Parents' worries about children compared to actual risks.

To investigate the concerns of parents, questionnaires were given to the "first 100" parents waiting for their child's pediatric appointment in four different medical settings. They were asked to rate whether they worry "frequently," "occasionally," or "not at all" about 17 physical health issues, 16 psychosocial problems, 7 possible injuries, 4 instances of victimization, and 4 questions about parents' ability to provide discipline, affection, values and financial support. The response rate was 94%; 89% were completed adequately for analysis. Parental concerns were compared to data from the National Center for Health Statistics about the statistical likelihood of the risks occurring. Ear infections (65%) were the most common health concern, followed by reaction to immunization (57%), common colds (51%), and cancer (50%). The greatest psychosocial concern was about children watching too much television (53%), followed by concerns about the quality of day care (50%). Three-quarters of parents worry about car accidents and 72% worry about abduction of their children. Parents worry significantly about their own contribution to their child's welfare: appropriate discipline (73%), affection (56%), values and being a role model (55%), and financial support (66%). Parents who had not completed high school worried more than parents who had more than a high school education (P less than 0.03).

Invasive Haemophilus influenzae infections among children in Rochester, Minnesota: a population-based study.

The incidence of invasive Haemophilus influenzae infections was studied among all residents of Rochester, Minnesota, under 20 years of age during the period 1975-1983. The incidence in children under 5 years of age was 115 and 64 cases per 100,000 children per year for all invasive cases and for meningitis, respectively. These rates are among the highest reported for an essentially all-Caucasian population in the United States, while the ratio of meningitis to non-meningitis cases (1.1:1) is among the lowest. This suggests possible under-ascertainment of non-meningitis cases in previous US studies of Haemophilus influenzae infections.

Trends in infantile hypertrophic pyloric stenosis in Olmsted County, Minnesota, 1950-1984.

In the 35-year period, 1950-1984, 154 Olmsted County, Minnesota, infants were diagnosed with definite infantile hypertrophic pyloric stenosis (IHPS). Patients were identified using outpatient and inpatient records of all providers of care to the circumscribed population, and ascertainment was complete insofar as diagnosed cases are concerned. The overall incidence of IHPS was 2.6 per 1000 person-years (95% confidence interval: 2.2-3.0), with a male:female ratio of 4.1:1. A dramatic rise in incidence was seen among male infants over the study period, but not for females, so that by 1980-1984 the rates for the two sexes were 6.2 and 0.9 per 1000 person-years, respectively. Improvements in diagnostic capabilities and case identification may have occurred but seem unlikely to entirely account for these changes. Aetiologic hypotheses should reflect the different trends for male and female infants.

Population-based studies of varicella complications.

Population-based data on varicella complications are presented using information both from national sample surveys of hospitalizations and physician office visits and from reviews of medical records for all cases occurring within one community (Olmsted County, Minnesota) during a specified period. Acute cerebellar ataxia is the most common neurologic complication of varicella and occurs about once in 4,000 varicella cases among children younger than 15 years of age. Among adults, varicella pneumonia is the most common complication and results in hospitalization about once in every 400 varicella cases. Overall, varicella accounts for approximately 4,000 hospitalizations and 364,000 physician office visits annually in the United States and represents an important continuing source of childhood and adult morbidity.

Weight loss and body temperature changes in breast-fed and bottle-fed neonates.

Among 1138 newborns in a Level II nursery, breast-fed and formula-fed infants were comparable in terms of sex, mode of delivery, gestational age, birth weight, and birth temperature. Breast-fed neonates subsequently lost more weight and a greater percentage of their birth weight (mean, 7.4% vs. 4.9%) than did formula-fed infants. Loss of more than 10 percent of birth weight was associated with short gestation and low birth weight and with breast feeding. Birth weight loss of greater than or equal to 3 percent was associated with a risk of fever (greater than or equal to 37.5 degrees C) among breast-fed and formula-fed infants, but there was no gradient of increasing risk of fever with increasing percentage weight loss beyond 3 percent. After weight loss and other significant variables were adjusted for in a multivariate analysis, breast feeding was not independently predictive of fever. Although breast feeding may be associated with weight loss, it is not prudent to assume that this is the cause of fever in a breast-fed neonate.

Epidemiology of herpes zoster in children and adolescents: a population-based study.

