Outpatient treatment of croup with nebulized dexamethasone.

PURPOSE: To determine if treating children who have acute, moderate croup with nebulized dexamethasone sodium phosphate in the emergency department results in clinical improvement by 4 hours and a decrease in the hospitalization rate. DESIGN: Randomized, double-blind, placebo controlled trial. SETTING: Emergency department, children's hospital. PATIENTS: Fifty-five children with croup who were in moderate respiratory distress after treatment with mist for 30 minutes who met inclusion and exclusion criteria. MEASUREMENTS: Croup score, respiratory rate, heart rate, and oxygen saturation were assessed by one of us (D.W.J. or S.S.) before treatment and 2 and 4 hours after treatment. A staff pediatrician or senior pediatric resident, also "blind" to treatment, decided on admission to or discharge from the hospital. The differences between groups for change in croup score and hospitalization rate after treatment were analyzed. RESULTS: Evaluation of the croup scores disclosed a significant improvement in the dexamethasone-treated group compared with the placebo group at 4 hours (P=.005, Mann-Whitney U). However, the hospitalization rate was not statistically different at the end of treatment (33% vs 52%, P=.28) or after 24 hours (48% vs 60%, P=.56, Yates corrected chi(2)). Our study has 80% power to detect a two-thirds reduction in hospitalization rate. Two patients with neutropenia treated with dexamethasone had a clinical course consistent with bacterial tracheitis. CONCLUSIONS: Treatment of moderate croup with nebulized dexamethasone results in clinical improvement within 4 hours. We did not show a decrease in hospitalization rates, although our sample size was only large enough to detect a 67% reduction in the rate of hospitalization. Given the infectious complications and the absence of evidence for a sustained clinical effect, we do not recommend that patients with croup be treated with nebulized dexamethasone.

Sexual climate and reported rape: a state-level analysis.

Data on the US states are used to study two aspects of sexual climate: sexually liberal attitudes and sex magazine readership, and their relationship to reported rape. The two sexual climate measures are correlated (r = 0.50), but each also seems to measure a different facet of sexual climate: tolerance for the sexual behavior of others in the case of the Sexual Liberalism Index, and perhaps sexuality per se in the case of sex magazine readership. States in the Northeast have the highest average sexual liberalism score, and states in the West have the highest average readership of sex magazines. The relationship between sexual climate and the incidence of reported rape was investigated using multiple regression. Results indicate no relationship between sexually liberal attitudes and rape, but that sex magazine readership, urbanization, poverty, and a high percentage of divorced men are each significantly associated with the incidence of reported rape. The findings are interpreted within a theoretical model that posits rape as a function of social disorganization and hypermasculine gender roles and sexuality.

The role of family therapy in treating physical illness.

Family relationships, behavior patterns, and the manner of responding to stress are important causal factors in physical illness and in health. Using case examples from his own practice as well as a review of the literature, he demonstrates ways that families help create and complicate physical illness. Elements of his family therapy program that he feels contribute to its success include helping the family focus on the past in relation to present concerns, investigating ways the family reacts to the illness, asking the patient why he is ill, conducting classes in stress release, and helping the family change patterns of interaction.