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Biomedical subjects

I B Pless

Publications and source records attributed to I B Pless.

At least 109 records · Page 6Linked to original sources
PubMed1986

Family support system in newborn medicine: does it work? Follow-up study of infants at risk.

Acute illness in early childhood generates chronic anxiety in parents, which may manifest itself in part by inappropriate use of health care. To minimize this and the development of other psychosocial sequelae associated with neonatal illness, a family support system (FSS) was developed and implemented in a neonatal intensive care unit. The effectiveness of the FSS was assessed by the evaluation of emergency room and inpatient hospital service utilization in 80 patients born before, and 90 patients born after the institution of the program. At the outset, the groups had similar medical and social characteristics. There was no difference between the two groups in the utilization of emergency services in the first year after discharge. However, during the second year the control group used the emergency room twice as often as the study group did (P less than 0.025). During the first 2 years, half of the control group was readmitted, compared with less than a third of the study group (P less than 0.005). Overall, after discharge from the neonatal intensive care unit the control group spent an average of 9 days per patient in hospital, compared with a mean of 3 days per patient in the study group (P less than 0.025). It appears, therefore, that the FSS may be an effective way to reduce some of the psychosocial sequelae of illness in newborn infants requiring intensive care.

Adolescent↗
PubMed1986

Sleep patterns and problems in adolescents.

A sleep questionnaire was administered to 390 students in an urban high school. Total sleep hours per week appeared to decrease between the ages of 12 and 18 years. In general, girls slept more than boys. The quality of sleep and the perception of sleep adequacy also decreased with age. Reporting of the occasional use of sleep medications and alcohol at bedtime was 4.6% and 10.5%, respectively. These findings suggest that sleep problems among adolescents represent normal physiologic processes as well as some serious disturbances that may reflect the social pressures prevalent during adolescence.

Adolescent↗
PubMed1985

Birth defects and psychosocial adjustment.

A one-year prospective study was conducted to examine the extent to which type of disability, severity, and family functioning serve to predict maladjustment. One hundred forty children, aged 4 to 13 years, born with cardiovascular disorders, cleft lip or palate, or hearing defects were assessed using the Child Behavior Checklist at two points in time. The results suggest that the type of disorder and severity are associated with remaining or becoming maladjusted. Deaf girls and boys with cardiac problems were most likely to be affected, followed by boys with clefts and boys with hearing problems. A direct relationship is found with severity assessed by the Functional Status Measure. Family functioning, however, is not significantly related to maladjustment. These findings provide a framework for better understanding factors contributing to the increased risk of maladjustment for some children with birth defects.

Adaptation, Psychological↗
PubMed1985

A comparison of observed and reported restraint use by children and adults.

The reliability of estimates of automobile restraint use reported by interview is questionable. It is reasonable to assume that some respondents will give a socially desirable response, i.e. a false report about restraint use. To verify this assumption this study compares verbal reports about automobile restraint use with what was actually observed, both for the respondents and and their children. For the children the rate of parental over-reporting was 38% while for adults it was 24%. Additional analyses suggest that the discrepancy between reported and observed use is related to parents' educational level, father's occupation, child's sex and whether the mother works outside the home. However, these relationships differ between parents and their children.

Adult↗
PubMed1985

Determinants of weight and adiposity in the first year of life.

To overcome methodologic defects (failure to control for confounding factors, univariate statistical analyses) in previous studies of etiologic determinants of childhood adiposity, we carried out a prospective cohort study of 462 healthy, full-term infants observed from birth to 12 months. Postpartum, we obtained sociodemographic data and administered two recently validated scales of maternal attitudes toward feeding and infant body habitus. Parental heights and weights and infant feeding variables were determined by interview, and at 6 and 12 months we measured height and weight and triceps, subscapular, and suprailiac skinfolds. Multiple regression analysis was used to determine independently predictive factors for weight, body mass index (BMI = weight/height), and the sum of the three skinfold measurements. Birth weight, sex, age at introduction of solid, and duration of breast-feeding were all significant predictors of weight at 12 months (r2 = 0.296, P less than 0.0001). Significant determinants for BMI included birth weight, duration of breast-feeding, sex, and IBH (r2 = 0.125, P less than 0.0001); those for total skinfold were age at introduction of solid foods and birth weight (r2 = 0.038, P = 0.002). Similar results were obtained at 6 months, although slightly less of the variance was explained. We conclude that the ability to predict which babies will be heavy or obese during the first year is limited. Breast-feeding and delayed introduction of solid foods do offer some protective effect, however, and thus efforts to encourage these practices may be reaping some benefit.

