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Fatal choking in infants and children.

Food asphyxiation in infants/children follows a different pattern from the adult "cafe coronary." In the absence of ethanol intoxication, infants/children are prone to mishandling nonfriable, firm, slippery foods/objects with a rounded contour. The Dade County Medical Examiner's files were searched from 1956 to mid-1983 for accidental pediatric choking deaths. Seventeen food and six foreign body asphyxiations were found. The male/female ratio was 1.4/1 and 1/1, respectively. The white/black ratio was 0.9/1 for food asphyxiation whereas no black victims were encountered choking upon foreign objects. Seventy-eight percent of all victims were between 2 months and 4 years of age. Infants/children asphyxiated on items such as a hot dog, hard candy, peanut, toy rattle, tissue paper, balloon, marble, etc. The choking event was recognized by nearby adults in most instances. Risk factors include the availability of riskful foods/objects, natural diseases with difficulty feeding, poor eating habits, and uneducated or ignorant parents/others at the scene. Although public education, package labeling, and changes in food/object design may be appropriate, the ubiquituous risk foods and small foreign objects will, on occasion, escape the eye of even the most watchful parent.

Adolescent↗

Premedication of pediatric tonsillectomy patients with oral transmucosal fentanyl citrate.

UNLABELLED: We assessed the safety and efficacy of oral transmucosal fentanyl citrate (Fentanyl Oralet; Abbott Laboratories, Abbott Park, IL), administered preoperatively to provide both preoperative sedation and postoperative analgesia, in a randomized, double-blind, placebo-controlled study in 40 children, 2-10 yr of age, scheduled for tonsillectomy. In the preoperative holding area, one group (Group O) received Fentanyl Oralet (fentanyl 10-15 micrograms/kg), and the other (Group IV) received only the candy matrix. Patients in Group O received an i.v. injection of saline, and those in Group IV received an i.v. injection of fentanyl (2 micrograms/kg) after removal of the first tonsil. Except for the opioid, patients received a standard anesthetic. Preoperative sedation and cooperation were assessed. Postoperative pain was evaluated using an objective pain scale. Patients in Group O were more sedated but no more cooperative at the induction of anesthesia compared with those in Group IV. No patient vomited preoperatively or experienced preoperative or postoperative desaturation. Time to postanesthesia care unit (PACU) discharge was not different between groups. There was no significant difference in the number of patients requiring morphine in the PACU (6 of 21 in Group O versus 10 of 19 in Group IV). Plasma fentanyl concentrations were not a reliable indicator of the need for postoperative morphine. Among the patients who required morphine postoperatively, there was an 11-fold variation in plasma fentanyl concentrations at the time of morphine administration. Derived pharmacokinetic parameters were similar to those previously reported in children; bioavailability of the fentanyl in Fentanyl Oralet was 0.33. We conclude that premedication with Fentanyl Oralet did not differ with i.v. fentanyl in regard to the induction of anesthesia and postoperative analgesia. IMPLICATIONS: In this double-blind, randomized study, we studied the efficacy of Fentanyl Oralet (10-15 micrograms/kg) preoperatively for providing postoperative analgesia in children undergoing tonsillectomy. We found no incidence of preoperative desaturation or vomiting in any patient. This is in contrast to other studies, in which there was a longer time interval between Fentanyl Oralet completion and induction of anesthesia. The bio-availability of the fentanyl in Fentanyl Oralet was estimated to be 33%, which is less than that reported in adults (approximately 50%). There was no difference in postoperative opioid requirements between patients who received 2 micrograms/kg of fentanyl i.v. and those who received Fentanyl Oralet.

Administration, Oral↗

Effect of reserpine on salivary gland radioiodine uptake in thyroid cancer.

