Progress in worldwide control and elimination of disease through immunization.
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Child Health Services↗
Biomedical subjects
G F Hayden
Publications and source records attributed to G F Hayden.
Comparison of three topical antimicrobials for acute bacterial conjunctivitis.
One hundred fifty-eight patients, 21 years of age or less, presenting with culture-positive (Haemophilus influenzae or Streptococcus pneumoniae) conjunctivitis were treated with trimethoprim-polymyxin B (TP), gentamicin sulfate (GS) or sodium sulfacetamide (SS) ophthalmic solution for 10 days. Clinical response at 3 to 6 days after start of therapy was similar for all test agents: 26 of 55 (47%) patients cured, 25 of 55 (45%) improved for TP; 28 of 57 (49%) cured, 26 of 57 (46%) improved for GS; and 19 of 46 (41%) cured, 22 of 46 (48%) improved for SS. Clinical response at 2 to 7 days after completion of therapy was also similar: 46 of 55 (84%) patients cured, 5 of 55 (9%) improved for TP; 50 of 57 (88%) cured, 5 of 57 (9%) improved for GS; and 41 of 46 (89%) cured, 2 of 46 (4%) improved for SS. Bacteriologic response at 2 to 7 days after completion of therapy was similar for all antimicrobials: 44 of 55 (83%) patients for TP; 39 of 57 (68%) for GS; and 33 of 46 (72%) for SS.
Administration, Topical↗
Management of the ambulatory patient with a sore throat.
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Ambulatory Care↗
Use of phencyclidine among adolescents attending a suburban drug treatment facility.
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Adolescent↗
Providing free samples of baby items to newly delivered parents. An unintentional endorsement?
Recent studies have suggested that providing free sample packs of baby items to newly delivered parents may adversely influence parental health behavior. To determine the extent of this practice in Virginia, the head nurses of all 68 newborn nurseries and a random sample of 200 pediatricians were surveyed. Formula samples were being distributed at all hospitals. Formula packs were given to breast-feeding mothers at 65 (95%) hospitals although only 66 percent of the surveyed pediatricians approved of this practice. Samples of baby items other than formula (e.g., baby powder) were being distributed at 66 (97%) hospitals. Some physicians (18%) objected to the distribution of these nonformula samples, and others were not familiar with the content of these packs. In most instances, the hospital medical staff had not voted to approve the distribution of these packs. Parents were being informed only rarely about the source and intent of the packs. The provision of sample packs to newly delivered parents affects approximately 3,000,000 babies each year in the United States. The short- and long-term effects of providing these packs have been inadequately explored. Physicians should make an active decision whether to distribute sample packs. Those physicians choosing to dispense these samples may wish to review and edit the content of the packs and to enclose in the pack a brief note explaining that the provision of the products does not constitute a medical endorsement.
Advertising↗
Urinary cannabinoids in monitoring abstinence in a drug abuse treatment program.
Urine specimens from 162 adolescents entering a drug treatment program were tested for cannabinoids using a photometric immunoassay (EMITst) and thin-layer chromatography (TLC). The EMITst has a cutoff point of detection 25 ng/mL or less of 9-carboxy-tetrahydrocannabinol. When reported as positive, both tests appeared to be reliable. There were two false-positive EMITst results and three false-positive TLC results in the 67 urine specimens that did not contain cannabinoids. When reported as negative, however, the EMITst with its 100 ng/mL cutoff failed to detect almost 40% of all cannabinoid-positive specimens. Of the 65 chronic marijuana smokers in the present study who stated that they had smoked within two days of their admission into the treatment facility, 17 (26%) went undetected by the 100 ng/mL cutoff used by the EMITst method. In clinical settings such as drug treatment programs, tests for urinary cannabinoids should use a detection threshold at 20 ng/mL or less.
Adult↗
The reevaluation visit for acute otitis media.
Seventy children with acute otitis media diagnosed at a suburban, private primary care practice were examined after a ten-day course of antibiotic therapy and were then monitored closely for an additional 20 days. Parents were advised to seek prompt attention if symptoms of earache, fussiness, or fever recurred at any time during the 30-day study period. Of 14 symptomatic recurrences of acute otitis media, eight (57 percent) occurred within one week of discontinuing antibiotic therapy. Four (10 percent) of 41 children with persistent otitis media with effusion on days 10 to 14 developed symptomatic acute otitis media over the next 18 days, as did four (17 percent) of 23 children who had a normal middle ear examination on days 10 to 14. Early follow-up visits immediately following antibiotic therapy commonly detect persistent otitis media with effusion but appear to have limited value in detecting asymptomatic, posttreatment acute otitis media. the optimal timing of reevaluation visits for children with acute otitis media deserves further study.
Acute Disease↗
Adequate illumination for otoscopy. Variations due to power source, bulb, and head and speculum design.
