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Biomedical subjects

K K Christoffel

Publications and source records attributed to K K Christoffel.

At least 19 recordsLinked to original sources
PubMed1992

Calories count. Improved weight gain with dietary intervention in congenital heart disease.

OBJECTIVES: We assessed the nutritional status of patients with congenital heart disease (CHD) to evaluate the role of dietary intake in impaired weight for patient length. Underweight patients with CHD underwent nutritional counseling to evaluate the role of this intervention in improvement of weight for length. RESEARCH DESIGN: We prospectively evaluated a clinical protocol for nutritional assessment and counseling in patients with CHD. Eligible patients were enrolled from a cardiology clinic during a 13-month period. Initial anthropometric measurements and measurements of dietary intake of underweight and normal-weight patients were compared. Initial and follow-up measurements of underweight patients who received nutritional counseling were compared. PATIENTS: Nineteen underweight patients with CHD and 16 normal-weight patients with CHD, aged 1 month to 2 years, were studied. Exclusion criteria included noncardiac factors that could affect growth (eg, low birth weight, Down syndrome, gastrointestinal deficit, and any severe abnormality of the central nervous system). Seventeen of the 19 underweight patients underwent nutritional counseling in the presence of a parent every 2 months for 6 months. Caloric and protein intakes were maximized using high-calorie formulas. MEASUREMENTS AND RESULTS: Baseline dietary intake was lower in underweight patients than in normal-weight patients (mean percentage of the recommended daily allowance of calories, 89% vs 108%). Follow-up evaluation in normal-weight patients showed no change in percentage of ideal body weight for length. Follow-up evaluation in underweight patients showed improvement in mean dietary intake (from 90% to 104% of the recommended daily allowance of calories) and in mean percentage of ideal body weight for length after intervention (from 83.1% to 88.3%). CONCLUSION: Nutritional evaluation of patients with CHD demonstrated that underweight children had inadequate diets. Underweight patients with CHD who received nutritional counseling showed increased dietary intake and improved anthropometric measurements on follow-up.

Anthropometry↗
PubMed1992

Standard definitions for childhood injury research: excerpts of a conference report.

As awareness of the huge human and other costs of injury has grown, research has expanded. There has not been any standard set of terminology for use in this research. As a result, research and surveillance data are too often difficult to interpret and compare. To overcome this impediment to gains in needed knowledge about childhood injuries, a conference was held in 1989 by the National Institute of Child Health and Human Development to develop a set of standard definitions. The full conference report is available from the US Government Printing Office. This report presents excerpts, emphasizing those--core--variables likely to be of use to the largest number of investigators. The conference recommendations presented address cross-cutting factors (age, race/ethnicity, location, socioeconomic status, and biopsychosocial development), effect modifiers (exposure, medical risk factors, substance abuse, time, injury severity, and social risk factors), and specific injuries (motor vehicle injuries, central nervous system injuries, falls, fire/burns, drowning, and violence). It is expected that childhood injury investigators will strive to meet the recommendations of this conference and that use of these definitions will lead to improvements in research and, ultimately, to revision of the definitions.

Child↗
PubMed1991

Tykes on bikes: injuries associated with bicycle-mounted child seats.

We reviewed US Consumer Product Safety Commission (CPSC) data for 1978-1988 concerning injuries related to seats used for carrying children on adult bicycles, ie, bicycle-mounted child seats. There were an estimated 4960 injuries to children during the 11-year period. The peak age of injury was two years. Fifty-five percent of victims were male. Falls accounted for 80% of the estimated injuries. Head (51%) and face (21%) injuries predominated. Twenty-one percent of estimated injuries were mild, 60% were moderate, and 19% were severe. All severe injuries involved the head or face, and all mild injuries were to extremities. Riding in a bicycle-mounted child seat exposes the child to adult-level forces, risking injury because of the bicycle's size, speed, and instability and the child's size and development. Injury prevention requires recognition of this problem, use of bicycle helmets, improvements in seat design, and educational efforts by physicians and their organizations. This report demonstrates use of CPSC national injury estimates to evaluate a product-related childhood injury and underscores the need to protect potential victims when avoidance of injury is beyond their own capabilities.

