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Biomedical subjects

I B Pless

Publications and source records attributed to I B Pless.

At least 127 records · Page 7Linked to original sources

Locus of control in juvenile diabetic campers: changes during camp, and relationship to camp staff assessments.

Locus of control was measured at the beginning and end of a three-week camp experience in 156 children with juvenile diabetes. The results were compared with those of 30 diabetic children who did not attend camp. Both the Nowicki Strickland Children's Locus of Control and the Parcel Health Locus of Control scales were used. In addition, subjective assessments of diabetes management skills were made in all campers by several staff members. Significant changes toward internal locus of control on the NSLC but not the CHLC were found. The changes in NSLC seem to have persisted for at least one year in a small subsample of 23 children who were retested. Initial scores on both scales correlated moderately with the diabetes management skills ratings made at the end of camp. In view of the apparent importance of the locus of control construct in the self-care expected of most children with juvenile diabetes, the results should stimulate further efforts to examine the usefulness of this measure in relationship to achievement of good control of diabetes.

Adolescent↗

The effect of chronic nephrotic syndrome on the affected child.

The effect of the nephrotic syndrome on various aspects of behavior and development was examined in a group of 44 patients. The results of parent interviews, teacher ratings, and psychological tests (using the Self Observation Scales and the Children's Service Questionnaire) were compared with a closely matched group of healthy children. Very few statistically significant differences were noted. Comparisons were made with results of other studies of chronic disorders and their effect on the child's behavior and development.

Adolescent↗

The organization and evaluation of a computer-assisted, centralized immunization registry.

The rationale for, and establishment of, a computer-assisted, centralized immunization registry are described. This registry was created to improve the quality and quantity of information regarding immunization status for a defined population receiving primary care from a variety of providers, principally public clinics and private practitioners. An evaluation of the feasibility of the registry after one year's function shows that 93 per cent of eligible providers initially agreed to participate and 73 per cent continue to do so. Their reports have resulted in the creation of 17,500 individual patient files. Of a prospective cohort of newborns, 23 per cent were identified as "high-risk" for overdue immunizations. After one year, the immunization rates in audited groups improved significantly. The direct cost of this registry is less than 65 cents per currently registered child per year.

Canada↗

Use of automobile seat restraints by children in two Canadian cities.

A telephone survey was conducted in Montreal and Calgary to determine the extent to which parents use safety restraints for their children in cars, the types of restraints used and the factors associated with such use. Of the combined sample 39% reported that their child regularly used a restraint, and 47% of the children in Montreal and 55% of those in Calgary wore an age-appropriate safety device. Birth order and the child's and the respondent's ages were significantly related to the use of restraints. However, the respondent's use of seatbelts was the factor most likely to affect the rate of use of restraints for children. Although a large proportion of the parents with younger children owned a carseat, one in four did not use it regularly. Parents who did not use carseats believed they were useless or dangerous; many preferred to hold the child in their laps or arms. The seatbelt law in Quebec and the existence of a carseat rental program in Calgary appear to have had some influence on the rate of the use of restraints for children.

Accidents, Traffic↗

Pediatricians and general practitioners: a comparison of the management of children with febrile illness.

To assess the relative competence of pediatricians and general practitioners in managing febrile illnesses in childhood, a prospective study was undertaken of 259 children less than 10 years of age seen consecutively at the emergency room of a children's hospital and a general hospital. Both groups of patients were similar in demographic characteristics, age, sex, presenting complaints, and height and duration of fever. Of the 148 patients entered in the study at children's hospital and the 111 at general hospital, 90% and 94%, respectively, were interviewed by telephone within two weeks of their emergency room visit to determine outcomes based on duration of the acute illness episode and further physician contacts or admissions to hospital. Although no significant differences in the measured outcomes of febrile illnesses seen by pediatricians or general practitioners were found, a trend in favor of those cared for by pediatricians was discernible with respect to two key measures: unresolved symptoms at one week (8.3% vs 12.5%) and subsequent hospitalization (0.8% vs 3.0%). The overall frequency of laboratory use and antibiotic prescriptions was the same in both groups; however, significant differences were noted in the type of laboratory test used: general practitioners ordered three times more roentgenograms than pediatricians and one fifth the number of microbiologic tests. Larger prospective studies are needed to test how these findings may be generalized in view of their importance for quality assurance in the primary care of children.

