Polyarteritis nodosa presenting as temporal arteritis in a 9-year-old child

In a household survey in Guinea-Bissau, 319 episodes of diarrhea in children were followed by interviews every second day with the aim of investigating perceived morbidity and subsequent actions taken. The majority of the mothers had good knowledge of oral rehydration salts (ORS). However, only 58% of the episodes were treated with ORS and the amount given was insufficient. Mothers with no knowledge of ORS did not use it during the observed attack of diarrhea regardless of contact with a health center, which suggests that maternal knowledge is an important determinant of whether health personnel provide ORS. Children with diarrhea considered to be caused by teething were less likely to receive ORS in the acute phase (risk ratio = 0.6, 95% confidence interval [CI] = 0.5-0.9). Univariate analyses showed that the use of ORS was related to number of reported symptoms, the mother being the care taker, consultations, previous use of ORS, good knowledge of ORS, and having ORS sachets at home. Multivariate Cox regression analyses showed that the presence of ORS sachets at home at the onset of diarrhea was the strongest predictor of use (hazard ratio = 3.3, 95% CI = 1.9-3.6). Improved health education should focus more on the quantity of ORS needed, early signs of dehydration, treatment of teething diarrhea, and breast feeding, and address mothers who have no prior knowledge of ORS. Management of diarrhea may be improved by a more liberal distribution of ORS sachets.     

Infant feeding practices in St. Vincent and factors which affect them

A survey was conducted in the summer of 1975 in 2 towns in St. Vincent--Layou and Georgetown--in the effort to obtain information regarding infant feeding practices and some of the factors which may influence them. Mothers of children from 1-2 years of age were interviewed in their homes. Complete data sets were obtained on 192 of the 216 eligible children in the 2 towns. For most children the period of exclusive breastfeeding (no other milk product given) was very short. About 1/2 of the children had received milk by 2 weeks of age, and 75% by 1 month. This was followed by a much longer period of "mixed" feeding--both breast and bottle--until breastfeeding was stopped at a median age of 6.8 months. Many types of milk were used for infant feeding. For 73% of the infants, infant formula was the 1st type of milk given. This was commonly replaced by a "heavier" full cream powdered milk at a few months of age. Prelacteal feeds were very common, predominantly glucose water. "Tonics," often consisting of vitamin preparations, were another common supplement during the early months of life. Among solid foods, arrowroot, "custard," and commercial infant cereals were the first to be introduced. Relatively inexpensive locally bagged staple foods and milk powders were available in both towns, but most mothers relied heavily on packaged brand name products for infant feeding even though the cost was 2-10 times higher. It was not possible to pinpoint the exact causes for the high levels of bottle feeding, nor for the possible recent decline in breastfeeding, but several important factors were identified. Part of the problem appeared to be due to poor health and nutritional status of the mothers. In addition, in several cases the mothers reported that they had wanted to continue breastfeeding but had received no support from health professionals, and in a few instances had been ordered to stop for seemingly trivial medical reasons.     

Nursing in lactation mastitis]

Nowadays, the pathogenic staphylococcus plays the most important part in the etiology of mastitis. Further in depth studies of this disease are still necessary. The presence of this disease raises the question of breast feeding. Lactation mastitis disturbs the function of the manmary glands and decreases the quality of the milk. The authors conducted a clinical and bacteriological study of 102 women with unilateral purulent mastitis and their newborns. 95 women went through an operation within 2 days of their admission. The operation for mastitis is a serious intervention which necessitates a good training. 20 healthy women and their newborns aged up to 2 months, served as a control group. Before the operation, the examinations had revealed that the milk from the unaffected breast also contained pathogenic staphylococcus. As a result, the newborns nursed from the healthy mammary gland were showing frequent signs of infection. It is concluded that mothers with purulent lactation mastitis should not breast feed their children as this creates a serious risk of infection for the baby.     

