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Biomedical subjects

D A Wolfe

Publications and source records attributed to D A Wolfe.

At least 37 records · Page 2Linked to original sources
PubMed1994

Factors associated with the development of posttraumatic stress disorder among child victims of sexual abuse.

This study examined the relationship between the development of PTSD and selected victim and event characteristics. The sample consisted of 69 girls and 21 boys (mean age = 12.4 years) who had been referred to a child witness preparation program following documentation of sexual abuse. Comparisons of PTSD positive (N = 44) and PTSD negative (N = 46) subgroups found significant differences on variables of age, sex, duration of the abuse, and the use of violence or coercion by the offender. Comparisons on psychological test data indicated that the PTSD subgroup significantly differed from the non-PTSD subgroup on the basis of children's abuse-related fears, anxiety, depression, and feelings of guilt related to the abuse. Hierarchical multiple regression analysis indicated that factors related to the nature and severity of the abuse and the child's self-report of guilt feelings each contributed significantly to explaining 37% of the variance in PTSD symptoms, even after the variables of receptive language ability, age, and sex were controlled. Discriminant function analysis correctly classified 78.4% of the respondents. The importance of considering PTSD in relation to child sexual abuse is discussed, along with limitations of the current study.

Adolescent↗
PubMed1994

Witnessing domestic violence during childhood and adolescence: implication for pediatric practice.

The traditional role of the pediatrician, which consisted primarily of making diagnoses and prescribing treatments for specific disease entities in children, has expanded dramatically to include psychosocial aspects of health care as well as problems that are primarily psychological, emotional, or social in nature and that extend in various ways to the family and to the child's environment. One of these problems has been identified as the manner in which witnessing domestic violence, a significant and relatively commonplace event for many children today, affects child development and behavior. This paper reviews our existing knowledge of such events and explores how exposure to conflict and violence plays a major role in how children learn to relate to others, how they develop their self-concept and self-control, and how they interact with dating and marital partners in the future. We conclude with a discussion of the role of the pediatrician in interviewing children and other family members and in identifying appropriate avenues for prevention and treatment. Major recommendations derived from this paper include: decreasing the attitudinal barriers to exploring this issue; increasing sensitivity to clinical features and behavioral symptoms of children who witness domestic violence; and increasing knowledge of available resources for treatment and prevention.

Adolescent↗
PubMed1993

Usefulness of fluoxetine hydrochloride for prevention of resistant upright tilt induced syncope.

Recurrent vasovagally mediated episodes of hypotension and bradycardia are a common cause of recurrent syncope that can be identified by head-upright tilt table testing. Although the use of beta blockers, transdermal scopolamine, disopyramide, and fludrocortisone may be helpful in preventing further episodes, some patients are intolerant of or respond poorly to each of these agents. Following anecdotal observations, we investigated the utility of fluoxetine (a serotonin re-uptake antagonist) in preventing head-upright tilt induced hypotension/bradycardia in patients unresponsive to or intolerant of standard therapy. Sixteen patients (7 men and 9 women, mean age 42 +/- 21 years) with recurrent syncope and positive head-upright tilt studies (refractory to normal therapy) were placed on fluoxetine and restudied 5-6 weeks afterward. Three patients were intolerant of the medication. Of the 13 patients who underwent repeat tilt studies, seven patients (53% of the patients retested or 44% of the total group) were rendered tilt table negative, and, over a mean follow-up period of 19 +/- 9 months, have remained asymptomatic. We conclude that fluoxetine may be an effective therapy in patients with recurrent vasovagally mediated syncope refractory to other forms of therapy.

Adult↗
PubMed1993

Adaptive rate pacing controlled by right ventricular preejection interval for severe refractory orthostatic hypotension.

A 72-year-old African-American man with frequent recurrent syncope was found to have severe refractory orthostatic hypotension with concomitant supine hypertension. Pharmacotherapy was successful in controlling his supine hypertension but was unable to resolve his severe orthostatic hypotension. Temporary fixed rate tachypacing was only minimally effective in preventing syncope during upright tilt, while variable rate pacing based on degree of blood pressure fall was far superior. Following these observations, an adaptive rate pacing system controlled by right ventricular preejection interval was implanted (Precept DR Model 1200). The system adequately sensed the patient's fall in blood pressure when sitting or standing and augmented its rate accordingly, thus preventing syncope. While supine, the pacing rate fell to 60 ppm, thereby, avoiding an exacerbation of his concomitant supine hypertension. Over a 3-month follow-up period, he has had no further orthostatic or syncopal episodes. We conclude that adaptive rate pacing using right ventricular preejection interval may be an effective treatment for severe refractory orthostatic hypotension.

Aged↗
PubMed1993

Tilt table testing in the evaluation and management of athletes with recurrent exercise-induced syncope.

