Biomedical subjects

Tomas J Silber

Publications and source records attributed to Tomas J Silber.

15 recordsLinked to original sources

PubMed2006

Hospitalization of children and adolescents for eating disorders in the State of New York.

PURPOSE: To examine hospitalization patterns, length of stay, cost and insurance status for children and adolescents with Eating Disorders. METHODS: A cross-sectional study was conducted of patients with eating disorders aged 9 to 17 years, discharged from hospitals in the State of New York in 1995. All patients discharged in the state were registered by the State Planning and Research Collaborative System (SPARCS). A subset was identified based on coding by the International Classification of Diseases (ICD) for Anorexia Nervosa, Bulimia and Eating Disturbance Not Otherwise Specified. The Statistical Analysis System (SAS) was used for data analysis. The variables selected were gender, ethnicity, insurance status and length of stay. RESULTS: In one year there were 352 hospitalizations, 312 females (88.6%) and 40 males (11.4%); 279 Caucasians (79.3%), 35 African Americans (9.9%), and 38 Other (10.8%); commercial insurance 246 (69.9%), Medicaid 68 (19.3%), other 38 (10.8%). The diagnostic categories were Anorexia Nervosa 242, Bulimia 59, and Eating Disturbance Not Otherwise Specified 63 (reflecting dual diagnosis in 13). Mean length of stay was 18.43 days, the median was 7 days. The cost per stay ranged between 341.78 dollars and 148,471 dollars; with a median of 3817 dollars and a mean of 10,019 dollars. Length of stay was not influenced by gender, age, or ethnicity; only payor status, availability of insurance, was dominant. CONCLUSIONS: This is the first statewide report on hospitalization of children and adolescents for eating disorders. The mean cost in 1995 exceeded 10,000 dollars. A correlation was found between length of stay and insurance status. Hospitalizations for eating disorder have a significant public health impact, calling for the formulation of fair and rational strategies to optimize care.

Adolescent↗

PubMed2006

Clinical trials in pediatric traumatic brain injury: unique challenges and potential responses.

In order to optimize pediatric traumatic brain injury translational and clinical research, scientific and ethical challenges need to be recognized and addressed. Having recently conducted a multisite phase II safety/feasibility trial of magnesium sulfate as a neuroprotective agent, we supplement our own experience by a mini review of similar studies, identifying challenges and possible responses from the perspective of families, investigators, funding agencies and society.

Brain Injuries↗

PubMed2005

Ipecac syrup abuse, morbidity, and mortality: isn't it time to repeal its over-the-counter status?

PURPOSE: To review and address the abuse of ipecac, describing its epidemiology, toxicity, clinical characteristics, and laboratory assessment. METHODS: A Medline search (1980-2003) for Ipecac abuse and Ipecac toxicity, n = 34. RESULTS: Ipecac abuse occurs predominantly among adolescent and young adult females who are either experimenting with purging or have an eating disorder. Psychiatric comorbidity is common. Death can occur and is usually of cardiac origin. Morbidity includes myocarditis with arrhythmias, myositis, gastroesophageal pathology, including Mallory Weiss tears, diarrhea, and metabolic abnormalities (alkalosis, hypokalemia, dehydration). The injuries can reverse with cessation of ipecac use. A high index of suspicion is needed for early detection. Classic findings are abnormal EKG and echocardiography and/or elevation of muscle enzymes (CPK, adolase). Emetine, the alkaloid in ipecac, can be confirmed in serum, urine, and tissue by high performance liquid chromatography. CONCLUSIONS: Ipecac abuse is dangerous, even deadly. However, if abuse is discontinued, cardiac and muscle damage tends to reverse. Were ipecac syrup to remain an over- the-counter medication, or become a prescription medication, more stringent warning labels ought to be included and further education be provided about its toxicity and potential for abuse. Removing ipecac from the over-the-counter category would best eliminate its potential for abuse.

Adolescent↗

PubMed2005

Premenstrual dysphoric disorder in adolescents: case reports of treatment with fluoxetine and review of the literature.