Medical records were reviewed for all 173 cases of herpes zoster diagnosed among residents of Rochester, Minnesota, less than 20 years of age during the period 1960 through 1981. The incidence of zoster increased with age from 20 cases per 100,000 person-years in those residents less than five years of age to 63 cases per 100,000 person-years in those aged 15 to 19. Morbidity was less than has been described in adults, as only two patients required hospitalization and no postherpetic neuralgia or other late complications were diagnosed. The single case of subsequent cancer found in 1,288 person-years of follow-up was not significantly different from the number expected based on cancer incidence in the general Rochester population. The incidence of childhood zoster in patients with acute lymphocytic leukemia was 122 times higher than in children without an underlying malignancy. Chickenpox in the first year of life was found to be a risk factor for childhood zoster, with a relative risk between 2.8 and 20.9. Neither chickenpox in the second year of life nor recent vaccinations were found to be risk factors for childhood zoster.

The common cold.

The common cold continues to be the major cause of absences from school and work. A better understanding of the epidemiology and the natural history should lead to less anxiety about this disease. Although there is still much misinformation among the public, the time should soon come when better-informed patients with this disease will make fewer visits to the physician and will not expect unnecessary and worthless treatment.

Chickenpox hospitalizations among residents of Olmsted County, Minnesota, 1962 through 1981. A population-based study.

Age-specific incidence rates were determined for hospitalizations resulting from complications of chickenpox. We reviewed medical records for all Olmsted County, Minnesota, residents hospitalized for chickenpox during the 20-year period 1962 through 1981. Incidence rates based on these 25 cases showed good agreement with national rates computed from information compiled by the Commission on Professional and Hospital Activities for 669 statistically selected patients, representing about 5% of US varicella hospitalizations from January 1979 through June 1982 (about 4,000 hospitalizations annually). The most common complications were bacterial superinfections in children younger than 5 years old, varicella encephalitis (mainly acute cerebellar ataxia) and dehydration in 5- to 9-year-olds, and varicella pneumonia in adults. The high prevalence of chickenpox and its association with infectious and neurologic complications make it a continuing source of morbidity.

Human platelet phenol sulphotransferase: assay procedure, substrate and tissue correlations.

Procedures for the precise assay of human platelet phenol sulphotransferase activity were determined. The coefficient of variation of the assay was 5.8% when the enzyme activity was expressed per 10(8) platelets, and was 9.4% when it was expressed per mg soluble platelet protein. Mean platelet phenol sulphotransferase (PST) activity in samples from 102 randomly selected adults was 1.2 +/- 0.4 units/10(8) platelets (mean +/- S.D.), with a range from 0.2 to 2.9. The mean activity for umbilical cord blood platelet PST was 0.93 +/- 0.3 units/10(8) platelets (mean +/- S.D., n = 27). The substrate used routinely for the assay was 3-methoxy-4-hydroxyphenylglycol (MHPG). There was a significant correlation between the formation of MHPG sulfate by individual platelet preparations and the formation of sulfated product with each of the following substrates: tyramine (r = 0.92, n = 21); dopamine (r = 0.82, n = 16); 5-hydroxytryptamine (r = 0.94, n = 20); acetaminophen (r = 0.77, n = 17); and alphamethyldopa (r = 0.77, n = 17) (p less than 0.001 for each). Platelet PST activity correlated significantly with human renal cortex PST activity (r = 0.54, n = 20, p less than 0.02). The correlation coefficient between platelet PST activity and jejunal mucosal enzyme activity in eight patients was 0.67. These results raise the possibility that human platelet PST activity measured with MHPG as substrate might reflect the enzyme activity in other tissues and the degree of sulfate conjugation of a variety of substrates.

Recurrence of group B streptococcal infection.

It is clear that the group B streptococcus has become a major pathogen of young infants within the comparatively recent past. Further it is clear that, as with other endemic and epidemic pathogens, increasing clinical and laboratory experience brings to light variations not initially evident. In addition, therapy presumably effective in initial cases may not continue to be so. The following papers by coincidence were received over a relatively brief period of time. Hence, for emphasis of some of the problems related to this organism, they are presented as a group.

Graft-versus-host reaction (GVHR). A case report suggesting GVHR occurred as a result of maternofetal cell transfer.

A female infant with combined immune deficiency syndrome exhibited graft-versus-host reaction (GVHR) clinically during the nine weeks of her life. Pathologically, the first clue for GVHR was the lymphohistiocytic dermal and epidermal infiltrate with single cell necrobiosis seen on a skin biopsy specimen at 6 weeks of age. Two days before death, she received irradiated (3,500 rads) whole blood and plasma with specific antibodies against mother's lymphocytes, which was the first introduction of an allogenic hematopoietic substance. This suggests that the GVHR, which was confirmed at autopsy, occurred as the result of maternofetal cell transfer in utero or at time of delivery.