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Biomedical subjects

E Oken

Publications and source records attributed to E Oken.

9 recordsLinked to original sources
PubMed2001

Updates in pediatric nutrition.

Ongoing research in several areas of pediatric nutrition has new practical applications for community-based pediatricians. For example, a fresh understanding of risk factors for rickets persuades pediatricians to recognize and treat this disease, which was thought to be nearly extinct in the modern industrialized world. Similarly, an expanded awareness of the antibacterial components of breast milk encourages a more complete dialogue between pediatricians and new mothers about the potential benefits of breast-feeding. For those infants with feeding intolerance, new data help to refine the indications for hypoallergenic formulas, which are increasingly recommended for children with a variety of symptoms. The past year also has seen breakthroughs in our understanding of supplemental nutrition for children. Vitamin A may provide direct benefits for the most vulnerable of children, namely premature infants at high risk for lung disease. At the other end of the pediatric spectrum, adolescent athletes seeking to enhance their performance are consuming poorly studied sports supplements that may not be beneficial and may even be toxic. Finally, a greater appreciation for the epidemic of obesity that is sweeping the United States and other countries suggests that children at high risk may represent a far more diverse population than had been recognized previously.

Adolescent↗
PubMed2000

Updates in pediatric nutrition.

There have been many remarkable advances in pediatric nutrition. Solid scientific evidence now supports certain fundamental assumptions long held in the pediatric community. For example, obesity in children has for some time been believed to have adverse health effects; recent large scale studies now confirm relationships between childhood obesity and specific morbidities. Likewise, the beneficial effects of human breast milk on growth and development have been the focus of recent prospective studies of full term and preterm infants. There has been active research in the area of formula intolerance and allergy, allowing practicing physicians to better counsel parents about dietary choices. Although many health problems are caused by the abundance of high fat and high calorie foods in the average US child's diet, a large number of children remain at risk for hunger in the United States. Other research provides important breakthroughs in our understanding of the impact of pediatric nutrition on lifelong health. Retrospective epidemiological studies have uncovered relationships between prenatal factors and health later in life. These studies have lead to ongoing prospective observational trials that should provide further information about the extent to which certain health factors are determined before birth. In addition, basic science research has revealed previously unknown mechanisms by which essential minerals, such as iron, are transported into the body. In sum, this section reviews exciting new information in the areas of childhood diet quality, obesity, breast milk, formula intolerance, and iron metabolism.

Breast Feeding↗
PubMed1998

Iodine-induced hyperthyroidism: occurrence and epidemiology.

We have critically reviewed the available information on iodine-induced hyperthyroidism (IIH) from published sources and other reports as well as the experience of the authors in Tasmania, Zaire, Zimbabwe, and Brazil. Administration of iodine in almost any chemical form may induce an episode of thyrotoxicosis (IIH). This has been observed in epidemic incidence in several countries when iodine has been given as prophylaxis in a variety of vehicles, but the attack rate as recorded has been low. IIH is most commonly encountered in older persons with long standing nodular goiter and in regions of chronic iodine deficiency, but instances in the young have been recorded. It customarily occurs after an incremental rise in mean iodine intake in the course of programs for the prevention of iodine deficiency, or when iodine-containing drugs such as radiocontrast media or amiodarone are administered. The biological basis for IIH appears most often to be mutational events in thyroid cells that lead to autonomy of function. When the mass of cells with such an event becomes sufficient and iodine supply is increased, the subject may become thyrotoxic. These changes may occur in localized foci within the gland or in the process of nodule formation. IIH may also occur with an increase in iodine intake in those whose hyperthyroidism (Graves' disease) is not expressed because of iodine deficiency. The risks of IIH are principally to the elderly who may have heart disease, and to those who live in regions where there is limited access to medical care. More information is needed on the long-term health impact of IIH or "subclinical" IIH, especially in the course of prophylaxis programs with iodized salt or iodinated oil in regions where access to health care is limited.

Age Distribution↗
PubMed1998

Tetanus toxoid stimulation of the hypothalamic-pituitary-adrenal axis correlates inversely with the increase in tetanus toxoid antibody titers.

In humans, endotoxin activates the hypothalamic-pituitary-adrenal (HPA) axis, and the resulting increase in cortisol modulates the immune response. There is little information on the HPA axis response to other antigens. We examined the effect of the protein antigen tetanus toxoid on HPA axis activity in 10 healthy, premenopausal women (aged 28.6 +/- 2.6 yr). Subjects received im injections of placebo and tetanus toxoid at 1600 h on consecutive days. Blood samples for ACTH and cortisol were obtained every half-hour from--1 to 6 h and at 8, 12, and 16 h after each injection. Compared to placebo, tetanus toxoid administration stimulated significant increases in plasma ACTH and serum cortisol, with the maximum cortisol increase of 1.6-fold occurring 4.5 h after drug administration. Urinary free cortisol increased 1.8-fold in the 8 h after tetanus toxoid administration compared to that after placebo administration. Additionally, there was a significant inverse correlation (r = 0.87; P < 0.005) between the tetanus toxoid-induced increase in serum cortisol and the increase in tetanus antibody levels measured 1 month postvaccination. Thus, administration of the protein antigen tetanus toxoid activated the HPA axis in healthy, premenopausal women. This activation of the HPA axis correlated inversely with the antibody response to tetanus toxoid.

