Biomedical subjects

M C McCormick

Publications and source records attributed to M C McCormick.

At least 91 records · Page 5Linked to original sources

PubMed1987

Chronic disease: effect on health cognition and health locus of control.

An assessment of health cognition and health locus of control (HLOC) was obtained in 85 healthy and 81 chronically ill children, using instruments adapted from Piaget's work and standard HLOC measures. A relationship between HLOC and compliance was sought in a subset of children with spina bifida taught self-catheterization. Evidence of the developmental nature of health cognition and HLOC was documented. Contrary to the effect of experience in formal learning, experience with chronic disease did not alter developmental progression in these health-related areas. Our results suggest that in communicating with children about illness, the pediatrician's approach should not be altered by an appearance of superficial sophistication that some children may acquire as part of their experience with chronic disease.

Adolescent↗

PubMed1987

Minor head trauma in children: an intervention to decrease functional morbidity.

Minor head trauma is common among children and evokes strong parental reaction. Parents often rush the child to an emergency department or consult their pediatrician by telephone despite the minor nature of the injury. In a previous report we showed that children with minor head trauma appear to have limitations in their usual daily activities and a high rate of school absenteeism. This study was a prospective, randomized trial of an intervention designed to reduce this functional morbidity after head trauma. Parents in the control group (n = 168) received routine discharge instructions. Parents in the intervention group (n = 153) received a discharge interview during which the nurse gave more explicit and behaviorally oriented instructions. The nurse also called intervention parents the next day to reassure them and to urge that the children return to their usual routine. One month after the injury a questionnaire was administered by telephone to assess physical health status, social or functional limitations, and behavior problems. The majority of parents (85%) were anxious, and this was not alleviated by previous experience with head trauma. Triage nurses incorrectly rated one third of the parents as not anxious. Physical health status, role activity indices, and behavior problems, were similar for the intervention and control groups 1 month after the head injury. Subsequent morbidity was highly correlated with parental anxiety. In managing children with minor head trauma, pediatricians and emergency department physicians must focus their discharge instructions on the parent's anxiety, emphasize the minor severity of the injury, and urge that the children return to their usual routine.

Adolescent↗

PubMed1987

Impact of chronic illness on families.

Standard scales were used to measure the reaction of the parent and family to long-term disability in a child in terms of family stress, both emotional and financial. The most significant factors that bear upon family impact were the level of education of the respondent, parenteral perception of the health of the child, and the number of limitations of activities of daily living that were experienced by that child.

Adaptation, Psychological↗

PubMed1986

The impact of childhood rheumatic diseases on the family.

Much of the burden of providing health care and other services for children with rheumatic diseases falls on the parents, but little is known about the impact of these conditions on the family. A survey of the parents of 138 children revealed that the most important predictors of high family impact were the number of the child's activities of daily living that were limited by illness, the educational attainment of the mother, the child's sex, the mother's perception of the child's health, and the volume of medical care use. Our results provide guidelines for identifying families who are most vulnerable to the stress of having a child with a rheumatic disease.

Adolescent↗

PubMed1986

The very low birth weight transport goes home: impact on the family.

Very low birth weight (VLBW) infants are known to experience more health problems after discharge from the hospital, but the effects of such problems in terms of the demand for medical care and of the effect of this on the family are only just beginning to be described. A survey of the families of 132 children who were born weighing less than 1750 g at mostly suburban hospitals and transported to a Children's Hospital, who were 1-4 years old at the time of the survey, has revealed that these children continue to experience health problems to the extent that 35% are limited in one or more activities of daily living. They also incur greater use of health care services (17% hospitalized in the prior year; 54% with a doctor's visit in the prior month). The most important predictors of high perceived impact of these problems on the family is related to the number of activities limited by health, the age of the child, and the financial resources the family could bring to coping with the child's care. These findings provide further characterization of the families which may be most vulnerable to the ongoing health problems of the VLBW infant.

