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Biomedical subjects

R E Kleinman

Publications and source records attributed to R E Kleinman.

At least 19 recordsLinked to original sources
PubMed2000

Liver failure attributable to hepatitis A virus infection in a developing country.

In young children hepatitis A virus (HAV) infections are usually subclinical events. However, HAV is also associated with progressive hepatic failure and even death in some patients. This study was undertaken to characterize the course of hepatitis A-related acute liver failure in children from a developing country where hepatitis A is endemic and produces significant morbidity. Patients <15 years of age with confirmed hepatitis A, seen at the Aga Khan University Hospital between January 1991 and August 1998 were identified using the patient registry. Of the 2735 patients seen with hepatitis A, 232 were admitted to the hospital. Of these 30 patients developed progressive hepatic dysfunction and liver failure. During this period, 45 children were admitted with liver failure attributable to other causes. Of the patients admitted with hepatitis A-related liver failure, 25 (83.3%) were encephalopathic at presentation and 36.7% of the patients died. The prothrombin time was the most significant predictor of survival. There was a significant difference between those who survived and those who died on discriminant analysis with respect to age, grade of hepatic encephalopathy, duration of hospitalization, prothrombin time, and duration of jaundice when taken as a group. There is a striking prevalence of liver dysfunction progressing to hepatic failure among children seen at a hospital in Karachi, Pakistan. This study demonstrates the significant morbidity and mortality that can attend HAV infections in children in a developing country despite tertiary medical facilities. The risk of HAV and its sequelae could probably be effectively reduced in these settings with improved sanitation and universal immunization.

Acute Disease↗
PubMed1999

Oral rehydration solution for acute diarrhea prevents subsequent unscheduled follow-up visits.

BACKGROUND: Oral rehydration solutions (ORS) for the treatment of acute diarrhea remain an underutilized therapy in the United States, despite multiple clinical trials confirming their efficacy and safety. Economic barriers to their use have been identified. OBJECTIVE: To determine whether providing ORS to patients at the time of their office visit for acute diarrhea can increase ORS utilization and reduce unscheduled follow-up visits. DESIGN: Randomized, controlled clinical trial. SETTING: Seven health centers of a large health maintenance organization. PARTICIPANTS: Children (N = 479) 0 to 60 months of age with acute diarrhea (at least three watery or loose stools in the previous 24 hours for </=7 days). INTERVENTION: Prescription for 2 quarts of ORS filled for free at on-site pharmacy plus written instructions versus written instructions alone. PRIMARY OUTCOME MEASURES: Self-reported use of ORS; unscheduled follow-up visits in office, urgent care, and/or emergency department setting. RESULTS: Subjects in the intervention group were significantly more likely to use ORS after the initial office visit (85% vs 71%; RR: 1.19; 95% CI: 1.08-1.32). Of the standard treatment group subjects, 40 (17.3%) sought unscheduled follow-up care for diarrhea versus 27 (10.9%) of the intervention group subjects (RR: 0.63; 95% CI: 0.40-0.99). Subjects seeking unscheduled follow-up care tended to younger (15.7 vs 19.4 months old), have more stools (7.1 vs 6.2 stools), and more vomiting episodes (4.1 vs 3.0) in the 24 hours before initial evaluation than those not seeking unscheduled follow-up care. Multivariate analysis showed that randomization to the intervention group was associated with a 25% reduction in unscheduled follow-up visits for acute diarrhea. CONCLUSIONS: Providing ORS to families at the time of their office visit for acute diarrhea is associated with a significant increase in ORS use and substantially reduces the need for unscheduled follow-up visits. Health maintenance organizations should consider routine provision of ORS to children presenting with acute diarrhea.

Acute Disease↗
PubMed1998

The relationship of school breakfast to psychosocial and academic functioning: cross-sectional and longitudinal observations in an inner-city school sample.

