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Biomedical subjects

J D Baum

Publications and source records attributed to J D Baum.

At least 55 records · Page 3Linked to original sources
PubMed1990

Do changes in pattern of breast usage alter the baby's nutrient intake?

Twelve mother/baby pairs took part in a study of the difference in effect of two patterns of breast feeding--either feeding at one breast or at two breasts during a feed. Baseline measures were taken at 4 weeks, and the test patterns of feeding were followed for a week each, in random order. The two patterns of feeding led to differences in milk volume intake and mean feed fat concentration, but not in the baby's net fat intake per 24 h. The results indicate that the breast-fed baby can regulate his fat intake quickly and thus mothers should be encouraged to practice "baby-led" feeding.

Breast Feeding↗
PubMed1990

Development of co-ordination of sucking, swallowing and breathing: ultrasound study of term and preterm infants.

Fourteen newborn babies of different gestational ages (33 to 40 weeks) but similar postnatal age (four to 19 days) were studied during bottle-feeding using real-time ultrasonography, combined with respiratory monitoring. Previously undescribed tongue movements and graded changes in the temporal relationships between tongue movements, swallowing and breathing were observed among infants of differing maturity. These were most marked in the least mature infants, but were occasionally seen in term infants. The results suggest that adequate neuromuscular co-ordination is more a function of gestational maturity than of postnatal sucking experience. The pattern of intraoral events for infants of differing maturity described in this study provides a framework for the study of feeding problems of term and preterm infants.

Bottle Feeding↗
PubMed1990

Cerebral oedema complicating diabetic ketoacidosis.

Four children presented with cerebral oedema secondary to diabetic ketoacidosis, each of whom had a different clinical picture and time of onset of neurological deterioration. No single factor emerged as the cause of the cerebral oedema, but disturbances in brain water balance appeared to be already operative at the time of presentation with ketoacidosis. Irregularities in treatment may exacerbate these disturbances, leading to frank cerebral oedema. Diagnosis of this dangerous complication of diabetic ketoacidosis depends on clinical awareness; the diagnosis may be confirmed by CT scan. Management remains empirical.

Adolescent↗
PubMed1989

Imparting the diagnosis of life threatening illness in children.

The parents of children with life threatening or terminal illnesses were interviewed about their experiences of the way in which they were told the diagnosis. The interview was piloted on 25 families and then administered in a semistandardised manner to a further 45 families. Parents were asked how satisfied they were with the initial discussion about the diagnosis: 23 families were satisfied with how much information they were given; 22 with the information concerning prognosis; 20 with the pacing of the information; 33 with who was present; 32 with arrangements for follow up; and 26 were satisfied overall with the initial discussion. Clear patterns emerged about which elements of the discussion parents appreciated or resented. For example, they valued an open, sympathetic, direct, and uninterrupted discussion of the diagnosis in private that allowed sufficient time for them to take the news in and for doctors to repeat and clarify information. They disliked evasive or unsympathetic brief interviews. All parents remembered vividly the manner in which the diagnosis was imparted, and some were still preoccupied with this many years later. Analyses were carried out to test the possibility that reports of satisfaction and dissatisfaction were a function of current depression and anxiety, but no evidence was found for this.

Attitude of Health Personnel↗
PubMed1989

Relationships between nursing patterns, supplementary food intake and breast-milk intake in a rural Thai population.

Relationships between nursing patterns, supplementary food intake and breast-milk intake were examined in a group of 52 Thai babies under 1 year of age. All data were collected over two consecutive days, 24 h/day. Total sucking time (min/day) and supplementary food intake (kcal/day) were significant predictors of breast-milk intake after allowing for the age of the baby: R-squared is 0.32 for sucking time and 0.39 for supplementary food intake. The two variables were themselves correlated (r is -0.47). The number of breastfeeds per day and their mean duration was determined for each case, counting each episode of attachment to the breast as a separate feed. Number and mean duration of breastfeeds were then evaluated as predictor variables. The duration of feeds had no predictive power. Number of feeds was linearly related to milk intake and combined with age was as good a predictor of milk intake as total sucking time (with R-squared 0.34). These results suggest that a simple count of breastfeeds is as valuable as more complex measures of sucking duration in predicting to breast-milk intake.

Breast Feeding↗
PubMed1989

Predictors of breast milk intake in rural northern Thailand.

