Romanian health and social care system for children and families: future directions in health care reform. Children's Health Care Collaborative Study Group.
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Intrafamilial cases of infection with the same strain of Helicobacter pylori (H pylori) have been reported but these clusters were too small to distinguish between person to person spread or coinfection from a common environmental source. To gain more information on the mode of transmission of H pylori, an epidemiological survey with bacterial strain differentiation by restriction endonuclease analysis of chromosomal DNA was carried out in an institution of 117 children with encephalopathy (aged 3.5 to 19 years). All children with antibodies against H pylori had gastroscopy to obtain gastric biopsy specimens. The prevalence of infection (confirmed histologically or microbiologically, or both) was 38% (45/117), and rose to 67% in one of the five sections of the institution. H pylori was isolated in 34/45 cases, and 22 different strains were found of which five strains were present in more than one child. Up to seven children were infected by the same strain, five of them were living in the same section. Analysis of the characteristics of infected children showed the predominant role of living conditions and the period of time cohabiting in this unexpectedly high prevalence of H pylori infection in children living in good sanitary conditions.
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In looking at demographic, social, psychiatric, and medical characteristics of 125 mentally disturbed children admitted to a state mental hospital in southern California in 1971 and in 1976, the authors found evidence of family instability and disposition to violent behavior to be the most notable features of the group; many of the children did not reveal evidence of thought disorder while in the institution. Children with conduct disorders represented the majority of admission diagnoses. The children's mean age at admission was 13.2 years; most of them had several previous residential placements, and 80 per cent were Anglo-Caucasian. The authors believe that the ability to manage children predisposed to violent outbursts is the key issue involved in returning these children to community life.
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