OBJECTIVE: To determine if a relationship exists between participation in a school breakfast program and measures of psychosocial and academic functioning in school-aged children. METHODS: Information on participation in a school breakfast program, school record data, and in-depth interviews with parents and children were collected in 1 public school in Philadelphia, Pa, and 2 public schools in Baltimore, Md, prior to the implementation of a universally free (UF) breakfast program and again after the program had been in place for 4 months. One hundred thirty-three low-income students had complete data before and after the UF breakfast program on school breakfast participation and school-recorded measures, and 85 of these students had complete psychosocial interview data before and after the UF breakfast program. Teacher ratings of behavior before and after the UF breakfast program were available for 76 of these students. RESULTS: Schoolwide data showed that prior to the UF breakfast program, 240 (15%) of the 1627 students in the 3 schools were eating a school-supplied breakfast each day. Of the 133 students in the interview sample, 24 (18%) of the students ate a school-supplied breakfast often, 26 (20%) ate a school-supplied breakfast sometimes, and 83 (62%) ate a school-supplied breakfast rarely or never. Prior to the UF breakfast program, students who ate a school-supplied breakfast often or sometimes had significantly higher math scores and significantly lower scores on child-, parent-, and teacher-reported symptom questionnaires than children who ate a school-supplied breakfast rarely or never. At the end of the school term 4 months after the implementation of the UF breakfast program, school-supplied breakfast participation had nearly doubled and 429 (27%) of the 1612 children in the 3 schools were participating in the school breakfast program each day. In the interview sample, almost half of the children had increased their participation. Students who increased their participation in the school breakfast program had significantly greater increases in their math grades and significantly greater decreases in the rates of school absence and tardiness than children whose participation remained the same or decreased. Child and teacher ratings of psychosocial problems also decreased to a significantly greater degree for children with increased participation in the school breakfast program. CONCLUSION: Both cross-sectional and longitudinal data from this study provide strong evidence that higher rates of participation in school breakfast programs are associated in the short-term with improved student functioning on a broad range of psychosocial and academic measures.

Achievement↗
PubMed1998

Feeding problems in cystinosis.

Nephropathic cystinosis, a rare autosomal recessive storage disease characterized by intracellular storage of free cystine due to a defect in lysosomal cystine transport, is the most common cause of Fanconi syndrome in childhood. Although manifestations of extrarenal organ involvement during the course of the disease are diverse, the spectrum of gastrointestinal (GI) problems has not yet been examined. In responses to a questionnaire from 70 (35%) of the 200 registered members of the Cystinosis Foundation, we found that GI symptoms are more common, more diverse, and occur at a younger age in patients with cystinosis than previously recognized. Ninety-three percent of interviewed subjects had GI symptoms at initial presentation, and the overall lifetime prevalence of GI problems in this group was 100%. Thirty percent have received gastric/jejunal tube feedings, and 7% required continuous or intermittent total parenteral nutrition. Fifty percent have been formally tested for GI abnormalities, and among these 77% have documented functional abnormalities (reflux/dysmotility, pseudo-obstruction, swallowing dysfunction). Early recognition and aggressive therapy of GI problems in cystinotic patients may ameliorate or prevent the development of disabling symptoms.

Adolescent↗
PubMed1998

Relationship between hunger and psychosocial functioning in low-income American children.

OBJECTIVE: Using large-scale surveys from nine states, the Community Childhood Hunger Identification Project (CCHIP) estimates that 8% of American children under the age of 12 years experience hunger each year. CCHIP operationalizes child hunger as multiple experiences of parent-reported food insufficiency due to constrained resources. The current study examined the relationship between food insufficiency and school-age, low-income children's psychosocial functioning. The study also assessed the interinformant (parent versus child) reliability and time-to-time reliability of the CCHIP measure. METHOD: Two hundred four school-age children and their parents from four inner-city public schools were interviewed using parent, teacher, and clinician report measures of psychosocial functioning. Ninety-six children and their parents were reinterviewed 4 months later. RESULTS: Hungry and at-risk for hunger children were twice as likely as not-hungry children to be classified as having impaired functioning by parent and child report. Teachers reported higher levels of hyperactivity, absenteeism, and tardiness among hungry/at-risk children than not-hungry children. Parent and child reports of hunger were significantly related to each other, and time-to-time reliability of the CCHIP measure was acceptable. CONCLUSIONS: Results of this study suggest that intermittent experiences of food insufficiency and hunger as measured by CCHIP are associated with poor behavioral and academic functioning in low-income children. The current study also supports the validity and reliability of the CCHIP measure for assessing hunger in children.

