Infant walker injuries persist in Canada after sales have ceased.

OBJECTIVE: To identify the source of acquisition of infant walkers and attitudes regarding the continuing use of walkers following an injury to an infant in order to design preventive strategies. DESIGN: Descriptive and retrospective. SETTING: Emergency department of a children's hospital involved in primary, secondary and tertiary care. PATIENTS: All patients presenting with injuries associated with infant walkers over a 42-month period. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Source of acquisition of infant walker and actions taken after the injury. RESULTS: The demographic and outcome data of the 36 patients were similar to previous reports. The caretakers of 26 patients were reached by telephone. Eight walkers were purchased in the United States and 18 were second-hand acquisitions (new walkers are not available for sale in Canada). Only two families continued using their walkers in the same fashion as prior to the injury. CONCLUSIONS: Although new infant walkers are not sold in Canada, injuries associated with their use continue. An aggressive public education campaign discouraging infant walker use and an incentive driven recall campaign to retrieve circulating walkers are seen as complimentary preventive strategies. A similar approach should be considered in other countries that choose to regulate infant walkers.

A randomized single-blind evaluation of a discharge teaching book for pediatric patients with burns.

To evaluate the influence of a modular, multidisciplinary, pediatric burn discharge book on burn-care-related knowledge and satisfaction of caregivers, we studied children less than 17 years of age admitted with an acute thermal injury to the pediatric burn unit of a large, tertiary care hospital in Winnipeg, Canada over a 32 month period. Demographic characteristics of the population are similar to published profiles of other pediatric burn units with the exception that North American Indian (NAI) families were disproportionately admitted, with 59 out of the 123 (48%) admissions from a geographic area that has less than 15% NAIs. We randomly assigned the families to receive discharge instructions with the book (intervention group) or routine discharge teaching without the book (comparison group). Knowledge levels of burn care and satisfaction with discharge teaching of caregivers were evaluated with a questionnaire administered in single-blind fashion at the first outpatient follow-up visit. Sixty-two families received the book and 61 families received standard discharge teaching. Bivariate analysis showed greater knowledge in the intervention group, with an average score (range, 0.0 to 1.0) of 0.79 +/- 0.15 versus 0.73 +/- 0.15 in the comparison group (p < 0.05). We did not observe this positive effect of the book when we analyzed NAI families separately: 28 families instructed with the book scored 0.68 +/- 0.14 versus 0.63 +/- 0.13 in 31 families provided with routine teaching (p = 0.18). Stepwise multiple-regression analysis found that the influence of the book was limited to families with children who sustained scald burns (p < 0.05). Factors negatively related to the knowledge levels of caregivers (p < 0.05) were being of NAI origin and being NAI with no safety devices in the home. A positive correlation (p < 0.05) was found with having English as the first language, having a child with more extensive burns, having a younger age of the child with burns, and having fewer children in the home. In conclusion, we found that the discharge book improved the burn-care-related knowledge of caregivers. However, other factors, particularly ethnic and language background, were of greater influence.

Public awareness of the risks of drinking alcohol during pregnancy: the effects of a television campaign. Child Health Committee, Manitoba Medical Association.

OBJECTIVE: To evaluate the impact of a television public awareness campaign on knowledge of the dangers of drinking alcohol during pregnancy. DESIGN: A survey with five questions on alcohol and pregnancy and five health questions unrelated to alcohol was administered before and after the campaign. PARTICIPANTS: Three thousand women aged 15-45 years. INTERVENTION: A 30-second announcement with a message on alcohol and pregnancy was broadcast over ten weeks by five television stations in Manitoba. RESULTS: More respondents after the campaign thought that alcohol consumption in pregnancy would put the baby at risk, and attributed this information to "television". There were no differences in the responses to the five health questions unrelated to alcohol. CONCLUSIONS: An increase in awareness of the risks of drinking alcohol during pregnancy was observed after a mass media campaign.

The natural history and predictive value of early language delays in very low birth weight infants.

A cohort of 28 VLBW (less than or equal to 1500 g) infants was assessed at 1 and 3 years of age for hearing, language development and neurological status. Language delays were detected in 11 (39%) infants at 1 year, and in four (15%) at follow up at 3 years of age (P less than 0.05). Language quotients were significantly associated with perinatal variables at 1 but not at 3 years of age. Infants with neurological abnormalities had significantly lower language quotients at the 3-year follow up. No child with a normal language profile at 1 year exhibited a delay at 3 years of age.

A survey of pediatric discharge educational programs in North American burn units.

In this study we contacted all of the 149 major North American burn facilities that treat children. The survey determined topics covered in discharge teaching, personnel administering the programs, methods used, and obstacles encountered. The subjects addressed and the personnel involved have changed little from a decade ago. Unfortunately, one fourth of the centers still do not deal with emotional aspects of burns in their discharge programs. For program delivery, videotape is becoming an increasingly accepted teaching method. Eighty-five percent of burn facilities experienced barriers to patient education at discharge, with more than half reporting three or more difficulties. The most common difficulty was time constraints (50%), followed by language and sociocultural barriers (41%), lack of receptivity by clientele (39%), lack of educational materials and planning (26%), and inadequate funding (25%). Some of these problems might be alleviated by the establishment of a clearinghouse for burn educational materials.

