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Biomedical subjects

M Weitzman

Publications and source records attributed to M Weitzman.

At least 37 records · Page 2Linked to original sources
PubMed1997

Temporal corneal phacoemulsification in filtered glaucoma patients.

PURPOSE: To evaluate the effect of temporal clear corneal phacoemulsification on intraocular pressure (IOP) in eyes that had prior trabeculectomy. DESIGN: Retrospective case-control study. PATIENTS: Forty consecutive patients (cases; TRAB-PHACO group) who underwent temporal corneal phacoemulsification subsequent to trabeculectomy were identified. Forty patients (controls; TRAB group) who had trabeculectomy alone were matched to the cases for length of follow-up, age, IOP, number of anti-glaucoma medications, number of 5-fluorouracil (5-FU) injections, race, sex and diagnosis. MAIN OUTCOME MEASURES: Comparison of IOP before and one year after phacoemulsification in the TRAB-PHACO group, and comparison with the TRAB group. Survival analysis of IOP control after trabeculectomy in the TRAB-PHACO and TRAB groups. RESULTS: In the TRAB-PHACO group, IOP one year after phacoemulsification was not significantly different from the pre-phacoemulsification IOP value (p = 0.65). Kaplan-Meier survival analysis showed that the rates of IOP control at 3, 6 and 9 years after trabeculectomy in the TRAB-PHACO group were 80%, 66% and 44%; in the TRAB group these were 79%, 69% and 55%. These survival curves were not statistically different (p = 0.55). CONCLUSIONS: Cataract surgery by temporal clear corneal phacoemulsification in eyes with filtering blebs after trabeculectomy does not adversely affect long term IOP control.

Aged↗
PubMed1996

Increased drug use among old-for-grade adolescents.

OBJECTIVE: To determine whether students older than most other students at their grade level ("old for grade") are more likely to report engaging in alcohol, tobacco, and drug-related behaviors. DESIGN: Cross-sectional analyses of the Centers for Disease Control and Prevention Youth Risk Behavior Survey. SETTING: Monroe County, New York. PARTICIPANTS: A total of 1396 high school students from selected classrooms; 68 classrooms randomly selected within schools with the number of students per school proportionally selected from the 28 schools in the county. MAIN OUTCOME MEASURE: Rates of drug-related behaviors by age-for-grade status. RESULTS: Thirty-six percent of adolescents surveyed were old for grade. Adjusting for multiple potential confounders, old-for-grade high school students were more likely to report being regular smokers, chewing tobacco, drinking alcoholic beverages, driving in a car with someone who had been drinking, using alcohol or other drugs before last sexual intercourse, using cocaine in the past month, ever using crack, and using injected or other illicit drugs. CONCLUSIONS: Old-for-grade status is a potentially important marker for drug-related behaviors in adolescents. The antecedents of adolescent risk-taking behavior may begin before the teen years, and prevention of school failure or interventions targeted toward old-for-grade children could affect their propensity to experiment with or use drugs during adolescence.

Adolescent↗
PubMed1996

The role of community health centers in providing preventive care to adolescents.

OBJECTIVES: To (1) compare preventive health visits by poor and nonpoor adolescents, (2) describe adolescent users of community health centers (CHCs), (3) investigate adolescent preventive visits to CHCs, and (4) determine factors independently associated with timely preventive visits. DESIGN: Analysis of the nationally representative sample of 6635 adolescents aged 11 to 17 years in the Child Health Supplement to the 1988 National Health Interview Survey. RESULTS: Overall, 4% of US adolescents used CHCs for routine health care, and the percentage was higher for poor compared with nonpoor adolescents (11% vs 3%, P < .01). Although CHC users were more likely to be poor (41% vs 10%, P < .001), uninsured (23% vs 10%, P < .001), and to have behavior (16% vs 9%, P = .02) and school problems (56% vs 43%, P < .001), they were as likely to have had timely preventive visits (83% vs 81%, P = .61) as adolescents who used private practices. Using logistic regression, timely adolescent preventive visits were independently associated with having a source for routine care (odds ratio, 4.1; 95% confidence interval, 3.3-5.2), a chronic health condition (odds ratio, 1.2; 95% confidence interval, 1.0-1.5), and the use of seat belts all or most of the time (odds ratio, 1.4; 95% confidence interval, 1.2-1.6), but no independent association was observed between poverty status and timely preventive visits. CONCLUSIONS: Community health centers are an important source of preventive care for impoverished adolescents. Although those who use CHCs have greater psychosocial problems, they seek preventive care as regularly as those using private practices. Thus, periodic comprehensive visits may be an effective strategy for CHCs to provide preventive services to adolescents.

