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Objectives To provide an updated review and examine any trends among congenital malaria cases that might help guide diagnosis, treatment, and public health recommendations. Design Retrospective case series. Setting United States. Participants We reviewed all cases of congenital malaria reported to the US National Malaria Surveillance System between January 1, 1966, and December 31, 2004, including 1 unpublished case from 2005, encompassing all years for which data were collected and available. Main Exposures Maternal characteristics, including travel history, and malaria treatment. Main Outcome Measure Characteristics of congenitally acquired cases of malaria. Results For the 81 cases of congenital malaria reported in the United States in the past 40 years, the predominant infecting species was Plasmodium vivax (81%). Most mothers (96%) were foreign born, and 55 of 65 women (85%), for whom time of most recent exposure was known, were exposed 1 year or less before delivery. A common error in the treatment of infants with congenital malaria was the unnecessary administration of primaquine phosphate for P vivax infection. Conclusions Health care professionals should have heightened vigilance for malaria in pregnant women who have emigrated from or traveled to malaria-endemic areas within the past year, as well as in their offspring. Such women with episodes of fever during pregnancy should have a blood film to test for malaria performed promptly and should be treated appropriately. Treatment of a mother does not negate the need for heightened vigilance in her newborn. Health care professionals should be aware that congenital P vivax malaria does not need to be treated with primaquine.

Objectives To evaluate parental health beliefs regarding the varicella vaccine and to identify potential areas for interventions designed to increase immunization against varicella. Setting Data were collected in the offices of pediatricians who are members of the Puget Sound Pediatric Research Network, a regional practice-based research group in the Seattle, Wash, area. Methods At the time of an office visit, parents were asked to complete a survey on the varicella vaccine. Respondents indicated level of agreement with 10 health belief statements regarding the immunization using a 6-point Likert scale from "completely agree" to "completely disagree"; responses were subsequently transformed to an ordinal scale from 1 to 6, with 6 corresponding to highly positive beliefs. A composite health belief score for each respondent was computed by averaging responses to all statements. Parents also were asked to indicate the level of influence of their child's pediatrician on their decision to use the varicella vaccine. Results A total of 598 surveys were completed. Generally, parents agreed that the vaccine was worthwhile even if the only benefit was preventing a rare complication. Conversely, the majority of parents disagreed that varicella vaccine was worthwhile if the only benefit was preventing lost time from work, and that the immunization was worthwhile even if immunity was not lifelong. Parents who indicated that their child's pediatrician's opinion significantly influenced their decision to use the vaccine had higher composite health belief scores than those who indicated less influence (median scores, 4.3 and 4.0, respectively; P Conclusions In this sample, parents had more positive health beliefs about the ability of varicella vaccine to prevent rare complications than to save time lost from work. These data also suggest that pediatricians can have an important role in increasing positive health beliefs about the vaccine. These findings may help future interventions to increase the immunization rate against varicella.

ContextRespiratory syncytial virus (RSV) causes more lower respiratory tract infections, often manifested as bronchiolitis, among young children than any other pathogen. Few national estimates exist of the hospitalizations attributable to RSV, and recent advances in prophylaxis warrant an update of these estimates.ObjectivesTo describe rates of bronchiolitis-associated hospitalizations and to estimate current hospitalizations associated with RSV infection.Design and SettingDescriptive analysis of US National Hospital Discharge Survey data from 1980 through 1996.ParticipantsChildren younger than 5 years who were hospitalized in short-stay, nonfederal hospitals for bronchiolitis.Main Outcome MeasureBronchiolitis-associated hospitalization rates by age and year.ResultsDuring the 17-year study period, an estimated 1.65 million hospitalizations for bronchiolitis occurred among children younger than 5 years, accounting for 7.0 million inpatient days. Fifty-seven percent of these hospitalizations occurred among children younger than 6 months and 81% among those younger than 1 year. Among children younger than 1 year, annual bronchiolitis hospitalization rates increased 2.4-fold, from 12.9 per 1000 in 1980 to 31.2 per 1000 in 1996. During 1988-1996, infant hospitalization rates for bronchiolitis increased significantly (P for trend

