Screening for anemia in infants: evidence in favor of using identical hemoglobin criteria for blacks and Caucasians.

The purpose of this study was to evaluate the need for separate Hb screening criteria according to race by evaluating the Hb response to a therapeutic trial of iron in 1-yr-old infants. Among the 1128 infants who were screened, a significantly larger percentage of blacks (37%) than Caucasians (22%) had a Hb less than 11.5 g/dl. However, when these screen-positive infants were treated with oral iron for 3 months, the percentage who had a greater than or equal to g/dl response was similar in blacks (38%) and Caucasians (35%). Our results indicated that a slight but significant inherent tendency to lower Hb values among the black infants was counter-balanced by a substantially higher prevalence of iron deficiency anemia. These findings are in favor of using uniform Hb screening criteria in similar populations.

A cluster of tick-borne infections: association with military training and asymptomatic infections due to Rickettsia rickettsii.

During the spring of 1989, 86 members of a military unit from the state of Maryland, USA, participated in two-week-long training manoeuvres in the states of Arkansas (location FC) and Virginia (location FAPH). Acute febrile illnesses due to infections with two tick-borne pathogens, Rickettsia rickettsii and Ehrlichia sp., were confirmed serologically in 2 initial cases who were admitted to the hospital. A seroepidemiological investigation among unit members found an additional 17 of 109 individuals (16%) with elevated post-exposure indirect immunofluorescent antibody (IFA) titres to R. rickettsii (16 cases) and/or E. canis (2 cases). The seropositivity rate of personnel who trained at FC was 38% (15 of 40), compared to only 13% (4 of 31) and 8% (3 of 38) of personnel who trained at FAPH or who did not train in the field, respectively (P < 0.001). Seropositivity was associated with symptoms suggestive of a tick-borne illness. Only 4 (22%) and 6 (33%) of the 18 personnel seropositive for R. rickettsii reported an erythematous or petechial type of rash or a febrile illness, respectively, within 4 weeks of exposure; 5 of 18 (28%) personnel infected with R. rickettsii reported no symptoms and only 8 of 18 (44%) received medical treatment. Mild infections with R. rickettsii, or a closely related spotted fever group agent, may have accounted for the high infection rate experienced by this group.

Role modeling: an educational strategy to promote effective cancer pain management.

Successful pain management is a crucial element in the nursing care of the patient with cancer. Among the many problems underlying poorly managed pain, one prominent concern is healthcare professionals' lack of current knowledge. Although educational programs are an established method of increasing knowledge, specific programming strategies may have a more significant impact on knowledge retention. This quasiexperimental study used role modeling as an educational method to improve knowledge retention. A purposive sample of 20 RNs participated in an educational program in which a lecture-only format was used for the control group and a lecture format plus a role-modeling component was used for the experimental group. An oncology pain management assessment tool was administered in a pretest/post-test design with repeated measures. A one-tailed t-test for gain scores was used to test the hypothesis. Mean change scores between groups were similar. Future studies are needed to further analyze the impact of role modeling on similarly matched, but larger, groups.

Evaluation of health, sanitation, and nutrition in Forces Command Child Development Centers.

In 1992, Forces Command had 42 Child Development Centers on 22 installations. We evaluated program compliance in the areas of health, sanitation, and nutrition using inspection findings from April 1991 through June 1992. Each program was rated on 20 items, using inspection checklists developed for this evaluation. We also surveyed Haemophilus influenza type b (Hib) vaccination records among enrolled children. Most programs and facilities were fully or partially compliant in most areas. By quantifying the inspection findings, we were able to identify compliance items that needed further attention. The most frequent problem area across all programs was documentation of child immunization and health records. For children between 13 and 60 months of age, 77.7% had records indicating appropriate vaccination against Hib. Comparisons with the prior year's findings indicated a trend toward improvement.

Pediatric poisoning the first 30 minutes.