Adolescent↗
PubMed1996

Illicit substance use, gender, and the risk of violent behavior among adolescents.

OBJECTIVES: To analyze data from a nationally representative sample of high school students to investigate the relationship between substance use and violent behavior among adolescents and to examine this relationship in both male and female adolescents. DESIGN: Cross-sectional analyses of the 1991 Centers for Disease Control and Prevention's Youth Risk Behavior Survey. SETTING: Public and private schools in the 50 states. PARTICIPANTS: The participants were 12,272 high school students. MAIN OUTCOME MEASURE: To determine the prevalence of weapon carrying and physical fighting among male and female adolescents. RESULTS: A significant increase in the number of male and female adolescents carrying weapons and physically fighting was associated with all forms of substance use. Reports of carrying a weapon increased with recent alcohol consumption (34% vs 17%, P < .001) and use of marijuana (48% vs 22%, P < .001), cocaine (71% vs 25%, P < .001), and anabolic steroids (62% vs 25%, P < .001). The prevalence of physical fighting was also significantly higher among adolescents who used illicit substances than among adolescents who denied drug use. The risk of violent behavior increased significantly, and was of equal magnitude, for adolescent females and males who were illicit substance users. CONCLUSIONS: Alcohol and illicit substance use are highly associated with an increased risk of violent behavior. These data also demonstrate that the risk of violence by adolescent females who are substance users is substantial.

Adolescent↗
PubMed1996

School-based health services.

Children, particularly adolescents, have unique health care needs and experience frequent barriers to receiving needed medical care. The expansion of school-based health services since the early 1970s is one recent development in the area of health services delivery that is a specific response to facilitate meeting the medical needs of youth. Limited resources, shrinking budgets, demographic and behavioral changes among our nation's youth, and recent trends toward managed care all demand innovative strategies by school-based health services if they are to ensure their viability in providing adequate health care to children and adolescents. This article reviews the recently published literature regarding the role of school-based health centers as sites providing primary care services to children and adolescents. In addition, it addresses recent efforts to develop strategies that school-based health centers may need to consider in order to adapt and survive within the environment of health care reform and managed care.

Adolescent↗
PubMed1996

Lead-contaminated house dust and urban children's blood lead levels.

OBJECTIVES: This study assessed the relationship between lead-contaminated house dust and urban children's blood lead levels. METHODS: A random-sample survey was used to identify and enroll 205 children, 12 to 31 months of age, who had resided in the same house since at least 6 months of age. Children's blood and household dust, water, soil, and paint were analyzed for lead, and interviews were conducted to ascertain risk factors for elevated blood lead (> or = 10 micrograms/dL). RESULTS: Children's mean blood lead level was 7.7 micrograms/dL. In addition to dust lead loading (micrograms of lead per square foot), independent predictors of children's blood lead were Black race, soil lead levels, ingestion of soil or dirt, lead content and condition of painted surfaces, and water lead levels. For dust lead standards of 5 micrograms/sq ft, 20 micrograms/sq ft, and 40 micrograms/sq ft on noncarpeted floors, the estimated percentages of children having blood lead levels at or above 10 micrograms/dL were 4%, 15%, and 20%, respectively, after adjusting for other significant covariates. CONCLUSIONS: Lead-contaminated house dust is a significant contributor to lead intake among urban children who have low-level elevations in blood lead. A substantial proportion of children may have blood lead levels of at least 10 micrograms/dL at dust lead levels considerably lower than current standards.

Black or African American↗
PubMed1996

Racial differences in Urban children's environmental exposures to lead.

