Immunity to hepatitis B, poliomyelitis and measles in fully vaccinated Aboriginal and Torres Strait Island children

Objective: To determine the immunity to hepatitis B, poliomyelitis and measles in fully vaccinated Aboriginal and Torres Strait Island children in north Queensland.
Methodology: A cross-sectional survey of immunity in a sample of children; 101 fully vaccinated Aboriginal and Torres Strait Island children, with a median age of 24.5 months, from 10 communities in North Queensland participated in this study. The main outcome measures were the prevalence of adequate antibody levels against hepatitis B, poliomyelitis and measles.
Results: Only 54% (95% Cl 44–63%) of the children had adequate immunity (10 m iu/mL) to hepatitis B, and one child had been infected despite vaccination. Although all the children (95% Cl 96–100%) had adequate immunity (i.e. neutralizing antibodies at a dilution of 1:8) to poliovirus 2, only 93% (95% Cl 86–96%) and 60% (95% Cl 50–69%) had adequate immunity to polioviruses 1 and 3, respectively. Nearly all (96%; 95% Cl 90–98%) of the children had adequate immunity (i.e. detectable IgG antibody) to measles.
Conclusions: Although a relatively low proportion of the children had adequate antibody levels against hepatitis B the clinical significance of this observation is uncertain. Further studies are needed to determine whether fully vaccinated Torres Strait Island children have been adequately protected and whether they require a booster dose of hepatitis B vaccine. A substantial proportion of fully vaccinated Aboriginal and Torres Strait Island children are inadequately protected against poliomyelitis, and therefore any such child with acute flaccid paralysis should be investigated fully for poliomyelitis. Vaccinated Aboriginal and Torres Strait Island children are well protected against measles, as are other Australian children.     

Intellectual function and age of repair in cyanotic congenital heart disease.

Eighty one children, comprising 51 with tetralogy of Fallot and 30 children with transposition of the great arteries (TGA) were assessed using the Wechsler intelligence scale for children--revised, and a battery of neuropsychological measures. They were compared with a group of 33 children who had surgery for ventricular septal defect. All children were aged over 10 years when reviewed and were in good health, attending normal schools. No significant negative correlation was found between any component or subtest of the IQ scores and operating age. There was no evidence of a detrimental effect of older age at operation in the children who had cyanotic heart disease as assessed by neuropsychological measures. Delaying surgery for children with TGA or tetralogy of Fallot does not appear to adversely affect their intellectual development. This finding may provide reassurance in cases where surgery has to be delayed for medical, social, or economic reasons.     

Stress and mental health in neonatal intensive care units.

The views of 34 neonatologists (a 78% response rate) and 192 neonatal intensive care nurses (a 66% response rate) were obtained on work, stress, and relationships in neonatal intensive care units. The survey was conducted by post and included Goldberg''s General Health Questionnaire (GHQ). A comparison of the responses of neonatologists and nurses to 21 identical statements showed significant differences in 12. Most neonatologists felt that they involved nurses in critical patient care decisions, provided adequate pain relief for their patients, gave nurses adequate information on patients'' progress after discharge, and were aware of little doctor-nurse conflict. However, the nurses'' responses differed significantly in these areas, suggesting that the neonatologists may have a more rosy view of life in the neonatal intensive care unit than their nurse colleagues. Twenty seven per cent of neonatologists and 32% of nurses had GHQ scores indicating psychological dysfunction. The neonatologists who had dysfunctional scores differed from their colleagues in only one area surveyed--a higher proportion experienced conflict between the demands of their work and their personal lives.     

Magnetic resonance angiography findings in the early post-carotid endarterectomy period

This preliminary study was designed to investigate the ability of multiple axial volume three-dimensional fourier transform (3DFT) time-of-flight (TOF) magnetic resonance angiography (MRA) to depict the carotid bifurcation in the early post-carotid endarterectomy period. Five patients underwent intra-operative digital subtraction angiography (DSA) and carotid MRA within 5 days of carotid endarterectomy. An axial volume fast imaging in steady-state precession (FISP) gradient-echo 3DFT TOF carotid MRA technique in this limited series appeared to display accurately the surgically significant abnormalities at the carotid bifurcation after endarterectomy. However, in normal or near-normal intra-operative DSA studies, overestimation of internal carotid artery stenoses was encountered. Postoperative MRA demonstrates potential as a useful non-invasive investigation after carotid endarterectomy but should be interpreted with caution until larger studies become available.     

Mothers of abused children. A comparison study

A group of 36 mothers whose children had suffered from child abuse at an average of 5 1/2 years previously was compared with a group of mothers of similar social class where there had been no reported instances of abuse of their children. There was no significant difference between the two groups with regard to marital, housing, or financial problems or in physical health. Statistically significant differences were found between the abuse and comparison group mothers in the following areas: the abuse group mothers (1) were less likely to have been brought up by their own parents; (2) had more negative feelings towards their fathers; (3) were more likely to have received help for an emotional disorder; (4) had higher expectations for their children; (5) perceived a greater number of personality problems in their children; and (6) were more likely to have assertive, demanding, and suspicious personality traits. It is possible that these maternal factors will influence the emotional development of their children.     

