Learning disorders and delinquency

Learning disorders of various types are relatively common, and the reaction of the affected child can lead to social problems. The higher the children's intelligence the more frustrated they can become. Lack of self-esteem can cause unacceptable behaviour in trying to counteract this, and boost the child's confidence. There is evidence that learning disabilities are prevalent among those who are delinquent. Theories suggest this may be due directly to the learning difficulties, or to failure at school, starting a series of events leading to delinquency, or to the idea that those with learning difficulties are treated differently, especially when it comes to legal proceedings. Epilepsy can easily lead to learning disorders; particularly if the temporal lobes are involved, there are associated emotional disorders, or side effects of treatment. Also this association is often found amongst children with attention deficit disorders. If the link between learning disorders and delinquency is recognised there is considerable scope for prevention.

The school entry medical examination. What do teachers think of it?

Questionnaires were sent to 76 schools in the Macclesfield district. Seventy-four of these were returned by head teachers and/or reception teachers. Replies concerned the school entry medical examination, information on individual children, general health information and access to professionals. Additional comments on any aspects of the service were also solicited. The results have been analysed. The majority of teachers considered that the school entry medical examination is of value, but the quality of information reaching teachers is viewed more critically. Meetings were the most favoured means of communication, but there are obvious defects in the system. Some teachers did not even know of access channels. If improvements do not occur some of the value of the examination will be lost. Suggestions for better communications are made. With local management of schools, teacher opinion must be considered if a better school health service is to be provided for the children of the district.

The more unusual sleep disturbances of childhood

The sleep patterns of children often cause anxiety to their parents. Some disturbances are unusual, and therefore may cause diagnostic difficulties. Sleep walking and night terrors can be confused with epileptic seizures. The sudden sleep of narcolepsy can lead to false accusations, when in fact the episodes are beyond the child's control. The associated phenomena of cataplexy, hypnogogic hallucinations and sleep paralysis can be particularly alarming, especially if they occur in the absence of narcolepsy. The overlap between narcolepsy and the Kleine-Levin syndrome is confirmed. Although of a different nature the sleep apnoea syndrome is equally important from the point of view of diagnosis and treatment.

Independence for the physically disabled

The difficulties in giving even relative independence to handicapped children are reviewed. A compromise has to be worked out between too much and too little independence. The personality of the child will be a governing factor, but there are many environmental influences. Not least among these are the attitudes of the parents, and to what extent they accept the handicapped child and encourage self-reliance. Education must be realistically based on the child's ability and likely potentials on leaving school. Acquiring daily-living skills may be as important as academic qualifications. More needs to be learnt about the balance between independence and over-protection, and the success of management for an individual child can only be judged when maturity is reached with adequate self-confidence, and a maximal ability to compete in the adult world.

Ethics rounds at the nursing home: an alternative to an ethics committee

The increased attention in US medicine to medical ethics reflects in large part the "new" demography of a growing elderly population and the conflict of whether decisions regarding medical care should be based on cost-effectiveness or "human-effectiveness." Currently, about 40 percent of the nation's elderly end up in nursing homes where they confront ethical and legal dilemmas that would not arise in their own homes. In the nursing home, difficult medical-ethical decisions generally rely on two approaches: the often used but frequently invalid concept of informed consent and little used ethics committees. At The Jewish Home and Hospital for Aged in New York City we have developed a program of "ethics rounds" as an alternative to ethics committees. We conduct the rounds in the open style of a forum or clinical conference rather than with the aura of a decision-making group. We encourage the participation of patients and family and seek to educate the staff, any one of whom may choose to attend. The rounds consist of a multidisciplinary case presentation, an interview of patient and/or family, a discussion by the staff, and an overview by an ethicist. Staff response to the educational and interdisciplinary aspects of the rounds has been remarkably positive.

Specific learning disorders: the possible role of brain damage

The causes of many of the more subtle disorders of cerebral function are often obscure. Are they due to impaired development of the brain or to damage to the brain? Particularly if there is no definite evidence of the latter, and when talking to parents, it is better to use such terms as "minimal cerebral dysfunction". However this must not lesson in any way the constant search for the etiology of these disorders. There is no doubt about their frequency, and in one form or another, about one in ten children have special educational needs. There is therefore a major medical contribution to be made to the problems of these children, especially in terms of prevention. A review of the literature shows, among other causes, how often episodes during pregnancy and birth can lead to learning problems during school life. In the future the development of new neuroradiological, and other techniques, will help to explain these common disabilities.