Activities of Daily Living↗

PubMed1986

Assessing the impact of a child with spina bifida on the family.

This study examined the characteristics of families which may be more vulnerable than others to the impact of caring for a child with spina bifida. Morbidity and the use of health services were unexpectedly high. The impact on the family was related less to clinical diagnoses than to the characteristics of the child's functioning in the home and of the family. Major predictors of greater impact on the family were the number of the child's activities of daily living, parental perceptions of the child's health, low maternal educational attainment, low family income, the number of adults in the family, insurance status, the number of visits to a doctor in the month before the interview, and whether the adults in the family were employed. These results reinforce the need for assessments to include the child's function in the home, and for additional resources to help some families care for their child.

Adolescent↗

PubMed1986

Morbidity following minor head trauma in children.

Head trauma, the most common form of accidental injury among children, is a source of concern for parents and pediatricians. Parents worry about a child's loss of intellectual function. Pediatricians often see the well-documented sequelae of severe head trauma as a basis for parental instructions on observation of a child after minor head injury. A prospective study of 321 children, 6 months to 14 years of age, who had sustained minor head injury within the previous 24 hours was conducted in the emergency department of the Children's Hospital of Philadelphia. Parents of all children completed a ten-minute triage questionnaire and received discharge instructions after their child had received standard medical management. One month after the injury, a questionnaire was administered in a telephone interview to assess the child's physical health status, social or functional limitations, and behavior problems. Physical morbidity was rare, and headache, the most frequent complaint, occurred in only 7% of the children. However, parents reported substantial functional morbidity, and there were significantly more behavioral problems in the 2- to 14-year-old head trauma patients than reported for the standard normal population. Therefore, children who have sustained minor head trauma manifest substantial functional morbidity despite the rarity of physical sequelae. This functional morbidity probably reflects parental overreaction and possibly family dysfunction. It is recommended that pediatricians who have determined that a child's head injury is mild should focus parental education on the rarity of physical sequelae and the importance of the child's returning to a normal routine.

Absenteeism↗

PubMed1985

The regionalization of perinatal services. Summary of the evaluation of a national demonstration program.

The success of modern perinatal management techniques has led to the recommendation of the regional organization of perinatal services. This report summarizes the evaluation of a national demonstration program of such regionalization that was funded by the Robert Wood Johnson Foundation (RWJF) in 1975. In both funded regions and comparison areas, the neonatal mortality rates decreased sharply over the decade of the 1970s. This decline was linked to shifts in the hospital of delivery that indicated antepartum risk identification and transfer of management of high-risk pregnancies to tertiary centers for delivery, a change in service pattern consistent with some aspects of regionalization. The centralization of high-risk deliveries appeared so widespread that the special effect of the RWJF program could not be detected. Surveys of surviving 1-year-old infants showed that the decrease in neonatal mortality was accompanied by a decrease in selected morbidity.

Child Health Services↗

PubMed1985

The contribution of low birth weight to infant mortality and childhood morbidity.

The low-birth-weight infant remains at much higher risk of mortality than the infant with normal weight at birth. In the neonatal period, when most infant deaths occur, the proportion of low-birth-weight infants, especially those with very low weight, is the major determinant of the magnitude of the mortality rates. Furthermore, differences in low-birth-weight rates account for the higher neonatal mortality rates observed in some groups, particularly those characterized by socioeconomic disadvantages. Much of the recent decline in neonatal mortality can be attributed to increased survival among low-birth-weight infants, apparently as a result of hospital-based services. The application of these services is currently considered cost-effective, although whether this will continue to be true in the future is unclear because of the increased survival of very tiny infants. Although low-birth-weight infants remain at increased risk of both postneonatal mortality and morbidity in infancy and early childhood, the risk is substantially smaller than that of neonatal death. In addition, these adverse later outcomes have not offset the gains achieved in the neonatal period. Nonetheless, the increased survival of high-risk infants raises concern about their future requirements for special medical and educational services and about the stress on their families. Despite increased access to antenatal services, only moderate declines in the proportion of low-birth-weight infants has been observed, and almost no change has occurred in the proportion of those with very low weight at birth. In addition, in many areas of the country the birth-weight-specific neonatal mortality rates are similar for groups at high and low risk of neonatal death. In view of these findings, continuation of the current decline in neonatal mortality and reduction of the mortality differentials between high- and low-risk groups require the identification and more effective implementation of strategies for the prevention of low-weight births.

