The adoption of foreign children

Over the last twenty years, adoptions of foreign children have increased considerably, even as the number of French children eligible for adoption has fallen. Most adopted foreign children come from South America, India and the Far East, which are all socioeconomically underprivileged areas. Private Agencies for Adoption in foreign countries and Adoptive Family Organizations play a beneficial role. The adoption process is complex and varies from country to country, raising considerable difficulties for the adoptive parents. The child's foreign origin may compound the relational problems that can arise in any adoption. Considerable efforts have been made to provide adoptive parents with the necessary information and support. The outcome of foreign adoptions depends largely on these efforts, that must therefore be intensified.     

Predicting adoption of home smoking restriction by inner-city black smokers

OBJECTIVE: To identify predictors of future adoption of home smoking restriction (HSR), given that 40% of inner-city smokers report current HSR. DESIGN: Secondary analysis of data on smokers enrolled in a double-blind, placebo-controlled, randomized trial of bupropion hydrochloride for smoking cessation. SETTING: Community health center in Kansas City, Kan, from August 1, 2000, to December 31, 2001. PARTICIPANTS: Six hundred eligible black smokers, at least 18 years old, who smoked at least 10 cigarettes per day and were interested in quitting within the next 30 days. Enrollment was limited to 1 smoker per household. MAIN OUTCOME MEASURES: Adoption of HSR by 6 months by those who did not have it at baseline.Result Baseline HSR was reported by 36% of all smokers. Of 383 smokers without baseline HSR, 311 smokers had complete baseline and 6-month data. Thirty-seven percent of households without HSR at baseline had adopted HSR by 6 months. Adoption was associated with a nonsmoking adult or children in the home, progress in stage of change, and smoking cessation. Odds of adopting HSR increased with progress in stage of change (odds ratio [OR], 4.20), baseline preparatory stage of change (OR, 3.28), and having a nonsmoking partner (OR, 2.35) or children (OR, 1.75) in the home. CONCLUSIONS: A smoker's motivation to quit and the presence in the home of a nonsmoking adult or of children predict adoption of HSR by inner-city black smokers. Therefore, health professionals should motivate the smoker toward HSR and the nonsmoking partner toward advocating home smoking bans, thereby eliminating environmental tobacco smoke in the home.     

Exercise electrocardiography of health black children

Exercise electrocardiography was performed on 170 healthy black children 7 to 14 years of age in order to determine the normal childhood electrocardiographic response to exercise. R-wave amplitude decreased from 27 +/- 8 (SD) to 22 +/- 8 mm (P less than .01) and the S-wave amplitude increased from 6.9 +/- 4.4 to 7.8 +/- 5 mm (P less than .01), indicating a shift of the mean QRS vector to the right at maximum exercise. J-point depression of 1.0 mm or greater was observed in 2.3% of children at maximum exercise, using the PR isoelectric line. ST-segment slope increased from 1.5 +/- 0.7 to 4.3 +/- 1.5 mV/sec at maximum. T-wave duration decreased with exercise and T-wave amplitude initially decreased with mild exercise but exceeded resting values at maximum exercise. No dysrhythmias were observed during or after the exercise study.     

When children cannot return home: adoption and guardianship

Since the 1970s, finding alternative permanent families for children in foster care who could not return to their birth parents has been a primary goal of the child welfare system. Since that time, significant gains have been made in helping such children find permanent homes through adoption and guardianship. This article analyzes these trends and finds: A majority of states have doubled the number of adoptions from foster care over the 1995-97 baselines established by the federal government. Legal guardianship initiatives at the state level have been instrumental in helping thousands of children achieve permanence. Children who exit foster care to adoption tend to be younger than those who exit to guardianship. Postpermanency services and supports are important to the long-term success of these placements. Innovative efforts to find adoptive parents and legal guardians for children in foster care could transform the nature of foster care if the number of children permanently living with families who receive state subsidies begins to exceed the number of children living in foster care. Looking forward, these changes would require child welfare agencies to think creatively and thoughtfully about how best to serve families and the children in their care.     

