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Biomedical subjects

W Feldman

Publications and source records attributed to W Feldman.

At least 55 records · Page 3Linked to original sources
PubMed1990

Methodologic limitations in the literature on vesicoureteral reflux: a critical review.

We analyzed studies concerned with four important aspects of vesicoureteral reflux in infancy and childhood: the imaging procedures for the evaluation of vesicoureteral reflux, the treatment of reflux, and the correlation between reflux and later development of hypertension and end-stage kidney disease. The objectives of the study were to evaluate the validity and reliability of the current literature, to draw conclusions, and to recommend future studies for unresolved issues. We reached the following conclusions: (1) Retrograde cystography should be the gold standard for diagnosing vesicoureteral reflux. When ultrasonography and cystography are performed together, all clinically important abnormalities in the urinary system are detected. Intravenous pyelography is needed only when either or both of these studies are abnormal. (2) Other than abolishing reflux, surgery offers no short-term advantages (in terms of preventing breakthrough urinary tract infections, improving renal function, or preventing the development of new scars, hypertension, or end-stage kidney disease) over medical management. (3) The short periods of follow-up and methodologic flaws encountered in the reviewed studies make determination of the incidence of hypertension in children with vesicoureteral reflux impossible. (4) Although indications for an association between vesicoureteral reflux and end-stage kidney disease exist, the strength of this association has not been determined.

Child↗
PubMed1990

Ultrasonographic studies in the management of recurrent abdominal pain.

The medical records of 65 children and adolescents who had abdominal ultrasonography for the evaluation of recurrent abdominal pain were reviewed. Fifty-three subjects (81%) had normal results; in 12 cases (19%) an abnormality was detected. In no case could the pain be attributed to the abnormal finding. Furthermore, in 3 subjects, disclosure of the abnormal findings could have caused more harm than good. The role of the abdominal ultrasonographic study in the management of recurrent abdominal pain in children and adolescents is discussed.

Abdomen↗
PubMed1990

Initial evaluation of heart murmurs: are laboratory tests necessary?

Heart murmurs, most of them innocent, are the most common reason for referrals to a pediatric cardiologist. In the evaluation of murmurs, the electrocardiogram and echocardiogram are often included. The purpose of this study was to determine the utility of these examinations in the initial assessment of heart murmurs in children and adolescents. In a prospective series of 161 patients, the clinical diagnosis of heart murmurs by a pediatric cardiologist was compared with that obtained after electrocardiogram and echocardiogram (two-dimensional, M-mode, Doppler, and color-Doppler). On the basis of the clinical diagnosis the patients were classified as having "innocent murmur," "pathologic murmur," or "possible pathologic murmur." A total of 161 patients (51% males), aged 1 month to 17 years (median 3.2 years), were studied. After electrocardiogram, no diagnosis was changed. After echocardiogram, the clinical diagnosis of innocent murmur in 109 patients changed in 2 to pathologic (small ventricular septal defect 1, small atrial septal defect 1); pathologic murmur in 46 changed to innocent in 3 and possible pathologic in 2; and possible pathologic in 6 changed to innocent in 3 and to pathologic in 2. The clinical examination by an experienced pediatric cardiologist is an accurate means of assessing newly referred patients with murmurs. The clinical examination had a sensitivity of 96%, specificity of 95%, positive predictive value of 88%, and negative predictive value of 98%. The electrocardiogram, unlikely to disclose any unsuspected heart disease, may assist in reaching the lesion-specific diagnosis when there is underlying pathology. Echocardiography, although diagnostic when heart disease is suspected, is unnecessary in pediatric patients with clinically diagnosed innocent heart murmurs.

Adolescent↗
PubMed1989

Chronic disease and its impact. The adolescent's perspective.

Although evidence suggests that adolescents with chronic illness are at a greater risk for psychosocial disability, little is known about the adolescent's perception of the impact of the disease on his or her day-to-day life. Standardized measures of coping strategies, mastery, self-efficacy, social support, depression, and a semistructured interview on everyday difficulties were administered to matched groups (sex and age) of 31 adolescents with cystic fibrosis, 31 adolescents with diabetes, and 31 healthy controls. No differences were found between control and adolescents with a chronic disease responses on the standardized measures. The semistructured interview, however, revealed that the adolescent's perception of his or her physical health and the reaction of other family members to the illness were important sources of stress. These findings suggest that, in general, adolescents with a chronic illness cope effectively with their disability but that parents and clinicians must be sensitive to the adolescents' feelings and concerns regarding their health and its impact on the family.

Adolescent↗
PubMed1988

Trimethoprim-sulfamethoxazole v. amoxicillin in the treatment of acute otitis media.

