No abstract

The purpose of this study was to determine if Schönlein-Henoch purpura represents an abnormal host response to microorganisms. Among 1,222 cases, representing all new Danish cases in children during the years 1977-84, there was no tendency for the cases to cluster; this means that the disease is not caused by a single, contagious agent. In a smaller sample of 281 children examined in detail, a higher number than expected attended day nursery or nursery school and 17% had received antibiotic treatment during the week prior to admission. The latter findings, together with the seasonal variation of the incidence and the activation of the immune apparatus in many cases, suggest that Schönlein-Henoch purpura may be triggered by infection with several different microorganisms, but there is no evidence that a single one such as the streptococcus is the major offender.

Most infants are infected with respiratory syncytial virus (RSV) during the first 2 y of life. The majority have only a mild upper respiratory tract infection, but 1–2% develop a more severe illness and are admitted to hospital. Aim: To carry out a study of risk factors for hospital admission because of RSV infection in Denmark in children aged less than 2 y of age. Methods: The study population included all 1252 children admitted to hospital with verified RSV infection in two Danish counties during the 5‐y period 1990–1994. The investigation comprised a retrospective case‐control study with five matched controls per case. In a multivariate analysis the risk factors included medical and demographic variables, and in infants < 3 mo of age at hospitalization, two aspects of innate immunity: mannose‐binding lectin (MBL) concentration and maternal RSV serum antibody titre, measured on eluates from stored dried blood from the infants’4th day of life. The effect of each risk factor is expressed as an odds ratio, corresponding to the relative risk of being a case rather than a control if the risk factor is present. Results: The following independent risk factors were identified: age, sex, month of birth, gestational age, birthweight, presence of a sibling, up to 5 y older than the case, and maternal smoking during pregnancy. There was a marginal effect of maternal RSV antibody levels, but no effect of neonatal serum MBL concentration or of crowding in the household. Conclusions: Ninety percent of cases and 80% of controls had one or more risk factors. Even though several factors were found to increase the risk for hospitalization for RSV disease, all the effects were small and no single specific factor could be identified to explain the hospitalization of the minority of children with RSV infection.

Stress and burnout among general practitioners (GPs) is a serious problem. Some authors suggest supervision groups or Balint groups as a means of preventing burnout and others address how to treat the condition. This paper reports a case study of a supervision group for Danish GPs which, as well as training reflective practice, focuses specifically on the prevention of burnout. The concept of compassion fatigue is extended to cover the circumstances reported by some practitioners in supervision.