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[Body mass index and body image perception in a Mexican adult population: the accuracy of self-reporting].

OBJECTIVE: To evaluate the accuracy of the self-reported body mass index and body image perception in a population of Mexican adults. MATERIAL AND METHODS: In 1998, in the state of Morelos, Mexico, participants in the longitudinal study of Mexican Social Security Institute workers "IMSS Cohort Study" responded to a baseline, self-administered questionnaire designed to collect a large variety of lifestyle risk factors for chronic diseases. Participants self-reported their body image by selecting the silhouette that best portrayed them, from a set of silhouettes ranked from 1 to 9. Participants also self-reported their current weight and height, unaware that direct measurements of weight and height were to follow. Four to eight months later participants were weighed and their heights were measured using standardized procedures. Spearman correlations were computed to analyze the correlation between self-reported and measured data. The Kruskal-Wallis test was used to evaluate the magnitude of difference between measured and self-reported height, weight and body mass index (BMI) (measured minus self-reported), by educational level and categories of age. Robust regression was used to evaluate the potential effect of specific individual characteristics on differences between measured and self-reported weight and height. Logistic regression analysis was used to evaluate the sensitivity, specificity, and predictive values for BMI. RESULTS: The study included 934 subjects, of which 62.6% were female. Females had a mean measured height of 1.55 m (SD 0.06) and weight of 65.4 kg (SD 10.9), while males had a mean height of 1.67 m (SD 0.06) and weight of 77.7 kg (SD 12.5). The mean BMI was 27.4 kg/m2 (SD 4.3) (females: 27.2 kg/m2 +/- 4.45; males: 27.8+/-3.87). The median of body image perception (BIP) was 5 (25th percentile=4; 75th percentile=6). Correlations between measured and self-reported height, weight, and BMI for all subjects were 0.94, 0.96, and 0.90, respectively. The correlation between BMI and BIP was 0.64 (0.67 for females and 0.59 for males). Self-reported mean varied no more than 1.3 cm from measured height and no more than 3.17 kg from measured weight. Error estimations of height, weight, and BMI decreased with educational level. Sensitivity and specificity before adjusting self-reported BMI with overweight and obesity categories that were collapsed into one were 94.8 and 83.0%, respectively; for BIP, those values were 87.6 and 48.9%. CONCLUSIONS: The results suggest that self-reported BMI and BIP can be useful indicators of an overweight condition in Mexican adults. The sensitivities and specificities associated with corrected self-reported BMI categories could be used to adjust odds ratios and relative risks, calculated from BMI levels derived from the self-reported BMI. Body image perception made it possible to correctly classify individuals with BMI > or = 25, showing that it may be a valid estimate for use in epidemiological surveys.

Adolescent↗
PubMed2001

Men of low socio-economic and educational level possess pronounced deficient knowledge about the risk factors related to coronary heart disease.

BACKGROUND: The aim of the present study was to determine whether certain background factors such as gender, education and social status were associated with an individual's knowledge of coronary heart disease (CHD) risk factors. DESIGN: A questionnaire survey. METHODS: A questionnaire survey designed to evaluate participants' general knowledge about the risk factors for CHD was used. A total of 1011 50-year-old individuals (457 men and 554 women) from 34 Health Care Centers participated in the study. RESULTS: Knowledge about CHD risk factors was significantly poorer in men than in women. Low education and low socio-economic status were other factors related to poor knowledge of CHD risk factors. CONCLUSION: This study showed that men with low educational level and low socio-economic status had inadequate information about the risk factors involved in CHD.

Coronary Disease↗
PubMed1998

Snake bites recorded by veterinary practices in Australia.