Language development of very low birth weight infants and fullterm controls at 12 months of age.

Twenty-eight very low birth weight (VLBW) and 32 full term infants were prospectively assessed at one year of age for hearing, language development and neurological status. The prevalence of conductive hearing deficits was the same in both groups. Language scores in VLBW infants were significantly lower than in fullterm controls and 39% had significant language delays. VLBW infants exhibited a shorter attention span and were less likely to understand simple questions, to recognize objects or body parts when named, to initiate speech-gesture games, to follow simple commands and to imitate or use words consistently. Language quotients were directly associated with gestational age and five minute Apgar scores and inversely associated with severity of intraventricular hemorrhage, bronchopulmonary dysplasia and length of hospital stay. VLBW small for gestational age infants exhibited more advanced language skills than VLBW appropriate for gestational age infants. Language delays were more prevalent among, but not limited to, infants with mild to moderate neurological abnormalities. The influence of prematurity and VLBW on language development is complex and multifactorial and research is continuing to determine the predictive validity and long term significance of the early language delays described in this study.

Dissociation in alternative healers and traditional therapists: a comparative study.

Nineteen psychiatry residents were compared to 12 community-based alternative healers on the Dissociative Experiences Scale and the Dissociative Disorders Interview Schedule. Neither group showed evidence of extensive psychopathology. However, the alternative healers reported more Schneiderian symptoms, extrasensory experiences, and secondary features of multiple personality disorder. Among the healers, these experiences did not seem to be indicative of psychopathology, and were in fact valued and sought after. Dissociative experiences are not necessarily indicators of psychiatric disorder in nonclinical groups.

Giardiasis associated with the use of a water slide.

Although Giardia lamblia cysts are an important contaminant of surface water supplies, only one swimming pool outbreak, involving an infant and toddler swim class, has been reported. We describe an outbreak of giardiasis associated with a hotel's new water slide pool which was cleansed by both bromination and sand filtration. Among the 107 hotel guests and their visitors surveyed, 29 probable and 30 laboratory-confirmed cases of Giardia infection were found. Cases ranged from 3 to 58 years of age, with a mean age of 21 years. The 5-year modal age grouping was 5 to 10 years of age. Symptoms in the 59 cases included: diarrhea (48), cramps (38), foul smelling stools (29), loss of appetite (23), fatigue (20), vomiting (18), greasy stools (15), fever (11) and weight loss (10). Four children and 2 adults were hospitalized. Significant associations were found for staying at the hotel, using the water slide pool and swallowing pool water. A possible contributing factor was the emptying of an adjacent toddlers' wading pool, a potential source of fecal material, into the water slide pool. Transmission of Giardia can occur in water slide pools and therefore should be considered in cases of protracted diarrhea among users of such pools.

Where Manitoba children obtain their cigarettes.

People who start to smoke as children put themselves at greater risk of dying prematurely or being disabled by tobacco-induced disease. One solution is to restrict children's access to cigarettes, thereby reducing consumption of the product and, ultimately, damage to health. This study found that in 1985 the majority of Manitoba public school children 8 to 15 years of age who smoked "regularly" (defined as usually every day) obtained their cigarettes from stores. This source could be reduced, if not eliminated, were a federal regulation passed in 1908 enforced. Under Canada's Tobacco Restraint Act it is illegal for merchants to sell tobacco to anyone under the age of 16 years. By implementing this existing law, authorities would not only be keeping the profit from almost a million dollars in cigarette sales in Manitoba alone out of tobacco company coffers but also be having an impact on the leading cause of preventable premature death and disability in Canada.

Day-care versus inpatient pediatric surgery: a comparison of costs incurred by parents.

The cost-effectiveness for parents of day-care pediatric surgery was assessed by comparing time and financial costs associated with two surgical procedures, one (squint repair) performed exclusively as a day-care procedure, the other (adenoidectomy) performed exclusively as an inpatient procedure. All but 1 of 165 eligible families participated. The children underwent surgery between February and July 1981. The day-care surgery group (59 families) incurred average total time costs of 16.1 hours, compared with 37.1 hours for the inpatient surgery group (105 families), as parents in the latter group remained with their child during the longer hospital stay. Parents from out of town incurred the greater time and financial costs. In both groups parents of younger children tended to spend more time at the hospital than parents of older children. Type of surgical management was not a significant factor in out-of-pocket expenses. Loss of income was associated with employment of the mother as a professional or a manager and may reflect inequalities in access to compassionate leave between men and women in equivalent positions. Opening day-care surgery facilities on weekends might reduce the financial burden on working mothers. Overall, day-care surgery was found to be cost-effective for families.

Pediatric day-care surgery: a 30-year hospital experience.

Over a 30-year period (may 1955 to December 1985), day care surgery was performed on 39,654 patients at the Winnipeg Children's Hospital (WCH). Up to 51% of all pediatric surgical cases and 59% of elective pediatric cases, involving more than 50 different procedures, were performed annually on a day-care basis. The overall incidence of postoperative problems and admission to hospital was 1.5% and 1.1%, respectively. A unique preoperative home visiting program by nurses was demonstrably effective in reducing late cancellations by 75%. The WCH experience adds further evidence that day-care surgery in a pediatric hospital is safe and effective for a large proportion of infants and children requiring operation.