Nine patients with thyroid cancer were treated with reserpine in an attempt to reduce radiation exposure to the salivary glands from 100-150 mCi doses of I-131 therapy to thyroid remnants or metastases. Three control patients were not treated with reserpine but did receive 100-150 mCi of I-131. Parotid/background ratios of activity after radioablative doses of I-131 in patients not treated with reserpine were significantly higher than the patients treated with reserpine, and this was also true seven days after the radioablative dose. Combined therapy with reserpine, chewing gum, lemon candies, and hydration is suggested for the prevention of sialadenitis and xerostomia due to large doses of radioiodine.

Adenocarcinoma↗

Identifying culturally appropriate strategies for educating a Mexican immigrant community about lead poisoning prevention.

Lead paint is one source of exposure for lead poisoning; however, recent Latino and other immigrant populations are also at risk of exposure through ceramic cooking pots with lead glaze, some imported candies, and certain stomach ailment home remedies. Public health agencies and practitioners acknowledge that Latino families should be educated about lead poisoning prevention but report barriers to conducting outreach and education in Latino communities. This study reports findings from focus groups and interviews with the local Latino immigrant community and professionals on (1) current knowledge and beliefs about lead poisoning and (2) recommendations of culturally appropriate educational strategies.

Adult↗

Childhood burns in camping and outdoor cooking accidents: a focus for prevention.

We have seen increasing numbers of children who present with serious burns related to camping and outdoor cooking, prompting this 5-year review. Of 34 children (21 boys and 13 girls), with an average age of 5.2 years (4 months to 17 years) and average burn size of 15% (1% to 98%) cared for (4 as outpatients and 30 as inpatients), there was one fatality (3%). Mechanisms of injury included falling into free pits, throwing flammables into grills or pits, placing hands on hot objects in or near a fire, walking or falling into hot embers from an extinguished fire, spills from insect repellant candies, tent fires, burning of paper eating utensils, and cooking scalds. We have initiated a directed prevention program with the regional state park systems.

Accident Prevention↗

Determination of the efficacy of topical oral pilocarpine for postirradiation xerostomia in patients with head and neck carcinoma.

Pilocarpine hydrochloride suspended in a candy-like pastille was evaluated as a topical treatment for radiation-induced xerostomia in head and neck cancer patients. This local delivery system, which differs from systemically administered pilocarpine preparations, was developed to hopefully maximize the local response and minimize the systemic side effects. A prospective, randomized, double-blind, placebo-controlled trial was undertaken to determine objective and subjective efficacy in reversing the decrease in salivation. Forty previously irradiated patients received increasingly higher pilocarpine dosages in pastilles for 5 successive weeks. At each successive dose of pilocarpine, no significant increased salivation was noted. However, 25 (74%) of 34 patients reported that pilocarpine alleviated their subjective xerostomia. Topical pilocarpine administration has shown similar results to previous systemic delivery methods for radiation-induced xerostomia, but with improved patient tolerance.

Administration, Oral↗

Ultrafine flexible spinal endoscope (myeloscope) and discovery of an unreported subarachnoid lesion.

STUDY DESIGN: Introduction of a new diagnostic procedure and a report on its usefulness. OBJECTIVES: To introduce a new endoscope (myeloscope) developed for the examination of the spinal canal and to present a previously unreported subarachnoid condition as a cause of paraparesis revealed by it. SUMMARY OF BACKGROUND DATA: In spite of the availability of advanced imaging technology, there still exists a significant number of patients with spinal diseases in whom a diagnosis cannot be made. Direct visualization of the pathologic area is required in these patients. Recent advances in fiberoptics have made this possible. METHODS: The endoscope consisted of a fiberscope with an external diameter of 0.5, 0.9, or 1.4 mm. It was inserted into the subarachnoid space in the lumbar spine and carefully advanced cranially. Since 1987, this examination has been performed on 18 patients aged 7 to 69 years who had pain or other neurologic symptoms of unknown origin. RESULTS: The surface of the spinal cord, roots, properties of the arachnoid membrane, and small vessels could be observed clearly. The scope could be advanced as far as the upper cervical spine. Cotton-candy-like proliferation of fibrous tissue was identified by myeloscopy in four paraparetic patients who had clinical and radiologic features similar to those of a spinal cord herniation. The fibrous tissue beat on the spinal cord with the pulsation of the spinal fluid. Resection of the fibrous tissue with conventional surgery resulted in neurologic improvement. Complications included one case of meningitis in the early period and five cases of postspinal headache. No nerve injury was apparent. CONCLUSIONS: Myeloscopy provides detailed information about the subarachnoid space and even reveals dynamic conditions that cannot be identified during open surgery or at autopsy. It will bring new concepts to the diagnosis of spinal diseases.

