Feelings of mastery in aggressors: a conceptual replication of an American experiment in France.
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Adolescent↗
Biomedical subjects
J M Driscoll
Publications and source records attributed to J M Driscoll.
Exploring attitudes of white dental students regarding willingness to treat people with HIV.
This descriptive field study examines the willingness of ninety white dental students to provide care to people with Human Immunodeficiency Virus disease (HIV disease). This study suggests that perceived clinical ability, attitudes toward gay men, and white racial attitudes account for white dental students' willingness to provide dental care to patients with HIV disease. Likewise, this study suggests that white dental students' perception of risk of occupational infection with HIV is uniquely predicted by the same variables. A hierarchical regression found that in white dental students, racial attitudes were significant predictors of willingness to treat persons with HIV disease beyond the significant contributions of perceived clinical competence and attitudes toward gay men. In terms of perceptions of occupational risk, results of the hierarchical regression were that both perceived clinical competence and attitudes toward gay men were significant predictors. Thus, the results of this study show that attitudes regarding cultural diversity can influence clinical intentions.
Adult↗
The treatment of non-HIV-related conditions in newborns at risk for HIV: a survey of neonatologists.
OBJECTIVES: The purpose of this study was to examine attitudes of neonatologists about treatment of conditions unrelated to the human immunodeficiency virus (HIV) for critically ill newborns at risk for HIV. METHODS: Questionnaires were mailed to the 1508 members of the Section on Perinatal Medicine of the American Academy of Pediatrics; 63% completed the survey (n = 951). The survey included structured questions about treatment for hypothetical cases and open-ended questions eliciting reasons for decisions. RESULTS: Differences in recommendations for treatment by both maternal and infant HIV status were substantial and statistically reliable. For example, 98% of respondents recommended life-saving cardiac surgery for a neonate with no risk for HIV, but only 93% recommended such surgery for a child of an HIV-positive mother; only 50% recommended the same surgery for a newborn known to be infected. The corresponding figures for chronic dialysis were 91%, 61%, and 26%. Most expected diminished quality of life for both infected and uninfected children of HIV-positive mothers. CONCLUSIONS: Recommendations about life-sustaining treatment for non-HIV-related conditions varied by HIV status. These data on physician attitudes raise the possibility that infants labeled as HIV positive, whether infected or not, may suffer discrimination.
Adult↗
Hearing and neurodevelopmental outcome in survivors of persistent pulmonary hypertension of the newborn.
Thirty-four infants who had a diagnosis of severe persistent pulmonary hypertension of the newborn at birth (alveolar-arterial oxygen difference greater than 600) were treated without paralysis or hyperventilation to induce alkalosis. All survived. Twenty-seven of these 34 eligible infants (79%) underwent neurologic, intelligence, and audiologic testing between 10 months and 6 years of age. Children who were younger than 1 year of age at the initial hearing test were retested after they reached 2 years of age. The average IQ was within the normal range (mean = 96.23). None had sensorineural hearing loss. Severe neurologic abnormalities were seen in 4 children, 3 of whom had been severely asphyxiated at birth (determined by biochemical criteria). Mild neurologic abnormalities were observed in 5 children. Two infants had bronchopulmonary dysplasia because they required supplemental oxygen for 29 and 66 days, respectively, and had abnormal chest roentgenograms; 1 patient takes intermittent doses of albuterol (Ventolin) and neither currently requires supplemental oxygen. This study of 27 infants with severe persistent pulmonary hypertension of the newborn suggests that conservative management without induced alkalosis or respiratory paralysis is accompanied by no sensorineural hearing loss and a good neurologic outcome.
Apgar Score↗
Treatment choice for infants in the neonatal intensive care unit at risk for AIDS.
Many infants admitted to neonatal intensive care units are the children of women infected with the human immunodeficiency virus (HIV); they have approximately a 30% risk of infection. To investigate attitudes surrounding treatment for such newborns, we conducted a survey of professionals at six neonatal intensive care units in New York City. A significant proportion of the 247 respondents recommended less aggressive treatment for non-HIV-related conditions for infants at risk for HIV compared with those not at risk. For example, 97% of respondents recommended open heart surgery for an infant with no known HIV risk but only 77% recommended surgery for an infant whose mother had acquired immunodeficiency syndrome; if certain the infant was infected, 42% of respondents recommended surgery. We conclude that perceived HIV status may influence decision making about treatment for non-HIV-related conditions for critically ill patients, including infants not actually infected. Ethical issues concerning the relevance of HIV status need to be examined.
Acquired Immunodeficiency Syndrome↗
Time-trends in necropsy prevalence and birth prevalence of lung hypoplasia.