OBJECTIVE: To determine the extent of the snake bite problem in domestic animals, its regional significance and the effects of antivenom treatment. DESIGN: A questionnaire was designed seeking information on the number and type of domestic animals referred, whether treated or untreated, type of snakes and management of the bite. PROCEDURE: The survey form was sent to 10% of veterinary surgeons, selected at random throughout Australia. RESULTS: The response of 106 veterinary surgeons revealed that snake bite in domestic animals is frequent, with an estimated 6200 cases reported annually. Bites were more prominent in rural (78%) than urban areas (22%) with brown, tiger and black snakes accounting for 76%, 113% and 6% of cases, respectively. Cats and dogs were the most frequently reported victims. Ninety-one percent of cats and 75% of dogs survived following the administration of antivenom whereas 66% of cats and 31% of dogs survived without antivenom. Overall, in 33% of cases antivenom was not used, and venom detection kits were used in only 1% of cases. A number of drugs were used in various combinations with or without antivenom and intravenous fluids in the treatment of animals with snake bite, but their role in reducing the severity of envenomations was not assessed. CLINICAL IMPLICATIONS: Antivenom significantly improves the chances of survival of domestic animals bitten by snakes.

Animals↗
PubMed2001

First steps in developing a managed clinical network for vascular services in Lanarkshire.

AIM: To survey key personnel involved in setting up a Managed Clinical Network (MCN) for vascular services in Lanarkshire to assess their views, knowledge and understanding about networking, with a view to facilitating the implementation of the MCN. DESIGN: A questionnaire was designed covering current networking practice, use of protocols, audit and training. It was piloted with the MCN core group and extended to the wider steering group. Semi-structured interviews were completed with core group members focusing on the structure and management of the network. SETTING: Lanarkshire Health Board, Lanarkshire Acute Hospital Trust and Lanarkshire Primary Care Trust. SUBJECTS: The core group and steering group for the development of a Managed Clinical Network for Vascular Surgical Services. RESULTS: Clinicians tend to have more contacts with clinicians and managers with managers. There was close and frequent networking among clinicians of equal status. Respondents shared increased expectations for participation in audit, working to protocols, training and development and improved means of obtaining patients' views and providing information. All respondents recognised the necessity for network leadership although, in this study, it was not possible to define the style of leadership. CONCLUSION: This study identified a degree of existing, informal networking among members of the core group and steering group and it will be important to build on that foundation as the MCN develops. Further research is required to determine the most appropriate form of leadership for the network, and to identify, more clearly, what is understood by a managed network and what accountability there should be.

Attitude of Health Personnel↗
PubMed2003

Reflection: a casualty of modularisation?

INTRODUCTION: The use of reflection in nursing and midwifery is well-established and reflective skills are taught on both pre- and post-registration courses as a way of integrating theory and practice, and of developing students' critical and analytical skills. Reflection is generally regarded positively with an assumption that reflective skills benefit both practitioners and patients. The aim of this study was to identify the educational strategies used to develop reflective skills in one pre-registration diploma in nursing curriculum. METHODS: The survey was cross-sectional in design. A questionnaire was designed for the study to explore perceptions of both students and lecturers in one educational establishment. Curriculum documentation was analysed to examine where in the curriculum the development of reflective skills was prominent. The sample consisted of two student cohorts from the adult branch and all senior lecturers within the Institute who taught on the pre-registration programme. RESULTS: The findings revealed a complex picture of students' and lecturers' views of the teaching and learning strategies used to develop reflective skills. Lectures and group work were the strategies cited most commonly by the students, whereas the lecturers felt the strategies used most often were personal tutorials, group work and case scenarios. The documentary analysis revealed that out of the 13 modules, there was explicit reference in only three modules to reflective practice. Furthermore, it was evident that the majority of lecturers were not clear where in the curriculum reflective skills were taught which suggested that an overview of the whole curriculum is not always evident. CONCLUSIONS: Modularisation may have contributed to a fragmentation in the way in which some key health practitioner skills are developed and built upon throughout a curriculum. There needs to be agreement on the nature of the skills which are central to the development of reflective practitioners and clear thinking on how these are developed and assessed within a curriculum.

Attitude of Health Personnel↗
PubMed1999

Pharmacists' knowledge, attitudes and practices concerning sugar-free medicines.