Adolescent↗
PubMed1998

Hunger in children in the United States: potential behavioral and emotional correlates.

OBJECTIVE: Results from a recent series of surveys from 9 states and the District of Columbia by the Community Childhood Hunger Identification Project (CCHIP) provide an estimate that 4 million American children experience prolonged periodic food insufficiency and hunger each year, 8% of the children under the age of 12 in this country. The same studies show that an additional 10 million children are at risk for hunger. The current study examined the relationship between hunger as defined by the CCHIP measure (food insufficiency attributable to constrained resources) and variables reflecting the psychosocial functioning of low-income, school-aged children. METHODS: The study group included 328 parents and children from a CCHIP study of families with at least 1 child under the age of 12 years living in the city of Pittsburgh and the surrounding Allegheny County. A two-stage area probability sampling design with standard cluster techniques was used. All parents whose child was between the ages of 6 and 12 years at the time of interview were asked to complete a Pediatric Symptom Checklist, a brief parent-report questionnaire that assesses children's emotional and behavioral symptoms. Hunger status was defined by parent responses to the standard 8 food-insufficiency questions from the CCHIP survey that are used to classify households and children as "hungry," "at-risk for hunger," or "not hungry." RESULTS: In an area probability sample of low-income families, those defined as hungry on the CCHIP measure were significantly more likely to have clinical levels of psychosocial dysfunction on the Pediatric Symptom Checklist than children defined as at-risk for hunger or not hungry. Analysis of individual items and factor scores on the Pediatric Symptom Checklist showed that virtually all behavioral, emotional, and academic problems were more prevalent in hungry children, but that aggression and anxiety had the strongest degree of association with experiences of hunger. CONCLUSION: Children from families that report multiple experiences of food insufficiency and hunger are more likely to show behavioral, emotional, and academic problems on a standardized measure of psychosocial dysfunction than children from the same low-income communities whose families do not report experiences of hunger. Although causality cannot be determined from a cross-sectional design, the strength of these findings suggests the importance of greater awareness on the part of health care providers and public health officials of the role of food insufficiency and hunger in the lives of poor children.

Affective Symptoms↗
PubMed1996

Olestra and the FDA.

Explore the source record for details and available documents.

Dietary Fats, Unsaturated↗
PubMed1996

Infant formula, past and future: opportunities for improvement.

Infant formulas provide nutritional support to health infants that promotes growth and development equivalent to that in healthy infants fed human milk. Formula-fed infants are not as well protected against infections, and there remain infants whose health, growth, and development may not be supported optimally by either the formulas currently available or human milk. Some infants may be better supported by genetically engineered formulas that contain immunity-enhancing antibodies or antigens. Formulas that contain cytokines promoting epithelial cell growth and integrity may be protective against necrotizing enterocolitis. Formulas containing proteins with genetically excluded allergenic epitopes or formulas with tolerogenic peptides may be useful in treating allergic diseases of suppressing the development of autoimmune disorders later in life. Formulas with genetically engineered biologically active substances might increase the absorption of nutrients in infants with compromised absorption or digestion, enhance host immunity and mucosal integrity, and, potentially militate or protect against the risk of disease.

Animals↗
PubMed1996

Dietary guidelines for children: U.S. recommendations.

The primary goal for pediatric dietary guidelines is to provide nutrients to support optimal growth and development at different ages from infancy through the end of adolescence. Over the past 15 years increasing attention has been directed toward developing nutrition recommendations that may lower the risk of chronic illness later in life. Recent evidence supports earlier studies that demonstrate that atherogenesis begins in childhood, is an evolving process and is influenced by environmental factors. As a result, in part, because of nutritional recommendations to lower the fat content of the diet, total fat and saturated fat as a percentage of total energy intake have declined in the diet of children and adolescents over the past 20 years. At the same time there has been no increase in the prevalence of growth failure; children, in fact, are heavier than their counterparts of 15 years ago. With a decrease in dietary fat, the mean serum cholesterol of the population as a whole has decreased steadily over the past 20 years. Children can safely eat a lower fat diet in which fat contributes 30% of total energy and saturated fat < 10% of total energy.

