PubMed Health⌕ Search

Biomedical subjects

R K Neff

Publications and source records attributed to R K Neff.

At least 19 recordsLinked to original sources
PubMed1993

The Boston Teacher Questionnaire. 1. Definition of syndromes.

To obtain information about the academic function of 9-year-old children from their school teachers, we created a short, forced-choice questionnaire that asked about the child's knowledge and use of arithmetic tables, reading, spelling, persistence at tasks, flexibility of approach, ability to function independently, distractibility, daydreaming, impulsivity and overexcitability, hyperactivity, and ability to follow simple and sequential directions. Questionnaires were collected from the teachers of 3451 white children whose mothers had enrolled in the National Collaborative Perinatal Project. Six syndromes in girls and five in boys were identified by both cluster and factor analyses of these data. Common to both sexes were five syndromes we labeled arithmetic, tasks (ie, impersistent/dependent/inflexible), reading, attention, and hyperactive. A syndrome characterized by difficulty following directions was seen in girls only. The prevalence of these syndromes ranged from a low for hyperactivity of 2.3 per 100 girls to a high for the attention syndrome of 27.6 per 100 boys. The congruent results obtained with clustering and factor analysis, and the agreement between the observed prevalence of syndromes and prior expectations suggests that the Boston Teacher Questionnaire, as this instrument is called, identifies learning problems in 9-year-old children.

Attention Deficit Disorder with Hyperactivity↗
PubMed1993

The Boston Teacher Questionnaire. 2. Assessments of validity.

We assessed the validity of the Boston Teacher Questionnaire in a sample of 3451 9-year-old children. Those identified by the questionnaire as having a learning difficulty syndrome were compared to those without any characteristic of that syndrome. The validity reference measures were individually administered neuropsychological assessments at age 7 years and a group-administered reading achievement test at age 9 years. Girls and boys with the reading syndrome had much lower reading scores at age 9 years than did their peers. Boys, but not girls, with the arithmetic syndrome were much more likely than their peers to have arithmetic scores more than one grade below the expected level at age 7 years. Girls and boys with the tasks syndrome, characterized by impersistence, dependence, and inflexibility, were more likely than those without any features of the syndrome to be classified as having little or no goal orientation by a neuropsychologist who assessed the children in an office setting. Similarly, the neuropsychologist was much more likely than expected to have classified children with the attention syndrome as having a short attention span, and to have classified boys, but not girls, with the hyperactivity syndrome as having an unusual/extreme level and nature of overactivity. Children with any syndrome were more likely than others to have low scores on components of the Wechsler Intelligence Scale for Children, items of the Bender-Gestalt Test that assessed integration and distortion, and measures of reading comprehension. We conclude that the Boston Teacher Questionnaire validly identifies children with learning problems.

Attention Deficit Disorder with Hyperactivity↗
PubMed1990

Maternal theophylline consumption and the risk of stillbirth.

Women in the Collaborative Perinatal Project who received theophylline during pregnancy were no more likely to be delivered of a stillborn infant than were women who did not receive theophylline. These findings add to the safety record associated with maternal receipt of theophylline during pregnancy.

Asthma↗
PubMed1987

Epidural anesthesia and analgesia in high-risk surgical patients.

The authors conducted a randomized controlled clinical trial to evaluate the effect of epidural anesthesia and postoperative analgesia (EAA) on postoperative morbidity in a group of high-risk surgical patients. A total of 53 patients were admitted to the study, 28 received EAA, and 25 received standard anesthetic and analgesic techniques without EAA. Surgical "risk" was evaluated preoperatively and found to be comparable in the two groups. When compared to control patients, patients who received EAA had a reduction in the overall postoperative complication rate (P = 0.002) and in the incidence of cardiovascular failure (P = 0.007) and major infectious complications (P = 0.007). Urinary cortisol excretion, a marker of the stress response, was significantly diminished during the first 24 postoperative hours in the group receiving EAA (P = 0.025). Finally, hospital costs were significantly reduced for patients who received EAA (P = 0.02). The authors conclude that EAA exerted a significant beneficial effect on operative outcome in a group of high risk surgical patients.