AIMS: To examine the attitudes of pharmacists to sugar in medicine and sugar-free preparations and their levels of knowledge concerning sugar-free preparations and the implications for dental health. DESIGN: A questionnaire was designed with a mixture of closed and open-ended questions. SETTING: Pharmacists practising in the Greater Belfast area of Northern Ireland. METHOD: Seventy pharmacists were randomly chosen from the list of pharmacists practising in the area and were asked to participate in the study. RESULTS: Responses were obtained from 52 of the 70 selected pharmacists, representing a response rate of 74%. Seventy-five per cent of the pharmacists stated that they had not received formal education concerning sugar in medication and it's effect on dental health. Their main source of information on the subject was dental health literature. Eighty-seven per cent felt that all medication should be available in sugar-free form. Forty-six per cent stated that sugar in medication was definitely an important cause of dental caries in children and 44% felt that it was a possible factor. The major factors influencing the provision of sugar-free medicines were parental request, health promotion literature, reports and media advertising. Thirty-nine per cent of the pharmacists always offered a sugar-free preparation for over-the-counter medication (provided that a sugar-free alternative was available), and 56% sometimes did so. Fifty per cent always offered a sugar-free form for prescribed items wherever possible, the remainder depended on it being specified by the prescriber. CONCLUSION: There is a high level of interest in this issue among pharmacists, but there is a need for an increased educational input on a continuous basis.

Attitude of Health Personnel↗
PubMed2004

Outcome of cardiogenic shock complicating acute myocardial infarction.

OBJECTIVE: To analyze the characteristics and in-hospital outcome of patients with cardiogenic shock (CS) complicating acute myocardial infarction (AMI) and to evaluate the influence of urgent coronary revascularization on in-hospital mortality. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi. January 2001 to December 2001. MATERIALS AND METHODS: All consecutive patients with AMI and CS, admitted at The Aga Khan University Hospital, Karachi Pakistan, during the year 2001 were reviewed. A pre-designed questionnaire was used for data collection. Analysis was done using the SPSS statistical package. RESULTS: Out of 615 patients with AMI, 53 (8.6%) had CS. Mean age was 60.9 +10.7 years. 62.3% were men, 52.8% were hypertensive and 43.4% were diabetic. Most infarcts were anterior in location (56.6%). Thrombolytic therapy (Streptokinase) was administered to 43.5% of patients with ST segment elevation myocardial infarction. 64.2% required ventilatory support while swan ganz was used in 37.7%. Intra-aortic balloon pump was inserted in 39.6%. Ventricular tachycardia was the most common complication (39.6%). Overall in-hospital mortality was 54.7%. CS associated with mechanical complications had 80% in-hospital mortality. In patients without mechanical complications (n=48), in-hospital mortality was significantly lower in the revascularization group (31.6% vs. 65.5%, p-value = 0.021). However, there were significant differences in the baseline characteristics in the two groups because of the selection bias. CONCLUSION: CS occurring in patients with AMI has an extremely poor prognosis. Patients selected for revascularization strategy has favorable in-hospital outcome.

Aged↗
PubMed2004

Perinatal mortality rate in relation to gender.

OBJECTIVE: To calculate the gross and gender adjusted perinatal mortality rate (PMR) and determine the association between gender and susceptibility towards perinatal death. DESIGN: A cross-sectional hospital-based study conducted at Gynae Unit-I of Bolan Medical Complex Hospital, Quetta from 1st January to 31st December, 2002. PATIENTS AND METHODS: The study included the total births and perinatal deaths over one year period. The cause of death was ascertained through specifically-designed questionnaires and external autopsy. PMR was defined as the number of fetal deaths from 28 weeks of gestations to early neonatal deaths within 7 days after birth. Birth weight of >1000 grams or 35 cms crown-heel length was considered in lieu of unknown gestational age. Multiple pregnancies and stillbirths occurring at home were excluded. Extended Wiggles Worth classification was used to study the etiology of perinatal death separately. RESULTS: The PMR was calculated to be 113 per 1000 births. Stillbirth rate was 103 per 1000 total births; out of these, 56.5% were intrapartum and 43.3% antepartum. Male stillbirths were 89.24% in intrapartum and 62.5% in antepartum (df=1,X2=16, p < 0.001). Out of 16 early neonatal deaths, 11 were male infants. Aberdeen classification revealed obstetric causes of PMR as antepartum haemorrhage (34 cases;76% males), malpresentations (28 cases; 57% males), and congenital anomalies (26 cases; 80% males), after adjusting for maternal age and parity. CONCLUSION: This study shows fetal gender as statistically significant risk factor and it will pave the way for future community-based studies to confirm such an association, after adjusting for other co-variables.

