Attempted to examine the generalizability of environment/development relationships among 3 ethnic groups across the first 3 years of life. Social status did not show a consistent relationship to either quality of home environment or children's developmental status across the various groups. Results indicated a fairly consistent relationship between HOME scores and children's developmental status, although there were some ethnic and social status differences in the relationship. Measures of specific aspects of the child's home environment, such as parental responsivity and availability of stimulating play materials, were more strongly related to child developmental status than global measures of environmental quality such as SES. When the child's early developmental status and early home environment were both very low, the likelihood of poor developmental outcomes was markedly increased compared with cases when only one was low.
The reason that children with cleft palates tend to have a greater prevalence of tooth decay than normal children is unclear. We hypothesized that children with cleft palates would have increased oral clearance times for foods and, consequently, higher levels of caries and caries-associated micro-organisms than control children. Children aged 6-16 yrs, with (n = 81) or without (n = 61) cleft palates, were studied. Children with cleft palates had DMFT and dmft scores greater (p < 0.01) than those of the control group. The number of caries-associated organisms was greater in the saliva of the cleft palate children (all p < 0.001). The oral hygiene, plaque and gingival index scores were greater (p < 0.0001), oral clearance was longer (p < 0.01), and levels of sucrose and starch-derived saccharides higher (p < 0.01) in the cleft palate group. However, salivary concentrations of organic acids were lower in the children with craniofacial disorders, probably reflecting the altered physiology of the more mature dental biofilm. The longer oral clearance times of foods and the consequent generation of fermentable sugars from starches may contribute to the higher caries prevalence observed in children with cleft palates.
193 basically healthy working-class and middle-class mothers and their infants participated in a 4-year longitudinal study which focused on the relative potency of several clusters of variables for predictions of intellectual and language outcome during the preschool years. The major results were: (1) Measures of perinatal or infant physical status were extremely weak predictors of 4-year IQ or language. (2) Assessments of child performance were poor predictors prior to 24 months, but excellent predictors from 24 months on. (3) Assessments of mother-infant interaction and general environmental quality were among the best predictors at each age tested, and were as good as measures of child performance at 24 and 36 months in predicting IQ and language. (4) Measures of the family ecology (level of stress, social support, maternal education) and parent perception of the child, especially when assessed at birth, were strongly related to child IQ and language within a low-education subsample, but not among mothers with more than high school education. Patterns of prediction were similar for 48-month IQ and 36-month receptive language; predictions were notably weaker for 36-month expressive language.
Clostridium difficile is most commonly associated with colonic infection. It may, however, also cause disease in a variety of other organ systems. Small bowel involvement is often associated with previous surgical procedures on the small intestine and is associated with a significant mortality rate (4 of 7 patients). When associated with bacteremia, the infection is, as expected, frequently polymicrobial in association with usual colonic flora. The mortality rate among patients with C. difficile bacteremia is 2 of 10 reported patients. Visceral abscess formation involves mainly the spleen, with 1 reported case of pancreatic abscess formation. Frequently these abscesses are only recognized weeks to months after the onset of diarrhea or other colonic symptoms. C. difficile-related reactive arthritis is frequently polyarticular in nature and is not related to the patient's underlying HLA-B27 status. Fever is not universally present. The most commonly involved joints are the knee and wrist (involved in 18 of 36 cases). Reactive arthritis begins an average of 11.3 days after the onset of diarrhea and is a prolonged illness, taking an average of 68 days to resolve. Other entities, such as cellulitis, necrotizing fasciitis, osteomyelitis, and prosthetic device infections, can also occur. Localized skin and bone infections frequently follow traumatic injury, implying the implantation of either environmental or the patient's own C. difficile spores with the subsequent development of clinical infection. It is noteworthy that except for cases involving the small intestine and reactive arthritis, most of the cases of extracolonic C. difficile disease do not appear to be strongly related to previous antibiotic exposure. The reason for this is unclear. We hope that clinicians will become more aware of these extracolonic manifestations of infection, so that they may be recognized and treated promptly and appropriately. Such early diagnosis may also serve to prevent extensive and perhaps unnecessary patient evaluations, thus improving resource utilization and shortening length of hospital stay.
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