Biomedical subjects

M G Fowler

Publications and source records attributed to M G Fowler.

At least 55 records · Page 3Linked to original sources

PubMed1996

Randomized study of the tolerance and efficacy of high- versus low-dose zidovudine in human immunodeficiency virus-infected children with mild to moderate symptoms (AIDS Clinical Trials Group 128). Pediatric AIDS Clinical Trials Group.

The current dosage of zidovudine for children is 180 mg/m2 every 6 h. To investigate whether a lower dosage was equally effective, human immunodeficiency virus (HIV)-infected children (3 months to 12 years) with mild to moderate symptoms were randomly assigned to receive either high-dose (180 mg/m2/dose) or low-dose (90 mg/m2/dose) zidovudine (double-blind). Treatments were compared with respect to neuropsychologic function, survival, clinical and laboratory evidence of disease progression, and safety and tolerance. Four hundred twenty-six HIV-infected children were enrolled; median time for receipt of study drug was 35 months. Zidovudine in either dose was well tolerated, with no difference in efficacy or tolerance by treatment group using any clinical or laboratory parameter. In children with mild to moderate disease, a reduction of zidovudine to 90 mg/m2/dose will result in substantial cost savings and should be the recommended dose.

AIDS Dementia Complex↗

PubMed1996

After AIDS clinical trial 076: the changing pattern of zidovudine use during pregnancy, and the subsequent reduction in the vertical transmission of human immunodeficiency virus in a cohort of infected women and their infants. Women and Infants Transmission Study Group.

To determine the impact of the AIDS Clinical Trials Group (ACTG) Protocol 076 results on the subsequent use of zidovudine during pregnancy and the transmission rate of human immunodeficiency virus (HIV) in a cohort of mother-infant pairs (Women and Infants Transmission Study), a retrospective analysis was done. Transmission rates were calculated by simple proportion for infants with at least 6 months of follow-up, stratified by date of birth (n = 453 born on or before 1 March 1994; n = 103 born after 1 March 1994). Transmission rates decreased from 19% to 8% (P = .005, Fisher's exact test). Zidovudine use increased during pregnancy (22% vs. 89%) and in newborns (1% vs. 79%). Both cohorts were similar with respect to maternal immunosuppression, mode of delivery, and demographics. In summary, in a perinatal HIV observational study, the release of results of ACTG Protocol 076 was associated with an increase in zidovudine use during pregnancy and a concomitant decline in HIV transmission from mothers to infants.

Adult↗

PubMed1996

Overview of perinatal HIV infection.

The global HIV epidemic is having a profound impact on the health and survival of children. As of 1994, it is estimated that about 2 million children worldwide (WHO, 1994) and 12 thousand children in the United States are HIV infected (Davis et al. 1995). Almost all HIV infection among infants and young children are from mother-to-infant transmission. By the year 2000, HIV is projected to infect 40 million men, women, and children unless effective prevention strategies are developed. Perinatal HIV transmission rates currently vary from 14-40% with the lowest rates being seen in Europe and highest rates in Africa. Known risk factors for perinatal transmission include advanced maternal HIV disease, lower CD4+ counts, and increased viral burden during pregnancy. Observational cohort data suggest that prenatal vitamin A levels, maternal drug use, and duration of membrane rupture during labor also are related to risk of transmission. The United States clinical trial utilizing an antiretroviral (zidovudine [AZT]) prenatally, intrapartum, and for 6 weeks to the infant demonstrated that perinatal HIV transmission was reduced by two-thirds. This dramatic result gives strong encouragement that simpler perinatal prevention strategies applicable to developing countries may also be successful. A number of international studies are underway or planned including perinatal vitamin A and micronutrient trials in Africa.

Child↗

PubMed1996

Association of maternal drug use during pregnancy with maternal HIV culture positivity and perinatal HIV transmission.