Cross-Sectional Studies↗
PubMed1998

Risk of squamous cell carcinoma and methoxsalen (psoralen) and UV-A radiation (PUVA). A meta-analysis.

OBJECTIVE: To assess the risk of squamous cell carcinoma (SCC) and the relation of dose to risk among groups of patients with psoriasis exposed to psoralen-UV-A (PUVA). DATA SOURCES: Four electronic databases were searched from 1984 to 1998. STUDY SELECTION: In addition to the PUVA Follow-up Study, we included all English-language studies from the United States and Europe with at least 150 patients enrolled, who were followed up for at least 5 years as identified from our bibliographic search. DATA EXTRACTION: A custom-designed questionnaire was used to extract data from each of the articles. For each study, if possible, we determined the incidence of basal cell carcinomas and SCCs and the incidence rate ratio of SCC among patients exposed to low-dose (we defined as < 100 treatments or 1000 J/cm2) compared with high-dose PUVA (> 200 treatments or 2000 J/cm2). Exact methods were used to calculate the incidence rate ratios. DATA SYNTHESIS: In addition to our study, we identified and reviewed 8 other studies. Overall, the incidence among patients exposed to high-dose PUVA was 14-fold higher than among patients with low-dose exposure (95% confidence interval, 8.3-24.1); a greater dose-dependent increase in risk than that observed in the PUVA Follow-up Study. CONCLUSION: Although the incidence of SCC reported among groups of PUVA-treated patients followed up for at least 5 years varies greatly, compared with the risk in low-dose patients, long-term high-dose exposure to PUVA was consistently observed to significantly increase the risk of SCC in all studies reviewed.

Carcinoma, Squamous Cell↗
PubMed2006

Factors influencing coexistence of toenail onychomycosis with tinea pedis and other dermatomycoses: a survey of 2761 patients.

OBJECTIVE: To evaluate the prevalence and factors influencing the presence of concomitant dermatomycoses in patients with toenail onychomycosis. DESIGN: Prospective study based on a specially designed questionnaire completed by dermatologists. PATIENTS: A total of 2761 patients with toenail onychomycosis. MAIN OUTCOME MEASURES: The diagnosis of fungal skin infections was confirmed by direct microscopic examination or by culture. RESULTS: In 1181 patients (42.8%) with toenail onychomycosis, concomitant fungal skin infections were noted. Tinea pedis was the most common and was found in 933 patients (33.8%). Other concomitant fungal skin infections were fingernail onychomycosis (7.4%), tinea cruris (4.2%), tinea corporis (2.1%), tinea manuum (1.6%), and tinea capitis (0.5%). The presence of concomitant fungal skin infections depended on number of involved toenails; duration of onychomycosis; sex, age, and education level; area of residence; and type of isolated fungus. CONCLUSIONS: The coexistence of toenail onychomycosis with other types of fungal skin infections is a frequent phenomenon. It could be hypothesized that infected toenails may be a site from which the fungal infections could spread to other body areas. Effective therapy for onychomycosis might therefore be essential not only to treat the lesional toenails but also to prevent spreading the infection to other sites of the skin.

Adolescent↗
PubMed2006

Full-body skin examinations and the female veteran: prevalence and perspective.

