Epidemics of Tuberculosis in Canada in the Sixties

Data on 24 localized tuberculosis epidemics occurring in Canada from January 1960 to March 1965 have been analyzed. In a population of about 13,000 at some degree of risk 308 new cases of active tuberculosis occurred—an incidence of 2.3%. In individual outbreaks, however, the incidence was as high as 31%. Epidemics occurred under a wide variety of circumstances—in schools, homes, communities, an army camp and a hockey team. Detected source cases included parents, school teachers, a cook, a hired man and a “den mother”.Because of the involvement of children, about four out of 10 new active cases were primary tuberculosis. Approximately two out of 10 were moderately or far advanced pulmonary cases. The findings suggest the need to reconsider BCG vaccination of the younger age group as a means of raising the level of herd immunity.     

Lead Poisoning in Blind Children

Many partially sighted children use the mouth, lips, and tongue as an aid in identifying objects—this has been termed discriminatory pica. Investigation of a case of lead poisoning in a pupil at a residential school for the blind led to the discovery of others with asymptomatic lead poisoning, all of whom had the same habit.All the children recovered without treatment when they abandoned their habit of discrimination by use of the mouth. Authorities responsible for schools for the blind should be aware of this risk.     

THERAPY OF PARKINSON'S DISEASE

The most disabling form of Parkinsonism is that occurring after encephalitis. It may occur in persons of any age. The results of surgical treatment, which has been used for the most part only for seriously handicapped patients, have been discouraging in general, although in a few isolated circumstances operation has been of dramatic benefit.The solanaceous alkaloids—atropine, stramonium and hyoscine—either in pure forms or in mixed extracts or tinctures — are the best established drugs at present for the treatment of the postencephalitic forms of Parkinsonism. They have not proven too helpful for patients in the older age group with paralysis agitans. The antihistaminic compounds, particularly Benadryl,® have been a very valuable addition. They are of greatest value for patients in the older age group. The newer synthetic compounds, Artane® and Panparnit,® are also valuable additions. Amphetamine and the related and subsequently produced agents in this group are very helpful for patients showing undue fatigue and lethargy. Tolserol® is proving helpful, particularly for patients with painful spasms of rigid muscles.     

The Influence of Texting Language on Grammar and Executive Functions in Primary School Children

When sending text messages on their mobile phone to friends, children often use a special type of register, which is called textese. This register allows the omission of words and the use of textisms: instances of non-standard written language such as 4ever (forever). Previous studies have shown that textese has a positive effect on children’s literacy abilities. In addition, it is possible that children’s grammar system is affected by textese as well, as grammar rules are often transgressed in this register. Therefore, the main aim of this study was to investigate whether the use of textese influences children’s grammar performance, and whether this effect is specific to grammar or language in general. Additionally, studies have not yet investigated the influence of textese on children’s cognitive abilities. Consequently, the secondary aim of this study was to find out whether textese affects children’s executive functions. To investigate this, 55 children between 10 and 13 years old were tested on a receptive vocabulary and grammar performance (sentence repetition) task and various tasks measuring executive functioning. In addition, text messages were elicited and the number of omissions and textisms in children’s messages were calculated. Regression analyses showed that omissions were a significant predictor of children’s grammar performance after various other variables were controlled for: the more words children omitted in their text messages, the better their performance on the grammar task. Although textisms correlated (marginally) significantly with vocabulary, grammar and selective attention scores and omissions marginally significantly with vocabulary scores, no other significant effects were obtained for measures of textese in the regression analyses: neither for the language outcomes, nor for the executive function tasks. Hence, our results show that textese is positively related to children’s grammar performance. On the other hand, use of textese does not affect—positively nor negatively—children’s executive functions.     

