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Biomedical subjects

K J Roghmann

Publications and source records attributed to K J Roghmann.

At least 73 records · Page 4Linked to original sources
PubMed1985

Intervention strategies for children: a research agenda.

This background review has attempted to pinpoint problems and issues of intervention strategies to promote health among children. Some traditional interventions as they are now provided in preventive service packages, for example, are critically assessed; new interventions like neonatal intensive care, prenatal diagnosis, periconceptional vitamin supplementation, and nutritional supplementation during later pregnancy are welcome; supportive outreach services through nurse home visitors to bring proved technologies to those in greatest need, while they may not be new have shown renewed effectiveness. Recently recognized problems like the "new morbidity," and newly recognized prevention potentials like the great prospects for accident prevention, adequate school health programs, and special adolescent care programs are promising areas for preventive services effectiveness. We do not claim that a comprehensive list has been presented. Rather, an attempt has been made to challenge some traditional preventive techniques, e.g., preoperative x-rays, to stimulate thinking about new organizational forms of care delivery, and to keep an open agenda. As a result, the reader will feel a "lack of closure"--challenges without definitive answers. The general assertion is that personal preventive care is only weakly related to health and that preventive care delivery is not a simple technical problem. Let me summarize the main points. First, the lack of evidence and comprehensiveness. Other reviews of preventive care packages could have been discussed. The presentation by Fielding [164] in the Institute of Medicine's background papers to Healthy People also includes service listings for pregnant women, normal infants, preschool children, schoolchildren, and adolescents. The Lifetime Health-Monitoring program by Breslow and Somers [165] set goals and services that have already become practice patterns for large parts of the country. Many more cost-effectiveness studies of immunizations and screenings could have been cited. The point, however, is not whether technologies with the potential for prevention exist, but whether these technologies have been used and are now used effectively for that purpose, and whether their performance in the real world represents the best use of scarce and expensive resources. Scientific evidence of organized delivery effectiveness is rare.(ABSTRACT TRUNCATED AT 400 WORDS)

Accident Prevention↗
PubMed1984

Empirical test of the interaction model of client health behavior.

The general concepts, variables, and relationships described by the Interaction Model of Client Health Behavior (IMCHB) were used to guide a secondary data analysis of 203 women's decisions to request an amniocentesis. Step-wise multiple regression explained 58% of the variance in these decisions by jointly examining the factors which define the client as unique in her responses to an at-risk pregnancy, as well as factors describing the client-provider interaction. The women could be correctly classified as users or nonusers of prenatal diagnosis with 87% accuracy in a discriminant analysis based on the variables derived from the conceptual model. Finally, structural equation modeling was used to estimate the causal paths described by the general model. While the relationships proposed in the model need further empirical evaluation, this first application serves to demonstrate the testability of the IMCHB and its potential to direct nursing inquiries.

Adult↗
PubMed1984

Mental health problems among children seen in pediatric practice: prevalence and management.

An ambulatory care survey involving 40% of all pediatricians in Monroe County, NY, was conducted between January and December 1979 to obtain an estimate of the prevalence of mental health problems among children seen by pediatricians. If a child with such a problem was identified, the pediatrician described the problem in detail, its impact on the family and the patient, and the action taken to handle the problem. The weighted 40% probability sample was representative of all pediatric practices in the county. During the 2 months for which each of the 30 pediatricians reported on all visits, there were 21,575 visits made by 18,351 children. There were 935 children detected at their first visit as having a problem, and another 48 children at a repeat visit during the reporting period. This is equivalent to a point prevalence at time of first visit of 5.09%. There was considerable variation between pediatricians: group practitioners reported a point prevalence of 4.06%, solo practitioners reported 5.06%, and health center pediatricians reported 7.33%. High rates were reported among children 7 to 14 years old (8.0%), boys (6.2%) compared with girls (3.9%), those on Medicaid (8.3%), and those whose presenting complaint was a chronic physical disorder (13.1%). The slightly higher rate among blacks than whites appeared to be related to the generally lower socioeconomic status among blacks. The rate among children in one-parent families was twice as high as in two-parent families. With regard to the mental health problem, most frequent diagnoses (primary or secondary) were adaptation reaction (31.5% of "problem" children), speech and language disorder (18.4%), other specific learning disorder (17.1%), hyperkinetic disorder (16.8%), and conduct disorder (14.7%). Functional impairment was moderate or severe in more than half the affected children; most frequent treatment provided by the pediatricians was supportive therapy or counseling (81.4%); drugs were prescribed for 11.3% of the affected children, amphetamines for 4.7%.

