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Biomedical subjects

R H Haslam

Publications and source records attributed to R H Haslam.

At least 37 records · Page 2Linked to original sources
PubMed1992

The physician and Down syndrome: are attitudes changing?

A survey of attitudes of pediatricians, child neurologists, and pediatric surgeons toward Down syndrome is compared with a similar study reported in 1975. A contemporary physician would be much more aggressive in treating a child with Down syndrome who has associated anomalies such as duodenal atresia or congenital heart disease. Few would recommend institutionalization of a person with Down syndrome; the majority expect that such individuals could productively spend their adult lives in group homes. Positive changes in physicians' attitudes during the past 15 years have been influenced by parent advocacy groups, court decisions, and studies showing that the ultimate intellectual and social skills of Down syndrome children are greater than was previously believed. The most prominent variable associated with attitudes was the physician's age: the older the physician, the more likely he or she would be nonsupportive of active treatment on behalf of the Down syndrome individual. These findings suggest that ongoing education of medical students and pediatric residents in the field of developmental disabilities and bioethics is required in order to promote well-informed advocacy for the mentally handicapped.

Adult↗
PubMed1990

Age- and gender-related differences in clinical productivity among Canadian pediatricians.

The desire to control health care costs in Canada has led to reductions in postgraduate training posts and physician immigration. To determine the possible effects of these cutbacks on pediatric manpower, a country-wide study was conducted to assess the practice patterns and productivity of Canadian pediatricians. Of the 1960 pediatricians in Canada, 69% completed and returned our questionnaire. Practice descriptions were as follows: 37% practice primary, 25% secondary, and 38% tertiary care. A total of 70% of Canadian pediatricians are men, although this will change with time because 49% of pediatricians younger than 35 years of age are women. Clinical productivity was assessed by five indices: number of clinical hours, patients seen, consultations provided, and hours on call per week, and number of hospital admissions per year. Younger pediatricians were significantly less clinically productive than older pediatricians. Age-matched groups of female pediatricians were significantly less clinically productive than their male counterparts in three of the five indices assessed. Overall, female pediatricians were significantly more likely to work part-time than were male pediatricians (22% vs 16%, P less than .05). When the clinical productivity of part-time pediatricians was assessed, there was no male to female difference noted. However, among full-time pediatricians, men worked significantly more clinical hours per week and saw significantly more patients than did women (P less than .05). According to results, women pediatricians were more satisfied with their practice now than when starting practice than were men (47% vs 41%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Pediatric manpower in Canada: a cross-country survey.

Health care costs and government cutbacks in Canadian training posts have caused concerns about physician manpower. To determine the present pediatric manpower situation a cross-country survey was undertaken of all pediatricians and their practice patterns. Of the 2060 recipients of a questionnaire 5% were found to not be pediatricians. Of the remaining 1960, 69% returned a completed questionnaire. Overall, 70% of the pediatricians were men, although among those less than 35 years of age 49% were women. Across Canada 37% of the pediatricians practised primary care, 25% secondary care and 38% tertiary care. There were wide regional differences in practice patterns, with large numbers of primary care pediatricians in Winnipeg, Toronto, Ottawa and the province of Quebec; few pediatricians in the Maritimes and the remainder of western Canada practised primary care. Non-Canadian graduates accounted for 33% of the pediatricians and represented a considerable proportion of tertiary care pediatricians. Cutbacks in numbers of pediatric training positions and restrictions on immigration of foreign pediatricians may lead to unexpected deficiencies in the availability of some types of pediatric practitioners, especially those in tertiary care.

Aged↗
PubMed1987

Neurotoxic complications of contrast computed tomography in children.

Four children with brain tumors had marked alterations in levels of consciousness and vital signs after contrast-enhanced cranial computed tomography (CT). Each had clinical evidence of increased intracranial pressure but was alert and coherent before CT. During the procedure, 2 to 2.5 mL/kg 60% diatrizoate meglumine was administered intravenously, and within hours the patients became progressively lethargic and disoriented and bradycardia and hypertension developed; two had generalized seizures. Two children died immediately after the CT procedure. Contrast-enhanced CT may produce grave neurologic complications in children with brain tumors, and this study should be reserved for those patients in whom the probability of obtaining additional information is high. Use of low-osmolality agents or nonionic contrast agents may decrease the morbidity and mortality associated with the procedure.

Brain Neoplasms↗
PubMed1986

Tentative assignment of piebald trait gene to chromosome band 4q12.