The Educationally Handicapped Child—The Physician's Place in a Program to Overcome Learning Disability

Under California Assembly Bill 464, special classes may be provided by school districts for children designated as educationally handicapped. An educationally handicapped child is not mentally retarded or physically disabled. He may have neurological handicap or emotional disorder, but he must show impaired achievement in relation to his tested abilities.A physician may be asked to participate in the program, either as a specified member of the admissions committee of the school district or to provide a medical clearance for entrance of one of his own patients into the program.He does a thorough history and physical examination but adds special examination of attention, activity, coordination and attitudes.The educationally handicapped child is helped most by the physician who does not reject the idea of educational handicap even if the medical examination is negative; who treats his minor ills; who medicates, when it is indicated, for hyperactivity, distractibility or extreme anxiety; who cooperates with parents and school personnel.     

THE GEOTROPIC REACTION OF RODLESS MICE IN LIGHT AND IN DARKNESS

"Black—short ears—kinky tail—rodless" mice, controlled by "pink eyed—dilute—brown" mice, were tested on an inclined plane in order to determine if they are photically sensitive, and, if so, to get a quantitative expression for their visual receptivity. Rodless and control animals were tested in the dark to obtain an expression for normal geotropic orientation. Light was then introduced to modify these reactions if possible. Under light, the controls failed to orient, whereas the rodless gave reactions almost identical with those in the dark. This test has failed in this experiment to suggest sight in the rodless mouse.     

CORRECTABLE CARDIAC FAILURE

The concept of reversible cardiac failure has hitherto been applicable mostly to rare instances of acute afflictions of the myocardium wherein cardiac compensation returns with the healing of the process. Recent strides in cardiac surgery have brought into focus a wide variety of conditions where operative removal of the cause of heart failure can successfully restore compensation.The concept of increased work of the heart—cardiac overload—is presented and classified with special reference to those forms where surgical removal of the cause of the overload is possible.Now, since surgical treatment of a patient in functional class IV need no longer entail risk of prohibitive mortality, a careful search is indicated in patients in a state of chronic cardiac failure, particularly in the younger age group, for a correctable factor or factors.     

Screening for fetal alcohol syndrome in primary schools: a feasibility study

BACKGROUND: This project was undertaken as a feasibility study to determine the possibility of screening for fetal alcohol syndrome (FAS) in early school-age children for epidemiological and interventional purposes. METHODS: All elementary schools in two counties in Washington State were asked to screen first graders for possible FAS. A child was screen positive if found to be growth deficient, to have certain specific facial abnormalities, or have a known history of substantial alcohol exposure in gestation. All screen-positive children were invited to "special diagnostic clinics" for final diagnosis and treatment planning. RESULTS: In County A, virtually all students were screened. In County B only about 25% of children were screened. This difference was related to the number of schools that agreed to participate in the project and the methods employed by each county to obtain parental permission. In each county, only about one-half of the screen-positive children were seen in the special clinics for diagnostic considerations. Only one of the seven children found to have FAS had been diagnosed previously. The minimal prevalence of FAS in County A was 3.1 in 1,000 students. The minimal prevalence of FAS in County B could not be calculated. The most efficient component in the screening process leading to a diagnosis of FAS was finding the specific facial features of the disorder. The diagnosis of FAS was generally helpful in improving educational planning. CONCLUSIONS: This study demonstrated that population-based FAS screening within a school system may be possible, but participation is dependent on local trust and understanding of the project before its inception within the schools and the community at large.     

Isolation of keratinophilic fungi from floor dust in Arab elementary and preparatory schools in the West Bank of Jordan

Floor dust collected from classrooms of thirty three elementary schools (16 for girls, and 17 for boys) (children aged 6–11), and twenty four preparatory schools (13 for girls, and 11 for boys) (children aged 12–14) was studied for the occurrence of keratinophilic fungi with respect to human presence and age of children. Tichophyton mentagrophytes was present in 15.4% of the preparatory schools for girls, in 12.5% of elementary schools for girls, and in 11.8% of elementary schools for boys. It was not found in preparatory schools for boys. Microsporum gypseum was found in preparatory schools for girls only (7.7%). Trichophyton terrestre was also only isolated from elementary schools for boys (5.9%). Chrysosporium species were present in 30.3% of all elementary schools (10 schools/33), and in 20.8% of all preparatory schools (5 schools/24). Geotrichum candidum was the most frequent and predominant keratinophilic species in all schools. Pathogenic and potentially pathogenic keratinophilic fungi comprised a large proportion of all fungal isolates recovered from all schools ; they comprised 87.2 %–89.5 % of all fungal isolates in the elementary schools, and 90.4%–93.5% of all fungal isolates in preparatory schools.     

