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Biomedical subjects

R E Klein

Publications and source records attributed to R E Klein.

At least 37 records · Page 2Linked to original sources
PubMed1990

Use of illiterate volunteer workers for malaria case detection and treatment.

We evaluated the use of illiterate community volunteers for malaria case detection and treatment in Guatemala. Volunteer workers, known as Volunteer Medicators, were selected by members of their communities and were trained and supervised by National Malaria Service (NMS) staff. Their responsibilities included recording basic demographic data and administering a three-day course of chloroquine (25 mg kg-1) to all febrile patients who visited their homes. Patient information was recorded on a special form which consisted of stick-figure drawings. During a one-year evaluation period, no differences were noted between literate and illiterate Volunteer Medicators with respect to the length of time required for their training or supervision, the average number of patients they treated per month, the frequency of errors in recording data or administering medication, or their acceptance by the community residents.

Community Health Workers↗
PubMed1987

Delivering bad news: the most challenging task in patient education.

Communicating clinical findings that a patient's vision cannot be improved and/or will deteriorate is a challenging patient education responsibility. The bad news will be upsetting for the patient no matter how it is presented. By presenting findings in a thoughtful, step-by-step manner taking into account the patient's shock and distress and providing appropriate patient education information, the practitioner plays a critical role in facilitating the patient's participation in the rehabilitation process.

Communication↗
PubMed1984

Heterogeneous growth and mental development of intrauterine growth-retarded infants during the first 3 years of life.

Postnatal growth and development were studied in two groups of term infants with intrauterine growth retardation (IUGR) and one group of infants with normal birth weight up to 3 years of age (total sample, 205 infants). Infants with IUGR were classified as having low ponderal index (IUGR-LPI) or adequate ponderal index (IUGR-API). At birth, the two groups of infants with IUGR had similar birth weight, but length and head circumference measurements were significantly different. Overall, the IUGR-API infants remained lighter and shorter and had smaller head circumferences up to 30 months of age. The IUGR-LPI infants experienced catch-up growth in weight during the first months, because of greater fat deposition. At 24 months of age, the IUGR-API infants scored below the others on mental items. At 3 years of age the IUGR-API infants had the lowest values on seven of eight developmental measures and on the composite score; at these two time periods, the group with normal birth weight scored the highest, and the IUGR-LPI infants obtained intermediate values. It is concluded that infants with IUGR tend to follow postnatal growth and developmental patterns that are associated with their physical characteristics at birth.

Body Height↗
PubMed1983

[Critical analysis of the validity of arm circumference as an indicator of protein-energy nutritional status in preschool children].

Arm circumference has been recommended as a useful indicator for malnutrition screening, particularly in rural areas. The great advantages of the arm circumference over other anthropometric indicators are that the measure is easily obtained in rural areas and that the method for assessing arm circumference is simple, inexpensive and rapid. In this paper the validity (specificity and sensitivity) of arm circumference is analyzed as compared to more valid indicators of nutritional status in preschool children. We conclude that arm circumference is relatively valid for detecting global malnutrition (as indicated by weight-for-age), but of limited validity when used for detecting acute or chronic protein-calorie malnutrition. Furthermore, when compared to weight-for-age in detecting populations or individuals at high risk of acute or chronic protein-calorie malnutrition, it was found that weight-for-age has a higher level of specificity and sensitivity than arm circumference. Finally, it was found that sensitivity and specificity of arm circumference vary with age, suggesting that arm circumference cannot be considered an age-independent indicator of nutritional status. It is therefore recommended that these possible limitations of arm circumference be kept in mind when used in public health programs.

Anthropometry↗
PubMed1982

Postnatal growth of intrauterine growth retarded infants.

205 single, term newborns were followed up to their first birthdays. Each was classified as intrauterine growth retarded (IUGR) (59), or adequate birth weight (ABW) (146), and further subdivided by their individual ponderal index at birth (PI). By the end of their first year the IUGR infants had not reached the weight and length of their normal counterparts. Those with low PI obtained adequate PI values by the third month; IUGR infants with adequate PI at birth remained shorter and lighter but with adequate PI throughout the first year of life. The catch-up process in the IUGR infants with low PI can be explained by a higher growth velocity in weight, triceps and subscapular skinfolds apparent during the first trimester of postnatal life. The limitations of using PI as a tool to monitor the growth patterns of a heterogenous group of IUGR infants are discussed.

Birth Weight↗
PubMed1982

Relationship of maternal and infant nutrition to infant growth.