Endoscopic and radiographic evaluation of the murine colon

Endoscopic and radiographic techniques have not been widely applicable in the evaluation of chemically induced murine colon cancer. The authors investigated methods of cleansing the rat colon and refined endoscopic and radiographic techniques. They compared total colonoscopy (TC) and air-contrast (ACBE) and single-contrast barium enema (SCBE) findings with those obtained at necropsy in rats with 1,2-dimethylhydrazine (DMH)-induced colon cancer. Gastrograffin enemas with bisacodyl suppositiories showed complete evacuation of solid feces. Sprague-Dawley rats treated with DMH had their colons cleansed and then underwent TC (5.0-mm Olympus bronchoscope) and either SCBE or ACBE. Colonoscopy and ACBE were equally sensitive (81.5% and 76.3%, respectively), although SCBE was significantly insensitive in identifying lesions (P less than 0.001). This study demonstrates that: (1) mechanical cleansing of the rat colon is feasible, (2) TC and barium radiology can be done routinely after mechanical cleansing, and (3) TC and double-contrast BE are sensitive in identifying colon lesions. These techniques will provide a means for manipulation of murine tumors and in vivo surveillance.

Antibiotics in elective colon surgery. A randomized trial of oral, systemic, and oral/systemic antibiotics for prophylaxis

A prospective, randomized double-blind study was undertaken to compare the efficacy of three prophylactic regimens (oral neomycin and erythromycin, intravenous cefoxitin, and a combination of both oral and intravenous antibiotics) in patients undergoing elective colorectal surgery. One hundred sixty-nine patients were randomized and 146 patients were evaluable. Septic complications occurred in 11.4 per cent of patients receiving oral antibiotics only, in 11.7 per cent of patients receiving intravenous cefoxitin alone, and in 7.8 per cent of patients receiving both oral and intravenous antibiotics. These differences were not statistically different. The greatest number of septic complications occurred in those patients with anastomotic disruptions. Two patients died (1.3%), both of whom had major anastomotic failures. There was no advantage between any of the groups in the incidence of wound infection (3.9-6.8%). Thus, no advantage could be identified in this study in the combination of oral and intravenous antibiotics in elective colorectal surgery.

The preschool medical: an evaluation of this examination and its role in child health surveillance

Records of 244 preschool medicals were studied retrospectively. The value of the examination to the children, their parents and teachers, and the use of clinical medical officer time was considered. Fifty-seven per cent had previously undetected problems deemed to require follow-up. This number was subsequently corrected to 50% in the light of current practice. Fourteen per cent warranted referral to other professionals and 4.5% received treatment. The high number of vision defects noted suggests further study. Fifteen per cent of the parents wished to discuss concerns about their children with the clinical medical officer. Clinical medical officer practice varied, but showed the incidence of follow-up to be inversely proportional to the referral rate. The number of previously undetected problems recorded in the survey supports medical examination of all children at this age. However, review of criteria and further study is indicated to make the best use of resources.

An epidemiologic investigation of birth outcomes in relation to dibromochloropropane contamination in drinking water in Fresno County, California, USA

This report describes an epidemiologic investigation of the relationship between dibromochloropropane (DBCP), contamination in drinking water and birth outcomes between 1978 and 1982 in Fresno County, California, USA. Census tracts in the county were categorized according to DBCP level in drinking water. A direct comparison between exposure categories was done by the use of the Mantel-Haenszel chi-square procedure to compute relative ratios or risks for low birth weight and birth defect, adjusting for age, race, percent Hispanic, and parity. No correlation between these birth outcomes and DBCP contamination was found. In addition, we did not find any difference in sex ratio in relation to DBCP contamination.

Metachromatic leukodystrophy (MLD) in hospitalized adult schizophrenic patients resistant to drug treatment

Metachromatic leukodystrophy (MLD) is a rare inherited neurodegenerative disease associated with a defect in the catabolism of sulphatide (galactocerebroside-sulphate) which accumulates in the nervous system. MLD can be diagnosed biochemically by demonstrating deficiency in the activity of the enzyme arylsulphatase A (ASA) and an excess of sulphatide in urine and tissues. Clinically adult MLD may present as a schizophrenic-like psychosis, which typically develops years before the onset of neurologial signs which are not inevitable. Urinary ASA was investigated in 99 chronic hospitalized psychiatric patients (including 77 schizophrenics). Thirteen showed reduced ASA activity. Of the nine who were available for further study, only one evinced reduced ASA activity in other tissues (for example, leukocytes and cultured fibroblasts). However, there was no evidence of sulphatidurea with impaired sulphatide hydrolysis in his intact cultured fibroblasts. Therefore, he tested negative for MLD. This biochemical profile is known as pseudosulphatase deficiency. The possible relationship of pseudosulphatase deficiency to schizophrenic-like conditions is discussed.