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Biomedical subjects

H L Weinberger

Publications and source records attributed to H L Weinberger.

At least 19 recordsLinked to original sources
PubMed1999

Sudden infant death syndrome, child sexual abuse, and child development.

Since the introduction of the Back to Sleep Campaigns, there has been a dramatic reduction in sudden infant death syndrome in this country. Steven Blatt and Victoria Meguid review the literature surrounding sleep position. Investigators have continued efforts to find other modifiable risk factors of sudden infant death syndrome. A prospective study of more than 33,000 neonates found a link between a prolonged QT electrocardiogram interval and sudden infant death syndrome. Also discussed are investigations seeking to explain the relationship between smoking and sudden infant death syndrome. Ann Botash, Florence Jean-Louis and Mongkae Ploy Siripornsawan review the latest thinking on genital warts and their relation to specific viral etiologies and child sexual abuse. Other symptoms and signs of sexual abuse are the focus of a number of articles that can help the practitioner care for these unfortunate children. Catherine Church reviews medication options for children diagnosed with pervasive developmental disorders or autism spectrum disorders. Finally, in this article, risperidone, fluoxetine and naltrexone are reviewed.

Autistic Disorder↗
PubMed1997

Autism, child abuse, and sudden infant death syndrome.

The current literature regarding the standard and nonstandard therapies for children with autism is reviewed. A long term, comprehensive, individualized, multidisciplinary approach remains the best treatment. Physicians caring for the victims of child abuse are frequently asked to render an opinion regarding soft-tissue bruising. A review of the literature suggests that estimation of the age of a bruise should not rely solely on color, but rather should be the result of careful history, a through physical examination, and possibly laboratory testing. The need for a standardized and systematic approach to sudden infant death syndrome is also reviewed. The psychological effects on the parents following sudden infant death is discussed and reveals maternal anxiety and depression and, to a lesser degree, paternal anxiety and depression following the loss of a child. Currently, sleep position continues to be a risk factor for sudden infant death syndrome, although immunizations may not be.

Autistic Disorder↗
PubMed1996

Child abuse, sudden infant death syndrome, and psychosocial development.

A review of the literature on child abuse continues to emphasize the importance of careful attention to physical findings. Children who are allegedly sexually abused very often have no abnormal physical findings, yet they may be subjected to repeat examinations in an attempt to document possible physical effects of the abuse. Information is reviewed about the potential psychologic impact of these repeated assessments on young children. Controversy regarding the etiology of sudden infant death syndrome persists, and risk factors are reviewed. Changes in recommendations for infant sleep position by the American Academy of Pediatrics are not universally implemented. The importance of death scene investigations in cases of sudden unexplained infant death is emphasized. A review of the current research on infant colic does not provide many new insights, and the etiology remains controversial. The primary care pediatrician has an important role in providing advice and counseling, albeit on an empiric basis.

Burns↗
PubMed1995

Child abuse, sudden infant death syndrome, and attention-deficit hyperactivity disorder.

A review of recent literature helps to clarify normal variations in the physical examination of children who are thought to have been sexually abused. In many instances, no abnormal physical findings are discovered. Clinicians must continue to pay careful attention to the history and work with other professionals to implement appropriate management, despite the lack of physical findings. Guidelines for evaluating sudden and unexpected infant deaths are reviewed. The current recommendations of the American Academy of Pediatrics for infant sleep positions are discussed in light of epidemiologic studies in the United States and other countries. Attention-deficit hyperactivity disorder appears to respond best to a combination of stimulant medication, parent training in coping with behavior of affected children, and social skill training for the affected children themselves. A review of recent research failed to reach consistent correlations between resistance to thyroid hormone and attention-deficit hyperactivity disorder.

Attention Deficit Disorder with Hyperactivity↗
PubMed1993

Prevalence of lead exposure in a clinic using 1991 Centers for Disease Control and Prevention recommendations.

OBJECTIVE: To determine the effects of applying the October 1991 recommendations of the Centers for Disease Control and Prevention to lower the acceptable blood lead level to 0.48 mumol/L (10 micrograms/dL) and to use blood lead levels as the primary method of screening in young children. DESIGN: Retrospective patient series. SETTING: Outpatient pediatric department in a university hospital. PARTICIPANTS: Two hundred thirty-three children between the ages of 9 and 24 months presenting at well-child visits during 1991. SELECTION PROCEDURES: Consecutive children. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: All children underwent venous sampling for measurement of blood lead and erythrocyte protoporphyrin levels. Of 78 children aged 9 to 12 months, and 155 children aged 12 to 24 months, 25.5% and 36.1%, respectively, had elevated blood lead levels (> or = 0.48 mumol/L) (10 micrograms/dL). Of the 80 children with elevated levels of erythrocyte protoporphyrin, 55 (68.8%) had acceptable blood lead levels. Of 153 children with normal levels of erythrocyte protoporphyrin, 51 (33.3%) had elevated blood lead levels. CONCLUSIONS: These data demonstrate the high prevalence in our clinic of lead poisoning among children aged 9 to 12 months and 12 to 24 months. Measurement of erythrocyte protoporphyrin has poor sensitivity and specificity and is no longer an adequate screening test. Greater efforts at primary and secondary prevention of lead poisoning are needed for young children. Repeated screening is necessary to identify those who would benefit from increased surveillance and intervention.

