Biomedical subjects
Publications and source records attributed to J de Traversay.
Using predefined guidelines, the California HMO Quality Management Coalition monitored access by HMO members to six different types of health services across provider groups. Results highlight regional differences and point to some significantly poorer scores in the urgent visits and specialty referrals. Design considerations are discussed and suggestions are made for follow-up quality improvement.
We studied acoustic startle response and its modulation by prestimulation and by short-term and long-term habituation in 54 autistic patients and 72 normal age-matched controls. The startle response was measured as the amplitude and onset latency of the integrated orbicularis oculi EMG. There were no consistent significant differences between the autistic and control subjects in startle modulation by inhibitory or facilitatory prestimulation, short-term habituation of startle amplitude, long-term habituation of either startle amplitude or latency, or unmodulated startle amplitude. Differences between autistic and control subjects were limited to prolongation of unmodulated startle onset latencies in the autistics in all of the experimental paradigms (significant p = .005 only in the context of short-term habituation) and a statistically significant (p < .05) slower rate of short-term habituation of startle onset latency in the autistic patients, relative to the controls. Results provide only limited support for hypotheses of brainstem pathophysiology and no support for hypotheses of cerebellar pathophysiology in autism.
This study examined the presurgical 2-deoxy-2[18F]-fluoro-D-glucose positron emission tomography (PET) patterns of regional cerebral glucose metabolism in the non-resected hemisphere of 13 children who underwent hemispherectomy for early-onset intractable seizures. These patterns were compared with the rate of change in the children's non-verbal communication scores, measured before and after surgery. Irrespective of the side of surgery, the pre-operative glucose metabolism in the non-resected prefrontal cortex correlated significantly with the postoperative rate of change in the children's ability to focus the attention of an adult on an object or event (joint attention). These preliminary findings suggest that pre-operative PET patterns might be associated with certain aspects of the developmental outcome of children undergoing hemispherectomy.
Startle modulation was induced by prestimulation in 43, 6-11 year old boys with attention-deficit hyperactivity disorder (ADHD), 13 of whom were or had been enuretic, 17 age-matched enuretic boys, and 42 age-matched normal boys, using 60-ms and 120-ms prestimulation intervals and a 4000-ms continuous tone. There was a significant multivariate effect of enuresis on startle amplitude modulation. This effect was attributed primarily to the reduction of amplitude inhibition following the 120-ms prestimulation interval regardless of whether or not enuresis was associated with ADHD. There was no effect of ADHD on startle modulation by prestimulation. The inhibition following the 120-ms prestimulation interval in the enuretic boys was reduced to the level of 5-year-old normal children, suggesting a maturational component of the deficient startle inhibition. The neurophysiologic dysfunction underlying the deficient startle inhibition in enuresis, but not ADHD, is discussed in terms of a possible dysfunction of mesopontine reticular mechanisms mediating preattentive processing of signals associated with spinal reflexes involved in urinary bladder control.
The continuous high-intensity noise in the neonatal intensive care unit (NICU) is both stressful and harmful for the premature infant. Although some researchers have found evidence that loud noise can cause hearing loss and alter physiologic and behavioral responses, no study to date has investigated the benefits of noise reduction by the use of earmuffs. In this study earmuffs were placed over the premature infants' ears to reduce noise intensity in the NICU while physiologic and behavioral responses were measured. Two sites were used to collect data: in the first setting, 17 low birth weight infants were randomly assigned to an experimental and a control group, whereas 13 infants from a second hospital acted as their own controls and were tested with and without earmuffs. Earmuffs that reduced the intensity of noise by 7 to 12 dB were worn by infants in the experimental group only during the observation periods. Infants in the control group were exposed to the usual noise in the NICU. The infant's physiologic and behavioral responses were observed for four 2-hour intervals, morning and evening, on two consecutive days. Most of the significant results were from the site at which infants acted as their own controls. When infants wore the earmuffs, they had significantly higher mean oxygen saturation levels and less fluctuation in oxygen saturation. Furthermore, these infants had less frequent behavioral state changes, spent more time in the quiet sleep state, and had longer bouts in the sleep state. It is imperative that NICUs develop aggressive antinoise policies to substantially and consistently reduce noise.
The purpose of this study involving a cross-cultural group of single, pregnant adolescents was to examine the association of depression with self-esteem, social support, discomforts of pregnancy, and selected sociodemographic variables. The sample comprised 62 pregnant adolescents recruited from a residential maternity home. Subjects ranged in age from 14 to 20 years (mean 16.67 years) and were predominantly Hispanic and black. All subjects completed the Center for Epidemiological Studies Depression Scale, Coopersmith's Self-Esteem Inventory, a physical discomfort checklist, and a sociodemographic questionnaire. A high level of depression symptoms was reported by the majority of participants. Nearly two thirds of the young women reported adequate levels of emotional support; however, the remaining subjects claimed inadequate levels. Results of the multiple regression analyses revealed that, of the predictor variables investigated, only the total self-esteem score was statistically significant (p = 0.0001) and explained 32.6% of the variance. In further statistical analysis a multifactor analysis of variance found social support to be a significant variable influencing depression. On the basis of these results, several recommendations for assessment and intervention with similar groups of pregnant adolescents are suggested, including screening for depression symptoms and development of treatment programs for affected youth.