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Biomedical subjects

S R Kimmel

Publications and source records attributed to S R Kimmel.

11 recordsLinked to original sources
PubMed1996

Breaking the barriers to childhood immunization.

Although about 98 percent of children have received their basic series of immunizations at the time of school entry, only 67 percent of two-year-old children are appropriately immunized. Parental, provider, economic and system barriers to immunization must be overcome if the United States is to achieve the objective that 90 percent of two-year-old children receive the basic vaccination series against the major preventable childhood diseases by 1996. Parents must be educated about the importance of vaccines and the hazards of the diseases they prevent, and they must be given proper information about vaccine side effects and contraindications. Physicians should take advantage of all appropriate patient contacts, including acute office visits for minor illnesses, to keep children's immunizations current. Audits of office records, as well as tracking or reminder systems, improve vaccination rates. The Vaccines for Children Program is intended to remove cost as a barrier to the immunization of some children. The single immunization schedule endorsed by the American Academy of Family Physicians, the American Academy of Pediatrics and the Advisory Committee on Immunization Practices may alleviate confusion about the appropriate time to administer different vaccines.

Child↗
PubMed1996

An update on vaccine safety.

Vaccination has dramatically reduced the number of annual cases of pertussis, diphtheria, measles and congenital rubella syndrome. Although side effects of immunizations can occur, serious adverse events are rare for all vaccines commonly used in the United States. Infantile spasms and sudden infant death syndrome are not associated with childhood vaccines. Compared with whole-cell pertussis vaccine, acellular pertussis vaccines are significantly less likely to produce moderate reactions such as fever, fussiness, pain, drowsiness, anorexia and local redness or swelling. Despite the documented safety and efficacy of childhood vaccines, concerns about vaccine safety increase when diseases such as measles, pertussis and rubella are no longer common. Parents need to be reminded that their child is susceptible to these diseases, that these diseases are preventable by reasonably safe and effective immunizations and that their child needs a series of vaccines at regular intervals by the age of two years. Since 1994, all physicians have been required by law to use the Vaccine information Statements for measles-mumps-rubella vaccine, diphtheria and tetanus toxoids and pertussis vaccine, poliovirus vaccines and tetanus and diphtheria toxoids for adults.

Child, Preschool↗
PubMed1995

Stages of embryonic development of the zebrafish.

We describe a series of stages for development of the embryo of the zebrafish, Danio (Brachydanio) rerio. We define seven broad periods of embryogenesis--the zygote, cleavage, blastula, gastrula, segmentation, pharyngula, and hatching periods. These divisions highlight the changing spectrum of major developmental processes that occur during the first 3 days after fertilization, and we review some of what is known about morphogenesis and other significant events that occur during each of the periods. Stages subdivide the periods. Stages are named, not numbered as in most other series, providing for flexibility and continued evolution of the staging series as we learn more about development in this species. The stages, and their names, are based on morphological features, generally readily identified by examination of the live embryo with the dissecting stereomicroscope. The descriptions also fully utilize the optical transparancy of the live embryo, which provides for visibility of even very deep structures when the embryo is examined with the compound microscope and Nomarski interference contrast illumination. Photomicrographs and composite camera lucida line drawings characterize the stages pictorially. Other figures chart the development of distinctive characters used as staging aid signposts.

Animals↗
PubMed1994

Assessing child development.

The family practitioner has an important role in the detection of infants and young children with developmental delays. The physician may be the first or only professional in regular contact with infants and young children. Interpretation of a child's developmental status is best done with a clear understanding of the child's family and social environment, and the family practitioner is in a unique position to possess this knowledge by virtue of his or her established relationship with the family.

Child↗
PubMed1993

Head-upright tilt test: a new method of evaluating syncope.

