Pediatric rheumatology in the United Kingdom: data from the British Pediatric Rheumatology Group National Diagnostic Register

OBJECTIVE: To establish a computerized national diagnostic register for pediatric rheumatology in the UK; to describe the demography and diagnostic classification of children referred to pediatric rheumatology clinics; to estimate the current incidence of juvenile arthritis (JA) in the UK. METHODS: A diagnostic register was established in 1989: 23 centers have contributed data on all new cases seen since they joined the register; 18 centers have also contributed data on all current attenders. For 2 centers with well defined catchment areas, the incidence of JA was estimated. RESULTS: A total of 4948 cases were registered, of whom 2962 (60%) were female. 1991 (40%) had a diagnosis of JA. The 2nd largest category was mechanical/orthopedic problems (24%). Pauciarticular juvenile chronic arthritis was the most common subtype of JA. Seropositive RA was rare. Tertiary referral centers saw proportionately more JA and district general hospitals saw proportionately more mechanical problems. The annual incidence rate for JA from 2 centers was 10/100,000, and for all rheumatic disorders was 32-42/100,000 children under age 16. CONCLUSION: The relative proportion of patient diagnoses varies between centers. Nevertheless, the incidence of hospital referred JA seems very uniform.     

Pediatric rheumatology clinic populations in the United States: results of a 3 year survey. Pediatric Rheumatology Database Research Group

OBJECTIVE: To describe the patient population referred to pediatric rheumatology centers (PRC) across the US 1992-95; and to compare these results to data on regional PRC populations. METHODS: A Pediatric Rheumatology Disease Registry was established in 1992. Data on new patients seen at 25 PRC across the US were submitted to the registry for a 36 month period from 1992 through 1995. RESULTS: A total of 12,939 patients were submitted to the registry. Of these patients, 5245 (40.5%) had rheumatological diagnoses. Patients with juvenile rheumatoid arthritis were the largest group of the patient population (2071 patients-16% of total diagnoses). There were 1568 patients with other forms of childhood arthritis (12%), 1172 with collagen vascular diseases (9%), and 434 with vasculitis (3.3%). Over 50% of the patients had nonrheumatologic diagnoses, including 1577 with idiopathic pain syndromes (12%). Other diagnoses included infections, orthopedic conditions, and malignancies. Fourteen percent of the patients were not given a diagnosis at the time of the initial visit. CONCLUSION: PRC see a wide variety of patients. Although the majority do have rheumatologic conditions, over 50% of new patients have conditions not autoimmune in origin. Fourteen percent of the patients cannot be diagnosed at the time of their first clinic visit, requiring time to see the evolution of their symptoms before a definitive diagnosis can be assigned.     

Blood pressure in tenth-grade students: results from the Chicago Heart Association Pediatric Heart Screening Project

This report is based on 13,231 tenth-grade students who participated in the Chicago Heart Association Pediatric Heart Screening Project. The blood pressures of these fifteen and sixteen-year-olds were analyzed with respect to sex, race, adiposity, pulse rate, and father's educational attainment. The mean systolic blood pressure was higher in boys than girls by nearly 5 mm Hg, but mean diastolic blood pressure was lower by less than 1 mm Hg. Black tenth-graders had higher mean diastolic blood pressure than whites; the difference in systolic blood pressure was not statistically significant. Adiposity and resting pulse rate were positively correlated with systolic blood pressure and, to a lesser degree, with diastolic blood pressure. After taking adiposity and pulse rate into account, father's educational attainment had a small but statistically significant negative association with diastolic blood pressure in white but not in black students. Nearly 5 percent of students were recalled for a second test because the initial screening blood pressures equaled or exceeded 150 mm Hg systolic or 90 mm Hg diastolic, and almost half of students at the recall examination continued to have pressures of 145/85 or greater.     

Role of the Institute of Rheumatology in formation and development of State controlling system of rheumatic diseases]

The paper gives a brief account of the stages of formation and development of rheumatological care in the country, which are closely related to the researches and practical activities of the Institute of Rheumatology.     