Premenstrual dysphoric disorder (PMDD) is a periodic, recurrent, debilitating condition with severe psychological or affective symptoms during the late luteal phase. PMDD often begins during adolescence. Dysregulation of the serotonergic system has been proposed recently as its cause and fluoxetine has been recommended as an appropriate treatment. We report 3 adolescents with PMDD who were treated for 2 years with fluoxetine, resulting in complete symptom resolution, and review the clinical trials supporting its use. Case reports of successfully treated teenagers are an addition to the accumulated evidence of the efficacy of fluoxetine for treatment of PMDD in adult women. Together they may provide some justification for the compassionate use of fluoxetine for adolescent girls who are being disabled by PMDD. However, more research is called for: a randomized placebo-controlled trial in adolescents is warranted.

Adolescent↗

PubMed2005

Will I be alive in 2005? Adolescent level of involvement in risk behaviors and belief in near-future death.

OBJECTIVE: We examined the association between a belief in one's future mortality and various risk-taking behaviors among urban black adolescents. In particular, we investigated whether adolescents with higher levels of participation in various risk behaviors were more likely to believe in their future death as compared with adolescents with lesser levels of risk-taking behavior. METHODS: Data obtained from April 1994 to March 1997 were analyzed for a total of 2694 adolescents, aged 12 to 21 years. The odds of believing that one would die within the next 2 years were calculated for various levels of participation in risk behaviors involving alcohol, drugs, and criminal or violent acts. RESULTS: A total of 160 adolescents (7.1% of all boys and 5.4% of all girls) reported that they believed that they would die within the next 2 years. The adjusted odds of future death belief among adolescents who both actively engaged in and knew others who participated in all of the various risk behaviors, relative to adolescents who neither personally engaged in nor knew others who participated in any of the risk behaviors, was 3.22 (95% confidence interval [CI]: 2.01-5.17) vs 1.14 (95% CI: 0.67-1.95) for drug use and drug selling, 2.01 (95% CI: 1.38-2.92) vs 0.8 (95% CI: 0.39-1.62) for combined alcohol and drug use, and 5.60 (95% CI: 2.03-15.47) vs 1.61 (95% CI: 1.08-2.42) for violent physical behavior. In addition, residence in a foster home was significantly associated with death belief after adjustment for all other variables. CONCLUSIONS: There is a significant relationship between certain risk behaviors and belief in near-future death. Moreover, higher levels of involvement in risk behaviors were associated with a stronger likelihood of belief in near-future mortality. Identification of adolescents who engage in certain risky behaviors, combined with a recognition of the degree to which the adolescent participates in the particular behavior(s), may be used to facilitate more rapid intervention among youths who either believe in their imminent demise or engage in behaviors that increase the likelihood of their untimely death.

Adolescent↗

PubMed2004

Nocturnal nasogastric refeeding for hospitalized adolescent boys with anorexia nervosa.

Boys with anorexia nervosa have nutritional needs exceeding those of their female counterparts. For many males with anorexia nervosa, oral refeeding alone may result in low discharge weight, a critical risk factor in relapse. This study compared the short-term outcomes of oral refeeding (OR) and a combination of OR with supplemental nocturnal nasogastric refeeding (NNGR) in a sample of hospitalized boys. This was a retrospective chart review with a cohort design. Subjects were partitioned into: The OR group (n = 8, mean age = 14.9, SD = 1.7) and the OR + NNGR group (n = 6, mean age = 13.8, SD = 2.0). The NNGR group had greater increase in weight and Body Mass Index. Their average length of hospitalization was also shorter. Nocturnal nasogastric refeeding, complementing oral refeeding, should be considered as an alternative initial therapy for weight restoration in males with anorexia nervosa.

Adolescent↗

PubMed2003

Urine testing for drugs of abuse: a survey of suburban parent-adolescent dyads.