To determine the working condition of otoscopes used in our community to diagnose middle-ear disease in children, we examined 221 otoscopes located in a hospital clinic, four emergency rooms, and the private offices of 96 physicians. The light output of each unit was measured in "as is" condition and then remeasured after a new lamp and, when possible, a new battery had been placed in the unit. A light output of 100 foot-candles or more was judged optimal for clinical otoscopy. Replacement of the bulb was significantly more likely than replacement of the battery to restore adequate light output to those units with initially poor performance (80% vs 26%). Almost one third of physicians reported changing otoscope bulbs less often than every two years, and several did not know how to replace the bulb. Almost half of the 93 rechargeable nickel-cadmium batteries inspected were outdated, but even these "expired" batteries provided adequate power when fully charged. Office otoscopes should be maintained properly to ensure optimal performance.
Evaluation Studies as Topic↗
Leukocyte counts in children with acute otitis media.
Peripheral blood leukocyte counts were performed in 167 children with acute otitis media who underwent myringotomy with culture of the middle ear exudate. A markedly elevated (greater than 97th percentile for age) leukocyte count was noted at initial presentation among 28% of these children, and counts exceeded 20,000/microL among 9%. Children older than six years were more likely than younger children to have marked leukocyte (41 v 24%, P less than 0.1). Children with culture-positive and culture-negative acute otitis media had similar leukocyte counts. There was no difference in frequency of posttreatment leukocytosis between those children who had complete resolution of acute otitis media and those children who had persistent otitis media with effusion. At follow-up 10 to 14 days later, relative leukopenia was observed significantly more often than at initial presentation (13 v 2%, P less than 0.001), and was most common among children two to five years old. Absolute neutropenia was likewise more common at the follow-up than at initial presentation (10 v 2%, P less than 0.01). Children treated with the fixed combination of erythromycin ethyl succinate-sulfisoxazole acetyl were somewhat more likely to have absolute neutropenia than those children who were treated with amoxicillin, but this difference was not statistically significant (14 v 6%, P less than 0.1). Acute otitis media, and perhaps the specific antibiotic therapy prescribed for acute otitis media, may exert marked effects upon peripheral blood counts.(ABSTRACT TRUNCATED AT 250 WORDS)
Age Factors↗
Child abuse reporting by physicians.
Despite the prominent role of physicians in the child abuse reporting statutes of all 50 states, there is little published information concerning child abuse reporting by physicians. Our study examines the number and type of child abuse reports originating from physicians compared to other reporting sources. Reports by physicians comprised only 8% of the total number of child abuse reports received in Virginia in 1983. Reports by physicians were founded more often than reports from any other source, however, so that physicians contributed 14% of the reports that were ultimately founded. When compared to reports by all other sources, physician reports contained a significantly greater proportion of cases of physical abuse (P less than .0001), but a smaller proportion of physical neglect (P less than .0001). Physicians appear to be reporting those types of abuse that they are in a unique position to observe.
Child↗
Marijuana use among middle-class adolescents.
One hundred sixty-two adolescents being seen for sick or well visits at two suburban private pediatric practices completed an anonymous, written questionnaire about drug habits. The respondents' ages ranged from 14 to 17 years; all were white and from middle-class or upper-middle-class families. The adolescents reported high self-esteem, good general health, and few psychologic problems. The majority of respondents stated that they and their good friends never used drugs. Seven adolescents (4%), however, reported having used marijuana during the previous week, and 13 (8%) during the previous month. When asked about the frequency of marijuana use by their good friends, 13 respondents (8%) said their friends had smoked marijuana 51 to 100 times, and another ten (6%) replied 21 to 50 times. The most frequently cited source of drugs was another student at school, whereas places drugs were commonly used included parties, rock concerts, and friends' houses. Even among a population of middle-class adolescents having follow-up in a suburban pediatric practice, use of marijuana and other drugs may constitute a serious health and psychologic problem. Physicians caring for adolescents must be aware of patterns of drug availability and use in their community, and should be prepared to recognize and remediate drug-related problems occurring in their patients.
Adolescent↗
Group F streptococci in the pharynx: pathogens or innocent bystanders?
beta-Hemolytic streptococci (BHS) of Lancefield group F were isolated in moderate to heavy growth from throat cultures taken from 46 children and adolescents with symptomatic pharyngitis. In most instances, oxygen deprivation by means of an anaerobe jar was required for these beta-hemolytic organisms to grow. In relation to a comparison group of children with throat cultures positive for group A BHS, children with group F isolates were more likely to be adolescents and less likely to have fever and cervical adenopathy. It appears that group F BHS are not a major cause of nonepidemic pharyngitis in the pediatric age group. More precise determination of how commonly these organisms cause pharyngitis will require either comparison of isolation rates of group F BHS from the throats of both sick and well children, or further elucidation of the serologic response to these organisms so as to distinguish invasive infection from asymptomatic carriage.
Adolescent↗
Intern ranking versus subsequent house officer performance.
The rankings of candidates for pediatric internship by the Pediatric Intern Selection Committee (ISC) of the University of Virginia Medical Center were compared with subsequent performance rankings of house officers by faculty members and chief residents. Although a positive correlation was found between the rankings, the absolute magnitude of the correlation coefficients was relatively low and not statistically significant. We discuss factors responsible for the poor correlation and suggestions for ISCs.
Clinical Competence↗
Children less than three-years-old with pharyngitis. Are group A streptococci really that uncommon?