Aged↗
PubMed1986

Effects of retinoids in N-nitrosobis(2-oxopropyl)amine-treated hamsters.

The effect of feeding four synthetic retinoids was evaluated in carcinogen-treated hamsters. Syrian golden hamsters were injected with 20 mg/kg of N-nitrosobis(2-oxopropyl)amine (BOP) and then fed retinoid-supplemented diets for 39 weeks. All retinoid-treated groups grew more slowly than controls, and average survival was shorter in female retinoid-treated groups. A significant incidence of testicular atrophy was noted in male hamsters fed 2-hydroxyethylretinamide or 4-carboxyphenylretinamide. The incidence of pancreatic carcinomas was lower in 12 of 14 retinoid-fed groups than in the corresponding control groups, although the differences approached significance only in groups fed two of the retinoids--male hamsters fed N-4-propionyloxyphenylretinamide and those fed retinylidene dimedone. A low incidence of carcinoma in the control groups limits the conclusions that can be drawn from this study, but it is of note that there was no evidence of promotion.

Adenocarcinoma↗
PubMed1985

Clinical prediction rules. Applications and methodological standards.

The objective of clinical prediction rules is to reduce the uncertainty inherent in medical practice by defining how to use clinical findings to make predictions. Clinical prediction rules are derived from systematic clinical observations. They can help physicians identify patients who require diagnostic tests, treatment, or hospitalization. Before adopting a prediction rule, clinicians must evaluate its applicability to their patients. We describe methodological standards that can be used to decide whether a prediction rule is suitable for adoption in a clinician's practice. We applied these standards to 33 reports of prediction rules; 42 per cent of the reports contained an adequate description of the prediction rules, the patients, and the clinical setting. The misclassification rate of the rule was measured in only 34 per cent of reports, and the effects of the rule on patient care were described in only 6 per cent of reports. If the objectives of clinical prediction rules are to be fully achieved, authors and readers need to pay close attention to basic principles of study design.

Diagnostic Errors↗
PubMed1985

Computer diagnosis of depression and anxiety: the Stirling County Study.

A computer programme (DPAX) was constructed for a longitudinal study of psychiatric epidemiology in Stirling County (Canada). It identifies disorders involving the syndromes of depression and anxiety based on responses given in structured questionnaire interviews. The programme follows a diagnostic algorithm that uses criteria for: (1) essential features; (2) number, frequency, and pattern of associated symptoms; (3) impairment; and (4) duration. The programme reproduces case evaluations provided by psychiatrists, as conveyed by a sensitivity of 92% and a specificity of 98%.

Anxiety Disorders↗
PubMed1985

Determination of cardiac output at rest and during exercise by carbon dioxide rebreathing method in obstructive airway disease.

We evaluated the accuracy of the CO2 rebreathing method (CO2rb) for measuring cardiac output at rest and during steady-state exercise in 15 patients (mean +/- SD age, 59.7 +/- 7.5 yr) with obstructive airway disease. At rest, there was a significant correlation between direct Fick and CO2rb methods using measured arterial PCO2 (r = 0.70; p = 0.002), but not with using end-tidal PCO2 (r = 0.38; p = NS). During exercise, there was greater correlation with CO2rb using arterial PCO2 (r = 0.79; p = 0.001) than using end-tidal PCO2 (r = 0.63; p = 0.007) compared with the direct Fick determination. Correlation between the CO2rb and direct Fick methods was greater with moderate air-flow obstruction (n = 6) than with severe airway disease (n = 9), and the CO2rb method was more accurate during exercise than at rest. The CO2rb method using either end-tidal or arterial PCO2 underestimated the direct Fick measurement in 13 of 15 patients at rest, which may reflect inadequate equilibration between alveolar and oxygenated mixed venous PCO2. However, no consistent error was observed during exercise when higher CO2 production and an increased venoarterial PCO2 difference would diminish potential inaccuracies. We concluded that the CO2rb technique is an acceptable method for measuring cardiac output during exercise in patients with moderate and severe obstructive airway disease as long as arterial PCO2 is directly measured rather than estimated from end-tidal PCO2.