Clinical benefits of diagnosing incipient AA amyloidosis in pediatric rheumatic diseases as estimated from a retrospective study

We describe here a newly established cell line from an eccrine carcinoma which produced an abundant amount of granulocyte colony-stimulating factor (G-CSF). An eccrine carcinoma of the scalp of a 69 year-old-Japanese female had metastasized to the pleura. Clinically, she had marked neutrophilia (up to 60,000/mm3), and a high level of G-CSF (38.7 x 10(3) pg/ml) was detected in the pleural effusion, as determined by enzyme-linked immunosorbent assay (ELISA). We established a cell line in vitro and maintained the cells in culture for 30 months in 90 subcultures. We investigated whether these tumor cells were able to produce G-CSF in culture and found that they were. We also found that the amount of G-CSF produced paralleled the rise in cell number (26.5 x 10(3) pg/ml at confluency). When culture media were administered to rabbits (25 ml/rabbit), the amount of circulating neutrophils increased until the number was equal to or greater than that resulting from injection of recombinant human G-CSF (rhG-CSF)(75 micrograms). This effect persisted for 7 days. When tumors were induced in SCID and nude mice by injecting cultured cells (1 x 10(7) cells/mouse), the number of circulating neutrophils also correlated well with tumor size in these mice (200,000/mm3, 3 cm tumor). After tumor removal, the neutrophil number returned to normal within 30 days. G-CSFmRNA in cultured, cells was detected by RT-PCR. Based on these results, it was confirmed that the marked neutrophilia observed in the patient was caused by the tumor-generated G-CSF. This is the first G-CSF-producing cell line developed from a cancer of the skin.     

Infection after pediatric heart transplantation: results of a multiinstitutional study. The Pediatric Heart Transplant Study Group

BACKGROUND: Detailed information regarding the spectrum and predictors of infection after heart transplantation in children is limited because of relatively small numbers of patients at any single institution. We therefore used combined data obtained from the Pediatric Heart Transplant Study Group to gain additional information regarding infectious complications in the pediatric population. METHODS: To determine the time-related risk of infection and death related to infection in a large pediatric patient population, we analyzed data related to 332 pediatric patients (undergoing heart transplantation between January 1, 1993, and December 31, 1994) from 22 institutions in the Pediatric Heart Transplant Study Group. RESULTS: Among the 332 total patients, 276 infections were identified in 136 patients. Of those patients with development of infection, a single infection episode was reported in 54% of patients, 21% had two infections, and 25% had three or more infections. Of the 276 infections, 164 (60%) were bacterial, 51 (18%) were due to cytomegalovirus, 35 (13%) were other viral (noncytomegalovirus) infections, 19 (7%) were fungal, and 7 (2%) were protozoal. Bacterial infections were more common in infants younger than 6 months of age at time of transplantation, comprising 73% of all infections as compared with 49% in patients older than 6 months of age. The incidence of bacterial infection peaked during the first month after transplantation, with the actuarial likelihood of a bacterial infection among all patients reaching 25% at 2 months. The most common sites of bacterial infection were blood and lung (74% of bacterial infections). Cytomegalovirus accounted for 59% of viral infections, with a peak hazard occurring at 2 months after transplantation. Among all infections, cytomegalovirus was less common in infants younger than 6 months of age (8% of all infections) than in older patients (25%). By multivariate analysis, risk factors for early infection included younger recipient age (p = 0.05), mechanical ventilation at time of transplantation (p = 0.0002), positive donor cytomegalovirus serologic study result with negative recipient result (p = 0.004), and longer donor ischemic time (p = 0.04). The overall mortality rate from infection was 5%, with an actuarial freedom from death related to infection of 92% at 1 year after transplantation. The mortality rate was high in patients with fungal infections (52%), yet was low for those with cytomegalovirus infection (6%). Infections accounted for 27% of the overall mortality rate in infants younger than 6 months of age, compared with 16% for older patients. CONCLUSIONS: Although most infections in pediatric heart transplant recipients are successfully treated, infection remains an important cause of posttransplantation morbidity and death, especially in infants. Bacterial infections predominate within the first month after transplantation, whereas the peak hazard for viral infections occurs approximately 2 months after transplantation. Cytomegalovirus infections are common in the pediatric transplant population, but death related to cytomegalovirus is low.     

Founding the Canadian Psychological Association: The perils of historiography.

Addresses the question of when and where the decision was made to form the Canadian Psychological Association (CPA). The purpose of this article is 3-fold: (1) to document the sequence of events that led to the decision to form the CPA, (2) to highlight some of the ambiguities contained in the literature regarding the beginnings of the association, and (3) to explain how and why these ambiguities may have arisen. This article illuminates a number of historiographical issues that may be of importance for those writing the history of Canadian psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The code of ethics of the Canadian Psychological Association and the Canadian Medical Association: Ethical orientation and functional grammar analysis.