A case of de novo del(4)(q12q21.1) is presented. Three of four patients with comparable deletion show abnormal integumentary pigmentation, which is compatible with the known autosomal dominantly inherited piebald trait. Further analysis of breakpoints of five cases with proximal interstitial 4q deletion suggests the possible localization of the piebald trait gene within the band 4q12.

Child↗
PubMed1985

Cough syncope mimicking epilepsy in asthmatic children.

Cough syncope is a more common complication of childhood asthma than formerly recognized. We report twelve children with typical cough syncope who were identified in a pediatric clinic over a period spanning seven years. The condition may be confused with epilepsy because of frequently associated brief clonic convulsive movements during the height of the cerebral anoxia. Cough syncope is readily distinguished from epilepsy by a thorough history. The management and prevention of cough syncope is directed at the aggressive control of bronchospasm in children with asthma.

Adolescent↗
PubMed1985

Recurrent de novo interstitial deletion of 16q in two mentally retarded sisters.

Two sisters with similar clinical features are described. Their clinical manifestations include mental retardation, delayed speech development, low percentiles for height, weight and head circumference, dysmorphic ears, cubitus valgus, pseudoclubbing of fingers, flexion deformity of toes, small kidneys, elevated serum creatinine and blood urea nitrogen (BUN). High resolution chromosome analysis revealed a complete deletion of 16qh with a concurrent small deletion of the adjacent euchromatic segment 16q12.1 in one of the no. 16 chromosomes of both sisters, whereas the parents had normal no. 16 chromosomes. Length polymorphism of the 16qh regions appeared to indicate a maternal origin of the deleted no. 16 chromosome in both sisters. The clinical features of both sisters were attributed to the 16q12.1 deletion. Since both parents were cytogenetically normal, the two sisters were considered as a recurrence of a similar de novo interstitial deletion. Possible mechanisms which could lead to recurrence of a seemingly de novo event are discussed.

Abnormalities, Multiple↗
PubMed1984

Effects of megavitamin therapy on children with attention deficit disorders.

The effectiveness of a megavitamin regimen utilizing a two-stage trial in 41 subjects with attention deficit disorders was studied. Stage 1 was a 3-month clinical trial of vitamins (daily maximum: 3 g of niacinamide and ascorbic acid, 1.2 g of calcium pantothenate, and 0.6 g of pyridoxine). State 2 consisted of four, 6-week, double-blind repeated crossover periods. Twenty-nine per cent of the subjects showed significant behavior improvement during stage 1, and these subjects were used in the double-blind crossover phase of the study to evaluate megavitamin therapy. Using analysis of variance methods for crossover studies, there was no significant difference (P greater than .05) in most behavior scores between children receiving vitamin and those receiving placebo during stage 2. Children exhibited 25% more disruptive classroom behavior when treated with vitamins v placebo (P less than .01). There was no significant difference in serum pyridoxine and ascorbic acid levels between subjects and control subjects. Forty-two per cent of subjects exceeded the upper limits of serum transaminase levels while receiving vitamins. It is concluded that megavitamins are ineffective in the management of attention deficit disorders and should not be utilized because of their potential hepatotoxicity.

Analysis of Variance↗
PubMed1983

Infantile Huntington's disease.

A unique case of Huntington's disease is reported because of the extremely early onset and death, and the atypical mode of presentation including severe behavioural problems and a negative family history. Although rare, Huntington's disease must be considered along with the established degenerative disorders of white and gray matter peculiar to the pediatric population when one examines an infant or child with progressive motor deterioration, rigidity, mental retardation and behavioural abnormalities. Computed tomography is a reliable and non-invasive method of establishing the diagnosis during life.

Age Factors↗
PubMed1981

Cerebral asymmetry in developmental dyslexia.

The computed cranial tomograms (CCTs) of 26 dextral boys with developmental dyslexia were examined for asymmetry of width and length in the frontal and occipital regions. Contrary to several previous reports, reading disability was not associated with an increase in the frequency of reversed occipital widths. There were, however, proportionately more symmetric occipital widths than expected in comparison with a control sample and previously established norms. Differences in verbal or performance IQs were not related to relative cerebral size. Language delay was also not associated with brain measurements. The CCT may be increasing in use as a tool in the investigation of children with developmental dyslexia. We conclude that CCT is not warranted unless an underlying disorder associated with significant neurologic signs is discovered by examination.

Adolescent↗