Adolescent↗

Saliva nicotine as an index of plasma levels in nicotine skin patch users.

This study examined whether salivary nicotine concentrations would provide a useful index of plasma concentrations in studies of the effects of transdermal nicotine administration. Twenty-four subject smokers abstained from smoking for 12 h prior to admission to a clinical research unit ward and for 36 h while remaining confined to the ward. Three doses of nicotine skin patches were applied to different groups of subjects, and blood and saliva samples were collected at several time points. Saliva flow was stimulated by three different methods: (a) sucking on a lemon candy, (b) dissolving a sugar cube in the mouth, and (c) chewing on parafilm. Nicotine and cotinine concentrations were measured in both saliva and blood using gas chromatography. There was a high correlation between blood and saliva values of nicotine (r = 0.82). Overall, saliva nicotine concentrations were approximately 8.1 times higher than those of plasma. Saliva and blood cotinine concentrations were also highly correlated (r = 0.94), replicating results of previous studies. Results suggest that saliva nicotine may be a useful marker of nicotine intake during nicotine skin patch treatment. Saliva collection may be advantageous under conditions in which blood collection is impractical and may provide greater sensitivity because of the high concentration of nicotine in saliva relative to that in blood.

Administration, Cutaneous↗

Mirror agnosia.

Normal people rarely confuse the mirror image of an object with a real object so long as they realize they are looking into a mirror. We report a new neurological sign, 'mirror agnosia', following right parietal lesions in which this ability is severely compromised. We studied four right hemisphere stroke patients who had left visual field 'neglect'. i.e. they were indifferent to objects in their left visual field even though they were not blind. We then placed a vertical parasagittal mirror on each patients' right so that they could clearly see the reflection of objects placed in the (neglected) visual field. When shown a candy or pen on their left, the patients kept banging their hand into the mirror or groped behind it attempting to grab the reflection; they did not reach for the real object on the left, even though they were mentally quite lucid and knew they were looking into a mirror. Remarkably, all four patients kept complaining that the object was 'in the mirror', 'outside my reach' or 'behind the mirror'. Thus, even the patients' ability to make simple logical inferences about mirrors has been selectively warped to accommodate the strange new sensory world that they now inhabit. The finding may have implications for understanding how the brain creates representations of mirror reflections.

Aged↗

Individual difference in the number of chewing strokes and its determinant factors.

This study was carried out to clarify the distribution and individual variation of the number of chewing strokes before last swallowing (NCS), as well as to assess the factors that affect NCS, when dentulous adults masticate the same type of food. NCS was measured in 75 dentulous adults using gummy candies. Measurements were repeated five times to obtain the average and variation. Moreover, the correlation of NCS with various physiological factors (lateral width and vertical distance of chewing loop, angle of opening and closing path, opening and closing time, occlusal time, masticatory performance, number of occlusal contact points, occlusal contact area, occlusal force, flow rate of whole saliva and viscosity of whole saliva) and 28 personality factors were analysed by both of the single variate analysis and the multivariate analysis. The results showed that the average NCS was 41.0 +/- 16.0, and the coefficient of variation was 0.090 +/- 0.040. Additionally, the correlation between NCS and each factor was investigated, and found that any of these factors did not function as a single determinant for NCS. Following, determinant factors were further examined by the stepwise method of linear multiple regression analysis. From these analysis we found that when opening and closing time and four personality factors were combined, they were significantly involved in determining NCS (P < 0.01). Therefore, we conclude that individual NCS until last swallowing is not determined by a sole, specific physiological factor but is affected by multiple factors including personality.