Pneumococcal bacteraemia--a study of 75 black children

Seventy-five black children from 0 to ten years old with pneumococcal bacteraemia, who were hospitalized during a one-year period, were studied retrospectively from case records. Half the children were under one year and 68% under two years of age. Sixty-seven per cent were malnourished, 34% severely so. The overall case-fatality-rate was 26.7% being highest in children presenting in autumn (52.4%) and in those with meningitis (54.5%), severe protein-calorie malnutrition (42.8%) or associated infections (61.5%). Host defences against the pneumococcus are discussed, especially in relation to their deficiencies in malnourished and young children. Special mention is made of early-onset neonatal sepsis due to the pneumococcus and of the association between pneumococcal bacteraemia and acute post-streptococcal glomerulonephritis. This study indicates that pneumococcal bacteraemia is a serious infection in children, especially in those with malnutrition and other infections. In view of the emergence of penicillin-resistant strains, its treatment may become more difficult in the future.     

Trauma among children and parents within the context of international adoption

Although the large majority of international adoptions are problem free, some of them involve a certain degree of suffering as much for the children as for the adoptive parents. These stumbling blocks in the relationship need to be studied taking into account the trauma experienced by each of the protagonists.     

Blood pressure studies in black children.

Blood pressure measurements were obtained under office conditions by auscultatory method, using appropriate cuff sizes, in 1,668 healthy black children (827 boys and 841 girls) ranging in age from 4 to 17 years. We found no significant difference between the mean systolic blood pressure of black children in our study and that of whites as reported in the literature. However, mean diastolic blood pressure was lower in black children. Some black children (3.6%) were found to have blood pressure more than 2 standard deviations above the mean for their age and should be closely observed for developing hypertensive cardiovascular changes.     

Extramembranous nephropathy in black South African children

Membranous nephropathy is the most frequent histological category among black children with nephrotic syndrome. In this study 31 African children with this condition are described. There were more boys than girls and the peak age was four to 11 years. The incidence of this histological category and clinical outcome in the African children were similar to these features in adults with membranous nephropathy. During a follow-up period of up to six years there was spontaneous remission in a third of patients, persistent proteinuria in just over a third (37.5%) and persistent relapse in under a third (29.2%). Hypertension occurred more frequently (19.3%) and spontaneous remission less often (33.3%) than in children with membranous nephropathy elsewhere. Hypertension, the lower remission rate and persistence of proteinuria during the course of the disease were similar to the disease seen in adults. Renal failure was not encountered in any patients. Steroids were of little value in the treatment of these children. Five children (16.2%) had associated infections. HBsAg was present in three of six children tested.     

Nosocomial infections in black South African children

Nosocomial infections in infants and children were prospectively studied in the general wards of a hospital serving a developing community. Of 1350 admissions in 5 months, 193 (14.3%) developed 302 infections (22.4/100 admissions). The major risk factors were malnutrition, age less than 2 years and prolonged hospitalization. The most common sites of infection were the lower respiratory and gastrointestinal tracts. The most frequently isolated organisms were Staphylococcus aureus and Klebsiella species and the site of most frequent isolation was the lower respiratory tract for which the method most commonly used was endotracheal aspiration. Seventy percent of isolates were resistant in vitro to conventional antibiotics. Thirty-one percent of infections developed while the patient was awaiting a diagnostic procedure or waiting to be sent home. During the study period 60 patients (4.4% of admissions) were admitted with a nosocomial infection acquired elsewhere (31 at this hospital and 29 from other hospitals). Measles and its complications accounted for 28 of these cases and 7 deaths. This study provides information on nosocomial infections in children from a developing community.     

Prognosis of black children with acute lymphocytic leukemia

To assess the racial differences in survival of children with acute lymphocytic leukemia, we analyzed data for 1,675 white and 126 black children, diagnosed from 1955 to 1969. Blacks had a significantly shorter median survival and lower one-year and three-year survival rates than whites. There was substantial variation in racial differences by age. In addition, much of the variation between races seemed to be due to socioeconomic factors rather than strictly racial ones. Identification of the specific factors responsible for the poorer survival of children from lower social classes is sorely needed.