Accident Prevention↗
PubMed1991

Toward reducing pediatric injuries from firearms: charting a legislative and regulatory course.

Each year in the United States, approximately 3000 children and adolescents younger than age 20 die as a result of homicides, suicides, and unintentional injuries from firearms. The young children, relatives, neighbors, and friends of the 30,000 adults killed by firearms each year in the United States are also affected by this uniquely American epidemic. It is estimated that half of all American homes contain 200 million firearms, including 60 million handguns. Increasingly, pediatricians are becoming involved in efforts to reduce the prevalence of injuries from firearms, as parent educators, experts on children and adolescents, and advocates in the political process. This commentary is intended to aid in the last of these roles. The advocacy goal is identified as reducing the accessibility of guns in the environments of children and adolescents. The pros and cons of 17 possible approaches--ranging from mandatory safety courses in schools to handgun bans--are presented. It is concluded that, while there is no perfect approach, many available approaches will help; there is every reason to be both bold and optimistic.

Accident Prevention↗
PubMed1990

Violent death and injury in US children and adolescents.

Violence, including homicide, child abuse and neglect, and assault by peers and others, causes over 2000 deaths a year to US children aged 0 to 19 years. Homicide is a leading cause of death for US children and adolescents, and so a major cause of years of potential life lost. Infantile and adolescent patterns of homicide are recognized: child abuse by parents characterizes the former; gunshots and other assaults by peers characterize the latter. Nonfatal violent injury is far more prevalent than the fatalities. Reliable estimates indicate that each year close to 1 million female adolescents are sexually assaulted, and more than 1.5 million children and adolescents are abused by the adults responsible for them. Adolescents experience violent crimes at extremely high rates. Risk factors for violent injury are recognized. The most consistent include male sex (except for sexual abuse) and urban residence. Despite the toll of violence, surprisingly little is known about its origins and means to prevent it. The only prevention approach that has been both well evaluated and of apparent benefit is the home health visitor for prevention of child abuse in infants of young, impoverished, unmarried primiparous women. Many other approaches are plausible, promising, and/or being implemented, and these require thorough trial and evaluation. Research on numerous aspects of the precursors and correlates of violence against children is also needed.

Adolescent↗
PubMed1990

Pediatricians' attitudes concerning motherhood during residency.

Because half of pediatric residents are women, pregnancy is increasingly common among pediatric house staff. We hypothesized that the heavy work load of pregnant pediatric residents is tolerated because those who have experienced a residency themselves underestimate the strain of residency compared with other work. A questionnaire, designed to survey pediatricians' attitudes concerning the effects of employment on the fetus, mother, and newborn infant, was produced in two formats, which were identical except that one concerned residents, while the other concerned women employed full-time in other jobs. Each type of questionnaire was sent to 1000 randomly selected members of the American Academy of Pediatrics. Respondents in both groups shared many attitudes concerning the effects of maternal employment. Certain subgroups (eg, males, those married to spouses not employed, and those women not pregnant in residency) judged employment as more harmful in general. Contrary to the original hypothesis, however, all subgroups consistently judged residency as more deleterious than other work. Training programs need to adopt humane strategies to integrate motherhood with residency.

Attitude of Health Personnel↗
PubMed1990

Childhood obesity. Medical and familial correlates and age of onset.