Aged↗
PubMed1984

Long-term effects of labor and delivery on offspring: a matched-pair analysis.

An investigation was undertaken in an effort to learn whether the type of delivery or the pattern of labor progression has any lasting effect on the infant. Paired-data design was chosen to ensure that the comparisons between homogeneous groups would be valid. Our objective was to reduce potential bias based on unequal distribution of patient characteristics that might be more or less commonly associated with abnormal labors or with difficult deliveries. Seven-year intelligence quotient data for matched pairs of cases showed significant long-range adverse impact from midforceps operations but not from low-forceps procedures. Comparable paired-data analysis for the effect of labor disorder on the infant verified a similar deleterious influence from both arrest and protraction patterns.

Child↗
PubMed1984

Breast cancer in mothers given diethylstilbestrol in pregnancy.

We compared the incidence of breast cancer in 3033 women who had taken diethylstilbestrol (DES) in pregnancy during the period from 1940 to 1960 with the incidence in a comparable group of unexposed parous women. We ascertained vital status in 95 per cent of the exposed women and in 93 per cent of the unexposed women and received completed questionnaires for 88 and 85 per cent, respectively. With over 85,000 woman-years of follow-up in each group, the incidence of breast cancer per 100,000 woman-years was 134 in the exposed group and 93 in the unexposed group, yielding a crude relative risk of 1.4 (95 per cent confidence interval, 1.1 to 1.9). The elevated incidence did not appear to be due to bias or to confounding by other risk factors measured in the study. Breast-cancer mortality was slightly higher in the exposed women (relative risk, 1.1) but not significantly so (95 per cent confidence interval, 0.7 to 2.0). We conclude that the incidence of breast cancer is moderately increased in women given DES, but we cannot exclude the possibility that some unrecognized concomitant of DES exposure accounts for this increase.

Actuarial Analysis↗
PubMed1984

Stability of prevalence. Depression and anxiety disorders.

Information about point prevalence of depression and anxiety disorders from two cross-sectional surveys in Stirling County (Canada) indicates that an overall prevalence rate of 12.5% characterized a year close to midcentury and a prevalence rate of 12.7% characterized another year toward the end of the century's third quarter. The stability of the prevalence rates contrasts sharply with the fact that numerous social changes took place over this period of time in this place of study. There were, however, small trends in the distribution of depression and anxiety by sex and age, especially an increased similarity in the overall rates for men and women in the age range of 40 to 69 years. Hypotheses are offered about social circumstances that may have influenced the diminishing difference between the sexes.

Adolescent↗
PubMed1982

Prenatal diagnosis of neural tube defects. VIII. The importance of serum alpha-fetoprotein screening in diabetic pregnant women.

Maternal serum alpha-fetoprotein (AFP) screening of routine pregnancy is a valuable tool for the prenatal detection of neural tube defects (NTDs). Against our background experience with greater than 24,000 screened pregnancies, we have studied 411 pregnant insulin-dependent diabetic women. More than a tenfold increase (19.5/1,000) in the frequency of NTDs was observed in the offspring of these diabetic patients (p less than 0.000001). Serum AFP values were lower in diabetic than in nondiabetic women. Our data indicate that the normal standard of care for diabetic pregnancy should include serum AFP screening.

Female↗
PubMed1982

Sudden infant death syndrome in infants with bronchopulmonary dysplasia.

