Child health care in Charles County, Maryland: a needs assessment.

In response to the perception of community leaders in Charles County, Maryland, that more health care services should be available for disadvantaged infants and young children in the county, an informal needs assessment was carried out. First, available public health statistical data were used to estimate the number of children under 10 years of age residing in low-income households without health insurance. Next, a household survey and a physician survey were used to determine community and professional attitudes regarding unmet child health care needs, barriers to care, and possible solutions. Survey results validate the existence of unmet health care needs of county children as well as support for a volunteer clinic to address these needs.

Functional screening of lower-limb amputees: a role in predicting rehabilitation outcome?

The Functional Independence Measure (FIM), a single-score instrument used to measure independent functioning in six areas of basic self-care skills, was used to evaluate 68 patients following lower-limb amputation. Patients in a rehabilitation hospital were assessed with the FIM upon admission and discharge. Admission scores averaged 52.7, ranging from 25.2 to 70.0. Patients scoring in the lowest and highest quartiles were compared: no remarkable gender, ethnic, or age differences were evident. Persons with the lowest scores (ie, lowest functioning) had a higher prevalence of hypertension, coronary artery disease, and noninsulin-dependent diabetes mellitus. The success of rehabilitation in patients in the lower two quartiles upon admission was variable and not predicted well by the FIM. In contrast, predictability of rehabilitation success was high in patients functioning higher at admission, the majority achieving near-perfect scores by discharge. Length of hospitalization appeared to be largely unrelated to the net difference in FIM scores over the course of hospitalization.

Is childhood obesity associated with high-fat foods and low physical activity?

Childhood obesity is a major health problem with serious long-term health implications. Efforts to determine risk factors beyond genetic predisposition have been equivocal. Common notions of overeating and under-exercising as causes have not been supported by prior research. This combined prevalence and case-control study analyzed a population of children ages 8-10 to ascertain the association between exposure to high-fat foods and low levels of exercise, and obesity. The sample population of Texas school children revealed a 100% greater prevalence of childhood obesity relative to national normative standards established from 1976-1980. Neither high-fat food intake nor reported level of physical activity were independent risk factors for this condition. However, they may exert a synergistic effect when both are present in the same child. Development of more sophisticated population-based instruments will enable larger studies to investigate risk factors for childhood obesity.

Physical findings in a psychiatric outpatient clinic.

To determine the frequency of previously undiagnosed, positive physical findings in a psychiatric outpatient clinic population, the authors examined the case records of 910 consecutively admitted patients who had been given screening physical examinations including urinalyses. They found that 20.4% of the patients had some medical abnormality that was previously undiagnosed, and they encourage psychiatrists to make the physical examination a routine part of their total psychiatric evaluation.