Edem E. Ekwo

Evaluation of a program for the pharmacologic management of children with asthma

Abstract An evaluation of a program used for the pharmacologic management of asthma was conducted by a retrospective chart review of patients seen by the Pediatric Allergy and Pulmonary Service at the University of Iowa. A scheme for drug selection based on pharmacologic and physiologic principles had been used to determine the medication requirements needed to attain specified therapeutic goals. Explicit criteria, defined prior to the review, were used to confirm the diagnosis, characterize the patients as chronically or intermittently symptomatic, and grade the disease by severity prior to the initiation of therapy. Of the 25 patients with intermittent symptoms, none of the patients with the 2 least severe grades of asthma required more than as-needed bronchodilators for control of symptoms while 80% of the patients in the 2 more severe grades required corticosteroids (p = 0.002). Among the 172 patients with chronic symptoms, a single noncorticosteroid prophylactic drug (usually theophylline in optimal doses) was the final management requirement for nearly 90% of the 27 patients in the 2 least severe grades of chronic asthma, for 70% of 129 patients in grade III, and in only 30% of the 16 patients in grade IV, the most severe grade (p

Psychosocial Factors Influencing the Duration of Breastfeeding by Primigravidas

ABSTRACT. We studied factors which influence the duration of breastfeeding by 81 primigravidas by use of a Likert‐type questionnaire. Three primary independent variables related inversely to the duration of breastfeeding in a multiple regression analysis. The most important of these variables was maternal perception of difficulties in scheduling breastfeeding on her return to work (p < 0.01). Also total family income (p < 0.01) and maternal worries about the demands of breastfeeding (p < 0.01) inversely related to the duration of breastfeeding. Causal analytical technique was used to identify secondary variables relating to the primary independent variables. Maternal worries about the demands of breastfeeding related strongly to her worries about the lack of family psychosocial support. Maternal age and complications of breastfeeding did not relate to the duration of breastfeeding.

Moral and religious influences on the amniocentesis decision

Abstract As early as 1973 Fletcher documented moral problems families encountered as they struggled with the decision of whether or not to have amniocentesis. In this study we asked 202 women accepting and 50 women rejecting amniocentesis extensive questions about religious beliefs, behaviors, and beliefs about abortion. Members of small Protestant denominations were the most conservative. Catholics and other Protestants were intermediate with smaller differences between these middle groups. Those respondents claiming no religion or one of a non‐Christian denomination were the most liberal. Net predictors of acceptance of amniocentesis included respondents’ support for laws permitting abortion for medical reasons, negative responses about belief in the sanctity of life, having insurance, and the respondents’ political affiliation. Education and religious attendance were the most consistent net predictorsof moral attitudes. We concluded that the amniocentesis decision is influenced by many religious belief...

The physician assistant in rural primary care practices: physician assistant activities and physician supervision at satellite and non-satellite practice sites.

Nineteen practice sites in Iowa were studied to determine the differences in the types of physician (MD) supervision the physician assistant (PA) received at work at satellite (separate from the major practice site of the supervising MD) and non-satellite practice sites. The MDs supervised PA functions in 12.9 per cent of the patients seen by the PAs at non-satellite and 15.9 per cent of patients they saw at satellite practice sites. All patients with presenting manifestations that suggested life-threatening conditions were seen by MDs at satellite and non-satellite sites. The MD spent 9.2 minutes per patient at satellite clinics, compared to 4.4 minutes per patient at non-satellite clinics. PAs working at satellite sites appeared to receive as much supervision as PAs working at non-satellite clinics.

PREVENTION OF ECZEMA

Allergies are becoming more and more prevalent in the Western world. Depending on people’s age, we see different manifestations of allergy, including eczema, food allergies and hay fever. Eczema or atopic dermatitis is one of the first manifestations of allergy and affects approx. 20 percent of all children1. Genetic background plays an important part in this as well. If one of its parents has atopy, a child will be 25% more likely to develop atopic conditions. If both parents have atopy, this figure goes up to 50%. Children who have had a type of allergy at a young age, are at a greater risk of developing another allergy manifestation. Such a succession of different manifestations is also referred to as “allergic march”2. Allergies have an adverse effect on quality of life and represent a major financial burden for society3.

Monitoring Health Care: Children with Bacteriuria

A program which used a nurse clinician to monitor the health care received by children with bacteriuria is described. We identified 152 patients with significant bacteriuria (≥ 105 organisms/ml) by urine culture from 351 patients who either had symptoms suggestive of urinary tract infections or routine urinalysis during health care visits. Adequate health care was provided to 116 (76 per cent) of the 152 patients and inadequate health care to 31 (24 per cent) of these patients. A significant number of patients who received inadequate therapy (12 of 36, or 37 per cent) compared to 8 (7 per cent) of 116 patients who received adequate therapy failed to clear their bacteriuria (Chi-square = 17, p < 0.001). Eight patients with recurrent bacteriuria despite adequate therapy were shown to have no urinary tract anomaly by radiography. The use of recurrence of UTI as a criterion for measuring adequacy of therapy and the uniqueness of the program are discussed.

38 FACTORS MOTIVATING PHYSICIANS TO HIRE PHYSICIAN ASSISTANTS IN RURAL OFFICE PRACTICES

Factors motivating physicians to hire physician assistants (PA) are not well delineated, yet 23% of PA activities in primary health care settings in Iowa involve children less than 15 years old. Of 64 Iowa physicians who employed PA from 1973 to 1977 in their offices, 75% completed a ten point scale questionnaire. 37/51 (73%) of these physicians still employed PA at time of study and 8/13 (62%) had terminated PA employment. 31 of these 51 practice sites with PA in active practice had populations < 10,000. Factors which strongly motivated physicians to hire PA were MD practice from multiple offices serving populations < 5,000 (40% of sites). Other motivating factors were physicians belief that MDs should delegate certain tasks to non-MDs (65%), and also MDs desire to provide innovative care (51%), optimal care (55%), new services (33%), more of the usual service (63%), to more patients (57%), and to reduce waiting time for appointments (49%). Non-motivating factors were prior MDs work or educational experiences with similar health personnel, the MDs desire to provide services at less cost, reward faithful employee, increase earning, compete favorably with colleagues, work fewer hours, and to create time for continued education. Similar motivating factors were found among physicians who had hired and dismissed PA. These findings have educational, legislative and social implications.

TAMPON CULTURE FOR CERVICOVAGINAL HERPES SIMPLEX VIRUS

From 101 to 106 TCID50 of herpes simplex viruses types I and II in 0.10 ml volumes can be quantitatively recovered from vaginal tampons in vitro. The distal several centimeters of tampon were extracted in Hanks buffered saline containing fetal calf serum, penicillin, streptomycin and amphotericin B, for end-point titration. Virus could be recovered from 7 brands of tampons.In 5 patients with clinically apparent genital herpes simplex infection, viral cultures were obtained from vulvar vesicles, from direct cervical swabs performed at pelvic examination and from tampons inserted by the patient. Virus was eluted from swabs and tampons and end-point titrations were performed. The cervical viral titers recovered by the 2 methods were similar:Thus, quantitative cervicovaginal cultures can be obtained by tampon culture without pelvic examination.