Biomedical subjects

V Keane

Publications and source records attributed to V Keane.

13 recordsLinked to original sources

PubMed1998

Effectiveness of pediatric practice consultation on missed opportunities for immunization.

OBJECTIVE: To evaluate the effectiveness of pediatric practice consultation in reducing missed-opportunity rates at eight pediatric sites in Baltimore, Maryland. The overarching goal was to decrease the occurrence of missed opportunities from 33% to 15% for the first, second, and third diphtheria and tetanus toxoids and pertussis vaccines during visits at which children were eligible for the vaccines. DESIGN: The effect of an in-office educational program alone at four sites is compared with the educational program and a consultation on office vaccination practices at four matched sites. All eight sites received a small grant ($2,000) to fund practice changes. The medical records of children making visits before and after the interventions were audited to determine missed-opportunity rates. The policies and operations and the knowledge, attitudes, and practices of physicians and nurse practitioners at each site were also assessed. RESULTS: The four education-consultation sites experienced a statistically significant 14% net reduction in the missed-opportunity rate relative to the education-only sites. This positive effect, however, was largely due to an increase in missed opportunities at one education-only site. There was a 10% increase in the missed-opportunity rate among the education-only sites and a 4% decrease among the education-consultation sites; neither change was statistically significant. Two of the three sites that reduced missed opportunities were matched health maintenance organizations (HMOs). Shortly after the interventions, both HMOs implemented tracking and follow-up information systems, which were planned before the interventions. CONCLUSIONS: There is no evidence that either the educational program alone or the educational program and consultation combination reduced missed opportunities. The findings suggest that improved tracking and follow-up data systems and vaccination of children at sick visits may reduce missed opportunities.

Baltimore↗

PubMed1997

Risk factors for disruption in primary caregiving among infants of substance abusing women.

OBJECTIVE: To identify perinatal factors that are predictive of disruption in primary caregiving among infants of substance abusing women. METHOD: A randomized longitudinal cohort study. One hundred and fifty two mother/infant dyads were assessed for evidence of disruption of primary caregiving or neglect during the first 18 months of life, defined by mother's inability to provide care. Data analyzed included neonatal characteristics, urine toxicology at delivery, maternal history of drug use, maternal depression, social support, and social and health history. RESULTS: Sixty-six infants (43.4%) had disruption in their primary care during the first 18 months of their life, 86 infants (56.6%) remained in the care of their mothers. Women who were younger, were heroin users, had two or more children, had other children in foster care, and reported depressive symptoms were least likely to provide ongoing primary care for their infant. CONCLUSIONS: Although all infants born to substance abusing women are at a high risk for disruption in the continuity of their primary caregiving, maternal demographic and psychosocial factors present at delivery can predict which infants are likely to experience an early disruption in their primary caregiving. Identifying these families can enable health care providers to monitor them more closely and, when appropriate, encourage support from the extended family.

Adolescent↗

PubMed1996

The contribution of missed opportunities to childhood underimmunization in Baltimore.

OBJECTIVE: To determine the community-wide incidence of missed opportunities to vaccinate, to describe the clinical settings in which they occur, and to estimate the impact of missed opportunities on immunization coverage. DESIGN AND METHODS: We abstracted outpatient medical records from a random, community-based sample of 2-year-old children whose residence was inner-city Baltimore. The date of each vaccine and the date, diagnoses, and temperature at each visit were collected for 502 children at 98 different provider sites. MAIN OUTCOME MEASURES: Missed opportunities to vaccinate and up-to-date vaccination status. RESULTS: By 24 months of age, 75% of the children had at least one missed opportunity and only 55% were up-to-date for the 4:3:1 series. Missed opportunities occurred at more than one third of eligible visits for each vaccine, including > 20% of preventative care visits. Diagnoses commonly associated with missed opportunities were "well child," otitis media, upper respiratory infection, gastroenteritis, skin infection, and resolving illness. If no missed opportunities had occurred, 73% of the children would have been up-to-date by 24 months. CONCLUSIONS: Missed opportunities occurred commonly at providers serving inner-city children in Baltimore and represent a major factor in underimmunization. Reduction of missed opportunities by accurate screening at all visits and adherence to the contraindication guidelines is a provider-based, low-cost method to increase immunization coverage.

