Is venepuncture in neonatal research ethical?

AIM: To determine whether venepuncture accords with the accepted (BPA) criteria of not causing more than minimal physical or psychological distress during non-therapeutic research. METHODS: Ninety two venepunctures were carried out in 69 neonates between days 6 and 10 of life, and in some cases, on day 28. Parents were fully informed of the need for the procedure and allowed to attend while it was performed. Ninety parents and 87 doctors completed questionnaires to assess the levels of perceived parental and child distress and anxiety before and after the procedure. RESULTS: Only three parents were very upset, and 47% reported the test as being better than they expected, compared with 10% who thought it worse than expected. Seven babies were recorded as being very upset. Doctors tended to underestimate the degree of anxiety before the procedure and the level of distress afterwards. CONCLUSIONS: Venepuncture in neonates seems to be acceptable to most parents and is associated with a favourable risk: benefit ratio using semiquantitative assessment of risk and benefit.

Teenagers' views on the general practice consultation and provision of contraception. The Adolescent Working Group.

BACKGROUND: The rate of unwanted pregnancies in adolescents in the United Kingdom (UK) is one of the highest in Europe and is a major reason for the RCGP's concern at the under-use of general practitioners' (GPs') contraceptive services by young people. AIM: To discover the attitudes of 15- to 16-year-olds to the GP consultation and contraceptive services. METHOD: Questionnaires were completed as part of an evaluation of a novel sex education programme in 30 schools in 1994, and provided the data for this study. A total of 4481 teenagers (51.6% male and 48.4% female completed the questionnaires in their classrooms under conditions of complete confidentiality. RESULTS: The median consulting rate per year was two for males and three for females. Over 60% of adolescents attended the consultation with a parent. Of the males, 27.5% 'felt that the discussion with their GP could be relayed to their parents against their wishes', as did 25.1% of the females. Other difficulties with GP appointments were identified as embarrassment (63% of females and 46% of males), difficulty getting a quick appointment (44% of both males and females), and an unsympathetic GP (32% of females and 20.5% of males). CONCLUSIONS: Adolescents identify significant factors blocking them from easy access to consultation with their GP. These included lack of trust in confidentiality, lack of staff friendliness, and delay in appointment. Consideration of how these blocks can be removed will assist in providing improved contraceptive services in primary care. General practices need to consider the above factors when providing contraceptive and other services to their teenage patients.

Haemorrhagic disease of the newborn in the British Isles: two year prospective study.

OBJECTIVE: To determine the incidence of haemorrhagic disease of the newborn in the British Isles, study risk factors, and examine the effect of vitamin K prophylaxis. DESIGN: Prospective survey of all possible cases of haemorrhagic disease of the newborn as reported by consultant paediatricians using the monthly notification cards of the British Paediatric Surveillance Unit and a follow up questionnaire for each case to validate the diagnosis and accrue further data. SETTING: Britain (England, Scotland, and Wales) and Ireland (Northern Ireland and the Irish Republic) during December 1987 to March 1990. PATIENTS: 27 infants classified as having confirmed (n = 25) or probable (n = 2) haemorrhagic disease of the newborn. RESULTS: 24 of the 27 infants were solely breast fed. 10 suffered intracranial haemorrhage; two of these died and there was clinical concern about the remainder. 20 infants had received no vitamin K prophylaxis, and seven had received oral prophylaxis. Relative risk ratios for these groups compared with babies who had received intramuscular vitamin K were 81:1 and 13:1 respectively. Six infants had hepatitis (alpha 1 antitrypsin deficiency in four), unsuspected until presentation with haemorrhagic disease of the newborn, of whom four had received oral prophylaxis. One other baby had prolonged jaundice. One mother had taken phenytoin during pregnancy. CONCLUSIONS: All newborn infants should receive vitamin K prophylaxis. Intramuscular vitamin K is more effective than oral prophylactic regimens currently used in the British Isles.

Teenagers, sex, and risk taking.

