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Biomedical subjects

P Stratton

Publications and source records attributed to P Stratton.

11 recordsLinked to original sources
PubMed1992

A survey of zidovudine use in pregnant women with human immunodeficiency virus infection.

BACKGROUND AND METHODS: The expanding indications for zidovudine treatment make it important to elucidate the safety and toxicity of this drug for pregnant women and their fetuses. We asked pediatricians and obstetricians at the AIDS (acquired immunodeficiency syndrome) Clinical Trials Units to report information about pregnant women infected with the human immunodeficiency virus (HIV) who were continuing their pregnancies and had received, or were receiving, zidovudine during gestation. RESULTS: Reports of 43 women were received from 17 institutions. Doses of zidovudine ranged from 300 to 1200 mg per day, and 24 women took the drug for at least two trimesters. There were two reported instances of maternal toxicity (one gastrointestinal and one hematologic). No teratogenic abnormalities occurred in the 12 infants with first-trimester exposure to zidovudine. All the infants, including two sets of twins, were born alive. The 38 singleton infants born at term for whom birth weights were reported had a mean birth weight of 3287 +/- 670 g; two cases of intrauterine growth retardation were reported among the infants delivered at term. Hemoglobin values, which were available for 31 newborns, ranged from 7.0 to 12.4 mmol per liter (11.2 to 20 g per deciliter); 3 of the 7 newborns with hemoglobin values of less than 8.4 mmol per liter (13.5 g per deciliter) were born prematurely. CONCLUSIONS: Zidovudine was well tolerated by the pregnant women and was apparently not associated with malformations in the newborns, premature birth, or fetal distress. No pattern of hematologic toxicity was observed in the newborns, but the anemia and growth retardation seen in a minority of the infants could, in part, have resulted from their mothers' treatment with zidovudine.

Abnormalities, Drug-Induced↗
PubMed1992

Human immunodeficiency virus infection in pregnant women under care at AIDS clinical trials centers in the United States.

The federal government supports a nationwide network of medical centers to evaluate promising therapies against the human immunodeficiency virus (HIV) and the opportunistic infections and cancers that characterize AIDS. Forty-five obstetricians from the 49 medical centers receiving federal research support for the conduct of AIDS-related clinical trials, in preparation for a meeting, provided summary information about the number and clinical status of the known HIV-infected pregnant women under their care and the prenatal screening policies for HIV infection at their institutions. In the 12-month period before December 1989, an estimated 1000-1801 HIV-infected women delivered at these centers. The majority (82%) were asymptomatic, 12% were symptomatic, and 6% had AIDS. Routine T-cell testing of infected women was done as part of prenatal care in only 30 of 45 centers. Pneumocystis carinii pneumonia was reported in 35 women. Zidovudine was administered during pregnancy in 29 women. Formal prenatal screening policies have been implemented at the majority (43 of 45) of the medical centers. Most of the infected women identified at these centers chose to continue the pregnancy. With the increasing incidence of HIV infection in women, information concerning the clinical and immunologic state of pregnant infected women and the present use of antiretroviral and other related therapeutics during pregnancy can guide the approach to women's health care and is crucial to the design and implementation of AIDS clinical trials.

Clinical Trials as Topic↗
PubMed1992

Treatment options for human immunodeficiency virus-infected pregnant women. Obstetric-Gynecologic Working Group of the AIDS Clinical Trials Group of the National Institute of Allergy and Infectious Diseases.

The increasing seroprevalence of human immunodeficiency virus (HIV) among women of reproductive age and the risks of vertical transmission of HIV have led to recommendations for routine prenatal HIV counseling and testing. The incentive to undergo such testing is related not only to fetal concerns, but also to the potential benefit of early and comprehensive therapy for women. Treatments that should be considered for use during pregnancy include the antiretroviral agent zidovudine and prophylactic agents to prevent Pneumocystis carinii pneumonia, the most common opportunistic infection seen in patients progressing to AIDS. Assessment of the risks and benefits of these treatments during pregnancy is complex and requires discussions between physician and patient. This paper reviews current information and provides recommendations for incorporating therapies into obstetric practice.

Female↗
PubMed1992

Chronic regurgitation among persons with mental retardation: a need for combined medical and interdisciplinary strategies.

A survey of institutionalized adults with severe mental retardation and chronic regurgitation was conducted. A high prevalence of dysphagia and gastroesophageal abnormalities was found. Many of these abnormalities require further evaluation and treatment prior to the diagnosis of rumination. More studies are needed to explore the causes and treatment approaches for chronic regurgitation in adults with developmental disabilities.

Adult↗
PubMed1992

Epidemiology of HIV infection and AIDS in childbearing women in the United States.