Malignant Disease in Children whose Mothers had Chickenpox,Mumps, or Rubella in Pregnancy

To test the hypothesis that leukaemia may follow virus infection in pregnancy an analysis was made of deaths which occurred in a cohort of children born in 1951 and 1952 after pregnancies in which the mothers suffered virus infections—chickenpox or mumps at any stage of gestation or rubella in the first 18 weeks. All deaths which occurred between the children''s second birthday and the end of 1971 were studied.Two deaths from leukaemia occurred among the children whose mothers suffered from chickenpox, a significant excess. There were no deaths from leukaemia among the other children, but the causes of the two deaths after maternal mumps—Ewing''s tumour and Still''s disease—are noted because of their rarity.     

Prevalence of Myopia and Its Risk Factors in Urban School Children in Delhi: The North India Myopia Study (NIM Study)

PurposeAssess prevalence of myopia and identify associated risk factors in urban school children.MethodsThis was a cross-sectional study screening children for sub-normal vision and refractive errors in Delhi. Vision was tested by trained health workers using ETDRS charts. Risk factor questionnaire was filled for children with vision <6/9.5, wearing spectacles and for a subset (10%) of randomly selected children with normal vision. All children with vision <6/9.5 underwent cycloplegic refraction. The prevalence of myopia <-0.5 diopters was assessed. Association of risk factors and prevalence of myopia was analyzed for children with myopia and randomly selected non myopic children and adjusted odds ratio values for all risk factors were estimated.ResultsA total number of 9884 children were screened with mean age of 11.6 + 2.2 years and 66.8% boys. Prevalence of myopia was 13.1% with only 320 children (24.7%) wearing appropriate spectacles. Mean myopic spherical error was -1.86 + 1.4 diopters. Prevalence of myopia was higher in private schools compared to government schools (p<0.001), in girls vs. boys (p = 0.004) and among older (> 11 years) children (p<0.001). There was a positive association of myopia with studying in private schools vs. government schools (p<0.001), positive family history (p< 0.001) and higher socio-economic status (p = 0.037). Positive association of presence of myopia was observed with children studying/reading > 5 hours per day (p < 0.001), watching television > 2 hours / day (p < 0.001) and with playing computer/video/mobile games (p < 0.001). An inverse association with outdoor activities/playing was observed with children playing > 2 hours in a day.ConclusionMyopia is a major health problem in Indian school children. It is important to identify modifiable risk factors associated with its development and try to develop cost effective intervention strategies.     

Anthropometric and Micronutrient Status of School-Children in an Urban West Africa Setting: A Cross-Sectional Study in Dakar (Senegal)

Background

Urban areas in West Africa are not immune to undernutrition with recent urbanization and high food prices being important factors. School children often have a poor nutritional status, potentially affecting their health and schooling performance. Yet, generally school children do not benefit from nutrition programs. The objective of the study was to assess the anthropometric and micronutrient status of children from state schools in the Dakar area.

Methods

School children (n = 604) aged from 5 to 17 y (52.5% girls, 47.5% ≥10 y) were selected through a two-stage random cluster sample of children attending urban primary state schools in the Dakar area (30 schools × 20 children). The prevalence of stunting (height-for-age<−2 z-scores) and thinness (BMI-for-age<−2 z-scores, WHO 2006, and three grades of thinness corresponding to BMI of 18.5, 17.0 and 16.0 kg/m2 in adults) were calculated from weight and height. Hemoglobin, plasma concentrations of ferritin (FER), transferrin receptors (TfR), retinol binding protein (RBP), and zinc, and urinary iodine concentrations were measured. Correction factors were used for FER and RBP in subjects with inflammation determined with C-reactive protein and α1-acid-glycoprotein.

