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Biomedical subjects

I B Pless

Publications and source records attributed to I B Pless.

At least 55 records · Page 3Linked to original sources
PubMed1997

Cholesterol screening of children at high risk: behavioural and psychological effects.

OBJECTIVE: To assess the behavioural and psychosocial effects of screening asymptomatic children at high risk for hyperlipidemia. DESIGN: Observational study involving prospective longitudinal and cross-sectional portions. SETTING: Two tertiary care pediatric lipid clinics in Montreal. SUBJECTS: Longitudinal portion: all children aged 4 to 17 years who presented for screening at the lipid clinics between April 1990 and June 1991. Of the 56 eligible children 52 (93%) (and their mothers) agreed to participate, 34 with hyperlipidemia (case subjects) and 18 without hyperlipidemia (control subjects). Thirty-five children (67%) completed 3 assessments over 12 months. Cross-sectional portion: all children aged 4 to 17 years in whom hyperlipidemia had been diagnosed 2 to 5 years earlier at one of the lipid clinics. Of the 58 eligible children 48 (83%) (and their mothers) participated. OUTCOME MEASURES: For children, mean scores on the Child Behavior Checklist (Behavior Problems subscale) (CBCL), the Children's Depression Inventory (CDI) and the State-Trait Anxiety Inventory for Children (STAIC); for mothers, mean scores on the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI). RESULTS: In the longitudinal portion of the study, there was no significant difference between the case and control subjects in the mean CDI or STAIC scores at 1 or 12 months. At 1 month after diagnosis the case subjects in the longitudinal portion had a significantly higher mean CBCL score than the children in the cross-sectional component (p = 0.01). With the control group as the reference group, the adjusted odds ratios for a high CBCL score (greater than 62) for the case subjects were 15.5 (95% confidence interval [CI] 2.4 to 99.8) at 1 month and 15.8 (95% CI 1.1 to 223.4) at 12 months. The corresponding values for the children in the cross-sectional component were 1.3 (95% CI 0.3 to 6.2) and 5.0 (95% CI 0.5 to 50.9). CONCLUSIONS: The observed behavioural problems in children with a recent diagnosis of hyperlipidemia were independent of other risk factors, such as age and sex of child and mother's age and BDI score. Our results suggest that identification of hyperlipidemia in children may have harmful psychological effects in the families involved. This evidence strengthens arguments for the exclusion of cholesterol measurement from the periodic health examination of children at moderately high risk.

Adolescent↗
PubMed1997

Deeper meanings.

Explore the source record for details and available documents.

Humans↗
PubMed1997

An international study of the exposure of children to traffic.

OBJECTIVES: To examine the extent of international differences in children's exposure to traffic as pedestrians or bicyclists. DESIGN: Children's travel patterns were surveyed using a parent-child administered questionnaire. Children were sampled via primary schools, using a probability cluster sampling design. SETTING: Six cities in five countries: Melbourne and Perth (Australia), Montreal (Canada), Auckland (New Zealand), Umeå (Sweden), and Baltimore (USA). SUBJECTS: Children aged 6 and 9 years. MAIN OUTCOME MEASURES: Modes of travel on the school-home journey, total daily time spent walking, and the average daily number of roads crossed. MAIN FINDINGS: Responses were obtained from the parents of 13423 children. There are distinct patterns of children's travel in the six cities studied. Children's travel in the three Australasian cities, Melbourne, Perth and Auckland, is characterised by high car use, low levels of bicycling, and a steep decline in walking with increasing car ownership. In these cities, over a third of the children sampled spent less than five minutes walking per day. In Montreal, walking and public transport were the most common modes of travel. In Umeå, walking and bicycling predominated, with very low use of motorised transport. In comparison with children in the Australasian and North American cities, children in Umeå spend more time walking, with 87% of children walking for more than five minutes per day. CONCLUSIONS: There are large international differences in the extent to which children walk and cycle. These findings would suggest that differences in 'exposure to risk' may be an important contributor to international differences in pedestrian injury rates. There are also substantial differences in pedestrian exposure to risk by levels of car ownership-differences that may explain socioeconomic differentials in pedestrian injury rates.

Australia↗
PubMed1996

Childhood injury prevention: time for tougher measures.

