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Biomedical subjects

D Geva

Publications and source records attributed to D Geva.

54 records · Page 3Linked to original sources
PubMed1996

Prenatal alcohol exposure and academic achievement at age six: a nonlinear fit.

This is a report on the effects of prenatal alcohol exposure on the academic achievement of children at 6 years of age. In this longitudinal study, women were interviewed at the end of each trimester of pregnancy, at delivery, and at 8, 18, 36, and 72 months postpartum. The women were of lower socioeconomic status, high school-educated, and moderate users of alcohol. The offspring received age-appropriate physical and developmental assessments at each follow-up. Linear regression and nonlinear curve fitting were used to investigate the nature and shape of the relationship between prenatal alcohol exposure and achievement. In addition, the role of child IQ in this relationship was explored. Alcohol exposure during the second trimester predicted deficits in each of the three subtests of the Wide Range Achievement Test-Revised (WRAT-R): reading, spelling, and arithmetic. The relationship was partially reduced by the addition of IQ to the model, but prenatal alcohol exposure still predicted significant deficits in achievement, even after controlling for IQ. Tests for the shape of the relationship demonstrated that the effect of prenatal exposure on the arithmetic subtest of the WRAT-R was a linear or dose-response relationship. By contrast, the relationships between prenatal alcohol exposure and performance on the spelling and reading subtests of the WRAT-R were better modeled as threshold effects. The thresholds for both were approximately 1 drink/day in the second trimester.

Achievement↗
PubMed1995

Labor and delivery complicated by acute mitral regurgitation due to ruptured chordae tendineae.

Acute mitral regurgitation due to ruptured chordae tendineae is a dramatic and life-threatening clinical situation. Rarely does this complication occur during pregnancy. We present a case of a 30-year-old woman in week 31 of her pregnancy who developed acute mitral regurgitation, secondary to bacterial endocarditis and ruptured chordae tendineae. This acute event resulted in preterm labor a few hours later. Delivery was uneventful and successful and was followed by open heart surgery 5 days later. A review of the literature on chordae tendineae rupture and resulting mitral regurgitation during pregnancy is presented.

Acute Disease↗
PubMed1995

Prenatal tobacco and marijuana use among adolescents: effects on offspring gestational age, growth, and morphology.

OBJECTIVE: This longitudinal study examined the effects of tobacco and marijuana use during pregnancy on the gestational age, growth, and morphology of 310 offspring of adolescents. Data were collected during 1990 through 1993. METHODOLOGY: The adolescents were drawn from a prenatal clinic in Pittsburgh, PA. They were interviewed at mid-pregnancy and at delivery to obtain information on tobacco, marijuana, and other substance use before and during pregnancy. Infants were examined 24 to 36 hours after birth. RESULTS: The average maternal age was 16.1 (range 12 to 18 years); 70% were African-American. Prenatal tobacco use was associated with reduced birth weight, length, head and chest circumferences, and ponderal index, but not gestational age or the number of morphological abnormalities. Prenatal marijuana exposure was associated with reduced gestational age. Among whites, first trimester marijuana exposure was associated with an increased rate of minor physical anomalies. Prenatal marijuana exposure was not associated with any growth outcomes. CONCLUSIONS: These effects of prenatal tobacco and marijuana use were prominent despite lower levels of prenatal exposure in the offspring of adolescent mothers as compared with the offspring of adult mothers from the same clinic. Young maternal age may increase the offspring's risk of negative effects from prenatal tobacco and marijuana exposure.

Abnormalities, Drug-Induced↗
PubMed1994

Decision making in high dependency environments--can we learn from modern industrial management models?

Increasing complexity and increased restraints affect the task of patient management in High Dependency Environments, which has become intricate and difficult. Medical knowledge alone is not enough any longer for proper patient care. Management ability and facilities are required. Current medical knowledge should be expanded by management methods and techniques. By looking at management models in the industry, we found striking similarities between the industrial management situation and clinical patient management. Both systems share complexity in structure, complexity in interaction and evolutionary character. Clinical patient management can be compared with a navigation process. The patient is steered by a control system, and course information is given by control dimensions. Clinical patient management becomes a succession of steering activities influenced by the surrounding systems. This system can be structured in three interacting layers: an operational level, in which information is collected and actions executed; a strategic level in which strategies based on goal-oriented mental anticipation of a probabilistic system are formulated; and a normative level at which principles and norms are defined. It is possible then, to define the tools which have to be developed and implemented to improve clinical management capabilities. At the operational level these tools are addressed to improve clinical decision making by providing information in an ergonomical way. They include artifact elimination, data reduction, increase in meaningful information and unwanted data filtering. At the strategic level, tools to check the feasibility of the applied strategies have to be developed, such as: ideal patient course plots and increased training in strategic thinking.(ABSTRACT TRUNCATED AT 250 WORDS)

Decision Making↗
PubMed1994

Patterns and covariates of tobacco use in a recent sample of pregnant teenagers.

