Recognition, evaluation, and treatment of anaphylaxis in the child care setting.

BACKGROUND: Anaphylaxis can occur anywhere. Many young children with a history of allergic reactions or anaphylaxis spend considerable time in child care centers. However, little is known about the centers' knowledge of, experience with, and capability to manage anaphylaxis. OBJECTIVE: To evaluate the ability of child care centers to recognize, evaluate, and treat anaphylactic episodes in children aged 1 to 6 years. METHODS: Eighty-five child care centers in the suburbs of Chicago were randomly selected. They were contacted by telephone and asked to participate in a study by completing an initial questionnaire. Center directors and teachers were then offered an allergy seminar addressing anaphylaxis avoidance, recognition, evaluation, and treatment. Center directors completed a questionnaire after the seminar. RESULTS: Forty-four of the 85 centers contacted agreed to participate. Forty-two surveys were completed before the seminar and 39 after the seminar. On average, each center has up to 7 children with an identifiable food allergy. Information provided by the parents was the most commonly reported source of education concerning allergies. Before seminar completion, only 24% of child care centers would administer intramuscular epinephrine for a severe allergic reaction. After the seminar, 77% of centers stated that they would administer intramuscular epinephrine (P < .001). Also, center staff significantly improved their knowledge of typical allergy symptoms and of the correct method of intramuscular epinephrine administration. CONCLUSIONS: There is a need for greater anaphylaxis education among child care providers. Our intervention significantly increased the ability of child care staff to recognize, evaluate, and treat anaphylaxis.     

Emotional availability, attachment, and intervention in center-based child care for infants and toddlers

According to data from the 1997 NICHD Study of Child Care, center-based child care can have deleterious effects on children's social-emotional development. We hypothesized that training child care professionals to develop positive relationships with children in their care would improve the quality of center-based child care. Thirty-three professional caregiver-child pairs participated in the intervention group and 24 professional caregiver-child pairs were assigned to a care as usual comparison group. The intervention consisted of an informational and a practice component with an emotional availability (EA) coach. The infants and toddlers (ages 11 to 23 months) in the classrooms were enrolled in the project only if they spent at least 20 hr per week in center-based care. The measures included were (a) the EA Scales, (b) the Attachment Q-Sort, and (c) the Classroom Interaction Scale. The intervention group professional caregiver-child relationships showed improvements on the EA Scales, Attachment Q-Sort, and the Classroom Interaction Scale from pre- to posttest, compared to the comparison group, who showed some decrements over a comparable period of time.     

妇婴保健与儿童发展

本文介绍了上海市第一妇婴保健院近20年来为提高出生人口素质方面所进行的工作。在孕产期保健方面,重点讲述了胎教、导乐陪伴分娩、孕产妇的健康教育、母婴健康促进中心等的进展:在新生儿保健方面重点讲述了新生儿窒息复苏、母乳喂养、早产儿医疗护理、宣传教育和资料的制作等方面的创建与成绩。这些工作不但取得了明显的成果,能为儿童健康发展打下良好的基础;而且在推动全市及全国相关工作的开展上,都起到重要作用。     

Developmental and paediatric care of the pre-school child

Through an Upjohn Travelling Fellowship I visited 27 experts in childcare and sought their opinions on the privileges, possibilities, and problems in organising developmental and paediatric care for pre-school children in the United Kingdom.

The role of the general practitioner was seen by many of the experts clearly. How he is to play it is shrouded in uncertainty. Research is urgently needed both on the tools of surveillance and on the different methods of arranging care.

     

Day care management of severe ovarian hyperstimulation syndrome avoids hospitalization and morbidity

Severe ovarian hyperstimulation syndrome (OHSS) is a dreadedcomplication of ovulation mductlon for assisted reproductiontreatment. In the past, conservative management has been recommendedand this leads to prolonged hospitalization. A total of 18 patientswho developed severe OHSS were managed according to two protocols.The first group (n=8) was managed conservatively with hospitalization,i.v. hydration and supportive therapy. The average durationof hospitalization was 11 days and the patients were uncomfortablethroughout. A second group (n=10) was managed on an out-patientbasis with early, ultrasound-guided trans-abdominal paracentesis.While the patient was hydrated intravenously, 1–3 I offluid were removed over 2–3 h. The duration of hospitalizationwas between 6 and 7 h and no in-patient stay was required. Promptrelief of symptoms was reported and none of the patients requiredre-tapping. Pregnancy was achieved in 68% of all patients. Daycare management with easy abdominal paracentesis was found tobe simple, safe and effective; patients found it more acceptableas it avoided in-patient hospitalization.     

Day hospital and residential addiction treatment: randomized and nonrandomized managed care clients

Male and female managed care clients randomized to day hospital (n=154) or community residential treatment (n=139) were compared on substance use outcomes at 6 and 12 months. To address possible bias in naturalistic studies, outcomes were also examined for clients who self-selected day hospital (n=321) and for clients excluded from randomization and directed to residential treatment because of high environmental risk (n=82). American Society of Addiction Medicine criteria defined study and randomization eligibility. More than 50% of followed clients reported past-30-day abstinence at follow-ups (unadjusted rates, not significant between groups). Despite differing baseline severities, randomized, self-selecting, and directed clients displayed similar abstinence outcomes in multivariate longitudinal models. Index treatment days and 12-step attendance were associated with abstinence (p<.001). Other prognostic effects (including gender and ethnicity) were not significant predictors of differences in outcomes for clients in the treatment modalities. Although 12-step attendance continued to be important for the full 12 months, treatment beyond the index stay was not, suggesting an advantage for engaging clients in treatment initially and promoting 12-step attendance for at least a year.