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Biomedical subjects

J M Leventhal

Publications and source records attributed to J M Leventhal.

At least 73 records · Page 4Linked to original sources
PubMed1986

Educational intervention by computer in childhood asthma: a randomized clinical trial testing the use of a new teaching intervention in childhood asthma.

To affect asthma-related knowledge, behavior, and morbidity, researchers tested a new educational intervention for children with asthma: an asthma-specific computer game called Asthma Command, which was specifically designed for this study. Sixty-five children with moderately severe asthma were randomly assigned to one of two groups, and 54 completed the study. Both groups were seen approximately six times during the 1 year of the study. Control subjects (n = 29) played routine computer games. Experimental subjects (n = 25) played Asthma Command. Compared with children in the control group, experimental subjects showed improvement in knowledge about asthma (P less than .001), behavior related to the management of asthma (P less than .008), and a trend toward the reduction of acute visits due to asthma (P less than .13). Children in the experimental group also scored higher on the assessment of behaviors related to the management of asthma that were specifically addressed by the intervention provided by Asthma Command (P less than .01). Differences between the control and experimental groups showed a greater improvement in the experimental group in 21 (84%) of the 25 outcome variables in the study (P = .004, Sign test). The study indicates that an asthma-specific computer game can significantly affect knowledge and behavior and may potentially affect morbidity in childhood asthma.

Asthma↗
PubMed1985

Mothers' perceptions of problems of feeding and crying behaviors. A prospective study.

During early infancy, problems of crying, colic, spitting, and feeding difficulties often provoke anxiety and lack of self-confidence in parents. We studied prospectively what proportion of mothers felt that their infants had problems of this type and determined risk factors for perceived problems identified in the early postnatal period. The mothers of 189 breast-fed and 184 formula-fed infants completed questionnaires post partum and responded to a follow-up interview at four months. Thirty-five percent of mothers in each group reported that their infants had moderate or severe problems of feeding or crying behavior. Risk factors for perceived problems were identified using stepwise logistic regression analyses. Inquiry about, and early attention to, risk factors may alleviate the parents' concerns and possibly affect the development of these problems.

Bottle Feeding↗
PubMed1985

Problems of early infancy, formula changes, and mothers' beliefs about their infants.

Problems of early infancy are sometimes managed by changing an infant's formula from a cow milk formula to a soy protein or casein hydrolysate formula ("special formulas"). This study was designed to determine the frequency of formula changes, mothers' reports of problems that lead to such a change, and mothers' beliefs about the causes of these problems. Mothers of 189 breast-feeding (BF) and 184 formula-feeding (FF) infants were enrolled postpartum. Follow-up data were obtained by telephone interviews at 4 months. After starting a cow milk formula, 11% of the BF and 25% of the FF infants were given special formulas. Mothers frequently reported problems related to feeding, bowel movements, and crying behavior; 32% of infants with such problems were given special formulas. Excessive crying and colic were the most common problems leading to a formula change. When a formula was changed, mothers more frequently believed that the cause of the problem was intrinsic to the child (P less than 0.001) and that their infant had had a "disease or illness" (P less than 0.001). When formula changes occurred, 26% of mothers believed that their infants were allergic to cow milk. These beliefs may affect a mother's perceptions of her child's vulnerability.

Behavior↗
PubMed1984

Reassessment of the relationship of perinatal risk factors and child abuse.

We performed a case-control study to examine the relationship of child abuse to several perinatal risk factors. Cases were children who had been born at Yale-New Haven (Conn) Hospital and were reported for physical abuse to the Hospital's Child Abuse Committee. For each case, a control was chosen from the hospital's log of births and matched according to five demographic variables. We identified 117 case-control pairs. No relationship was found between either prematurity or low birth weight and child abuse. In contrast, there was an association between child abuse and young maternal age (both at the birth of the index child and at the birth of the first child). We conclude that prematurity and low birth weight are not risk factors for physical abuse but that young maternal age is related to abuse.

Adolescent↗
PubMed1984

Marital adjustment to chronic childhood illness: a critique of the literature.

Thirty-four studies of marital adjustment were selected from the literature on family adjustment to chronic childhood illness. Studies were reviewed to determine whether divorce rates were elevated or marital adjustment was poorer compared with that of families of healthy children. Of 23 studies reporting divorce rates, only six used a group of families without a chronically ill child for comparison. These studies showed no significant differences in the divorce rates between groups. Of 23 studies of marital adjustment, 83% investigated marital distress. Four of seven studies with comparison groups showed that marital distress was increased in parents of chronically ill children. Other areas of marital adjustment, such as communication, decision-making, and role flexibility, have received almost no attention by researchers. It is questioned whether divorce or distress is an adequate indicator of marital adjustment in general. Further studies are needed to understand the relationships between divorce, distress, and other important areas of marital adjustment to chronic childhood illness.

Adaptation, Psychological↗
PubMed1982

Research strategies and methodologic standards in studies of risk factors for child abuse.

A major focus of studies of child abuse has been the identification of children who are at high risk for abuse. Despite this emphasis, little has been written about the research methodology in such studies. This paper reviews the three major research strategies to investigate risk factors: (1) randomized controlled trials, (2) prospective or observational cohort studies, and (3) retrospective or case-control studies. In addition, eight methodological standards are presented that should help to minimize bias in studies of risk factors for child abuse. These standards are: (1) clear description of abuse, (2) choice of a specific control group, (3) equal demographic and clinical susceptibility, (4) clear definition of the risk factor or protective factor, (5) unbiased ascertainment of the risk factor, (6) clear temporal sequence between risk factor and abuser, (7) equal detection of child abuse, and (8) unequal review of abused and nonabused subjects. Most studies of risk factors for child abuse have used either a case-control or, less frequently, an observational cohort design, both of which are nonexperimental research strategies. In such studies, the use of comparable control groups (standards 2 and 3) and equal detection of abuse in exposed and nonexposed children (standard 7) are of major importance in minimizing bias.

