The epidemiology of leisure accidents in Scotland.
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Accidents↗
Biomedical subjects
H Campbell
Publications and source records attributed to H Campbell.
Audit of the support for breastfeeding mothers in Fife maternity hospitals using adapted 'Baby Friendly Hospital' materials.
BACKGROUND: The objective of this study was to assess the level of support given to breastfeeding mothers during their stay in maternity hospitals. The audit was carried out in maternity hospitals in Fife with the co-ordination of the Fife Joint Breastfeeding initiative. METHODS: The subjects consisted of ten maternity hospital staff (medical and midwifery), and 12 antenatal and 21 postnatal women. The design of the study consisted of an audit of hospital policies and practices in comparison with ten internationally recognized standards. This was carried out by adapting the external evaluation instruments from the WHO-UNICEF "Baby Friendly Hospital" materials. Methods relied not only on reported practices but also on direct observation and enquiry. RESULTS: Action was taken to address areas of practice which fell below the WHO-UNICEF standards: supplementary feeding of breastfed babies, particularly overnight, was reduced; discharge "bounty packs" advertising baby milk manufacturer products were discontinued; a hospital breastfeeding support group was established; the hypoglycaemia policy was revised; and the need for an orientation session on breastfeeding policies for medical staff was recognized. CONCLUSIONS: This audit approach using "Baby Friendly Hospital' materials has helped to define policy, measure performance against recognized standards, identify quality specifications for maternity service agreements and has improved hospital support for breastfeeding mothers. This approach is suitable for maternity hospitals whose breastfeeding rates make them ineligible for "Baby Friendly Hospital" accreditation, and has the potential to be extended to encompass wider "health-promoting hospital" issues such as promotion of infant car seats.
Adult↗
Potential interventions for the prevention of childhood pneumonia in developing countries: a systematic review.
This article describes the background and framework for a systematic review of potential interventions for preventing pneumonia among under-5-year-olds in developing countries. Twenty-eight intervention areas are identified in six groups -- immunization, case management/chemoprophylaxis of high-risk children, improving nutrition, reducing environmental pollution, reducing transmission of pathogens, and improving child care practices. Calculation of the potential impacts is illustrated and the expected outcomes are also described.
Child Welfare↗
The immunogenicity and safety of Haemophilus influenzae type b-tetanus toxoid conjugate vaccine in Gambian infants.
In developing countries, Haemophilus influenzae type b is a major cause of meningitis and pneumonia in the 1st year of life. The safety and immunogenicity of a Haemophilus influenzae type b polysaccharide-tetanus toxoid conjugate vaccine (PRP-T) were evaluated in two studies of Gambian infants. In the first study, 131 infants were recruited and randomized into three groups to receive PRP-T at 1 and 3 months (group A), PRP-T at 2 and 4 months (group B) or no PRP-T (group C). The liquid form of PRP-T was used. The geometric mean titre (GMT) of anti-PRP antibody 1 month after the second dose was 0.26 microgram/ml in group A and 0.41 microgram/ml in group B. In the second study, 66 infants were given PRP-T in the lyophilized form at 2, 3 and 4 months of age. The GMT 1 month after the first dose was 0.09 microgram/ml, after the second 0.74 microgram/ml and after the third 2.32 micrograms/ml. After the third dose, 72% of children had antibody levels greater than 1.0 microgram/ml and 93% greater than 0.15 microgram/ml. No serious side-effects were observed and the rate of adverse reactions was consistent with the concurrent administration of diphtheria-tetanus-pertussis (DPT) vaccine.
Age Factors↗
Preventing SIDS. Evidence of health visitors changing their practice.
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Community Health Nursing↗
Sudden infant death in Scotland.
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Humans↗
Child protection in schools: a survey of the training needs of Fife schoolteachers.
Teachers have an important role to play in child protection. This lies not only in the detection and reporting of possible cases of child abuse but also in multi-disciplinary teamwork, and in contributing to the ongoing support and monitoring of the abused child. Their role can only be properly carried out if teachers are equipped with the relevant skills. Appropriate in-service training in child protection for teachers is of key importance in both emphasising child protection issues and in promoting these skills in teachers. In order to guide the development of a training course for teachers in child protection, a survey of Fife teachers was carried out to investigate the knowledge, attitudes and practices of teachers with respect to a range of child protection issues. This confirmed that teachers consider child protection to be an important subject of direct relevance to their work as teachers. In-service training on this issue was almost unanimously welcomed. The study showed that although the knowledge of teachers regarding the signs of child abuse was reasonably good, in practice 40% of teachers did not feel confident in handling these issues. This has important implications for the design of training courses. Very few schools had established school child protection policies although the majority of teachers stated that such policies would be useful.
