Playground equipment injuries in a large, urban school district.

We studied the epidemiologic features of playground equipment-related injuries occurring in a large, urban school district over a two-year period. Nurses in each of the district's 68 elementary schools completed self-coded reporting forms on all injuries meeting standardized criteria. A total of 511 equipment-related injuries were reported, an incidence of 8.9 injuries per 1,000 student-years. One-fourth of the injuries were severe, and climbing equipment was disproportionately represented among playground equipment associated with injuries. Extreme variability was found among school-specific rates of equipment injury, with schools at the two extremes separated by as much as a 40-fold difference in incidence. Two school characteristics--smaller student enrollments and the presence of alternative educational programs--were significantly associated with higher equipment-related injury rates.

Epidemiology of injuries in a large, urban school district.

Injuries represent the single greatest threat to the health and well-being of US children. A large number of childhood injuries are sustained in schools, yet little is currently known of the epidemiologic features of school-related injuries. A surveillance of injuries occurring in a large, urban school district during a 2-year period was conducted. Nurses in each of the district's 96 schools completed reporting forms on all injuries meeting standardized criteria, and both principals and nurses completed questionnaires on school characteristics that were judged potentially important to the injury rate in individual schools. A total of 5,379 injuries were reported, among the district's 55,000 students, for an overall injury rate of 49 injuries/1,000 student-years. Injury rates were higher for boys than girls at all age levels. Self-caused and sports-related injuries comprised nearly half of all those reported, and 14% were related to use of playground or sports equipment. Eighteen percent of injuries were severe, and playground- and equipment-related injuries were significantly more likely to be severe (P less than .001). Rates of injury among individual schools varied markedly, with schools at the two extremes separated by a 25-fold difference in rates. Higher overall injury rates were found in schools with longer hours, alternative educational programs, less experienced school nurses, and lower student-to-staff ratios (P less than .0001).

An analysis of physician-parent communication in pediatric prenatal interviews.

Thirty-three prenatal interviews done in the offices of four practicing pediatricians were audio-recorded, transcribed, and analyzed for content by two separate methods. Interviews with the individual pediatricians varied markedly in length and were significantly longer if the father was present. Pediatricians took charge of the interviews by asking more questions than parents and by talking twice as much as parents. A relatively small number of topics (medical care of the infant, infant feeding, business aspects of the pediatrician's practice, and history of the current pregnancy) occupied a majority of the interview time. Although interviews with individual pediatricians tended to include a standard set of topics, any given visit was individualized to address parents' issues. Follow-up interviews with mothers showed that they were highly satisfied with the visits and perceived the doctors as having been warm and friendly. Mothers' highly favorable reactions were achieved in spite of the fact that interview style was generally doctor-active/parent-passive, indicating that, in some medical settings, this approach may be quite appropriate.

A survey of physician consultations in an urban school district.

A survey of physician encounters was conducted in a large, urban school district following the institution of consultative, rather than full-time, school physician services. Review of the encounter data over a six-month period revealed that: (a) the majority of consultations related to the problems of individual children; (b) there was a high prevalence of behavioral and psychosocial issues among the problems addressed; and (c) physicians were prominently involved in cross-disciplinary interactions. The survey provides an analysis of physician utilization under an emerging model of school health services in which physicians serve as consultant members of a medical and educational team.

Amphotericin B and imidazole therapy for coccidioidal meningitis in children.

Coccidioidal meningitis is a fatal form of Coccidioides immitis infection. Amphotericin B (AMB) therapy has reduced mortality but is itself toxic, and experience with it in very young children is meager. We are treating six children for coccidioidal meningitis diagnosed at 19 to 74 months of age. All had acute hydrocephalus and ventriculitis. The first four patients were initially treated with AMB but were changed to imidazole therapy (miconazole and ketoconazole). In the last two patients therapy was begun with the imidazoles. Ommaya reservoirs for cisternal therapy have been of limited usefulness. AMB therapy has been limited by local and systemic toxicity and by failure in one case. All children have improved with 15 to 22 mg oral ketoconazole per kg per day and 3 to 5 mg intraventricular miconazole for instillation therapy, including those with noncommunicating hydrocephalus in whom the intraventricular drug does not reach the basilar cisterns. Peak concentrations of ketoconazole in ventricular fluid were 0.08 to 5.6 micrograms/ml. Shunt obstruction and bacterial superinfections have been the major causes of morbidity. Imidazole therapy of coccidioidal meningitis may be more effective than is AMB in young children, and it offers the advantages of fewer side effects and not requiring intrathecal or cisternal administration.

Characteristics of prenatal interviews provided by pediatricians.

A questionnaire regarding use of pediatric prenatal interviews was mailed to 235 pediatricians. From 197 responses, we identified 118 practicing pediatricians who see a minimum of 25 newborns per year. Eighty-six (73%) of this group of 118 physicians conduct prenatal visits. In the practices of these physicians, an average of 22% of mothers (or couples) have a prenatal visit. Physicians unanimously favored father's presence at the visit. Prenatal visits were more frequently done by urban than by nonurban physicians. Only 15% charge for a prenatal visit, despite spending an average of 20 office minutes as compared to 16 office minutes for a well-baby visit. Pediatricians have positive attitudes about the use of prenatal interviews, regardless of whether or not they conduct them. High consensus regarding the importance of these visits combined with the low prevalence of their actual use suggest the need for more parent and physician education of this aspect of pediatric care.

Use of pediatric prenatal visits by family physicians.

A questionnaire regarding the use of pediatric prenatal counseling interviews was mailed to 235 randomly chosen family physicians. From 164 responses, 69 practicing family physicians who see a minimum of ten newborns per year were identified. Thirty-five (51 percent) of this study group conducted pediatric prenatal visits with the expectant parents. They saw a mean of 65 percent of mothers (or couples) for such an interview and were unanimously in favor of fathers" attending the session. Whether members of the study group did or did not conduct prenatal visits did not correlate with geographic location, number of years in practice, or board certification. Those who did conduct prenatal interviews saw significantly more newborns per year than those who did not. The average prenatal visit lasted significantly longer than a well-baby visit. Study group members, regardless of whether they conducted prenatal interviews, had positive attitudes about their use. High consensus regarding the usefulness and importance of prenatal visit combined with the low prevalence of their actual use suggest the need for more parent and physician education around this aspect of the care of infants and parents.