PubMed Health⌕ Search

Biomedical subjects

E K Marcuse

Publications and source records attributed to E K Marcuse.

At least 19 recordsLinked to original sources
PubMed1992

Immunization practices of Washington State pediatricians--1989.

Administration of immunizations has become complicated by issues about consent, cost, and liability. To determine if these issues have changed the immunization practices of pediatricians, we surveyed pediatricians in private practice in Washington State. The survey results show that about one half of vaccines administered in pediatricians' offices are provided by the Washington State Health Department. The mean charge for administration of each parenteral vaccine was $7.02. Respondents strongly agreed that they would administer vaccine supplied by the Washington State Health Department if it was available. They also agreed that they referred patients to Health Department clinics for vaccination because of inability to pay and not because of concern about liability.

Child↗
PubMed1991

Diphtheria-tetanus-pertussis vaccine and serious neurologic illness: an updated review of the epidemiologic evidence.

A widespread impression that DTP vaccine does cause brain damage has been based first on historical precedent--smallpox and rabies vaccines were recognized as sometimes causing devastating neurologic illness; analogy to pertussis--the disease can cause encephalopathy; and more recently on anecdotal evidence, particularly case series. A noncausal relationship--coincidence--could explain the temporal relation between DTP vaccine and neurologic illness, inasmuch as DTP vaccine is given at the age of emergence of idiopathic neurologic disease. The relationship between DTP vaccine and neurologic illness lacks specificity. Case series have had an impact on both physicians' and the lay public's impression of the safety of pertussis vaccine greatly out of proportion to their scientific importance. Case series can be useful for generating hypotheses but cannot provide evidence that pertussis vaccine is causally related to acute neurologic illness or brain damage. Observational studies using cohort and ecologic designs did not find an association between DTP vaccine and serious neurologic illness, but they were not powerful enough to detect an association as rare as that observed by the NCES investigators. The case-control design offers the best chance of providing causal evidence regarding DTP vaccine and serious neurologic illness. The NCES is the only published case-control study of this issue. This study found a rare association between DTP vaccine and some types of acute neurologic illness. Bias and chance are unlikely to account entirely for the association demonstrated by the NCES. However, the association has not yet been replicated by other case-control studies. The NCES does not demonstrate that DTP vaccine causes permanent brain damage.

Case-Control Studies↗
PubMed1990

The NCES reconsidered: summary of a 1989 workshop. National Childhood Encephalopathy Study.

A 1989 workshop provided a forum for independent review of the National Childhood Encephalopathy Study (NCES). No official summary will be published. Workshop panelists noted: firstly, that the magnitude of the reported association between acute neurological illness and pertussis vaccine might have been overestimated because of bias, but bias was believed unlikely to account for all of the excess risk; and secondly that because of problems with study design and methodology, the NCES is not informative with regard to long-term outcome of acute neurological illness associated with recent diphtheria-tetanus-pertussis (DTP) vaccination. The workshop panel discouraged use of the NCES estimate of the attributable risk of persistent neurological damage.

Brain Diseases↗
PubMed1990

Nutritional rickets.

Nutritional rickets was diagnosed in 18 infants aged eight to 24 months. Clinical features included progressive leg bowing, poor linear growth, a diet deficient in vitamin D, seizures, and abnormal serum calcium, phosphate and alkaline phosphatase levels. Wrist radiographs and serum alkaline phosphatase levels were the most useful confirmatory tests. Breast milk may not contain enough vitamin D to protect infants, particularly dark-skinned children and those living in cloudy, northern U.S. cities, from rickets after six months of age. As breast feeding becomes more widely practiced, care is required to ensure that infants at high risk for rickets receive appropriate vitamin D supplementation.

Breast Feeding↗
PubMed1988

Family practitioners' immunization consent practice. Washington State, 1986.

Of 400 Washington State family practitioners surveyed in 1986, 46% of those who give routine immunizations reported that they require written parental consent before administering vaccine. In all, 57% of respondents said they discuss diphtheria-tetanus-pertussis, measles-mumps-rubella, and oral polio vaccine with their patients. Nearly half provide written information on these immunizations, except for inactivated polio vaccine, for which fewer than 20% of the physicians surveyed provide verbal or written information.

Consent Forms↗
PubMed1987

Pediatricians' immunization consent practices in Washington state.

A survey of Washington state pediatricians and allied health professionals showed that two thirds provide written information to parents on diphtheria-tetanus-pertussis; measles-mumps-rubella; and oral polio vaccines. Twenty-two percent of pediatricians provide written information on inactivated polio vaccine. Sixty-two percent of pediatricians who give immunizations require a parent's signature as evidence of having provided information or obtained consent.