OBJECTIVE: To evaluate the relationship of drug use with maternal HIV culture positivity at delivery and perinatal HIV transmission. DESIGN: Multicenter prospective cohort study. SETTING: Obstetric and pediatric clinics in five cities in the United States. PARTICIPANTS: Five hundred and thirty HIV-infected pregnant women and their infants. MAIN OUTCOME MEASURES: Multivariate logistic regression was used to evaluate the association of 'hard drug' use (one or more of the following: cocaine, heroin/opiates, methadone, injecting drug use) assessed by self-report and urine toxicology with positive maternal HIV culture at delivery and perinatal HIV transmission. RESULTS: Forty-two per cent of women used hard drugs during pregnancy. Increased probability of a positive maternal delivery HIV culture was significantly associated with prenatal hard drug use [odds ratio (OR), 3.08] and maternal cocaine use (OR, 2.98) among HIV-infected women with > 29% CD4+ lymphocytes. After adjusting for maternal culture positivity at delivery, CD4+ lymphocyte percentage and gestational age, significantly greater transmission risk was observed with hard drug use among women with membrane rupture > 4 h. CONCLUSIONS: On the basis of self-report and urine toxicology, overall maternal hard drug use and cocaine use in the WITS cohort were associated with maternal HIV culture positivity at delivery, and maternal hard drug use was associated with perinatal transmission.

Alcohol Drinking↗

PubMed1996

Clinical and laboratory characteristics of a large cohort of symptomatic, human immunodeficiency virus-infected infants and children. AIDS Clinical Trials Group Protocol 152 Study Team.

BACKGROUND: A large cohort of antiretroviral therapy-naive, symptomatic, HIV-infected children were enrolled into a controlled therapeutic trial (AIDS Clinical Trials Group Protocol 152), providing an opportunity to describe their clinical and laboratory characteristics and determine age-related distinctions. METHODS: Study entry evaluations for 838 of 839 enrolled children were analyzed. Weight, head circumference (if < 30 months of age), neuroradiologic imaging of the head, developmental or cognitive status and neurologic examination were assessed. Laboratory studies included hemoglobin, absolute neutrophil count, CD4 cell count, serum amylase, alanine aminotransaminase, p24 antigen and HIV blood culture. Data were categorized by age (3 to < 12 months, 12 to < 30 months, 30 months to 6 years and > or = 6 years). RESULTS: Younger children had significantly higher rates of abnormalities before antiretroviral therapy, especially factors relating to growth and neurologic or cognitive function. Lower CD4+ cell counts and percentages as well as a positive serum p24 antigen correlated with lower weight-for-age Z scores and developmental indices. CONCLUSIONS: These data provide a description of the clinical characteristics of HIV-infected US children at the time antiretroviral therapy is initiated for HIV-related symptoms. The high rate of abnormalities of growth, development and cognitive ability that were observed in children < 30 months of age demonstrates that treatment strategies should be developed for earlier intervention.

AIDS-Related Opportunistic Infections↗

PubMed1994

Evaluation of a home-based intervention program to reduce infant passive smoking and lower respiratory illness.

We conducted a randomized controlled trial to determine whether a home-based intervention program could reduce infant passive smoking and lower respiratory illness. The intervention consisted of four nurse home visits during the first 6 months of life, designed to assist families to reduce the infant's exposure to tobacco smoke. Among the 121 infants of smoking mothers who completed the study, there was a significant difference in trend over the year between the intervention and the control groups in the amount of exposure to tobacco smoke; infants in the intervention group were exposed to 5.9 fewer cigarettes per day at 12 months. There was no group difference in infant urine cotinine excretion. The prevalence of persistent lower respiratory symptoms was lower among intervention-group infants of smoking mothers whose head of household had no education beyond high school: intervention group, 14.6%; and controls, 34.0%.

Adult↗

PubMed1994

Pediatric HIV infection: neurologic and neuropsychologic findings.

Neurologic and neuropsychologic findings are early and important prognostic indicators of symptomatic HIV disease among infants and young children. The most common presentations include progressive encephalopathy, loss of motor milestones, and corticospinal tract abnormalities. It is hypothesized that, in some instances, the more severe neurologic manifestations of HIV noted in infancy may reflect the consequences of in utero HIV infection, or the increased vulnerability of infants to HIV infection during a time of rapid brain growth. Current research suggests that infants with basal ganglia calcification and those with plummeting or low CD4+ counts are at particular risk of severe central nervous disease progression. In contrast to infants and toddlers, older children and adolescents appear to demonstrate only subtle neurologic dysfunction until very late in their illness. Findings seen include attentional difficulties, fine motor tremors, visual sequencing problems, and depressive affect. One of the challenges for the 1990s will be rapidly to identify those infants who are at high risk of central nervous system disease progression, and to institute effective treatments that can halt the devastating effects of HIV on the developing brain. In addition to early identification of the high-risk infants, neuropsychologic, neuroimaging and laboratory measures need to be identified that will allow effective monitoring of responses to therapy.