Child↗
An observational study of car occupant restraint in Fife: impact of recent legislation.
During August 1992 an observational study of car occupant restraint use was carried out at 14 sites throughout Fife (representing traffic-signal-controlled junctions in rural and non-rural sites and observations made outside primary schools). This study replicated another completed in April 1991 before the most recent legislation on rear seat restraints. The overall restraint use found at the traffic signal sites (excluding taxis) was 87% (drivers 94%, front seat passengers 93% and rear seat passengers 59%). There was lower restraint use (68%) in cars taking children to and from primary schools (drivers 87%, front seat passengers 77% and rear seat passengers 50%). Passengers seated in rear centre seats were least likely to be restrained (40%) especially where they were an older child or adult (only 14% of this latter group being restrained). Restraint use in taxi cabs was low (drivers 11%, passengers 41%). Since rear seat legislation was introduced in July 1991 there has been a 77% increase in rear seat restraint use, especially in older children and adults (233% increase) and in 1-4-year-old children (119% increase); it is likely that these improvements are largely as a result of the legislation. However, approximately 40% of rear seat passengers still travel without rear seat belt restraint. There is therefore a continuing need to emphasise both public education and the enforcement of current legislation. Educational measures should be targeted at groups known to be low users such as drivers and passengers in taxis, children carried on school 'delivery trips' and adults in rear seats.
Adolescent↗
Persistence of antibody at 18 months following vaccination of young Gambian infants with PRP-OMPC Haemophilus influenzae type b conjugate vaccine.
The rate of decline in anti-PRP antibody levels was measured in two groups of Gambian children who had been given PRP-OMPC at 1 and 3 months or 2 and 4 months of age. In the younger group (n = 70), the geometric mean titre fell from 1.32 micrograms/ml at 4 months to 0.44 micrograms/ml at 18 months. In the older group (n = 54), the geometric mean titre fell from 1.18 micrograms/ml at 5 months to 0.46 micrograms/ml at 18 months. The proportion of vaccinated children with antibody levels over 1.0 microgram/ml fell from 54% 1 month after the second dose of vaccine to 27% at the age of 18 months, while the proportion with levels over 0.15 micrograms/ml fell from 82% to 60%, with no significant differences observed between the vaccination groups. For those children who did not show evidence of environmental boosting, the half-life of anti-PRP antibody was about 100 days. This did not differ between the groups. These findings suggest that to provide lasting immunity PRP-OMPC should be given with a late booster dose at 12-15 months, as is the current practice in the USA. The need for a late booster dose may limit the value of this vaccine in developing countries where vaccination of children is difficult after the 1st year of life.
Antibodies, Bacterial↗
Rational use of measles, mumps and rubella (MMR) vaccine.
Measles, mumps, rubella (MMR) vaccine is a live vaccine preparation containing attenuated strains of all 3 viruses. MMR vaccine is widely used throughout the world, with the US having the widest experience with the vaccine. In countries where the vaccine has been introduced successfully, significant reductions in all 3 diseases for which it is protective have occurred. The vaccine has been shown to be highly immunogenic, with seroconversion rates of 95 to 100% being achieved for each of the 3 component vaccines. This immunity appears to be long-lasting and may even be lifelong. Minor adverse effects may occur approximately 1 week after immunisation. Rarely, mumps vaccine-induced meningitis (milder than that associated with wild mumps virus) may occur, its frequency varying with the strain of attenuated mumps virus contained in any particular vaccine. Clinically, the vaccine is indicated for infants aged between 12 and 15 months, and should be administered by intramuscular or deep subcutaneous injection. A few specific contraindications exist, including a genuine hypersensitivity to eggs, and to the aminoglycoside antibiotics kanamycin and neomycin. An increasing number of countries are now adopting a 2-stage MMR policy in an attempt to prevent epidemics among those who remain unprotected, and to move towards eventual disease eradication.
Drug Combinations↗
An evaluation of the personal child health record in Fife.