Immunization↗
PubMed1986

Use of bacterial antigen detection in the diagnosis of pediatric lower respiratory tract infections.

Two immunochemical methods were used to identify Haemophilus influenzae and Streptococcus pneumoniae capsular antigens in the urine and serum of 162 children with acute lower respiratory tract infection. These methods were compared with standard bacterial blood culture. Viral and mycoplasma cultures of respiratory secretions were obtained simultaneously to determine the frequency of antigenuria at the time of nonbacterial acute lower respiratory tract infection. Urine from groups of well children and children with acute otitis media was tested for capsular antigens to determine the incidence of antigenuria. Antigenuria was found in 24% of children 2 months to 18 years of age with acute lower respiratory tract infection compared with a 2% incidence of bacteremia. Antigenuria was found in 4% of asymptomatic children and 16% of children with acute otitis media. One third of children with symptoms of acute lower respiratory tract infection and viral isolates from the oropharynx had bacterial antigenuria. The sixfold increase in frequency of bacterial antigenuria in children at the time of lower respiratory symptoms suggests that bacterial acute lower respiratory tract infection may be more common than identified by traditional culture techniques. Because bacterial antigen may come from other sites such as the middle ear, further studies are needed to determine the role of antigen detection in the diagnosis of pediatric acute lower respiratory tract infection.

Acute Disease↗
PubMed1985

Is childhood appendicitis familial?

Family history of appendicitis was studied in 135 children with histologic confirmation of acute appendicitis and in 212 control children without appendicitis, matched by age, sex, and admission date. Parents of patients with appendicitis were approximately 10% more likely than parents of control children to have a positive history of this disease, a difference that could have easily arisen by chance. In contrast, seven patients with appendicitis had siblings with a history of appendicitis, whereas only 0.64 would have been expected on the basis of the proportion among the control group. A significant positive trend was also noted between the proportion of family members with a history of appendicitis and risk for this disease in children. These results indicate some familial tendency for appendicitis, although not to the extent suggested by previous studies.

Adolescent↗
PubMed1985

The epidemiology and treatment of radial head subluxation.

The incidence and treatment of radial head subluxation were evaluated in emergency room and private office settings. Factors associated with recurrence and with successful reduction were identified, and ways to prevent this common injury were sought. Of 54 reductions during which a click was either felt or heard, all but one reduction resulted in reuse of the arm within 30 minutes. Of 13 reductions in which a click was neither felt nor heard, only four reductions resulted in reuse of the arm within 30 minutes. A supination maneuver resulted in reuse of the arm within 30 minutes in all 27 patients seen two or more hours after injury vs 85% (34/40) of patients seen less than two hours after injury. Remanipulation 12 to 106 hours later resulted in reuse of the arm in all those children who had failed to respond to previous treatment.

Child↗
PubMed1985

Fiber intake and childhood appendicitis.

Parents of 135 children with appendicitis and of 212 comparison children were interviewed about their children's diet. Children in the upper two quartiles of fiber intake were estimated to have a 30 per cent lower risk of appendicitis than children in the lowest quartile. Estimated risk of appendicitis decreased as monthly intake of whole-grain foods increased. Children 7 to 18 years of age who had an intake of whole-grain foods in the upper fiftieth percentile were estimated to have a 50 per cent lower risk of appendicitis. This reduction in risk was not observed in the group of children less than 7 years of age.

Adolescent↗
PubMed1985

Childhood appendicitis: factors associated with perforation.

A retrospective study was performed to identify factors associated with perforation in 150 children with acute appendicitis. The children's parents were interviewed about the nature and timing of care, family history of appendicitis, and history of abdominal pain episodes, and the children's medical records were reviewed. Delay in treatment--the interval between first recognized symptoms of abdominal pain and surgery--was most predictive of perforation. A treatment delay of more than 36 hours was associated with a 65% or greater incidence of perforation. Mean delay for the group with perforation of the appendix was 66.7 hours compared with 35.8 hours for the group having appendicitis without perforation (P less than .01). Mean professional delay was significantly longer in the group with perforated appendicitis than in the group having appendicitis without perforation (P less than .01), but mean parental delay was not. Children aged 1 to 4 years and those aged 5 to 8 years had a 74% and 66% incidence of perforation, respectively, compared with a 30% to 42% incidence in older children (P less than .01). Age had a significant effect upon perforation even when adjusted for delay in treatment. Other factors associated with perforation were family history of appendicitis, social class, advice given by the first health professional contacted, and the presence of fecaliths. When all factors were considered simultaneously by using logistic regression techniques, delay in treatment, age, and absence of a family history of appendicitis were all significant predictors of perforation.

Acute Disease↗