The prevalence of obesity in U.S. children is rising. Etiologic studies have focused on infants and school age children but little is known about obesity in early childhood. To study the development of childhood obesity and its medical correlates, the authors reviewed 175 charts of obese children seen in a nutrition clinic. The 61 study subjects (37% of charts reviewed) had growth records for ages 7 years and less and were without developmental delay syndromes. Thirty-nine (64%) of 61, were girls; ages at presentation were 1 to 14 years. Data collection included previous and presenting weights, heights, medical problems, and evidence of parental and sibling obesity. Study subjects' mean percent of ideal body weight for height (% IBWH) at presentation was 160 percent. Many study subjects had medical problems considered to be related to obesity: 30 percent had asthma, 25 percent elevated blood pressure, and 28 percent hyperlipidemia. Thirty (63%) of 48, study subjects with data on maternal weight and height, had obese mothers and 14 (31%) of 45 had obese fathers. Fourteen (50%) of 28 had one or more obese siblings. Among all study subjects, the proportion of obese (% IBWH greater than 120%) and severely obese children (% IBWH greater than 140%) increased between ages 1 and 7 years. For example, the proportion greater than 140% IBWH was zero percent at 1 year and 3 years; 0.1 at 2 years; 0.2 at 4 years; 0.5 at 5 to 6 years; and 0.6 at 7 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

Age-related patterns of violent death, Cook County, Illinois, 1977 through 1982.

To clarify age-related patterns of violent death in childhood, a study was undertaken of medical examiner records concerning 437 deaths of Cook County, Illinois residents, aged younger than 15 years, who died from 1977 through 1982, and whose deaths were ruled as homicides or of an undetermined manner. Males outnumbered females after the age of 1 year. Black children were overrepresented. Perpetrators were usually parents for victims aged younger than 5 years and others for victims aged 5 years or older. Different circumstances of death characterized victims who were younger (mainly beatings) and older (mainly gunshots). Incidence was associated with urban residence and poverty, and it was highest among the youngest and oldest children. Striking differences were found in death rates for age subgroups within standard age groupings (eg, 19.77/100,000 for 1 and 2 years and 6.35/100,000 for 3 and 4 years). Different geographic areas had the highest rates for younger and older victims. We conclude: (1) Separate strategies are needed to protect the two groups at highest risk for homicide: black children aged younger than 3 years and older than 11 years in poor urban areas. (2) Standard homicide reporting practices should include narrow age groupings. (3) Age-related patterns of child homicide must be considered in the planning of prevention trials. (4) Research is needed to clarify why children of different ages are at differing risks in different communities.

Accidents↗
PubMed1989

Mirror image of environmental deprivation: severe childhood obesity of psychosocial origin.

We report 12 children with severe obesity in very early childhood who had no evidence of organic causes for their obesity and whose families evidenced psychosocial dysfunction comparable to that often seen in growth failure of psychosocial origin. Features seen include family disorganization, separation of mother and child, displacement of child care to others, maternal depression, denial of the growth abnormality, hostility towards health care providers, and inconsistent medical follow-up. In all cases, parental limit setting was impaired. We suggest that this condition should be called "severe obesity of psychosocial origin." Very severe obesity of early childhood may be conceptualized as the mirror image of growth failure. Like growth failure, it requires evaluation and management focused on psychosocial issues. Research is needed to clarify the prevalence, diagnostic features, and optimal treatment of obesity of psychosocial origin.

Body Height↗
PubMed1989

Pediatric emergencies in office practices: prevalence and office preparedness.

Because of a nationally apparent increased interest in emergency medical services for children and the need for a greater understanding of the relationship between office pediatric and emergency department care of children, a questionnaire was mailed to practitioners to (1) describe office physician involvement with emergent conditions, and (2) evaluate physician office preparedness for pediatric emergencies. Responses were received from 280 pediatricians and family practitioners, including information regarding the availability of equipment and medication, physician training, and practice characteristics. Of the responding physicians, 62% reported that they assessed in their offices more than one child each week who required hospitalization or urgent treatment. A preparedness score was developed and multiple regression analysis was used to investigate the relationship between this score and physician and practice characteristics. The mean overall preparedness score was 53.7 of a possible 156 (range 5 to 136, SD = 31.3). Characteristics related to this score were type of practice and advanced cardiac life support certification. Large multispecialty practices and practices with physicians trained in advanced cardiac life support tended to have better preparedness scores. Family practitioners tended to have more complete stock of medications than pediatricians. The data presented suggested that critically ill children who enter the medical system via the office setting may have a better than even chance of finding the office unprepared to treat the emergency: in fewer than one third of the offices in which it was reported that at least one patient was seen weekly with asthma, anaphylaxis, sickle cell vasoocclusive crisis, status epilepticus, and sepsis were they fully equipped to treat emergencies related to these conditions.(ABSTRACT TRUNCATED AT 250 WORDS)

Chicago↗
PubMed1989

Cervical spine fractures sustained by young children in forward-facing car seats.

