Preventing community-wide transmission of Cryptosporidium: a proactive public health response to a swimming pool-associated outbreak--Auglaize County, Ohio, USA.

The incidence of recreational water-associated outbreaks in the United States has significantly increased, driven, at least in part, by outbreaks both caused by Cryptosporidium and associated with treated recreational water venues. Because of the parasite's extreme chlorine tolerance, transmission can occur even in well-maintained treated recreational water venues (e.g. pools) and a focal cryptosporidiosis outbreak can evolve into a community-wide outbreak associated with multiple recreational water venues and settings (e.g. childcare facilities). In August 2004 in Auglaize County, Ohio, multiple cryptosporidiosis cases were identified and anecdotally linked to pool A. Within 5 days of the first case being reported, pool A was hyperchlorinated to achieve 99·9% Cryptosporidium inactivition. A case-control study was launched to epidemiologically ascertain the outbreak source 11 days later. A total of 150 confirmed and probable cases were identified; the temporal distribution of illness onset was peaked, indicating a point-source exposure. Cryptosporidiosis was significantly associated with swimming in pool A (matched odds ratio 121·7, 95% confidence interval 27·4-∞) but not with another venue or setting. The findings of this investigation suggest that proactive implementation of control measures, when increased Cryptosporidium transmission is detected but before an outbreak source is epidemiologically ascertained, might prevent a focal cryptosporidiosis outbreak from evolving into a community-wide outbreak.

Targeting of mRNAs to domains of the endoplasmic reticulum.

The targeting of proteins to specific regions of the cell by signal elements within the polypeptide sequence has received much attention, but proteins can also be directed to their appropriate cellular locations by localization of their mRNAs. This mechanism is seen clearly in polar cells like germ and embryonic cells, neurons and epithelia. Recent evidence indicates that mRNAs may also be localized to morphologically and functionally distinct endoplasmic reticulum membranes, thereby facilitating sorting of the proteins they encode to subdomains of the reticulum or to polarized plasma membranes.

Preventive dental care: the role of the pediatrician.

The pediatrician can assist the dental profession in preventing dental disease and maintaining the oral health of children. Pediatricians are urged to counsel parents in dietary and oral hygiene practices that will prevent dental caries and to refer patients for professional dental care when appropriate. Systemic fluoride supplements should be prescribed when needed but only after a careful review of requirements and daily consumption.

Double-stranded DNA antibodies: a comparison of four methods of detection.

Thirty-four antinuclear antibody (ANA) positive systemic lupus erythematosus (SLE) sera were tested for antibodies to double-stranded DNA (dsDNA) simultaneously using Farr, haemagglutination, Crithidia luciliae (CL) kinetoplast fluorescence and human metaphase chromosome fluorescence assays. Significant correlation (p less than 0 x 05) was found between the Farr and CL assays, with the two fluorescence tests (CL and metaphase) displaying the greatest degree of association (p = 0 x 00001). No correlation could be demonstrated between the haemagglutination test and any of the other three assays. Six hundred and ninety-one sera from patients with a range of provisional rheumatological diagnoses were prospectively analysed for dsDNA antibodies using Farr and metaphase assays. A correlation coefficient of 0 x 84 was obtained between the two assays. The metaphase assay provides comparable results to other more established assays, and because it is simple, reliable and sensitive, it should be seriously considered for routine use in testing for dsDNA antibodies.

Dental development in precocious puberty.

One hundred and one children with precocious puberty were given an oral examination. Dental root development was assessed using panoramic radiographs. All mandibular canines, pre-molars, and molars which could be visualized without apparent distortion were included. The patients were grouped for analysis according to the etiology of their precocity, e.g., McCune-Albright syndrome, familial male, congenital adrenal hyperplasia, central nervous system lesions, and idiopathic precocious puberty. Dental development was significantly retarded relative to their chronological age in patients with idiopathic precocious puberty. However, no significant abnormal dental development was detected in any of the other groups. Individual oral-facial growth and development remain the primary considerations for timing orthodontic treatment.

Terminal deoxynucleotidyl transferase-negative acute lymphoblastic leukemia.