OBJECTIVES: To determine the frequency of full-body skin examinations (FBSEs) among female veterans and to determine whether patient risk factors for skin cancer alter the frequency of screening. Subjects were also queried as to attitudes about FBSE. DESIGN: Questionnaires pertaining to whether patients underwent regular FBSE, their opinions and attitudes about this screening test, and their risks for developing skin cancer. SETTING: A primary health care clinic for female veterans at a Veterans Affairs medical center. PARTICIPANTS: A convenience sample of 245 patients awaiting clinic appointments. Of those asked to participate, 201 agreed, for a participation rate of 82%. MAIN OUTCOME MEASURES: Patient report of undergoing FBSE, attitudes regarding FBSE, and risk factors for cutaneous malignancy. RESULTS: Eighteen percent of all respondents reported undergoing regular FBSE by their primary care provider, whereas 9 (45%) of the 20 with a history of skin cancer reported undergoing FBSE. Fifteen percent of subjects reported embarrassment with FBSE. Seventy-nine percent reported that their primary care provider would be considered thorough by performing FBSE, and 69% would like their primary care provider to perform FBSE regularly. We found that 16% of subjects would refuse the examination if the primary care provider were of the opposite sex, whereas 38% would not refuse but be less willing to be examined. CONCLUSIONS: Female veterans report a low incidence of FBSE, although those with a personal history of skin cancer are more likely to undergo screening. Despite embarrassment expressed about a sex difference between the patient and examiner, female veterans have a strong preference to undergo FBSE.

Adult↗
PubMed1995

Cognitive test performance in detecting, staging, and tracking Alzheimer's disease.

OBJECTIVES: To identify the specific cognitive deficits that characterize Alzheimer's disease (AD) and determine which cognitive tests, or combination of tests, are best for detecting AD (ie, distinguishing patients with AD from normal control subjects), staging AD (ie, distinguishing different severities of dementia), and tracking disease progression. SUBJECTS: Patients with AD (n = 123) and normal control subjects (n = 60) of comparable age, education, and gender distribution. SETTING: Outpatient care. MEASURES: Ten cognitive tests of memory, language, visuospatial abilities, and reasoning; the Information, Memory and Concentration subtest of the Blessed Dementia Scale, and the total score on an activities of daily living questionnaire. DESIGN: Patients with AD were tested every 6 to 24 months over a span of up to 5.5 years. RESULTS: Patients with AD were significantly inferior to normal control subjects on all cognitive tests. The scores of patients with AD worsened over time. Delayed recall of stories and figures showed sharp deterioration to an early floor, consistent with the finding that these tests discriminated patients with mild AD from normal control subjects well but were poor for staging. Confrontation naming, semantic fluency, and immediate recognition of geometric figures showed steady linear decline across time for patients with AD, consistent with these tests being found best for staging dementia severity. CONCLUSIONS: We postulate that the pathologic bases of impairment in delayed recall are atrophy of cholinergic ventral forebrain neurons and partial deafferentation of the hippocampus, both of which occur early in the course of AD. Worsening language and visuospatial abilities likely reflect progressive loss of neocortical neurons and their connections.

Aged↗
PubMed2001

Pediatric cochlear implantation: the parents' perspective.

OBJECTIVE: To analyze parental views on cochlear implantation, before and in the years following implantation, to determine whether the results from the intervention met their expectations. DESIGN: Prospective longitudinal study to assess parental perspectives of an unselected group of children with cochlear implantation. SETTING: Tertiary referral pediatric cochlear implant center in the United Kingdom. SUBJECTS: Forty-three parents of children with cochlear implantation. INTERVENTION: A specifically designed questionnaire was administered to assess preimplant expectations and observed changes and concerns at 1, 2, and 3 years following implantation. Three key domains were evaluated: (1) communication with others, (2) listening to speech without lipreading, and (3) the development of speech and language. RESULTS: Preoperative expectations were met or surpassed at each of the follow-up intervals. In the area of communication, 35 (81%) parents expected a definite improvement preoperatively, and 3 years following implantation, 42 (98%) actually saw such an improvement. The respective numbers in the area of listening to speech were 15 (35%) and 38 (88%), and for speech development, 37 (86%) and 37 (86%). Speech development was the major area of concern at all intervals. CONCLUSION: This study demonstrates the ability of cochlear implantation to meet or surpass parental expectations in 3 important outcome domains: communication, listening to speech, and the development of speech and language.

Child↗
PubMed1995

Purposes, problems, and proposals for progress in cancer staging.

