Are ball pits the playground for potentially harmful bacteria?

Ball pits, enclosed play areas with padded floors and pits of small plastic balls, have become popular features for children at fast food restaurants. This pilot study sought to identify and confirm bacterial organisms that place children at a potential health risk in three play pits within fast food restaurants. Data for this descriptive study were randomly collected from restaurants offering play pits with multicolored, round, hollow, plastic balls within urban communities of the Tidewater region of Virginia. Specimens were collected from entrances into the ball pits as well as various areas of the bottom lining to incur a representative sample. Results indicated an increased level of normal flora as well as nonhuman flora, demonstrating that bacteria are present within the ball pits. The results question the safety of these play pits for both health care providers and parents. Nurses play a vital role in public awareness through health education. Disinfection protocol and proper handwashing are the keys to making ball pit play areas safe for children.

The effect of lysosomotropic amines on beige mouse cells.

The beige mutant in the mouse is characterized by enlarged lysosomes in many cell types due to increased fluidity of cellular membranes and organelle fusion. In this study, mutant fibroblasts derived from C57BL/ 6J;bgJ/bgJ animals were compared with control fibroblasts (C57BL/6J;+/+) for vacuolation when treated with lysosomotropic weak bases including ammonium chloride, trimethylamine, and methylamine. These amines produce vacuolation by their accumulation in cellular acidic compartments, which causes osmotic swelling and fusion of organelles due to the increase in pH. Beige cells exhibited greater vacuolation than control cells for all treatments, which was indicative of the mutant's effect on organelle fusion and membrane fluidity. Trimethylamine caused the most pronounced difference in vacuolation between mutant and control cells. This method allows for a simple morphological distinction between beige and control cells that also utilizes a physiological difference in the expression of the beige gene.

One for tea, not two.

This case report illustrates a potentially common cause for the inhibition of iron absorption that can be overlooked at the initial consultation and may lead to extensive investigation of a patient with iron deficiency. The case shows that early questioning of the patient regarding their beverage intake can lead to a positive outcome and avoid unnecessary investigation or treatment.

Impact of adversity on functioning and comorbidity in children with attention-deficit hyperactivity disorder.

OBJECTIVE: Prior research on risk factors for attention-deficit hyperactivity disorder (ADHD) has shown that familial risk factors play a role in the disorder's etiology. This study investigated whether features of the family environment were associated with ADHD. METHOD: One hundred forty children with ADHD and 120 normal control probands were studied. Subjects were Caucasian, non-Hispanic males between the ages of 6 and 17 years. Exposure to parental psychopathology and exposure to parental conflict were used as indicators of adversity, and their impact on ADHD and ADHD-related psychopathology and dysfunction in children was assessed. RESULTS: Increased levels of environmental adversity were found among ADHD compared with control probands. The analyses showed significant associations between the index of parental conflict and several of the measures of psychopathology and psychosocial functioning in the children. In contrast, the index of exposure to parental psychopathology had a much narrower impact, affecting primarily the child's use of leisure time and externalizing symptoms. CONCLUSIONS: A relationship appears to exist between adversity indicators and the risk for ADHD as well as for its associated impairments in multiple domains. These findings confirm previous work and stress the importance of adverse family-environment variables as risk factors for children who have ADHD.

Randomized prospective study of self-management training with newly diagnosed diabetic children.

This study was designed to evaluate the effects of a self-management training (SMT) program on metabolic control of children with insulin-dependent diabetes mellitus (IDDM) in the first 2 yr after diagnosis. After standard in-hospital diabetes education, 36 children (mean age 9.3 yr, range 3-16 yr) were randomized to conventional follow-up, conventional and supportive counseling (SC), or conventional and SMT, which emphasized use of data obtained from self-monitoring of blood glucose. SC and SMT interventions consisted of seven outpatient sessions with a medical social worker during the first 4 mo after diagnosis and booster sessions at 6 and 12 mo postdiagnosis. Groups were similar with respect to age, sex, body mass index, socioeconomic status, C-peptide, and severity of illness at diagnosis. Metabolic control, measured quarterly by glycosylated hemoglobin (HbA1), improved substantially in all three treatment groups during the first 6 mo. SMT patients had significantly lower HbA1 levels than conventional patients at 1 yr (P less than 0.01) and 2 yr (P less than 0.05) postdiagnosis. SMT patients also had lower HbA1 levels than SC patients, but this did not reach statistical significance. The lower HbA1 levels of SMT patients were not explained by severity of illness at diagnosis, or insulin dose, body mass index, and C-peptide levels at 2 yr. These results suggest that an SMT program during the first few months after diagnosis helps avoid the deterioration in metabolic control often seen in children with IDDM between 6 and 24 mo after diagnosis.

In-hospital bedside blood glucose monitoring: the importance of a quality control program.

This study examined the adequacy of a quality control program to assure accuracy of blood glucose monitoring performed at the bedside by nurses in a general pediatric hospital. A standard quality control program during which all nurses received inservice training and demonstrated proficiency resulted in accuracies (percentage of values within 15% of the laboratory) of only 68.6% and 69.2% over two successive 3-month periods. A standardized refresher course did not improve accuracy. Expansion of the program to include identification and reinstruction of individual nurses who had more than 20% of their blood glucose measurements more than 10% off the laboratory value or any one value more than 40% off the laboratory during the previous quarter resulted in improved accuracies (83%, 78%, and 91%) over three successive 3-month periods. These findings indicate that a systemic quality control program including individual monitoring and remedial retraining is required to improve the long-term accuracy of bedside blood glucose monitoring by nurses in a general pediatric hospital.

Self-monitoring of blood glucose by adolescents with diabetes: technical skills and utilization of data.

Two studies of adolescent patients were conducted to determine their technical skills and utilization of data obtained by self-monitoring of blood glucose (SMBG). In Study 1, direct observations of 58 adolescents revealed an overall SMBG technical accuracy score of 82%. Most frequent errors were not cleaning fingers (45%), not placing blood on strips correctly (21%), and wiping strip at wrong time (14%). Technical performance was inversely correlated with blood glucose concentration, but was unrelated to other variables. In Study 2, a questionnaire was used to determine SMBG practices among 64 adolescents. Although the majority of patients reported doing daily SMBG, most did not record results in logbooks every time or utilize such data for self-management. No significant relationships were found between SMBG behaviors and other variables. We conclude that periodic evaluation and retraining are required for maintenance of SMBG skills and that methods to enhance utilization of SMBG data be developed for this patient population.