Adult↗

Occupational asthma and rhinoconjunctivitis from inhalation of dried cow's milk caused by sensitization to alpha-lactalbumin.

A chocolate candy worker was diagnosed as having occupational asthma and rhinoconjunctivitis on the basis of clinical record and methacholine challenge. Positive conjunctival and bronchial challenge tests with lactalbumin showed that this protein was the pathogenetic agent. Type I hypersensitivity mechanism is demonstrated by means of skin prick test and RAST.

Adult↗

The effects of television food advertisement on children's food purchasing requests.

BACKGROUND: Children's eating habits and their food consumption have direct relations with obesity, diabetes, cancers, hypertension and coronary heart disease. Television advertisements directly affect children's eating habits and their food consumption. This study was conducted in order to examine television advertisements and children's food consumption while watching television and their desire to purchase goods that they see on television advertisements. METHODS: In the first stage of the study, content analysis of the television advertisements was conducted. In the second stage of the study, a questionnaire (check list) was developed in order to examine children's food consumption while watching television and their purchasing requests while shopping in the supermarket. It was given to 347 mothers who have children aged between 3 and 8 years. RESULTS: When the results of the study were examined it was found that the time devoted to children's programs was approximately 121 min and the advertisements during this period were approximately 35 min. A total of 344 of the 775 television advertisements shown were related to food. It was also found that most of the food advertisements were about candy/chocolate, chips, milk and milk products such as cheese, yoghurt, and breakfast cereals. The results also revealed that 89.6% of the children either drank or ate something while watching television and the food they consumed most while watching television were fruits, soft drinks, popcorn/nuts, cake, chips and candy/chocolate. The results also revealed that 40.3% of the children asked their parents to purchase the goods that they saw on the television advertisements and that 8.9% of them argued with their parents and/or cried in order for their parents to buy that particular product. It was found that the children tended to request more sweetened products such as candy, ice-cream, biscuit, cake or soft drinks. CONCLUSION: More than half of the food presented in television advertisements were rich in fat and sugar. Children ask their parents to buy the goods they see on television advertisements both while watching television and while shopping. Television advertisements especially affect young children's unhealthy food consumption.

Advertising↗

Interference control in a new rule use task: age-related changes, labeling, and attention.

Three experiments examined 3- to 6-year-olds' interference control using a task in which children saw 2 corresponding sets of colored cards, a large set in front of them and a small set behind them. A colored candy (Smartie) was placed on a large card with mismatching color, and children could win the Smartie by selecting the small card that matched the color of the large card. Three-year-olds performed poorly whereas older children performed well. Having children label the correct color before responding improved 3-year-olds' performance (Experiment 2), as did pointing to the large card (Experiment 3); decreasing the affective salience of the stimuli (colored beads vs. Smarties) did not (Experiment 3). Results reveal the role of selective attention in action control.

Attention↗

Unit bias. A new heuristic that helps explain the effect of portion size on food intake.

People seem to think that a unit of some entity (with certain constraints) is the appropriate and optimal amount. We refer to this heuristic as unit bias. We illustrate unit bias by demonstrating large effects of unit segmentation, a form of portion control, on food intake. Thus, people choose, and presumably eat, much greater weights of Tootsie Rolls and pretzels when offered a large as opposed to a small unit size (and given the option of taking as many units as they choose at no monetary cost). Additionally, they consume substantially more M&M's when the candies are offered with a large as opposed to a small spoon (again with no limits as to the number of spoonfuls to be taken). We propose that unit bias explains why small portion sizes are effective in controlling consumption; in some cases, people served small portions would simply eat additional portions if it were not for unit bias. We argue that unit bias is a general feature in human choice and discuss possible origins of this bias, including consumption norms.