OBJECTIVE: To learn the opinions of selected members of the American Society for Head and Neck Surgery about the purpose of cancer staging and the problems with the current system, and to use these opinions to suggest improvements. DESIGN: Questionnaire survey. PARTICIPANTS: One hundred one physicians, based on their prominence in the field of head and neck cancer, selected from the society membership directory. OUTCOME MEASUREMENT: Responses to the six questions and other comments provided by the responding physicians. RESULTS: Sixty-six physicians returned the questionnaire. Of the six purposes of cancer staging, comparing end results was rated most important. Considerable variation existed among the respondents in the rank order of importance of the six purposes. The TNM strengths were its simplicity, low cost, relative accuracy, objectivity, universal acceptance, and lack of need for special technology. Weaknesses included inconsistencies, inaccuracies, observer variability, and problems with various T, N, and M classification criteria. Most believed that the TNM system should be expanded to include host factors, such as functional status, severity of comorbidity, immunocompetence, and symptom severity. CONCLUSIONS: These results suggest a wide range of opinion about the purpose of cancer staging. Several problems with the present TNM system, such as the exclusion of additional prognostic factors, limit the usefulness of the system. Progress in cancer staging will occur when the current system is augmented by these prognostic factors.

Attitude of Health Personnel↗
PubMed2001

Dental concerns unrelated to trauma in the pediatric emergency department: barriers to care.

OBJECTIVES: To describe patients with nontraumatic dental problems treated in our pediatric emergency department (PED) and to determine if barriers to access prompted seeking care in the PED rather than from a dentist or dental clinic. DESIGN: Questionnaire administered to a convenience sample of patients with nontraumatic dental complaints. SETTING: An urban PED. MAIN OUTCOME MEASURES: Insurance status, primary medical and dental care, duration of symptoms, diagnosis, and reason for seeking care in the PED. RESULTS: Two hundred patients were enrolled. Median age was 17 years (range, 1-22 years). Forty-five percent were African American. Forty-nine percent had Medicaid. Fifty percent identified a regular dentist, whereas 71% had a primary care physician. Thirty-four percent of patients 4 years and older had not seen a dentist in more than a year. Children younger than 13 years were more likely than teenagers to identify a regular dentist (odds ratio [OR] = 2.8; 95% confidence interval [CI], 1.3-6.1). Those with a regular medical provider were more likely to have a regular dentist (OR = 7.7; 95% CI, 3.4-18). The most common reasons for not going to a dentist were as follows: dentist closed, 34%; lack of dental insurance or money, 17%; and lack of a dentist, 16%. Patients with symptoms for more than 72 hours were more likely to cite lack of a dentist as their reason for coming to the PED (OR = 7.4; 95% CI, 1.9-33). CONCLUSIONS: Many pediatric patients do not have regular dental care, and this is associated with a lack of primary medical care. Access barriers to acute dental care include lack of insurance or funds, lack of a dentist, and limited hours of dental care sites. Improved insurance reimbursement, active enrollment of adolescents into preventive dental care, and expansion of provider hours may limit PED dental visits and improve the health of patients.

Adolescent↗
PubMed1993

Physicians treating their own children.

OBJECTIVES: To determine the types of health care interventions physicians provided to their own children, identify those conditions most often treated by physician-parents, compare the differences in treatment practices among physician groups, and explore the reasons physicians give for treating their own children. DESIGN: Questionnaire. SETTING: University-affiliated teaching hospital in Iowa City, Iowa. PARTICIPANTS: Three hundred fifty-three physicians in residency and fellowship training and faculty who were parents of children aged 18 years or younger. INTERVENTIONS: None. MEASUREMENTS/MAIN RESULTS: The majority of physicians reported treating their afebrile child for acute illness. Fifty-five percent of physicians reported that they rarely or never treated their febrile child (temperature > 38.3 degrees C) without consultation with the child's physician. Only 47% of physicians reported that they always performed a physical examination on their child before treating. Physician-parents were more likely to auscultate the child's chest or perform otoscopy and less likely to obtain urine samples or throat swabs for culture before treating. Sixty-two percent of physicians reported that they have never performed routine health maintenance examinations on their own children, but 29% referred their children to a specialist. Medications were prescribed for their children by 65% of physicians. Neither gender nor level of training influenced the treatment practices of physician-parents. Primary care physicians were less likely to contact the child's physician for advice in treating their febrile child than were subspecialists. Pediatricians more often treated their afebrile and febrile children, performed physical examinations and laboratory studies, and prescribed medications than did other primary care physicians. Convenience was the most important reason physicians gave for treating their own children. CONCLUSIONS: Physicians frequently treat their own ill children, prescribe medications for them, and self-refer them to specialists largely for the sake of convenience.