Two distinct subpopulations in the pediatric age-group are particularly at risk for poisoning, and the substances likely to be ingested by each group differ. The method of critical care given here incorporates consideration of specific types of poisoning into an overall plan of general diagnostic and therapeutic measures.

Maximizing the exercise stress test. Critical factors that enhances its validity.

The maximal exercise stress test continues to be an important diagnostic and prognostic tool in the primary care office setting. But are you getting the most accurate information possible? Drs Driggers and Marchant discuss several factors that are crucial to the test's validity--and thus to its usefulness in your clinical practice.

Emergency resuscitation in children. The role of intraosseous infusion.

Intraosseous infusion is a temporary procedure for use in pediatric emergencies when intravenous access is difficult. Multiple drugs and fluids can be safely administered through the intraosseous route. Dosage and rate of infusion are essentially the same as with intravenous infusion.

The family continuity of care contract.

Continuity of care has been defined as a contract between a patient and physician for medical care. This study looks at continuity of care in a community family practice residency program before and after office contact has been made with at least one member of the family by the assigned physician. It is assumed that during such a visit a contract for care of the family is made. Using this premise, continuity of care increased significantly when the different resident levels and faculty were compared over a 2.5-month period. It seems reasonable to measure the continuity of care provided an assigned family only after a contract has been made. This contract should be accomplished in an initial intake interview or during the initial office contact with the assigned physician.

Poisoning in childhood and adolescence: a study of 111 cases admitted to a military hospital.

One hundred eleven cases of poisoning (over a 4 1/2-year period) were retrospectively reviewed at a military medical center. Results of the review included the following: (1) two peak age ranges for poisoning were identified: the 1 1/2- to 4-year-old child who accidently ingests both drugs and non-drugs, and the female adolescent who ingests drugs as a suicide attempt or gesture; (2) hydrocarbons and aspirin were the most common agents ingested; however, if grouped, drugs with anticholinergic effects would replace aspirin as the second most common poison; (3) emergency treatment included emesis or lavage in four fifths of poisonings except in ingestions of hydrocarbons or caustics where its use is controversial; (4) incidence of recurrence of poison ingestion was three percent, and morbidity and mortality combined were less than one percent; and (5) two thirds of patients were asymptomatic on admission and hospitalized primarily for observation.

The maximum exercise stress test: is it a behavior-modification tool?

The controlled study presented demonstrates the results obtained when using the maximum exercise stress test (MEST) as a behavior-modification tool for coronary artery disease risk factors. Changes in attitudes, behaviors, and objective measurements of health were assessed in a low-risk population. Only exercise level was significantly altered (P less than .03). Changes in the other measured parameters were insignificant. The MEST test is also expensive, and no benefit has been demonstrated in terms of its ability to decrease the morbidity and mortality seen in coronary artery disease.

Infant nutrition made simple.

During the first six months of life, infants should gain about 1 oz. of weight daily. In the second six months of life, they should gain at about half that rate. To attain this rate of weight gain, infants must receive 120 kilocalories (kcal.) per kg. per day during the first six months and 100 kcal. per kg. per day in the second six months. Iron deficiency is the leading specific nutritional disorder in this age group.

Managing the dehydrated child.

Hypotonic fluid losses lead to hypertonic dehydration. Because the extracellular fluid compartment has the ability to draw fluid from the intracellular compartment, intravascular volume is better maintained in hypertonic dehydration than in isotonic or hypotonic dehydration. When the amount of weight loss is known, the fluid deficit can be easily calculated; otherwise, a clinical assessment of the percentage of dehydration is required.

Hemorrhagic shock.

Shock is a consequence of insufficient blood flow for adequate oxygenation at the cellular level. Early recognition of the signs permits prompt therapy to maintain the effective circulating volume before irreparable organ damage occurs. Classification of shock on the basis of percentage of blood loss is helpful in guiding initial management. Replacement of red blood cells may be required for acute blood loss of more than 25 percent of the patient's circulating volume. Adequate arterial PO2 is essential for maintaining cellular oxygenation.