A random sample of 52 mothers and infants from a rural area of Northern Thailand were studied in their homes for 48 h. Infants were breast fed on demand. Daytime feeds were test weighed with electronic averaging balances and nighttime intake estimated using a new method, Indirect Test Weighing. All feeds, both day and night, were timed to the nearest minute. Other variables measured by direct observation were infant weight, and supplementary food and water intake. Mean 24-h breast milk intake was 579 g (range 78-1,011 g) with a median between day coefficient of variation of 8.8%. The proportion of 24-h breast milk intake consumed at night ranged from 8 to 91%, and increased with increasing infant age. Significant positive associations were found between breast milk intake, and sucking time and infant weight. There were significant negative associations between breast milk intake and age, and supplementary food and water intake.

Body Weight↗
PubMed1989

Staff stress and job satisfaction at a children's hospice.

A study of staff stress and job satisfaction was undertaken in a children's hospice. In addition factors were investigated which might be stressful or which helped staff to manage in difficult circumstances. Three quarters were under comparatively little stress and in general showed very few psychological symptoms but a distinct subgroup were under a great deal of stress. A number of factors, notably recent personal bereavement and unresolved grief about a death that had occurred before they came to work at the hospice, distinguished this small group. Job satisfaction was generally high. The main sources of stress were: the sense of impotence staff felt when they were unable to relieve perceived needs or distress; dealing with negative responses in families, and conflicts within the staff group. The most important mitigating factors were: the informal support that staff provided for each other in this small cohesive working unit, the homelike atmosphere of the hospice, and the diversity of professional and personal skills among the staff group. The implications of these findings for reducing stress among staff dealing with dying people are discussed; this includes not only staff on paediatric wards, intensive care and neonatal units, but also community paediatric nurses.

Adult↗
PubMed1989

Life threatening illness and hospice care.

A retrospective study was undertaken of 25 families and their 26 ill children attending the first children's hospice in the United Kingdom. The study examined the family's perceptions of the care offered and the impact of chronic and life threatening illness. Eighteen (72%) of the families felt they had been well supported by the hospice and valued the family like atmosphere, perceiving the staff to be friendly, approachable, and helpful. The actual nature of hospice care, in an environment with other terminally ill children, was, however, considered a drawback for a few families. A number of families still had unmet needs, notably appropriate child minding when away from the hospice. The impact of chronic life threatening illness on the families was substantial. The parents (particularly the mothers), the index children, and their siblings all experienced much higher levels of psychological symptomatology than would have been expected from normal samples. While families felt greatly helped over symptom control, a proportion remained very worried about certain symptoms, particularly breathlessness, seizures, and pain. A high proportion of families were experiencing financial and employment difficulties as a result of their children's illnesses.

Adolescent↗
PubMed1988

Circadian variation in fat concentration of breast-milk in a rural northern Thai population.

1. Twenty-five northern Thai mothers, breast-feeding their infants on demand, were studied in their homes for 24 h. All breast-feeds were test-weighed and pre- and post-feed expressed breast-milk samples (0.5 ml) taken at each feed. 2. The fat concentration of milk taken during a feed showed significant circadian variation, with maximum values between 16.00 and 20.00 hours and minimum values between 04.00 and 08.00 hours. Fat concentration at the start and at the end of a feed also varied significantly over 24 h. 3. Multiple regression analysis showed that the most important predictor of fat concentration at a feed was the length of time elapsed since the previous feed--the longer this interval, the lower the subsequent fat concentration. Other significant predictors were the fat concentration at the end of the previous feed, and the milk intake at the previous and at the current feed. 4. Fat concentration declined between feeds in proportion to the length of time between feeds, but the decline was less between sleep feeds than between waking feeds. This would appear to be a reflection of the lower post-feed fat concentration and higher pre-feed fat concentration of sleep feeds compared with waking feeds, when other variables relating to feeding pattern are taken into account. 5. The larger the milk intake at a feed, the greater was the increase in fat concentration from the start to the end of the feed. The change in fat concentration was less in feeds taking place during the sleep period than in daytime feeds.

Adult↗
PubMed1988

Estimation of 24 h breast-milk fat concentration and fat intake in rural northern Thailand.

1. The present study assesses the accuracy with which mean 24 h breast-milk composition can be estimated if milk samples can only be collected during the daytime. 2. Twenty-five northern Thai mothers, feeding their infants on demand, were studied in their homes for 24 h. All feeds were test-weighed and 0.5 ml pre- and post-feed expressed milk samples taken at each feed. 3. If daytime sampling was restricted to two breast-feeds, it was found that the best estimate of 24 h fat concentration was given by two randomly chosen daytime feeds, predicting 24 h fat concentration with 95% confidence limits of +/- 7.0 g/l (equivalent to 21% of mean 24 h fat concentration). 4. Alternative sampling methods using the mean fat concentration of the feed after 08.00 hours and after 18.00 hours, or the first two feeds after 12.00 hours, predicted fat concentration with 95% confidence limits of +/- 9.7 g/l and +/- 8.9 g/l (28 and 26% of mean 24 h fat concentration) respectively. 5. If well-tolerated by mothers, it would be preferable to sample all daytime feeds, since this reduces the 95% confidence limits to +/- 3.3 g/l, equivalent to 10% of the mean 24 h fat concentration.