Although amoxicillin has long been the preferred drug for treatment of acute otitis media, resistant strains of two relatively common causal organisms have emerged, prompting a search for other antibiotics. We performed a randomized double-blind trial comparing amoxicillin and trimethoprim-sulfamethoxazole in 221 children in whom acute otitis media was diagnosed in an outpatient setting. Diagnosis was on the basis of symptoms, otoscopic examination and acoustic reflectometry. No culture specimens were taken. A research nurse, using the same methods, evaluated patients in a follow-up home visit at around 14 days and measured compliance by examination of the medicine bottle. Equal proportions of children in the two groups were cured or improved (88% and 87%). Therapeutic efficacy was related to compliance in both groups, and there were few side effects in either group. This study had statistical power of 80% to detect a difference of 15%. We conclude that trimethoprim-sulfamethoxazole can be considered a first-line antibiotic in the treatment of acute otitis media.

Acute Disease↗
PubMed1988

Culture versus biology: children's attitudes toward thinness and fatness.

Many of the studies regarding children's acquisition of prevailing cultural concepts of physical attractiveness are flawed by small and unrepresentative samples, measurement instruments of questionable reliability and validity, and experimental designs that do not protect against bias. Additional studies in which these methodologic flaws are overcome must be carried out if we are to understand truly when and how cultural concepts of beauty are acquired. Nevertheless, the majority of the studies already done find that children acquire prevailing cultural values of beauty before adolescence and that thinness is desirable to girls considerably before puberty. It is suggested that the etiology of eating disorders and the reasons for their increasing prevalence will not be discovered by studying only clinical cases. We propose that those interested in this important health problem study children before adolescence in an attempt to learn how preoccupation with weight begins and why thinness is believed to be attractive. Once these are understood, a greater challenge will be the development and testing of interventions--be they in the schools or using the media--which can effectively prevent this public health problem. When culture and biology clash, people may suffer.

Attitude↗
PubMed1986

Health concerns and health-related behaviours of adolescents.

Health promotion and treatment programs for adolescents must be tailored to the unique concerns and needs of this population. A questionnaire was mailed to 1000 adolescents aged 12 to 20 years in the Ottawa-Carleton region; 729 responded, giving information on their health concerns and habits. The teenagers reported worrying mostly about chronic conditions such as acne, menstrual disorders, emotional problems, dental problems and being overweight. Some of these conditions can be treated if care is sought. The psychosocial problems most important to the adolescents were school and family problems. Girls tended to report health concerns more often than boys, but there was little variation by age or social group. Although the proportions of adolescents who were smoking cigarettes, drinking alcoholic beverages or using "recreational" drugs or who had ever had sexual intercourse were relatively high, the number of respondents who perceived such habits as health problems was low. There was a low level of concern about birth control among the respondents, including those who indicated that they had had sexual intercourse. The fact that significantly more girls than boys reported that they smoked and had engaged in sexual intercourse suggests specific targets for health promotion activities.

Adolescent↗
PubMed1986

Inappropriate use of antibiotics in croup at three types of hospital.

Despite recent suggestions that bacterial infection is an increasingly important cause of serious croup, most authorities still consider croup a viral disease in which antibiotic therapy is unnecessary. To assess the frequency of antibiotic use in croup among children in hospital, we reviewed the records at three types of hospital in Ontario. Children with evidence of a concurrent infection that might be bacterial were considered to have received antibiotics appropriately. Whereas only 6% of cases at a university-affiliated children's hospital were inappropriately treated with antibiotics, the proportions at a small rural community hospital staffed by general practitioners and a general hospital staffed by both pediatricians and general practitioners in a medium-sized city were 63% and 38%. Possible reasons for these differences are discussed.

Anti-Bacterial Agents↗
PubMed1986

Characteristic craniofacial appearance and brachytelephalangy in a mother and son with Kallman syndrome in the son.

We report on a mother and son with a similar facies characterized by a square forehead, small nose, telecanthus, and thin upper lip. They both had a similar metacarpal-phalangeal profile characterized by marked brachytelephalangy. They were both short in comparison to other family members, and the son had hypogonadotropic-hypogonadism and anosmia. We favor the hypothesis of a single autosomal dominant gene with variable expression of the hypogonadism and anosmia, although there are alternative explanations for the combination.

Adolescent↗
PubMed1986

Clinical approach to recurrent abdominal pain in children.

Recurrent abdominal pain of childhood is a frequent complaint that is often difficult for the physician to manage. This paper outlines the various psychological and physiological factors that have been implicated in causing recurrent abdominal pain and in difficulties in coping with the disorder. Guidelines for diagnosis and management are offered.

Abdomen↗
PubMed1986

Adolescent health needs. II: Utilization of health care by adolescents.

In a random, mailed survey, 730 adolescents supplied information on their patterns and preferences for health care. The majority of respondents reported that they usually receive medical care from a private physician. Girls consulted physicians more frequently than boys, but there was no significant variation by age or social group. As the age of the respondent increased, the proportion visiting pediatricians decreased. When asked what they liked and disliked about their physician, respondents placed great emphasis upon the personal characteristics of the practitioner. Long waiting periods were the most common complaint. A significant proportion of adolescents with health concerns do not consult a health professional, even in cases where efficacious treatment may be available. Nervous/emotional problems, obesity, and birth control are concerns of adolescents which should be discussed with health professionals.