PURPOSE: Little is known about the prevalence and patterns of smoking among pregnant teenagers. We provide a comprehensive description of the prevalence, patterns and correlates of smoking from a recent sample of 199 pregnant adolescents. METHODS: We interviewed pregnant teenagers at mid-pregnancy and delivery to obtain information on tobacco and other substance use before and during pregnancy and on demographic, medical and psychosocial status. RESULTS: The average age was 16.1 years (range 12-18); 70% were African-American. Smoking was prevalent and increased from first (59%) to third (62%) trimesters. This increase was in sharp contrast to decreases in other substances. Caucasians had higher rates of smoking and heavier smoking. For Caucasians, third trimester smoking was predicted by peer smoking and early onset of sexual activity. For African-Americans, third trimester smoking was related to older age, not living with parent(s), dissatisfaction with social support, early pregnancy binge drinking, peer smoking, and early onset of sexual activity. CONCLUSIONS: The high prevalence and increasing pattern of prenatal smoking in teenagers is a major public health concern. Effective education and cessation programs must be targeted at pregnant teenagers.

Adolescent↗
PubMed1994

Alcohol, marijuana, and tobacco: effects of prenatal exposure on offspring growth and morphology at age six.

Little is known about the long-term effects of prenatal exposure to alcohol. There are even fewer reports on the longitudinal effects of exposure to either marijuana or tobacco during pregnancy. This study is on the 6-year follow-up of 668 children enrolled in the Maternal Health Practices and Child Development Project. Mothers were interviewed at the 4th and 7th months of pregnancy, and mothers and children were evaluated at delivery, 8, and 18 months, and 3 and 6 years postpartum. At 6 years of age, children who were exposed to alcohol prenatally were significantly smaller in weight, height, head circumference, and palpebral fissure width. These effects on size were mediated by the effect of prenatal alcohol exposure on the offspring at 8 months. Prenatal alcohol exposure was also significantly associated with maternal reports of the child's appetite at 6 years. There were no effects of prenatal marijuana or tobacco exposure on growth when the children were age 6. There were also no significant relationships between prenatal exposure to alcohol, marijuana, or tobacco and the rate of morphologic anomalies, including the features of the fetal alcohol syndrome.

Alcohol Drinking↗
PubMed1994

A comparison of prenatal drinking in two recent samples of adolescents and adults.

The drinking patterns of 124 pregnant teenagers are described and compared with those of 267 pregnant adults attending the same prenatal clinic in Pittsburgh. Adults had a significantly higher average daily volume of alcohol prior to pregnancy than adolescents, but that higher level was no longer significant during pregnancy. However, the rate of binge drinking during the first trimester was higher in the teenage sample than in the adult sample. Rates of binge drinking and heavy drinking were highest among the white teenage group. Use of marijuana and cocaine/crack decreased precipitously during pregnancy for both teenagers and adults. Tobacco use also decreased among the adults, but increased from 56% to 71% during pregnancy in the teenage sample. Based on our findings, patterns of drinking among adult pregnant women do not generalize to pregnant adolescents. Offspring of white adolescents, in particular, may be at higher risk for intermittent high peak alcohol exposure farther into the pregnancy than are offspring of older women.

Adolescent↗
PubMed1993

Drinking patterns and correlates of drinking among pregnant teenagers.

Many adolescents drink, and the rate of teenage pregnancy is increasing, yet the effect of drinking among pregnant teenagers has received little attention. We present a description of the drinking patterns of 124 pregnant teenagers attending a prenatal clinic in Pittsburgh. Sixty-nine percent of the women were African-American, and the average age was 16 years (range 13-18 years). Eighty-two percent drank the year before pregnancy, while 54%, 19%, and 15% drank during the first, second, and third trimesters, respectively. All substance use decreased between the first and third trimesters, with the exception of tobacco, which rose significantly. Binge drinking (5+ drinks/occasion) occurred in 31% of the sample before pregnancy, rose to 35% in the first trimester, and then fell precipitously. Binge drinkers during pregnancy were more likely to be white and heavier users of tobacco, marijuana, and cocaine. Binge drinkers experienced alcohol and tobacco use and sexual intercourse earlier than nonbinge drinkers. Binge drinking in the first trimester may be considered a risk factor for infants of adolescents.