A methodology for sampling and accessing homeless individuals in Melbourne, 1995-96

BACKGROUND: After resection of advanced abdominal neuroblastoma, children may have persistent postoperative diarrhea. Until recently, the magnitude of this problem had not been appreciated. METHODS: To assess the incidence, severity, and management of chronic postoperative diarrhea in these patients, we reviewed the case notes of all children with stage III or IV abdominal and pelvic neuroblastoma who underwent tumor resection in our hospital between January 1985 and September 1996. We classified the severity of diarrhea as follows: mild, less than 3 loose stools per day; moderate, 3 to 5 loose stools per day; and severe, more than 5 loose stools per day and/or urgency, incontinence, or nocturnal diarrhea. RESULTS: Seventy-seven children underwent resection during this period, and 23 (30%) had postoperative diarrhea, classified as mild in 11 patients, moderate in 7, and severe in 5. Dissection around the superior mesenteric and celiac arteries was associated with a significantly higher incidence of diarrhea. Fifteen children (65%) received treatment with loperamide, which reduced but did not abolish symptoms. Twelve children subsequently died of progressive neuroblastoma. Of the 11 surviving children (mean duration of follow-up, 8.4 years), 8 have persistent loose stools. CONCLUSIONS: Diarrhea, probably resulting from disruption of the autonomic nerve supply to the gut during clearance of tumor from the major vessels of the retroperitoneum, is common after resection of advanced abdominal neuroblastoma. Many children require long-term treatment to slow intestinal peristalsis, and a few have severe and unremitting diarrhea. More effective medical management of this complication is needed.     

Prospective study of the atopy preventive effect of maternal avoidance of milk and eggs during pregnancy and lactation

The preventive effect of maternal avoidance of cow's milk and eggs on the development of atopic dermatitis and sensitization to food allergens was studied in a prospective trial with families at high risk for atopy, intervention included encouraging exclusive breast feeding for at least 3 months and delaying the controlled introduction of solid foods. In addition, one group received a maternal diet with the complete avoidance of milk and eggs in the last trimester of pregnancy and during the period of exclusive breast feeding, another group had the same diet starting after delivery, and mothers of the third group had no dietary restrictions. The period prevalences of atopic dermatitis as well as the rates of specific sensitization to eggs and milk at 6 and 12 months were not significantly different between groups. We were unable to demonstrate a significant preventive effect of maternal diet. Conclusion: While breast feeding should be promoted for children at risk for atopy, mothers can be encouraged to stay on normal diet during pregnancy and the breast feeding period.     

Baby feeding: the thoughts behind the statistics

AIM: To investigate attitudes towards baby feeding and to identify reasons why women stop breast feeding. METHOD: A series of six focus groups were held with thirty eight mothers with babies aged between 3 and 18 months, who had been breast and/or bottle fed. RESULTS: The discussions identified a number of significant themes. Decisions on baby feeding were made before birth. Women felt under considerable pressure to breast feed and felt guilty about bottle feeding. Information available about baby feeding was generally inconsistent, unrealistic and incomplete although all women were well informed about the benefits of breast feeding. Most women found breast feeding more difficult than anticipated and needed more help with common problems. A number of difficulties were identified with bottle feeding. Those women who enjoyed breast feeding were most likely to continue. The best support for breast feeding came from other mothers and supportive partners. Ceasing breast feeding was difficult for some women. CONCLUSION: Exploring mothers' attitudes to breast feeding highlighted the need for non judgemental attitudes to baby feeding and consistent information and support on both breast and bottle feeding. Duration of breast feeding is likely to be improved if problems can be addressed. A larger, more detailed prospective study would more accurately identify problem areas and suggest ways of solving them.     

