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The Preliminary Training School (PTS) for nurses which opened at Glasgow Royal Infirmary in 1893 was the first attempt to provide a theoretical pre-clinical course for 'pupil' nurses. The notebooks of two pupils are reviewed in terms of the contemporary medical and nursing knowledge and provide indications of subject matter that pupil nurses were taught.
The Holmes-Adie syndrome (HAS) is characterised by initially monolateral, then bilateral enlargement of the pupil with delayed responses to near vision and subsequent redilation, and absent tendon reflexes. The diameter of the affected pupil is oval or irregular, sometimes with spontaneous movements of the pupillary sphincter muscle. Reaction to light may require several minutes' exposure to bright light, as it does redilation after a prolonged stay in a dark room. The reaction to near vision is tonic and delayed, as the subsequent redilation. In 10% of cases there is a permanent failure of the pupil to react either to light or to near vision. Absence of deep tendon reflexes is acquired and permanent, most frequently involving the Achilles' tendon reflex. Loss of different degrees of ciliary and spinal ganglia neurons, without evidence of inflammatory findings, are the neuropathological data accounting for the clinical signs of HAS. Polyneuropathies of different origin can be complicated by a symptomatic form of HAS.
OBJECTIVE: This study is aimed at establishing the prevalence of Chlamydia trachomatis infections among school pupils in Sana'a, Republic of Yemen, and to explore the association of infection with environmental and social factors. METHODS: A total of 787 school children, 529 boys and 258 girls, were randomly selected for enrollment in this study. Four hundred and twenty-nine were from 4 schools in Sana'a city, and 358 from 3 rural schools around Sana'a, Republic of Yemen. Questionnaire forms were filled in for each child to investigate environmental and social factors. Sera were tested for anti Chlamydia trachomatis IgG antibodies using enzyme-linked immunosorbent assay CTM-IgG . RESULTS: An overall rate of infection of 45.9% was determined. The rate of infection among rural pupils (73.2%) was higher (P<0.0001) than that among urbanones (23.1%). The rate of infection was found significantly (P<0.001) inversely correlated with age of the pupils. Environmental factors which were found to influence the infection rate were; rural residence, unplastered walls, mud floor, lack of stand pipe water, lack of latrine and presence of animals within dwelling with odds ratio of 9.1, 6.3, 6.1, 5.2, 3.7, 3.5 and 1.7. Also, the male sex and illiteracy of the parents has been found to be risk factors for infection. CONCLUSION: Prevalence of Chlamydia trachomatis infection was found to be high. The prevalence correlates inversely with age. Rural residence, environmental conditions and social factors were risk factors for infections. Yemen could be identified as a trachoma endemic area, which should be targeted by the control programs.
In a rural community block of north India we initiated a programme for control of rheumatic fever and rheumatic heart disease (RF/RHD). This included a training campaign for all 74 health workers, 773 school teachers and 12,500 older pupils (class V to X) to enable them to suspect and refer cases of RF/RHD and counsel them about secondary prophylaxis. Training material was used by project staff, medical officers and teachers to convey that this serious disease with onset between 5 and 15 years can be recognized by four simple criteria: fever with joint pain or swelling; breathlessness and fatigue; involuntary face and limb movements. One year later we evaluated awareness generated by training by administering a questionnaire to random samples in the intervention area and in a noncontiguous control area. Health workers, teachers and pupils of the intervention block were significantly better aware of the nature, severity and presentation of the disease and reported having recognized cases whom they had referred for diagnosis, prophylaxis and counselled for follow up. We conclude that a training protocol incorporating simple messages can effectively create practical awareness for RF/RHD control among teachers, health workers and pupils in a rural community.
The German-French biological experiment AQUARIUS-XENOPUS which flew on the Soyuz flight Andromede to the International Space Station ISS (launched October 21, 2001 in Baikonour/Kazakhstan) was extended by an outreach project. Pupils of class 10 to 12 from Ulm/D and Nancy-Tomblaine/F studied swimming behavior of Xenopus tadpoles on ground. They were instructed to perform all experimental steps following the protocol of similar video recordings on ISS. After the flight, they evaluated the kinetics of swimming of both ground controls and space animals. The pupil project included theoretical components to introduce them to the field of gravitational biology. One feature of the project was the exchange of ideas between pupils by meetings which took place in Ulm (June 2001), Nancy (February 2002) and Paris (May 2002). We consider our approach as a successful way to include young people in space experiments on a cheap cost level and to bring ideas of gravitational biology into the curricula of European schools.
The study set out to assess the health status of pupils of a school for children with mental disability. The school is Modupe Cole Memorial Child Care and Treatment Home School, Akoka, Lagos. The records of 211 pupils were reviewed and the pupils were clinically examined by the author. Seventy-four (35.1%) of the subjects had complete immunization, 48(22.7%) had incomplete immunization while 44(20.9%) received no immunization. The probable aetiology of mental disability in the subjects was due to postnatal causes (96; 45.5%), natal causes (44; 20.8%), prenatal causes (12; 5.7%) and unknown (59; 28.0%). The most abnormal findings on physical examination were in the central nervous system (199; 94.3%), the musculoskeletal system (137; 64.9%), the mouth/teeth (125; 59.2%) and the skin (98; 46.4%). These findings were worse amongst the residential students than in the non-residential students (p < 0.001). The information obtained from this study will help to serve as a reference for purposes of health planning and policy formulation for children with mental disability.
