Joel J. Alpert

Children as participants in medical research

The use of children in research raises the questions about proper justification, assessment of benefit in relation to risk, ability to consent, compensation, and the just selection of subjects. Although substantive and procedural standards have evolved, subpopulations of vulnerable children created new challenges and concerns.

A study of attitudes and support systems of innercity adolescent mothers

Because the simultaneous demands of adolescence and motherhood could result in special infant rearing attitudes and concerns, a prospective pilot study of inner city adolescent mothers was undertaken. A sample of primiparous adolescent mothers was compared with primiparous and multiparous nonadolescent mothers. Data were collected by home interviews at two weeks and three months postpartum. The major hypothesis, that the simultaneous occurrence of adolescence and motherhood would result in special infant rearing attitudes, concerns, and support systems which interfered with mothering, was not fully supported by our findings. Few of the adolescent mothers were married (8%) but of those not married, most (95%) lived in an extended family. Adolescent mothers, when compared with older mothers, were more likely to seek medical advice from their mothers as opposed to health professionals and were more insecure in their maternal self-image if caretaking was shared. Attitudinal differences around feeding were seen, but attitudes about spoiling, perception of the babys behavior, discipline, caretaking, and enjoyment were the same among groups. Adolescent mothers and their infants provide physicians and other child health professional with a special pediatric family. The differences in available support systems and maternal self-image suggest areas for further investigation.

Utilization of Pediatric Emergency Services: A Critical Review

The incidence of and reasons for inappropriate use of hospital emergency rooms are discussed. Among the approaches considered for decreasing non-emergency use of emergency rooms are educating the public as to proper use, redesigning emergency facilities to accommodate non-emergency patients, instituting hospital-based group practices, and educating health care providers as to the reasons patients seek emergency care.

DEMOGRAPHIC AND EDUCATIONAL CHARACTERISTICS OF INNER CITY MIDDLE SCHOOL PROBLEM ABSENCE STUDENTS

Results of a study of characteristics of middle school students revealed highly significant differences between problem absence students and non-problem absence students on all study variables except sex. Characteristics such as increasing grade, being behind appropriate grade, busing and special education status, and the particular school attended were highly correlated with this behavior, as were race and increasing age.

Bendectin and fetal development

As part of a prospective study investigating maternal characteristics and habits during pregnancy and their impact on fetal development, 1,690 mother/infant pairs were studied. Of the mothers, 375 reported using Bendectin during pregnancy. Multivariate analyses examining birth weight, length, head circumference, gestational age, and congenital malformations as dependent variables demonstrated no associations between Bendectin exposure and adverse fetal outcome.

Maternal cigarette smoking psychoactive substance use and infant Apgar scores.

A study of 1,709 mother/child pairs at Boston City Hospital examined whether maternal cigarette smoking, drinking, or the use of other psychoactive substances was associated with low infant Apgar scores. The potential confounding effects of other labor and delivery risks were controlled in the analysis. In contrast to previous reports, univariate and stepwise multiple regression analyses did not identify a significant negative association between cigarette smoking and 1- or 5-minute Apgar scores. None of the substance use variables was significantly associated with low infant Apgar scores at 1 and 5 minutes. Other labor and delivery risks, such as short length of gestation, abnormal delivery presentation, placental abnormalities, nuchal cord, and exposure to general anesthesia during delivery, were associated with low Apgar scores.

Strengthening academic generalist departments and divisions

Academic departments of family medicine and divisions of general internal medicine and general pediatrics exist in the majority of medical schools in the United States and have important roles in generalist medical education. The major organizational issues facing these units concern institutional influence, faculty development, role in medical education, research productivity, financial stability, and clinical responsibilities. These issues must be understood in order for medical schools and teaching hospitals to achieve the societal goal of producing necessary generalist physicians.

Informed Consent and Pediatric Care

The nature and scope of medical practice over the past century has expanded rapidly. The physician’s ability to diagnose and to treat exceedingly complex diseases has brought a new set of ethical, psychosocial, legal, and economic dilemmas. Today’s physician is in a cultural milieu with demands and expectations that far surpass those of his predecessors. These changes have affected the physician-patient relationship that has evolved from one with the patient dependent upon the physician to one that requires more interaction.

Maternal Psychoactive Substance Use and Its Effect on the Neonate

This chapter reviews the impact of maternal psychoactive drug use during pregnancy on the newborn. Substances such as tobacco, coffee, alcohol, and marijuana are commonly used by women during pregnancy, whereas other substances such as heroin, methadone, diazepam, barbiturates, and amphetamines are used less frequently. Drugs such as cocaine and phencyclidine appear to be used more frequently now than in the past. Some of these drugs when used during pregnancy have well-documented teratogenic effects, while for others, particularly marijuana, little information is available. For cocaine and phencyclidine only a small number of case reports are available.

Residency Training in Community Pediatrics

A required PL-3 rotation in community pediatrics, including assignments to preschool and school settings, private pediatric offices, and in-hospital re sponsibilities, is described. A university-affiliated community hospital pro vides the organizational base for the program. After 14 PL-3 rotations, analysis of program content, as well as resident and community response, shows the experience to be a practical and workable model for incorporating community pediatrics into residency training.