Biomedical subjects
T L Cheng
Publications and source records attributed to T L Cheng.
Index of suspicion. Case 3. Dermoid cyst.
Explore the source record for details and available documents.
Successful approaches to community violence intervention and prevention.
The field of injury prevention and control is diverse, cross-cutting, and has attracted the efforts of individuals from multiple disciplines. Many types of interventions have been applied in the area on intentional injury, specifically interpersonal violence. The results have been variable with few projects demonstrating scientific efficacy. Among the acknowledged stumbling blocks have been issues of project design, and deficiencies in the incorporation of communities into project development and implementation. This article discusses those elements that are critical to the creation of any community-based violence prevention intervention and offers guidelines for establishing a project's community context.
Ability to measure sensitive adolescent behaviors via telephone.
INTRODUCTION: Difficulty in measuring sensitive behaviors in 12-15-year-old adolescents is a barrier to research. This study determined whether early adolescents reported substance use and sexual activity similarly in assisted paper-and-pencil versus touch-tone telephone responses. METHODS: Adolescents 12-15 years old completed confidential, interviewer-assisted questionnaires first in a physician office by paper-and-pencil and then at home by touch-tone approximately 3 months later. Adolescents were from a high-risk urban area, 71% were minority, and all had parent consent to participate. RESULTS: The follow-up participation rate was 94% (follow-up n = 207). Test-retest stability was generally poor for low-frequency behaviors such as injection drug use, anal intercourse, and sexual behaviors in 12-13-year-olds. Test-retest stability was fair to good for common substance use items. Test-retest stability was generally good among females and 14-15-year-old adolescents, and poor to fair among males and 12-13-year-olds, for common sexual experiences in the last 3 months. Test-retest stability was generally good to excellent for all lifetime sexual experiences except among 12-13-year-olds in which it was generally poor. Internal consistency of the self-esteem scale was high using both response technologies. Both response technologies reproduced correlations between substance use and lifetime sexual experience. CONCLUSION: A high participation rate and reliable data capture were achieved when assessing sensitive behaviors of 14-15-year-olds using touch-tone telephone response. Sexual behaviors were more reliably captured using a "lifetime" versus "last 3-month" reference period. Low prevalence contributed to poor reliability in 12-13-year-olds.
Parental literacy level and understanding of medical information.
OBJECTIVE: To ascertain the impact of literacy level on parents' understanding of medical information and ability to follow therapy prescribed for their children. DESIGN/METHODS: A prospective cohort of parents accompanying their children for acute care. Parents were interviewed about demographic status, their child's health, and use of pediatric preventive services. The Rapid Estimate of Adult Literacy in Medicine (REALM) test was used to assess parental literacy. The same parent was interviewed 48 to 96 hours later and asked to recall the child's diagnosis, any medication prescribed, and instructions. RESULTS: A total of 633 patients were enrolled. Follow-up was obtained in 543 patients (85.8%). Mean parental age was 32.43 years (SD = 9.07). Mean REALM score was 57.6 (SD = 10.9), corresponding to a 7th- to 8th-grade reading level, with a mean parental educational level of 13.43 years (SD = 2.09). Low REALM score was significantly correlated with young parental age and parental education. African-American race was associated with lower REALM scores. After controlling for these variables, REALM score significantly correlated with parental perception of how sick the child was, but not with use of preventive services, comprehension of diagnosis, medication name and instructions, or ability to obtain and administer prescribed medications. CONCLUSIONS: Parental literacy level did not correlate with use of preventive services or parental understanding of or ability to follow medical instructions for their children.
Iron deficiency anemia.
Explore the source record for details and available documents.
Poly(ethylene glycol) modification of beta-glucuronidase-antibody conjugates for solid-tumor therapy by targeted activation of glucuronide prodrugs.
Methoxypoly(ethylene glycol) (PEG) modification of Escherichia coli beta-glucuronidase (betaG) was examined as a method to improve the stability and pharmacokinetics of antibody-betaG conjugates for the targeted activation of glucuronide prodrugs at tumor cells. Introduction of 3 PEG molecules did not affect betaG activity whereas higher degrees of PEG modification produced progressively greater loss of enzymatic activity. The enzyme was found to be stable in serum regardless of PEG modification. PEG-modified betaG was coupled via a thioether bond to mAb RH1, an IgG2a antibody that binds to the surface of AS-30D hepatoma cells, to produce conjugates with 3 (RH1-betaG-3PEG), 5.2 (RH1-betaG-5PEG) or 9.8 (RH1-betaG-10PEG) PEG molecules per betaG with retention of 75%, 45% and 40% of the combined antigen-binding and enzymatic activity of the unmodified conjugate RH1-betaG. In contrast to the rapid serum clearance of RH1-betaG observed in mice, the PEG-modified conjugates displayed extended serum half-lives. RH1-betaG-3PEG and RH1-betaG-5PEG also exhibited reduced spleen uptake and greater tumor accumulation than RH1-betaG. BHAMG, the glucuronide prodrug of p-hydroxyaniline mustard (pHAM), was relatively nontoxic in vivo. Injection of 6 mg/kg or 12 mg/kg pHAM i.v. depressed white blood cell numbers by 46% and 71% whereas 80 mg/kg BHAMG reduced these levels by 22%. Although the tumor/blood ratio of RH1-betaG-5PEG was adversely affected by slow clearance from serum, combined therapy of small solid hepatoma tumors with this conjugate, followed 4 and 5 days later with i.v. injections of BHAMG, cured all of seven mice with severe combined immunodeficiency. Combined treatment with a control antibody-betaG conjugate and BHAMG delayed tumor growth and cured two of six mice while treatment with pHAM or BHAMG alone was ineffective.