Adolescent↗
PubMed1995

Allergic gastroenteropathy in children.

OBJECTIVE: To review the pathogenesis, symptoms, and treatment of gastrointestinal disorders linked to immunopathologic reactions associated with the ingestion of food antigens in infancy and childhood. DATA SOURCES: A computerized MEDLINE search was performed for the following topics: allergic colitis, allergic proctitis, eosinophilic gastroenteritis, eosinophilic colitis, cow milk intolerance, protein losing enteropathy, and malabsorption. This search was restricted to the English language and human subjects. Articles published between 1960 and 1993 were included as references. The textbooks which were used as references include: (1) Walker WA, et al, eds. Pediatric gastrointestinal disease; pathophysiology, diagnosis, management, Philadelphia: BC Decker, 1991; (2) Wyllie R, et al, eds. Pediatric gastrointestinal disease; pathophysiology, diagnosis, management, Philadelphia: WB Saunders, 1993; (3) Targan SR, et al, eds. Immunology & immunopathology of liver and gastrointestinal tract. Igaku-Shoin, 1991; (4) Goldman H, et al, eds. Pathology of the gastrointestinal tract. Philadelphia: WB Saunders, 1992. CONCLUSION: The symptoms of allergic gastroenteropathy may be those of classic allergic reactions or present as symptom complexes that may include diarrhea, malabsorption, and protein-losing enteropathy. The immunopathogenesis of allergic gastroenteropathy is complex and is still not clearly understood. As our understanding of the gastrointestinal mucosal system evolves, we should be able to manage and care for the infants and children who suffer from this group of disorders better.

Allergens↗
PubMed1994

Fat and cholesterol in the diet of infants and young children: implications for growth, development, and long-term health.

Fat is necessary in the diets of infants and young children because of their extraordinary energy needs and limited dietary capacity. In addition, essential fatty acids provide the substrates for arachidonic acid, docosahexaenoic acid, and their metabolites. Deficiencies in the amounts of these long-chain fatty acids in the diet during infancy may affect the maturation of the central nervous system, including visual development and intelligence. Efforts to link the diet in infancy and early childhood to the development of chronic diseases in adulthood are hampered by a lack of supportive epidemiologic and clinical data. Serum cholesterol and lipid levels during childhood correlate only weakly with their levels at maturity. Studies in twins suggest that there is a large genetic component to serum lipid levels. Similarly, the correlation between obesity in early childhood and in adulthood is weak. Young children who receive fat-restricted diets in which fat accounts for 30% or less of their intake appear to grow normally but are more likely not to consume the recommended dietary allowances of many nutrients. Therefore fat should not be restricted in the diets of infants and young children. Restricting fat to approximately 30% of the calories consumed is reasonable after the age of 2 years, but the benefits of this recommendation remain to be proved.

Adult↗
PubMed1994

Inflammatory bowel disease: diagnosis and treatment.

The primary feature of IBD which distinguishes pediatric from adult patients is the presence of or potential for significant growth failure. Recognizing this complication before permanent stunting occurs is critically important. The onset of these disorders during childhood also means that many of these children will have a lifetime of disease and therapy, during both growing as well as reproductive years. The impact of this lifelong process on the psychosocial development of the child and adolescent also needs to be recognized and addressed. Treatments must be carefully considered for their chronic adverse consequences (side effects) as well as immediate benefits. This includes the risks of early, and likely repeated, bowel resections as well as potentially mutagenic or teratogenic medications. The resurgence of tuberculosis and other chronic intestinal infections, particularly in certain high-risk pediatric populations, requires a careful consideration of the differential diagnosis of IBD in children. Finally, promising therapies must be tested in children as well as adults to develop the most effective approach to controlling IBD in pediatric patients by taking advantage of potential age-related differences in intestinal immune barrier function.

Child↗