Showing papers by "Alan Leviton published in 1984"

The relationship between prenatal exposure to lead and congenital anomalies

Abstract: We obtained umbilical cord blood from 5,183 consecutive deliveries of at least 20 weeks' gestation and analyzed them for lead concentration. Those demographic and socioeconomic variables, including lead, which were shown on univariate analysis to be associated with increased risk for congenital anomalies were evaluated and controlled by entering them into a stepwise logistic-regression model with malformation as the outcome. Coffee, alcohol, tobacco, and marijuana use, which were associated with lead level, but not risk of malformation, were also controlled. The model was reduced in steps by eliminating the variables with the highestPvalue, until the most parsimonious model was created. The relative risk for anomalies associated with lead was then calculated while holding other covariates constant. Lead was found to be associated, in a dose-related fashion, with an increased risk for minor anomalies. (JAMA1984;251:2956-2959)

Acquired perinatal leukoencephalopathy

Abstract: Between 36 and 44 weeks after conception, telencephalic white matter in the newborn appears to be particularly vulnerable to insults that result in morphological disturbances. Available evidence indicates that this disorder (or group of disorders), named acquired perinatal leukoencephalopathy, reflects a decrease in blood flow through the distal vessels supplying paraventricular white matter and/or a metabolic disturbance produced by, or in response to, an infectious agent. Major advances in our understanding of the causes, mechanisms, and sequelae of acquired perinatal leukoencephalopathy may be made in the next decade because of improvement in brain imaging techniques, improved survival of high-risk babies, and relatively routine follow-up of these high-risk babies.

Early sensory-motor development and prenatal exposure to lead.

Abstract: As part of a longitudinal study of the early developmental effects of exposure to lead, we administered the Bayley Scales of Infant Development at age 6 months to infants classified into three groups based on their umbilical cord blood lead levels ("low": mean = 1.8 micrograms/dl; "mid": mean = 6.5 micrograms/dl; "high": mean = 14.6 micrograms/dl). No infant had a cord blood lead level greater than 30 micrograms/dl, the level currently regarded as the upper limit of "normal" for young children. Multiple regression analyses indicated that high cord blood levels were associated with lower covariance-adjusted scores on the Mental Development Index. Scores on the Psychomotor Development Index were not significantly related to cord blood lead level. The level of lead in blood at 6 months of age was not associated with scores on either the Mental or Psychomotor Development Index. These data are compatible with the hypothesis that low levels of lead delivered transplacentally are toxic to infants.

A computerized behavioral assessment for children with headaches.

Abstract: SYNOPSIS We have developed a computerized interview program suitable for school-age children with headaches. Behavioral assessment questions have been included. Between 18 and 39% of children and teenagers acknowledge that something happens to influence their headache either the day before, or the day of the headache. Some of the more frequent antecedents included “an especially hard day at work/school/home,” skipping a meal, worrying a lot, and unexpected excitement or pressure. The older the child or adolescent, the more likely he/she acknowledged that an “unpleasant emotional situation” preceded the headache. Chocolate was the only food or beverage identified as a headache antecedent. Heat and sun glare were reported most frequently as weather concomitants of headache. Approximately 30% of the children and teenagers were concerned about headaches interfering with their activities, and between 22 and 46% wanted to control their headaches without medications. Our experience indicates that children who read can complete a computer-based interview containing behavioral assessment questions, and that an appreciable number of children brought to medical attention for their headaches are receptive to behavioral therapies.

Variability of blood lead concentrations during infancy.

Abstract: As part of a study of early childhood development, more than 200 children had their blood lead concentrations (PbB) determined semiannually during the first 2 yr of life. These children were selected from 11,837 consecutive births surveyed for umbilical cord PbB at Boston Lying-In Hospital. Candidate subjects were drawn from the highest, lowest, and middle deciles of PbB. The mean PbB was 7.2 ± 5.3 (standard deviation) μg/dl at birth and did not change appreciably with age. However, the average change in an individual's PbB every 6 months was 4 μg/dl, which was several fold in excess of the analytical reproducibility. Only 25% of the children in the highest category at birth were in the highest category at 2 yr of age. Approximately 40% of the children remained in their immediately previous PbB fertile category. A stochastic description of these patterns of change fits the data. Our results should caution investigators who might wish to rely on a single determination to categorize children with PbB.

Age-Related Headache Characteristics

Abstract: • A computerized headache interview was completed by 255 children, adolescents, and adults. Children did not differ from adults in the frequency of auras or prodromes. Younger children were more likely than older patients to have brief headaches and headaches that tended to occur on weekdays, and to feel "great" after a headache. They were less likely than older patients to acknowledge multiple kinds of headaches, headaches located on one side of the head or posteriorly, and such concomitant occurrences as blurring, photophobia, irritability, frustration-anger, light-headedness, trouble with concentration, numbness-tingling, and lack of appetite. We do not know how much these differences can be attributed to age-related differences in language, physiology, or medical care selection factors.