A case is presented in which an alternative surgical method for managing poorly dilating pupils preoperatively or intraoperatively was employed. The technique uses iris sutures, is simple, safe, easily reproducible, and reversible, and does not require new devices for pupil enlargement. This new surgical method is appropriate for extracapsular cataract extraction and phacoemulsification or posterior segment surgeries, and maintains pupillary appearance and function postoperatively. Although other techniques are generally available, this technique may be useful in unique situations where other pupil devices or methods are not available.
AIM: To analyse relationships between selected elements of family, school and peer environments and susceptibility to medically treated repeated injuries in pupils aged 11, 13 and 15 yrs in Poland. MATERIAL AND METHODS: The survey was carried out in 2002 on the representative sample of pupils (N=6383), within the Health Behaviour in School-aged Children: A WHO Collaborative Cross-national Study (HBSC). RESULTS: Outcomes of the study indicate that frequency of repeated injuries amounts to 8.6% and rises for pupils from incomplete families (for children living with stepmother OR=3.6, 95% CI 1.40-8.99), being in touch with many friends (OR=2.35, 95% CI 1.82-3.03), whose parents are not ready to help them with school problems (OR=4.28, 95% CI 2.24-8.18) and teachers are not friendly (OR=2.79, 95% CI 1.78-4.38). CONCLUSIONS: Improving relations in families and schools can help in decreasing the frequency of repeated injuries among adolescents.
Pupillary size and reactivity have long been a critical component of the clinical assessment of patients with neurological disorders. The pupillary examination may provide critical information related to new or worsening intracranial pathology and facilitate prompt intervention to minimize further neuronal damage. With this in mind, intensive care nurses caring for neurologically impaired patients frequently must perform pupillary examinations in concert with assigning a Glasgow Coma Scale score. The purpose of this study was to test the accuracy and reliability of an automated pupillometer compared with the standard manual examination as a preliminary step in assessing the usefulness of automated pupillometry in the critical care setting. Twenty patients in the intensive care units of a teaching hospital were examined by two groups of three examiners using both the manual examination with a penlight or similar light source and a portable automated pupillometer capable of measuring pupil size and reaction. Measurements by a static pupillometer before and after each pupillary examination were used to determine the mean "true" size of the pupil. This study found that the automated pupillometer is more accurate and reliable than the manual examination in measuring pupil size and reactivity. For these reasons, such a device may be a beneficial addition in the clinical assessment of neurologically impaired patients.
The curricula of schools for the physically handicapped have, as yet, been influenced too much by those of regular schools. Which is why at special schools, too, the primary focus of all educational and therapeutic measures is placed on a qualification of the pupils. Also those pupils who, as a result of the severity of their disability, will not be able to enter vocational training are instructed on the basis of curricula modelled for the non-disabled. The purpose of the following article is to introduce this problem complex which has been present for years but not yet received satisfactory solutions. It is hoped that the described experiences gained with the three groups of pupils will stimulate the discussion.
Pupil is richly innervated by autonomic nerves. Therefore, its size or movement well reflects the autonomic nervous function. By analyzing dynamics of pupil movement for light stimulus followed by infrared video-pupillography, the abnormality of autonomic nervous system can be expressed in a quantitative manner. Clinical applications of pupillography and pharmacological examination to Horner syndrome, Adie syndrome, diabetes mellitus, pupillary involvement of Behçet disease, pupil of brain death and patients with chemical sensitivity have been described. Segmental spasm of iris in Horner and Aide syndrome, especially, nasal side of iridoplegia was seen in early stage of Aide syndrome from pupillary dynamics to light stimulus. An involvement of sympathetic nerve subserving iris dilator muscle was confirmed from pupillography, drug reaction to topically applied l-epinephrine in the diabetics. An involvement of cholinergic nerve which subserve the iris sphincter muscle was seen in Behçet disease when there was no manifest eye involvement. Mild mydriasis in brain death patients was seen under denervation of central nervous system. Dysfunction of sympathetic nerve from pupillary light reflex in chemically sensitive patients for cholinated hydrocarbon pesticides.
Audiometric screening was conducted in Dhofar region to study the magnitude of ear problems and cost-effectiveness of screening first-year preparatory-school children in Oman. None of the 1894 pupils had otitis media with effusion or sensory neuronal hearing loss. Six children (0.32%) had impacted wax, 4 (0.21%) chronic suppurative otitis media and 2 (0.11%) dry perforation of eardrum. In all, 14 children (0.74%) with suspected hearing impairment were referred to a specialist but only 2 attended. Physicians and nurses spent 8-10 minutes for ear examination per child for a yield of less than 1%. The screening expenditure was US$ 5 per pupil. As the prevalence of serious ear conditions was low, we conclude that expanding the audiometric screening of schoolchildren to first-year preparatory pupils is not cost-effective.