CD4 Lymphocyte Count↗

PubMed1994

Geographic mobility and children's emotional/behavioral adjustment and school functioning.

OBJECTIVE: To evaluate the relationship of geographic mobility to children's emotional/behavioral adjustment and school functioning. DESIGN: Analysis of data from the 1988 National Health Interview Survey of Child Health in which multistage probability sampling was used to obtain data for nationally representative estimates of health and demographic characteristics of US children. PARTICIPANTS: 10,362 US school-age children and their families. MEASUREMENTS: The 1988 National Health Interview Survey of Child Health includes data on health and demographic characteristics, emotional/behavioral variables, school functioning, and geographic mobility for 10,362 US school-age children. This study examined the relationship of children's geographic mobility to children's reported emotional problems, use of psychological help, scores on a Behavior Problem Index, repeating a grade in school, and being suspended or expelled from school. RESULTS: Twenty-four percent of children have never moved, 35% of children have moved once or twice, and 39% of children aged 6 to 17 years have moved three or more times in their lifetime. Using multiple logistic regression to control for important demographic variables, children who moved three or more times were 2.3 times more likely to have received psychological help, 1.7 times more likely to have repeated a grade, and 1.9 times more likely to have been suspended or expelled from school compared with children who had never moved. Multiple regression was also used to analyze the impact of mobility in relation to scores on the Behavior Problem Index. Children who moved three or more times were 1.6 times more likely to be in the top tenth percentile of scores on the Behavior Problem Index compared with children who had never moved. CONCLUSIONS: Children who move three or more times are at increased risk for emotional/behavioral and school problems. Thus, pediatricians, other health professionals, and educators should be alert to the potential educational and psychological problems among children from highly mobile families.

Adolescent↗

PubMed1993

The role of outcome and efficacy expectations in an intervention designed to reduce infants' exposure to environmental tobacco smoke.

The purpose of this paper is to examine the role of a theoretical framework in an intervention program designed to reduce infants' exposure to environmental tobacco smoke (ETS). The content of a nurse-based intervention focused on two psychosocial constructs: expectations of outcomes which may result from behaviors associated with ETS exposure and expectations of self-efficacy associated with the mother's ability to engage in these behaviors. This study found both constructs predictive of change in, and maintenance of, ETS exposure control. In particular, mothers reporting both low outcome and low efficacy expectations tended to have infants with the highest levels of ETS exposure. We also found that our intervention was effective in changing outcome and efficacy expectations in the desired direction. These findings suggest that outcome and efficacy expectations are changeable, and, therefore, represent important targets in future programs aimed at controlling ETS exposure.

Adolescent↗

PubMed1993

Child care arrangements and repeated ear infections in young children.

OBJECTIVES: The purpose of this study was to assess the association between child care arrangements and repeated ear infections in young children. METHODS: Data on 5818 children younger than 6 years of age were taken from the 1988 National Health Interview Survey of Child Health. RESULTS: Seventeen percent of the children had had repeated ear infections in the year preceding the interview. Multiple logistic regression analysis showed that factors significantly associated with repeated ear infections were age (1 to 2 years), race (White), sex (male), and medical history (repeated tonsillitis, enlarged adenoids, or asthma). When these factors were controlled for, children in a current child care arrangement still had a 50% higher chance of repeated ear infections than did children not in care. Children in day care centers were at higher risk than children cared for in homes. Care in settings with more than six children elevated the risk, but hours per week of care did not. CONCLUSIONS: Decreasing the risk of repeated ear infections in young children in out-of-home child care settings may require smaller group sizes. Given the increasing use of child care, research should continue to identify specific aspects of child care that contribute to this problem.