Adrenal Glands↗
PubMed1997

Psychosocial barriers to health promotion in an American Indian population.

Northern Plains Indians (N = 200) completed the Indian Specific Health Risk Appraisal and measures assessing beliefs about risk factors and personal risk. Participants rated personal risk optimistically, judged their risk factor standing as superior to that of their peers, and neglected to consider risk factor standing when appraising personal risk. Moreover, participants were often not improving their standing on risk factors they considered relevant to their health. Such biases in health beliefs may prevent health interventions from being successful.

Adolescent↗
PubMed1992

Minority women and sexual choice in the age of AIDS.

As rates of HIV infection among women continue to rise, health education efforts promoting safer sexual practices have increasingly targeted the female population. However, the wisdom of these efforts is often questioned on the grounds that women, particularly disadvantaged, minority women, lack the necessary power in their relationships with men to influence the course of sexual decision-making. Using a qualitative, focus group methodology, the present study explored the bases of sexual decision-making among groups of high risk black and hispanic women. Sixteen focus groups were conducted with a total of 134 women recruited from drug treatment centers and community agencies in three Northern New Jersey cities. Three groups each were conducted with black and hispanic IV drug users and HIV positive women and 2 groups each with sex partners of IV drug users. Findings suggest that minority women often retain substantial power vis a vis their male partners with respect to sexual decision-making. Factors relating to perceptions of risk are frequently more salient barriers to the practice of safer sex in this population.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Insurance and quality of care for children with acute asthma.

BACKGROUND: Increasing attention has been paid to the role of insurance in determining quality and outcomes of care. Pressures to reduce health costs and to improve quality have prompted attempts by managed care organizations to decrease the use of the emergency department (ED) for acute asthma, but performance comparisons between insurance types remain rare. METHODS: We used prospective data from the Multicenter Airway Research Collaboration on 965 children with acute asthma presenting to 36 EDs. We compared measures of quality of pre-ED care, acute severity, and short-term outcomes (length of stay, percent relapse, and percent with ongoing symptoms) across 4 different insurance categories: managed care, indemnity, Medicaid, and uninsured. We used multivariate regression to control for differences in education, estimated income, race/ethnicity, and chronic asthma severity and acute asthma characteristics. RESULTS: Children with managed care and indemnity had similar demographic and asthma characteristics, but these children differed significantly from Medicaid and uninsured patients. Managed care and indemnity insured children had similar ratings on all 7 quality measures, with Medicaid and uninsured children ranking significantly lower on most measures, including (1) percent with primary care provider (PCP) (P <.001), (2) percent using ED as usual site of asthma care (P <.001), (3) percent using ED for prescriptions (P <.001), (4) percent with a ratio of >1 of ED visits to acute office visits within the past year (P =.003), and (5) percent visiting their PCP within the week prior to ED visit (P <.001). Children with managed care were more acutely ill than were indemnity, Medicaid, or uninsured children on presentation to the ED (pulmonary index of 4.6, 4.0, 4.2, and 3.9, respectively, P =.007). There were no significant differences in length of hospital stay, relapse, and ongoing exacerbation. CONCLUSIONS: Our results indicate similar quality of care, greater severity of acute asthma, and no worse outcomes for children with managed care compared to children with indemnity insurance. We found uninsured children to have consistently poorer quality of care than insured patients.

Analysis of Variance↗
PubMedDate not supplied

Along for the ride: the prevalence of motor vehicle passengers riding with drivers who have been drinking in an American Indian population.

American Indians, especially those residing in the Northern Plains, experience considerable preventable morbidity and mortality from alcohol-related motor vehicle events. Research focusing on unintentional injuries associated with drinking drivers has disregarded the epidemiology of their passengers, who are equally at risk. The purpose of this investigation was to define the prevalence of motor vehicle passengers riding with drivers who have been drinking on a Northern Plains Reservation. We surveyed a sample of 151 Northern Plains Indians about their experiences riding with drinking drivers. Associated behavioral and demographic risk factors were also examined to identify possible predictor variables. The majority (54%) of respondents reported riding with a driver who had been drinking at least once during the previous three months. Most often, passengers ride with a friend who has been drinking, on a weekend night. Injury risk may be compounded because few respondents reported regular seat-belt use. The results off our study suggest the need for immediate comprehensive prevention efforts focusing on motor vehicle passengers.

Adolescent↗