Homeless children

The aim of the study was to evaluate the applicability to urine samples of the Amplified Mycobacterium tuberculosis Direct Detection Test (AMTD), which is currently used to identify this organism in respiratory specimens within a few hours. The study was performed on 95 patients, comprising 35 subjects with a high index of suspicion for active tuberculosis of the urinary tract and 60 subjects with evidence of non-mycobacterial disease. One urine specimen from each subject was examined by microscopy, culture and AMTD. AMTD was positive in 38 specimens and negative in 57. Assuming culture as the reference standard, the sensitivity, specificity, positive predictive value and negative predictive value of AMTD were 100%, 91.93%, 86.84% and 100%, respectively. Reassessing the discrepancies between AMTD and culture by review of patients' charts, the sensitivity, specificity, positive predictive value and negative predictive value of AMTD were 100%, 93.44%, 89.47% and 100%. The results of the study as well as the characteristics of AMTD encourage its use for the rapid recognition of urinary tract tuberculosis, although its findings should be interpreted cautiously when the clinical picture is not consistent with an active tuberculosis.     

Identification of caries risk children and prevention of caries in pre-school children

A special model for dental care in pre-school children was used in a small clinic in the county of Blekinge in southern Sweden. The model is based on screening of caries risk performed by a dental assistant before the caries attack. Any single risk factor or risk behavior in pre-school children was considered. The aim was to 1) evaluate the dental assistant's selection of caries risk children up to the age of three years, 2) compare dental health variables in 4 yr olds in the test clinic with those for the whole county in 1994 and 3) compare time spent by the dentist and the dental assistant in the test clinic and in the whole county per child up to the age of four. 102 children participated. One specially trained dental assistant screened all children using background factors combined with clinical examinations at ages 1, 2 and 3. Eighty-two children participated each year from one year. A systematized form for questioning the parents was used. Individual caries prevention was given including fluoride and antimicrobial treatments as well as fissure sealants in primary molars at caries risk. The proportion of children with caries lesions at four years and a caries risk assessment up to the age of two was 1.0 (sensitivity). The proportion of children with no caries lesions at four years and no caries risk assessment at year two was 0.7 (specificity). The most frequent risk factors found at 2 yrs were frequency order: lack of oral hygiene (visible plaque), deep fissures in molars and frequent intakes of sweet drinks. The proportion of children with no caries lesions at 4 yrs of age in the test clinic was 92.9% compared to a county mean of 76.4%. In the group of children where a risk assessment was made each year from one year the proportion of caries free children was 96.3%. The total time spent per child in the test clinic was 22 minutes more than the county mean. However, dentist's time, excluding assistance, was 28 minutes less in the test clinic. The results suggest that the model used for caries prevention in pre-school children is cost-effective, and that dental health can be remarkably improved.     

Prevalence of fibromyalgia in children: a clinical study of Mexican children

OBJECTIVE: To determine the prevalence of fibromyalgia (FM) in schoolchildren according to the 2 stage classification process proposed by the 1990 American College of Rheumatology (ACR) Multicenter Criteria Committee on Fibromyalgia. METHODS: Stage 1: we administered a pain questionnaire to a sample of 548 schoolchildren (264 boys, 284 girls; mean age 11.9 yrs, range 9-15). Stage 2: two rheumatologists examined all children with diffuse pain. Using thumb palpation, they examined 18 fibromyalgia tender points and 3 pairs of controls points followed by dolorimetry. Additionally, a random sample of 79 children with no pain were selected as controls, following the same procedures (thumb palpation and dolorimetry). The Wilcoxon test was used to compare the distribution of tenderness thresholds between FM and non-FM groups. Kappa statistics for multiple raters was used to assess interobserver agreement. RESULTS: Seven children, all girls, fulfilled the ACR diagnostic criteria for FM. Thus, the prevalence of FM in this group of schoolchildren reached only 1.2%. The girls with FM had a mean of 14 tender points, whereas controls (n = 79) had 2.4. Pain thresholds were 3.4 kg in children with FM and 5.1 kg in controls (p = 0.004). CONCLUSION: The prevalence of FM in our study was 5-fold lower than a previous report. This variance may be due to (1) racial and sociocultural differences between populations; and (2) differences in methodological approach. The difficulties of making accurate estimates of FM across different studies are highlighted.     

Tetanus of immunized children

Five children aged five to 15 years contracted tetanus in Finland between 1969 and 1985, together with 101 adults. Four of the five had been adequately immunized against tetanus. The clinical picture of tetanus was mild or moderate, and none of the children needed respirator treatment. Epilepsy, meningitis and psychogenic symptoms were considered in the differential diagnosis. The course of tetanus in immunized patients is atypical and often benign, but the diagnosis is problematic--in contrast to affected children in developing countries, whose populations are not adequately immunized and where neonatal tetanus is common and often fatal.     

Victimization of children.