Adolescent↗
PubMed1995

Infantile colic. Seasonal incidence and crying profiles.

OBJECTIVES: To determine the occurrence of infantile colic and its seasonal variation in an unselected population and to evaluate the amounts of crying in colicky infants and noncolicky controls. DESIGN: Questionnaire survey and a prospective substudy of parental diaries of crying. SETTING: All families with a full-term, healthy-born infant in the Turku City (Finland) district during 1 year. PARTICIPANTS: Colic was defined as paroxysms of crying for 3 or more hours per day for 3 days or more per week during a period of at least 3 weeks. The questionnaires containing this definition were distributed to 1221 families in postpartum wards, and an invitation to a prospective follow-up study was presented to the families if their infant showed colicky symptoms. The incidence questionnaire was to be returned after 3 months. Six hundred four (49%) of the questionnaires were returned, and an additional 355 (29%) families were reached by phone. A total of 59 families with a colicky infant enrolled in the prospective substudy when the infants were at a median age of 5 weeks; age-matched controls were invited from the same population. RESULTS: The incidence of infantile colic was 13%; possible infantile colic was 8%. No seasonal variation was found. The mean amount of total crying was 241 min/d (95% confidence interval [CI], 216 to 266 minutes) in the colic group and 112 min/d (95% CI, 95 to 130 minutes) in the control group during the first recording week. The mean amount of colicky crying was 122 min/d (95% CI, 102 to 142 minutes) in the colic group and 19 min/d (95% CI, 12 to 26 minutes) in the control group. CONCLUSIONS: The incidence of colic was 13% with no seasonal variation. Parental perception of infantile colic correlated well with the amount of crying.

Colic↗
PubMed1997

Assessments of girl's genital findings and the likelihood of sexual abuse: agreement among physicians self-rated as skilled.

OBJECTIVES: To measure agreement about genital examination findings among physicians who rate themselves as skilled in evaluating children for suspected sexual abuse, to compare these physicians' descriptions and interpretations with consensus standards developed by an expert panel, and to investigate the effects of physician and case characteristics on agreement. STUDY DESIGN: Questionnaires including 7 simulated cases, each consisting of a brief history and 1 photograph of a girl's genitalia, were mailed to random samples of 2 groups: the members of 4 physician organizations concerned with child abuse or pediatric gynecology, and pediatricians at large. Among the surveyed physicians who rated their own skill in evaluating cases of suspected sexual abuse as higher than average, we measured agreement, both overall and between those with the most and with less clinical experience, and assessed their conformity with consensus standard descriptions and interpretations. RESULTS: We received responses from 548 (50.9%) of 1076 physicians; 414 responses (75.5%) were analyzable. Two hundred six physicians (50%) rated themselves as skilled in assessing children for sexual abuse. On average, 45% of these physicians' descriptions and 72.6% of their interpretations conformed with the consensus standards. In 4 cases, between 5% and 20.7% of these physicians described genital findings that the expert panel had considered absent from the photographs. Conformity with standard interpretations tended to be higher in cases with photographs concordant with the accompanying, unambiguous histories (P=.06). The most experienced physicians resembled the expert panel more closely than did the less experienced self-rated skilled physicians in interpreting 3 simulated cases (P< or =.001). CONCLUSIONS: Assessments of girls' genital findings by physicians who rate themselves as skilled in examining children for suspected sexual abuse often differ. In some cases, among physicians who all rate themselves as skilled, assessments made by very experienced physicians may conform more closely to consensus standards than do assessments made by less experienced physicians.

Child↗