Adult↗
PubMed1985

Pedestrian injuries to children and youth.

Prevention of pedestrian injuries constitutes a most difficult problem, involving not only driver and pedestrian behavior, but also the design of streets, highways, and automobiles. The epidemiology of these injuries is assessed, using the host-agent-environment model, and approaches to prevention are presented, from child behavior modification to engineering.

Accidents, Traffic↗
PubMed1985

Clinicians' knowledge about the families of their patients.

This study was designed to determine what doctors and nurses in family medicine actually know about the families of their patients; to assess the accuracy of the professed knowledge; and to relate this knowledge to the patient's level of satisfaction and compliance. Clinicians completed questionnaires dealing with their knowledge of personal and family information about patients. These patients completed a mirror-image questionnaire--to assess the accuracy of the clinician's responses--and a questionnaire about their satisfaction with the consultation. At a follow-up visit by the patients, clinicians completed questionnaires which assessed patients' compliance. Clinicians thought they knew the patient's occupation in 86% of cases and were correct in 73% of the total. The respective percentages for the spouse's level of education were 49% and 35%. Clinicians and patients agreed on whether there was a marital or a financial problem 66% and 47% of the time respectively. High clinician knowledge scores were not associated with either high satisfaction or good compliance on the patient's side.

Consumer Behavior↗
PubMed1985

Health care delivery to foster children: a study.

The health of 900 children in foster care was assessed through a review of 257 medical charts and an examination of a subsample of 35 children. Although major handicapping conditions among the children were well cared for, prevention, the care of minor conditions and emotional problems, and overall coordination of care were found to be lacking. On the basis of these findings, the authors propose how health care delivery to foster children can be improved.

Adolescent↗
PubMed1984

The family as a resource unit in health care: changing patterns.

Medicine has long asserted that the family is one of the principal units of medical care. Concurrent with a resurgence of interest in holistic medicine, there has been a major increase in attention being paid to the role of the family unit in health care. There are, however, very few examples of how this interest has been put into practice, nor is it evident that it is reflected in teaching or graduate training programs. This paradox persists in spite of the growth of family medicine as a primary care discipline, especially in North America. The results of three studies are summarized to support the impression that, in general, these 'family specialists', along with other primary care practitioners (e.g. pediatricians), know relatively little about the structure or functioning of the families of patients they treat. The findings also suggest that there is little relationship between such knowledge and various indicators of the processes or outcomes of medical care. The question then arises whether such knowledge is lacking because it is truly of little value clinically, or whether these findings reflect methodological limitations in research of this kind. Intuitively it is reasonable to suppose that such a relationship does exist, and there is an extensive body of well-documented theory to support this view. How relevant such knowledge could or should be in practice, is an issue of particular importance in the context of the rapid changes taking place in the nature of the family itself.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Psychosocial implications of chronic illness in adolescence.

One hundred forty-four young adults and adolescents representative of an upstate New York community were studied on two occasions to identify relationships between chronic illness and psychosocial well-being. In the 8 years since the original survey, the health status of 62 of the 106 with a chronic medical condition improved, remained unchanged in 27, and worsened in 17. Subjects whose chronic medical problem persisted and was associated with at least mild impairment in daily living demonstrated significantly more psychosocial problems, centering around future plans, perceptions of family life, and having a driver's license. Those who had recovered from their illness or did not have any associated impairment appeared no different from the controls. Multidimensional scaling confirmed that chronic illness and poor psychosocial functioning are related, as are physical wellness and better psychosocial function. These results confirm the contention that chronic illness persisting into adolescence has a small but measurable effect on psychosocial adjustment.

Adolescent↗
PubMed1984

Clinical assessment: physical and psychological functioning.

This article has provided evidence that children with chronic disorders of all kinds are at increased risk for psychosocial disturbances. That they are also likely to experience some degree of physical disability is self-evident. Accordingly, in the comprehensive care provided for these children the pediatrician is obliged to attempt to assess the status of functioning in these domains. A variety of methods for doing so in the context of a busy office practice has been presented.

Child Behavior Disorders↗
PubMed1984

The use of preventable adverse outcomes to study the quality of child health care. A new application of case-control research.