Baltimore↗

PubMed1996

Parental attitudes do not explain underimmunization.

OBJECTIVE: This article describes the results of a community-based study to determine the effect of family knowledge and attitudes on the immunization rates of a random sample of children younger than 2 years in the poorest census tracts of Baltimore. DESIGN AND METHODS: The two sources of data were (1) parent interviews that provided data on knowledge, attitudes, and beliefs related to immunization and sociodemographic characteristics, and (2) medical record audits from which data on immunization status were obtained. The protection motivation theory, a model of behavioral change, was used to select the variables to assess the relation of parental attitudes with immunization status. A multivariate logistic regression analysis included only variables found to be significantly associated with immunization outcome in the preliminary analysis. RESULTS: Mothers were well informed and generally had favorable attitudes toward immunizations. Immunization status was more strongly associated with the sociodemographic characteristics of the children than with the protection motivation theory variables. Only two protection motivation theory variables were associated with more than one immunization outcome. The children of mothers who perceived that timing of vaccination did not matter were less likely to be immunized than children of care takers who thought that it did matter and children whose parents believed in the safety of multiple immunizations were less likely to be immunized than children whose parents did not hold this belief. CONCLUSIONS: In this study, parents' attitudes and beliefs had little effect on their children's immunization levels. Interventions intended to heighten parental awareness about immunization may have little impact. In poor urban neighborhoods, African-American children whose mothers are young, have multiple siblings, and do not use the Women, Infants and Children program may be at highest risk for delayed immunization.

Adult↗

PubMed1995

Malaria in east African refugees resettling to the United States: development of strategies to reduce the risk of imported malaria.

Resettlement to the United States of malaria-infected refugees can pose problems for both the refugees and their resettlement communities. To formulate malaria management strategies for East African refugees before resettlement to the United States, epidemiologic data were reviewed and malaria prevalence surveys were conducted among refugees awaiting resettlement in Mombasa, Kenya, and Khartoum, Sudan, in 1993. Overall, 279 Somali (Mombasa) and 127 Ethiopian (Khartoum) refugees were surveyed. Malaria contributed significantly to morbidity in Mombasa: 15% (43/279) of Somalis were parasitemic; 39 infections (91%) were due to Plasmodium falciparum. Sulfadoxine-pyrimethamine was effective treatment. In Khartoum, only 0.8% (1/127) were parasitemic; recent fever or antimalarial use were uncommon. Presumptive sulfadoxine-pyrimethamine treatment before departure was recommended for all resettling refugees from Mombasa; in Khartoum, individual assessment of febrile illness was recommended. Prevention of malaria parasitemia by mass drug administration or individual therapy can minimize the burden of malarial illness to refugees and their resettlement communities.

Africa, Eastern↗

PubMed1995

Development of a culturally, theoretically and developmentally based survey instrument for assessing risk behaviors among African-American early adolescents living in urban low-income neighborhoods.

The creation of developmentally and culturally appropriate data-gathering instruments is necessary as health researchers and interventionists expand their investigations to community-based minority adolescent populations. The creation of such instruments is a complex process, requiring the integration of multiple data-gathering and analytic approaches. Recent efforts have delineated several issues to be considered in survey design for minority populations: community collaboration; problem conceptualization; application of the presumed model of behavioral change; and dialect and format of delivery. This paper describes the process of creating a culturally and developmentally appropriate, theoretically grounded instrument for use in monitoring the impact of an AIDS educational intervention on the behavior and health outcomes of urban African-American pre-adolescents and early adolescents. Three phases of research were involved: preliminary (and ongoing) ethnographic research including extensive participant observation, as well as, focus group and individual interviews with 65 youths; construction and testing of the preliminary instrument involving two waves of pilot testing (N1 = 57; N2 = 45); and, finalization of the instrument including reliability testing and assessment of tool constructs and selection of the mode of delivery (involving 2 additional waves of pilot testing (N3 = 91; N4 = 351). The essential role played by the community in all phases of instrument development is underscored.