This small study set out to establish the abilities of a group of pupil nurses in a rural hospital in Botswana to accurately calculate intravenous driprates and drug dosages, and how targeted teaching could improve their performance. Thirteen pupils were asked to complete a seven-item questionnaire comprising set questions on intravenous therapy, then take a second questionnaire after receiving targeted teaching. Comparison revealed that two specific problems, related to dripsets and dilutent displacement, remained after teaching, but that improvements in scores in the 'incorrect with little immediate risk' and 'correct' categories had been achieved. The author suggests that formal testing and targeted teaching are appropriate methods of helping pupil nurses evaluate and improve their skills and knowledge base.
Childhood deafness interferes with the cognitive development of the child, so it is considered a major handicap. The present work was carried out to reveal possible risk factors of deaf-mutism and the magnitude of each. The case control design was chosen as a research methodology. A 50% sample of deaf-mute pupils at the primary level were selected at random from each of the two governmental schools for the deaf-mutes in Alexandria (boys=96, & girls=76). A control group chosen at random from a main stream governmental school and matched by age and sex of the pupils as well as with education and occupation of the father. Matching was carried out at the sampling phase, pairing each case to its control. Data were collected by interviewing the mothers using an interviewing schedule. Matched analysis was carried out where pairing of cases and controls was retained. The likelihood estimate of Odds ratio conditional on the number of discordant pairs was estimated using McNemer's test. The 5% level was chosen as the level of significance. The study revealed 172 deaf-mute pupils. Their mean age was 9.48+/-1.981 years. Boys outnumbered girls (55.8% and 44.2% respectively). In 59.4% parents were cousins. Deafness was first noticed at 6 to 60 months of age with a mean of 14.70+/-10.2 months. Most fathers and mothers were illiterate (48.84% and 61.63%). Heredity was a risk factor, where 84.82% of cases had a positive family history compared to none of the controls. Moreover, in case of consanguinity the Odds ratio=5.60. Acquired deafness constituted the second important group of all causes of deafness. Meningitis featured as the most important cause of acquired deafness with an estimated relative risk of 18.5, followed by fever (Odds ratio=4.67), then repeated attacks of acute tonsillitis and ear disease where the case control percent difference was 8.72% and 4.65% respectively.
The repeatability of pupil response measurements made with the Pupilscan instrument has been assessed. Two operators made 32 repeat recordings of the pupil response in each eye of eight normal subjects over four days. A total of 512 recordings were made and the results analysed by variance analysis. Room light levels were carefully controlled. The instrument measured initial pupil diameter, and after a 0.2 s light stimulus measured minimum and final diameters, maximum diameter change, constriction velocity and time to minimum diameter. For all measurements except time to minimum, there were significant differences (P less than 0.001) between the normal subjects. Day-to-day variation was also significant (P less than 0.005), but did not mask the differences between subjects. It is concluded that the average of at least four repeat measurements are made, giving error ranges similar to those observed from day-to-day changes.
This study compares the oral health status, as reflected by caries experience and periodontal status, of 3 cohorts of institutionalised handicapped pupils. The 3 groups of impairments studied were physical, visual and aural disability. 267 institutionalised handicapped high school pupils were examined. 163 (61 per cent) were physically, 84 (31.5 per cent) visually, and 20 (7.5 per cent) aurally handicapped. 34 per cent of the study population was caries-free with a mean DMFT of 2.63. There was no statistically significant difference (p greater than 0.05) between the caries experience of the three handicapped groups. Similarly no significant difference (p greater than 0.05) was observed between males and females. More than half of the calculus accumulation occurred among the physically disabled. At the 90 per cent confidence interval there was no significant difference in bleeding and shallow pocketing among the three groups. However, there was a significant difference for the presence of calculus. The physically disabled pupils consistently indicated the highest proportion of bleeding, calculus accumulation and shallow pocketing.
A comprehensive nutritional survey conducted in Chengdu, 1986 among 488 day-school pupil aged 6 to 12 years showed that definite improvement in the dietary intake of heat energy, protein, iron, thiamin, niacin and ascorbic acid and other nutrients as compared with 1982, apparently the result of improved living standards. Nevertheless, the intake of energy food in breakfast meals were still inadequate. The findings revealed that 38.3% of the pupils suffered mild anemia. Special attention should be paid to the pupils' nutritional status during the adolescent growth spurt.
The authors compared pupil responsiveness to light, convergence, and the effects of topical cocaine 4%, epinephrine 1%, phenylephrine 1%, homatropine 10%, and pilocarpine 1% in a group of 62 diabetics with a sex- and age-matched group of normal subjects. The duration of disease, metabolic control, and type of diabetes mellitus, the presence and severity of diabetic retinopathy, and evidence of systemic vegetative neuropathy were considered. It was found that sympathetic denervation was related significantly to the duration of disease and to the development of systemic autonomic neuropathy. There were also signs of iris myopathy in the pupil alterations of long-standing diabetics, explaining the poor pupil responsiveness to mydriatics occasionally found in these patients. Pupillary autonomic diabetic neuropathy should be considered an early and major sign of the development of systemic vegetative diabetic disease.