Biomedical subjects
Publications and source records attributed to J J Alpert.
A survey was completed of US pediatric residency programs about the use of community sites in training. A total of 85% of program directors responded and reported a wide use of the 21 identified survey sites. Further study is needed to determine the appropriate contribution that community sites can make to pediatric training.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
The use of children in research raises the questions about proper justification, assessment of benefit in relation to risk, ability to consent, compensation, and the just selection of subjects. Although substantive and procedural standards have evolved, subpopulations of vulnerable children created new challenges and concerns.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Despite the magnitude and importance of the problem, little is known about why many students are absent from school. This study assessed what a sample of excessively absent students and their parents believed were the reasons for the students' absences. In response to an open-ended question about their main reason for absence, almost half of the students reported a health-related reason. When asked whether any of 15 potential problems contributed to their absence, many reported common and acute physical illnesses, headaches or stomachaches, and other aches or pains. Half mentioned factors relating to low motivation or a concern about the school environment. The parents' responses were remarkably similar except they were more likely to cite emotional problems of the student, school violence, and racial problems. When individual student's responses were compared with those of his or her parents, agreement on individual items were little better than would be expected by chance.
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Excessive school absence is a major educational and social problem in the United States, yet very little is known about its etiology or how to prevent or ameliorate it. This paper reports results from a series of related studies conducted in seven Boston middle schools (grades 6, 7, and 8) to test the hypotheses that health problems and unmet health needs are major characteristics distinguishing excessively absent students from regular attenders and that a health-oriented approach using medically mediated interventions is effective in reducing absences among excessively absent students. There were no significant differences between regular attenders and excessively absent students on multiple measures of student and family health status, health habits, and health service utilization patterns in a case-control study. The intervention program was not associated with a significant decrease in absence school-wide or for participating students. We conclude that demographic and educational characteristics of students exert a greater effect on their behavior in regard to absence from school than do health status or receipt of health services and that a health-oriented approach, such as the one used here, will not have a major impact on what remains one of the most profound educational and social problems involving children in the United States today.
Excessive school absence is a major educational and social problem in the United States which is most pronounced in urban school systems. A case control study of excessively absent inner-city middle-school students and regular attenders failed to demonstrate any differences between groups in terms of health status, health-related behaviors, or utilization of health services. These results contrast dramatically with the findings of a previous study which identified a number of educational and demographic characteristics which clearly distinguish excessively absent students from regular attenders. It is concluded that educational and demographic factors are far more important in influencing excessive absence behavior than are health-related factors. The implications of these findings for the pediatrician are discussed.
Pediatricians' success in the role of advocate can be associated with fewer injuries to children. The authors emphasize the importance of pediatrician advocacy for injury prevention, including preventive health maintenance, education, community organization, professional education, development of emergency medical services, and legislation and regulation.
The authors designed a pilot study to test if exposure to child abuse or neglect is associated with suicidal behavior in adolescence. Each of 159 adolescents who had attempted suicide was age- and sex-matched with two comparison subjects who had been treated for medical conditions unrelated to suicide attempts. The registry of the Massachusetts Department of Social Services was searched for the names of the subjects and comparison subjects. For both sexes prior contact with the Department of Social Services was three to six times more likely for probands than for the comparison subjects.
Because the simultaneous demands of adolescence and motherhood could result in special infant rearing attitudes and concerns, a prospective pilot study of inner city adolescent mothers was undertaken. A sample of primiparous adolescent mothers was compared with primiparous and multiparous nonadolescent mothers. Data were collected by home interviews at two weeks and three months postpartum. The major hypothesis, that the simultaneous occurrence of adolescence and motherhood would result in special infant rearing attitudes, concerns, and support systems which interfered with mothering, was not fully supported by our findings. Few of the adolescent mothers were married (8%) but of those not married, most (95%) lived in an extended family. Adolescent mothers, when compared with older mothers, were more likely to seek medical advice from their mothers as opposed to health professionals and were more insecure in their maternal self-image if caretaking was shared. Attitudinal differences around feeding were seen, but attitudes about spoiling, perception of the baby's behavior, discipline, caretaking, and enjoyment were the same among groups. Adolescent mothers and their infants provide physicians and other child health professional with a special pediatric family. The differences in available support systems and maternal self-image suggest areas for further investigation.
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The career choices and professional behavior of three cohorts of students who participated in a family medicine program were studied by mail questionnaire. Cohort I (1957--1960), as part of an educational experiment, had been randomly assigned to the course; unselected classmates were used as controls. Cohort II (1961--1965) and Cohort III (1966--1970) were volunteers; alphabetically adjacent classmates were used as a comparison group. The results suggest that the impact of a given medical school course on future behavior must be evaluated in the context of general medical school orientation and societal trends extraneous to the school itself.
This paper summarizes an experiment evaluating the effectiveness of primary pediatric care delivered to a sample of low-income inner-city families. Primary pediatric care in this study was similar to pediatric group practice. The study findings indicated that the effects of primary care compared with the episodic care received by the control families were appreciable. This included the decreasing of hospitalizations, operations, illness visits, and appointment breaking; increasing of health supervision visits, preventive services, and patient satisfactions; and accomplishing these changes at a lower cost. Patient morbidity was not altered. Medicaid made no difference in the care patterns of the experimental families and apparently benefited only those control families who were white. The controlled clinical trial offers the best opportunity to compare different models of priervices for children.