HIV infection and AIDS is of increasing prevalence among women in the United States, as documented by the AIDS surveillance data and HIV-seroprevalence data from pregnant women and parturients. Monitoring epidemiologic trends in childbearing women has required clever and creative strategies like those of Hoff et al. The impact on women in the reproductive years, on the reproductive health of these women, and on the outcome of their pregnancies is of substantial concern. The effect of HIV infection on pregnancy and of pregnancy on HIV infection must be clarified but suggests that monitoring T cell levels in pregnancy may be of benefit in identifying women at risk of serious infections. Treatment of HIV-infected women with antiretroviral and other therapies may happen in the future not only to treat the mother but also to investigate the prevention of in utero transmission. In the meantime, studies of the natural history of HIV infection in HIV-infected pregnant women are necessary to clarify when, by what mechanism, and how to prevent in utero transmission of infection from mother to fetus. The committee on AIDS Research and the Behavioral, Social and Statistical Sciences of the National Research Council is optimistic that "the statistics derived from the survey of childbearing women in the United States will provide a basis both for projecting future AIDS cases among infants and, perhaps most importantly, for monitoring the prevalence of infection among an important part of the population of heterosexually active women." The epidemic of HIV in men, women, and children will be controlled not only by finding effective treatments but also by developing strategies that prevent the spread of infection from one person to another. As Quinn et al. stated in a recent editorial, "The rate of increase will be influenced markedly by our degree of success in preventing the sexual, parenteral and perinatal transmission of HIV.... Without immediate action, the spread of HIV and related retroviruses is likely to escalate throughout our hemisphere and to have a profound impact on the medical, cultural, economic and political structure of the Americas."

Acquired Immunodeficiency Syndrome↗
PubMed1990

Pregnancy outcomes among mothers infected with human immunodeficiency virus and uninfected control subjects.

Between June 26, 1985, and Feb. 24, 1989, 101 seropositive pregnant women and 129 seronegative pregnant women from the same prenatal clinics in Brooklyn and the Bronx were recruited into a prospective study of human immunodeficiency virus infection in pregnant women and their offspring. This report details the course of pregnancy and short-term neonatal outcomes of 91 seropositive women and 126 seronegative women who gave birth during the study period. Seropositive mothers were significantly more likely to have sexually transmitted diseases (17.6% vs 7.1%, p = 0.017) and medical complications (43.0% vs 25%, p = 0.006) during pregnancy. No other obstetric complications (e. g., chorioamnionitis, endometritis, toxemia, or placental problems) were associated with serologic status. After controlling for confounding variables (drug use, tobacco use, age of mother, and clinic), we found that the mother's serologic status was not significantly associated with birth weight, gestational age, head circumference, or Apgar scores among live infants. For example, after adjustment on confounders we found that children born to seropositive mothers weighed about 7 gm more than children of seronegative mothers (95% confidence interval, -180 to 194 gm). We conclude that in this population human immunodeficiency virus infection has little demonstrable impact on the status at birth of live neonates.

Adult↗
PubMedDate not supplied

Beyond the milestone model--a systems framework for alternative infant assessment procedures.

Recent theoretical and methodological advances in developmental psychology offer new possibilities in the assessment of developmentally disordered infants which carry significant advantages over current procedures. It is argued that infant competence is not solely a quality inherent within the individual, but is a function of a particular individual within a particular environment. The understanding of early developmental processes as being based upon infant-environment transactions, requires an assessment methodology which can take account of complex and changing relationships, and can recognize the role of the infant in determining characteristics of the caregiving environment. It is proposed that systems theory offers a useful framework on which to construct new assessment procedures. Different levels of the infant environment system are identified, and examples of the ways in which recently developed procedures may be incorporated into the model are described.

Adaptation, Psychological↗
PubMedDate not supplied

A 2-year follow-up study of children with motor coordination problems identified at school entry age.

Children attending primary schools in Leeds were tested soon after school entry with the Standardized Motor Test Battery (SMTB), specifically designed for this study and comprising: finger tapping, peg moving, bead threading, standing on one leg, hopping and walking. Norms of motor performance are provided for each test. Seventeen children failed the SMTB and were designated to the clumsy group and then matched for age and sex with a control group of children from the survey. Observations by parents and teachers rated the clumsy children inferior to their controls in writing, sporting ability and clumsiness. The clumsy children and their controls were then followed up for a minimum of 2 years, when educational performance was assessed and motor performance reassessed. The clumsy children were found to have impaired educational attainment, particularly in writing, compared to their controls, and their motor performance although much improved was still very inferior to controls. The findings of this study suggest that the SMTB is a sensitive test for the early identification of clumsy children.

Achievement↗