A developmental framework for memory rehabilitation in children

Memory difficulties in adults with acquired brain injuries have been reported in the literature for some time. In recent years, the consequences of memory difficulties from acquired and neurodevelopmental disorders in children have also been investigated. Initial studies have suggested that, like adults, children can experience severe and specific memory deficits. However, there are important developmental differences, both in terms of the nature of cognitive difficulties experienced, and the subsequent consequences for learning, educational attainment and everyday living. Despite the advances made in developmental memory studies, as yet, there appears to be scant literature to guide effective rehabilitation specifically targeted at children. As a starting point, it may be appropriate to consider adaptation of adult rehabilitation strategies to address memory problems in children. This paper describes some of the common principles and practices of adult rehabilitation strategies and then considers the validity of such strategies against developmental models of the memory system and child's learning environment. In particular, four important areas are highlighted: the development of normal memory functions in children, the range of cognitive deficits that can occur in a developing brain, the interaction of memory deficits with other immature cognitive skills and the context of the psycho-social environment in which rehabilitation may take place.     

A staged plan for laboratory diagnosis of hereditary metabolic diseases

When clinical evidence provides grounds for suspecting inborn errors of metabolism it is urgent to perform the necessary, relevant, specific laboratory investigations in good time and with a view to quality. Normally, the realization depends on individual initiatives and the use of laboratories mainly designed for pediatrics and human genetics. Consequently the results are equally a matter of chance. Nothing in this situation can be changed in principle by using the catalogue of services of the Society for Human Genetics of the GDR. Central administrative provisions are necessary to improve the present unsatisfactory situation. Proposals for regulations, division of responsibility and a graduated programme of parameters are discussed here with a view to establishing uniform procedures.     

A health plan to reduce poverty

Noting that the failures of the U.S. health care system are compounding the problems faced by low-income Americans, Alan Weil argues that any strategy to reduce poverty must provide access to health care for all low-income families. Although nearly all children in families with incomes under 200 percent of poverty are eligible for either Medicaid or the State Children's Health Insurance Program (SCHIP), the parents of poor children often lack health insurance. Parents who leave welfare normally get a year of coverage but then lose coverage unless their employer provides it, and many employers of low-wage workers do not offer health insurance. Similarly, parents who take low-paying jobs to avoid welfare usually have no coverage at all. This lack of coverage discourages adults from working and may also affect the health of children because adults without health insurance are less likely to take their children for preventive care. Weil proposes creating a federal earned income health credit (EIHC) and redefining the federal floor of coverage through Medicaid and SCHIP. His aim is to make health insurance affordable for low-income families and to make sure enough options are available that individuals and families can get coverage using a combination of their own, their employer's, and public resources. Weil would expand Medicaid eligibility to include all families whose income falls below the poverty line. The EIHC would be a refundable tax credit that would be available to parents during the year in advance of filing a tax return. The credit, which would be based on taxpayer earnings and family structure, would phase in as earnings increase, reach a plateau, and then phase out farther up the income scale. The credit would be larger for families with dependents. The EIHC would function seamlessly with the employee payroll withholding system. It would be available only to adults who demonstrate that they had health insurance coverage during the year and, for adults with children, only if their eligible dependent children were enrolled in either a private or public insurance program. Weil's proposal would cover individuals who receive coverage from their employer and those who do not. The proposal smooths transitions from public to private coverage, and it anticipates a substantial role for states. Weil estimates that his policy would cost about $45 billion a year.     

链球菌感染后风湿热和风湿性心脏病

风湿热(rheumatic fever)是儿童上呼吸道或皮肤等感染A族链球菌(group A streptococcus,GAS)后引起的一种自身免疫性疾病。在结缔组织有多发的非化脓性病变,主要累及心脏和关节,脑、皮肤、粘膜、血管、肺、肾等亦可受累,而心脏为本病唯一留有后遗症的器官,可导致永久性瓣膜损害、心力衰竭,甚至死亡。一、流行病学风湿热初次发病以儿童和青少年为多见,4岁前及25～30岁以后发病者少见,女性发病似较男性多见。在发达国家风湿热和风湿性心脏病的发病率已大幅下降,在发展中国家仍居高不下。近几十年来,国外报告GAS感染激增,我国也有明显的上…     

A case of acute rheumatic carditis with heart-block

Conclusion A case of rheumatic carditis has been studied in detail. The occurrence of heart-block has been demonstrated. This was scarcely suspected in a clinical examination. A slow pulse rate in the presence of a grave general condition was all that could suggest a heart-block. Electrocardiographical examinations revealed the true nature of the case. This sign should in any case be borne in mind in cases of rheumatic infection. A close follow-up of the case in all details shows that the block may be essentially a feature of rheumatic infection. Therapeutic measures to control the block and the progress of the disease have been depicted in charts and curves. The importance and value of adjuvant treatment of the associated blood condition with liver extract preparation has been pointed out. From the Carmich?l Medical College Hospitals, Calcutta.