Adult↗
PubMed1988

Measuring psychosocial adaptation to diabetes in adolescence.

We have developed a psychometric test to assess psychosocial adaptation to diabetes in young people aged from 10 to 17 years. This includes subscales which describe emotional difficulty with, and attitude to, diabetes. The content of the scales was drawn from unstructured discussions with 27 young people with diabetes. The scales were piloted on two further unselected groups of adolescents (n = 50, n = 99) to examine their reliability, validity, and acceptability. Highly significant correlations were found between the results of the scales and measures of psychosocial function (p less than 0.001), parents' perceptions. Performance on the scale also correlated with a number of behaviour variables and differentiated those who were reported to be restricted by their diabetes (p less than 0.005) and those who had had a previous psychiatric referral (p less than 0.05). The scales appear reliable within the constraints of the small population examined.

Adaptation, Psychological↗
PubMed1988

Diabetes mellitus.

The diagnosis of diabetes mellitus implies a life-time regimented by insulin therapy, dietary manipulations and monitoring glycaemic control. There is also the ever present risk of ketosis and hypoglycaemia and as the child grows up there is an increasing awareness of the later complications of diabetes. This paper is concerned with the care of the child with diabetes from diagnosis, within the context of his home and school, with an emphasis on the emotional response of the child and his family.

Adolescent↗
PubMed1987

Goals of treatment in diabetes: a comparison of doctors and parents of children with diabetes.

Treatment failure is usually understood as a problem of patient compliance. This paper suggests another approach: to see this problem as resulting from a difference in the goals of the two parties involved, the doctor and the patient. Comparison was made between the goals of doctors and those of parents in treating children with diabetes. Significant differences emerged between the goals. Parents' goals of treatment were governed more by avoidance of the short-term threat of diabetes (hypoglycemia); doctors' goals more by the long-term threat of diabetes (diabetic complications). The outcome of treatment (diabetic control) was more closely related to parents' than doctors' goals of control. These results indicate that doctors and patients do not always share the same goals in treatment. It is suggested that a more effective clinical alliance would result if the goals of the clinical team were at least made explicit, even if they were not always shared.

Adolescent↗
PubMed1987

The automatic sampling shield: a device for sampling suckled breast milk.

The automatic sampling shield uses the negative pressure exerted by the breast-feeding baby during sucking to withdraw a series of small samples from the milk stream. Shield performance was studied at four feeds for each of 13 babies. Acceptance of the shield was good (96% of feeds) and samples were obtained in 88% of feeds. Sample weight was large enough for micro-biochemical analysis of composition (median weight 1.3 g), without depriving the baby of important amounts of milk (median percentage of weight of milk intake was 4.3% and sample weight was less than 5 g in all cases). The shield should sample a constant proportion throughout the feed, in order to obtain a sample that is representative of the infant's nutrient intake. Fractional test-weighing of feeds showed a tendency for a larger proportion of the feed to be collected at slower flow rates. Modelling on the basis of the observed flow profiles in conjunction with a theoretical fat concentration profile showed that the observed 'disproportionality' would have over-estimated fat intake by a mean of 2.6% per feed (S.D.9.1 range -18.9% to + 16.9%). Using the shield in random sequence at two out of the first four feeds after 0800 h, showed that an infant's mean milk intake with the shield was on average 32% less than on control feeds. Allowing for possible compensation by the infant when control feeds followed low shield intakes, mean milk intakes with the shield were 17% smaller than without the shield.

Breast Feeding↗
PubMed1987

Family life and diabetic control.

Seventy two children with diabetes and their parents were studied to examine the relationship between family functioning and diabetic control. Children in families characterised by cohesion, emotional expressiveness, lack of conflict and a mother satisfied with her marriage, had better diabetic control than children living in families with opposing characteristics. Children living with both biological parents or with a single parent had significantly better diabetic control than those living with a step-parent or adoptive parents. There was no relationship between social class, family income, employment status or educational attainment of either parent, and diabetic control.

Adaptation, Psychological↗