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Biomedical subjects

W A Altemeier

Publications and source records attributed to W A Altemeier.

At least 19 recordsLinked to original sources
PubMed1992

Antecedents of child neglect in the first two years of life.

To determine the prenatal antecedents of child neglect by low-income women, data from a prospective study of child maltreatment were reviewed. Mothers determined to be at high risk prenatally for maltreatment were more likely to be identified as neglectful within 24 months of the interview. Neglectful mothers were less likely to have completed high school, had more children younger than 6 years of age, and had more aberrant responses on parenting skills and support systems scales. Neglected children were lower in birth weight, were rated more difficult temperamentally, and had poorer mental and motor developmental scores.

Child Abuse↗
PubMed1992

Suppression of longitudinal versus transverse conduction by sodium channel block. Effects of sodium bolus.

BACKGROUND: Arrhythmias resulting from treatment with sodium channel-blocking antiarrhythmic drugs have been successfully treated with sodium infusion, although the mechanism underlying this effect is uncertain. METHODS AND RESULTS: In this study, we used a multielectrode array to examine the effects of O-desmethyl encainide (ODE), a potent sodium channel-blocking metabolite of encainide, on conduction in canine ventricle. ODE depressed both longitudinal and transverse conduction velocities in a plasma concentration-related fashion (r = -0.74, -0.60; p less than 0.001). At ODE concentrations less than or equal to 300 ng/ml (n = 34), conduction velocity was depressed to the same extent in the longitudinal (-21.9 +/- 8.4%, SD) and transverse orientations (-22.0 +/- 8.8%). However, at concentrations greater than 300 ng/ml (n = 17), conduction was significantly more impaired longitudinally than transversely (-44.5 +/- 11.7% versus -34.4 +/- 13.7%, p less than 0.02). In 12 animals with high concentrations (mean, 432 +/- 32 ng/ml), a 5-meq/kg bolus of sodium chloride over 1 minute immediately increased conduction velocity; this effect was significantly greater and longer lasting in the longitudinal orientation. In two animals, conduction block in the longitudinal orientation was documented at high plasma ODE and was immediately reversed by sodium bolus. CONCLUSIONS: We conclude that the major effect of sodium in animals with excess sodium channel block is improvement of longitudinal propagation; this effect may underlie the antiarrhythmic action of sodium in the analogous clinical setting.

Animals↗
PubMed1992

Improving resources for foster care.

The number of foster children and their psychological and medical morbidity are growing. To gain insight into how to recruit and retain foster homes, characteristics of 64 foster families were determined by interview. Foster parents had low-to-moderate incomes, were approaching middle age, had underutilized home space, and wanted more children. Most enjoyed foster care and planned to continue. Twenty-three percent of the 64 had half of all foster children in the study in their homes at interview and had cared for seven times as many children in the past, including 66% of all the teens and 83% of all the handicapped children who had been in the 64 homes. These "high providers" functioned like group homes for mentally handicapped individuals. Adapting the group-home concept to foster homes could improve care, especially for children with special needs.

Adult↗
PubMed1992

Randomized trial of comprehensive prenatal care for low-income women: effect on infant birth weight.

The effect of comprehensive prenatal care on birth weight was examined using a prospective randomized design. A total of 428 pregnant women were randomly assigned to comprehensive prenatal care (n = 217) or standard prenatal care (n = 211). Comprehensive care was provided by a multidisciplinary team of nurse-midwives, social workers, a nutritionist, paraprofessional home visitors, and a psychologist. Standard prenatal care consisted of medical care provided by obstetric residents. Multiple regression analysis using behavioral, demographic, and medical variables showed a strong relationship between the set of predictors and birth weight. Comprehensive care was related to higher birth weights for primiparous but not multiparous mothers. Separate analyses of variance for primiparas and multiparas similarly showed a favorable effect of comprehensive care on birth weight for primiparous but not multiparous mothers.

Birth Weight↗
PubMed1991

Interpretations of colposcopic photographs: evidence for competence in assessing sexual abuse?

Accurate assessment of physical findings for child sexual abuse is medically and legally important. This study evaluated (1) interobserver reliability of clinicians rating colposcopic photographs, and (2) correlates of reliable interpretations. Seventy physicians and two nurse practitioners, divided by professional levels, assessed colposcopic photographs and completed a questionnaire. Ratings by a professional with extensive experience in this field were used as an accuracy standard. Leaders in the field of child sexual abuse assessment made significantly more "accurate" assessments than pediatricians, pediatric and family practice residents, and intern physicians. Leaders made fewer "inaccurate" interpretations than interns. Predictors of agreement with standard assessments, although weak, were knowledge of female perineal anatomy and professional level. Total number of sexual abuse examinations conducted and knowledge of sexually transmitted diseases as acquired by children were not significant predictors of accurate assessment. The findings are interpreted as to their potential relevance to actual sexual abuse evaluations of children.