Recurrent idiopathic exercise-related syncope in the young athlete is often a challenging and frustrating condition. Vasovagally mediated hypotension and bradycardia is believed to be a common, but difficult to prove, cause of this form of syncope. This study evaluated the usefulness of head-upright tilt table testing in the evaluation and management of young athletes with recurrent idiopathic exercise-related syncope. Twenty-four trained young athletes (12 male, 12 female mean age 18 +/- 3.4 yr) with recurrent unexplained exercise-related syncope were evaluated by use of an upright tilt table test for 30 min, with or without an infusion of isoproterenol (1-3 micrograms.min-1 given intravenously) in an effort to provoke bradycardia, hypotension, or both. Ten control patients with no history of syncope were also studied. Syncope occurred in 10 patients (41%) during the baseline tilt and in nine patients (37%) during the isoproterenol infusion (total positives 79%). Seventeen patients who had positive test results eventually became tilt table negative with pharmacotherapy, and over a mean follow-up period of 23 +/- 7 months, no further syncopal episodes have occurred. Two patients refused pharmacotherapy and have continued to experience syncope. We conclude that head-upright tilt table testing combined with isoproterenol infusion is useful in the diagnosis of vasovagal syncope in young athletes with recurrent exercise related syncope, and in the evaluation of prophylactic pharmacotherapy.

Adolescent↗
PubMed1993

Nonparametric procedures for comparing umbrella pattern treatment effects with a control in a one-way layout.

In this paper we are concerned with comparing umbrella pattern treatment effects with a control in a one-way layout. The problem of testing whether there is at least one treatment that is better than the control is considered. Distribution-free tests are proposed for both cases where the peak of the umbrella is known or unknown. Approximate small-sample critical values are presented and the results of a Monte Carlo power study are discussed.

Drug Therapy↗
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↗
PubMed1992

Syncope and seizures of psychogenic origin: identification with head-upright tilt table testing.

Psychogenic seizures and psychogenic syncope are common disorders but are difficult to identify. Head-upright tilt table testing has emerged as a promising means of evaluating vasovagally mediated syncope and convulsive syncope. Of a total of 42 patients evaluated by head-up tilt for recurrent syncope and 10 evaluated for recurrent idiopathic seizures, a total of 5 patients experienced syncope and 3 had tonic-clonic seizure activity unaccompanied by any significant changes in blood pressure, heart rate, transcranial Doppler cerebral blood flow velocity, and electroencephalographic monitoring. Psychiatric evaluation revealed that seven patients suffered from conversion reactions and one from probable malingering. We conclude that patients who pass out or convulse during head-upright tilt without any change in physiologic parameters can be presumed psychogenic in origin and may be referred for psychiatric evaluation without further expensive diagnostic studies.

Adolescent↗
PubMed1986

Child witnesses to violence between parents: critical issues in behavioral and social adjustment.

This study examined the impact of exposure to family violence on children's adjustment. Two groups of residents of shelters for battered women (current and former residents) were compared to a nonviolent control group. All three groups of mothers completed interviews and self-report questionnaires related to both their own and their children's adjustment. Children recently witnessing violence tended to have the lowest levels of social competence ratings, and their mothers reported the most health and emotional difficulties. Former residents of shelters experienced the highest level of family/social disadvantage. The results are discussed in the context of previous research findings, and implications for intervention programs are outlined.

Adolescent↗
PubMed1986

Evaluation of a brief intervention for educating school children in awareness of physical and sexual abuse.

The development and evaluation of procedures for imparting information to children regarding inappropriate treatment by adults is a challenging task that warrants increased methodological sophistication. The present study was conducted to evaluate proximal changes in fourth and fifth graders' knowledge and attitudes of physical and sexual abuse following brief skits and focal discussion in the classroom. The study used a control group of children that did not receive the intervention, which permitted a more accurate understanding of the program's effectiveness. Relative to controls, children who received the program showed an overall increase in knowledge of correct actions to take in the event of potential or actual abuse. Limitations of the study, as well as suggestions for broadening the scope and impact of child abuse prevention programs for children are discussed in relation to these findings.

Child↗
PubMed1986

Emotional and physical health problems of battered women.

The present study focused on the emotional and physical health problems of battered women by comparing a sample of residents in shelters with a group of women in the community matched for family income, length of marriage, and number of children on the General Health Questionnaire. The results indicated that battered women report a significantly higher level of somatic complaints, anxiety, and depression. These effects tended to be associated with other life stressors and children with serious behavior problems. The implications of the study are discussed in terms of assessing the needs of battered women and their children as well as being vigilant for family violence as an etiological factor for other presenting problems.

Child Behavior Disorders↗
PubMed1984

A parent-administered program to reduce children's television viewing.

A parent-administered program to reduce television viewing of primary school-aged children was tested on two boys and three girls from three different families who were heavy viewers of television. Children were given 20 unearned tokens each week by their parents, which they could exchange for up to 10 hours of viewing time. The child earned a gold token for viewing in accordance with the rules for 4 consecutive weeks, which was exchanged for a reward. Parents were given instructions to follow the program independently. Data on hours of television viewing, homework, and reading were recorded each day by one or both parents. A multiple-baseline analysis of the effects of the TV reduction program indicated that children reduced their baseline television viewing by more than half once the program was implemented, and continued to maintain these changes 6 months and 1 year after the program was discontinued. Reading time increased for all children whereas effects on homework varied across children. The results support the effectiveness of a parent-administered program for nonbehavior problem children who watch excessive amounts of television.

Journal Article↗