Adolescent↗

PubMed1994

Do provider practices conform to the new pediatric immunization standards?

OBJECTIVE: Standards for pediatric immunization practices were issued by the Centers for Disease Control and Prevention, Atlanta, Ga, in May 1992. This article provides baseline data on immunization practices related to eight of the standards. DESIGN: Survey of pediatric providers before publication of the standards. SETTING: Baltimore, Md. PARTICIPANTS: Forty of the 41 health centers, clinics, and private practices serving children in designated high-risk census tracts participated in the survey. One hundred seventy-three of the 251 eligible physicians and nurse practitioners at the sites responded. MAIN OUTCOME MEASURES: Conformity with the eight standards was measured as a percentage of either sites or physicians and nurse practitioners across the sites. RESULTS: Conformity with the standards varied, ranging from nearly universal conformity with the need to educate parents and guardians about immunizations (standard 5) to less than 3% for simultaneous administration of all vaccine doses when a child is first eligible (standard 8). For most of the standards, considerable variability was found between and within public and private sites. CONCLUSIONS: Providers often followed practices that did not conform to the new standards (prior to issuance). Some of the standards are ambiguous and require clarification before they can be fully applied. The impact of the standards on immunization rates and pediatric primary health care has yet to be tested empirically.

Baltimore↗

PubMed1994

Immunization coverage and its relationship to preventive health care visits among inner-city children in Baltimore.

OBJECTIVE: To provide empirical data on immunization coverage and the receipt of preventive health care to inform policy makers' efforts to improve childhood immunization. DESIGN AND METHODS: We surveyed a random sample drawn from a birth cohort of 557 2-year-old children living in the inner-city of Baltimore. Complete information on all their preventive health care visits and immunization status was obtained from medical record audits of their health care providers. MAIN OUTCOME MEASURES: Age-appropriate immunizations and preventive health care visits. RESULTS: By 3 months of age, nearly 80% made an age-appropriate preventive health visit, but by 7 months of age, less than 40% had a preventive visit that was age-appropriate. In the second year of life, 75% made a preventive health visit between their 12- and 17-month birthdays. The corresponding age-appropriate immunization levels were 71% for DTP1, 39% for DTP3, and 53% for measles-mumps-rubella vaccine. Infants who received their DTP1 on-time were twice as likely to be up-to-date by 24 months of age. CONCLUSIONS: Our analyses focus attention on the performance of the primary health care system, especially during the first 6 months of life. Many young infants are underimmunized despite having age-appropriate preventive visits, health insurance coverage through Medicaid, and providers who receive free vaccine from public agencies. Measles vaccination coverage could be improved by initiating measles-mumps-rubella vaccine vaccination, routinely, at 12 months among high risk populations.

Baltimore↗

PubMed1994

Efficacy of albuterol in the management of bronchiolitis.