The association between bronchopulmonary dysplasia and sudden infant death syndrome was studied retrospectively in low-birth-weight infants discharged from the neonatal program at Harvard Medical School. The incidence of sudden infant death syndrome was seven times greater in infants with bronchopulmonary dysplasia when compared with a group of control infants without bronchopulmonary dysplasia. Confounding factors, including birth weight, sex, multiple birth, socioeconomic status, and apnea were evaluated. The results indicate that there is an association between bronchopulmonary dysplasia and sudden infant death syndrome.

Apnea↗
PubMed1980

Nifedipine therapy for coronary-artery spasm. Experience in 127 patients.

We report clinical experience with the coronary vasodilator nifedipine in 127 patients with symptoms of myocardial ischemia associated with electrocardiographic or angiographic evidence, or both, of coronary-artery spasm. In the majority of patients conventional antianginal therapy including nitrates and beta-adrenergic blockers failed, and in one third of the patients at least one episode of ventricular tachycardia developed during an attack of angina. Nifedipine (40 to 160 mg every 24 hours) significantly reduced the mean weekly rate of anginal attacks from 16 to two (P less than 0.001). Similar marked reductions in the nitroglycerin requirement were noted. In 63 per cent of the patients complete control of anginal attacks was achieved, and in 87 per cent the frequency of angina was reduced by at least 50 per cent. Nifedipine was generally well tolerated, with only 5 per cent of the patients requiring termination of the drug because of intolerable side effects. This experience with nifedipine suggests that it is a highly effective drug for the treatment of coronary-artery spasm and variant angina.

Adult↗
PubMed1980

Prenatal diagnosis of neural tube defects. IV. Maternal serum alpha-fetoprotein screening.

The maternal serum alpha-fetoprotein (AFP) in 6161 women in routine pregnancy [2771 in a hospital obstetric clinic (group 1) and 3390 in private practices (group 2)] was studied. Group 1 studies enabled the delineation of the normal range of serum AFP, whereas group 2 represented a true screening experience. In group 2, 39 (2.5%) of 1566 women at 16 to 18 weeks' gestation had raised (2.5 times the median or more) serum AFP. Of these 39 women, 3 (7.8%) had neural tube defects (NTDs), 6 (15.4%) had multiple pregnancies, 1 (2.6%) had congenital nephrosis, 7 (17.9%) had spontaneous abortions, 7 (17.9%) had miscellaneous associated factors, and 15 (38.5%) had raised serum AFP for no obvious reason. Only 16 (1%) women had "unnecessary" amniocenteses. None of these aborted subsequently. Analysis of the combined data showed that NTDs were detectable in 87.5% of patients-all 6 with anencephaly and 1 of 2 with spina bifida (1 spina bifida lesion closed); multiple pregnancy was determined in 45% (18/40 cases), and spontaneous abortion ensued in 14.5%. In group 1 a raised serum AFP was associated with a host of complications in 77.3% of the women. Low AFP values had associated complications in 72.2% of cases. Maternal serum AFP screening represents another potentially important tool for early detection of high-risk pregnancy.

Amniocentesis↗
PubMed1979

Risk of respiratory distress syndrome after prenatal dexamethasone treatment.

A prospective double-blind randomized clinical trial was carried out to determine whether glucocorticoid treatment reduces the risk of respiratory distress syndrome (RDS) in prematurely born infants. There were 127 infants born to 122 mothers who received either steroid (dexamethasone phosphate) or placebo. No differences between groups occurred in risk factors for RDS (eg, prepartum asphyxia, male sex, cesarean section). When those who received a full course of dexamethasone therapy were compared with those who received placebo, a significant reduction was found in risk, severity, and deaths due to RDS. An increased incidence of infection in mothers treated with steroid was evident, particularly after premature rupture of membranes. We conclude that steroids are effective in reducing risk of RDS, but safer and more efficacious approaches for the prevention of RDS should be sought.

Clinical Trials as Topic↗