During a 15-month period, 148 infants and children less than 3-years-old who presented with signs and/or symptoms of pharyngitis were monitored in a private pediatric practice. Clinical signs included fever (95 or 64%), tonsillar exudate (16 or 11%), and cervical adenopathy (5 or 3%). Beta-hemolytic streptococci (BHS) from group A were isolated from throat swabs in 37 (25%) instances. These isolations were more common among children 25-35 months old than among children less than 2 years old (35% vs. 19%, p less than 0.05), and were significantly more likely when overnight anaerobic culture techniques were used rather than conventional aerobic methods (23% vs. 11%, p less than 0.01). Group A BHS may be isolated relatively frequently from symptomatic children under 3-years-old. Whether these isolations reflect invasive infection or asymptomatic carriage is uncertain.
Bacteriological Techniques↗
Drinking patterns and social consequences: a study of middle-class adolescents in two private pediatric practices.
One hundred sixty-two adolescents who were seen at two suburban private pediatric practices completed an anonymous, written questionnaire about drinking and drug habits. The respondents' ages ranged from 14 to 17 years; all were white and from middle- or upper middle-class families. The adolescents reported high self-esteem, good general health, and few psychologic problems. The majority (63%) reported having drunk alcohol at some time, and the proportion who professed never to drink alcohol became progressively smaller with age, to only 15% at age 17 years. Overall, one fifth claimed that they had to drink more than six beers before they "got a buzz," and this proportion increased to 43% by age 17 years. Among the 17-year-old respondents, 40% replied that their good friends had used alcohol more than 50 times. Twenty-four percent of respondents said that a good friend had received a citation for driving while intoxicated. Almost one fifth of respondents stated that someone in their family drinks alcohol every day, and that someone close to them has a drinking problem. Social acceptance of drinking, peer pressure, and the ready availability of alcohol have led to an epidemic of alcohol use among teenagers and to social, academic, and health problems in many frequent users. Pediatricians should play a more active role in the identification and management of alcohol abuse by their adolescent patients.
Adolescent↗
Skin diseases encountered in a pediatric clinic. A one-year prospective study.
To determine the frequency and nature of skin disorders encountered in a medical center pediatric clinic, we prospectively surveyed 1,547 patient visits during a one-year period. A primary skin complaint had prompted 6% of all of the visits and 9% of the visits that were for reasons other than well-child care. More than 21% of the visits featured either a skin complaint or a skin finding. Among 235 visits by children with primary or secondary skin complaints, the most frequent diagnoses included skin infections (36%), diaper dermatitis (16%), and atopic dermatitis (9%). Although the range of skin lesions encountered was very broad, the great majority (86%) of diagnoses fell within nine general categories. Because dermatologic problems constitute such an important component of primary care pediatric practice, appropriate emphasis should be placed on teaching basic principles of dermatology to pediatricians both during and after residency training.
Adolescent↗
Characteristics of earache among children with acute otitis media.
The frequency and correlates of earache were studied prospectively among 335 consecutive episodes of acute otitis media with effusion (AOME) diagnosed in a suburban pediatric practice. Earache was severe in 142 (42%) episodes, mild/moderate in 135 (40%), and absent in 58 (17%). The incidence of apparently painless AOME was higher among children less than 2 years old than among older children (25% v 7%). Redness of the completely bulging tympanic membrane was associated with an increased likelihood of earache. Neither gender nor the extent of involvement (one v both ears) was independently related to earache. Earache is not an invariable component of AOME, especially among infants and young children. Detection of all cases of AOME among young children requires a high index of suspicion, even in the apparent absence of earache.
Age Factors↗
Laboratory detection of marijuana use. Experience with a photometric immunoassay to measure urinary cannabinoids.
The urinary excretion of cannabinoids was determined using a photometric immunoassay technique among adolescents and young adults who had an abrupt and closely supervised cessation of drug use on entering a strict rehabilitation program. No falsely positive urine test results were encountered among 70 persons admitted consecutively to the program. Among five subjects with a history of chronic, heavy marijuana use (approximately 56 g/mo [approximately 2 oz/mo]), urinary cannabinoids were detected for an average of 13 days (range, nine to 25 days), following cessation of use. Among four subjects with a history of moderate marijuana use (approximately 28 g/mo [approximately 1 oz/mo]), test results remained positive for an average of 4.7 days (range, two to eight days). Test results were negative 48 hours after cessation in two subjects with a history of infrequent use (less than 7 g/mo [0.25 oz/mo]), who had smoked marijuana within the preceding two days. The specificity of the method for detecting recent marijuana use appears excellent; the sensitivity depends on the potency of the cannabis preparation, the time of last use, the frequency of previous use, and the specific gravity of the urine specimen. On the basis of this preliminary experience, positive test results for more than eight consecutive days suggest either surreptitious continued use or previous chronic, heavy use in a newly abstinent person. Purposeful adulteration of known-positive urine specimens with bleach, blood, vinegar, salt, and liquid soap produced falsely negative results. Unless samples are collected under direct observation, urine color, temperature, specific gravity, and dipstick tests for blood and pH should be recorded.
Adolescent↗