Cognition↗

Dental health status and attitudes to dental care in families participating in a Danish fluoride tablet program.

The caries experience and dental fluorosis of 84 Danish children, who had used fluoride tablets for 1-4 yr in the period 1976-80, were compared with those of a group matching in sex, age, place of living, and socioeconomic status. The average age of the children at the time of examination was 5.8 yr. A recording of mothers' attitudes to dental care, knowledge about tooth brushing, attitudes to candy, and number of teeth in the maxilla showed no difference between the fluoride tablet group and the non-users' group. Moreover, there was no significant difference between the two groups with respect to dental caries. The findings are discussed in relation to recent reports on the decline of dental caries resulting from widespread use of local administration of fluorides.

Adult↗

Relationship between diet-related behavior and caries in a group of 14-year-old Danish children.

Dietary factors related to dental caries may be both biological and behavioral. In the present study the relative contribution of a number of behavioral characteristics is analyzed in order to differentiate between caries-active (CA) and caries-inactive (CI) children. The study group comprised 49 CA and 55 CI 14-yr-old Danish children, constituting the dichotomous dependent variable. Several variables related to the social and cultural context in which food and snack consumption takes place were studied. Subsequently, their relative contributions to the discriminant function (CA vs. CI) were estimated using discriminant analysis. The three strongest discriminating variables were "weekly milk consumption" (-0.726), "packed lunch from home" (0.554), and "weekly consumption of candy in DKK" (0.306) as measured by standardized canonical discriminant function coefficients. These variables may be indicative of the impact of the social environment on dietary habits, pointing to the need for incorporating the social network as reinforcing agent in dietary counseling if dietary behavior is to be changed.

Adolescent↗

Oral health and factors related to oral health in Polish schoolchildren.

The oral health and factors related to oral health were surveyed in 168 schoolchildren, aged 10-12 years, attending one school in Warsaw. The children were examined for dental caries and gingival status, dental plaque and salivary Streptococcus mutans and Lactobacillus counts. An interview on dietary habits and use of fluoridated toothpaste was also performed. The results showed a mean DMFT of 4.7 in the sample. Gingival Index 1 and Plaque Index 3 were median scores for the majority of the children. S. mutans was demonstrated in 94% of the children and high numbers were found in 15%. Lactobacillus sp. were present in all examined children, with high counts in 56% of the subjects. The interview revealed that most of the children eat five or six times per day and consume candies or cakes each day. Fluoridated toothpaste was not used regularly by any of the children. In conclusion this study shows a high prevalence of dental disease and an unfavorable combination of etiologic factors.

Child↗

Dimensions of dietary and other health-related behaviors in a group of Danish adolescents.

The relationship between dietary, dental health behaviors, and other health-related behaviors was studied using factor analysis. The study group comprised 234 8th graders from 11 schools in the municipality of Aarhus. A semi-structured interview included 12 items of health behavior (e.g. sugar intake, meal pattern, sports activities, sleeping habits, and consumption of alcohol, cigarettes, vitamin pills, candy, and milk). The analysis is based on the assumption that the 12 observed variables are determined by a reduced number of underlying but unobservable factors. Four dimensions of health behavior which explained 38.6% of the variance between the variables were produced. The four unrotated factors accounted for a varying proportion of the total variance (17.6%, 11.8%, 4.4%, 4.3%, respectively). Factor 1 was denoted "Sugar behavior", factor 2: "Regularity of dietary behavior", factor 3: "Problem behavior" and factor 4: "Spare-time activity". This could imply that the motives underlying sugar consumption are different from those of other health-related behaviors. The present behavioral pattern is consistent with that of other studies in which health behavior has been shown to be multidimensional.

Adolescent↗