Frank A. Loda

Epidemiologic patterns of acute lower respiratory disease of children in a pediatric group practice

Comprehensive surveillance of acute lower respiratory illnesses of children seen in apediatric group practice was maintained for 67 months in Chapel Hill, North Carolina. The common pathogenic agents associated with these illnesses were respiratory syncytial virus, parainfluenza virus types 1 and 3, and Mycoplasma pneumoniae . Consistent patterns have been observed in the clinical manifestations, seasonal occurrence, and age and sex distribution of infections; these provide guidelines for clinicians, which allow reasonable estimates of the etiologic diagnoses. These studies have important implications for the understanding of disease pathogenesis and for the development of optimal methods of prophylaxis.

Evaluation of a home-based intervention program to reduce infant passive smoking and lower respiratory illness

We conducted a randomized controlled trial to determine whether a home-based intervention program could reduce infant passive smoking and lower respiratory illness. The intervention consisted of four nurse home visits during the first 6 months of life, designed to assist families to reduce the infants exposure to tobacco smoke. Among the 121 infants of smoking mothers who completed the study, there was a significant difference in trend over the year between the intervention and the control groups in the amount of exposure to tobacco smoke; infants in the intervention group were exposed to 5.9 fewer cigarettes per day at 12 months. There was no group difference in infant urine cotinine excretion. The prevalence of persistent lower respiratory symptoms was lower among intervention-group infants of smoking mothers whose head of household had no education beyond high school: intervention group, 14.6%; and controls, 34.0%.

Studies on the role of viruses, bacteria, and M. pneumoniae as causes of lower respiratory tract infections in children.

The etiological roles of bacteria, viruses, and mycoplasmas were assessed simultaneously in 2 different populations of children from the same geographic area. These patients, some from a typical private practice in a small town and others from a rural environment, represent groups that have not been studied extensively. The significance of the agents varied between the groups in terms of frequency, character of associated illness, and age of patients involved. The data indicate the need for long-term observations in differing epidemiological settings to provide a rational basis for prophylaxis, diagnosis, and therapy of acute respiratory diseases.

The association between mothers' social support and provision of stimulation to their children

Specific forms of maternal social support were analyzed for their relationship to a validated measure of home stimulation (the Inventory of Home Stimulation). The 69 study families were chosen to represent a wide variability of social support at the time of the childs birth. All index children had been discharged from a neonatal intensive care unit 3 years before the study. The overall Maternal Social Support Index (MSSI) developed for the study explained a significant (p < .01) amount of variance in the home stimulation of 3-year-olds after income, race, maternal age, and other possible confounding variables had been controlled. In addition, specific MSSI items were strongly associated with various forms of environmental stimulation. The data suggest that augmentation of specific aspects of mothers social support networks may increase their childrens informal learning opportunities.

Ecology of passive smoking by young infants

This study provides a detailed description of passive smoking by 433 infants (mean age 18 days) enrolled from a representative population of healthy neonates in central North Carolina during 1986 and 1987. Sixty-four percent (276) lived in households with smokers or had contact with nonhousehold smokers. During the week before data collection, two thirds (184) of these 276 infants reportedly had tobacco smoke produced in their presence. Seventy-five percent of smoking mothers smoked near their infants. The amount smoked by the mother near the infant correlated with the amount smoked near the infant by nonmaternal smokers. Cotinine, an indicator of smoke absorption, was found in the urine of 60% (258) of all study infants. The amount smoked in the infants presence, as well as the amount smoked farther away from the infant, especially by the mother, were the most significant correlates of the urine cotinine concentration. The results of this study suggest that efforts to reduce passive smoking in young infants should emphasize the importance of the mothers smoking behavior, smoke produced anywhere in the home, and household social influences on smoking behavior near the infant.