OBJECTIVES: This study explored whether differences in environmental lead exposures explain the racial disparity in children's blood lead levels. METHODS: Environmental sources of lead were identified for a random sample of 172 urban children. RESULTS: Blood lead levels were significantly higher among Black children. Lead-contamination of dust was higher in Black children's homes, and the condition of floors and interior paint was generally poorer. White children were more likely to put soil in their mouths and to suck their fingers, whereas Black children were more likely to put their mouths on window sills and to use a bottle. Major contributors to blood lead were interior lead exposures for Black children and exterior lead exposures for White children. CONCLUSIONS: Differences in housing conditions and exposures to lead-contaminated house dust contribute strongly to the racial disparity in urban children's blood lead levels.

Black People↗
PubMed1996

Lead poisoning risk determination in a rural setting.

OBJECTIVES: To determine the prevalence of elevated blood lead levels among children living in a rural area and to determine the effectiveness of the Centers for Disease Control and Prevention (CDC) Lead Risk Assessment Questionnaire and additional questionnaire items in correctly identifying rural children having elevated blood lead levels. RESEARCH DESIGN: Comparison of results of a questionnaire that is intended to identify children as being at low or high risk for lead poisoning with children's blood lead levels. SETTING: The three practice sites of the only pediatric group in a rural county of upstate New York. PATIENTS: A consecutive sample of 705 children ages 6 to 72 months who were seen for health supervision visits between June and September 1993. RESULTS: Sixty-nine percent of the children were considered to be at high risk for lead poisoning by the CDC questionnaire. Overall, 8.4% of the children in the study had blood lead levels of 10 micrograms/dL (0.48 mumol/L) or higher, and 2.1% had blood lead levels of 15 micrograms/dL (0.72 mumol/L) or higher. No significant difference was noted between the percentages of high- and low-risk children who had elevated blood lead levels. To devise a more effective lead risk assessment tool for children in this setting, the two items from the CDC questionnaire and the two additional items that had the greatest predictive utility were combined to form a short alternative questionnaire. The alternative questionnaire thus consisted of items concerning whether the child has a sibling or playmate with lead poisoning, whether the child lives near an industry that potentially may release lead, whether the child lives in rented or owner-occupied housing, and whether the child has a parent who is a migrant farm worker. Children categorized as high risk with the alternative questionnaire were much more likely to have elevated blood lead levels than those who were categorized as low risk. The alternative questionnaire was very effective in correctly identifying children with elevated blood lead levels. Eighty-eight percent of children having blood lead levels of 10 micrograms/dL or higher and 100% of children having blood lead levels of 15 micrograms/dL or higher were classified as high risk by the questionnaire. Children classified as low risk were very unlikely to have elevated blood lead levels; 98% of low-risk children had blood lead levels of less than 10 micrograms/dL, and 100% had blood lead levels of less than 15 micrograms/dL. CONCLUSIONS: These results suggest that the CDC lead risk assessment questionnaire is of limited benefit in identifying rural children with blood lead levels 10 micrograms/dL or higher or 15 micrograms/dL or higher. An alternative questionnaire, however, seems to have marked clinical utility for identifying rural children with elevated blood lead levels.

Centers for Disease Control and Prevention, U.S.↗
PubMed1996

A randomized trial of the effect of dust control on children's blood lead levels.

OBJECTIVE: Dust control is recommended as one of the cornerstones of controlling childhood lead exposure; however, the effectiveness of dust control has not been demonstrated for children who have low to mild elevations in blood lead (ie, less than 25 micrograms/dL). The objective of this study was to determine whether dust control, as performed by families, had an effect on children's blood lead levels and dust lead levels in children's homes. DESIGN: Randomized, controlled trial. SETTING: Community-based trial in Rochester, NY. PARTICIPANTS: One hundred four children, 12 to 31 months of age at baseline. INTERVENTION: Families and children were randomized to one of two groups. Families of children in the intervention group received cleaning supplies, information about cleaning areas that are often contaminated with lead, and a cleaning demonstration. Families in the control group received only a brochure about lead poisoning prevention. OUTCOME MEASURES: Baseline measurements of lead in blood, house dust, soil, water, and paint were taken from both groups. Seven months after enrollment, a second blood lead assay was obtained, and lead levels in household dust were measured. The main outcome measures were change in blood lead levels and dust lead levels by treatment group. RESULTS: The median blood lead level of children enrolled in the study was 6.7 micrograms/dL (range, 1.7 to 30.6 micrograms/dL). There was no significant difference in the change of children's blood lead levels or dust lead levels by treatment group. The median change in blood lead levels among children in the intervention group was -0.05 micrograms/dL compared with -0.60 micrograms/dL among those in the control group. There also was no significant difference in the change of dust lead by group assignment, although there was a trend toward a significant difference in the percentage of change in dust lead levels on noncarpeted floors, which was greater among houses in the intervention group. CONCLUSIONS: These data suggest that an intervention that consists only of providing cleaning supplies and a brief description of dust control is not effective at reducing blood lead levels among urban children with low to mild elevations in blood lead levels at a 7-month follow-up.

