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Biomedical subjects

J Pearn

Publications and source records attributed to J Pearn.

At least 19 recordsLinked to original sources
PubMed1992

Medical aspects of drowning in children.

Accidental, homicidal and suicidal drowning comprise a special challenge to the clinician and preventive medicine advocate, alike. In South-east Asia and Australasia, accidental immersion accidents rank highly among the causes of preventable child trauma. Bath-tub and bucket drownings affect infants and toddlers under the age of 12 months, and some 10 percent of fatal bucket-tub immersions affecting infants are the result of child abuse. Immersion accidents in the sea have special characteristics, not specifically as a result of differences in water osmolarity, but related to hypothermia, secondary lung complications, and immersion times. Swimming pool drownings are the major cause of preventable death affecting pre-school children in some regions of Australasia. Resuscitation of the near-drowned child is topical because, (a) of controversies about the optimality of mouth-to-nose expired air resuscitation (EAR) in infants under six months of age; (b) of controversies about the degree of brain damage among child survivors following intensive care salvage; and (c) the difficulties of having "every parent a first-aider". A major study of childhood immersions (The Brisbane Drowning Study has shown that of all survivors, some 70 percent will be completely normal, 30 percent will suffer some selective deficit (with wide disparities on sub-scale scores on formal IQ testing), and 3 percent will live in a permanent vegetative state. Vigorous preventative campaigns using the triad of (a) public media education and campaigns, (b) better safety standards and safety devices, and (c) safety legislation, can reduce both the population risk and the individual clinical severity of immersion accidents.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

An epidemiological and clinical study of snake-bites in childhood.

The last decade has seen major changes in the first-aid management of elapid snake-bites and the introduction of a new venom-detection kit which can identify the genus of medically-important snakes. In the light of these developments, we report a 10-year study that comprised 218 consecutive children who were admitted to hospital in southeast Queensland, after a confirmed or a suspected snake-bite. One-third (34.9%) of victims were preschool children (zero to five years of age) but the highest "at-risk" group comprised prepubescent boys. In 70% of cases, the bite was on a single lower limb. Of the 218 children who were admitted to hospital, 42% manifested local or systemic symptoms that were consistent with a confirmed snake-bite, irrespective of whether or not the species of snake was venomous. A positive identification of the genus of the offending snake was established in 18.8% of cases. In 35.8% of cases, the Commonwealth Serum Laboratories' Venom Detection Kit was used in an attempt to identify the involved snake, with 10 (4.6% of all cases) positive test-results. We have found that appropriate first aid was applied in the field in a maximum of 18% of cases. Antivenom was administered to 14 children, seven of whom received polyvalent antivenom; one child manifested a severe anaphylactic reaction. There were no fatalities in this series, and no permanent morbidity.

Adolescent↗
PubMed1987

Bicycle accidents in childhood.

The results of a 10 year study of bicycle fatalities and an eight year study of serious non-fatalities are reported for urban Brisbane (population 1,000,000). There were 845 serious non-fatal bicycle accidents and 46 fatalities during the study. Boys were involved in 86% of accidents. Boys have an accident rate of 134.21 per 100,000 population at risk and a fatality rate of 5.06 per 100,000 at risk. Serious bicycle accidents have increased by 50% in this decade; but considering fatal cases alone, no secular trend was evident over the 10 year period of the study. This suggests that an increase in the overall rate of bicycle accidents has been in part compensated by less serious injuries. In 70% of fatalities children had head injuries, and 87% of fatalities followed a collision between a cyclist and a motor vehicle or a train. Bicycle accidents on the roads most commonly occur to boys aged between 12 and 14 years on a straight road at "mid-block" between 3 and 5 pm in clear weather conditions and in daylight. It is concluded that injuries and fatalities after bicycle accidents can be reduced by protecting children's heads, separating child cyclists from other road traffic, or educating and training both cyclists and other road users in safe behaviour. The compulsory use of helmets and the restriction of access to the roads by child cyclists to reduce injuries are, however, still controversial in many areas.

Accidents, Traffic↗
PubMed1987

Ethics committees and paediatric research: a personal viewpoint.

Surveillance of clinical research involving child subjects, or tissues taken from them, continues to become more formalized and sophisticated. Many doctors and most paediatricians can be expected to be offered the opportunity to serve on paediatric Institutional Ethics Committees (IEC) at some stage of their professional lives. Fearless and independent Ethics Committees have considerable influence on both the design and implementation of clinical research, and on the topics of allowable research in which infants and children will be involved. The composition of IECs generally is designed to give a balance of sexes, professional backgrounds, and institutional and non-institutional affiliations. In addition to these now well established compositional guidelines, IECs adjudicating on paediatric research have a pragmatic requirement for three extra specific roles: those of in loco parentis, in loco infanti, and the special role of nursing staff. These roles and the ethical basis for them are defined. Further, the in loco parentis role is ethnically complex, and an IEC considering this role should be clear about its implications. Paediatric research projects involve not only specific risks inherent to the project in question, but also more general risks inherent in any clinical research intervention endeavour itself. Paediatric IECs should act in a mode of encouragement, rather than purely as 'doctor watchers', and should insist ab initio on the publication of results as a condition of permission to undertake the research in question. One particularly effective form of ethical audit is the national and international peer review that follows such publication of paediatric research. This report discusses these special themes in the evolving context of greater surveillance of paediatric research.

Child↗
PubMed1987

A classification of clinical paediatric research with analysis of related ethical themes.

Different types of clinical research are associated with different degrees of risk and with varying utility. Usually classified as therapeutic or non-therapeutic, clinical research involving children necessitates a balance between the conflicts of intrusion into a group of vulnerable subjects, and the obvious advantages which such intrusion engenders. To understand better the potential ethical dilemmas of paediatric research the author has expanded the classification of such clinical research involving children. Five types of such research--preventive research, curative research, research to alleviate symptoms, studies to establish norms and baselines, and curiosity research--are discussed in the context of their ethical constraints, and the different ethical questions which confront workers operating in each of these different themes.

Child↗
PubMed1979

Bee-sting anaphylaxis in childhood.

The syndrome of bee-sting anaphylaxis is described. Children who have suffered crescendo reactions to previous bee stings, especially children with a history of asthma, are significantly at risk. Desensitization is required in such cases; adrenaline should be kept in the home, and parents should be trained in its emergency use. The immunological mechanisms of bee-sting anaphylaxis are described. The striking seasonal incidence of anaphylaxis suggests that pollen or plant products which are incorporated in the venom may also be important in its genesis; it suggests also that antigens prepared from either whole-body or pure-venom extracts should be prepared from bees which are collected in late spring.

Aerosols↗
PubMed1979

Oleander poisoning.

The two common oleanders, Thevetia peruviana and Nerium oleander, contain a mixture of poisons including cardiac glycosides, and are extremely toxic. They are cultivated universally throughout Australia, and rank equally with mushrooms as the major cause of children's admission to hospital after accidental plant ingestions. A seven-year total population survey from south-east Queensland has revealed that, in practice, the rate of clinical poisoning due to oleander is inconsequential, and mortality is negligible. The annual age-specific admission rate for children (aged from birth to 12 years of age), for all plant ingestions is 2.33 per 100 000, and 0.62 per 100 000 specifically for oleander. Oleander ingestion causes a syndrome of combine cardiac and gastrointestinal symptoms and signs. A case series of 13 children is described, and the clinical features summarized. After accidental oleander ingestion, current experience indicates that the prognosis is excellent.

Antidotes↗