The Canadian Code of Ethics for Psychologists has been the subject of several recent investigations. This work has focused, for example, on the validity of its hierarchical organization of ethical principles. In the present research, we subjected the code to both a content and a functional grammar analysis. Our content analysis was aimed at determining the theoretical ethical orientation (deontological, teleological or caring) of each statement in the document, while the functional grammar analysis provided information about implicit messages embedded within the code. We contrasted the results of our analysis with those of previous work on the code of ethics adopted by the Canadian Medical Association (CMA). We concluded that, compared to CMA's code, the Canadian Psychological Association's document has greater educational value, is less authoritarian, provides a clear rationale for ethical behavior, and is more empowering to the decision-maker. We argue that the results of our functional grammar and content analyses have implications for future attempts to improve ethics codes for psychology and other professions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nomenclature and classification of the rheumatic diseases

BACKGROUND: A pilot study was performed to prospectively evaluate the safety and efficacy of "low-dose" OKT3 induction after liver transplantation. METHODS: Sixteen patients received a 5- to 10-day course of OKT3 (2.5 mg i.v. daily) along with azathioprine, prednisone, and the delayed introduction of cyclosporine (Neoral). RESULTS: Patient and graft survival rates at 1 year were 88% and 82%. Five patients (31%) had biopsy-proven rejection; all five were treated successfully with steroids. There were 15 infections in 12 patients, including 5 cytomegalovirus infections. Adverse events attributed to OKT3 consisted of low-grade fever (five patients), transient hypoxemia (three patients), and transient hypotension (two patients). Pharmacy acquisition costs for OKT3 averaged $2,139 less as compared to a group of historical controls receiving full-dose therapy. CONCLUSIONS: Low-dose OKT3 induction appears to be a safe and useful method of postoperative immunosuppression after liver transplantation. Its ultimate clinical, immunologic, and economic efficacy awaits determination by randomized trial.     

Health assessment in the rheumatic diseases of childhood

Assessment of children and adults with rheumatic diseases, both in clinical practice and controlled clinical trials in rheumatology, has traditionally focused on the measurement of disease activity. More recently emphasis has been placed on the need to incorporate estimates of physical, social, and mental functioning into health assessment. Thus there has been a tremendous growth in the development of measurement instruments that evaluate health status, functional status, disability, and quality of life. This type of measurement has become essential, particularly for clinical trials in adults with rheumatic diseases, for which the AIMS (Arthritis Impact Measurement Scales), the HAQ (Health Assessment Questionnaire), and the MACTAR (McMaster-Toronto arthritis) patient preference questionnaire have been the most widely used. In the past few years, similar measures have been developed for application in children with rheumatic diseases. These include the CHAIMS (Childhood Arthritis Impact Measurement Scales), the CHAQ (Childhood Health Assessment Questionnaire), the JAFAR (Juvenile Arthritis Functional Assessment Report), the JASI (Juvenile Arthritis Self-report Index), the JAQQ (Juvenile Arthritis Quality of Life Questionnaire), and the CAHP (Childhood Arthritis Health Profile). In this review, the development and measurement properties of these childhood instruments are discussed, with particular emphasis on their potential roles as supported by recent literature.     

Childhood sexually transmitted diseases and child sexual abuse: results of a Canadian survey of three professional groups

The purpose of this national survey was to determine the knowledge and attitudes of Canadian health and social services professionals about the occurrence of sexually transmitted diseases (STDs) in children and its implications for child sexual abuse. A mailed questionnaire was sent to a randomly selected sample of 4,500 nurses, physicians, and youth/social workers across the country. Response rates varied from over 60% of nurses and youth/social workers to only 38% of the physicians. Nurses and youth/social workers were younger than physicians, had a proportionately higher number of females within their groups, and more frequently reported that they had or might have been sexually abused as children. Although there was no statistically significant difference among the groups on the composite knowledge score, physicians scored higher than the other two groups on knowledge about STDs, and youth/social workers had the highest knowledge scores about sexual abuse. Some differences in attitudes among the groups were also noted. Overall, the rates of respondents reporting confidence in their ability to treat children with STDs or child sexual abuse were low (26% and 35% respectively). This paper presents the overall results of the survey, and makes recommendations for strategies to enhance professional expertise in the area.     

Canadian Psychological Association: Minutes of the Annual Business Meeting.

Minutes of the Annual Business Meeting are provided. The meeting was held on June 8, 1973. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Canadian Psychological Association: Minutes of the Annual General Meeting.

Presents the minutes of the Annual General Meeting of the Canadian Psychological Association held June 4, 1981 in Toronto, Ontario. (PsycINFO Database Record (c) 2010 APA, all rights reserved)