Biomedical subjects

P Visintainer

Publications and source records attributed to P Visintainer.

22 records · Page 2Linked to original sources

PubMed1992

Death in the city. An American childhood tragedy.

OBJECTIVE: To look at trends in mortality and homicide rates in a specific metropolitan area, comparing the urban and suburban mortality trends. DESIGN: Descriptive study of mortality rates. Linear regression determined whether changes in mortality rates over time represented significant trends. SETTING: Industrial metropolitan area in the United States, population, 2,337,891. PARTICIPANTS: Pediatric deaths (1 to 18 years of age) in a 9-year period. Population characteristics: 36% black, 64% white, 50% each urban and suburban. MAIN OUTCOME MEASURES: Pediatric mortality rates for 1980 through 1988, grouped by urban vs suburban, age, gender, and race. Rates calculated using national census figures and plotted over time. RESULTS: There was a 50% increase in all-cause mortality in the urban pediatric population as compared with no change or a slight decline in the suburban and national populations. The increase was found in the black urban population. Homicide showed the largest increase (252%). Firearm-related homicides accounted for the majority of homicide deaths. CONCLUSIONS: (1) There were significant differences in mortality between the urban and suburban pediatric populations. (2) The increase in homicides, specifically firearm homicides, in the urban population accounted for the increase in overall mortality rates. (3) The increase in homicide rates was significant only for the 10- to 14-year-old males and the 15- to 18-year-old male and female portions of the black urban population. (4) Firearm homicides have become epidemic in the black urban population we studied.

Adolescent↗

PubMed1990

Psychiatric and physical morbidity effects of caregiving.

Existing empirical literature on the prolonged or cumulative consequences of exposure to the stresses of caregiving is reviewed. Specific goals are to identify psychiatric and physical morbidity effects, report the magnitude of those effects, evaluate research and analytic methods used to assess morbidity, and make recommendations for future research. Overall, the literature indicates increases in self-report psychiatric symptomatology and increases in psychiatric illness among most caregivers when compared to population norms or appropriate control groups. However, there is little information on the population prevalence or incidence of clinically significant psychiatric conditions attributable to caregiving. Studies of physical health effects as assessed by self-report, health care utilization, and immune function are less conclusive but, nevertheless, suggest increased vulnerability to physical illness among caregivers. We conclude with a discussion of why morbidity effects are difficult to obtain in caregiver studies and with recommendations for future research.

Attitude to Health↗

PubMedDate not supplied

Intravenous anesthesia with propofol for painful procedures in children with cancer.

OBJECTIVE: To study the safety and efficacy of propofol-based intravenous anesthesia in children with cancer undergoing painful procedures. METHODS: This study is a retrospective analysis of data collected from 52 consecutive children who underwent 335 procedures using propofol anesthesia. These data were routinely collected in all patients: time to induction, duration of the procedure, time to recover, and the doses of the drugs used. Monitoring with electrocardiography and pulse oximetry was continuous during the procedure; blood pressures were recorded before and after the procedure and every 5 to 10 minutes during the procedure. The patients received one of these four propofol-based intravenous regimens according to the anesthesiologist's preference: propofol only; propofol plus fentanyl; propofol plus midazolam; or propofol, fentanyl, and midazolam. The efficacy of sedation was rated by this scoring system: 3 = no movement during procedure; 2 = minimal movement that did not interfere with the procedure; 1 = moderate movement requiring physical restraint to complete the procedure. RESULTS: There were six episodes of mild hypoxia (oxygen saturation 85%-94%) and one episode of laryngospasm. None required intubation. Two patients had agitation and one patient had emesis during the postrecovery phase. There was no difference in the efficacy of sedation between the four regimens. Patients receiving the combination of propofol, fentanyl, and midazolam received the least amount of propofol and required the least time to recover. There were no life-threatening complications. CONCLUSIONS: Propofol-based anesthesia, when administered by an anesthesiologist in a controlled setting, is safe and effective for performing painful procedures in children with cancer.

Ambulatory Care↗

PubMedDate not supplied

Corticosteroid prophylaxis for neurologic complications of intravenous immunoglobulin G therapy in childhood immune thrombocytopenic purpura.

To assess in a retrospective analysis if there is evidence suggesting corticosteroids can prevent the neurologic complications of intravenous immunoglobulin (IVIG) therapy in children with immune thrombocytopenic purpura (ITP). From March 1985 to September 1997, 112 children received IVIG (1 g/kg/day for one or two dosages) for the treatment of ITP. During the years 1990 to 1997, 23 children nonrandomly received a short course of prednisone (2 mg/kg/day during and for 3 days after the completion of IVIG therapy) as a prophylaxis against the neurologic complications of IVIG therapy. The authors analyzed the data of all 112 children and compared the incidence of neurologic complications in those who received prednisone prophylaxis with those who did not. The severity of the complications was assessed as follows: grade 1, headache only; grade 2, headache plus vomiting; grade 3, headache, vomiting, and fever; grade 4, headache, vomiting, fever, and meningeal signs (aseptic meningitis). Of the 23 children who received prednisone prophylaxis, 2 (8.7%) experienced headache and vomiting after the completion of prednisone prophylaxis. Of the 89 children without prednisone prophylaxis, 27 (30.3%) experienced neurologic symptoms of varying severity, including one patient with aseptic meningitis proven by examination of the spinal fluid. Twelve of these patients needed additional hospital care for the complications. Children receiving prednisone had a 78% lower risk of neurologic complications (OR = 0.22; CI = 0.05-0.90; P = 0.036). This retrospective study shows a short course of prednisone therapy, given during and until 3 days after the completion of IVIG infusion, is likely to decrease the incidence and severity of neurologic complications of IVIG in children with ITP.

Adolescent↗