Child Welfare↗
PubMed1996

Blood lead screening practices among US pediatricians.

OBJECTIVE: In 1991, the Centers for Disease Control and Prevention (CDC) decreased the blood lead level of concern to 10 micrograms/dL (0.48 mumol/L) and recommended universal screening. Because these guidelines continue to provoke controversy, we conducted a study to: 1) estimate the proportion of pediatricians who are members of the American Academy of Pediatrics (AAP) who report screening for elevated blood lead levels; 2) describe their clinical practices regarding screening for elevated blood lead levels; 3) compare attitudes of universal screeners, selective screeners, and nonscreeners; and 4) identify characteristics of pediatricians who universally screen. DESIGN: Confidential, cross-sectional survey of a nationally representative random sample of 1610 pediatricians conducted through the AAP Periodic Survey. SUBJECTS: The study included 1035 responders (64% response rate). Analysis was limited to the 734 pediatricians who provide well-child care (ie, primary-care pediatricians). RESULTS: Fifty-three percent of pediatricians reported screening all their patients aged 9 to 36 months, 39% reported screening some, and 8% reported screening none. Among those who screen, 96% use a blood lead assay. The primary risk factors for which selective screeners screen are: history of pica (94%); living in an older home with recent renovations (92%); living in an older home with peeling paint (93%); and having a sibling who had an elevated blood lead level (88%). Among primary-care pediatricians, 73% agree that blood lead levels > or = 10 micrograms/dL should be considered elevated, and 16% disagree. However, 89% of primary-care pediatricians believe that epidemiologic studies should be performed to determine which communities have high proportions of children with elevated blood lead levels, and 34% of primary-care pediatricians believe that the costs of screening exceed the benefits. CONCLUSIONS: Three years after the Centers for Disease Control and Prevention issued new guidelines for the management of elevated blood lead levels, a slight majority of primary-care pediatricians in the United States who are members of the AAP report that they universally screen their appropriately aged patients, while most of the remaining pediatricians report screening high-risk patients. Many pediatricians may want additional guidance about circumstances under which selective screening should be considered.

Attitude of Health Personnel↗
PubMed1996

Bed-wetting in US children: epidemiology and related behavior problems.

OBJECTIVE: To better understand the epidemiology and behavioral correlates of bed-wetting in a nationally representative sample of children. METHODS: Bivariate and multivariate logistic regression analyses of cross-sectional data regarding 10 960 children aged 5 through 17 years from the 1981 Child Health Supplement to the National Health Interview Survey. Behavior problems were determined by extreme scores on a 32-item Behavior Problem Index (BPI, > 90th percentile). RESULTS: Bed-wetting was reported in 33% of 5-, 18% of 8-, 7% of 11-, and 0.7% of 17-years-olds. At all ages, infrequent bed-wetting (fewer than six episodes per year) accounted for half of all reported bed-wetting. Lower age, male gender, and extreme scores on the BPI all were independently associated with both infrequent and frequent bed-wetting. Extreme scores on the BPI were more common among children with bed-wetting than those who did not wet the bed, and the risk for this was similar among children with infrequent and frequent bed-wetting (adjusted odds ratios, 1.8 and 1.7, respectively). Parents' perceived need for help with emotional and behavioral problems, however, was increased only among children with frequent bed-wetting. CONCLUSIONS: Bed-wetting in children aged 5 years and older, irrespective of its frequency, is associated with increased rates of behavior problems. Thus, although infrequent bed-wetting may not warrant medical intervention, this condition should prompt health care providers to explore behavioral issues in greater depth.

Adolescent↗
PubMed1996

Financing pediatric education in community settings.