Child Care↗

PubMed1993

Families on the move and children's health care.

OBJECTIVE: To evaluate the relationship of family moves to children's health care use. DESIGN: Analyses of data from the 1988 National Health Interview Survey of Child Health (NHIS-CH). This survey uses a multisite probability cluster technique to achieve nationally representative estimates of health and demographic characteristics of the US civilian population. PARTICIPANTS: 17,110 US children and their families who took part in the 1988 NHIS-CH. MEASUREMENTS: The 1988 NHIS-CH collected health and demographic data including family mobility information on 17,110 US children and their families. This study analyzed the relationship of number of family moves to reporting a regular site for preventive pediatric health care services, a regular site for pediatric sick care, and routine use of emergency departments when a child was sick. RESULTS: Overall, 8% of US children were reported to lack a regular site for preventive care services, 7% a site for sick care, and 3% routinely used an emergency department for sick care. However, 14% of children who had moved three or more times lacked a regular site for preventive care and 10% lacked a regular site for sick care, compared to only 3% of children who had never moved. Children who had moved more than twice were three times as likely to lack a regular site for preventive or sick care and 1.6 times as likely to use an emergency department for sick care, as were children who had never moved. CONCLUSIONS: Families with increased mobility are more likely to lack a regular site for both preventive and sick care and to use emergency departments when their children become ill.

Adolescent↗

PubMed1992

School functioning of US children with asthma.

Data from the 1988 US National Health Interview Survey on Child Health, a nationally representative cross-sectional survey, were used to determine national estimates of school outcomes (grade failure, learning disabilities, and suspension/expulsion) and mean number of absences for children with asthma (CWA) compared to well children without current health conditions. Families indicated that 536 (4.9%) of the 10,362 survey children in grades 1 through 12 had had asthma in the previous 12 months. Families reported 18% of CWA vs 15% of well children had grade failure, 9% of CWA vs 5% of well children had learning disabilities, and 5% of CWA vs 6% of well children had been expelled or suspended. Children with asthma averaged 7.6 school days absent compared with 2.5 days for the well group. Multiple logistic regression was used to compare the odds of grade failure, learning disabilities, and suspension/expulsion among CWA and well children, overall and stratified by income. Similar methods were used to assess the role of health status among asthmatic children. After adjustment for demographic factors, CWA had similar risks of grade failure and suspension/expulsion, but 1.7 times the risk of learning disability compared with well children. Also, among families with incomes below $20,000, CWA had twice the odds of grade failure compared with well children. For asthmatic children, reported health status was an important predictor of learning disability. Ten percent of CWA were reported to be in fair-poor health. After adjustment for demographic factors, those in fair-poor health were twice as likely to have a reported learning disability compared with those in good-excellent health.(ABSTRACT TRUNCATED AT 250 WORDS)

Absenteeism↗

PubMed1991

Comparison of infant mortality among twins and singletons: United States 1960 and 1983.

Infant mortality among US black and white twins and singletons was compared for 1960 and 1983 using the Linked Birth/Infant Death Data Sets from the National Center for Health Statistics. Both twin and singleton infant mortality rates showed impressive declines since 1960 but almost all of the improvement in survival for both twins and singletons was related to increased birth weight-specific survival rather than improved birth weight distribution. One-half of white twins and two-thirds of black twins weighed less than 2,500 g at birth, and 9% of white twin births and 16% of black twin births were in the very low (less than 1,500g) birth weight category. In 1983, twin infant mortality rates were still four to five times that of singletons. However, twins had a survival advantage in the 1,250-3,000 g range, which persisted after adjustment for gestational age. Cause-specific mortality among twins was considerably higher for every major cause of death: twin mortality risks due to newborn respiratory disease, maternal causes, neonatal hemorrhage, and short gestation/low birth weight were six to 15 times that of singletons. The lowest twin-to-singleton mortality ratios observed were for congenital anomalies and sudden infant death syndrome with relative risks twice that of singletons. The data underscore the need to develop effective strategies to decrease infant mortality among twins.

Birth Weight↗

PubMed1991

Double jeopardy: twin infant mortality in the United States, 1983 and 1984.

