Biomedical subjects
Publications and source records attributed to M A Wakefield.
A nine-year-old girl with symmetrical acral deformities and anomalies of the renal tract is described. There have been four previous reports of this association, all in phenotypic males. In each case there was moderate intellectual retardation and in two cases dermatoglyphic analysis revealed abnormalities. It is suggested that there is now sufficient evidence to give the acro-renal syndrome independent status.
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A further case of mesangiocapillary glomth reduced serum C3 levels is reported. The father of the patient was also found to have C3 deficiency. This lends support to the hypothesis that C3 deficiency may be the primary disorder relating these conditions and there is evidence in this case that the deficiency may be genetically determined. It is suggested that the complement state of close relatives, particularly younger siblings, of patients with these disorders should be investigated and, if abnormalities are found, they should be followed-up in order to elucidate the role of hypocomplementaemia in these uncommon disorders.
OBJECTIVES: The present study aims to describe the use of health services by children with asthma, and examine disease-specific, parental and sociodemographic variables associated with different levels of health-service utilization. METHODS: Parents of 135 children attending an emergency room (ER) completed questionnaires measuring the children's asthma symptoms, and sociodemographic and psychological variables. Parents were contacted monthly for 6 months to document the number of planned and unplanned visits to hospital and community health-care services for asthma. RESULTS: At least one further unplanned visit to the ER was made by 37% of children, while 62% made at least one unplanned visit to a general practitioner (GP). Fifty-five per cent made planned review visits to a GP, 30% to paediatricians and 5% to hospital clinics. After controlling for the level of asthma symptoms, parental anxiety and parental perceptions of children's vulnerability were associated with unplanned GP visits (P = 0.05 and P = 0.01, respectively); a planned review visit and the child being admitted to hospital for the index attack were associated with unplanned ER visits (P = 0.05 and P = 0.004, respectively). CONCLUSIONS: Children with asthma more frequently attend GP services than hospital services for both planned and unplanned asthma management. Different variables predict the unplanned use of GP and ER services. Understanding these differences is imperative if children and families are to make the most effective use of health services.