Adolescent↗
PubMed1984

The changing pattern of primary pediatric care: update for one community.

The changing pattern of pediatric practice in the Rochester, New York, community between the late 1960s and the late 1970s is described, and some extrapolations for the next decade are discussed. The child population shrunk from 243,000 in 1970 to 192,000 in 1980 and is expected to decrease further to 160,000 in 1990, possibly stabilizing at 140,000 by 2000. The number of pediatric beds as well as occupancy rates declined, but the number of full-time equivalent practicing pediatricians increased slightly. One third of them are now practicing out of neighborhood health centers or health maintenance organizations. Problems of manpower shortage and inadequate access to care for the inner city residents have long since disappeared. Utilization rates by race and socioeconomic area are similar once the children enter the care system. For "well child" care, however, there may still be lower utilization for blacks, especially for older children. The high "market penetration" for child health services by pediatricians, and the high proportion of well child visits (40%) among all visits, may be atypical for the nation as a whole, but is probably indicative of what pediatric care elsewhere will be in the future. Fewer children, and less acute care per child, will allow pediatricians to focus increasingly on preventive, developmental, and psychosocial needs.

Adolescent↗
PubMed1984

Mental health problems of children: analysis of a cumulative psychiatric case register.

The advent of community mental health centers has brought a marked increase in treatment of mental health problems of children, especially for minorities. The number of children receiving care and the prevalence and the utilization rates by age, sex, and race from 1960 to 1977 in a large metropolitan county in upstate New York have been described previously. For the same time and community, the episodes of care by diagnostic grouping, type and length of treatment, and health status at the end of an episode have now been examined. An increase in treatment occurred in two areas: situational disorders and behavioral disorders. The number of treatments for psychotic, neurotic, and personality disorders remained stable. Affective and psychotic disorders emerged as qualitatively unique problems which often required multiple treatments and predicted high adult utilization. The average length of treatment for all episodes was 110 days. One third of the treatment episodes were associated with an improved health status. Most contacts were for first episodes, but a few patients had an extraordinarily large number of treatment episodes. A comparison with mental health problems seen in pediatric practice is presented.

Adolescent↗
PubMed1984

Bronchiolitis as a possible cause of wheezing in childhood: new evidence.

A historical cohort study was performed in order to assess the hypothesis that even mild bronchiolitis in infancy in a predictor of wheezing later in childhood. Subjects who had experienced bronchiolitis and a matched control group were compared in terms of reported wheezing 8 years later. A highly significant difference was found between the bronchiolitis group and the control group in terms of current wheezing (P less than .0001, relative risk 3.24). This difference was maintained after adjusting for many potentially confounding variables including family history of allergy and other allergic manifestations in the child. Results suggested that 13.6% of a normal practice population in the age range 6 to 9 years currently wheeze, but that 44.1% of children who experienced bronchiolitis currently wheeze. Based on the incidence of bronchiolitis (4.27/100 children in their first 2 years of life) and the relative odds for wheezing derived from a logistic regression model including variables that measured passive smoking, genetic tendency to wheeze, and bronchiolitis, calculations of attributable risk suggested that wheezing in 9.4% of the population of children who currently wheeze was attributable to bronchiolitis.

Adolescent↗
PubMed1984

Job satisfaction and stress among neonatologists.

Neonatology is reputed to be a stressful pediatric subspecialty. To quantify objectively this stress and to assess the factors involved, a questionnaire was mailed to neonatologists in the northeastern United States. Ninety-six (70%) replied. A five-point scale was used to determine the level of satisfaction with neonatology as a career and the level and type of stress experienced at work. Almost all neonatologists experienced stress at work: 34% moderately severe and 16% very severe stress. Open-ended questions indicated that the major causes of stress were excessive work load, eg, on call too often or calls at night; problems in patient care, especially dealing with infant death; and staff disagreements, especially nurse or housestaff conflicts. Twenty percent of those surveyed suffered a stress-related illness in the previous 5 years. One sixth of the neonatologists were either moderately or very dissatisfied with their career. Major dissatisfactions were: too much work, especially managing many sick patients; lack of resources, including inadequate salary; too much stress at work; and administrative demands. Job satisfaction was derived from patient care, teaching, intellectual stimulation, and research. Altering subspecialty had been considered at some time by 58% (15% very seriously). This study confirms that neonatology, in the eyes of those who practice it, is a highly stressful career. It also suggests that job stress is a greater problem than job dissatisfaction.