Birth Weight↗

PubMed1985

Publication of research presented at the pediatric meetings. Change in selection.

The adequacy of research presented in abstract form for presentation at scientific meetings remains a concern, as indicated by the proportion of such research appearing in scientific journals after peer review. This report examines the publication of research presented at the pediatrics meetings and the effect of a change in selection procedure for abstracts presented at the Ambulatory Pediatric Association meetings for the years 1979 and 1980. Throughout the period, about half of the presentations were published, usually in general pediatric journals, with an average time to publication of about 20 months. The change in selection procedure resulted in little change in the proportion published among either presentations or abstracts submitted but not selected for presentation, but it did lead to a reduction in time to publication. This experience suggests a mechanism for enhancing the timeliness of publication of research presented at scientific meetings without adversely affecting the process of selection.

Abstracting and Indexing↗

PubMed1985

Compliance with oral theophylline therapy in asthmatic children.

Serum theophylline levels were obtained from 111 children on continuous theophylline therapy when seen in the emergency department for acute episodes of wheezing. Sixty-six percent of patients were at least partially compliant and only 34% were noncompliant in medication taking on the basis of a serum theophylline level of less than 5 micrograms/mL. The main factors associated with compliance were type of primary care source, whether the patient had difficulty keeping appointments, and the relationship of the caretaker to the patient.

Adolescent↗

PubMed1984

High-risk young mothers: infant mortality and morbidity in four areas in the United States, 1973-1978.

An examination of the changes in infant mortality and morbidity in four regions in the United States has revealed high levels of health problems among the infants of two groups of mothers: those less than or equal to 17 years and 18-19 year-old multiparas, many of whom began their childbearing under age 18. Despite decreases over the period of observation, neonatal mortality rates remain over one and a half times as high for infants of these mothers as for other mothers, largely due to the relatively high proportion of low birthweight (LBW) infants born to these mothers. Post-neonatal mortality rates also remain high, and may be increasing; this change cannot be explained solely by differences in proportion of LBW infants between these and older mothers. Both the high post-neonatal mortality rates and the type of morbidity experienced by surviving infants is consistent with the socioeconomic disadvantage of young mothers. The data further indicate the limited resources available to these mothers to cope with their children's health needs, and their potential vulnerability to decreases in public programs supporting child health care.

Adolescent↗

PubMed1984

Fever therapy: an educational intervention for parents.

Fever in children is a common problem, but one which often alarms parents. Parental misconceptions often lead them to unnecessarily aggressive and inappropriate management of fever in their children. A prospective controlled trial of an educational intervention to improve parental understanding and management of fever, involving the parents of 108 children, aged 6 months to 4 years, was performed in a private group practice. Although the majority of these patients were well educated, most were found to be misinformed about many aspects of the seriousness of fever and its management. Parents in the intervention group received a standardized interview in which the management of fever was discussed, demonstrated, and practiced. In addition, they received a printed information sheet for reinforcement 2 months after the initial interview. Parents in both the control group and intervention group revealed an increase in knowledge about fever over time, but only in the intervention group were inappropriate physician contacts and medication errors reduced. The effectiveness of an active learning approach to anticipatory guidance for the management of transient febrile illness was documented and it is suggested that extension of this approach to other common problems in the private practice setting be examined.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed1983

Changes in infant morbidity associated with decreases in neonatal mortality.

