Detection of Haemophilus influenzae type B antigen in cerebrospinal fluid after immunization.
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Antigens, Bacterial↗
Biomedical subjects
B Caldwell
Publications and source records attributed to B Caldwell.
Congenital disorders of sexual differentiation: MR findings.
A broad spectrum of anomalies of sexual differentiation may exist at birth. These include male and female pseudohermaphroditism, gonadal dysgenesis, and true hermaphroditism. When ambiguous genitalia are present, expedient identification of the anomaly is required for proper gender assignment and appropriate surgical or hormonal correction. As the appearance of the external genitalia often is not distinctive enough to make a specific diagnosis, this must be accomplished by clinical findings along with a combination of cytogenetic, biochemical, and radiologic studies. Because the causes of abnormal sexual differentiation are diverse and often exhibit incomplete expression, they produce much anatomic variability. Sonographic and radiographic studies are often used initially to evaluate such conditions. The noninvasive multiplanar nature of MR imaging makes it a useful alternative method with which to characterize the abnormal anatomy in this group of disorders, as we illustrate in this pictorial essay.
Disorders of Sex Development↗
Perinatally acquired human immunodeficiency virus infection: extent of clinical recognition in a population-based cohort. Massachusetts Pediatric HIV Surveillance Working Group.
To evaluate factors that may affect the timely diagnosis of children with human immunodeficiency virus (HIV) infection, we compared data derived from two population-based pediatric HIV studies. Data from anonymous newborn HIV serosurveys were used to estimate the number of children born to HIV-seropositive mothers. A statewide active surveillance project determined the number of HIV-exposed children who had been clinically recognized. Of 88,732 Massachusetts newborn specimens tested anonymously for HIV antibodies during a 12-month period (November, 1987, to October, 1988), 223 were positive. As of October, 1991, 78 of these children (35%) had been identified by a statewide network of infectious disease physicians. HIV-exposed children born in inner city hospitals were more likely to have come to medical attention than those born in suburban hospitals (47% vs. 17%). Among the 29 children with confirmed HIV infection (13% of 223), the initial evaluation for HIV occurred at an earlier age among children born in inner city hospitals than among children born in other areas. HIV testing practices that rely heavily on risk assessment may result in delayed diagnosis of HIV infection in children whose mothers are not perceived to be at risk.
AIDS Serodiagnosis↗
Educare: new product, new future.
On September 2, 1990, something very informative about the evolution of early childhood programs in the minds of people appeared in The New York Times. Perhaps only another historian of trivia would have noticed it, but it was significant. The Sunday crossword puzzle had the following cue for 4 down: "Places for day-care" (spelled, with the purist's uncertainty, with a hyphen). Even such a cautious horizontal-vertical weaver as I am did not have to wait very long before filling in the correct 10 letters: "preschools." Preschools = day-cares; day-cares = preschools. I am told that actors and authors and scientists know that they have it made when their names are required as solutions in a Times crossword puzzle. If so, perhaps we now have tangible proof that those of us have at last been heard who have urged acceptance of the concept that early childhood education (or preschool education) and child care (or day care) are really one and the same essential service operated for different lengths of time. Day care, the illegitimate child of the scientific field that gave birth to the early childhood movement, has turned out to be the only offspring sufficiently well endowed and robust to make it in the modern world. It is the only one possessing the characteristics that will enable it to take the family enterprise into the future. At this juncture, near the close of the century during which programs for young children multiplied to the point where they cannot be ignored as significant factors in family and public life, we are on the threshold of a new era.(ABSTRACT TRUNCATED AT 250 WORDS)
Child Care↗
Development of a WHO Child Care Facility Schedule (CCFS): a pilot collaborative study.
This paper describes the research conducted by a WHO collaborative study group for the development of a questionnaire method for the assessment of quality in child-care settings. The results of an inter-rater reliability study undertaken in Greece and Nigeria suggest that the Child Care Facility Schedule (CCFS), composed of 80 items, offers a satisfactory system of rating, especially after modifications were made to refine certain items, alter the scoring system so as to grasp nuances, and clarify the instructions in the users' manual, including revisions in the interviewing technique. A validity study to confirm the usefulness of this method is being carried out in Athens.
Child Care↗
Ovarian antibodies detected by immobilized antigen immunoassay in patients with premature ovarian failure.