Adult↗
PubMed1983

The prevalence of juvenile arthritis.

A secondary analysis of two new large practitioner surveys, one national and one local, showed the prevalence of juvenile arthritis to be between 0.16 and 0.43 cases per 1,000 children. These rates compare quite closely with the majority of reports both in the United States and the world. We believe the prevalence of juvenile arthritis is between 0.2 and 1 case per 1,000 children (13,000--63,000 children), with the best estimate being about 0.5 cases per 1,000 children. Based on the 1980 census data, this latter estimate means there are approximately 32,00 children with juvenile arthritis in the United States.

Adolescent↗
PubMed1983

Satisfaction with medical care: replications and theoretic reevaluation.

Satisfaction with medical care is frequently measured in health services research but for many different reasons. The widening conceptualizations and uses of satisfaction reported make comparisons between studies difficult. Questions regarding the structure and dimensionality of satisfaction remain. The relation of satisfaction with utilization still requires theoretic and empiric clarification. This article reports on several surveys containing measures of satisfaction conducted in a research program in community pediatrics. Using multidimensional scaling techniques, the stability of the structure of satisfaction and patients' preferences for care is examined across several samples. The different structures that emerged seem to reflect unique patient experience. Several multivariate approaches were applied to study the relation between satisfaction and utilization. A regulatory self-equilibrating model was offered. Satisfaction is seen as a multifaceted concept related to short-term and long-term processes. Specific models are required to link satisfaction to the various health and illness behaviors.

Blue Cross Blue Shield Insurance Plans↗
PubMed1983

The selective utilization of prenatal genetic diagnosis. Experiences of a regional program in upstate New York during the 1970s.

The regional prenatal diagnosis program of the Finger Lakes Health Systems Area in upstate New York has been monitored since its start in 1971. By the end of 1980, more than 1,250 diagnostic procedures had been successfully completed. Based on analyses of regional vital statistics, genetic services data, repeated surveys of obstetricians, and an ongoing survey of recent mothers older than 34 years of age, the authors concluded that: 1) in the study region, most women with an indication for prenatal diagnosis because of age are aware of the possibility of prenatal diagnosis; 2) the majority of obstetricians discuss amniocentesis with their patients; 3) after a period of rapid growth the utilization rate in the study region reached about 40% in 1981; 4) nonuse of prenatal diagnosis is based mostly on a patient's decision rather than system deficiencies; and 5) a community approach to increase utilization will have to focus on how to provide a supportive social climate for these services rather than on increasing awareness among potential patients or more referrals by providers.

Abortion, Induced↗
PubMed1983

Reassurance through prenatal diagnosis and willingness to bear children after age 35.

This study reports on a survey of 2,209 women age 25-45; most were married. Respondents were asked about their reproductive plans and whether prenatal reassurance might influence their reproductive intentions. For almost two-thirds of the age 35-45 respondents, either the woman or her husband had already chosen sterilization; of those able to bear children, but with uncertain plans, 25 per cent of 35-39 year olds and 12.8 per cent of 40-45 year olds indicated an increased willingness to have children if they were reassured that their baby had none of the birth defects detectable by amniocentesis.

Adult↗
PubMed1982

The increasing number of children using psychiatric services: analysis of a cumulative psychiatric case register.

Psychosocial problems of children have received increasing attention in the pediatric literature, but it remains unclear to what extent psychiatric services are available and used for the treatment of these problems. This paper examines the utilization of psychiatric services by children over an 18-year period in Monroe County, NY, where a psychiatric case register monitors utilization since 1960. Reporting to the register is estimated at more than 90% of utilization for the child population. By 1977, the last year for which reasonably complete data are available, enough information had accumulated to study the lifetime utilization of all children up to 17 years of age. During the last three years of the study period, the lifetime prevalence of illness treated in psychiatric facilities including private psychiatrists' offices was 3% for children aged 5 to 9 years, 5.5% for children aged 10 to 14 years, and 7.3% for those aged 15 to 17 years. The incidence of newly recognized and treated illness was approximately .7% per year in the age range 5 to 14 years and 1.0% for those aged 15 to 17. Community mental health centers brought a marked increase in treated incidence especially for the nonwhite population. Utilization rose during the first 15 years of the study period and reached a plateau by the mid-1970s. Two interpretations of this stabilization of utilization are offered. The first one suggests that needs and utilization are still increasing, but that this rise is masked in the data by a drop in reporting providers. The second interpretation suggests that supply and demand for services have become balanced since the establishment of four community mental health centers.

