Biomedical subjects

Larry Burd

Publications and source records attributed to Larry Burd.

23 records · Page 2Linked to original sources

PubMedDate not supplied

Body mass index in fetal alcohol syndrome.

INTRODUCTION: Prenatal alcohol exposure is an important cause of growth impairment. In this study we examined the stability of the growth measurements, including height, weight, and body mass index (BMI) percentiles, from birth to age at the time of diagnosis for subjects who were referred for evaluation to determine if they had fetal alcohol syndrome. METHODS: We utilized subjects from the North Dakota Fetal Alcohol Syndrome Registry. Each person referred for assessment was provided a standardized assessment completed by a medical geneticist. We also examined differences in the diagnostic schema from the Institute of Medicine. The population consisted of 315 subjects with paired weight measurements, 234 subjects with paired height measurements, and 322 subjects with current BMI measurements. RESULTS: Increases in weight percentiles and decreases in height percentiles were found. Children with FAS had consistently lower growth measurements. There was significant movement in and out of lower 5th and 10th percentiles by partial and no FAS children from birth to diagnosis. DISCUSSION: The requirement for growth impairment needs to be broad rather than narrow, if most subjects with a diagnosis of FAS and partial FAS/ARND are to be captured.

Age Factors↗

PubMedDate not supplied

A comparison of the effects of parental risk markers on pre- and perinatal variables in multiple patient cohorts with fetal alcohol syndrome, autism, Tourette syndrome, and sudden infant death syndrome: an enviromic analysis.

The prevalence and magnitude of effect of individual risk markers for specific developmental disorders vary widely across diagnostic category. The four study cohorts for this project were patients from four diagnostic registries in North Dakota for fetal alcohol syndrome (FAS), autism, sudden infant death syndrome (SIDS), and Tourette syndrome. These four cohorts were used to estimate prevalence and magnitude of effect of parental risk markers in patients with developmental disabilities. Cases with North Dakota birth certificates were matched with controls. Using birth certificate data, we then examined five parental risk markers for each cohort and estimated direct and indirect effects for each risk marker by cohort. The authors found two significant paternal risk markers (age in SIDS and education in FAS). Significant maternal markers were age in SIDS, education in FAS, autism, and SIDS. Marital status was a significant risk marker in FAS. Effect sizes were estimated using paired t tests, odds ratios, and population attributable risk (PAR) for both direct and indirect effects for each marker. We estimated both direct and indirect effects to allow for direct comparisons of the differential effect estimates of each of these markers. The direct effect of parental markers differs across diagnostic cohorts of patients. Use of cohorts from similar denominator populations obtained from prevalence studies is a useful methodological tool for estimating the prevalence and magnitude of effect of risk markers.

Age Factors↗

PubMedDate not supplied

Prenatal alcohol exposure assessment: multiple embedded measures in a prenatal questionnaire.

Alcohol exposure during pregnancy is a well-recognized public health problem. Accurate assessment of prenatal alcohol exposure is especially important to identify women in need of intervention. In this study, a 36-item prenatal questionnaire was utilized to survey a representative sample of prenatal care providers to examine prevalence rates of exposure. The questionnaire included three common screening tools for alcohol use during pregnancy and the items necessary to establish a maternal risk profile. In North Dakota, 1081 pregnant women were included in the sample. Eighty (7.4%) were Native American and 952 (88%) were White. The TWEAK screening tool was positive for 253 (23.4%) of the women. Native American women had a 71% increase in positive TWEAK screenings compared to White women. Logistic regression was used to develop a high-risk model. The data from prenatal care can also be used for maternal risk stratification. Early identification can provide opportunity for early interventions to decrease total exposure during pregnancy and to improve the outcome for the child.

Adolescent↗

PubMedDate not supplied

Recognition and management of fetal alcohol syndrome.

Fetal alcohol syndrome (FAS) is a common cause of developmental disability, neuropsychiatric impairment and birth defects. The disorder is identified by the presence of growth impairment, central nervous system dysfunction, and a characteristic pattern of craniofacial features. The reported prevalence of the disorder varies widely and recent estimates approach 1% of live births. Expression of these features varies by age. People with FAS have high rates of comorbid conditions: attention deficit hyperactivity disorder (40%), mental retardation (15-20%), learning disorders (25%), speech and language disorders (30%), sensory impairment (30%), cerebral palsy (4%), epilepsy (8-10%). Birth defects are common. In the United States, the annual birth cohort of persons with FAS could be as high as 39,000 cases annually. Cause-specific mortality is 6% for patients with FAS. The disorder is expensive to treat and most patients have lifelong impairment. The annual cost of care in the United States would approach US$5.0 billion. Early recognition and entry into appropriate treatment programs appear to improve outcome. Prevention efforts should involve screening for alcohol use prior to pregnancy and at the first prenatal care visit.

Adolescent↗

PubMedDate not supplied

Infant mortality reviews in the Aberdeen Area of the Indian Health Service: strategies and outcomes.

OBJECTIVE: To determine cause and manner of death for consecutive infant deaths in the Aberdeen Area of the Indian Health Service (AAIHS) from 1998 to 2002 and to identify risk markers for infant mortality. METHODS: Infant deaths in the AAIHS were identified from four data sources: death certificates from the four states in the AAIHS, deaths reported by local IHS Service Units, from obituaries in local and regional newspapers, and deaths reported by area hospitals. Each infant death is then sent to the local IHS service unit for review, where data from the infant and mother's chart is extracted and recorded. Local community factors, birth and death certificates, and autopsy reports are collected. The case is then reviewed at the Perinatal Infant Mortality Review (PIMR) meeting and a cause and manner of death is assigned. Summary data for the cohort was examined and then compared by mortality category and three age-at-death groups. RESULTS: Sudden infant death syndrome accounted for 33% of all infant deaths in the AAIHS. Prematurity was the second most prevalent cause-specific mortality category, accounting for 22% of all infant deaths. The authors found that infant mortality was surprisingly recurrent, with 32% of mothers of this infant having had a previous infant death. CONCLUSIONS: The PIMR committee requires substantial resources to support a review committee with appropriate expertise and their travel. Participation of local IHS staff and tribal members provides an important cultural and community perspective for the review process. Quality improvement changes are currently being implemented. These include increasing data on substance use, mental health needs, and reviews of fetal deaths. The process of mortality review has been very helpful in public education in the AAIHS.

Cause of Death↗