Strategies to increase adherence with tuberculosis test reading in a high-risk population.
OBJECTIVE: To determine the most effective strategy to encourage adherence with tuberculosis test reading in a high-risk population. Design. Prospective randomized controlled trial. SETTING/PARTICIPANTS: Consecutive sample of 627 children ages 1 to 12 years due for a tuberculosis (TB) test in an urban children's hospital outpatient department. One child per family was enrolled. INTERVENTION: All families received education regarding the importance of skin testing for TB and the need for follow-up, and written and verbal instructions regarding test reading. Families were randomly assigned to one of five strategies for follow-up TB test reading at 48 to 72 hours: 1) routine verbal and written instructions, 2) reminder phone call, 3) transportation tokens and toy on return, 4) withholding of school forms until time of reading and need to repeat TB test if not timely read, 5) parents taught to read induration with nurse home visit. Those who did not have tests read at 48 to 72 hours by a trained professional were phoned 1 week later. RESULTS: The five groups did not differ with regard to TB risk factor score, maternal education, transportation source, or perceived importance of TB testing. Before the study the follow-up rate of TB test reading by a trained professional was 45%. Reading rates in this study were 58%, 70%, 67%, 70%, and 72% for groups 1 to 5, respectively. In group 4, only 39% had school forms to be completed and their adherence rate was 84% (53/63). Compared to group 1, the only statistically significant improvement was in group 4, especially for those who needed school forms completed, and in group 5. Those not adhering in groups 1 to 4 did not differ from returnees with regard to TB risk factors, maternal education, transportation, or perceived importance of testing. The most common reasons for failing to return included forgetfulness, transportation, and time constraints. Group 5 was stopped early because of difficulty with nurse visits (N = 98). When told of the nurse visit, 9% (9/98) families could not find a time for the visit. Seventeen percent (17/98) were visited but the child was not home, and 7% (7/98) were not visited because of a nurse scheduling problem. CONCLUSIONS: In a high-risk population, adherence with TB test reading is poor. However, education and return of school forms at reading time can significantly improve adherence. Although requiring larger investment in resources, visiting nurses may also aid in test reading.
Tuberculosis testing. Physician attitudes and practice.
OBJECTIVE: To assess physician agreement with and adoption of American Academy of Pediatrics' (AAP) recommendations on tuberculosis screening in children. DESIGN AND PARTICIPANTS: Survey of a random sample of 1272 community pediatricians and family physicians (excluding academic institutions) in 4 mid-Atlantic states and the District of Columbia. RESULTS: The response rate was 66%. Seventy-five percent of the respondents were aware of the 1994 AAP screening recommendations. Most (64%) test children at low risk periodically (at age 1 year, preschool age, and adolescent age), and 81% test children at high risk annually. Eighty-one percent of the respondents estimated that 10% or less of their patients were at high risk for tuberculosis. Most use patient-specific factors, geographic or community prevalence, or both as principal criteria to determine risk. Eighty-seven percent used multiple-puncture tests in 1993; this declined to 55% in 1994. Multiple-puncture tests are still used exclusively by 29% of the respondents. Ninety-one percent of those using multiple-puncture tests and 19% of those using the Mantoux test allow parents to read the test reaction. Forty-six percent of the respondents believed that if a return visit was required for reading the test reaction, 50% or less of their patients would return. Only 22% of the respondents adhere to the 1994 AAP recommendations regarding frequency, testing method, and reading the test reaction. Factors associated with adherence to AAP recommendations included physician and practice characteristics and knowledge of AAP recommendations. CONCLUSIONS: Physician practice of tuberculosis testing varies widely; most do not adhere to the 1994 AAP recommendations. Most physicians vary the frequency and testing method based on a patient's risk status. The use of multiple-puncture tests has declined, although they are still widely used. Accurate reading of screening tests remains a major concern.