Adolescent↗
PubMed1993

A longitudinal analysis of the effect of prenatal alcohol exposure on growth.

Cross-sectional analyses have demonstrated that prenatal exposure to alcohol can result in growth deficits at birth and in early childhood. However, there have been few longitudinal analyses of this relationship. This study presents an analysis of the longitudinal effect of prenatal alcohol exposure on growth. The model used for analysis was a general unbalanced repeated-measures model with a fully parameterized covariance matrix. Application of the model demonstrated that for length and head circumference, the effect of prenatal alcohol exposure was constant over time. The relationship between prenatal alcohol exposure and growth in weight was more complex. Prenatal alcohol exposure affected the rate of growth between birth and the eight month. Subsequently, the relationship between weight and prenatal alcohol exposure was constant. Therefore, for length and head circumference, prenatal alcohol exposure suppresses the rate of growth in the fetus but not at subsequent time points. For weight, exposure affects the rate of growth through the eighth month but not at subsequent time points. For each of the growth parameters, there is no catch-up growth, and the smaller size observed in the offspring is maintained.

Adolescent↗
PubMed1993

Thionyl-chloride-induced lung injury and bronchiolitis obliterans.

Thionyl-chloride (TCl) is used in the manufacture of lithium batteries, producing SO2 and HCl fumes on contact with water. We report two cases of accidental TCl exposure resulting in lung injury that may vary from a relatively mild and reversible interstitial lung disease to a severe form of bronchiolitis obliterans causing, after a latent period, an acute/chronic respiratory failure as well as other complications (spontaneous pneumothorax and bronchopleural fistula), previously unreported in TCl fume inhalation.

Accidents, Occupational↗
PubMed1991

The effects of prenatal alcohol use on the growth of children at three years of age.

In this prospective study of substance use during pregnancy, women were interviewed in their 4th and 7th prenatal months, and women and children were assessed at 24 hr, 8, 18, and 36 months postpartum. Data are presented on the outcome of 519 children at age 3. At 3 years, children who were exposed prenatally to alcohol were smaller in weight, length, and head circumference. They also had an increased number of minor physical anomalies. These effects were found even after controlling for nutritional and environmental factors. The persistence of growth effects at age 3 suggests that children exposed to alcohol prenatally may have a diminished capacity for growth.

Body Height↗
PubMed1991

Prenatal alcohol exposure and offspring growth at 18 months of age: the predictive validity of two measures of drinking.

This is an analysis of the effect of prenatal alcohol exposure on growth of the offspring at 18 months of age. In this prospective study, a cohort of women was interviewed at the end of each trimester of pregnancy, at delivery, and at 8 and 18 months. Offspring were examined at each follow-up point. Two drinking scales, average daily volume (ADV) and frequent heavy drinking (FHD), were used to explore the effect of different patterns of drinking. We found significant relationships between both prenatal FHD and ADV and offspring growth at 18 months. A significant and inverse relationship was found between ADV during the second and the third trimesters of pregnancy and weight, height, and head circumference at 18 months. Frequent heavy drinking during all three trimesters predicted a significant decrease in head circumference at 18 months. FHD during the second trimester was significantly related to weight and height at 18 months. Analyses demonstrated that ADV was a better predictor of growth deficits than FHD.

Adult↗
PubMed1990

Adult respiratory distress syndrome: roles of leukotriene C4 and platelet activating factor.

The relationship between leukotriene C4 (LTC4), platelet activating factor (PAF), and adult respiratory distress syndrome (ARDS) was studied in nine patients and 84 control subjects. A leukocyte adherence inhibition (LAI) assay induced by each of the ligands was used to monitor the subjects for 3 consecutive days or until clinical recovery was noted. LAI was considered to be positive if the nonadherence index (NAI) was greater than 30 for LTC4 or greater than 20 for PAF. LAI was negative in all healthy subjects using both ligands. LTC4-induced LAI was positive in all nine ARDS patients and reverted to negative after recovery from the syndrome, while three (33.3%) of nine patients responded to PAF. In contrast, of the 84 control subjects, LAI was induced by LTC4 in only three (3.3%) and by PAF in five (5.9%). The mean NAI (52.2 +/- 18) of LTC4-induced LAI in ARDS patients was significantly (p less than .05) higher when compared with the control group (-5 +/- 6.4), whereas that of PAF-induced LAI was less than 20 in both groups, indicating that LTC4 is a more specific ligand than PAF. All three patients in whom ARDS was caused by sepsis responded to both LTC4 and PAF, but results of specific receptor-antagonist experiments indicated that each compound acted independently. The mean NAI for LTC4 (58.5 +/- 10) and PAF (49.1 +/- 12) in patients with septic ARDS were significantly (p less than .05) higher when compared with those of patients with sepsis alone (0.5 +/- 9.9 and 4.4 +/- 17, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Neonatal seizures: electroclinical dissociation.

