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Infection control in day-car centers: Present and future need
Virginia Layng Millonig, PhD, RN, CPNP Associate Professor, Nursing Continuing Education Program George Mason University, Fairfax, Va
Effects of Theophylline on learning and Behavior: Reason for Concern or Concern Without Reason?
n
Weinberger, M., Lindgren, S., Bender, B., Lerner, J., & Szefler, S. (1987). The louma/ of Pediatrics,
111, 471-473.
T
heophylline has been used in children for the treatment of asthma for more than 40 years. The early popularity of products conbining ephedrine and theophylhne gave way to single-drug formulation after reports of the synergism for adverse effects of these two orally administered bronchodilators. Recently, reported findings suggest that theophylline can cause behavior problems and poor school performance in children. These claims were made on the basis of reports of teachers’ impressions that higher activity levels and decreased concentration were observed during short-term administration of theophylline or placebo in two groups of 10 children without active symptoms of asthma. However, no drug effects could be detected by parents or by direct evaluation of cognitive skills, and no direct measures of academic achievement were examined. Even before this report appeared, its conclusions were summarized in a national news story with the headline “Asthma Drug Hard on Kids.” That article quoted the investigators as saying, ‘Teachers said kids couldn’t sit still, they weren’t remembering as well, they were acting up. . . their handwriting had changed . . . they were also getting into more fights.” This study in particular raised doubts regarding the safety of theophylline in children, but the critical data regarding results of the teacher evaluations were conmsing and incomplete. The article further states that adverse effects of theophylline and other drugs used in treatment of asthma in children have sometimes been difficult to document because of problems in separating effects of the medication from the neuropsychologic effects of asthma. The authors also indicate that inconsistencies in the current literature on theophylline effects are more striking than the consistencies. De270
pending on which study is selected, theophylline has been linked to improvements in or worsening of depression, improvements or decrements in learning, and adverse behavioral effects or lack of deterioration in behavioral functioning. Some of the differences among studies can be attributed to differing study populations, differing measurements, variations in the degree of blindedness and control of expectancy effects, different doses and serum concentrations of theophylline, and short- vs long-term administration of the medications. Nonetheless, a coherent picture does not emerge from the currently available data.
Infection Control in Day-Care Centers: Present and Future Need
n
Lopez,
I., Diliberto,
American Journal
J., & McGuckin,
of Infection Control,
M. (1988).
16, 26-29.
D
ay-care center operators run a labor-intensive, loosely regulated custodial educational business that lacks basic infection control practices. This study was designed to determine the current practices of infection control in 12 day-care centers (DDCs) in an urban university community and to determine the feasibility of an infection control educational model for day-care staff members and parents. The study was conducted over a &month period. Personal interviews were conducted with each DDC director to determine the scope of infection control policies and practices in effect. On-site observational visits were conducted to determine staff compliance or noncompliance with infection control principles. Results showed that the DCC staff members frequently do not understand how diseases are transmitted, nor do they have guidelines for managing a child with infectious disease. Their level of education does not correlate with the knowledge needed to prevent, recognize, control, and report the infectious diseases common to DCCs. The study confirmed the need for further development of infection control education programs, surveillance, and written policy and procedure manuals. JOURNAL
OF PEDIATRIC
HEALTH
CARE
Effects of Theophylline on learning and Behavior: Reason for Concern or Concern Without Reason?
n
Weinberger, M., Lindgren, S., Bender, B., Lerner, J., & Szefler, S. (1987). The louma/ of Pediatrics,
111, 471-473.
T
heophylline has been used in children for the treatment of asthma for more than 40 years. The early popularity of products conbining ephedrine and theophylhne gave way to single-drug formulation after reports of the synergism for adverse effects of these two orally administered bronchodilators. Recently, reported findings suggest that theophylline can cause behavior problems and poor school performance in children. These claims were made on the basis of reports of teachers’ impressions that higher activity levels and decreased concentration were observed during short-term administration of theophylline or placebo in two groups of 10 children without active symptoms of asthma. However, no drug effects could be detected by parents or by direct evaluation of cognitive skills, and no direct measures of academic achievement were examined. Even before this report appeared, its conclusions were summarized in a national news story with the headline “Asthma Drug Hard on Kids.” That article quoted the investigators as saying, ‘Teachers said kids couldn’t sit still, they weren’t remembering as well, they were acting up. . . their handwriting had changed . . . they were also getting into more fights.” This study in particular raised doubts regarding the safety of theophylline in children, but the critical data regarding results of the teacher evaluations were conmsing and incomplete. The article further states that adverse effects of theophylline and other drugs used in treatment of asthma in children have sometimes been difficult to document because of problems in separating effects of the medication from the neuropsychologic effects of asthma. The authors also indicate that inconsistencies in the current literature on theophylline effects are more striking than the consistencies. De270
pending on which study is selected, theophylline has been linked to improvements in or worsening of depression, improvements or decrements in learning, and adverse behavioral effects or lack of deterioration in behavioral functioning. Some of the differences among studies can be attributed to differing study populations, differing measurements, variations in the degree of blindedness and control of expectancy effects, different doses and serum concentrations of theophylline, and short- vs long-term administration of the medications. Nonetheless, a coherent picture does not emerge from the currently available data.
Infection Control in Day-Care Centers: Present and Future Need
n
Lopez,
I., Diliberto,
American Journal
J., & McGuckin,
of Infection Control,
M. (1988).
16, 26-29.
D
ay-care center operators run a labor-intensive, loosely regulated custodial educational business that lacks basic infection control practices. This study was designed to determine the current practices of infection control in 12 day-care centers (DDCs) in an urban university community and to determine the feasibility of an infection control educational model for day-care staff members and parents. The study was conducted over a &month period. Personal interviews were conducted with each DDC director to determine the scope of infection control policies and practices in effect. On-site observational visits were conducted to determine staff compliance or noncompliance with infection control principles. Results showed that the DCC staff members frequently do not understand how diseases are transmitted, nor do they have guidelines for managing a child with infectious disease. Their level of education does not correlate with the knowledge needed to prevent, recognize, control, and report the infectious diseases common to DCCs. The study confirmed the need for further development of infection control education programs, surveillance, and written policy and procedure manuals. JOURNAL
OF PEDIATRIC
HEALTH
CARE