OBJECTIVE: Terminal deoxynucleotidyl transferase (TdT) is a useful marker in the diagnosis of acute lymphoblastic leukemia (ALL) (French-American-British [FAB] L1 and L2) and is most useful in distinguishing ALL from mature B-lymphoid neoplasms, such as Burkitt lymphoma (FAB L3) and other lymphoid malignancies. The frequency of TdT-negative ALL is not known. Here we report 3 TdT-negative ALL cases that met the criteria for T-cell ALL. DESIGN: We reviewed approximately 200 cases of ALL retrieved from the database at our institution. All cases were evaluated using Wright-Giemsa, myeloperoxidase, butyrate, and TdT staining; immunophenotyped using flow cytometry; and studied using Southern blot analyses for T-cell receptors and immunoglobulin gene rearrangement. RESULTS: All ALL cases (L1 and L2) were TdT-positive, except for 3 cases that were of early T-cell lineage. None of the 3 cases demonstrated positivity for TdT in immunofluorescence staining with polyclonal antibodies or flow cytometry with monoclonal antibodies. Flow cytometric analysis confirmed a pre-T-cell immunophenotype in all 3 cases. One of the cases showed rearrangement of a T-cell antigen receptor and immunoglobulin heavy chain (J(H)). A second case showed germline configuration of T-cell receptors, but also showed rearrangement of the J(H), despite the expression of T-cell markers only.

Praising child compliance: reinforcement or ritual?

Praising child compliance is a common therapeutic recommendation to parents with noncompliant children. There are currently no studies documenting the independent contribution of the praise component to successful parent training programs. Three projects were designed to evaluate the hypotheses underlying the use of contingent praise routines. Namely, it has been suggested that conduct-disordered children are relatively unresponsive to adult approval at pretreatment, yet become responsive by posttreatment. In contrast to the hypotheses, data indicated that child compliance levels were not associated with child responsivity to maternal social reinforces; noncompliant children were responsive to maternal praise both before and after treatment; child responsivity to maternal praise did not covary with successful treatment; previously noncompliant but successfully treated children continued to comply to maternal instructions after contingent praise was withdrawn; a nonclinic child demonstrated extensive compliance persistence in the absence of contingent praise. Praising child compliance appeared to be more of a polite ritual than an active therapeutic component for altering noncompliance.

The effect of time-out release contingencies on changes in child noncompliance.

This project evaluated the effect of time-out release contingencies on changes in child noncompliance to maternal instructions. Twenty-four clinic-referred, non-compliant, preschool children served as subjects. Each child was assessed under baseline conditions and then under one of three experimental conditions: Parent Release, Child Release, or Control. Children in the Parent Release and Child Release conditions experienced time-out contingent upon noncompliance. Temporal and behavioral time-out release contingencies were present in the Parent Release condition but not in the Child Release condition. A spanking procedure was used to inhibit premature escape from time-out for children in Parent Release group. The results indicated that both time-out groups demonstrated increased compliance ratios. However, improvement associated with the Child Release condition was considered to be clinically insignificant.

An analysis of the physical punishment component of a parent training program.

One component of a well-researched, standardized parent training program is to spank children for escape from time-out. The contribution of the spanking component to compliance acquisition in a clinic analog setting was evaluated. Time-out duration and child disruption at time-out release were balanced across spank and no-spank ("barrier") conditions. Sixteen noncompliant, clinic-referred pre-school children participated. The data indicated that both spank and barrier procedures were equally effective at increasing compliance ratios. Physical punishment did not appear to be a critical component. Given prior research, it was concluded that the enforcement of a minimum time-out duration is critical for compliance acquisition within the analog setting.

The assessment of maladaptive parent-child interaction by direct observation: an analysis of methods.

Six direct observation technologies for assessing parent-child interactions are examined: Descriptive-narrative, event recording, three types of interval sampling, and sequential event recording. Selected articles in the clinical literature are reviewed to illustrate use of each technology. Furthermore, the yield of each procedure in terms of four assessment criteria was evaluated: precise description of the parent-child interaction, target selection, identification of the intervention strategy, and evaluation of the intervention technique. The sequential-event-recording technology was determined to be most advantageous in terms of the four criteria.

Clinic observations of structured parent-child interaction designed to evaluate externalizing disorders.

Observing structured parent-child interaction in clinic analogs has been a tradition in child clinical assessment since the 1960s. The clinic analog is designed to re-create important conditions from natural contexts such that dysfunctional parent-child patterns can be observed and modified. To those basic goals, the modern clinician would add diagnosis and treatment evaluation. Three classes of parent-child clinic analogs designed to evaluate preadolescent children with externalizing disorders were reviewed: free play, parent-directed play, and parent-directed chores. Free-play analogs and parent-directed chore analogs were found to have merit, but remain psychometrically underdeveloped. Practitioner reliance on questionnaires and interviews appears likely to continue until observational analogs have attained sufficient psychometric qualities to facilitate routine clinical decisions.

