Environmental factors and symptoms in infants at high risk of allergy.

STUDY OBJECTIVE: To identify environmental determinants of six symptoms associated with allergic disease in infancy. DESIGN: Infants were participants in a prospective randomised controlled trial of feeding practices in families with a history of atopy. SETTING: Infants were recruited in two maternity hospitals in S Wales and followed up in the community for 1 year. PARTICIPANTS: Mothers of 519 infants agreed to participate, but 36 were excluded (mainly for moving home or failing to attend for follow-up), leaving 483 in the study (253 male, 230 female). Infants were followed up and examined for evidence of allergic disease at 3, 6, and 12 months. MEASUREMENTS AND MAIN RESULTS: At each examination, mothers were questioned about episodes of illness in the infant, and the data presented relate to (reported and observed) eczema and nasal discharge, and (reported) wheeze, prolonged colds, diarrhoea and vomiting. Mothers kept a diary with details of feeding for the first 6 months. All homes were visited by a nurse who took samples of dust for dust mite antigen analysis. Extensive socio-demographic data were collected. None of the factors studied showed a convincing relationship with eczema. In a multiple logistic regression analysis breast feeding appeared to protect against wheeze, nasal discharge, colds, vomiting and diarrhoea. Having more siblings increased the likelihood of prolonged colds, and (together with overcrowding) of wheeze and nasal discharge. Maternal smoking and low social class were associated with wheeze, and house dust antigen with prolonged colds. Respiratory symptoms were associated with some aspects of housing but these could not be distinguished clearly from other social factors. Babies born in Autumn were at increased risk of wheeze, vomiting and diarrhoea. CONCLUSIONS: Environmental factors play an important part in determining risk of symptoms in potentially atopic babies. These factors are in principle open to manipulation.

Assistive technology in elderly care.

New developments in assistive technology are likely to make an important contribution to the care of elderly people in institutions and at home. Video-monitoring, remote health monitoring, electronic sensors and equipment such as fall detectors, door monitors, bed alerts, pressure mats and smoke and heat alarms can improve older people's safety, security and ability to cope at home. Care at home is often preferable to patients and is usually less expensive for care providers than institutional alternatives.

Who needs a nursing home? A simple and effective screening test.

The aim of this study was to determine whether the Barthel Index (BI) or Folstein's Mini-Mental State Examination (MMSE) could distinguish between patients who might continue at home with domiciliary care and those requiring institutional long-term care. The results of the BI and the MMSE were compared with decisions made by an expert multidisciplinary team, including geriatricians. A Barthel score of 15 or less had a sensitivity of 90%, a specificity of 83% and a predictive value of 84% for determining those patients requiring nursing home placement. The BI proved to be a simple, accurate and reliable indicator of patients requiring nursing home care. The MMSE was of no predictive value in distinguishing the patients' discharge destinations.

Benefits of an accident and emergency short stay ward in the staged hospital care of elderly patients.

OBJECTIVE: To study the potential of a short stay ward attached to an accident and emergency (A&E) department to improve care and reduce admissions to hospital by enabling elderly patients to be monitored closely for up to 24 h before being formally admitted to hospital or discharged home. Patients admitted to the short stay ward were those who appeared to need only a brief period of assessment or treatment. METHODS: The medical records of all patients aged 65 years and above admitted to the short stay ward over a nine month period (April to December 1993, inclusive) were reviewed. RESULTS: 13% of all the patients over 65 attending A&E were admitted to the A&E ward. Of patients over 65 who were admitted to hospital, 20% were first admitted to the A&E ward. There were 502 admissions to the short stay ward of patients aged 65 years and above, who constituted 38% of the total admissions to that ward. Admitting these selected patients to the short stay ward allowed 71% to be discharged home, usually within 24 h, rather than being formally admitted to hospital. CONCLUSIONS: The addition of a short stay ward can shorten the hospital stay for selected elderly patients and reduce the demand for inpatient hospital beds. This ward also improves the quality of care to elderly patients attending the A&E department.

Missed diagnoses among elderly patients discharged from an accident and emergency department.

OBJECTIVE: To investigate how often elderly patients are discharged from an accident and emergency (A&E) department with unrecognized but remediable problems. METHODS: Over a period of six months, 174 elderly patients fulfilling inclusion criteria for the study were discharged from A&E, and of these 97 (56%) agreed to be reviewed in the day hospital. They were assessed by a doctor, nurse, physiotherapist, occupational therapist, speech therapist, and social worker. A full blood count, urea and electrolytes, liver and thyroid function tests, a chest radiograph, and an electrocardiogram were performed. A Barthel activity of daily living index was performed on the first visit and before discharge. RESULTS: 28% had missed diagnoses which benefited from day hospital attendance and a further 13 patients had been admitted before they could attend day hospital. Those patients presenting with falls and living alone constituted a high risk group. CONCLUSIONS: Elderly patients attending A&E merit special consideration to detect underlying medical or social problems.

Infant feeding and allergy.

The effect of withholding cows' milk was examined in 487 infants at high risk of allergic disease. Before birth they were randomly allocated either to a control group, most of whom received cows' milk preparations, or to an intervention group, who were offered a soya based substitute. Eczema and wheezing occurred to a similar extent in the two groups during the first year of life, although napkin rash, diarrhoea, and oral thrush were commoner in the intervention group, especially during the first three months. Breast feeding for any length of time was associated with a reduced incidence of wheezing and diarrhoea.

Infant feeding and allergy: 12-month prospective study of 500 babies born into allergic families.

This investigation studied 487 babies for symptoms of allergic disease during their first year of life. Because of their positive family histories all the babies are at high risk of becoming allergic. The babies were randomly divided such that cows' milk was deliberately withheld from one group; infants in this group were fed with a soya substitute where required. No benefit resulted from withholding cows' milk, indeed symptoms were more usually associated with this group. Breast feeding, even for a short period, was clearly associated with a lower incidence of wheeze, prolonged colds, diarrhoea, and vomiting. It seemed that the duration of breast feeding was less important than whether or not the child had been breast-fed at all. Wheezing was both more common among boys than girls (P less than .05) and if the mother was a smoker. Other environmental features related to wheezing were social class, month of birth, lack of breast feeding, exposure to dampness, mould and coal fires, but not to domestic pets nor to the numbers of mites found in bedding and carpets. Mite exposure was, however, associated with prolonged colds. Eczema was the only allergic symptom not positively associated with any environmental factor; moreover, it was neither associated with a lack of breast feeding nor with inclusion of cows' milk in the diet. Eczema was associated with the incidence of positive skin prick tests and IgE antibodies to egg white. IgE and IgG4 antibodies were estimated at birth (mothers' and cord bloods) and 3 and 12 months later.(ABSTRACT TRUNCATED AT 250 WORDS)