Children suffer more victimizations than do adults, including more conventional crimes, more family violence, and some forms virtually unique to children, such as family abduction. On the basis of national statistics, these victimizations can be grouped into 3 broad categories: the pandemic, such as sibling assault, affecting most children; the acute, such as physical abuse, affecting a fractional but significant percentage; and the extraordinary, such as homicide, affecting a very small group. They can also be differentiated by the degree to which they result from the unique dependency status of children. A field called the victimology of childhood should be defined that adopts a developmental approach to understanding children's vulnerability to different types of victimizations and their different effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preoperative evaluation of children

Preoperative evaluation and preparation are directed toward minimizing the intrinsic risks of anesthesia and surgery by having the child in the healthiest possible condition prior to surgery. The pediatrician can contribute to this goal by understanding the effects of general anesthesia on the physiology of children. This knowledge allows an appreciation of the anesthesiologists' concerns regarding underlying diseases, which may seem "stable" (and, therefore, of little present concern to the pediatrician) but which may have grave consequences during anesthesia. The preoperative evaluation is designed to ensure that the child's preoperative needs may be met by providing the anesthesiologist both qualitative and quantitative information regarding the child's state of health and disease. The relationship between the child, parents, and pediatrician places the pediatrician in an ideal position to prepare families for their children's surgical experience.     

Nutritional problems of children

In the underdeveloped areas of the world malnutrition frequently starts "in utero" as indicated by a high proportion of low birth weight babies. These "small for date" babies have a high risk of death and contribute significantly to the high infant mortality rates observed in these populations. After birth inadequate physical growth is the most frequent manifestation of malnutrition. It is not yet clear if the observed mental retardation is directly related to malnutrition or more to psycho-social deprivation, but is is anyhow an important problem. The effects of transculturization resulting in early weaning is complicating the situation even more by producing severe malnutrition at earlier ages.     

Language differences between black children and white children.

Examined 48 black and 48 white children, matched for social class and nonverbal intelligence, in a free-recall situation on vocabulary words and sentences presented in black dialect and standard English. On standard English sentences, both groups performed equally well. On sentences in black dialect, the white Ss performed significantly worse. Findings are interpreted as support for bilingual language development in black ghetto children and emphasize the importance of social class and intelligence when comparing black and white Ss on language tasks. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Vasculitis in children

A group of experts from gastroenterology, internal medicine, health economics, medical outcomes, and managed care met in San Francisco, Calif, on September 27, 1994, in an effort to develop clinically and economically effective disease management guidelines to assist physicians in their treatment of gastroesophageal reflux disease in a managed care environment. This article represents a consensus opinion based on the evidence and expert interpretation at the time of that meeting.     

The Prozac children

Rumors have been flying that the Joint Commission is going to eliminate the requirement for a single nurse executive as required by standard NR. 1 in the Comprehensive Accreditation Manual for Hospitals (CAMH). This column clarifies the JCAHO's intent in this regard.     

Save our children

This paper reports changes in adrenocorticotrophic hormone (ACTH), insulin and insulin-like growth factor-1 (IGF-1) concentrations in cats from a previously published study. The cats were given oral megestrol acetate (MA, 5 mg once daily for 14 days), subcutaneous proligestone (PRG, 100 mg on two occasions one week apart) or subcutaneous saline (1 ml as for PRG). In the cats given saline (n = 6), basal ACTH, insulin and IGF-1 did not change significantly throughout the following seven weeks. The cats given MA (n = 7) developed significant suppression of plasma ACTH concentrations and hyperinsulinaemia during treatment and for two to four weeks after MA dosage ceased. In the cats given PRG (n = 7), plasma ACTH concentrations were not significantly altered although three cats had markedly suppressed values for some time after PRG treatment had ceased. Serum insulin concentrations were not significantly altered in the PRG-treated cats. The results suggest PRG may be a preferable alternative to MA in some situations.     

Adolescent children of alcoholic parents and the relationship of Alateen to these children.

25 adolescents with an alcoholic parent who are not members of Alateen (Group 1) had significantly higher scores on the negative scales of the Profile of Mood States and a significantly lower score on the positive scale and significantly higher scores (indicating low self-esteem) on the Rosenberg Self-Esteem Scale than a control group of 25 adolescents without an alcoholic parent or 25 adolescents who have an alcoholic parent but are members of Alateen. Group 1 also had problems at school or with law enforcement officials. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

My children and me: Midlife evaluations of grown children and of self.

215 midlife parents (mean age 53.7 yrs) were interviewed about how their adult children (mean age 27.6 yrs) had "turned out." These assessments were then related to parents' views of themselves. Perceived accomplishments and adjustment of children were expected to be positively linked with parents' well-being (e.g., self-acceptance, environmental mastery, purpose in life), and social comparisons were hypothesized to contribute to the link between parents' assessments of children and their own well-being. Multiple regression analyses revealed that children's perceived adjustment significantly predicted 6 of 7 well-being outcomes for mothers and fathers. Children's attainment was less strongly linked with parental outcomes. Personal comparisons were significant negative predictors: Parents who saw their children as better adjusted than themselves had lower well-being. (PsycINFO Database Record (c) 2010 APA, all rights reserved)