1996 Peritoneal Dialysis Core Indicators Study: report on nutritional indicators

BACKGROUND: The duration of breast feeding has not yet been thoroughly described in France. A prospective survey has been performed on 150 breast feeding mothers to determine its duration. The objective of this study was to analyse predicting factors of this duration. METHODS: A questionnaire including sociological, psychological and medical variables was completed by the mothers and fathers. After discharge, the mothers were contacted every month by a physician until the completion of weaning. RESULTS: The median duration was 10 weeks. By univariate analysis, several variables were associated with a longer duration: decision to breast feed before pregnancy (12 weeks vs 9 weeks; P < 0.01), multiparity (17 weeks vs 12 weeks, P < 0.05), high paternal social level (14 weeks vs 9 weeks, P < 0.001), high maternal education level (12 weeks vs 9 weeks; P < 0.05), mother's idea of "bad" milk (9 weeks vs 30 weeks; P < 10(-6), satisfied mothers (11 weeks vs 2 weeks; P < 0.001), motivation to breast feed (P < 0.05), baby and mother in the same room during the night (13 weeks vs 10 weeks; P < 0.05), and formula supplementation (6 weeks vs 13 weeks; P < 0.01). The mother's return to work was related to a decline in the breast feeding rate at 12 weeks, yet working women generally breast fed the most frequently before returning to work, and many women breast fed and worked concomitantly. A Cox multivariate analysis took into account six significant variables: "bad" milk (lower duration), mother who had been fed, mother satisfied with breast feeding, multiparity, high maternal education, closer proximity of baby to mother (longer duration). DISCUSSION: The duration in our study is longer than in other studies in France. Predictive factors are sociological, linked to maternal education, and psychological, with antecedent of mother breast feeding and decision before pregnancy. The role of the mother's occupation was not very important because working women are generally at a higher social level. The role of the father was analysed, as well as the role of professional workers, family and breast feeding women's associations. CONCLUSION: Factors of breast feeding duration can be somewhat modified, but it is necessary to respect the plans of both the mother and the father. However, early assistance in the hospital and after discharge can help parents realize their plans for prolonged breast feeding and helps obviating the cessation of 20% of mothers during the 1st month.     

Stillbirth is no longer managed as a nonevent: a nationwide study in Sweden

BACKGROUND: Giving birth to a stillborn child is a tragedy. The aim of this study is to investigate the meeting of mothers with their stillborn children and the women's experiences of support during and after the delivery. METHODS: In a nationwide study in Sweden, data from 636 women who gave birth to a stillborn or live baby were collected by means of an anonymous postal questionnaire in 1994. RESULTS: Among the 314 women who gave birth to a stillborn child, nearly every mother had seen her child, and 80 percent had carressed her baby. More than 90 percent of the mothers stated that the medical staff showed respect, and about 80 percent of the mothers stated that staff exhibited tenderness toward their dead children. The mother's assessment of respect and tenderness to her child by medical staff was almost identical between stillbirths and live births. Nearly 70 percent of the women reported that the hospital had good routines to support mothers of stillborn children. Feelings of sadness and having been deeply hurt or angered by the medical staff's behavior were reported by 37 percent of the women. A difficult balance is still to be achieved between women being forced to encounter the baby when not yet ready versus others who wish the staff had given more encouragement. The value of properly taken photographs is described. CONCLUSIONS: Treating stillbirth as a nonevent has been largely, if not entirely, abandoned in Sweden. Most mothers of a stillborn child experience that the medical staff treat their dead children appropriately.     

Young child feeding in a rural area in the Red River delta, Vietnam

Infant and young child feeding practices were investigated in a sample survey (1132 mothers) in a rural area in northern Vietnam. Pre-lacteal feeding was almost universal. Mean duration of breast feeding was 17 months, but foods other than breast milk were introduced early. Only 50% of infants between 3 and 5 months of age were predominantly breast fed. The educational level of the mother was strongly associated with breast feeding duration, with illiterate mothers breast feeding the longest. Christian mothers breast fed for longer than non-Christians. Very few were using feeding bottles at the time of the study, although formulas and bottles have recently been appearing on the local market. The breast feeding pattern described together with the rapidly changing social and economic situation in Vietnam could mean a risk of rapid decline in breast feeding.     

Infant weaning practises of some Idoma women in Makurdi, Nigeria

The weaning practices in infants aged 4-9 months of two hundred Idoma women resident in Makurdi were examined. A pre-tested standard questionnaire was used to collect data from mothers who regularly visited the post-natal health clinics in Makurdi. The results showed that better educated mothers breast fed for a shorter time or planned to cease breast feeding after a shorter period than mothers who had little education or no formal training. Most mothers (97%) fed milk formula which they claimed was used to supplement breast milk and was good for their babies. The most influential factors were the hospital and the husband. The majority of the mothers fed pap; 73% using corn in its preparation, with 91% of them storing such paps in flask. More than half of the mothers used a bottle in feeding the paper or gruel to their infants while a similar proportion (65.5%) fed legumes to their infants in addition to fruits. The implications of these practices in comparison with other ethnic groups is discussed.     

