Short stay facilities: the future of efficient paediatric emergency services

OBJECTIVE: To assess the reactions of parents and their children to the request for a blood sample and an attempt to take blood. METHODS: 1859 children aged 1.5-4.5 years took part in a national survey of diet and nutrition. A retrospective inquiry of the parents' and children's reported reactions was carried out six to 18 months later by postal questionnaire sent only to the 1157 who had given consent for an attempt to take blood. RESULTS: 866 questionnaires were returned; 790 were from parents of children in whom an attempt to take blood had been successful. Thirteen per cent said that their child had given blood previously. About 30% discussed the request with the family doctor or nurse. Some 90% said that they were given enough information and that the phlebotomist was sympathetic. Attempting to take blood caused upset in over 50%, which, in most, lasted for less than five minutes. A substantial minority were upset for up to 30 minutes and a few much longer. Bruising or bleeding occurred in 20-27%. Degree and duration of upset were both adversely associated with a failed attempt to obtain blood. CONCLUSION: The majority of preschool children experienced no more than a little upset of short duration after an attempt to take blood, but a substantial minority exhibited a greater degree of upset. These responses should be taken into account when assessing the benefits and risks of the procedure. The best equipment and expertise should be employed for taking blood as successful attempts are less upsetting.     

Nutritional factors and thalassaemia major

Abnormal growth is a common feature of thalassaemia major in children. In an attempt to determine whether it has a nutritional cause, 12 children aged 1 to 3 years with thalassaemia major were studied under metabolic ward conditions. Nutritional status was assessed by anthropometry and biochemistry before and after an intensive nutrition regimen. Five children had wasting or stunting on admission. As a result of the nutrition intervention, mean weight for height improved significantly. The mean height increase of 0.4 cm after one month was not significant. Plasma zinc, depressed in half the children on admission, improved, as did alpha tocopherol, while copper decreased. Plasma insulin-like growth factor-I also increased commensurate with improved growth. Fat absorption was normal in all children. Undernutrition is an important cause of associated growth disturbances in children with thalassaemia major. Malnutrition was primarily caused by inadequate nutrient intake, as indicated by the capacity to gain weight appropriately when provided with nutrition support, and by the absence of intestinal malabsorption. While long term studies are required to determine if nutritional support will prevent stunting, these results underscore its central role in preventing nutritional deficiencies and in promoting normal growth in thalassaemic children.     

The descriptive epidemiology of pharyngeal cancer in Scotland

There have been recent reports of substantial increases occurring in the incidence of and/or mortality from tongue and mouth cancers in several countries. In this paper using data from Scotland (1960–89) we report on time trends in pharyngeal cancer. Similar increases in rates are evident for cancers of the oropharynx and hypopharynx while there has been little change in the occurrence of nasopharyngeal cancer (which has distinct aetiological factors). It therefore seems that reported changes in the incidence of and mortality from oral cancer may be real, and in Scotland, this is most probably due to changes in alcohol consumption.Corresponding author.     

Daily mortality and environment in English conurbations. Air pollution, low temperature, and influenza in Greater London.

With the decline in concentrations of suspended particulate pollution in Greater London the association seen in the 1950s and early 1960s between daily mortality and air pollution in the conurbation is no longer apparent. Associations between unusually cold weather and short-term increases in mortality have been noted; there appears to be a tendency for influenza epidemics to follow cold spells.     

THe changing seasonality of infant deaths in England and Wales 1912-78 and its relation to seasonal temperature.

Seasonal variation in the rates of stillbirth, and of deaths under the age of one year, were studied for England and Wales in order to examine (a) changes in the seasonal variation over the years and (b) the correlation between seasonal rates and seasonal temperatures. The quarterly rates of stillbirths were studied for the period 1928-78; and of deaths under the age of one year, in six different age groups, for the period 1912-78. A disappearance of seasonal variation in rates ('deseasonality') occurrred from stillbirths in about 1950, and for neonatal deaths in about 1965. For deaths at 1-2 months a trend towards deseasonality has been apparent since 1955, but there has been no such trends for deaths at 3-11 months of age. In the period before deseasonality, and for the first quarter of the year, there was a high negative correlation between the neonatal death rate and the mean temperature in England and Wales but this correlation fell as the seasonal variation in rates fell. The findings suggest that seasonal variation in the neonatal death rate was closely related to winter temperatures during the period 1921-60. For deaths at 1-11 months old, there has been and still is a relation between temperature and seasonal variation in rates, but the relation was less close than for the neonatal death rate.