A cohort of all infants born between January 1, 1969 and February 28, 1977 in four rural villages in Eastern Guatemala which were participating in a longitudinal project of nutrition and mental development was studied. As part of the study, prospective information on anthropometric measurements, morbidity, dietary intake and socioeconomic and cultural characteristics was collected. In addition, two types of food supplements were distributed: calorie and protein-calorie. Attendance at the feeding centers in each village and the amount of supplements consumed by children and pregnant and lactating mothers were recorded daily. We studied the effect of the supplements consumed by the mother during pregnancy and lactation and by the infant on trimestral infant weight and length changes during the first year of life. The data indicate that infant calorie supplementation before three months of age is significantly and negatively associated with infant growth; after three months of age, supplemental calories consumed by the infant are significantly and positively associated with infant weight and length gains. In addition, a small positive association was found between maternal caloric supplementation during lactation and infant growth during the first two trimesters of life, after controlling for potentially confounding factors for which data are available in this study.

Body Height↗
PubMed1982

Nutrition, lactation, and birth interval components in rural Guatemala.

The effects of maternal nutritional status and food supplementation ingested by the infant on the duration of postpartum amenorrhea and on the duration of the menstruating interval was examined. A significant negative association was found between the nutritional status of the mother during the 3rd trimester of pregnancy and infant supplementation, on the one hand, and the length of postpartum amenorrhea on the other hand. These associations remained significant after controlling for each other and for other potentially confounding factors for which data wee collected. These results support the hypothesis that maternal nutritional status, by determining the amount of breast milk available, hence the frequency, duration, and intensity of suckling, is indirectly, negatively associated to the length of postpartum amenorrhea. Furthermore, no association between maternal nutritional status and the length of the menstruating interval was found.

Adult↗
PubMed1982

Seasonality and nutritional status. A review of findings from developed and developing countries.

Studies of seasonality and growth from developed nations demonstrate distinct effects on weight and height gains according to the season. When maximal group gains in height are recorded, minimal weight gains are detected. Only a quarter and a third of all children had their minimal and maximal height gains respectively, in the same period as minimal and maximal group gains occurred. Rain and pre-harvest months are usually associated separately with the disease incidence peaks and with lower energy and nutrient intake. In most areas of the developing world, however, rainy months with a higher incidence of diseases coincide with the lean or hungry pre-harvest months. Some communities have devised certain mechanisms which are likely to buffer negative seasonal effects (rainy or pre-harvest months) on health and nutritional status. Thus, either as a result of lower intakes of energy and nutrients and/or less efficient utilization of energy and nutrients, one is likely to find important seasonal effects in poor agricultural communities of developing countries. The importance of adequate knowledge about seasonal effects to support the better use of existing resources allocated to health and nutrition programs is discussed.

Body Weight↗
PubMed1981

The relationship between physical growth and infant behavioral development in rural Guatemala.

The present study investigated the relationship between a number of anthropometric indices and behavioral development during the first 2 years of life in rural Guatemala. Length and weight were the indices most strongly correlated with behavioral development. If the effect of the infant's length and weight was statistically controlled for, none of the other anthropometric variables explained a significant proportion of the variance in behavioral development. Controlling the length (or weight) assessed at the same age as the behavioral assessment, length (or weight) for younger ages was not significantly correlated with behavioral development. Changes in length or weight over time correlated with changes in behavioral performance. We were unable to explain the association between physical growth and behavioral development by a number of variables including gestational age, nutrient intake, prevalence of disease, and familial characteristics.

Body Height↗
PubMed1981

The predictive validity of infant assessments in rural Guatemala.

The behavioral development of rural Guatemalan infants was assessed shortly after birth on a Neonatal Assessment Scale (NAS) and at 6, 15, and 24 months of age on a Composite Infant Scale (CIS). Summary variables based on NAS performance poorly predicted later assessed performance even as recently as 6 months after birth. The CIS was modestly correlated with later performance (between 3 and 7 years of age). These results are similar to those concerning samples from developed nations. Summary variables reflecting failure of easy items, the items most strongly predictive of 4-year performance, and the first principal component factor score all were highly correlated with each other. Of the variables generated they had the most predictive validity. A motor item variable had at least as impressive predictive validity as the mental items at 6 and 15 months. By 24 months the mental variable was a better predictor than the motor variable. In terms of predicting later performance, there seemed to be little justification for weighting items other than to achieve a characterization of overall performance.

Child↗