Tympanoplasty using chondro-perichondral graft. Indications, techniques and results. Apropos of a series of 127 cases

The knowledge about infant dental care (as a part of primary preventive programme) was delivered by the existing health team of CHC viz. medical doctors, multipurpose workers, health workers, Anganwadi workers (ICDS scheme), after due training from the dental experts, in the rural community of Raipur Rani (Haryana). The knowledge of community regarding infant dental care subsequent to intervention strategies when evaluated and compared to baseline values three years after intervention revealed that 72 percent of the community had the correct knowledge of prolonged breast/bottle feeding causing nursing bottle caries. 94 per cent had correct knowledge about harmful effects of thumb/finger sucking on teeth and jaw bones and 77 percent about harmful effects of mouth breathing. 98 percent of expecting mothers knew when to clean the gum pads and 62 percent how to clean the gum pads in an infant. 100 percent of the expecting mothers had the correct knowledge that pacifiers should not be used in small children.     

Breast feeding--a year's experience of one group practice

Dissatisfaction at the lack of support and encouragement in the immediate post-partum period of mothers in hospital wishing to breast feed is expressed in their own words. Analysis indicates that mothers in the upper social classes are more likely to breast feed and that those who manage to sustain breast feeding for one week are likely to continue this method of feeding for at least six weeks and possibly for much longer. There is also evidence indicating that women who are encouraged during pregnancy to breast feed have a high success rate. Those responsible for supervising infant feeding need to be better educated in all its aspects.     

Infant feeding practices among nursing personnel in Malaysia

Concerned by the alarming decline in breast feeding in the urban and rural areas of Malaysia, we conducted a critical review of infant feeding practices among nursing personnel from representative centres using questionnaires. It was found that although 75% of mothers breast-fed their babies at birth only 19% did so at 2 months and 5% at 6 months respectively. Chinese mothers initiated breast feeding less frequently compared with Indian or Malay mothers. The prevalence of breast feeding was higher among lower category nurses, lower income groups and those from health centres. Decision for breast feeding was based in most instances on conviction derived from reading, lectures or advice from relatives. The vast majority of mothers listed "work' as the main reason for termination of breast feeding followed by "insufficient breast milk' and satisfactory past experience with bottle feeding. The ramifications of these findings and measures to improve the prevalence and duration of breast feeding are discussed.     

The Inventory of Functional Status-Dialysis: development and testing

Pet and wildlife populations are a potential source of various public health problems, and injuries and complications due to animal bites and scratches are the most obvious. As no population based data on the frequency of animal bites were available at a national level in Switzerland, a study was conducted by the Swiss Sentinel Surveillance Network. The objectives of this study were to estimate the incidence of medical consultations due to bite and scratch injuries in humans caused by vertebrate animals, to identify possible risk factors, and to assess bite management habits in primary health care. An annual bite and scratch incidence rate of 325 per 100,000 population was estimated. Consultations peaked during the summer months and geographical differences in the reported incidence were observed. Dogs accounted for more than 60% and cats for about 25% of all cases reported. Animal bites and scratches were frequent in persons under 20 years of age. In most ages, the incidence was higher among women than among men, but not in children under the age of ten years. The incidence of cat bites was especially high in adult women. Bites to the head and neck were most frequent in infants and young children and accounted for approximately one third of the reported cases in this age group. Patients sought medical care principally for primary wound care (52.0%) and for vaccination advice (29.6%). Rabies postexposure prophylaxis was initiated in 1.1% of patients. Wound infection was reported in 10.9% of cases, with cat bites/scratches being more often infected than injuries due to dogs. Hospitalization was reported in 0.3 % of patients. Data from the emergency department of two district hospitals showed that head and neck injuries were more frequent in out-patients and a higher proportion of persons presented with wound infections (14.1%). The hospitalization rate for emergency department visits was 4.7%. Animal bites and scratches are common events in Switzerland. They represent a public health issue of growing importance due to the steadily increasing pet population. A practice based sentinel surveillance system may be an appropriate tool to monitor national trends in animal bites and scratches.     