The publication in this issue of an article describing the fatal strangulation of two children on clothing drawstrings (see pages 1417 to 1419) coincides with National Child Day. This juxtaposition prompts the author to examine Canadian child health policy and practices in relation to injury prevention and product safety. The absence of a central body in Canada responsible for injury prevention may reflect the absence of advocacy groups concerned exclusively with the prevention of childhood injuries and stands in sharp contrast to the attention given to various "high-profile" but comparatively rare childhood diseases. In Canada, taking a firm regulatory or legislative approach to product safety appears to be the exception rather than the rule. Instead, we rely on product safety bulletins, the effectiveness of which has never been evaluated. The adoption of tougher measures would be facilitated by the establishment of a national centre for injury prevention and control. Such centres in the United States and Sweden have been successful and demonstrate that the creation of a Canadian body responsible for addressing the epidemic of accidental injury is long overdue.

Accident Prevention↗
PubMed1995

How well they remember. The accuracy of parent reports.

OBJECTIVES: To determine the range of accuracy of parent recall for many different events when compared with pediatrician's records and to establish whether good recall is associated with the nature of the event, period of recall, or demographic characteristics. RESEARCH DESIGN: A nonconcurrent, descriptive survey of previous events. SETTING: Two pediatric group practices in Montreal, Quebec. PARTICIPANTS: Two hundred eighty-eight parents of children aged 1 to 13 years. INTERVENTIONS: None. MEASUREMENTS/MAIN RESULTS: Parents' responses to a self-administered questionnaire were compared with information extracted from pediatricians' records. The health events studied included asthma, bronchitis, otitis media, accidents, hospitalizations, office visits, and birth weight. Most parents (73%) were able to recall birth weight within 50 g, and 85% reported a frequency of hospitalizations that agreed exactly with the record. For asthma, bronchitis, and otitis in the last year, the percentages with good agreement were 91%, 85%, and 51%, respectively, while for the same disorders during the child's lifetime, the corresponding figures were 87%, 74%, and 53%, respectively. Each parent's responses were classified according to overall quality of agreement; associations between agreement and respondent characteristics were investigated. Mothers responded more accurately than fathers, and parents of younger children also showed better recall. Other factors, eg, education and occupation, were not significantly correlated with recall. CONCLUSIONS: When compared with pediatricians' records, parent reports are generally acceptable for most research purposes and may be a better source for some health events such as accidents.

Adolescent↗
PubMed1995

Pediatric mortality and hospital use in Canada and the United States, 1971 through 1987.

Since 1971 pediatric mortality rates have decreased markedly but differently in Canada and the United States. These trends were examined in light of changes in hospital use and health care financing. Annual mortality and hospital use rates for children aged 14 years and younger were calculated. Between 1971 and 1987, all-cause mortality in Canada fell from 165 to 74 per 100,000; the American rate fell from 172 to 96 per 100,000. American hospitalization rates remained essentially constant until 1983 and then fell by 27.5%, while Canadian hospitalization rates declined throughout. In 1987 Canadian children had higher hospitalization rates, while American children had higher mortality rates. These differences may be associated with differences in health financing; the adoption of US prospective payment systems was temporally coincident with sharp declines in hospitalization rates for American children.

Adolescent↗
PubMed1995

The relationship between vigilance deficits and traffic injuries involving children.

OBJECTIVE: This study was designed to determine whether there is an increased frequency of deficits in impulse control, vigilance, or both, among child bicyclists or pedestrians who have been injured in traffic accidents, as assessed using objective measures and parent and teacher reports. RESEARCH DESIGN: This was a case-control study, in which cases were children injured as pedestrians or bicyclists (excluding those with severe head injuries) and controls were those injured as passengers or in some other manner in which the child's behavior was unlikely to be a factor. SETTING: Children ages 5 to 15 years presenting to the emergency room of the Montreal Children's Hospital. PARTICIPANTS: For each of 286 cases, two controls were selected, making a total of 848 subjects. Among the cases, 172 were injured as pedestrians and 114 as bicyclists. MEASURES: Children were assessed using the Continuous Performance Task and the Delayed Response Test, both parts of a computerized test battery. Parents and teachers completed the Conners Abbreviated Symptom Questionnaire to assess hyperactivity. RESULTS: Cases and controls were similar on most sociodemographic and clinical measures but showed statistically significant differences in mean scores on the Continuous Performance Task measures of omissions and commissions, pointing to differences in vigilance, and on the Delayed Response Test measures of impulsivity. Mean Conners scale scores of both parent and teacher were significantly higher for cases than controls, and those of parents were higher than those of teachers. CONCLUSIONS: Among children whose behavior may have been a factor in the occurrence of an injury, there is subjective evidence of increased hyperactivity and objective evidence of deficits in vigilance and attention when compared with closely matched controls. These findings have important implications for prevention.

