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H Bauchner

Publications and source records attributed to H Bauchner.

82 records · Page 5Linked to original sources
PubMed1988

The impact of pediatric asthma education on morbidity. Assessing the evidence.

We reviewed the literature evaluating pediatric asthma education interventions to assess their impact on morbidity (school absences and health care utilization). Thirteen studies were analyzed, most of which reported favorable outcomes. Of the ten studies reporting on school absences, only seven used tests of statistical significance when reporting on postintervention reductions, and of those, only two found a significant decrease in absenteeism. Similarly, among the studies reporting on utilization, not all used tests of statistical significance when reporting on postintervention decreases in physician visits, ER visits, and hospitalization. Only four of the ten studies used adequate sample sizes to detect a 20 percent reduction in school absences, and stratification of the sample by severity of asthma suggests that some programs do reduce health care utilization among those children with more severe disease. We conclude that the effectiveness of asthma educational programs on reducing school absences and health care utilization may be small. These programs are best directed toward children with moderate or severe disease. Finally, it is important for pediatricians, children with asthma, and their families to have realistic expectations about what these programs may accomplish.

Absenteeism↗
PubMed1988

Cocaine use during pregnancy: prevalence and correlates.

Cocaine use during pregnancy was assessed by interviews and urine assays obtained prenatally and immediately postpartum from 679 urban women enrolled in prenatal care. Of these, 17% were found to have used cocaine at least once during pregnancy. Eight percent had urine assays positive for cocaine metabolites using the enzyme-mediated immunoassay technique with a cut-off of 300 ng/mL of benzoylecgonine. Of the cocaine users, 24% denied use at the time of the interview and were identified solely by urine assay. Cocaine users were significantly (P less than .01) less likely than nonusers to be married, Hispanic, or black born outside of the United States and were less well nourished. Users reported significantly (P less than .01) more sexually transmitted diseases, prior low birth weight infants, spontaneous and elective abortions, and greater use of alcohol, cigarettes, marijuana, opiates, and other illicit drugs during pregnancy. Because cocaine use is correlated with many potential risk factors, large sample sizes and multivariate statistical techniques are needed to determine whether cocaine use during pregnancy poses an independent risk for adverse neonatal outcomes.

Boston↗
PubMed1987

Prevalence of bacteriuria in febrile children.

To determine the risk of urinary tract infections in acutely ill febrile children younger than 5 years of age we obtained a urine culture from 664 children presenting to our walk-in clinic with an acute febrile episode. Only 11 children (1.7%) had significant bacteriuria. This figure is similar to the number of children who would be expected to have asymptomatic bacteriuria. These results suggest that pediatricians are not missing the diagnosis of urinary tract infection in febrile children.

Age Factors↗
PubMed1987

Do mothers overestimate the seriousness of their infants' acute illnesses?

The purpose of this study was to determine if mothers generally perceive their infants as more ill than do pediatricians, and if the presence of fever has an impact on the perceptions of either the mother or pediatrician. One hundred eighty-seven mothers and their infants, from a primary care clinic (n = 109) and private practice (n = 78), were enrolled at the 2-week well-child visit and were asked to contact a physician participating in the study whenever their infants became acutely ill. The mothers were asked to rate the severity of their infants' illness according to a 3-point scale, first at home and then simultaneously, but independently, with a physician in the office. In general, mothers rated their infants equally as ill at home as in the office (kappa = 0.59). However, both their home ratings (kappa = 0.15) and office ratings (kappa = 0.29) were in poor agreement with the ratings of the physicians. The mothers consistently rated their infants as more ill than did the pediatricians (p less than 0.0001). Both the mothers and physicians perceived infants with higher temperatures (greater than or equal to 38.9 degrees C) as significantly (p = 0.0004) more ill than infants with lower temperatures (less than 38.9 degrees C). We conclude that mothers generally perceive their infants as more ill than do pediatricians, and that it is important for pediatricians to address the perceptions of mothers in order to establish effective communication with them.

Acute Disease↗
PubMed1986

Studies of breast-feeding and infections. How good is the evidence?

We assessed the extent to which studies of the association between breast-feeding and infection met four important methodological standards that relate to both the scientific validity and the generalizability of the studies. Of the 20 studies (14 cohort, six case-control), only six met three or four of the methodological standards. Four of these six studies found that breast-feeding was not protective against infections and two found that breast-feeding was protective against infections. In the three studies in which statistical adjustments were made for three additional potentially important confounding variables--size of the family, smoking of cigarettes by the mother, and the mother's level of education-the apparent protective effect of breast-feeding against respiratory tract infections disappeared after the adjustments were made. We found that most of the studies have major methodological flaws that may have compromised their conclusions. The studies that met important methodological standards and controlled for confounding variables suggest that breast-feeding has at most a minimal protective effect in industrialized countries.

Breast Feeding↗
PubMedDate not supplied

Management of childhood lead poisoning: clinical impact and cost-effectiveness.

OBJECTIVES: No consensus exists regarding the preferred treatment of childhood lead poisoning. The authors used decision analysis to compare the clinical impacts and cost-effectiveness of four management strategies for childhood lead poisoning, and to investigate how effective chelation therapy must be in reducing neuropsychologic sequelae to warrant its use. METHODS: The model was based on a 2-year-old child with moderate lead poisoning [blood lead level 1.21 to 1.88 mumol/L (25 to 39 micrograms/dL)]. The following strategies were compared: 1) no treatment; 2) EDTA provocation testing, followed by chelation if testing is positive (PROV); 3) penicillamine chelation with crossover to EDTA provocation testing if toxicity occurs (PCA); 4) EDTA provocation testing with crossover to penicillamine chelation if testing is negative (EDTA). RESULTS: The EDTA and PCA strategies prevented 22.5% of the cases of reading disability and resulted in an increase of 1.02 quality-adjusted life years compared with no treatment. When the costs of outpatient EDTA testing and chelation are considered, the EDTA strategy is more cost-effective than the PCA strategy; when inpatient costs are considered, the PCA strategy becomes more cost-effective. When costs of remedial education are considered, all strategies are cost-saving compared with no treatment if chelation reduces the risk of lead-induced reading disability by more than 20%. CONCLUSIONS: Treatment strategies for childhood lead poisoning vary in clinical impact, cost, and cost-effectiveness. Chelation of the 1.4% of United States preschoolers whose blood lead levels are 2.21 mumol/L (25 micrograms/dL) or higher could prevent more than 45,000 cases of reading disability, and save more than $900 million per year in overall costs when the costs of remedial education are considered.

Chelation Therapy↗