Amos S. Deinard

A/NJ/8/76 influenza vaccination program: effects on maternal health and pregnancy outcome.

One hundred eighty-nine women who were immunized with Influenza A/New Jersey/8/76 virus vaccine (InfA/NJ) just prior to or during their pregnancy were compared with a control group of 517 pregnant women who did not receive the vaccine. This longitudinal, prospective study demonstrated no association between immunization with InfA/NJ and maternal, perinatal, or infant complications. No teratogenicity was demonstrated, and the two groups of infants did not differ in physical or neurological assessments at birth and at 8 weeks of life.

Doctor, my tooth hurts: the costs of incomplete dental care in the emergency room

OBJECTIVES This study aims to examine the charges and frequency of return visits for treating dental health problems in hospital emergency rooms (ERs) in order to provide a basis for policy discussion concerning cost-effective and appropriate treatment for those without access to private dental services. METHODS Records were abstracted from hospital administrative data systems for dental-related ER visits from five major hospital systems in the Minneapolis-St. Paul metropolitan area during a 1-year period. Data on the number of visits and charges were analyzed by age and type of payor (public or private). Similar data were obtained from records for a commercially insured population from a single large employer. RESULTS There were over 10,000 visits to ERs for dental-related problems with total charges reaching nearly

Doctor, my tooth hurts

5 million in 1 year, mainly charged to public programs and reimbursed at about 50 percent. The frequency of repeat visits suggests that while acute pain and infection were treated by the ER physicians, the underlying dental problem often was not resolved. In contrast, a population with commercial dental insurance rarely used hospital ERs for dental problems. CONCLUSIONS Access to preventive and restorative dental care is a critical public health problem in the United States, particularly for those without insurance and those covered by public programs. Public health policy initiatives such as the use of dental therapists should be expanded to improve access and to provide alternatives that offer more complete and less costly care for oral health problems than do hospital ERs.

Studies on the neutropenia of cancer chemotherapy

OBJECTIVES This study aims to examine the charges and frequency of return visits for treating dental health problems in hospital emergency rooms (ERs) in order to provide a basis for policy discussion concerning cost-effective and appropriate treatment for those without access to private dental services. METHODS Records were abstracted from hospital administrative data systems for dental-related ER visits from five major hospital systems in the Minneapolis-St. Paul metropolitan area during a 1-year period. Data on the number of visits and charges were analyzed by age and type of payor (public or private). Similar data were obtained from records for a commercially insured population from a single large employer. RESULTS There were over 10,000 visits to ERs for dental-related problems with total charges reaching nearly

Metabolic and Functional Studies of Monocytes in Congenital Neutropenia

5 million in 1 year, mainly charged to public programs and reimbursed at about 50 percent. The frequency of repeat visits suggests that while acute pain and infection were treated by the ER physicians, the underlying dental problem often was not resolved. In contrast, a population with commercial dental insurance rarely used hospital ERs for dental problems. CONCLUSIONS Access to preventive and restorative dental care is a critical public health problem in the United States, particularly for those without insurance and those covered by public programs. Public health policy initiatives such as the use of dental therapists should be expanded to improve access and to provide alternatives that offer more complete and less costly care for oral health problems than do hospital ERs.

Denver developmental screening test: cultural variations in Southeast Asian children

Cancer patients who are receiving chemotherapy are considered to be at an increased risk of infection when the peripheral neutrophil count falls below 2000 cells/mm3. To protect them from such risk, the treatment is discontinued. The size of the marginal neutrophil pool, the extent of marrow neutrophil reserves, the patients ability to develop a tissue neutrophil and mononuclear cell response to a non‐specific inflammatory stimulus, and the in vitro metabolic activity of neutrophils were measured in 25 patients with solid tumors betore and after a course of chemotherapy. Results indicate that infection only occurred with a depression of marrow neutrophil reserves and/or a depression in the tissue neutrophil and mononuclear cell response to non‐specific inflammation. The functional capability of neutrophils, as measured by the in vitro metabolic responses to phagocytosis of latex particles, remained intact despite peripheral neutropenia. Chemotherapy may be safely continued, despite peripheral neutropenia, as long as the marrow reserves and tissue leukocyte inflammatory responses remain intact.