Child↗
PubMed1991

Virtual cathode effects during stimulation of cardiac muscle. Two-dimensional in vivo experiments.

We have found that when suprathreshold cathodal stimuli were applied to the epicardium of canine ventricle, impulse propagation originated at a "virtual cathode" with dimensions greater than those of the physical cathode. We report the two-dimensional geometry of the virtual cathode as a function of stimulus strength; the results are compared with the predictions of an anisotropic, bidomain model of cardiac conduction recently developed in our laboratories. Data were collected in six pentobarbital-anesthetized dogs by using a small plaque electrode sewn to the left ventricular epicardium. Arrival times at closely spaced bipolar electrodes oriented radially around a central cathode were obtained as a function of stimulus strength and fiber orientation. The dimensions of the virtual cathode were determined by linear back-extrapolation of arrival times to the time of stimulation. The directional dependence of the conduction velocity was consistent with previous reports: at 1 mA, longitudinal (0 degree) and transverse (90 degrees) velocities were 0.60 +/- 0.03 and 0.29 +/- 0.02 m/sec, respectively. At 7 mA, the longitudinal velocity was 0.75 +/- 0.05 m/sec, whereas there was no significant change in the transverse velocity. In contrast to conduction velocity, the virtual cathode was smallest in the longitudinal orientation and largest between 45 degrees and 60 degrees. Virtual cathode size was dependent on both orientation and stimulus strength: at 0 degree, the virtual cathode was small (approximately 1 mm) and relatively constant over the range of 1-7 mA; at oblique orientations (45 degrees-90 degrees), it displayed a roughly logarithmic dependence on stimulus strength, approximately 1 mm at 1 mA and approximately 3 mm at 7 mA. The bidomain, anisotropic model reproduced both the stimulus strength and the fiber-orientation dependence of the virtual cathode geometry when the intracellular and extracellular anisotropies were 10:1 and 4:1, respectively, but not when the two anisotropies were equal. We suggest that the virtual cathode provides a direct measure of the determinants of cardiac activation; its complex geometry appears to reflect the bidomain, anisotropic nature of cardiac muscle.

Animals↗
PubMed1990

Should promethazine in liquid form be available without prescription?

Promethazine, available by prescription only since its introduction in 1946, has been widely used for pediatric patients because of its antihistaminic, antiemetic, and sedative properties. Recently, it's makers have sought Federal Drug Administration approval to introduce two liquid over the counter allergy/cold/cough products containing promethazine as an active ingredient. Although millions of doses have been administered, promethazine use has not been free of risk. Promethazine has been reported to cause significant sedation, agitation, hallucinations, seizures, dystonic reactions, and possibly apparent life-threatening events or sudden infant death syndrome. The impact of these relatively uncommon adverse reactions on children would be minimal if parents would use over the counter promethazine only for appropriate indications and only in children greater than 2 years of age. However, according to results of research evaluating the use of various over the counter medications by families for their children, promethazine will be used inappropriately. Both its over the counter status, implying a certain margin of safety, and its formulation as a syrup, providing ease of administration, should increase its use in all age groups including that by children less than 2 years of age who may be most vulnerable to the adverse reactions associated with the drug's use.

Chemistry, Pharmaceutical↗
PubMed1990

Play and imitation skills in the diagnosis of autism in young children.

Play behaviors and motor imitation skills of 91 children between the ages of 3 and 6 years were investigated to determine their utility in distinguishing autism from mental retardation and other communication disorders. The performance of 22 autistic children was compared with that of 15 mentally retarded, 15 hearing-impaired, 19 language-impaired, and 20 non-handicapped children. Play behaviors were assessed using structured observations of free-play activities, and imitation skills were measured using a set of 12 individually administered tasks. The autistic group spent less total time interacting with toys and using toys appropriately, engaged in fewer functional play acts, and obtained lower imitation scores compared with all other groups. Discriminant function analysis revealed that the latter three variables discriminated the autistic children from the nonautistic handicapped children, with motor imitation emerging as the most important differentiating measure. These results suggest that measuring play and imitation skills may be useful in the clinical diagnosis of autism.