Congenital lung hypoplasia (LH) has been identified with increasing frequency in perinatal and neonatal necropsy reviews. The available prevalence figures have been derived using various diagnostic criteria in different populations and at various times. We therefore reviewed our experience in 15 years of consecutive early neonatal necropsies using one constant set of diagnostic criteria for LH and looked for a time-trend. We determined the necropsy prevalence (no. of cases of LH/no. of necropsies) and the birth prevalence (no. of cases of LH documented at necropsy per 1000 livebirths for inborn patients, and per 1000 referrals for outborn patients) between 1971 and 1985. We then divided this 15-year period into five consecutive 3-year periods to determine if a time-trend was discernible. Whereas early neonatal mortality for neonatal intensive care unit (NICU) admissions progressively decreased from 11.4% to 4.0% between the first and the last 3-year periods, the number of cases of LH per 3-year period did not vary appreciably. As a result, the prevalence of LH at necropsy showed a slight upward trend with time. The overall prevalence was 18%; it was 13% during the first and 23% during the last 3-year period. We found no time-trend in birth or referral prevalence for this lesion, which averaged 1.1 per 1000 livebirths and 9.8 per 1000 referrals. We conclude that lung hypoplasia appears to be emerging as an increasingly prevalent necropsy finding as a result of a shift in proportionate mortality, with the number of patients dying of other causes (denominator) decreasing, and the number of patients dying with lung hypoplasia remaining constant.
Cause of Death↗
Birth weight, respiratory distress syndrome, and cognitive development. A four-year follow-up of preterm infants.
This study examined the relationship of respiratory distress syndrome (RDS) and birth weight to cognitive development in 30 white, middle-class, low-birth-weight, preterm infants. Cognitive ability was assessed at 12, 36, and 48 months of age. No significant difference was found at any age between children who had and did not have RDS during the neonatal period. Children with birth weights of 1500 g or less were found to have lower scores than those with birth weights greater than 1500 g in the first year of life. However, the difference diminished with increasing age.
Birth Weight↗
Experience with percutaneous indwelling peripheral arterial catheterization in neonates.
We present an experience with indwelling peripheral arterial catheters in preterm and term neonates. During a 12-month interval, 158 peripheral arterial lines were inserted in 115 infants. Eighty-eight infants required a single line while 27 infants required more than one line. Ninety-one catheters (57.6%) were electively removed, and 67 (42.4%) had to be discontinued prematurely. Vessels used included 110 radial arteries (69.6%), 27 posterior tibial arteries (17.1%), and 21 temporal arteries (13.3%). There were only two major complications (1.27%), both related to infections. The technique is described in detail. In our experience, with appropriate precaution, peripheral arterial cannulation has been a safe and reliable alternative to umbilical arterial catheterization.
Arteries↗
Pulmonary follow-up of moderately low birth weight infants with and without respiratory distress syndrome.
Pulmonary function was measured in 18 children aged 6 to 9 years who had been born prematurely (mean birth weight 1760 +/- 555 g) and who had each received greater than 100 hours (mean 177 +/- 74 hours) of mechanical ventilation for respiratory distress syndrome (RDS). We used as controls 26 children aged 6 to 7 years who had been born prematurely (mean birth weight 1636 +/- 554 g) but who had required no treatment for pulmonary disease. Results for total lung capacity, FEV1, ratios of functional residual capacity and residual volume to total lung capacity, specific airway conductance, and alveolar plateau slope did not differ in the RDS and control groups. Eight of the 18 children in the RDS group had had radiologic evidence of bronchopulmonary dysplasia at 30 days and oxygen dependence at 30 days, but did not differ from the control group for any of the indices of pulmonary function. However, FEV1 and specific airway conductance were significantly reduced in the premature control group compared with children born at term. Therefore, factors associated with prematurity rather than combined effects of RDS and its treatment determined pulmonary function at age 6 to 9 years.
Airway Obstruction↗
The effect of obstetric management on neonatal mortality and morbidity for infants weighing 700-1000 grams.
The obstetric and neonatal factors influencing survival and neurologic outcome are examined in 79 infants with birthweights of 700-1000 gm. The overall survival was 57%, with a normal neurologic examination at 1 year present in 73%. Factors that were significantly related to outcome were Apgar score at 5 minutes, birthweight, prenatal steroid administration, and lack of respiratory distress syndrome. Delivery by cesarean section did not improve survival or neurologic outcome. The implications of these results on the attitude toward management of the very-low-birthweight infant is discussed.
Adrenal Cortex Hormones↗
[Neonatal intracranial hemorrhage--update].
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Cerebral Hemorrhage↗
Gentamicin absorption during prophylactic use for necrotizing enterocolitis.