Adolescent↗
PubMed1981

Early adolescent childbearing: a changing morbidity?

Statistics on births and abortions in Monroe County, New York were analyzed for the years 1967 through 1978, with special attention to the proportion of infants born weighing less than 2501 g to mothers less than 14 years of age. For that age group, there was an overall increase in low-birth-weight infants from 12.5% to 16.2% of live births. The nonwhite younger adolescents experienced widely fluctuating changes in the proportion of low-birth-weight infants from year to year, with a slight overall increase in the 12 year interval; the white younger adolescents exhibited a steady dramatic increase from 9.1% to 19.2% of live births. Although these changes whether for single year pairs or for grouped years, have not reached statistical significance, we hypothesize that this trend is the result of use of abortion among young adolescents.

Abortion, Legal↗
PubMed1981

Relationship between frequency of sexual intercourse and urinary tract infections in young women.

We compared personal and sexual behavior of a group of 32 young adult women who had a culture proven urinary tract infection (UTI) and a group of 28 women who had no urinary symptoms. All women were sexually active, and the two groups were similar for age, race, marital status, history of previous pregnancy, and use of oral contraceptives. The major finding was an increase in the frequency of sexual intercourse by the study group immediately before the onset of symptoms. No group differences were found for manner of perineal hygiene, frequency of urination, frequency of refraining from voiding after the initial urge, and frequency of urinating after coitus. We conclude that an increase in sexual intercourse may be one of the factors involved in the development of a symptomatic UTI in young women.

Adolescent↗
PubMed1981

Prenatal care and pregnancy outcome in an HMO and general population: a multivariate cohort analysis.

We studied the use of prenatal care and pregnancy outcome in 4,148 deliveries among members of a well-established health maintenance organization (HMO) and 19,116 births among the 1973-1974 White birth cohort in the Portland, Oregon area. Mothers in the HMO were almost one year older on the average, slightly better educated, and less frequently unmarried, but had virtually identical past pregnancy histories when compared with the general population cohort. HMO members began prenatal care one month later and had three fewer visits than the general population (p less than .01); 78 per cent of the general population and only 64 per cent of HMO members began prenatal care in the first trimester (p less than .01). With maternal risk held constant, low birthweight, neonatal mortality, and infant mortality were 1.5 to 5 times greater with late, less frequent prenatal care than with early, frequent care. Multivariate analysis demonstrated a positive relationship between prenatal care and birthweight. Although this relationship was independent of risk factors recorded on birth certificates, it is not necessarily a causal relationship. Unadjusted prematurity, neonatal and infant mortality rates did not differ between the HMO and general populations. Multivariate analyses indicated that, independent of all maternal risk factors, HMO membership was associated with an increase of 30 grams in the predicted birthweight (P less than .01), but had no effect on mortality. The data suggest that, in Portland, Oregon, pregnancy outcome for HMO members is comparable to that of the general population.

Adult↗
PubMed1980

Prevention and treatment of serous otitis media with an oral antihistamine. A double-blind study in pediatric practice.

Serous otitis media (SOM) is a common and troublesome disease in childhood. Although antihistamines are commonly prescribed to prevent or treat SOM, there have been no controlled clinical trials to determine the efficacy of such interventions. This study was designed to determine if antihistamines are of value in the prevention or treatment of SOM. Using a randomized double-blind method, 206 children with acute otitis media were treated with antibiotics and either brompheniramine maleate or placebo. The children were evaluated two weeks later by tympanometry and, independently, by combined pneumatoscopy and otoscopy. There were no significant differences overall between the treatment and control groups in terms of preventing SOM: 44% of those on antihistamine and 41% of those on placebo had SOM after two weeks of therapy. However, children with a history of serous otitis media did significantly better on placebo than did those on antihistamine, and children without a history of serous otitis media did significantly better on antihistamine than did those on placebo. One hundred children continued to use antihistamine or placebo for four more weeks. There were no significant differences between the treatment and control groups in terms of resolution of SOM (64% versus 68%).

Adolescent↗