Autistic Disorder↗
PubMed1989

The importance of parents' concerns about their child's development.

Parents are often concerned about their child's development, but it is unknown whether concerns indicate actual developmental problems. Pilot studies within 96 families showed that parents' concerns about their children's development took the form of value judgments, could be classified into commonly accepted developmental domains, and related to performance on screening tests. In our study, 100 families seeking pediatric care were asked to list any concerns about their child's development while their children received developmental screening. Eighty percent of the children who failed screening had parents with concerns about articulation, language, fine-motor skills, or global development. Ninety-four percent of the children who passed screening had parents with no concerns or concerns in other developmental areas. The types of concerns parents raised did not vary significantly with level of education, experience in child rearing, or other demographic variables. These results suggest that parental concerns may be a helpful adjunct to standardized developmental screening.

Child Development↗
PubMed1989

Parental administration of chemical agents: a cause of apparent life-threatening events.

Nine infants with apparent life-threatening events that occurred as a result of poisoning by a caretaker are described. These episodes were characterized by apnea plus some combination of color change, choking or gagging, and abnormal muscle tone. Five of the infants responded to vigorous stimulation, and four required cardiopulmonary resuscitation. Most poisonings (seven infants) were detected by a urine drug screen. Medications detected included acetaminophen, amphetamine, benzodiazepines (two infants), cocaine, codeine, meperidine (two infants), Methadone, phenobarbital, and phenothiazines (three infants). Four infants received two or more drugs. Most perpetrators of the poisonings were mothers (seven) and five of the parents admitted administering the various agents. Reasons for the poisonings included an apparent attempt to harm an infant, the need to sedate a fussy infant, or a gross misunderstanding of the potential risk of various agents to infants. Because no history of drug administration was elicited at the time of hospital admission, six infants might have been discharged with a diagnosis of apnea of infancy had not an attempt been made to investigate the possibility of poisoning. These cases suggest that poisoning by a caretaker should be added to the differential diagnosis of any infant brought to medical attention because of an apparent life-threatening event and that urine drug screening should be considered in the evaluation.

Acetaminophen↗
PubMed1988

First step in obtaining child health care: selecting a physician.

To investigate the process by which families identified and selected their children's current physicians, a close-ended questionnaire was administered to 750 families in a mail panel. Of 630 responses (84.0%), 244 had children in the home; 229 (93.9%) identified a regular and current physician for their youngest child. However, parents did not spend much time or energy selecting a physician and rarely explored medical expertise in their decisions. Families averaged 1.2 sources of information consulted per decision; few considered more than two physician choices and infrequently considered alternative types of doctors (pediatricians v family or general practitioners). Selection priorities ranked in order of importance concerned parents' perceptions of their doctors' communication skills, accessibility, and quality as determined by recommendations of friends or physicians. Parents appeared less concerned with issues of cost and convenience. Families selecting pediatricians differed from those selecting family and general practitioners in sources of information used and selection priorities. The survey also identified 84 families who had changed or seriously considered changing the physician who was caring for their youngest child. The most frequent dissatisfaction was the perception that an illness was not being managed adequately, followed by believing that the doctor or staff were rude or unconcerned. Families unhappy with pediatricians expressed different reasons from those unhappy with family or general practitioners. The study results provide insight about the first step in obtaining child health care services, a relatively unexplored area of patient decision making.

Adolescent↗
PubMed1987

Physician reimbursement by salary or fee-for-service: effect on physician practice behavior in a randomized prospective study.

We used a resident continuity clinic to compare prospectively the impact of salary v fee-for-service reimbursement on physician practice behavior. This model allowed randomization of physicians into salary and fee-for-service groups and separation of the effects of reimbursement from patient behavior. Physicians reimbursed by fee-for-services scheduled more visits per patient than did salaried physicians (3.69 visits v 2.83 visits, P less than .01) and saw their patients more often (2.70 visits v 2.21 visits, P less than .05) during the 9-month study. Almost all of this difference was because fee-for-service physicians saw more well patients than salaried physicians (1.42 visits and .99 visits per enrolled patient, respectively, P less than .01). Evaluating visits by American Academy of Pediatrics' guidelines indicated that fee-for-service physicians saw more patients for well-childcare than salaried physicians because they missed fewer recommended visits and scheduled visits in excess of those recommendations. Fee-for-service physicians also provided better continuity of care than salaried physicians by attending a larger percentage of all visits made by their patients (86.6% of visits v 78.3% of visits, P less than .05), and by encouraging fewer emergency visits per enrolled patient (0.12 visits v 0.22 visits, P less than .01). Physicians' interest in private practice, as determined by their career plans, correlated significantly with total number of patients enrolled (r = .48, P less than .05) and total clinic patients seen by each resident during the study (r = .40, P less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Outcome of abuse during childhood among pregnant low income women.