Because cohort methods are insensitive in detecting rare outcomes, the authors used the more sensitive case-control technique to investigate whether pediatricians or nonpediatric generalists are better able to recognize severe acute illness or to avoid preventable complications. We selected "indicator" outcomes for four types of common acute illness and enrolled patients who had contacted a physician more than 24 hours prior to an index emergency room visit for the same illness. Case (N = 103) were patients with adverse outcomes, i.e. potentially preventable complications or delayed diagnosis, treatment, or referral. Controls (N = 103) were those with acceptable outcomes (uncomplicated illness or prompt diagnosis, treatment, or referral) and were matched according to age, SES, and illness type. The overall results indicate no evidence of better care by pediatricians: prior contract with a pediatrician was associated with an estimated relative risk (omega) of adverse outcome of 1.32 (95% confidence interval, 0.76-2.29). Within the two largest illness categories (gastroenteritis and pneumonia-respiratory), the results were similar: omega = 1.16 (0.68-1.99) and 2.23 (0.82-6.04), respectively. Potential confounders were controlled for by multiple logistic regression analysis, but omega remained virtually unchanged. Nor were the findings altered by elimination of outliers or restriction of "contact" to office visits only. The authors conclude that study pediatricians and generalists provide equivalent acute illness care to children and that the case-control method provides a feasible and highly suitable approach to the study of the quality of medical care.

Acute Disease↗
PubMed1984

A computerized recall system for office practice.

A computerized system that has been in use in a small group practice since 1980 is described. Although many pediatricians have begun to use personal computers in office practice, most accounts of their experience to date relate primarily to the role of computers in facilitating administrative tasks, such as billing. The procedures involved in establishing the system are described, along with details about the nature of the programming concepts and several of the most important applications. A particular focus was to enable the computer to be used to improve the follow-up of patients with problems requiring recall visits, eg, immunizations. The results indicate that the percent of patients judged to be overdue for immunizations fell from 15.4% prior to the introduction of the computer to 1.3% and 4.3%, respectively, in the following 2 years. The proportion of children with other health problems requiring follow-up, 44.5% of the entire active practice population are also described. It is concluded that the computerized system can enhance the quality of patient care and greatly facilitate office-based research.

Appointments and Schedules↗
PubMed1983

Effects of a seat belt law on child restraint use.

Automobile passenger fatalities account for almost 25% of all accidental deaths of children aged 1 to 14 years. Given that child automobile restraint devices provide effective protection against serious injury and death, several jurisdictions have adopted some form of child restraint law. In August 1976, Quebec enacted legislation requiring the use of seat belts by all front seat passengers weighing more than 23 kg. Although the law was chiefly aimed at adults, a series of observations extending throughout six years were performed to assess its impact on children. Prelaw rates showed 6.4% restraint use for children aged 0 to 11 years and 14.7% for drivers. In the year after legislation, rates for both drivers and children more than doubled and had increased to 55.5% and 24.5%, respectively, in 1981. The child's age and parent's use of a seat belt were important factors associated with restraint use among children.

Accidents, Traffic↗
PubMed1983

Maternal psychological determinants of infant obesity. Development and testing of two new instruments.

We have developed and tested two instruments to measure psychological factors that may affect infant feeding and thus "confound" the relationship between feeding and subsequent obesity. The Maternal Preconceptions of Ideal Infant Body Habitus (IBH) consists of 4 drawings of 9-month-olds exhibiting a range of body habiti from quite lean to very chubby; new mothers are asked to rank the 4 in order of preference for their new baby. The Maternal Feeding Attitudes (MFA) ia a 10-item questionnaire addressing the new mother's food "pushiness". Both the IBH and the MFA produced high test-retest intraclass correlation coefficients (RI's): 0.92 and 0.95, respectively. Significant inverse correlations were found between the IBH and both maternal age (r = -0.38; p = 0.004) and the Green SES index (r = -0.28; p = 0.025), indicating that older, higher-SES mothers prefer leaner infants. Breast-feeding mothers had significantly lower mean IBH scores than did formula-feeding mothers (p = 0.029). The MFA, by contrast, was not associated with any of these variables. We conclude that maternal adiposity preference and feeding attitudes can be reliably measured. Owing to their possible associations with infant obesity and its determinants, we suggest that these factors be included in future studies in this domain.

Adult↗