Syncope and near-syncope account for up to 600,000 visits to emergency departments or physicians' offices each year. Syncope is a prognostic indicator of early mortality. Although $750 million is spent each year to evaluate patients with syncope, 40 to 50 percent of cases elude diagnosis. The head-upright tilt test is a new tool for evaluating patients who are susceptible to vasovagal syncope. In susceptible patients, this test may reproduce the symptoms and signs of previous syncopal episodes. It can also help differentiate convulsive syncope from epilepsy. Patient education, medical therapy and even pacemaker placement may be effective in controlling the episodes in patients with recurrent vasovagal syncope.

Adolescent↗
PubMed1993

Answers to questions about the acellular pertussis vaccine.

Two acellular pertussis vaccines, which are usually combined with diphtheria and tetanus toxoids, are now licensed for use in the United States. These vaccines are immunogenic and produce fewer adverse reactions than whole-cell pertussis vaccines. At present, acellular vaccines are to be used only for the fourth and fifth booster doses of diphtheria-tetanus-pertussis vaccine in children 15 months of age or older. Efficacy of the acellular vaccines in younger children is currently being investigated.

Adult↗
PubMed1990

Bicycle safety knowledge and behavior in school age children.

The purpose of this study was to examine school age children's knowledge of bicycling rules of the road and their bicycling behaviors. A one-page questionnaire was administered in the classroom to 276 of 300 children in grades 4 through 8 of an upper middle class suburban school district. The children were questioned regarding their knowledge of three basic bicycling rules of the road, prior bicycle safety instruction, use of bicycle helmets, and the occurrence and severity of previous bicycle accidents. Students who reported receiving previous bicycle safety instruction were more knowledgeable than those receiving no instruction regarding rule 2, always stop at a stop sign or red light (90% compared with 74%), and rule 3, always stop and look when approaching a street from a driveway or alley (74% compared with 60%). Students who did not know rule 3 were more likely to have had a recent bicycle accident in which their bicycle was damaged (21% compared with 8%) and to have ever gone to the hospital or a physician because of injuries sustained in a bicycle accident (19% compared with 9%). Children who lacked knowledge of basic bicycling rules were more likely to have had a significant bicycling accident. Bicycle safety instruction increases children's knowledge of these rules and should be promoted by physicians caring for children.

Accident Prevention↗
PubMed1988

Perceptions of family practice residents regarding health care and poor patients.

The purpose of this study was to assess residents' beliefs about the poor. Residents from eight different Ohio residency programs completed the questionnaire (N = 130). No significant differences were found in beliefs about the poor based on resident age, year of residency training, size of the community in which the resident was raised, and percentage of low-socioeconomic-status patients cared for. Most residents perceived the welfare system as lacking; 83 percent agreed the poor are caught in a "cycle of poverty," 82 percent agreed welfare benefits cause the poor to be dependent upon the system, and 48 percent believed indigent women become pregnant and have babies so they can collect welfare support. Conversely, only one in four residents believed that most poor people become poor as a result of lack of effort on their part, and one in five believed that society is coddling the poor. The majority of residents believed that poor patients are more likely than others to miss appointments without canceling (73 percent), more likely to be late for appointments (51 percent), and less knowledgeable about their illnesses (80 percent). One in four residents believed that poor patients tend not to appreciate the work of physicians and nurses, and 43 percent claimed that the poor are more difficult patients. The majority of residents believed that the poor are unlikely to practice preventive health behaviors (72 percent) or to be compliant with their medical regimen (60 percent). Finally, 41 percent believed that poor patients usually care less than others about their own health status.

Adult↗
PubMed1986

Use of the peak flow meter in office practice.

The peak expiratory flow rate (PEFR) may be measured in the office or at home with an inexpensive, hand-held meter. Measurement of the PEFR provides a rapid, objective means of diagnosing and monitoring asthma. Use of the peak flow meter permits early detection of deteriorating function, allowing timely institution of additional therapeutic measures and preventing the need for hospital admission. During an acute attack of asthma, the PEFR aids in determining whether admission is necessary.

Adult↗