PIP: This study provides a baseline examination of teenage sexual relationships in 1991 in a sample drawn from 9 state and independent schools in southwest England; a follow up was conducted in 1992. 1025 students in year 11 and aged 15-16 responded in 1991; the follow up in 1992 showed 315 returning the questionnaire. Information was requested on knowledge of sexually transmitted diseases (STDs), age at first intercourse, sexual intercourse without use of contraception, the frequency of "one night stands" or relationships measured in days, and knowledge of friends who had STDs. Relative risk ratios were calculated for those engaging in sexual activity before and after the age of 16 years. The results showed that in the follow up more girls and persons with more academic interests, as represented by the school subjects taken for the General Certificate of Secondary Education, responded. There were no differences by social class. The average age of the sample was 16.9 years. 54% were sexually active. 84 had sexual intercourse when they were under 16 years and 84 has sexual intercourse between the ages of 16 and the administration of the questionnaire. Those engaging in intercourse prior to the age of 16 were twice as likely to not have used contraception (relative risk [RR] = 1.86, confidence interval [CI] = 1.33 - 2.60 at 95%). They also were more likely to have had sex within a short relationship (RR = 2.24, CI = 1.38 - 3.62). They were 3 times more likely to know a close friend with an STD (RR = 2.97, CI = 1.55 - 5.70). Only 5 of the nonsexually active teenagers knew someone with an STD. The extent of sexual activity was lower than reported from other surveys. The results confirm prior understanding that younger teenagers engage in more sexual risk taking and are less likely to use contraception. The suggestion is that this risk-taking behavior is related to the cognitive development of younger teenagers of the age of first intercourse.^ieng

School sex education: an experimental programme with educational and medical benefit.

OBJECTIVES: To develop and teach a school sex education programme that will lead to a decrease in sexual activity. DESIGN: A matched internal and external control experiment, comparing control populations which received their own sex education programmes with populations which received a novel sex education intervention that included medical and peer led teaching. SETTING: Comprehensive secondary schools; control and intervention populations within Devon, and distant controls from rural, semiurban, and urban areas of England excluding major conurbations. SUBJECTS: Schoolchildren were taught from age 12 to 16; three successive cohorts of students were evaluated in school year 11 (mean age 16.0). MAIN OUTCOME MEASURES: Questionnaire conducted under "examination conditions" and invigilated by the research team and other trained medical staff. RESULTS: In the intervention population, progressive increase in knowledge related to contraception, sexually transmitted diseases, and prevalence of sexual activity (chi 2 (trend) P < 0.001 for all three series); relative increase between intervention and control populations in knowledge, relative decrease in attitudes suggesting that sexual intercourse is of itself beneficial to teenagers and their relationships, relative decrease in sexual activity, and relative increase in approval of their "sex education" (relative risk > 1.00 with 95% confidence limits not including 1.00 for all series and for comparisons with both control populations); odds ratio (control v programme) for sexual activity of 1.45, controlling for sociodemographic variables. CONCLUSION: School sex education that includes specific targeted methods with the direct use of medical staff and peers can produce behavioural changes that lead to health benefit.

Effect of torso geometry on the magnetocardiogram.

Calculations of the effect of torso geometry on the extracorporeal magnetic field produced by a simple cardiac source have been carried out. Contrary to the results at present in the literature, it is found that the field solution is stable under perturbations of geometry in the sense that small relative changes in geometry produce comparably small changes in the magnetic field. Thus, simplified torso models may have a wider range of validity and usefulness than was previously thought.

Unknown syndrome: mental retardation with postaxial polydactyly, congenital absence of hair, severe seborrhoeic dermatitis, and Perthes' disease of the hip.

We report a six year old male with mental retardation, postaxial polydactyly and syndactyly, atrichia congenita totalis, severe seborrhoeic dermatitis, recurrent staphylococcal skin sepsis, and Perthes' disease of the hip. His birth may have resulted from an incestuous mating.

UNICEF/W.H.O. glucose electrolyte solution not always appropriate.