OBJECTIVE: To examine the efficacy of albuterol (0.15 mg/kg per dose) in the management of bronchiolitis. DESIGN: Randomized, double-blind, placebo-controlled outpatient clinical trial utilizing four study groups: neubulized albuterol, nebulized saline, oral albuterol, and oral placebo. SETTING: Pediatric emergency department and outpatient clinic at University of Maryland in Baltimore. PATIENTS: Eighty-eight infants (median age 5.5 months) being treated for their first episode of wheezing were randomly assigned to nebulized albuterol (n = 22), nebulized saline (n = 23), oral albuterol (n = 19), oral placebo (n = 24). INTERVENTIONS: The nebulized groups received two nebulizations 30 minutes apart, whereas the oral groups received one oral dose. MAIN OUTCOME MEASURES: Respiratory and heart rates, clinical score, oxygen saturation (Spo2), and the infant's state, ie, asleep, awake, or feeding, were recorded at baseline and at 30 and 60 minutes after treatment. RESULTS: Randomization produced equivalent groups in terms of demographics and baseline measures. There were no statistically significant differences in any outcomes among the four treatments, except for oral albuterol, which produced an increase in heart rate (15 beats per minute, P = .005). No differences in the need for additional treatment or hospitalization were observed. Change in the state of the infant during the trial had significant effects on respiratory rate and clinical score. CONCLUSIONS: Albuterol is as effective as oral placebo in the management of bronchiolitis. Past studies supporting the use of albuterol did not control for effects of change in state of the infant and did not use a truly inactive placebo group. This study underscores the importance of these design components in measuring the efficacy of albuterol in infants.

Administration, Inhalation↗

PubMed1993

Perceptions of vaccine efficacy, illness, and health among inner-city parents.

A resurgence of measles in the past decade has focused attention on the limitations of current immunization programs, particularly for inner-city, low-income populations. As part of a larger study of immunization rates, we discussed perceptions of disease severity and vaccine efficacy, as well as the prioritization of the tasks of parenthood, with 40 parents of infants living in inner-city Baltimore to discover their beliefs about immunization. Vaccines were considered only partly successful; susceptibility to chickenpox after vaccination was repeatedly cited as evidence of vaccine failure. Fever was seen as a primary indicator of illness; thus, vaccines were believed to cause, rather than prevent, illness. Immunization was not considered a high-priority parental responsibility. These findings suggest future interventions be aimed at changing parental perceptions of vaccines as ineffective and of fever after immunization as an indicator of illness. Finally, immunizations should be made easily available, even during clinic visits for a child's illness.

Baltimore↗

PubMed1993

Fragile X syndrome--a review.

Since the discovery of the Fragile X syndrome some 20 years ago, there have been numerous articles concerning clinical features, cognitive profile and transmission. It is a syndrome of importance to all those working in the mental health field and those involved in community health, such as General Practitioners, since it is second only to Down syndrome as a genetic cause of mental handicap.

Abnormalities, Multiple↗

PubMed1992

Dexamethasone suppression test and response to antidepressants in depressed mentally handicapped subjects.

Nineteen mentally handicapped subjects who were referred to the service with clinically significant depression were assessed with a view to determining the value of the dexamethasone suppression test (DST) in clinical diagnosis and in predicting response to antidepressant treatment. They were assessed initially and then 3 months after they had been treated with a tricyclic antidepressant. It was found that a significant proportion had an abnormal DST response which reversed after recovery in some but not in others. Non-reversal was more likely to occur in the more severely handicapped patients. It was concluded that DST was of little value as a diagnostic tool for the detection of depression in mentally handicapped subjects.

Adolescent↗

PubMed1991

Prolonged QT interval and risk of sudden death in South-East Asian men.

Sudden death in sleep occurs in substantial numbers among young men in South-East Asia. The frequencies of electrocardiographic abnormalities were measured in groups with varying risks of such sudden death. The mean heart-rate-corrected QT interval (QTc) was significantly (p less than 0.05) greater among 123 Laotian refugees in Thailand at high risk (405 [95% confidence interval 397-413] ms) than in 77 Laotian refugees in the United States at lower risk (364 [359-369] ms) and 199 non-Asian US residents at negligible risk (358 [354-362] ms). Among refugees in Thailand, prolonged QTc interval was associated with poor thiamine status and a history of seizure-like episodes in sleep. Thiamine deficiency may be a cause of prolonged QT interval and sudden death in this region.

Adolescent↗