Child Health publications (MU)
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Items in this collection are the scholarly output of the Department of Child Health faculty, staff, and students, either alone or as co-authors, and which may or may not have been published in an alternate format. Items may contain more than one file type.
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Item Lupus with Grave's disease : overlap disease vs drug induced lupus : a case report(2017) Smith, Kaitlin E.; Bachrach, Bert E.; Rheumatology Symposius (5th : 2017 : Columbia, Mo.)Background: Graves’ disease is one of the T-Cell mediated organ-specific autoimmune thyroid diseases, while SLE is mainly a B-Cell mediated autoantibody regulated systemic autoimmune disease. There is a well-established association of hypothyroidism, autoimmune thyroiditis, and thyroid cancer to systemic lupus erythematosus in age and sex matched controls in diverse populations across the world. The association of SLE and Graves’ disease is extremely rare in adults and has never been reported in the pediatric population. This case report suggests that pediatric patients with thyroid disease or systemic lupus erythematous should be evaluated for one another on the presentation of either.Item Decrease in Anogenital Distance among Male Infants with Prenatal Phthalate Exposure(Environmental Health Perspectives, 2005-05) Swan, Shanna H.; Main, Katharina; Liu, Fan; Stewart, Catherine S.; Kruse, Robin L.; Calafat, Antonia M.; Mao, Catherine S.; Ternand, Christine L.; Sullivan, Shannon; Teague, J. Lynn; Study for Future Families Research TeamPrenatal phthalate exposure impairs testicular function and shortens anogenital distance (AGD) in male rodents. We present data from the first study to examine AGD and other genital measurements in relation to prenatal phthalate exposure in humans. A standardized measure of AGD was obtained in 134 boys 2-36 months of age. AGD was significantly correlated with penile volume (R = 0.27, p = 0.001) and the proportion of boys with incomplete testicular descent (R = 0.20, p = 0.02). We defined the anogenital index (AGI) as AGD divided by weight at examination [AGI = AGD/weight (mm/kg)] and calculated the age-adjusted AGI by regression analysis. We examined nine phthalate monoester metabolites, measured in prenatal urine samples, as predictors of age-adjusted AGI in regression and categorical analyses that included all participants with prenatal urine samples (n = 85). Urinary concentrations of four phthalate metabolites [monoethyl phthalate (MEP), mono-n-butyl phthalate (MBP), monobenzyl phthalate (MBzP), and monoisobutyl phthalate (MiBP)] were inversely related to AGI. After adjusting for age at examination, p-values for regression coefficients ranged from 0.007 to 0.097. Comparing boys with prenatal MBP concentration in the highest quartile with those in the lowest quartile, the odds ratio for a shorter than expected AGI was 10.2 (95% confidence interval, 2.5 to 42.2). The corresponding odds ratios for MEP, MBzP, and MiBP were 4.7, 3.8, and 9.1, respectively (all p-values < 0.05). We defined a summary phthalate score to quantify joint exposure to these four phthalate metabolites. The age-adjusted AGI decreased significantly with increasing phthalate score (p-value for slope = 0.009). The associations between male genital development and phthalate exposure seen here are consistent with the phthalate-related syndrome of incomplete virilization that has been reported in prenatally exposed rodents. The median concentrations of phthalate metabolites that are associated with short AGI and incomplete testicular descent are below those found in one-quarter of the female population of the United States, based on a nationwide sample. These data support the hypothesis that prenatal phthalate exposure at environmental levels can adversely affect male reproductive development in humans.Item Care and Managed Care: Psychological Factors Relevant to Healthcare and its Delivery(2002) Fleisher, David R.; University of Missouri-Columbia. School of Medicine. Department of Child HealthWhat is the essence of clinical caring, how can its value be determined, and what are its origins? Caring for a patient is a bit like loving someone. In both cases, the wellbeing of the person who is loved or the patient who is cared for is felt to be overridingly important. Good clinical care goes beyond the diagnostic services, prescriptions or operations that the patient is billed for. It includes services done free of charge for the satisfaction of easing the patients' distress or enhancing their sense of security or optimism while they cope with illness. Love and clinical caring are not commodities to which a market value has relevance. They have value without price. Whereas a person in the business of selling services is motivated by the prospect of making a profit, the altruistic clinician is motivated by the desire to help the patient. He or she is paid to be sustained, albeit comfortably, not to be made rich.Item Is There a Contradiction Between the Bio-psycho-social Model and Evidence-based Practice?(2000) Fleisher, David R.Evidence-based knowledge is essential to good practice. However, there are fundamentally different ways of developing evidence. Data gathering by epidemiologic surveys is most likely to get at the “truth” when the diseases in question are caused by contingencies over which people have no control.. In such cases, the personalities of the individuals within the studied population are relatively unimportant. Looking at the incidence of Influenza in Missouri doesn't require knowledge beyond whether or not the individuals surveyed caught the flu and lived in Missouri.Item Integration of Biomedical and Psychosocial Management(Pediatric Gastrointestinal Motility Disorders. New York: Academy Professional Information Services, 1994) Fleisher, David R.Two concepts helped and hindered clinicians throughout the 20th Century: 1) the most important and legitimate use of physicians' time is in the diagnosis and cure of disease; and 2) patients are cured of illness through cognitive learning and compliance with rational prescriptions based on biomedical science. What has made these conceptions a hindrance is that they exclude most of what doctors and patients do together.