Child↗
PubMed1982

Synthesis of acid-soluble spore proteins by Bacillus subtilis.

The major acid-soluble spore proteins (ASSPs) of Bacillus subtilis were detected by immunoprecipitation of radioactively labeled in vitro- and in vivo-synthesized proteins. ASSP synthesis in vivo began 2 h after the initiation of sporulation (t2) and reached its maximum rate at t7. This corresponded to the time of synthesis of mRNA that stimulated the maximum rate of ASSP synthesis in vitro. Under the set of conditions used in these experiments, protease synthesis began near t0, alkaline phosphatase synthesis began at about t2, and refractile spores were first observed between t7 and t8. In vivo- and in vitro-synthesized ASSPs comigrated in sodium dodecyl sulfate-polyacrylamide gels. Their molecular weights were 4,600 (alpha and beta) and 11,000 (gamma). The average half-life of the ASSP messages was 11 min when either rifampin (10 micrograms/ml) or actinomycin D (1 microgram/ml) was used to inhibit RNA synthesis.

Alkaline Phosphatase↗
PubMed1982

Clinical predictors of pneumonia as a guide to ordering chest roentgenograms.

To develop criteria for a more efficient approach to the ordering of chest roentgenograms, patients with fever or respiratory symptoms who were being evaluated with this diagnostic test were prospectively monitored. During a six-month period, residents working in a pediatric emergency room collected data on 136 children, 3 months to 15 years of age. Pneumonia, defined by appropriate abnormal chest roentgenographic findings, occurred in 19 per cent. Of the 29 single symptoms or signs examined, the variable which was the best predictor of pneumonia was tachypnea. In addition, a cluster of pulmonary findings was also a good index, for pneumonia. If these clinical criteria had been applied to the patients under investigation, the number of chest roentgenograms obtained would have been reduced by 30 per cent.

Adolescent↗
PubMed1982

The pediatric prenatal visit: a questionnaire survey.

A questionnaire was sent to 83 pediatricians to determine which issues they considered important in the pediatric prenatal visit. Of the 64 respondents, 58 do prenatal interviews. Approximately half of the mothers of newborns entering these practices had prenatal visits. Most respondents indicated that the prenatal visit focused on meeting the family and discussing practical aspects of infant care. The finding that few respondents focused the interview on psychological aspects of parenthood raises questions about the role of the prenatal visit in pediatric care.

Female↗
PubMed1981

Laparoscopy for second-look evaluation in ovarian cancer.

Although second-look laparotomy to ascertain primary therapeutic effect on ovarian cancer has been generally accepted, laparoscopy for this purpose has been controversial. Between 1974 and 1978, 119 consecutive laparoscopic examinations were performed on 57 patients with ovarian cancer to monitor the effect of chemotherapy or to determine disease status. Most procedures included intraperitoneal biopsy and cytologic evaluation of peritoneal washings. Seventy-three percent of the procedures were successful. Fourteen percent of the patients had major complications requiring laparotomy, most of which involved bowel perforation. Complications were significantly reduced when routine laparoscopy was preceded by needle laparoscopy. A negative laparoscopy including biopsy and cytologic evaluation was associated with a significant increase in survival when compared with the entire patient group. Repetitive laparoscopy permitted early detection of recurrence and identified patients whose risk of recurrence after 24 months was low. With each successive negative laparoscopy, the mean duration of remission was longer and the probability of recurrence lower.

Female↗
PubMed1981

Risk factors for child abuse: methodologic standards in case-control studies.

To determine whether the findings of case-control studies of risk factors for child abuse may have been biased because of inattention to scientific principles of research design, 22-case-control studies were reviewed investigating either of two risk factors: (1) prematurity or low birth weight of the abused child or (2) young maternal age of the mother of the abused child. Each study was examined to determine compliance with seven methodologic standards that would minimize bias or distortion of the results. No study satisfied all seven standards. Two standards, choice of a specific control group and adjustment for differences in clinical and demographic susceptibility factors, most often affected the results. Studies complying with both of these standards indicated that prematurity or low birth weight is not a risk factor for abuse and that young maternal age at the birth of the abused child is likely to be a risk factor. Few studies complied with the standard concerned with avoidance of detection bias; this failure may have a major effect on the direction bias; this failure may have a major effect on the direction of the results of certain studies. Previous case-control studies of child abuse have important methodologic flaws that can affect the validity of the results. The standards presented should be helpful in planning methodologically rigorous studies.

Age Factors↗
PubMed1980

Operational criteria for adverse drug reactions in evaluating suspected toxicity of a popular scabicide.

A recently developed algorithm for the diagnosis of adverse drug reaction (ADR) was used to investigate the quality of evidence in reported cases of ADRs to 1% gamma benzene hexachloride (GBH), a popular scabicide and pediculicide currently under suspicion as a cause of central nervous system (CNS) toxicity, especially in children. Of the 53 reported cases of alleged toxicity, 37 were associated with lindane insecticide (greater than 1% GBH), which is not a pharmaceutical preparation. Of these 37 cases, 34 scored as definite or probable reactions on the algorithm. Of the 26 reports associated with the drug, 1% GBH, none scored as definite and only 6 as probable ADRs. Of these 6 probable cases, 5 represented inappropriate application or unintended ingestion. The use of rigorous operational criteria, such as those developed in this algorithm, permits a scientifically disciplined assessment of whether or not a drug has been fairly indicted, and also provides valuable clinical information about other aspects of suspected drug toxicity.

Bone Marrow↗