Electroclinical dissociation is a phenomenon in which the clinical component of a seizure occurs at times with or without an electrical correlate. The epidemiology of this observation was studied in a neonatal intensive care unit from July, 1983 to December, 1988. Infants demonstrating electroclinical dissociation were compared to those having exclusively electroclinical seizures. Sixteen percent of infants with electrographically-confirmed seizures and 19% of 243 analyzed seizures demonstrated electroclinical dissociation. The two groups revealed very few differences with respect to perinatal factors, etiology, and outcome. The subsequent electroencephalographic background was more disturbed in the electroclinical dissociation group, but did not correlate with clinical outcome. Extremity movements occurred at a statistically significant higher rate during electroclinical seizures. Electroclinical dissociation seizures arise from foci not consistently reflected in surface electrodes.

Brain Diseases↗
PubMedDate not supplied

Effect of prenatal marijuana exposure on the cognitive development of offspring at age three.

Marijuana is the most commonly used illicit substance among pregnant women. Although there has been substantial concern about the effects of substance use during pregnancy, few studies have assessed the effects of prenatal exposure to marijuana and even fewer have provided longitudinal data on the developmental outcome of offspring. This is a report from a longitudinal study of substance use during pregnancy. The women in the cohort were of lower socioeconomic status, most were single, half were white and half were African-American. Women were interviewed at the fourth and seventh prenatal months, and women and children were assessed at delivery, 8, 18, and 36 months. Pediatric assessment included physical and cognitive development. At each study phase, mothers were interviewed about life style, living situation, current substance use, sociodemographic, and psychological status. Findings are reported on 655 women and children who were assessed at the third year. There were significant negative effects of prenatal marijuana exposure on the performance of 3-year-old children on the Stanford-Binet Intelligence Scale. The effects were associated with exposure during the first and second trimesters of pregnancy. Among the offspring of white women, these effects were moderated by the child's attendance at preschool/day-care at age three.

Adolescent↗
PubMedDate not supplied

Intravenous administration of magnesium sulfate in acute stroke: a randomized double-blind study.

A randomized, placebo-controlled, double-blind study was performed as a pilot study to examine the benefit of the administration of magnesium sulfate given intravenously as a protective substance during the first 24 hours following a stroke. Patients who had cortical infarction in the middle cerebral artery territory with moderate to severe neurologic deficits lasting for more than 15 minutes with onset less than 24 hours were included. The patients were treated with magnesium sulfate or placebo for 5 days and examined by a blinded investigator. Patients had follow-up for 30 days. The primary efficacy variable was the proportion of patients reaching mild to moderate neurologic deficit on the Orgogozo scale (80 points) and relative functional independence on the Barthel index (60 points). Orgogozo scale and Mathew scale values were obtained on admission and days 2, 4, 8, and 30 after stroke. Barthel activities of daily living index and Rankin disability score were obtained on day 30. Forty-one patients (22 given treatment and 19 given placebo) demonstrated significant beneficial effects on the Orgogozo scale (84 +/- 11 vs. 64 +/- 10, p < 0.0001) and (83 +/- 14 vs. 70 +/- 15, p < 0.009), respectively. At the end of 1-month follow-up, the Barthel ADL index was nonsignificantly higher and the Rankin disability score was marginally significantly lower in the magnesium-treated group (84 +/- 26 vs. 71.8 +/- 26, p < 0.143) than in control subjects (2.3 +/- 1.1 vs. 3 +/- 1.3, p < 0.077). Intravenous magnesium sulfate had significant positive effect on the outcome in patients with acute stroke. Further studies on a larger scale are needed to confirm these findings.

Activities of Daily Living↗
PubMedDate not supplied

Developmental and individual differences in children's on-line representations of dynamic social events.

Developmental and clinical differences in children's on-line understanding of ongoing social events were examined. Boys with (n = 38) and without (n = 41) Attention Deficit Hyperactivity Disorder (ADHD) were compared. Prior social schemes and integrative processes were hypothesized to influence children's representation of incoming social cues. Younger children and children with ADHD were expected to differ from older children and children without ADHD, respectively, in what they encoded and how they organized the encoded information. Differences in on-line representation were postulated to underlie differences in children's recall and social reasoning. Children's prior social schemes, looking time and on-line verbal protocols, recall, and social reasoning were assessed. Younger boys and ADHD boys showed less integrated on-line representations, accounting for poorer recall and reasoning.

Age Factors↗