Kenneth D. Rogers

Vitamin C Prophylaxis in a Boarding School

Abstract A double-blind study to evaluate vitamin C supplements for respiratory-Infection prophylaxis was conducted among 641 children at a Navajo boarding school over a 14-week period. Supplements...

History of recurrent sore throat as an indication for tonsillectomy. Predictive limitations of histories that are undocumented.

As part of a prospective study of indications for tonsillectomy and adenoidectomy, we followed closely 65 children with histories of recurrent throat infection that seemed impressive (at least seven episodes in one year, five in each of two consecutive years or three in each of three consecutive years), but lacked documentation. During the first year of observation, only 11 children (17 per cent) had episodes of throat infection with clinical features and patterns of frequency conforming to those described in their presenting histories. Of the remaining 54 children, 43 (80 per cent) experienced no, one or two observed episodes each, and most of the episodes were mild. We conclude that undocumented histories of recurrent throat infection do not validly forecast subsequent experience and hence do not constitute an adequate basis for subjecting children to tonsillectomy.

Vitamin C and Acute Illness in Navajo Schoolchildren

To evaluate earlier observations, including our own, showing usefulness of vitamin C for managing the common cold, we performed a double-blind trial of vitamin C versus placebo in 868 children. There was no difference in number becoming ill (133 versus 129), number of episodes (166 versus 159) or mean illness duration (5.5 versus 5.8 days) between the groups. Children receiving vitamin C had fewer throat cultures yielding beta-hemolytic streptococcus (six versus 13, P less than 0.10), but no difference in overall complicated illness rate (24 versus 25). Plasma ascorbic acid levels were higher in the vitamin group 24 to 26 hours after supplementation (1.28 versus 1.04 mg per 100 ml, P less than 0.01). Children with high plasma ascorbic acid concentrations had longer mean illness (6.8 versus 4.0 days, P less than 0.05) than those with low levels. Vitamin C does not seem to be an effective prophylactic or therapeutic agent for upper respiratory illness.

EFFICACY OF ADENOIDECTOMY FOR RECURRENT OTITIS MEDIA: RESULTS FROM PARALLEL RANDOM AND NONRANDOM TRIALS

We defined 218 children at high risk for otitis media (OM) in that each had received myringotomy with tympanostomy-tube placement (M & T) and, subsequent to tube extrusion, had developed recurrent acute or secretory OM. 102 children were assigned to an adenoidectomy or control group randomly, and 116 according to parental preference, and all were followed closely. Standardized antimicrobial regimens were used for new episodes of OM, as were specified criteria for repeat MST for persistent middle-ear effusion. Each ear of each subject on each follow-up day was categorized as with or without tube, and with or without OM.Preliminary results in the random trial in subjects largely completing full years of follow-up were as follows:In the nonrandom trial, results also tended to favor surgical subjects, but the differences were not statistically significant.

Diagnostic Information Available in University and Community Hospital Medical Records: Patients With Cerebrovascular Disease

Medical records of 1,117 patients with cerebrovascular disease from one university and four community hospitals were abstracted by trained, nonphysician personnel at the rate of four cases per hour. The data obtained were adequate to describe eight cerebrovascular disease syndromes. In 56% of cases, data from the body of the medical record failed to support the hospiatls dicharge diagnosis. The eight study diagnoses were not identical with pathological diagnoses, but their characterstics suggest that they are distinct and related to recognized cerebrovascular disease entities. It is recommended that evaluations of diagnostic and therapeutic practice for stroke patients be carried out separately for each of the study syndromes; the care expected and the outcome observed are different for each.

A Community Medicine Clerkship on the Navajo Indian Reservation.

An elective clerkship in community medicine for medical students has been conducted for 16 years on the Navajo Indian reservation. An important part of the clerkship is a project in which most students select a health problem which they investigate using epidemiological methods of assessment and for which they seek a solution. The requisites for the projects are that real health problems are involved, scientifically sound methods are used, usable information is provided, and data collection can be completed within the clerkship tenure. Topics for the projects are selected jointly by the students and the faculty members from several general subject areas; this allows the work of individual students to be carried out as independent subprojects of larger projects, and this, in turn, produces more information about and has more impact on the problems addressed. Other clerkship objectives also are achieved through investigative projects that may involve students in planning, organization, and evaluation of health care and in public health practice.

First Aid and Emergency Care Training; its Effect on Prehospital Emergency Care

The effect of first aid and emergency care training programs on the delivery of prehospital care was evaluated by screening 862 emergency department patients in a suburban Pittsburgh hospital. Patients were categorized according to their conditions and prehospital attendants according to their training. Criteria were established to judge adequacy of prehospital care for several emergency conditions. Results indicated that personnel who had received the 81-hour Emergency Medical technician-Ambulance course provided the most adequate prehospital are of emergency patients. Those who had taken the 27-hour American Cross Standard and Advanced First Aid Courses provided adequate prehospital care 50% of the time. Prehospital care in the geographic area surveyed was adequate in slightly less than half the cases examined.

Infant and neonatal mortality rates during pre- and post-reactor periods for geographic areas adjacent to Shippingport, Pennsylvania.

Temporal trends in infant and neonatal mortality rates for populations residing in geographic areas surrounding the nuclear reactor at Shippingport, Pennsylvania are examined during the preand post-operational periods of the reactor. This examination, utilizing regression analysis, is a search for statistical evidence to support various hypotheses concerning the relationship of these trends to operation of the reactor. The results do not justify rejection of the statistical hypothesis that temporal trends were similar in the preand post-reactor periods.