Gentamicin absorption was measured after oral administration in 18 neonates treated prophylactically in an attempt to decrease the incidence of necrotizing enterocolitis. Patients were given 10 mg/kg/day in four divided doses via nasogastric tube for a total of 10 days. Levels were assayed using the Emit system. Serum levels ranged between 0 and 2.2 micrograms/ml. Mean levels over 10 days were 0.42 +/- (SD) 0.47 micrograms/ml and did not vary significantly from day to day. From these data we conclude that enterally administered gentamicin is not absorbed to a degree that would result in toxic or even therapeutic serum concentrations.
Birth Weight↗
Tension pneumothorax and intraventricular haemorrhage.
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Cerebral Hemorrhage↗
Necrotizing sialometaplasia: an early, nonulcerative presentation.
Necrotizing sialometaplasia usually presents as a painless, deeply excavating ulcer and is considered in the differential diagnosis of large palatal ulcers along with mucoepidermoid carcinoma and adenoid cystic carcinoma. This case is presented to illustrate that the early signs and symptoms of necrotizing sialometaplasia may be swelling with a purulent exudate, diffuse, vague pain, and numbness. It also demonstrates the rapidity with which initial signs of healing become apparent. This latter clinically suggests a benign process.
Adult↗
Perception of an aggressive interaction as a function of the perceiver's aggression.
This research examined whether persons high or low in naturally occurring aggression differ in attributions made to others engaged in an aggressive interaction. All participants were shown a videotaped aggressive exchange after which they completed a standard person-perception questionnaire and a self-report used to separate them into groups of persons high and low in aggression. The salience of the more aggressive stimulus person was manipulated as a means of relating results to existing findings and theory in person perception. Five of the seven dependent measures show effects of level of aggression consistent with prediction of more negative perceptions by persons high in aggression than by persons low in aggression. Level of aggression often interacts with salience and stimulus person, and some of these complex interactions are not easily interpretable. However, persons high in aggression than by persons low in aggression. Level of aggression often interacts with salience and stimulus person, and some of these complex interactions are not easily interpretable. However, persons high in aggression perceive greater injury, negative reactions, and domineering in such situations and make greater causal distinction among stimulus persons.
Adult↗
Mortality and morbidity in infants less than 1,001 grams birth weight.
A prospective study of 54 infants with birth weights of 1,000 gm or less was conducted over a period of two years. Of the 26 infants who survived, 24 weighed between 750 and 1,000 gm; two infants died after discharge and one was lost to follow-up, leaving 23 in whom serial observations were made over 18 months to 3 years of age. The incidence of neurologic deficit in these infants was 17% and of intellectual deficit, 13%. Of the four who were abnormal neurologically, two had spastic quadriparesis, one static encephalopathy, and one hydrocephalus secondary to intraventricular hemorrhage. The three with intellectual deficit had a developmental quotient less than 85. Of the perinatal factors examined, only birth asphyxia correlated significantly with both neonatal mortality and subsequent morbidity. Six (26%) of the surviving infants had mild, nonblinding retrolental fibroplasia; only one of them had a significant refractive error that required corrective lenses for vision. Sepsis was a significant contributor to neonatal mortality in ten of 28 infants who died, but was detected in only one survivor. Although the prognosis for the infant weighing 1,000 gm or less at delivery has improved significantly, there is promise for still further improvement by reducing perinatal asphyxia.
Asphyxia Neonatorum↗
Neonatal necrotizing enterocolitis. Survival, management, and complications: a 25-year study.
One hundred sixteen infants with neonatal necrotizing enterocolitis (NEC) have been seen during a 25-year period (1955 through 1979). Prior to 1972, the survival rate was 17%; subsequently, it has been 68%. This increased survival is attributed to (1) improved physiologic care of the critically ill infant, (2) the institution of a standard management protocol, and (3) early diagnosis and treatment. Survival following neonatal NEC is attended by a significant incidence of intestinal stricture (21%); however, physical development has been normal and there have been few long-term gastrointestinal tract problems.
Birth Weight↗
Effect of antiseptic cord care on bacterial colonization in the newborn infant.
A randomized controlled study was undertaken to compare the effectiveness of three umbilical cord treatment regimens in controlling neonatal bacterial colonization. The regimens studied included daily application of castile soap, triple dye and silver sulfadiazine. The triple dye and silver sulfadiazine regimens inhibited bacterial colonization. Staphylococcal colonization was inhibited most effectively by triple dye treatment. Group B streptococcal colonization was equally inhibited by triple dye and silver sulfadiazine. Silver sulfadiazine was more effective in controlling colonization with gram-negative microorganisms.
Anti-Infective Agents, Local↗