achieved by transplanting all candidates without delay would offset a large portion of the cost of the additional transplants.

Adolescent↗
PubMed2003

Abusive head injury as a cause of apparent life-threatening events in infancy.

BACKGROUND: An apparent life-threatening event (ALTE) refers to the sudden occurrence of a breathing abnormality, color change, or alteration in muscle tone or mental status in an infant. Several patients with ALTEs admitted to our institution were found to have sustained abusive head injuries. OBJECTIVE: To systematically examine the possible causes of ALTEs and their relative frequencies. STUDY DESIGN: Prospective consecutive case series of 243 infants younger than 12 months admitted to a tertiary care academic medical center for evaluation of an ALTE during a 32-month interval. RESULTS: Thirty-five different causes of ALTEs were identified. Six subjects (2.5%) were diagnosed as having abusive head injuries, or 1 admission every 5 months. Three patients died in the hospital, 2 of whom were diagnosed as having abusive head injuries. CONCLUSIONS: A wide spectrum of diseases and disorders can precipitate an ALTE. Among them, abusive head injury, a recently recognized cause, occurs frequently enough to obligate its inclusion in the differential diagnosis. An ophthalmologic evaluation with dilated fundus examination and cranial imaging should therefore be considered early in the investigation unless another cause becomes apparent soon after admission.

Child Abuse↗
PubMed2003

Childhood obesity: do parents recognize this health risk?

OBJECTIVE: This study examined parents' understanding of excess weight as a health risk, knowledge of healthy eating habits, and recognition of obesity in their children. RESEARCH METHODS AND PROCEDURES: An anonymous questionnaire was distributed during well-care visits involving children 4 to 8 years of age at a pediatric faculty practice. Parents indicated their level of concern about excess weight and other familiar health risks using a four-point Likert scale, answered multiple-choice questions concerning healthy eating patterns, and communicated their perceptions about their child's weight using a visual analog scale. A parent's perception was considered "accurate" if it deviated from the child's growth chart percentile by <30 points. RESULTS: Of the 83 parents surveyed, 23% (19/83) had overweight children (> or = 95th percentile of age- and gender-specific BMI growth charts). These parents did not differ from other parents in their level of concern about excess weight as a health risk or in their knowledge of healthy eating patterns, but the two groups of parents did differ in the accuracy of their perceptions about their children's weight. Only 10.5% of parents of overweight children (2/19) perceived their child's weight accurately compared with 59.4% of other parents (38/64; p < 0.001). Parents of overweight children invariably underestimated their children's weight. The median difference between their perception and the growth chart percentile was -45 points. DISCUSSION: Given that most parents of overweight children fail to recognize that their child has a weight problem, pediatricians should develop strategies to help these parents correct their misperceptions.

Body Weight↗
PubMed2003

Classifying asthma: disagreement among specialists.

OBJECTIVE: The asthma practice guidelines developed by the National Institutes of Health include a system for classifying asthma severity. The goal of the present study was to assess the interrater reliability of this classification system by measuring agreement among pediatric asthma specialists. DESIGN: A survey containing eight case summaries was mailed to 24 board-certified pediatric allergists and pulmonologists, who were asked to classify each case according to the national guidelines. The case summaries included the patient's medical history, physical examination, and chest radiograph and pulmonary function test results. Physicians were also asked to interpret the pulmonary function tests, to indicate the main factors used to classify each case (daytime symptoms, nighttime symptoms, pulmonary function testing, or various combinations), and to make treatment recommendations. kappa statistics were used to measure agreement. RESULTS: Fourteen of 24 surveys mailed (58%) were completed and returned. Agreement was poor for classifying asthma (kappa = 0.29; 95% confidence interval [CI], 0.25 to 0.33) and for the main factors used to make the classifications (kappa = 0.19; 95% CI, 0.14 to 0.23). Specialists exhibited higher agreement in their interpretation of pulmonary function tests (no asthma, kappa = 0.66; asthma on baseline, kappa = 0.53; exercise-induced asthma, kappa = 0.65). While physicians' treatment recommendations were consistent with their severity classifications, the low level of agreement in those classifications led to substantial variability in the treatments recommended. CONCLUSIONS: The low level of agreement among pediatric asthma specialists in classifying asthma severity suggests the need to refine the classification system used in the national guidelines to help ensure the consistent application of those guidelines.

Asthma↗
PubMed2002

Unrecognized thyroid dysfunction in patients with cancer.

Abnormal thyroid function can cause subtle medical symptoms in "healthy" individuals. Because cancer can cause similar symptoms, physicians may fail to suspect and test for thyroid abnormalities. We measured thyroid function in 158 patients with various types of cancers being followed at a comprehensive cancer center and found that 16% of them had a thyroid abnormality, which had not been diagnosed and treated in any of them. We conclude that thyroid dysfunction is usually unrecognized in cancer patients and may possibly contribute to their morbidity.

Adult↗
PubMedDate not supplied

Educational posters to reduce antibiotic use.

INTRODUCTION: Antibiotic overuse promotes resistant strains of bacteria and puts patients at risk for adverse reactions. Given the use of educational posters in government-sponsored public health campaigns, this study examined the effectiveness of a waiting room poster in reducing excessive antibiotic use in clinical practice. METHODS: Investigators conducted a 1-month trial of an educational poster with historical controls using three private pediatric group practices in Westchester County, New York. Children between the ages of 6 months and 10 years at the time of a visit to diagnose and treat symptoms of respiratory illness were enrolled as subjects. Antibiotic prescriptions for children with respiratory illnesses seen during the poster month were compared with prescriptions written during three 1-month historical control periods. The proportion of visits that resulted in a prescription for an antibiotic served as the outcome measure. RESULTS: Overall, 326 of the 720 patients (45.2%) enrolled in the study were treated with an antibiotic. Multiple logistic regression analysis revealed no statistically significant difference in the proportion of visits resulting in an antibiotic prescription among the 4 study months (P = .79), indicating that the educational poster had no effect on antibiotic use. DISCUSSION: Public education in the form of a waiting room poster was not sufficient to decrease antibiotic prescriptions. This finding has implications for current large-scale programs and for health care providers as they continue to attempt to educate patients on the appropriate use of antibiotics.

Anti-Bacterial Agents↗
PubMedDate not supplied

Seizure disorder as a risk factor for gastroesophageal reflux in children with neurodevelopmental disabilities.

The proportion of children with severe neurodevelopmental disabilities, in whom symptoms of gastroesophageal reflux develop after gastrostomy placement, has not been well studied. The medical records of children who received a gastrostomy tube (with or without a simultaneous antireflux procedure) at our institution between 1987 and 1997 were reviewed to identify neurologically related diagnoses at the time of the gastrostomy, diagnostic tests ordered to detect reflux, and dates and reasons for re-admissions within 2 years of discharge. Of 102 patients studied, 37 received a gastrostomy tube alone. Complete follow-up data were available for 30 of these patients, 7 of whom (23%) required subsequent antireflux surgery within 2 years. Patients with a seizure disorder had greater than a 4-fold risk of re-admission for this operation compared with other patients (57% [4/7] vs. 13% [3/23]; P=0.03). In a child with severe neurodevelopmental disability, the existence of a seizure disorder at the time of a gastrostomy operation increases the risk of subsequently requiring an antireflux procedure by a factor of 4.

Adolescent↗