Increasingly, hospital-based pediatric outpatient departments are recognized as settings that attempt to combine two critical, but not always compatible, mandates: (1) education of medical students and pediatric residents in outpatient pediatrics, and (2) service, often with inadequate resources, to a socially highrisk population with a disproportionately high prevalence of social, family, and psychological dysfunction. Coexistence of these two mandates has raised a number of concerns, because pediatric ambulatory care education and training have historically been based almost exclusively in a hospital setting. Trainees often get a false impression of the types of problems they will be dealing with in pediatric primary care and of how an efficient pediatric practice is managed. In addition, they often are supervised by full-time faculty who have little if any experience in community settings and who practice only part time or not at all. These problems have led to a widespread desire to train pediatric residents outside the hospital, in settings that more closely approximate the places in which they will practice in the future. Residency programs that address this issue also provide residents with the opportunity to be trained by seasoned practitioners whose primary professional responsibility is the outpatient care of children. To date, little has been written about the cost or the financing of such educational efforts. This article summarizes what is known about the costs. We also attempt to specify the costs that should be anticipated for the various components and steps involved in devising and implementing pediatric community-based educational programs and to describe potential sources of funding for such programs.

Costs and Cost Analysis↗
PubMed1996

Temporal corneal phacoemulsification combined with superior trabeculectomy: a controlled study.

OBJECTIVE: To determine the intraocular pressure (IOP)-lowering effects of combined temporal corneal phacoemulsification and separate incision superior trabeculectomy with those of trabeculectomy alone. METHODS: This is a retrospective case-control study of 40 consecutive patients who underwent combined temporal corneal phacoemulsification and superior trabeculectomy with low-dose 5-fluorouracil (5-FU) (cases), and 40 eyes matched with respect to age, race, preoperative medications, and preoperative IOP that had trabeculectomy alone with low dose 5-FU (controls). Survival analyses for IOP were performed for the cases and controls. We reviewed the charts of 40 consecutive patients who underwent combined temporal corneal phacoemulsification and superior trabeculectomy with low dose 5-FU to determine the effect on IOP, visual acuity, and requirement for glaucoma medications. For controls, we chose 40 eyes matched with respect to age, race, preoperative medications, and preoperative IOP who had trabeculectomy alone with low dose 5-FU. In both groups, trabeculectomy was performed with the same technique, was located superiorly, and employed a limbus-based conjunctival flap. In the combined surgery group, temporal corneal phacoemulsification immediately preceded trabeculectomy and employed a 3.5-mm incision and a one-piece silicone intraocular lens. All patients received 3 or 4 subconjunctival 5-FU injections of 5 mg each over the first 11 postoperative days. Patients were followed up for at least 1 year. Success of trabeculectomy was defined as an IOP less than 22 mmHg and 20% or more reduction from the preoperative level on 2 consecutive follow-up visits, regardless of the use of antiglaucoma medications. RESULTS: The mean postoperative intraocular pressure was higher in the combined surgery group than in the control group at each follow-up interval (P < 0.05). The mean (+/- SD) IOP reduction was 6.8 (+/- 5.5) mmHg in the combined surgery group, and 10.3 (+/- 7.6) mmHg in the trabeculectomy group at 1 year. The reduction in the number of antiglaucoma medications was 1.6 (+/- 0.9) in the combined surgery group and 2.0 (+/- 1.0) in the control group at 1 year. In the combined surgery group, the mean visual acuity beyond the first postoperative month was significantly better than at baseline (P < 0.001). Kaplan-Meier survival analysis showed that the cumulative success rate at 2 years was 62% in the combined surgery group and 86% in the trabeculectomy group. The time to failure was significantly shorter (P = 0.04) in the combined surgery group. CONCLUSIONS: Combined surgery for cataract and glaucoma is associated with less long-term IOP reduction compared with trabeculectomy alone, despite identical trabeculectomy techniques in both groups. Nevertheless, combined surgery effectively lowers IOP and reduces the long-term requirement for antiglaucoma medications without additional complications. This technique is appropriate in selected patients with coexisting cataract and glaucoma.

Aged↗
PubMed1995

A side-by-side comparison of dust collection methods for sampling lead-contaminated house dust.

