Secular trends in fatal and disabling child trauma

Abstract Types and rates of childhood accidents are constantly varying. From the point of view of the potential child victim, the danger-safety equilibrium is disturbed by changes in lifestyles, availability of new consumer goods, and changes in social order. Balance is achieved by the implementation of preventive measures, particularly safety legislation. 'Old' hazards affecting children in pre-industrial societies can re-emerge at any time as wealthy sophisticated societies aspire to recapture the delights of open space, the water, and 'country-style' living. Age-specific fatal accident rates are given for Australian children for the period 1960–1982. Whereas the total child (1–14 y) death rate has fallen from 159 per 100 000 (in 1960) to 86 (in 1982), road traffic deaths have risen from 8.3–11.7 (1–4 year olds) and have remained static (8.3–8.9) for 5–14 year old children. Drowning in older children has been reduced, but drownings among toddlers are still high (9.2 in 1960; 11.7 in 1982). The causes of secular trends, and factors which are known to influence these, are discussed.     

Medication compliance in children with asthma

A questionnaire to assess compliance with prescribed therapy was completed by 200 children with asthma. The validity of the questionnaire was assessed objectively by measuring plasma theophylline concentrations in 37 subjects and by weighing metered dose aerosol canisters before and after use in 19 subjects. The average compliance was 67.9%. The close agreement between answers to the questionnaire and the objective measurements of compliance indicated that most participants recalled the drug regimens accurately. Good compliance was related to whether Australia was the parents' country of origin, to knowledge of the disorder and to comprehension of medication but was not related to perception of the severity of the illness. This study demonstrates that compliance is relatively poor even in a clinic population which attends regularly and appears well-motivated.     

Jaundice: a 10 year review of 41,000 live born infants

ABSTRACT. A review is presented of jaundiced newborn infants during the 10-year period to 1980. Included are those whose serum bilirubin level was 154 μmol/l or more. Of 41,057 live births, 4,406 (10.7%) infants had hyperbilirubinaemia. The most common (19.9;%) aetiological factor was prematurity, followed by ABO erythroblastosis 7.1%; sepsis 3.4%; Rhesus erythroblastosis 2.7%; bruising 2.2%; multifactorial 1.0% and glucose-6-phosphate dehydrogenase deficiency 0.5%. Treatment was not undertaken in 2,855 (64.7%) infants, but 1,419 (32.2%) received phototherapy alone, 122 (2.7%) infants received both exchange transfusion and phototherapy and 10 (0.2%) infants received exchange transfusion alone. Of the infants requiring exchange transfusion 50.0% had Rhesus erythroblastosis, 28.0% ABO erythroblastosis, 10.6% jaundice of prematurity and the remainder were due to a variety of causes. Sixty-three (1.4%) infants died, with two deaths being related to the hyperbilirubinaemia, as their death was due to necrotizing enterocolitis following exchange transfusion. Phototherapy proved safe with no deaths directly attributable to its use.     

TREATMENT OF CYSTINOSIS WITH A DIET POOR IN CYSTINE AND METHIONINE

Two siblings with cystinosis are presented. Case 1, a 16-month-old boy, presented with a severe renal tubular insufficiency. Case 2, a 7-year-old girl, was a dwarf with both glomerular and tubular renal insufficiency. Case 1 was initially treated with high doses of vitamin D₂ and electrolyte supplements for more than 2 months without significant alteration of the condition. Thereafter he was treated for 23 days with 150 mg penicillamine per day again without any significant clinical or biochemical improvement. Both patients were then followed through 1 year on treatment with a diet poor in cystine and methionine supplemented with cholinechloride, an anabolic steroid, high doses of vitamin D₂, electrolytes, oral iron and a combined vitamin preparation. After some time there was considerable difficulty in giving the patients sufficient amounts of the diet, consequently the diet had to be modified with supplement of cow's milk. On this treatment case 1 attained a distinct clinical improvement with healed rickets and normal growth. There was no evidence of mobilisation of the stored cystine. Case 2 obtained a healing of the rickets and some gain in height during the treatment, but otherwise the general condition was unaltered, and she continued to have increasing renal glomerular insufficiency.     

Self-mutilation in female remanded prisoners II: A cluster analytic approach towards identification of a behavioural syndrome

Cluster analysis of phenomenological variables and the associated symptom profile of self-mutilation in 74 female prisoners identified a subgroup with a disorder of mood who injured themselves as a symptom-relieving mechanism and received a diagnosis of borderline personality disorder (BPD). Marked differences were found between the women in this cluster in the form of their behaviour and on a range of different variables compared with a second, more heterogeneous, cluster who had injured themselves as a reaction to life-events, psychotic illness, or in a suicide attempt. The relevance of a symptom-relieving mechanism to research into self-mutilation and BPD is discussed. It is proposed that future research should concentrate on the ‘affective instability’ component of BPD and the affective symptoms reported by subjects with this diagnosis prior to impulsive behaviours such as self-mutilation.     

Managing difficult behaviour in a long-term prison

Use of the term psychopathic disorder, or some related diagnostic concept, is avoided in this paper, as it is written from the perspective of a prison governor who has to manage difficult behaviour in a long-term prison. The context in which difficult behaviour is handled is vital, and this paper addresses some of the management aspects of the issues raised in the previous paper. It determines the nature of the behaviour and the options for responding to it: difficult behaviours rather than difficult individuals are the chief focus. The formal options for managers in the Prison Service are not always as effective as the informal controls exercised by staff and prisoners: indeed, the formal sanctions tend to be punitive in practice if not in theory. The special units in prisons have tried to develop a response which is therapeutic, not punitive. Access to these units is not easy and they have not been used by the Prison Service as much as was expected when they were set up. The special hospitals provide another opportunity to break the cycle of punishment and I believe there is a case for close cooperation between at least one special hospital and at least one unit as a half-way house facilitating the change of role from prisoner to patient and back to prisoner in a way that is helpful to the individual.     

ICD Data Storage: Value in Arrhythmia Management

Sophisticated diagnos tic information is provided by the latest generation of implantable defibriliators. The success of therapy and the type of therapy successful in terminating ventricular arrhythmias is provided by interrogating the ICD device. In addition, R to R interval information can be retrieved. In selected devices, either locai bipolar electrograms from the rate sensing leads or wide bipolar electrograms from the energy delivering leads provide visual confirmation of the presence of ventricular tachyarrhythmic events loading to ther apy. The value and limilations of this sophisticated diagnostic information in providing insight into the electrical events triggering therapy and the events triggering ventricular arrhythmias are discussed.