Anti-Bacterial Agents↗

The psychosocial functioning of young adults born with cleft lip or palate. A follow-up study.

A follow-up study of 96 young adults born with a cleft lip and/or cleft palate was conducted to determine their present psychosocial adjustment and to evaluate the services offered to them. Medical histories were obtained from hospital charts. Telephone interviews focusing on educational achievement, work performance, and social integration showed that 10 to 33%, depending on the criteria used, experienced psychosocial maladjustment, There was a high rate of persistent dissatisfaction with appearance, hearing, speech, teeth, and social life. An analysis of the services offered to these young adults, in the light that counseling or other social support might be offered routinely during childhood and, of equal importance, during adolescence when further medical, surgical, and dental treatment may also be required.

Adolescent↗

Equality in medical care under national health insurance in Montreal.

In November 1974, four years after national health insurance in Canada had eliminated all out-of-pocket payment for physicians' services, we surveyed 1559 households in a socially heterogeneous area of Montreal to assess social-class differences in the use of physicians' services. When reported health status as well as age and sex were taken into account, the rates of physician visits during the two-week period preceding the survey were essentially the same in the low, middle, and high economic classes, thus confirming that disparity of access had been reduced. However, relative to other groups, the poor still made considerable use of hospital clinics and emergency rooms for primary care and more of their visits entailed prescriptions and physician-initiated requests to return. The latter observations may indicate that the poor, as compared with other groups consulted the doctor for more advanced conditions. Official statistics showed no increase in the workload of the average physician, although the number of physician visits per person per year had risen steadily. There was no evidence of abuse of "free" medical care by the poor.

Data Collection↗

Early intervention for infants with Down syndrome: a controlled trial.

The mental development of 37 infants with Down syndrome, allocated either to an experimental or control group, was assessed over a six-month period by an independent evaluator. The experimental group participated in biweekly therapy sessions designed to stimulate normal development while the control group received no intervention. The Griffiths Mental Developmental Scales were used to assess changes in the developmental status in the two groups, which were shown to be equal initially on a variety of variables. No statistically significant differences in mental development between the experimental and control groups were found. The early intervention regimen investigated in this study was not efficacious in altering the pattern of mental development in those Down syndrome infants participating in the program.

Age Factors↗

Effects of nephrotic syndrome on the family: a controlled study.

The hypothesis that the parents and siblings of children with nephrotic syndrome are more likely to develop psychosocial problems than those of healthy children was tested. Seventy-nine siblings from 36 such families were compared with 79 healthy children from closely matched families using interviews, parent rating scales, teachers' reports, and psychological tests. Although few striking differences were found between the two groups, the findings suggest several areas of increased vulnerability among the parents and siblings of children with nephrosis. Parents often denied the existence of apparently stressful events, but the personality profiles of the siblings suggested decreased social confidence and a lesser degree of self-acceptance. Evidence of inhibition, such as less aggression and poorer academic performance, were also described in response to questions in the interview. These results should prove useful to clinicians in the management of families of children with this or other chronic illnesses.

Achievement↗

Apparent validity of alternative survey methods.

A comparison of results using three methods of obtaining the same survey data is reported. The assumption is made that in relation to a question for which there is a socially desirable response, e.g., use of seat restraints for children, those reporting nonuse or infrequent use are giving truthful answers. In an experiment in health education, follow-up assignments were made randomly, one third being interviewed face-to-face, one third by telephone, and the rest by a postal questionnaire. There were no significant differences by method of follow-up in the scores reflecting reported changes in behavior following instruction. Both the telephone and mail methods, however, appear to yield a higher proportion of "truthful", i.e., socially undersirable, responses; 30.4% of those contacted by telephone admitted to not using a restraint on the last trip, compared with 26.3% of those questioned by mail and 17.5% in a household interview. It is recommended that careful consideration be given to these alternative methods of obtaining data, particularly in view of their lower cost and possibly greater validity.