Personal child health records were introduced in Fife in March 1992; an evaluation carried out in November 1992-February 1993 sought the views of both parents and health professionals and examined a sample of the records. All 104 parents who were interviewed considered it important that they hold a copy of their child's health record. The majority made good use of the personal child health record by bringing it regularly to clinics and by reading or completing the appropriate sections. The views of health professionals were mixed and some specific problems were raised. However, there is still relatively limited experience with the record in Fife; it is possible that professional endorsement of it will grow with increasing experience in its use. Suggestions for improvements should be acted upon where possible to encourage regular and correct use. The loose leaf format of the record facilitates the incorporation of amendments. The use of the record in Fife should be promoted by emphasising that, despite individual views of health professionals about the record, the great majority of parents value it and the improved access to the information about their child's health which it represents.
Adult↗
Etiology of acute lower respiratory tract infections in children in a rural community in The Gambia.
Approximately 500 children younger than 5 years old resident in 7 villages in a rural area of The Gambia were monitored closely for 1 year for episodes of acute lower respiratory tract infection (ALRI). Each episode was investigated with antigen detection techniques and antibody assays as well as culture for bacteria and viruses. A pathogen was identified in 76 (34.2%) of 222 cases with clinical signs of ALRI and in 34 (42%) of the 81 cases who, in addition, had radiologic evidence of ALRI. Evidence of infection with a bacterial pathogen, most commonly Streptococcus pneumoniae or Haemophilus influenzae, was obtained in 32 (14.4%) cases with clinical signs of ALRI (23.5% of those with radiologically proved pneumonia). Viral agents were cultured from 42 (19%) of 221 cases but also from 14 (14.6%) of 96 controls some of whom had minor symptoms of upper respiratory tract infection. In the absence of an outbreak of respiratory syncytial virus the viral agents recovered most often were influenza A and adenoviruses.
Bacterial Infections↗
Effects of body temperature on respiratory rate in young children.
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Body Temperature↗
The magnitude of mortality from acute respiratory infections in children under 5 years in developing countries.
This article reviews the available evidence of mortality from acute respiratory infections (ARI) among children aged under 5 years in contemporary developing countries and compares the findings with European populations before 1965. In European populations before 1965, the level of mortality was found to be a determinant of the proportion of deaths due to ARI. There were marked differences according to regional patterns of mortality. Deaths from ARI played a smaller role after 1950, when the use of antibiotics became generalized. In developing countries, the role of ARI mortality seems to be similar to the European experience. The age pattern is very marked. In absolute values, ARI mortality is highest in the neonatal period and decreases with age. In relative values, ARI mortality is highest in the postneonatal period. ARI, mainly pneumonia, accounts for about 18% of underlying causes of death in developing countries. Pneumonia and other ARI are frequent complications of measles and pertussis; ARI is also commonly found after other infections and in association with severe malnutrition. Virtually no data are available in developing countries to provide final estimates of the role of ARI in mortality of children aged under 5 years. However, the WHO figure of 1 out of 3 deaths due to--or associated with--ARI may be close to the real range of the ARI-proportional mortality in children of developing countries. Results are discussed in light of the definitions of ARI used in various studies, the difficulties in ascertaining and coding multiple causes of death and the quality of data from some sources.
Acute Disease↗
The use of an adjuvant arterio-venous shunt in prosthetic femoro-crural bypass.
In limb threatening ischaemia the use of a long prosthetic graft to the distal calf vessels may be the only alternative to a primary amputation. Patency rates in these situations are relatively poor and the use of an adjuvant arteriovenous fistula (AVF) at the distal anastomosis to increase the velocity of flow above the thrombotic threshold seems logical. We present follow-up of up to 8 years in a series of 80 consecutive reconstructions to the distal crural vessels using human umbilical vein with an adjuvant AVF. The mean age of the patients was 68.3 years and 12 (15%) were diabetic. The indication for surgery was limb threatening ischaemia in all cases; 41 (51.2%) for established necrosis and the remaining 39 (48.8%) for severe ischaemic rest pain. The mean ankle:brachial index was 0.23. The common ostium (CO) configuration of AVF was used in 50 cases (62.5%) and pre-anastomotic in 30 cases (37.5%). The volume blood flow in 49 cases, measured peroperatively using an electromagnetic flowmeter, was 116 ml/min (+/- 62.5) with the shunt closed and 283 ml/min (+/- 132.2) with the shunt open (p less than 0.01, Student's t-test). Cumulative patencies of all grafts were 39% at 2 years and 29% at 4 years. The age of the patient and the type of AVF, common ostium or pre-anastomotic, had no significant effect on patency rates, but grafts under 70 cm in length had a cumulative patency at 2 years of 42.5% compared to 13.5% for those over 70 cm in length (p less than 0.01). Cumulative patencies were derived by life table analysis and compared using the log rank test. The size of the recipient vessels at the distal anastomosis is thought to be crucial to the outcome of these operations. An increase in velocity of flow produced by an AVF, increases the wall shear stresses at this site and may lead to an increased tendency for intimal hyperplasia. It may be possible to mitigate these effects by the use of additional surgical or pharmacological techniques and further studies are required.