Results

4.9% of children were stunted, 18.4% were thin, 5.6% had severe thinness (BMI-for-age<−3 z-scores). Only one child had a BMI-for-age>2 z-scores. Prevalence of anemia, iron deficiency and iron deficiency anemia was 14.4%, 39.1% and 10.6% respectively. 3.0% had vitamin A deficiency, 35.9% a marginal vitamin A status, and 25.9% zinc deficiency. Urinary iodine was <50 µg/L in 7.3% of children and ≥200 µg/L in 22.3%. The prevalence of marginal vitamin A, zinc deficiency, high TfR was significantly higher in boys than in girls (P<0.05). Height-for-age and retinol were significantly lower in participants ≥10 y and <10 y respectively.

Conclusion

Undernutrition, especially thinness, iron and zinc deficiencies in school children in the Dakar area requires special targeted nutrition interventions.     

Respite care on a children's ward.

In March 1984 a short term respite care facility for handicapped children was opened in a children''s ward catering primarily for acute medical and surgical problems. The facility was based on a four bedded room designed so that if beds became short in the main ward it could revert immediately to the care of acutely sick children. Three nurses were appointed specifically to staff the facility, the nursing budget for the rest of the ward being reduced proportionately. Conversions were funded by charities and some of the conversion work done by volunteers. The main users were totally dependent children aged under 5 with severe mental and physical handicaps. Parents found the service invaluable, and in addition to planned admissions it was usually possible to accept a child at short notice--for example, when some domestic crisis occurred. Only very rarely was admission impossible because of the needs of acutely ill children. A short term respite care facility not only helps parents cope and may provide beneficial experience for a handicapped child but is also a useful training ground for medical students and junior staff.     

London Education and Inclusion Project (LEIP): Exploring Negative and Null Effects of a Cluster-Randomised School-Intervention to Reduce School Exclusion—Findings from Protocol-Based Subgroup Analyses

This paper presents subgroup analyses from the London Education and Inclusion Project (LEIP). LEIP was a cluster-randomised controlled trial of an intervention called Engage in Education-London (EiE-L) which aimed to reduce school exclusions in those at greatest risk of exclusion. Pupils in the control schools attended an hour-long employability seminar. Minimisation was used to randomly assign schools to treatment and control following baseline data collection. The study involved 36 schools (17 in treatment—373 pupils; 19 in control—369 pupils) with >28% free school meal eligibility across London and utilised on pupil self-reports, teacher reports as well as official records to assess the effectiveness of EiE-L. Due to multiple data sources, sample sizes varied according to analysis. Analyses of pre-specified subgroups revealed null and negative effects on school exclusion following the intervention. Our findings suggest that the design and implementation of EiE-L may have contributed to the negative outcomes for pupils in the treatment schools when compared to those in the control schools. These findings call into question the effectiveness of bolt-on short-term interventions with pupils, particularly those at the highest risk of school exclusion and when they are faced with multiple problems. This is especially pertinent given the possibility of negative outcomes.Trial Registration: Controlled Trials: ISRCTN23244695     

CARE OF CEREBRAL-PALSIED CHILDREN—The Special Role of Pediatricians

Because the cerebral-palsied child is also a growing person whose development should be encouraged along as normal a course as possible, the pediatrician may well take the lead in coordinating orthopedic, psychiatric, educational and vocational services for such children. In El Centro this policy has been followed in a school for handicapped children serving 30 with cerebral palsy, 15 of them pupils at the school. Those with sufficient intelligence and milder physical handicap attend a regular public school, while others are unable to attend even the special school.Emphasis has been placed on working with children who are less seriously affected. As to children with severe neuromuscular and intellectual handicap, the chief effort is to prevent contractures and maintain function. The pediatrician confers monthly with all workers concerned with the child, and maintains liaison with the family physician who treats acute illnesses, including palsy seizures. Special effort has been made to investigate family circumstances such as foreign background which make it more difficult to evaluate the palsied child''s true capabilities.     