BACKGROUND: The American Academy of Pediatrics is opposed to involuntary diagnostic testing for drugs of abuse. OBJECTIVE: To gather data about attitudes of parents and their teenagers about involuntary drug testing on parental request. DESIGN: Adolescents and their accompanying parents separately answered a printed survey in the offices of their private pediatrician. The survey posed 2 hypothetical questions about urine testing: (1) Do parents have the right to ask a teenager's physician to order a urine test for drugs of abuse without the teenager's knowledge-if the teenager has falling school grades, an uncooperative attitude, and major untruthfulness? (2) In such a case, should the teenager's physician obtain a urine test for drugs on parental request only, without the teenager's consent? RESULTS: A total of 393 paired evaluable surveys were collected: 77.6% from Virginia and 22.4% from Ohio. There were no significant differences in answers between the 2 study sites. Of the students, 85.8% had either an A or a B grade point average. Current marijuana use was unusually low in our teenaged respondents. Of the parents surveyed, 81.7% would want a physician to be able to perform a urine test for drugs of abuse for a problematic teenager without the young person's consent. The answers to the 2 questions about urine drug tests had poor kappa coefficients of agreement between teenagers and parents (0.04 and 0.09, respectively). Reanalysis, using the variables of age, grade point average, and frequency of marijuana smoking, showed little difference in agreement scores. CONCLUSIONS: In the 2 suburban pediatric practices surveyed, parental opinions and expectations were at variance with the American Academy of Pediatrics policy statement on nonconsensual urine drug testing in the presence of clinical problems. Pediatricians need to be conscious of this clinical-ethical dilemma, become familiar with the American Academy of Pediatrics policy on drug testing, and develop their own position and expertise in this area. The dyad method (parent-teenager survey) is novel and improved the methodology of our study. We surveyed middle-class suburban adolescents while previous studies of adolescents surveyed inner-city populations.

Adolescent↗

PubMed2002

Eating disorders and health insurance understanding and overcoming obstacles to treatment.

Eating disorders are complex in cause and course, with biomedical, psychiatric, and psychosocial components. To maximize the likelihood of recovery, patients require skillful and coordinated care from various health care professionals, including medical professionals, mental health professionals, and nutritionists. All too often, at some point in treatment, clinicians discover that their patients' health insurance status has been compromised or that further treatment is denied because of maximization of mental health benefits. It is important for patients, families, and health care professionals to understand the health insurance issues that are involved in the treatment of eating disorders and learn strategies that may help to overcome the obstacles that these issues present.

Adolescent↗

PubMed2002

Supplemental nocturnal nasogastric refeeding for better short-term outcome in hospitalized adolescent girls with anorexia nervosa.

OBJECTIVE: Although controversy exists regarding nasogastric refeeding for patients with anorexia nervosa, current methods of inpatient care often result in low discharge weight, a critical risk factor in relapse. This study compared the short-term outcomes of standard oral refeeding and supplemental nocturnal nasogastric refeeding. METHOD: Subjects were 100 hospitalized Caucasian adolescent girls who met DSM-IV criteria for anorexia nervosa. Subjects were partitioned into two groups: oral refeeding (N=48, mean age=15.0 years, SD=1.8) and nocturnal nasogastric refeeding (N=52, mean age=14.8 years, SD=1.9). Unpaired t tests, with Bonferroni correction, were used to compare groups at hospital admission and at discharge. Multivariate linear regression was used to establish the independent effects of nocturnal nasogastric refeeding after adjustment for potential confounding variables. RESULTS: On admission, the groups were comparable in terms of age, weight, and other factors but differed significantly in number of prior hospitalizations (the nocturnal nasogastric refeeding group had more than the oral refeeding group). A series of separate multivariate linear regression models revealed that nocturnal nasogastric refeeding was a significant predictor of weight at discharge and absolute weight gain. CONCLUSIONS: Over a comparable period of time, patients treated with nocturnal nasogastric refeeding had a greater and more rapid weight gain than patients treated with traditional oral refeeding. Supplemental nocturnal nasogastric refeeding was more effective than oral refeeding alone in weight restoration during hospitalization. However, further study is needed on its short-term and long-term effectiveness.

Adolescent↗

PubMed1982