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Biomedical subjects

M S Kramer

Publications and source records attributed to M S Kramer.

At least 181 records · Page 10Linked to original sources
PubMed1983

Do infant formula samples shorten the duration of breast-feeding?

To determine whether advertising by infant formula companies shortens the duration of breast-feeding, we randomly assigned 448 breast-feeding new mothers to either receive or not receive a formula sample packet upon discharge from a maternity ward. These mother, unaware of the study, were then telephoned 3 months post partum by a research assistant blind to the randomisation status. "Sample" mothers were less likely to still be breast-feeding at 1 month (78% vs 84%, p = 0.07) and more likely to have introduced solid foods by 2 months (18% vs 10%, p = 0.01). These trends became more significant in three vulnerable subgroups: less educated mothers, primiparas, and mothers who had been ill post partum. Our results suggest that infant formula samples may shorten the duration of breast-feeding and hasten the age at which solids are introduced.

Breast Feeding↗
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↗
PubMed1983

Comparison of subclavian vein with femoral vein catheterization for hemodialysis.

Subclavian vein catheterization (SVC) is not widely accepted for vascular access because it is considered more invasive than femoral vein catheterization (FVC). The use of FVC and SVC for acute vascular access was compared for 9 mo each. Complications were minimal with both, but access related hospitalizations were lower and the number of out-patient dialyses performed were higher with SVC than FVC. Complications with SVC might have been minimized by using an 18-gauge metallic needle for insertion, avoiding interdialytic infusions and using SVC for less than 4 wk.

Catheterization↗
PubMed1983

Increment in dialysate sodium with sodium chloride or bicarbonate addition.

Hemodialysis was performed in 12 patients for 2 weeks each utilizing acetate dialysate containing 134 mEq/L sodium and dialysate containing 143 mEq/L sodium, achieved by the addition of sodium chloride or sodium bicarbonate to the acetate dialysate. Intradialytic morbidity was lower, dialysis hypoxemia less marked, and predialysis blood pH higher with the bicarbonate-than with the chloride-added dialysate. The long-term use of sodium bicarbonate-added dialysate in three patients was safe. Dialysate pH adjustment was not required. These findings suggest that the addition of sodium bicarbonate (50-75 g) to acetate dialysate may be preferred to sodium chloride for increasing dialysate sodium in selected patients.

Aged↗
PubMed1983

Growth and development of full-term nonasphyxiated small-for-gestational-age newborns: follow-up through adolescence.

Previous studies of growth and development in small-for-gestational-age (SGA) infants have been plagued by several methodologic defects, including a lack of control for socioeconomic status and parental height and an inability to distinguish among the effects of prematurity, neonatal asphyxia, and intrauterine growth retardation. An attempt has been made to overcome these defects in a study of 33 full-term, nonasphyxiated small-for-gestational-age neonates born between 1960 and 1966 and 33 matched control infants of normal birth weight. The infants were followed up and compared for physical growth and sexual, neurologic, and cognitive development at ages 13 to 19 years. Significant deficits in height, weight, and head circumference were found among the SGA cohort, even after statistical adjustment for differences in socioeconomic status and parental height. Sexual development and bone age were not delayed in the SGA group, however, indicating that the deficits in growth are permanent. On neurologic and cognitive testing, the SGA group had trends toward lower scores but scores were well within the normal range. It is concluded that full-term nonasphyxiated SGA infants have an impaired potential for physical growth, but a good prognosis for neurologic and cognitive development. Previous findings of more severe cognitive deficits are attributed to a failure to distinguish the effects of isolated intrauterine growth retardation from effects due to asphyxia.

Adolescent↗
PubMed1982

The case-control study. A practical review for the clinician.

The retrospective case-control study is an important research strategy commonly encountered in the medical literature. A thoughtfully designed, carefully executed case-control study can be an invaluable source of clinical information, and physicians must often base important decisions about patient counseling and management on their interpretation of such studies. Unfortunately, the retrospective direction of case-control studies--looking "backwards" from an outcome event to an antecedent exposure--is accompanied by numerous methodological hazards. Careful attention must be paid to selection of appropriate study groups; definition and detection of the outcome event; definition and ascertainment of the exposure; assurance that the compared groups were equally susceptible to the outcome event at baseline; and careful statistical analysis. If systematic bias enters the research at any of these points, erroneous conclusions can result. Greater familiarity with the case-control method should enable clinicians to be more critically insightful when interpreting the results of published studies using this design format.

Clinical Trials as Topic↗
PubMed1981

Do breast-feeding and delayed introduction of solid foods protect against subsequent obesity?

To correct methodologic flaws (Type II error, confounding variables, and nonblinding) in previous studies relating infant feeding to later obesity, we conducted case-control studies of 639 patients 12 to 18 years of age attending our Adolescent Clinic, and 533 similarly aged healthy children attending a Montreal high school. Each subject was classified as either obese, overweight, or nonobese based on measurements of height, weight, and triceps and subscapular skinfolds. Feeding history, family history, and demographic data were later ascertained "blindly" by telephone interview. Analysis of the raw data revealed a significantly elevated estimated relative risk of not breast-feeding and a significant trend for rates of breast-feeding among the three weight groups. The magnitude of the protective effect appeared to rise slightly with increased duration of breast-feeding. Delayed introduction of solid foods provided little if any additional benefit. Several demographic and clinical variables proved to be confounding, but the significant protective effect of breast-feeding persisted even after controlling for confounders. We conclude that breast-feeding does protect against later obesity and attribute the conflicting results of previous studies to insufficient attention to methodologic standards.

Adolescent↗
PubMed1981

Do breast-feeding and delayed introduction of solid foods protect against subsequent atopic eczema?

Previous studies relating infant feeding to subsequent atopic eczema have had methodologic flaws that include insensitive study designs, nonblind observation, and failure to control for confounding variables. To avoid these flaws, we conducted a case-control study of 636 patients attending a dermatology clinic. The dermatologic problem in each patient was classified as atopic eczema (case), dermatologic condition unrelated to atopy (control), or dermatologic condition with questionable relation to atopy (uncertain). The feeding history was ascertained later, along with family history and demographic data, by an assistant blind both to the question under study and to the case vs control status of each subject. Breast-feeding was not associated with any reduction in the estimated relative risk of developing atopic eczema. No significant relationship was found among the cases between severity of disease and breast-feeding nor between age of onset of disease and duration of breast-feeding or age at introduction of solid foods. Even when breast-feeding was redefined as "pure" and exclusive (no nonhuman milk or solids) for greater than or equal to 2 months, no protective effect was uncovered. We conclude that breast-feeding and delayed introduction of solids do not protect against atopic eczema, and that previous claims of protective effects were based on data probably biased by nonblinding and important confounders.

Adolescent↗
PubMed1981

Difficulties in assessing the adverse effects of drugs.

1 In recent years the phenomenon of the adverse drug reaction (ADR) has become a focus of increased attention and research, and we have become aware of the clinical complexity of the phenomenon and some of the difficulties inherent in assessing adverse effects. Evidence for such difficulties includes the discrepancies in figures for ADR incidence in epidemiological studies, the non-specificity and suggestibility of ADR symptoms, and the substantial disagreements, even among experts, in the diagnosis of ADRs. 3 An observed clinical manifestation heavily depends on the clinical setting and on the intent of the clinician, and the large number of factors that many confound the link between a given manifestation and an administered drug. A diagnostic algorithm, or branched logic decision format, has recently been developed. It comprises six axes of decision strategy and provides standardized, operational rules for rating the probability of an ADR.

Diagnosis↗