Arteriovenous Shunt, Surgical↗
Indoor air pollution exposure and lower respiratory infections in young Gambian children.
In a rural population-based cohort study of approximately 500 Gambian children under five years old followed for one year, incidence of acute lower respiratory infections (ALR) was related to various risk factors including parental smoking and regular carriage on the mother's back while cooking, a proxy measure for exposure to smoke from cooking fires. Two statistical analyses using a 'child-weeks at risk' approach were carried out, including and excluding multiple disease episodes in the same child. Weekly surveillance for ALRI found 75 episodes in 62 children. Stratified analyses using both approaches suggested father's smoking, and, for girls only, carriage on the mother's back while cooking and being part of a polygamous family were the main risk factors associated with infection: when multiple episodes occurring in the same child were excluded, not having a health card was an additional risk factor in children over a year old. Multiple logistic regression modelling of data from both approaches, including each of these risk factors and sex, age, village and season, suggested father's smoking, carriage on the mother's back while cooking and being part of a polygamous family increase risk of ALRI, the latter two for girls only. The analysis excluding multiple episodes in the same child also suggested that not having a health card is a risk factor for children aged 1-5 years. The difficulties in interpreting these findings are discussed.
Acute Disease↗
Etiology of acute lower respiratory tract infections in Gambian children: I. Acute lower respiratory tract infections in infants presenting at the hospital.
Ninety infants less than 1 year of age with pneumonia and 43 control infants were investigated for viral and chlamydial infection with the use of culture and serology and for bacterial infection with the use of blood cultures, lung aspirates, antibody assays and antigen detection procedures. One or more potential pathogens were identified in 62 (69%) cases with pneumonia and in 12 (28%) controls. Infection by respiratory viruses was identified in 42 (49%) cases and in 8 (19%) controls. Respiratory syncytial virus was the commonest pathogen identified and was found in 32 cases (37%). Bacterial infections were also common, being found in 27 (30%) cases and 3 (7%) controls, and predominantly involved Streptococcus pneumoniae (20%) or Haemophilus influenzae (11%). Bacterial infections were associated with raised white blood cell counts and were identified more often by antigen detection procedures (68%) than by culture of blood or lung aspirates (34%) or by serology (33%). Mixed viral-bacterial infections were identified in 13 cases (15%). Infection with Chlamydia trachomatis was diagnosed in 2 infants with acute lower respiratory tract infection and in 1 control infant.
Acute Disease↗
Etiology of acute lower respiratory tract infections in Gambian children: II. Acute lower respiratory tract infection in children ages one to nine years presenting at the hospital.
Seventy-four children ages 1 to 9 years hospitalized because of severe pneumonia were investigated using blood cultures, lung aspirates, nasopharyngeal aspirates, serology and antigen detection procedures. A bacterial infection was identified in 57 (77%), a viral infection was seen in 25 (34%) and 18 (24%) had mixed viral-bacterial infections. The bacterial pathogens most frequently identified were Streptococcus pneumoniae and Haemophilus influenzae found in 61 and 15% of patients, respectively. The viral pathogen most frequently recovered was respiratory syncytial virus (12%). Evidence of Chlamydia pneumoniae strain TWAR and Mycoplasma pneumoniae infection was found in 12 and 4% of cases, respectively. Overall a potential pathogen was identified in 60 (81%) children, with evidence of polymicrobial infection in 30 cases (40.5%). The study provides information on the relative role of different infectious agents in the etiology of severe pneumonia in children in a developing country.
Acute Disease↗