WHAT'S NEW IN CEREBRAL PALSY

Among new researches bearing on cerebral palsy are the growth of brain cells in tissue cultures for experimentation; the use of polysaccharides to prevent the formation of a glial barrier to nerve growth after injury; observation of changes in reactions of neurons at various stages of development; the finding of hypernatremia and hyperchloremia in lesions of the frontal lobe and the thalamus; stimulation of cerebral blood flow by injection of sodium bicarbonate and retardation with ammonium chloride; and studies of serial sections of brains of palsied children who died.Study of development in the early months of life has made possible the detection of significant abnormalities in behavior early in life. Loss of hearing may be tested in very young children by measuring minute variations in electrical resistance of the skin upon auditory stimulation of the sympathetic nervous system.Conditions which have been described as having been confused with cerebral palsy are dislocation of a cervical vertebra, hereditary spastic paraplegia, transverse myelopathy, injury to the spinal cord or cauda equina by anomalous growths of the spine, and also encephalitis and meningitis.Sedation has proved a valuable adjunct to electroencephalographic study of cerebral palsy. Better criteria for abnormality in the young child should be determined and the application of them more clearly standardized.Simple exercises are useful for early training of palsied children to stimulate development. “Crossed laterality”—the dominant eye being contralateral to the preferred hand—has been counteracted by special training with great success in eliminating emotional and behavior problems and accelerating development.Recent studies indicate that only 50 per cent of cerebral palsy patients have normal or better intelligence.Subluxation of the hip joint, a common deformity associated with cerebral palsy, can sometimes be corrected by operation if detected at an early stage. Radical ablation of epileptogenic foci in the cortex is also being done in young patients if drug control of seizures fails. Frontal topectomy, cingulate gyrectomy or prefrontal labotomy may be advisable in cases in which proper response to drug therapy is not obtained.Improvement in behavior as well as control of seizures may follow the use of Benzedrine,® Dexedrine,® Dilantin® sodium, Mebaral® and phenobarbital. Alcohol, paraldehyde and chloral hydrate have been effective as relaxants.     

Nutritional biology: a neglected basic discipline of nutritional science

On the basis of a scientific-philosophical analysis, this paper tries to show that the approaches in current nutritional science—including its subdisciplines which focus on molecular aspects—are predominantly application-oriented. This becomes particularly evident through a number of conceptual problems characterized by the triad of ‘dearth of theoretical foundation,’ ‘particularist research questions,’ and ‘reductionist understanding of nutrition.’ The thesis presented here is that an interpretive framework based on nutritional biology is able to shed constructive light on the fundamental problems of nutritional science. In this context, the establishment of ‘nutritional biology’ as a basic discipline in research and education would be a first step toward recognizing the phenomenon of ‘nutrition’ as an oecic process as a special case of an organism–environment interaction. Modern nutritional science should be substantively grounded on ecological—and therefore systems biology as well as organismic—principles. The aim of nutritional biology, then, should be to develop near-universal ‘law statements’ in nutritional science—a task which presents a major challenge for the current science system.     

Recovery of kidney function after dialysis initiation in children and adults in the US: A retrospective study of United States Renal Data System data

BackgroundLittle is known about factors associated with recovery of kidney function—and return to dialysis independence—or temporal trends in recovery after starting outpatient dialysis in the United States. Understanding the characteristics of individuals who may have the potential to recover kidney function may promote better recognition of such events. The goal of this study was to determine factors associated with recovery of kidney function in children compared with adults starting dialysis in the US.Methods and findingsWe determined factors associated with recovery of kidney function—defined as survival and discontinuation of dialysis for ≥90-day period—in children versus adults who started maintenance dialysis between 1996 and 2015 according to the United States Renal Data System (USRDS) followed through 2016 in a retrospective cohort study. We also examined temporal trends in recovery rates over the last 2 decades in this cohort. Among 1,968,253 individuals included for study, the mean age was 62.6 ± 15.8 years, and 44% were female. Overall, 4% of adults (83,302/1,953,881) and 4% of children (547/14,372) starting dialysis in the outpatient setting recovered kidney function within 1 year. Among those who recovered, the median time to recovery was 73 days (interquartile range [IQR] 43–131) in adults and 100 days (IQR 56–189) in children. Accounting for the competing risk of death, children were less likely to recover kidney function compared with adults (sub-hazard ratio [sub-HR] 0.81; 95% CI 0.74–0.89, p-value <0.001; point estimates <1 indicating increased risk for a negative outcome). Non-Hispanic black (NHB) adults were less likely to recover compared with non-Hispanic white (NHW) adults, but these racial differences were not observed in children. Of note, a steady increase in the incidence of recovery of kidney function was noted initially in adults and children between 1996 and 2010, but this trend declined thereafter. The diagnoses associated with the highest recovery rates of recovery were acute tubular necrosis (ATN) and acute interstitial nephritis (AIN) in both adults and children, where 25%–40% of patients recovered kidney function depending on the calendar year of dialysis initiation. Limitations to our study include the potential for residual confounding to be present given the observational nature of our data.ConclusionsIn this study, we observed that discontinuation of outpatient dialysis due to recovery occurred in 4% of patients with end-stage kidney disease (ESKD) and was more common among those with ATN or AIN as the cause of their kidney disease. While recovery rates rose initially, they declined starting in 2010. Additional studies are needed to understand how to best recognize and promote recovery in patients whose potential to discontinue dialysis is high in the outpatient setting.