An enzyme-linked immunosorbent assay (ELISA) was used to detect ovarian and oocyte antibodies in serum from 45 patients with premature ovarian failure (POF). Control sera were obtained from a similar group of normally cycling women without POF. A specific antibody reaction was found when POF sera were tested against human ovary (47%) or oocytes (47%). A combined total of 69% of the sera were positive for either ovary or oocytes. Fewer sera were positive for antibodies against human thyroid (18%) or human placenta (22%), and virtually no reaction with human liver (4%) was seen. LH antibodies were detected by ELISA against LH in only 3 POF sera that also contained ovarian antibodies. Therefore, gonadotropin antibodies alone do not appear to account for POF. In addition, 2 patients were treated by immunosuppression and became pregnant coincident with a decline in the serum concentration of ovarian antibodies. In summary, the results of this study are consistent with previous immunohistochemical data which indicate that ovarian and oocyte antibodies are common in patients with POF. This supports the concept that some forms of POF are associated with an autoimmune process. Furthermore, detection of ovarian and oocyte antibodies by ELISA may permit routine diagnosis of autoimmune POF and provide a basis for therapy.
Adult↗
Bromocriptine as primary therapy for prolactin-secreting macroadenomas: results of a prospective multicenter study.
To assess the effectiveness of bromocriptine in reducing the size of PRL-secreting macroadenomas with extrasellar extension, we conducted a prospective multicenter trial in patients without prior radiotherapy, applying a standard protocol of treatment and tumor size evaluation. Basal serum PRL levels [1441 +/- 417 (+/- SEM) ng/ml for women; 3451 +/- 1111 ng/ml for men] fell in all patients and to 11% or less of basal values in all patients but 1. Normal PRL levels were reached in 18 of the 27 patients. In 13 patients (46%), tumor size was reduced by greater than 50%, in 5 patients (18%) by about 50%, and in 9 patients (36%) by approximately 10-25%. The extent of tumor size reduction did not correlate with basal PRL, nadir PRL, percent fall in PRL, or whether PRL levels reached normal. However, a reduction in PRL levels always preceded any detectable change in tumor size. In 19 patients, reduction in tumor size was evident by 6 weeks, but in the other 8, such reduction was not noted until the 6 month evaluation. In the 4 patients in whom bromocriptine was discontinued at the end of 1 yr, tumor reexpansion occurred in 3. Visual fields improved in 9 of the 10 patients in whom they were abnormal. Because of the excellent results found in most of the patients in this series, we suggest that therapy with bromocriptine should be considered as initial management for patients with PRL-secreting macroadenomas.
Adenoma↗
School phobia.
Pediatricians and other primary care providers are in an ideal position to prevent, to diagnose and to treat children with school refusal. Detection requires recognition of high risk situations, and delineation of possible reality factors or environmental hazards. The physician will find school refusal associated with perceived or actual physical illness, debility, or vulnerability, family stresses including illnesses and marital problems, over-protective mother-child interaction patterns, and previous difficulties in achieving mother-child independence and separation. Confirming the diagnosis depends on interview with family members. Positive indicators are dysfunctional patterns of family communication, parental emphasis on illness, and manipulative behavior on the part of the child. Data from the school on absenteeism need to be supplemented by the school's observations of individual achievement and ability measures, grades, and teacher observations of peer and adult interaction. Treatment techniques center around returning the child to school by involving the child, the family, and the school in this process. Specific counseling techniques and principles aim to recognize each individual's feelings and to stress the active role of the parents in solving problems together. Follow-up is based upon assessment of clearly understood short-term and long-term goals. Referral should be rare, and should not be undertaken before proper evaluation has been completed. Making a referral "stick" depends greatly upon the degree of rapport and trust which has been established with the family. In most school refusal cases, management by the pediatrician or primary physician can be a rewarding, stimulating experience which provides a high degree of parent and physician satisfaction.
Adolescent↗
L-S ratio in predicting pulmonary maturity in utero.
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Amniocentesis↗
The role of traditional fertility regulation in Sri Lanka.
Among the countries of South Asia, Sri Lanka, with a birth rate of 26 per 1,000, has achieved by far the lowest fertility level. The research reported here shows that at least half of all fertility control there is still practiced by means other than those offered by the national family planning program. This paper reports on an investigation carried out by the Sri Lankan Department of Census and Statistics, employing a micro-approach to demographic research, on the levels of "traditional" methods of family planning and attitudes toward the practice of both modern and traditional contraception. It is shown that knowledge of rhythm was diffused throughout society as the cost of raising children increased during a period when other methods of family planning were not easily accessible. These traditional methods were employed efficiently and their high level of continued use arises from strong cultural resistance to the pill and IUD, based upon local interpretations of how these methods function. Thus, any programmatic effort to reduce dependence on traditional family planning might well result in higher fertility levels. In addition, low fertility among Indian Tamil workers on the Tea Estates, as early as the 1950s, probably resulted from a desire (manifested by lower levels of sexual activity and some abortion) to avoid frequent pregnancies, since pregnancy interrupts work that the female Estate workers cannot afford to miss.
Attitude↗