The Environmental Protection Agency is required to set a standard for lead-contaminated house dust, but whether dust lead loading (micrograms/ft2) or concentration (micrograms/g) is more predictive of children's blood lead levels, which dust collection method should be used, and which surfaces should be sampled are unknown. Using a random sample of sequential births, we enrolled 205 urban children, 12 to 30 months of age, who had lived in the same house since at least 6 months of age. Samples of dust were obtained from predetermined surfaces in each child's residence using a wipe method and two vacuum methods, the Baltimore repair and maintenance method (BRM) and the dust vacuum method (DVM). Other potential sources of environmental exposure also were analyzed for lead, including soil, water, and paint. In general, dust lead loading is more predictive of children's blood lead levels than is dust lead concentration. Dust lead loading as measured with the BRM sampler explained more of the variation in children's blood lead levels than did wipe loading and DVM loading (13.7, 10.1, and 5.9%, respectively, adjusted for other significant predictors). The partial correlation between BRM lead loading and children's blood lead was significantly different than that for DVM lead loading, but it was not significantly different than that for wipe lead loading. Of the four surfaces measured, noncarpeted floors and interior window sills or wells were significantly associated with children's blood lead levels in multiple regression models. These data indicate that dust lead loading is more predictive of children's blood lead levels than is dust lead concentration and that, to determine if a housing unit is safe for children, noncarpeted floors and interior window sills or window wells should be measured using either the BRM or wipe sampling method.

Air Pollution, Indoor↗
PubMed1995

Regional test-retest variability of confocal scanning laser tomography.

PURPOSE: To determine the regional differences in the test-retest variability of topographic measurements of the optic nerve head obtained with a confocal scanning laser retina tomograph. METHODS: Three 10-degree topographic images centered on the optic disk of 20 individuals (20 eyes), five normal subjects, seven glaucoma suspects, and eight glaucoma patients, were acquired and averaged. For each eye, the standard deviation of the mean height at each pixel was calculated from the three images and displayed as a gray scale map, which represents regional test-retest variability. The standard deviation of the mean height of the eight surrounding pixels of each pixel was calculated and plotted as a gray scale map, which represents regional steepness. RESULTS: The variability maps and steepness maps showed close correspondence in all eyes. Regions of high steepness had high variability (r = .31; P < .001). The average variability in relatively flat areas (sixth to 15th percentiles for steepness) was 19 microns, whereas steeper areas (81st to 95th percentiles for steepness) had an average variability of 37 microns. The overall mean variability was 28 +/- 7 microns. CONCLUSIONS: The regional variability of topographic measurements made with the confocal scanning laser tomograph correlates with the steepness of the corresponding region and is highest at the edge of the optic disk cup and along vessels. Because of their high test-retest variability, these steep areas may not be the best locations to follow up patients for progressive glaucomatous damage.

Adult↗
PubMed1995

Outcomes of trabeculectomy for primary open-angle glaucoma.

PURPOSE: To determine the long-term functional and structural outcomes in patients treated with trabeculectomy for primary open-angle glaucoma. METHODS: Records of 78 consecutive patients (78 eyes) who had their first trabeculectomy were studied retrospectively (duration of follow-up, 25 to 112 months). Serial automated perimetry and stereoscopic optic disc photographs were used to assess the long-term efficacy of trabeculectomy to prevent progressive glaucomatous damage. Stereoscopic optic disc photographs were available for 29 eyes (38%). Criteria for intraocular pressure control were a minimum intraocular pressure reduction of 20% and intraocular pressure at or below 20 mmHg. RESULTS: There was no evidence of progression of glaucomatous damage in 81% and 65% of the eyes after 3 and 6 years, respectively. The visual field deteriorated in 16 eyes (21%) and progressive structural optic nerve damage occurred in 4 eyes (5%) during follow-up. Deterioration of the optic nerve head in the absence of visual field progression was detected in three (4%) of those eyes. In 19 eyes (25%), further glaucoma surgery was performed. The probability of successful intraocular pressure control after a single operation was 48% and 40% at 3 and 5 years, respectively. CONCLUSION: Progressive glaucomatous damage occurs in about one third of eyes with moderate to severe primary open-angle glaucoma over a 6-year follow-up after trabeculectomy.

Adult↗