Accidents, Traffic↗
PubMed1994

The use of alternative medicine by children.

OBJECTIVE: Alternative medicine (AM) is of growing interest to the general public. Although several studies have been published concerning its use in adults, the use by children is less well known. The purpose of this study is to determine the frequency with which alternative medicine is employed in a pediatric population that also uses conventional medicine. A second goal is to investigate the sociodemographic factors that influence the choice of these forms of therapy. METHODS: Parents of children consulting the general outpatient clinic of a university hospital completed a self-administered questionnaire asking about previous use of AM for themselves or their children. RESULTS: Based on 1911 completed questionnaires, 208 children (11%) previously consulted one or more AM practitioners. Chiropractic, homeopathy, naturopathy, and acupuncture together accounted for 84% of use. Children who used AM differed significantly from those who only used conventional medicine in that they were older than the nonusers, their mothers were better educated, and their parents also tended to use AM. CONCLUSION: The findings indicate that AM is an aspect of child health care that no longer can be ignored. Being aware of these practices will enable physicians to discuss alternative therapies with parents in order to ensure the continuity of essential conventional treatments.

Adolescent↗
PubMed1994

A randomized trial of a nursing intervention to promote the adjustment of children with chronic physical disorders.

OBJECTIVE: This study was conducted to determine whether a specialized form of nursing could help prevent or reduce psychosocial maladjustment among children, aged 4 to 16 years, with chronic physical disorders. In contrast to other studies, nurses were chosen to provide the intervention based on their central role in health care and the appropriateness of their training for this task. METHODOLOGY: A clinical trial was conducted in which 332 children and their families were randomly assigned either to receive this specialized nursing for a 1-year period, or to remain in the control condition. The children were all active outpatients in nine clinics at the Montreal Children's Hospital. Three measures of psychosocial functioning administered before and after the intervention were the basis for assessing its efficacy. The measures included the behavior problems profile of the Achenbach Child Behavior Checklist, the Personal Adjustment and Role Skills, completed by the parents, and two versions of the Self-Perception Profile (Harter) for children aged 4 to 7 years and 8 to 16 years. RESULTS: Differences between groups were examined both categorically and quantitatively. In the former, the percent of children with clinical scores (those above or below a cut-off indicative of maladjustment) at baseline and postintervention were compared. In the latter, the mean scores at the end of the trial were analyzed using analysis of covariance with the baseline scores as covariates. Statistically significant positive differences were found in the domain of anxiety/depression on the Personal Adjustment and Role Skills, and in the areas of scholastic competence, behavior, and global self-worth on the Harter. CONCLUSION: The results indicate that this intervention helps children with chronic disorders by preventing or reducing maladjustment. Most university-prepared nurses already have the basic skills required to achieve these results; only a modest investment in reorientation may be needed. Thus, other pediatric centers should be able to replicate these findings and thereby take a major step toward improving the lives of children with chronic disorders.

Adjustment Disorders↗
PubMed1993

Advice seeking and appropriate use of a pediatric emergency department.

OBJECTIVES: To determine whether seeking advice prior to an unscheduled visit to a pediatric emergency department (PED) influences appropriate use of this setting for minor illnesses. DESIGN: Cross-sectional questionnaire survey. SETTING: The medical emergency department of the Montreal (Quebec) Children's Hospital, a major referral and urban teaching hospital. PARTICIPANTS: Four hundred eighty-nine of 562 consecutive parents visiting the PED over two periods, one in February and the other in July 1989. INTERVENTIONS: None. MEASUREMENTS/MAIN RESULTS: Parents of children between 0 and 18 years of age visiting the PED were asked whether they had previously sought advice from family, friends, or a physician. Other factors possibly related to the decision to seek care were also measured. Appropriateness was rated, blind to discharge diagnosis, by two pediatricians using a structured series of questions incorporating the child's age, time of the visit, clinical state, and problem at presentation. Thirty-four percent of visits among respondents were judged appropriate. In bivariate analysis, appropriate visits occurred significantly more often when a parent spoke to both a physician and a nonphysician (47%) prior to visiting the PED than when no advice was sought (29%; P < .05). In multivariate analysis, having a regular physician and being one of two children also contributed to appropriateness. CONCLUSIONS: Appropriate use of the PED was positively influenced by seeking prior advice from both a physician and family member, having a regular physician, and having prior child care experience.

Adolescent↗