Robert M. Brayden

Antecedents of child neglect in the first two years of life

To determine the prenatal antecedents of child neglect by low-income women, data from a prospective study of child maltreatment were reviewed. Mothers determined to be at high risk prenatally for maltreatment were more likely to be identified as neglectful within 24 months of the interview. Neglectful mothers were less likely to have completed high school, had more children younger than 6 years of age, and had more aberrant responses on parenting skills and support systems scales. Neglected children were lower in birth weight, were rated more difficult temperamentally, and had poorer mental and motor developmental scores.

Evidence for Specific Effects of Childhood Sexual Abuse on Mental Well-Being and Physical Self-Esteem.

Women who are sexually abused are at increased risk for having mental health problems long after the abuse. Other nonexploitive experiences can also be psychologically detrimental, may coexist with sexual abuse, and may explain some portion of subsequent mental health problems. This study addresses the association between childhood sexual abuse and a womans psychological functioning, independent of the quality of parental nurturance received during childhood and other variables which may influence mental health. Of 609 women completing mental health and self-concept measures, 98 reported sexual abuse; 110 of the remaining women were selected as comparisons. Women sexually abused as children scored lower on measures of mental health status. Both sexual abuse and fewer years of education were related to lower scores on a psychological well-being scale after variance accounted for by family and demographic variables was removed. Sexual abuse was not a predictor of general self-concept scores after the removal of family and demographic variables, but sexual abuse was independently associated with the subscale measuring the physical aspect of self-concept. These findings lend support to theorized causal links between child sexual abuse and some aspects of later psychological difficulties.

Chlamydial Pneumonia of Infancy in Siblings

We describe two brothers born 16 months apart who were hospitalized with culture-proved chlamydial pneumonia of infancy due to the same immunotype of Chlamydia trachomatis. Presumably the mother had either been chronically infected or had been reinfected. Chlamydial pneumonia of infancy is a preventable disease if genital infection in pregnant women is diagnosed and treated. However, if pregnant women at high risk are not screened for C. trachomatis, multiple offspring may acquire the infection and develop serious perinatal chlamydial disease.

Physician Identification of Barriers to the Delivery of Immunizations in Urban and Rural Areas of Colorado 615

Background: Limited data is available concerning the barriers to the delivery of immunizations in rural areas.

Physician Perceptions about Immunization Reimbursement in Urban and Rural Colorado 616

Background: Issues related to vaccine reimbursement influence physician decisions about service delivery policies. Vaccine reimbursement varies considerably depending on plan.

Immunization Practices Among Rural and Urban Clinicians 625

Background: Effective interventions to increase immunization coverage should address deficiencies in immunization delivery practices.

CHLAMYDIAL PNEUMONIA OF INFANCY IN SIBLINGS

Because Chlamydia trachomatis (Ct) genital tract infection in females may persist without symptoms for months to years, and because reinfection may occur, siblings born to chronically infected or reinfected women theoretically are at risk for perinatal Ct infection. We describe two brothers born 16 months apart with Ct pneumonia. A 3 week old infant with cough and eye discharge was hospitalized because of an apneic episode requiring resuscitation. He was afebrile, had eosinophilia, and bilateral interstitial infiltrates on chest x-ray. Ct was identified in nasopharyngeal (NP) washings by direct immunofluorescent microscopy and by culture. The mothers first child also had been hospitalized at 5 weeks of age with afebrile pneumonia. Ct pneumonia was suspected, but a culture of NP secretions, collected after the child had begun oral erythromycin, was negative. An earlier specimen, collected for viral studies before erythromycin was begun, was retrieved from the freezer; it was strongly positive for Ct by both immunofluorescent microscopy and culture. This experience highlights the risk of symptomatic Ct infection in siblings born to chronically infected or reinfected women and provides another important reason to treat the parents of infants with Ct infection for presumed Ct genital infection.