Demographic characteristics and medical aspects of menopausal women in Taiwan

This report describes the medical and demographic characteristics of menopausal women in Taiwan in order to provide information for consideration during future healthcare planning. The medical and demographic data analyzed were taken from officially published materials of the Government of the Republic of China on Taiwan, our own studies, and those of other researchers. In 1994, the average lifespan of men in Taiwan was 71.8 years and that of women was 77.7 years. The age of menarche was 13.6 years and the age of menopause was 49.5 years. Women aged 50 and over accounted for 18.3% of the total female population and 8.9% of the total population in Taiwan. In 1994, 68.9% of women in Taiwan aged 50 and over were married. The most frequently occurring menopausal symptoms in Taiwanese women were lumbago or low backpain (68%), fatigue (59%), impairment of memory (55%), vaginal dryness (50%), and hot flushes and sweating (49%). The spinal bone mineral density of women decreased markedly after the age of 50 years. The prevalence of vertebral fracture in women 65 years and over was 19.8%, which was higher than the 12.5% in men of the same age group. The prevalence of hypertension and coronary heart disease in women 50 years or older was also higher than in men. The most frequent sites of cancer in women in 1992 were the cervix uteri, breast, sigmoid colon and rectum, lungs, liver, stomach, thyroid, ovaries, hemopoietic and reticuloendothelial systems, and skin. There were 14,298 newly reported cases of malignant neoplasms in women in 1992. About 60% of these occurred in women aged 50 years or more. The median age of occurrence of cervix uteri, breast, and ovarian cancers was 48 to 49 years, which is very close to the menopause age. About 30% of menopausal women in Taiwan are currently living without a husband. Although 18.3% of women in Taiwan were at least 50 years old, approximately 60% of all malignant neoplasms in the female population occurred in this group. There is an urgent need for menopausal women in Taiwan to receive psychologic support and comprehensive medical care.     

Longitudinal study of early childhood injuries and acute illnesses in the offspring of adolescent mothers who were aggressive, withdrawn, or aggressive-withdrawn in childhood

In a 15-year longitudinal study, the medical records of 94 children whose adolescent mothers had childhood histories of aggressive, withdrawn, aggressive-withdrawn, or normative (nondeviant) social behavior were examined. The children's annual rates of visits to the emergency room (ER) and to nonemergency medical facilities, post-ER hospitalizations, diagnoses of injuries, acute illness and infection, asthma, and emergency surgical consultations were examined between birth and 48 months of age. Group differences were found for the annual rate at which children were brought to the ER and for injury-related post-ER hospitalizations. Sons of women in the aggressive group and both sons and daughters of women in the aggressive-withdrawn group had elevated and distinctive profiles in respect to specific emergency diagnostic and treatment variables compared with children of women in the nondeviant group.     

Class differences in the food rules mothers impose on their children: a cross-national study

Many studies indicate that children in middle-class families have healthier eating habits than children in lower class families. Class differences in food rules, which parents and especially mothers impose on their children, may underlie these social inequalities in food consumption. The present study uses education as a classifying variable and analyses whether mothers with higher education prescribe more "healthy" foodstuffs for their children and whether they restrict more "unhealthy" food items than less educated mothers. Moreover, the study examines whether higher class mothers consider health aspects more often and the preferences of their family members less often in their choice of food, and whether class differences in these considerations explain class differences in food rules. To answer these questions, questionnaires on the food practices of 849 women living in middle-class or lower class districts in Maastricht (the Netherlands), Liège (Belgium) and Aachen (Germany) were collected and analysed. The majority of mothers in each city prescribed primarily foods that were served at dinner like meat and vegetables, and most mothers limited their children's consumption of sweet foods, soft drinks and snacks. Higher class mothers restricted more foods, but prescribed as many food items as their lower class counterparts. Class differences in the number of restricted foods were partly, but not completely, explained by class differences in health and taste considerations. Despite national variations in dietary habits and possibly in the education of children, class differences in food rules and the explanatory power of health and taste considerations were comparable in the three cities.     