PIP: The authors defended Dr. Kahn's and Dr. Blum's suggestion, reported in the May 17, 1980 issue of Lancet, that the formula for making GES (glucose electrolyte solution), used for the management of gastroenteritis, should be determined by the age and condition of the patients in each locality. They disagreed with the proposal of Dr. Clements, reported in the July 5, 1980 issue of Lancet, that all patients could be treated with a single solution, the UNICEF/WHO CES, or with a dilution of this single solution. Recent studies confirmed that there was considerable epidemiological variation in the type and degree of electrolyte disturbances among infants with gastroenteritis. Factors such as age, nutritional status, climate, and the type of pathagens were linked to different type of electrolyte disturbances. These differences should be taken into account in formulating the appropriate GES.^ieng

Modification to single catheter exchange transfusion technique.

A simple modification to the standard 'in-out' exchange transfusion technique is described which requires cannulation of the umbilical vein only, yet provides many of the theoretical and practical advantages of a 2-catheter arteriovenous technique. The advantages include a reduction of cardiovascular disturbance; a reduction of the inevitable pressure changes in the portal venous system (probably important in the pathogenesis of complicating necrotizing enterocolitis); administration of alkali or drugs diluted in donor blood; accurate assessment of balance; a more efficient exchange; and general ease of management allowing better clinical observation of the infant.

Teenage sexual intercourse and pregnancy.

One hundred and one pregnant girls aged under 18 years were interviewed to collect information about the development of their sexual awareness, attitudes towards relationships, and about their social context. The data show that the girls were likely to come from homes where the parents were divorced, where the mother married when she was under 21 years of age, and where her first child was conceived out of wedlock. Altogether 76 of these pregnant girls first had intercourse before they were 16 years old. The younger the girl at first intercourse the sooner it occurred in the relationship and for almost half of the girls first intercourse was unplanned. Although almost half used contraception on the first occasion, only one third of the girls used contraceptives regularly. Most expressed the wish that they had delayed intercourse until they were older.

Illness experience and related knowledge amongst children with asthma.

Forty-nine children with asthma (aged 7-16 years) completed a questionnaire concerned with (1) general knowledge about the body and how it works, and (2) specific knowledge about the cause and prognosis of asthma, knowledge of allergens and self-care behaviours. Compared with a matched group of healthy children, they were less well-informed about general knowledge of the body. Knowledge of asthma was also poor. Few children made any specific attempts to avoid situations known to precipitate attacks. There was no significant increase with age in knowledge of allergens or awareness of how to control attacks. The results indicate a need to make asthmatic children more aware of their illness, particularly with regard to self-care.

Peer-led and adult-led school health education: a critical review of available comparative research.

Peer-led health education in school is widely used. Advocates suggest it is an effective method based on the belief that information, particularly sensitive information, is more easily shared between people of a similar age. Critics suggest that this is a method not based on sound theory or evidence of effectiveness. This review evaluates school-based health education programmes which have set out to compare the effects of peers or adults delivering the same material. The identified studies indicated that peer leaders were at least as, or more, effective than adults. Although this suggests that peer-led programmes can be effective, methodological difficulties and analytical problems indicate that this is not an easy area to investigate, and research so far has not provided a definitive answer.

Illness experience and children's concepts of health and illness.

The effects of chronic illness on children's knowledge of health and illness were investigated by interviewing 57 children with diabetes and the same number of healthy children of similar age and background. There were few differences between the groups in their definitions of health or knowledge of the cause of illness. The data are discussed in terms of their theoretical relevance to the development of ideas about health and illness.

Diabetes and developing knowledge of the body.

Fifty seven diabetic children were compared with healthy children for knowledge of their bodies and causes of diabetes. Diabetic children were more likely to include the pancreas and less likely to include the brain or stomach in drawing their bodies. The data have implications for understanding how illness affects psychological development.

Mucosal (Na+-K+)-ATPase and adenylate cyclase activities in children with toddler diarrhea and the postenteritis syndrome.

Assays for (Na+-K+)-ATPase and basal, fluoride stimulated and percentage of activation of adenylate cyclase have been established for small portions of human jejunal biopsies. Control means and ranges have been established for each activity in a group of children with failure to thrive but no gastrointestinal disease. Activities of (Na+-K+)-ATPase and percentage of activation and basal activity of adenylate cyclase are increased in children with toddler diarrhea. (Na+-K+)-ATPase activity is reduced in children with active postenteritis syndrome, and recovery from this syndrome is associated with an increase in this activity and of percentage of activation and basal activity of adenylate cyclase.