Child↗

The role of the pediatrician in the delivery of mental health services to children.

Nine pediatricians reported on all patients seen during a four-week period in January and February 1976 in Monroe County, N.Y., to determine the prevalence and nature of mental health problems seen in their practices, the characteristics of the affected children, and the treatment provided to them. Of the 3,742 patients seen, 187, or 5.0%,were reported to have an emotional, behavioral, or school problem. The prevalence rate ranged from 1.4% to 7.8% by pediatrician, with five reporting rates within +/- 1.2% of the mean. High rates were associated with children in the 7 to 14 year age group (9.9%), those on Medicaid (8.6%), those who were not living with a father (10.9%), those whose presenting complaint was a chronic physical condition (11.7%), and children with a disease of the digestive system (16.7%) or with ""symptoms, signs and ill-defined conditions'' (14.3%). Functional impairment was reported to be moderate or severe in 40% of the 187 children with mental health problems. The most frequently reported problems (primary or otherwise) were adaptation reaction (22.5%), specific learning disorder (19.3%), hyperkinetic disorder (19.3%), psychosomatic disorder (12.8%), and conduct disorder (12.8%). The most frequent form of treatment provided was supportive therapy or counseling (85.6%) and suggestions regarding environmental changes (43.3%). Drugs were prescribed for 16.0% of the affected children, with 6.4% receiving methylphenidate or amphetamines. Referral for psychological care or consultation was made for 36.9%. The frequency of mental health problems observed by the pediatricians was about five times the annual rate of Monroe County children contacting a psychiatric inpatient or outpatient setting.

Adolescent↗

Utilization of the preemployment health examination in a university staff health service.

This study assessed the utilization of a mandatory preemployment health examination (PEHE) for 507 new full-time university staff in 1976. A random sample of 126 new employees was interviewed by telephone. Of the 108(86%) who completed the interview, 80 (74%) had been examined by the staff health service. Notification to take the exam, a reminder, and the employee's perception of its importance were highly associated (p less than 0.0001) with compliance. Only 30% of the food handlers and maintenance personnel ahd their PEHE before employment started; the proportion was similar for all new employees (29%). Therefore, although this staff health service was moderately successful in getting most new employees to have a PEHE, if the value of the examination is to be enhances, more attention must be paid to notifying and reminding all prospective employees. Special consideration is needed to ensure that those in potentially high-risk jobs are examined prior to employment. The role of the university administration in improving compliance is emphasized.

Adolescent↗

Progress in community pediatric research.

This review examines three major facets of progress in community pediatric research. The number of publications with this orientation has increased substantially over a 10-year period, and abstracts submitted to the Ambulatory Pediatric Association meetings have doubled. New methodologies are identified and their application to ambulatory pediatric care is described. In particular, procedures and approaches are examined in the context of recognized criteria for sociomedical research.

Child↗

Health education literature for parents of physically handicapped children.

Parents, for many reasons, are not always able to understand the nature of their child's handicap. Many physicians recognize that they are not always as effective as they might wish to be in enabling parents to comprehend handicaps. Written hand-out materials as aids to better understanding can be helpful to both physicians and families as supplements to verbal descriptions of the disease and instructions for care. This compilation of currently available literature, grouped by category of disease and with addresses where they may be ordered, should offer the pediatrician and other health personnel a ready source of assistance.

Bibliographies as Topic↗

Child automobile restraints: evaluation of health education.

An experimental design was used to test the effectiveness of three modalities of instruction in pediatricians' offices. Parents in the experimental and control groups were asked if their children wore a car seat restraint on the way to the office. The parents in the experimental group were encouraged to have their children use restraints via one of the following methods: a pamphlet alone; a pamphlet and verbal instruction by the pediatrician; or a pamphlet, verbal instruction, and a brief slide-tape show. The parents were contacted by telephone, mail, or in person two weeks later and asked if their child used a restraint on their last car trip. There were no statistically significant changes in behavior in any of the gourps. Although the group that received all forms of instruction had the highest mean score, the greatest increase occurred with the control group.

Adolescent↗