Young adolescents' comfort with discussion about sexual problems with their physician.
OBJECTIVE: To identify factors associated with young adolescents' sense of comfort about discussing sexual problems with their physician. DESIGN: Confidential, assisted self-report questionnaires on physician-adolescent communication developed by the investigators and completed by participants at visits for general health examinations. SETTING: Five primary care pediatric practices at health maintenance organizations in Washington, DC. PATIENTS: A consecutive sample of all adolescents 12 to 15 years old who received a general health examination. Of 412 eligible patients, 221 received parental consent and participated. MAIN OUTCOME MEASURE: Adolescents' sense of comfort about talking to their physician about a sexually transmitted disease or some other sexual problem. This outcome was chosen for a substudy of a larger longitudinal prevention trial. RESULTS: Most adolescents valued their physicians' opinions about sex (89%) and said it was easy to talk to the physician during their visit (99%), but about half said they would be uncomfortable talking to the physician if they had a sexually transmitted disease or some other sexual problem (43%) [corrected]. Adolescents' sense of comfort was greater when physicians discussed sexual issues in the general health examination, adolescents perceived their personal risk of sexually transmitted disease to be high, adolescents had high self-esteem, and physicians were adolescents' usual physicians. CONCLUSIONS: This study emphasizes the need for physicians to discuss sexual risks with young adolescents and suggests ways physicians can help young adolescents feel more comfortable talking with them about sexual concerns.
Tailoring STD/HIV prevention messages for young adolescents.
Explore the source record for details and available documents.
Poor validity of parent reading of skin test induration in a high risk population.
Explore the source record for details and available documents.
Expectations, goals, and perceived effectiveness of child health supervision: a study of mothers in a pediatric practice.
The purpose of the study was to assess parent expectations and goals in child health supervision and variability by socioeconomic status (SES), family size, social support, and pediatrician. Home interviews were conducted with mothers and their pediatricians were surveyed. Two hundred mothers with at least one child age 2-3 years who see one of five pediatricians in a staff model health maintenance organization were asked to participate. Mothers' and pediatricians' goals in the following seven areas of health supervision were assessed: biomedical, development, behavior, family functioning, safety education, and interpersonal and system interaction. Mothers stated physicians were their main source of parenting information. Assurance of physical health and normal development were more important than discussion of behavioral, family, or safety issues. Mothers of low SES were more likely to feel that physical aspects of health should be the focus and were less interested in psychosocial issues. Physicians stressed interpersonal, safety, and behavioral goals more than mothers. Individual physician responses did not predict the responses of mothers in their practice. Our data suggest either that mothers do not feel that psychosocial and safety issues are the highest priorities in health supervision or that physicians are not effectively reaching mothers on these issues.
Assessing mothers' attitudes about the physician's role in child health promotion.
OBJECTIVE: This study assessed maternal attitudes about the physician's role in child health promotion. METHODS: Home interviews were conducted with 200 Massachusetts mothers (with one child age 2 to 3 years) enrolled in a health maintenance organization. RESULTS: Mothers chose growth and nutrition, physical development, and illness as the most important topics and felt that providers have the ability to prevent problems and to help. Psychosocial and safety issues were less important, although mothers felt susceptible to these issues and believed they greatly affected children's health. CONCLUSIONS: On all issues, mothers believed physicians were more effective in helping families after, not before, problems arose. The Health Belief Model provided insight into attitudes and possible interventions.
Use of checklists in pediatric practice.
Explore the source record for details and available documents.
The adolescent viewpoint. Implications for access and prevention.
Explore the source record for details and available documents.
Confidentiality in health care. A survey of knowledge, perceptions, and attitudes among high school students.
OBJECTIVE: To assess adolescent knowledge, perceptions, and attitudes about health care confidentiality. DESIGN: Anonymous self-report survey with 64 items addressing confidentiality issues in health care. SETTING: Rural, suburban, and urban high schools in central Massachusetts. PARTICIPANTS: Students in ninth through 12th grades from three schools. RESULTS: A total of 1295 students (87%) completed the survey: 58% had health concerns that they wished to keep private from their parents, and 69% from friends and classmates; 25% reported that they would forgo health care in some situations if their parents might find out. There were differences in response by gender, race, and school. About one third were aware of a right to confidentiality for specific health issues. Of those with a regular source of care, 86% would go to their regular physician for a physical illness, while only 57% would go there for questions about pregnancy, the acquired immunodeficiency syndrome, or substance abuse that they wished to keep private. Sixty-eight percent had concerns about the privacy of a school health center. CONCLUSIONS: A majority of adolescents have concerns they wish to keep confidential and a striking percentage report they would not seek health services because of these concerns. Interventions to address confidentiality issues are thus crucial to effective adolescent health care.