Adolescent↗
PubMed1985

The use of dietary fiber in the management of simple, childhood, idiopathic, recurrent, abdominal pain. Results in a prospective, double-blind, randomized, controlled trial.

Recurrent abdominal pain (RAP) affects 10% to 18% of school-age children and is caused by obvious organic pathology in fewer than 10% of cases. Two recent studies do not support previous beliefs that most RAP is psychogenic. Studies have shown disorders of bowel motility in children with RAP similar to those of adult irritable bowel syndrome (IBS); controlled trials of additional dietary fiber in adult IBS have shown beneficial results. We did a randomized, double-blind, placebo-controlled study in 52 children with RAP and demonstrated a clinically and statistically significant decrease in pain attacks (at least 50% fewer) in almost twice as many children who were given additional fiber as placebo. Compliance was excellent in both groups and side effects were few. Although the cause of RAP is poorly understood, it is hypothesized that the beneficial effect of added fiber is due to its effect on shortening transit time, as in IBS.

Abdomen↗
PubMed1985

Evaluation of child life intervention in emergency department suturing.

The effects of stress-reducing intervention in emergency department suturing were evaluated by comparing children receiving intervention from child life staff, with two control groups who did not receive intervention, control A at a pediatric hospital and control B at a general hospital. The following measures were obtained: observable anxiety during the procedure; the child's self-report of anxiety, self-report of pain, postemergency visit behavior, and anxiety about a return visit; the parent's overall rating of satisfaction with care given and the parent's feelings of anxiety. Children and parents in the intervention group received emotional support and information concerning the medical procedure, and were taught appropriate coping strategies. Measures were obtained across three age groups (four to six years, seven to 10 years, 11 to 14 years) divided by sex; site of cut (face or body), and extent of injury (five or fewer sutures, six or more sutures). Intervention had its greatest influence on 11- to 14-year-olds with a facial injury requiring six or more sutures. Children in the intervention group expressed fewer fears than children in the general hospital control group. Parents of children who received intervention reported a significantly higher degree of satisfaction with the overall care given in the emergency department.

Adolescent↗
PubMed1985

Environment and waiting behaviors in emergency waiting areas.

Environmental conditions and waiting behaviors of 625 children and their families were recorded in the waiting room and suture hall of a children's hospital and a general hospital. Randomized intervention and control days at the children's hospital resulted in children and their families being assigned to an experimental group receiving child life intervention or to a control group who did not receive child life intervention. A second control group at the general hospital did not receive child life intervention. The average waiting time was 1.5 hr. Significant differences were observed in noise level between the children's hospital and general hospital waiting areas, waiting behaviors of children who received child life intervention and those who did not, and parent-child interaction among the three groups. Suggestions for further study regarding the optimal use of waiting time are included.

Adolescent↗
PubMed1984

The pediatric walk-in clinic: competition for the private practitioner.

In an affluent city with many pediatricians a 20% increase in patients seen in a hospital-based walk-in clinic in 1982 prompted a study to determine the characteristics of clinic users and their reasons for using the clinic. It was found that users of the clinic were middle-class, that they had a higher employment rate than the average for the region, and that in 54% of the families both parents worked outside the home. The children of 85% of the families were patients of pediatricians in private practice; most of the others were patients of a family physician in private practice. Most of the children seen at the clinic had had symptoms for more than 24 hours, but few parents had attempted to contact their own physicians. In the previous 12 months 95% of the children had been seen at the clinic, 43% in the month preceding the study. They came to the clinic for two main reasons: the broad range of services offered --laboratory, radiology and pharmacy as well as medical--and the convenient hours, with 71% coming outside of their physicians' office hours. Given the reality of social trends pediatricians will either have to share their patients with facilities that offer services outside of regular office hours or devise another system for the treatment of their patients.

Child, Preschool↗
PubMed1984

How many well-baby visits are necessary in the first 2 years of life?

Since we could find no scientific basis for the 10 well-baby visits recommended in the first 2 years of life in Ontario, we carried out a randomized trial in 570 healthy, low-risk newborns to determine the efficacy and safety of decreasing the number of scheduled well-baby visits from 10 to 5. Among the 466 babies still in the trial at the end of the study period those in the 10-visit group had had a mean of 7.63 scheduled and 0.26 unscheduled well-baby visits and those in the 5-visit group a mean of 4.77 scheduled and 1.42 unscheduled well-baby visits. Reducing the recommended number of visits did not result in an increased incidence of illness or an increased prevalence of undetected abnormality, and the physical development of the babies in the two groups was almost identical. The mean scores of the two groups in assessments of mental development, maternal-child relations, maternal anxiety and parental satisfaction with health care were close. The results suggest that the recommended number of well-baby visits for healthy, low-risk newborns can be reduced to five for children of multiparas and six for children of primiparas. Any additional well-baby visits should be scheduled according to the needs and experience of the parents.

Child Development↗