The social impact of multiple sclerosis--a study of 305 patients and their relatives.

PURPOSE: to assess the effects of multiple sclerosis (MS) on the patients' ability to fulfil their chosen family and social roles and to examine the impact of the disease on their relatives. METHODS: a population-based survey of all known patients with MS and their relatives in Hampshire County, England, between 1986 and 1989. RESULTS: Seventy-four% of the total study population of 411 completed the study. The patients' mean age was 48.3 years (range 19-82) and the mean disease duration was 15.8 years. About 16% of patients were depressed on a mood rating scale and a similar number also exhibited symptoms of anxiety. The marital status of most patients had not changed since the onset of MS but 53% of those who were employed at the time of diagnosis gave up their jobs and the standards of living of 37% of patients and their families had declined as a direct result of the disease. The ability to continue in gainful employment or to maintain social contacts and leisure activities correlated with the course and severity of the disease and cognitive function. Most carers reported symptoms that clearly related to organic pathologies, anxiety and symptoms of depression. The occurrence of these symptoms was associated with disease severity. The professional career of 57% of relatives was also adversely affected by the patient's illness. CONCLUSIONS: MS has a profound impact on the patients' social roles and their relatives' well-being. In contrast to previous studies, a high divorce/separation rate among patients with MS was not observed. Severe disability and cognitive impairment are predictors of loss of employment, decline in the standards of living and withdrawal from social and leisure activities among patients and are strong indicators of stress among relatives.

Oral findings in anorexia nervosa and bulimia nervosa: a study of 47 cases.

These two clinically oriented articles deal with problems dentists are seeing more frequently. One hospital dental service sees an average of four to five patients weekly with eating disorders. The first article is a research study discussing problems found in 47 study participants with the eating disorders anorexia nervosa and bulimia nervosa. The second article describes a helpful technique for oral rehabilitation.

Oral manifestations of AIDS: a study of 84 patients.

Early diagnosis of AIDS is vital in providing appropriate referral for medical care and counseling. Subtle intraoral signs and symptoms identified by the dental practitioner can aid in the diagnosis of the disease. Because the role of the practitioner in detection and treatment of AIDS patients is becoming greater, signs found in 84 patients are described.

Oral effects of steroid therapy in a patient with systemic lupus erythematosus: report of case.

Steroids are used extensively in modern medicine and dentistry for their anti-inflammatory and immunosuppressive properties. However, this class of drugs can lead to adverse effects on other organs. In this case, developmental and functional disturbances of the primary and permanent dentition are seen. The patient's dental development and pharmacological history suggest prednisone as the offending agent.

Clinical evaluation of three acid-etch composite resin systems: two-year report.

One hundred fifty-seven fractured anterior teeth were restored with one of three acid-etch composite resin systems and were clinically and radiographically evaluated for 24 months. Of the three systems evaluated, the material activated by ultraviolet light provided the highest retention rate and clinical acceptance.

Bulimia nervosa. Its effect on salivary chemistry.

Erosion of the dental hard tissues and enlarged parotid and submandibular saliva glands are commonly associated with bulimia nervosa. In 15 patients and controls, no significant difference was detected in the concentrations of potassium, chloride, calcium, urea nitrogen or albumin. There was also no evidence of olfactory dysfunction.

Oral manifestations of the Rieger syndrome: report of case.

The Rieger syndrome is a rare, autosomal dominant disorder. It is characterized by defects of the anterior chamber of the eyes as well as developmental malformations of the dentition. A case is described that shows classic findings with emphasis on dental management. Oral abnormalities in the pedigree may also suggest subtle manifestations of the syndrome. Recognition of the dental anomalies may result in early diagnosis of the syndrome and prevent progressive visual loss.

Case review section of the American Board of Pediatric Dentistry: stumbling blocks and pitfalls.

The Directors of the American Board of Pediatric Dentistry are eager for eligible candidates to become Diplomates. It is important to the profession as well as to the individual that more of our colleagues become Board certified. Failure on a Section of the examination is distressing to us as well as to the candidate. Requirements for the Case Review Section are very specific and are intended to assist the candidate in preparing the cases. Carefully following the guidelines will minimize potential disappointment.

Oral manifestations associated with leukocyte adhesion deficiency: a five-year case study.

A five-year case study of a child with leukocyte adhesion deficiency is presented. The report describes the generalized progressive periodontitis and intraoral infections associated with both the primary and permanent dentition. The associated therapeutic challenges and largely unsuccessful treatment regimens utilized in the attempts to arrest the periodontal disease are described.