Development in children following abuse and nonorganic failure to thrive

Thirty-nine children who had been abused an average of 5 1/2 years earlier and 14 children who had been admitted to the hospital with nonorganic failure to thrive (NOFTT) 13 years earlier were studied to look at similarities and differences in their development. Each group was studied in relation to a comparison group matched for age, sex, social class, and ethnic background. The abused children and those with NOFTT were similar in their language ability, and were significantly behind their comparison groups in language development, reading age, and verbal intelligence. The abused children, but not the group who had NOFTT, were significantly behind their comparison group in general intelligence, interpersonal relations, and self-concept, but in contrast to the children with NOFTT they were not delayed in social maturity. The long-term adverse sequelae of these two conditions emphasize the need for a long-term, child-centered approach.     

Hip displacement in spastic cerebral palsy: repeatability of radiologic measurement

Radiologic measures of migration percentage (MP) and acetabular index (AI) taken from plain radiographs of the pelvis are the most commonly used tools for determining hip displacement and management options in children with cerebral palsy and spastic hip disease. This study determined interrater and intrarater reliability of MP and AI on pelvic radiographs chosen to represent a wide range of age (11 months to 8 years 5 months), MP (0%-56%), and AI (9 degrees -33 degrees ). The study demonstrated that an experienced rater would be expected to measure MP on a single radiograph to within +/-5.8% of the true value and a change in MP between two radiographs taken at different times to within +/-8.3% of the true value. Similarly for AI, the measurement error for a typical rater would be within +/-2.6 degrees on a single reading and +/-3.7 degrees if recording change between two occasions. The authors believe that the results indicating true change are acceptable in clinical practice, provided treatment decisions are based on a series of radiographs taken at 6-month intervals, methods and training are standardized, and consistent raters are used.     

Practical lessons from the management of an outbreak of small round structured virus (Norwalk-like virus) gastroenteritis

An outbreak of viral gastroenteritis caused illness in 92 people during October 2000. All the cases had an association with one hotel and 80% of cases identified had attended one of two buffet meals on 18th October 2000. Cohort analysis did not implicate any particular foodstuff in this outbreak. All bacteriological tests on food samples were negative. Small round structured virus (SRSV)/Norwalk-like virus (NLV) particles were seen by electron microscopy in 6 out of 27 stool samples submitted for analysis. This paper describes the outbreak and in particular the lessons learned from the management and control of it. These include practical points with regard to the outbreak control team, liaison with the microbiology laboratory, handling data, agreeing a case definition, and occupational health issues. All can be applied elsewhere by those responsible for managing outbreaks at a local level.     

Environmental influences on energy balance-related behaviors: A dual-process view

Background  

Studies on the impact of the 'obesogenic' environment have often used non-theoretical approaches. In this journal's debate and in other papers authors have argued the necessity of formulating conceptual models for differentiating the causal role of environmental influences on behavior.     

Long-term results of the lateral tunnel Fontan operation

OBJECTIVES: Completion of a total cavopulmonary anastomosis with an intra-atrial lateral tunnel is known to yield good early and midterm results. In this study, we sought to determine the long-term outcome (10 years) after a lateral tunnel Fontan procedure. METHODS: Between October 1987 and December 1991, 220 patients (aged 11 months to 32 years) with a wide range of underlying diagnoses underwent a fenestrated or nonfenestrated lateral tunnel Fontan procedure at our institution. Current follow-up information was available for 196 patients (94%, mean follow-up = 10.2 +/- 0.6 years). Risk factor analysis included patient-related and procedure-related variables, with death, failure, and bradyarrhythmia or tachyarrhythmia as outcome parameters. RESULTS: There were 12 early deaths (<30 days or hospital death), 7 late deaths, 4 successful takedown operations, and 4 heart transplantations. Kaplan-Meier estimated survival was 93% at 5 years and 91% at 10 years, and freedom from failure was 90% at 5 years and 87% at 10 years. Freedom from new supraventricular tachyarrhythmia was 96% at 5 years and 91% at 10 years; freedom from new bradyarrhythmia was 88% at 5 years and 79% at 10 years. Three patients had evidence of protein-losing enteropathy. Multivariable risk factors for development of supraventricular tachyarrhythmia included heterotaxy syndrome, atrioventricular valve abnormalities, and preoperative bradyarrhythmia. Risk factors for bradyarrhythmia included systemic venous anomalies. The sole risk factor for late failure was a previous coarctation repair. CONCLUSION: The lateral tunnel Fontan procedure results in excellent long-term outcome even when used in patients with diverse anatomic diagnoses. The incidence of atrial tachyarrhythmia is low and mainly depends on the underlying cardiac morphology and preoperative arrhythmia. The good long-term outcome after an intracardiac lateral tunnel Fontan procedure should serve as a basis for comparison with other surgical alternatives.