In a retrospective study, Elaine Ku and colleagues investigate factors associated with recovery of kidney function among adults and children receiving dialysis reported in the United States Renal Data System.     

The Impact of Food and Nutrient-Based Standards on Primary School Children’s Lunch and Total Dietary Intake: A Natural Experimental Evaluation of Government Policy in England

In 2005, the nutritional content of children’s school lunches in England was widely criticised, leading to a major policy change in 2006. Food and nutrient-based standards were reintroduced requiring primary schools to comply by September 2008. We aimed to determine the effect of the policy on the nutritional content at lunchtime and in children’s total diet. We undertook a natural experimental evaluation, analysing data from cross-sectional surveys in 12 primary schools in North East England, pre and post policy. Dietary data were collected on four consecutive days from children aged 4–7 years (n = 385 in 2003–4; n = 632 in 2008–9). We used linear mixed effect models to analyse the effects of gender, year, and lunch type on children’s mean total daily intake. Both pre- and post-implementation, children who ate a school lunch consumed less sodium (mean change −128 mg, 95% CI: −183 to −73 mg) in their total diet than children eating home-packed lunches. Post-implementation, children eating school lunches consumed a lower % energy from fat (−1.8%, −2.8 to −0.9) and saturated fat (−1.0%; −1.6 to −0.5) than children eating packed lunches. Children eating school lunches post implementation consumed significantly more carbohydrate (16.4 g, 5.3 to 27.6), protein (3.6 g, 1.1 to 6.0), non-starch polysaccharides (1.5 g, 0.5 to 1.9), vitamin C (0.7 mg, 0.6 to 0.8), and folate (12.3 µg, 9.7 to 20.4) in their total diet than children eating packed lunches. Implementation of school food policy standards was associated with significant improvements in the nutritional content of school lunches; this was reflected in children’s total diet. School food- and nutrient-based standards can play an important role in promoting dietary health and may contribute to tackling childhood obesity. Similar policy measures should be considered for other environments influencing children’s diet.     

Pathogenesis of Cardiac Oedema

When the heart ceases to meet the requirements of the body for oxygen, the sympathetic-adrenal system is activated. This occurs in people with a healthy heart when the demands for oxygen are excessive—for example, in heavy muscular work—and in subjects with a failing heart when the demands are normal or small. Eventually, when the heart is unable to meet even the ordinary requirements of everyday life, the sympathetic activity becomes more or less continuous. It may lessen during rest at night, but with a further failing of the heart its output may become inadequate even in complete rest.The sympathetically-medicated renal vasoconstriction, with reduction of the glomerular sodium load, redistribution of the blood flow in the renal cortex to the juxtamedullary glomeruli, and the mobilization of the renin-angiotensin-aldosterone system, is responsible for the salt and water retention which will ultimately become clinically manifest as oedema—especially when it is no longer counteracted by the tidal output of water and sodium at night. A by-product of this continuing dehydration reaction is a cumulative potassium loss which may lead to disastrous consequences if untreated.