Child passenger safety restraint laws have reduced the number of children killed or injured in motor vehicle accidents in the past few years. However, the increased used of child safety seats has brought with it an increase in the misuse of these devices. High cervical spine injuries sustained by five children less than 2 years of age while in forward-facing car seats are described. In the cases of three children, the care safety seat use was correct. Misuse of car seats and anatomic and biomechanical factors in the cervical spines of infants and young children appear to have contributed to the occurrence of these previously rare injuries. Like seat belts, car safety seats are now a factor in child passenger injury characteristics, and therefore, car safety seat design merits reevaluation. In light of this development, public and parent education by health care professionals concerning the correct use of car safety seats is necessary.

Accidents, Traffic↗
PubMed1989

Family history evaluation as a predictive screen for childhood hypercholesterolemia. Pediatric Practice Research Group.

A study was conducted to evaluate the efficacy of family history factors as screening criteria for childhood hypercholesterolemia. When they were seen for routine care at one of eight office practices, 1005 prepubertal children underwent random serum cholesterol determinations. Parental and grandparental histories of cardiovascular risk factors and atherosclerotic complications prior to 55 years of age were also obtained. Of the initial group, 274 children had total cholesterol levels greater than or equal to 175 mg/dL, and 175 of these children returned for retesting after an overnight fast. A total of 88 children were found to have low-density lipoprotein-cholesterol (LDL-C) values greater than or equal to 90th percentile for age and sex. Maternal and paternal histories of hypercholesterolemia were significantly associated with elevated LDL-C (odds ratio = 7.3 and 2.9, respectively), but had extremely low sensitivities (0.09, 0.15) despite modest positive predictive values (0.42, 0.22). Grandparental histories of sudden death, peripheral vascular disease, and gout were associated with elevated LDL-C, but sensitivities and positive predictive values for all of these factors were less than 0.22. Family history factors most commonly recommended as criteria for cholesterol screening in children did not identify half of all the children with elevated LDL-C and did not selectively identify the most severely affected children. Adding information concerning the presence of childhood obesity did not result in appreciable improvement in LDL-C detection beyond that achieved by family history factors alone. It was concluded that if thorough identification of young children with elevated LDL-C is desired, inclusive population screening rather than a family history-based strategy would be the most effective approach.

Adolescent↗
PubMed1988

Adolescent suicide and suicide attempts: a population study.

To clarify the epidemiology of adolescent suicide, a retrospective study was undertaken of suicides (1978 to 1982) and hospitalized suicide attempts (1979 to 1983) by adolescents aged 10 to 19 years in an affluent suburban area. Data included date of injury, demography (for both suicides and suicide attempts), and recorded personal and social history (available for attempts only). There were 11 deaths due to suicide (definite or possible) in the five years reviewed: seven male, 10 aged 15 to 19 years. The mean annual rate for suicide deaths (definite and possible, based on ICD codes) was 10.3 per 100,000 15 to 19 year olds, with male rates exceeding female rates. Male rates were lower in the study area than in Chicago, Illinois or the United States, but female rates were higher. Suicides represented an unusually high proportion of all adolescent deaths. Atypically, there were no firearm suicide deaths. Two hundred ten suicide attempts were studied: 77% aged 15 to 19 years, 70% female, and 82% white; 83% involved ingestion of medications or poisons. The mean annual suicide attempt rate was approximately 140 per 100,000 for 15 to 19 year olds, and 45 per 100,000 for 10 to 14 year olds, with female rates exceeding male rates. There was an association between suicide attempt dates and occurrence of holidays, and there was a peak in attempts at the end of the school year. Detailed analysis of personal and social attributes associated with suicide attempts was prevented by poor recording of relevant factors in the medical record.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