Sexually abused children: Identifying masked presentations in a medical setting

Sexual abuse of children frequently lies hidden while the victims receive medical care for other complaints. To identify clinical signals of latent abuse, we studied 50 children whose initial presentations masked the presence of sexual abuse and compared them with 31 overt cases identified by chief complaint. A broad variety of symptoms masked the abuse. While some, such as early adolescent pregnancy and genital symptomatology, might have suggested the diagnosis, unusual physical symptoms, psychosomatic, and behavioral disorders were as frequent. The masked group differed significantly from the more frequently studied overt group in that chronic history of sexual abuse was twice as common; school problems and psychosomatic disorders were three times as frequent; the alleged abuser was more often an immediate family member, usually the father; male victims were more likely to present in this disguised manner. Familiarity with typical masked presentations should aid earlier identification of these troubled children.

Passive smoking during the first year of life.

BACKGROUND AND PURPOSEnA description of passive smoking during the first year of life might assist planning preventive efforts.nnnMETHODSnChanges in the ecology of passive smoking were investigated in a sample of infants in central North Carolina followed from birth to one year of age.nnnRESULTSnThe prevalence of tobacco smoke absorption, indicated by excretion of cotinine, increased from 53 percent to 77 percent (95% CI of difference: 14, 35) during the first year of life. Most infants (92 percent) excreting cotinine at three weeks of age were also excreting it at one year. Moreover, 61 percent of infants not excreting cotinine at age three weeks were excreting it at one year. This increase reflected an increased exposure to household and, particularly, nonhousehold sources of smoke; the proportion of infants exposed to nonhousehold smokers increased from 14 percent to 36 percent.nnnCONCLUSIONSnThese findings suggest that prevention of the onset of passive smoking should begin very early.

Child-health supervision for children under 2years of age: A review of its content and effectiveness

education, counseling, anticipatory guidance, and continuity of care. Herein we evaluate the existing literature for the effectiveness of these strategies in meeting these goals. The emphasis in this discussion is on the clinicianpatient interaction. The underlying assumption is that the clinicians time is a valuable commodity that should be utilized in the most efficient manner. The clinical content areas included are physical evaluation, advice on physical concerns, parenting advice, parent-child interaction, and developmental advice. The effectiveness of current standards and issues for research are discussed in each of these areas. Certain topics relevant to child-health supervisior~, such as screening for disease or the use of physician extenders, are not discussed.

The Parainfluenza Viruses

The parainfluenza viruses are species of the paramyxovirus family. (3,43) They are exceeded only by respiratory syncytial virus as important causes of lower respiratory disease in young children, and they commonly reinfect older children and adults to produce upper respiratory illnesses. There is considerable diversity in both epidemiological and clinical manifestations of infections due to the parainfluenza viruses. Parainfluenza virus type 1 (Para 1) is the principal cause of croup (laryngotracheobronchitis) in children, and parainfluenza virus type 3 (Para 3) is second only to RS virus as a cause of pneumonia and bronchiolitis in infants less than 6 months of age. Parainfluenza virus type 2 (Para 2) resembles type 1 in clinical manifestations, but serious illnesses occur less frequently; infections with parainfluenza virus type 4 (Para 4) are detected infrequently and associated illnesses are usually inconsequential.

Determinants of foster care placement for the maltreated child.

This study examined the records of the North Carolina Central Registry of Child Abuse and Neglect to determine which social, family, and child characteristics were most influential in the decision to place a child in foster care. These records contained all theoretically relevant factors as well as demographic data. Analysis included the computation of odds ratios for foster care for each of 250 variables. A maximum likelihood logistic regression model was constructed to obtain the independent and cumulative contribution of each factor. Some expected variables such as parental stress factors (substance abuse) and types of abuse (burns and scalds) placed a child at a significant risk for placement in foster care (p less than 0.01). However, less obvious factors such as referral source (law enforcement agencies) or geographic area also placed children at risk. Overall, the model explained little of the variance of these decisions (R2 = 0.168) and poorly predicted placement (sensitivity 66.3 per cent, specificity 74.6 per cent). Using existing data, we were unable to adequately describe the decision process in selecting foster care.