Ambulatory Care Facilities↗
PubMed1992

Zinc-induced copper deficiency in an infant.

OBJECTIVE: To describe the case of a 13-month-old girl who developed copper deficiency as a result of excessive zinc gluconate ingestion. SETTING: Tertiary care hospital in Syracuse, NY. INTERVENTIONS: Cessation of zinc ingestion followed by intravenous and oral copper chloride therapy. MEASUREMENTS/MAIN RESULTS: Ingestion of zinc gluconate, 120 mg/d for 6 months, and thereafter 180 mg/d for 1 month, preceded the clinical presentation of listlessness, anemia, neutropenia, poor weight gain, abnormal sparse hair, and scorbuticlike bone changes. Findings on a bone marrow examination included ring sideroblasts and suggested copper deficiency. Plasma zinc level was 36.7 mumol/L, serum ceruloplasmin level was 20 mg/L, and serum copper level was undetectable. Clinical and laboratory abnormalities resolved shortly after initiation of copper therapy. CONCLUSIONS: This case demonstrates the reciprocal relationship of copper and zinc metabolism and exemplifies the important interrelationships of dietary trace minerals.

Bone Diseases, Metabolic↗
PubMed1990

Six children with lead poisoning.

Although most commonly seen in children from lower socioeconomic backgrounds, all children are at risk for lead poisoning. Management is a potential problem for all primary care providers. Because few individuals in the primary care practice of pediatrics have many patients with lead poisoning, it may be difficult to understand the nuances of management. We describe six patients, each of whom reflects different aspects of lead poisoning in children, and discuss the lessons we have learned in the course of their treatment. We have found that graphic representation of the blood lead and erythrocyte protoporphyrin values is helpful in the longitudinal follow-up of these youngsters.

Child, Preschool↗
PubMed1988

Evaluation of a communication skills course for second-year medical students.

A five-year evaluation and redesign of the communication skills component of the Introduction to Clinical Medicine course was undertaken at the State University of New York Health Science Center at Syracuse College of Medicine. The objectives of the evaluation were to determine the effectiveness of the component in teaching communication skills, identify areas of the component in need of change, and monitor the effectiveness of previous changes. In the first three years, the evaluation focused on the students' perceptions of the importance of communication skills in their training as physicians. Based on the evaluations for those three years, the component was modified substantially. One of the changes was the introduction in years four and five of simulated patients for practicing interviewing skills. The evaluations in years four and five focused on the effectiveness of using the simulated patients and the students' perceptions of how well the course objectives were met.

Communication↗
PubMed1987

An analysis of 248 initial mobilization tests performed on an ambulatory basis.

Data are presented on 248 initial mobilization tests performed in an ambulatory setting over an 11-year period. Results demonstrate that there is no single, consistent predictor of body burden of lead, although the higher the blood lead level, the greater the amount of excretable (mobilizable) lead. It is recommended that an appropriate ratio of lead excreted in response to chelant is equal to or greater than 0.5 based on this series of tests. A recommendation is also made to realign the Centers for Disease Control (Atlanta) guidelines for classification of risk. This realignment would coincide with a recommendation that mobilization tests be reserved for children whose blood lead levels ranged from 1.93 to 2.57 mumol/L (40 to 60 micrograms/dL). Those with higher levels would undergo chelation without prior mobilization studies.

Ambulatory Care↗
PubMed1984

A survey of pediatric resident training programs 5 years after the Task Force report.

Twenty-nine pediatric residency training programs responded to a survey with detailed descriptions of the scheduled rotations before and after the Report of the Task Force on Pediatric Education. This survey documented some changes in the overall structure of residency programming in that all programs demand 3 years of general pediatric training. Little if any changes were noted in the traditional emphasis on inpatient and neonatal training. Some changes in content area have been noted, namely a modest increase in the experiences in adolescent medicine. The survey failed to demonstrate any trend indicating increased emphasis on training experiences in the "new morbidity."

Curriculum↗
PubMed1976

An attempt to identify frequency of use of technical skills and procedures by the primary care physician.

Some technical skills required and learned during residency training are not often used in primary care. Pediatricians who practice primary care in rural settings for smaller communities) tend to perform a greater variety of procedures than those who practice in urban settings. Family practitioners report that they perform more of these procedures than either rural or urban practicing pediatricians. Training programs should define the skills and procedures which residents must learn to perform and should differentiate between those needed during the training period and those which will be used in primary care practice.

Family Practice↗