The outcome of experiencing abuse as a child was studied by comparing pregnant women who did recall versus those who did not recall this type of maltreatment. Fourteen hundred low income women were interviewed in prenatal clinic; those who said they were both punished by abuse and beaten by caretakers as children were considered abused. Abuse was recalled by more white than black women but families were followed after delivery and protective service reports of abuse for their offspring were equal. Because of low numbers, black subjects were dropped and the 95 white women who recalled abuse during childhood were compared to the remaining 832 white subjects. The groups did not differ in attitude about current pregnancy, age or marital status, and no differences were found for their children at birth. Abused mothers were more likely to have felt unwanted and unloved as children and to have lower self-images and more isolation than controls. Abused mothers had greater stress, and many of their stresses reflected disturbances in interpersonal relationships. Thus, women abused as children had some characteristics similar to those of known child abusers. Although abused women had more aggressive tendencies, their children were reported to protective services for abuse at the same frequency as control children. Intergenerational transmission of abuse was therefore not demonstrated prospectively. Classic theories of child abuse suggest a special child, special parent and stress act as independent agents to cause abuse. The above data suggest, alternatively, that abuse during childhood may lead to other risk characteristics and to greater stress. These may act together to increase risk for abuse. The special child may have an independent influence on abuse.

Adaptation, Psychological↗
PubMed1985

Prospective study of antecedents for nonorganic failure to thrive.

The cause of nonorganic failure to thrive (NFT) was studied prospectively in 274 low-income pregnant mothers by interviewing them for characteristics that retrospective studies indicated were associated with child maltreatment. After delivery, medical charts of mothers and infants were reviewed for complications of pregnancy, delivery, and postdelivery hospitalization, and the infants were observed for growth failure. The characteristics of 15 families with infants who developed NFT were compared with those of 86 selected randomly from the remaining families. Interview results suggest that NFT correlates significantly with aberrant nurture during the mother's childhood and with conflicts between the parents of the infants. Perinatal events correlating significantly with NFT include complications of pregnancy, short gestation, and residual minor medical problems at discharge from the nursery. We speculate that these events predispose to NFT by disturbing the development of the mother-infant relationship.

Failure to Thrive↗
PubMed1983

Staphylococcus in toxic shock syndrome and other surgical infections. Development of new bacteriophages.

Recent studies of Staphylococcus aureus isolates from patients with toxic shock syndrome (TSS) have shown the dominance of phage type 29/52 with the capacity to produce pyrogenic exotoxin C and enterotoxin F. They also showed that 29% of the isolates were nontypable and 90% of them had similar toxigenic properties. The existence of unknown and important phages in this disease was postulated. Five new phages were then developed and used for typing three groups of staphylococcal isolates: 236 from patients with TSS, 67 from patients without TSS, and 159 from patients with infected burns. Results showed a high correlation between the lytic action of the new phages and the 29/52 phages, and an additional typing capability in 35% of the previously nontypable TSS isolates, emphasizing further the potential of bacteriophage typing of S aureus in these infections.

Bacteriophage Typing↗
PubMed1982

Staphylococcus aureus associated with toxic shock syndrome: phage typing and toxin capability testing.

Phage type 29 Staphylococcus aureus was identified singly or with type 52 in 64.1% of 248 coded isolates from patients with toxic shock syndrome. These phage types also have a high capability of producing pyrogenic exotoxin C and enterotoxin F. The origin and development of these toxigenic strains were explored by studying 25,220 isolates of S. aureus stored in a staphylococcal bank between 1960 and 1979. A small percentage of phage types 29, 52 were found in 1960, but their prevalence increased between 1961 and 1970, and continued at elevated levels through 1979. The toxigenic capabilities of these phage types were apparently acquired about 1971 and increased up to 1975. High levels of prevalence persisted during the following 4 years, and receded in 1980 and 1981. Other evidence during 1980 and 1981 indicates that these strains of S. aureus have become an important pathogen in surgical wounds, burns, and other infections.

Bacterial Toxins↗