The United States Linked Birth/Infant Death Data Sets: 1983 and 1984 Birth Cohorts from the National Center for Health Statistics were used to identify maternal and infant characteristics related to twin infant mortality; 41,554 white and 10,062 black live-born matched twin pairs were evaluated. Twin birth weight distribution was skewed with 48% of white and 63% of black twins born weighing less than 2500 gm. Overall infant mortality rates were 47.1 and 79.3 deaths per 1000 live births for white and black twins, respectively (five times the rates for singletons). Three fourths of deaths were among twins weighing less than 1500 gm. White like-gender twins had about twice the risk of both twins dying compared with unlike-gender twins. Likewise, white twin pairs with greater than 25% birth weight disparity had a 40% to 80% increased risk of both twins dying, compared with twins whose weights were within 10% of each other. Twins born to high-risk women (on the basis of demographic factors) were twice as likely to die as twins born to low-risk women. Thus strategies to decrease twin infant mortality must address both maternal and infant risk factors.

Black People↗

PubMed1989

Ecology of passive smoking by young infants.

This study provides a detailed description of passive smoking by 433 infants (mean age 18 days) enrolled from a representative population of healthy neonates in central North Carolina during 1986 and 1987. Sixty-four percent (276) lived in households with smokers or had contact with nonhousehold smokers. During the week before data collection, two thirds (184) of these 276 infants reportedly had tobacco smoke produced in their presence. Seventy-five percent of smoking mothers smoked near their infants. The amount smoked by the mother near the infant correlated with the amount smoked near the infant by nonmaternal smokers. Cotinine, an indicator of smoke absorption, was found in the urine of 60% (258) of all study infants. The amount smoked in the infant's presence, as well as the amount smoked farther away from the infant, especially by the mother, were the most significant correlates of the urine cotinine concentration. The results of this study suggest that efforts to reduce passive smoking in young infants should emphasize the importance of the mother's smoking behavior, smoke produced anywhere in the home, and household social influences on smoking behavior near the infant.

Cotinine↗

PubMed1988

Teacher needs assessment for the educational management of children with chronic illnesses.

Three hundred forty-one North Carolina public school teachers were surveyed to determine frequency of teacher contacts with children with chronic health conditions and teachers' needs related to educational management of these children. More than 76% of respondents had taught children with chronic health conditions sometime during their career; 38% reported they had academic coursework related to chronic health conditions, and only 7% indicated their certification requirements were adequate. Parents were identified as the most important source of information about a child's health condition, while in-school resources were reported to be less available and often less helpful. Teachers identified several critical issues in educational management of children with teacher knowledge and preparation about health conditions as the most important concern. Findings indicate a need for more teacher preparation and improved resources for teachers.

Adolescent↗

PubMed1988

Neuropsychologic and academic functioning of children with sickle cell anemia.

This study compared neuropsychologic test results and academic functioning among 28 school-age children with sickle cell anemia (SCA), and 28 healthy, age-, sex-, and socioeconomically matched black peers followed at a tertiary care center. Children with SCA scored significantly lower on reading and spelling achievement scores than healthy matched peers. Also, older children with SCA performed significantly less well on tests of visual-motor and attention skills than younger children with SCA. These results were unrelated to most measures of physical illness severity. The data suggest that sickle cell anemia may be associated with subtle neuropsychological and learning deficits that can contribute to decreased school performance.

Adolescent↗

PubMed1987

Factors related to school absence among children with cardiac conditions.

This study compared psychosocial and health factors related to school absence among 62 children with cardiac disease and 62 age-, sex-, and race-matched peers without chronic health conditions. Parents of children with cardiac conditions perceived their children as more vulnerable and rated themselves and their children as having less control over improving their children's health status than did parents of the well children. Increased school absentee rates for the cardiac group were associated with measures of illness severity, parental patterns of absenting their child from school for minor illnesses, and decreased belief in their child's ability to improve his or her health status. For the well comparison group, increased absence was related to external health locus of control beliefs, increased maternal sick days, and demographic factors. School absence was not significantly related to social adaptation, self-esteem, or school achievement for either the well or cardiac groups.

Absenteeism↗