Hmong health care - reflections on a six-year experience.

Summary. Children with the severe form of congenital neutropenia usually die from infection by 2 yr of age. Metabolic and functional studies of monocytes from three patients with this disease were undertaken to understand further the role of monocytes in the hosts defences against bacterial infection. The bactericidal capacity of monocytes compared favourably to the bactericidal capacity of control neutrophils (PMN). Metabolic studies of monocytes and control leucocytes showed similar stimulation of oxygen consumption, hexose monophosphate pathway activity arid 125iodide fixation during phagocytosis. Further, myeloperoxidase (MPO) activity of patients’monocytes was comparable to the activity of control leucocytes. Using the Rebuck skin window, very few of the patients’mononuclcar cells were seen to migrate during the initial 2–4 hr of observation. During this time, the PMN migration of controls was maximal. Following the relatively acellular period observed in patients, a brisk mononuclear cell infiltration occurred apparently independent of the presence of neutrophils. Epinephrine injection into patients stimulated a marked increase of blood monocytes, suggesting the existence of a marginal monocyte pool. An injection of hydrocortisone caused an unexplained 3–8‐fold decrease in circulating monocytes. The delay of phagocytic cell migration to an inflammatory site, and the apparent sensitivity of monocytes to hydrocortisone may account in part for the increased susceptibility to infection in patients with severe congenital neutropenia.

Growth, behavioral, and psychologic measurements of adopted children: The influences of genetic and socioeconomic factors in a prospective study

TIlE DENVER DEVELOPMENTAL SCREENING TEST is commonly used to screen young children for delays in the areas of personal-social, fine motor-adaptive, language, and gross motor development. It is predicated on the concept that a child should have developed certain skills by a given age. Children of cultural backgrounds different from the population in which the test was standardized (predominantly white and middle class: 82% white, 11% Spanish, and 7% black t) may fail certain items because of cultural differences, z-4 Failure to recognize social or cultural variations in special groups of children may lead to scoring falsely certain items as developmental delays and thus to unnecessary referrals (and expense) for diagnostic assessment. Recently, many Southeast Asian refugee children (Hmong, Laotian, Vietnamese, and Cambodian) have been screened before obvious acculturation has taken place. The purpose of our study was to determine which DDST items may be failed because of cultural differences. METHODS

A study of steroid-induced granulocytosis in a patient with chronic benign neutropenia of childhood.

In this article difficulties experienced over the past six years in providing health care to Southeast Asian refugees are described. The need to involve patients in the planning process, particularly when dealing with patients who come from markedly different cultures, is discussed. The role of the bilingual interpreter is emphasized, and potential conflicts that may be encountered by them are highlighted. Shortcomings of the health care program and alternative approaches that might have resulted in better acceptance of Western health care by the refugees are detailed.

Iron deficiency among incarcerated juvenile delinquents.

Perinatal, growth, social, and psychologic data, collected through seven years of age on 144 adopted children and on 288 matched controls as part of a prospective study of 3,120 children, were subjected to statistical analysis. Only single births and healthy children were included. The adopted subjects were divided into two groups: 94 children who were adopted by nonrelatives (77 prior to one year of age and 17 after one year of age); and 50 children who remained with their biologic mothers and were subsequently adopted by stepfathers. Children who were adopted prior to one year of age had significantly higher IQs at four years of age then did their controls; at seven years of age, however, their IQs were similar even though the adopted children were raised in a higher socioeconomic environment. The adopted children had better academic achievement and were taller at four and seven years of age than were the controls. The performance of the children adopted after one year of age, even though they were raised in a higher socioeconomic environment, were, were like those of their controls at both four and seven years of age. The performance of the children who remained with their biologic mothers was similar to that of their controls. Maternal intelligence generally did not correlate well with adopted childrens intelligence; however, a specific significant positive correlation could be shown between maternal intelligence and the intelligence of children who remained with their biologic mothers.