Longitudinal study of early childhood injuries and acute illnesses in the offspring of adolescent mothers who were aggressive, withdrawn, or aggressive–withdrawn in childhood.

In a 15-year longitudinal study, the medical records of 94 children whose adolescent mothers had childhood histories of aggressive, withdrawn, aggressive–withdrawn, or normative (nondeviant) social behavior were examined. The children's annual rates of visits to the emergency room (ER) and to nonemergency medical facilities, post-ER hospitalizations, diagnoses of injuries, acute illness and infection, asthma, and emergency surgical consultations were examined between birth and 48 months of age. Group differences were found for the annual rate at which children were brought to the ER and for injury-related post-ER hospitalizations. Sons of women in the aggressive group and both sons and daughters of women in the aggressive–withdrawn group had elevated and distinctive profiles in respect to specific emergency diagnostic and treatment variables compared with children of women in the nondeviant group. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

AV nodal re-entry tachycardia in elderly patients: clinical presentation and results of radiofrequency catheter ablation therapy

STUDY OBJECTIVE: To assess the prevalence of respiratory problems, and the relation of these problems with school attendance, medicine use, and medical treatment. DESIGN: The Child Health Monitoring System. SETTING: Nineteen public health services across the Netherlands. PARTICIPANTS: 5186 school children aged 4-15 years, who were eligible for a routine health assessment in the 1991/1992 school year. MAIN RESULTS: Respiratory symptoms were present in 12% of the children. Recent symptoms suggestive of asthma (wheezing or episodes of shortness of breath with wheezing in the past 12 months, or chronic cough, or a combination of these) were reported for 8%. These symptoms were most frequent in the younger children, and in children at school in towns with less than 20,000 inhabitants. Of the children with recent symptoms suggestive of asthma, 37% reported school absence for at least one week during the past 12 months, compared with 16% in children without respiratory symptoms. School absence because of respiratory illness was reported for 22%, and medicine use for respiratory problems for 38% of the children with recent symptoms suggestive of asthma. Of these children, 21% were receiving medical treatment, compared with 15% of the asymptomatic children. CONCLUSIONS: Respiratory symptoms are a common health problem in children, and they are an important cause of school absence and medicine use. However, the percentage of children receiving medical treatment seemed quite low, indicating that proper diagnosis and treatment are probably still a problem.     

Prenatal vitamin supplementation and pediatric brain tumors: huge international variation in use and possible reduction in risk

An international case-control study of primary pediatric brain tumors included interviews with mothers of cases diagnosed from 1976-1994 and mothers of population controls. Data are available on maternal vitamin use during pregnancy for 1051 cases and for 1919 controls in eight geographic areas of North America, Europe and Israel. While risk estimates varied by study center, combined results suggest that maternal supplementation for two trimesters may decrease risk of brain tumor [odds ratio (OR)=0.7; 95% confidence interval (CI)=0.5-0.9], with a trend toward less risk with longer duration of use (P trend= 0.0007). The greatest risk reduction was among children diagnosed under 5 years of age whose mothers used supplements during all three trimesters (OR=0.5; CI=0.3- 0.8). This effect did not vary by histology and was seen for supplementation during pregnancy rather than during the month before pregnancy or while breast feeding. These findings are largely driven by data from the US, where most mothers took vitamins. The proportion of control mothers who took vitamins during pregnancy varied tremendously, from 3% in Israel and in France through 21% in Italy, 33% in Canada, 52% in Spain to 86-92% at the three US centers. The composition of the various multivitamin compounds taken also varied: daily dose of vitamin C ranged from 0 up to 600 mg; vitamin E from 0 to 70 mg; vitamin A from 0 to 30,000 IU and folate from 0 to 2000 mg. Mothers also took individual micronutrient supplements (e.g., vitamin C tablets), but most mothers who took these also took multivitamins, making it impossible to determine potential independent effects of these micronutrients.