Neonatal mortality and morbidity among infants surviving to 1 year of age in eight geographic areas have been compared to determine whether recent decreases in mortality have affected the risk of infants having congenital anomalies or developmental delay. Mortality was obtained from birth and death records in 1976 and either 1978 or 1979; morbidity through home interviews with mothers of random samples of infants and developmental observations on the children. It is concluded that the decrease in mortality was not offset by increases in children with defects. Neonatal mortality decreased by 18% in this 2- to 3-year period; risk of congenital anomalies or developmental delay (all types combined) declined by 16% among the surviving infants. The reduction in risk was concentrated in the minor congenital anomalies or developmental delay category; the proportion of children with severe or moderate congenital anomalies or developmental delay did not change. Decreases occurred at every birth weight including the very low birth weights of 1,500 g or less, a subgroup with especially high mortality and morbidity resulting from perinatal events.

Birth Weight↗

PubMed1982

Factors associated with maternal opinion of infant development--clues to the vulnerable child?

A mother's expectations about the development of her infant have been found to be a strong determinant of child development, but little is known about the factors that may affect maternal assessment of development. In this study, the relationship of the mother's opinion of the development of her infant with several sociodemographic, antenatal, intrapartum, and infant health variables was examined for a large sample of 1-year-old infants for whom gross motor observations were also obtained at the time of the interview. Among those observed to be developing at an appropriate rate, 4.0% were perceived by their mothers as developing more slowly than the mothers considered normal; among infants developing more slowly, 28.6% were considered to be developing slowly by their mothers. In both groups the major determinants of maternal opinion of slow development concerned the infant's health: low birth weight, congenital anomalies regardless of severity, hospitalization during the first year of life, and high ambulatory care use. These results indicate that maternal perception of infant development may not reflect the infant's level, but past or present illness, and raise questions about the influence of infant health on maternal-infant interactions and the effect of such interactions on subsequent development in the child.

Adolescent↗

PubMed1981

Injury and its correlates among 1-year-old children. Study of children with both normal and low birth weights.

Factors associated with injury in the first year of life were examined using data on a random sample of infants in eight regions in the United States. By 1 year of age, 8.6% of the 4,989 infants surveyed had had an injury for which medical care was sought, although serious sequelae (eg, death and developmental delay) were infrequent. The data suggest that the achievement of independent mobility, eg, walking, was a major factor in the risk of injury. Other risk factors included very young mothers and isolated mothers, but not socioeconomic status, illness in the infant, or low birth weight. However, identification of small groups at very high risk is not possible, so that health professionals should be prepared to counsel all new parents early about injuries.

Birth Weight↗

PubMed1981

Preliminary analysis of developmental observations in a survey of morbidity in infants.

Assessment of developmental status, particularly the identification of severe developmental disability, is an important outcome measure of the effect of many types of perinatal and early infant health programs. This report examines the feasibility of the use of a brief battery of developmental observations by a trained lay interviewer in the home as part of a large-scale survey of morbidity in one-year-old infants. A total of 4989 home visits was completed, and of these 3179 were to infants of low birthweight. The interviewers obtained a high degree of cooperation from the infants in this setting. Internal consistency, as measured by coefficient alpha and item-total score correlations, and inter-rater agreement for each observation on a small random sample (137) of revisits indicated reliability sufficient for research purposes for all except receptive language items. Good agreement was found between diagnostic and health are variables obtained through the interview with the mother and a developmental status classification based on the observations. While preliminary, these results are of importance in the design of infant follow-up programs.

Child Behavior↗

PubMed1981

The association of patient-held records and completion of immunizations.

Patient-held records have been advocated as a means of increasing knowledge of an compliance with the processes of health care. The association between one type of patient-held record, the immunization record, and completion of the recommended immunizations for the first year is examined. Immunization completion rates varied by socioeconomic and medical care use variables; but, for all variables studied, completion rates were higher for those infants for whom immunization records were available than those without such records. An experimental assessment of the usefulness of patient-held immunization records as a means of improving compliance and meeting national goals for levels of immunization is suggested.

Diphtheria Toxoid↗