Among medically underserved immigrant parents, access to nonprescription medicines for home treatment of minor childhood illnesses may be limited by scarce financial resources or language barriers.To design and implement a new clinical service for an urban ambulatory pediatric clinic with a large immigrant population that allows pharmacists to evaluate and to treat children and adolescents aged 6 months to 19 years with minor acute illnesses and to provide bilingual patient education materials.We developed protocols and encounter forms for pharmacist evaluation of 5 pediatric conditions: cough/cold, fever, diaper rash, vomiting/diarrhea, and head lice. We published bilingual patient education materials for these conditions in 8 commonly spoken languages. We assessed safety by thoroughly reviewing the medical records of all patients who returned within 1 week of a pharmacy encounter and by asking parents in a telephone survey to compare services received through the pharmacy and the acute care clinic for treatment of the common cold.During the first year of this pilot program, 191 patients were evaluated and treated, 145 (76%) for cough/cold. Seventy percent of the patients were immigrants. No unexpected or adverse outcomes were detected, although occasional deviations from established protocols were noted. Parent satisfaction with the pharmacy service was high, and similar to that received through the standard acute care clinic. Patients evaluated by pharmacists were more likely to be attended to promptly (15-minute wait) and were more likely to receive written information than patients evaluated by physicians for similar conditions.Pharmacist evaluation and treatment of minor pediatric illnesses seems to be both safe and well accepted. Further studies are needed to evaluate the cost-effectiveness of this service in diverse settings. In states that allow pharmacists to have prescriptive authority, pharmacy-based evaluation and treatment may improve access to care for children with minor illnesses.

Electrolysis is the process of decomposing a compound body by electricity. Applied in surgery this process has also the power of absorption. Webster's definition of absorption is: "Absorption is the process, or act, of being made passively to disappear in some other substance, through molecular or other invisible means, as the absorption of light, heat, electricity, etc." Therefore, I have called this action "a galvanic chemical absorption." The body to be decomposed or absorbed must be a conductor, and must possess certain elements susceptible of decomposition by the current; it must also contain water and a salt. Blood and muscular tissues are good electrolytes, and fibrous tissues are more or less decomposed, according to the elements which enter into their composition. If the parts to be acted upon are devoid of water, the electrolytic action will be slow, because water or moisture is an essential factor, and forms one of

(Concluded from page 393.) The previous statistics, showing certain points, do not give the history, details and progress of the treatment, which are necessary for a thorough understanding. To supply this want I will conclude with a record of cases, partly condensed and partly in extenso . While space does not permit details of all the 100 cases, typical cases will be given to represent groups. Group I .— Strictures complicated with urethral granulations or ulcers; use of the endoscope. No. 104 . E. S., Newark, N. J., aet. 25 years. Stricture of urethra; granular urethritis. June 26, 1882. Has had gonorrhœa once, 3 years ago. Was cured of it in 2 months. Noticed a stricture 8 months ago. A gleety discharge commenced a few months before the stricture was noticed. At present the stream is small, corkscrewed and of less power than formerly. Examination with bougie a boule finds the walls of the

My excuse for trespassing on the space of The Journal, is to correct any false impression that may have been created through the erroneous conclusions drawn by Dr. J. B. Thomas, of Pittsburgh (in The Journal of August 11), from an obvious misinterpretation of my report of the second hundred cases of urethral strictures treated by electrolysis. Dr. Thomas unqualifiedly condemns treatment of urethral strictures by electrolysis, and urges upon us his limited experience and failure in a very meagre report of one case. Is it sound logic to condemn an operation and method because a novice has made a failure in one or a few cases, when surgeons of undoubted standing from all parts of the world have reported hundreds of successful cases, endorsing, recognizing and establishing the method and operation as a success? Dr. Thomas' statement is, that his patient, S. K. M., presented himself with cystitis and

Read before the Section of Practice of Medicine of the American Medical Association at Washington, May 8, 1884. The object of this paper is to urge the necessity of having a reliable faradic battery ready to work, at a moment's notice, in every practitioner's office; and to exhibit here a new improvement, which promises the completion of this desideratum. The faradic current of electricity acts chiefly "mechanical." From reports of clinical cases, it seems that it has other qualities, which at present are not sufficiently defined, but unquestionably the principal action is "mechanical." It is a mistaken idea, which some entertain, that a faradic battery has some galvanic action, because one part of such a battery consists of one or two cells. The patient never gets an effect from these cells, as they act solely as a motor power to the induction coil; and never can give galvanism. The faradic

Much has been written on Basedow's disease or Graves, as exophthalmic goitre is often called. Notwithstanding the large amount of literature on the subject since 1835, its etiology and pathology is not definitely understood or settled. Most authors believe that it is a disease of the sympathetic system, having its origin in the cervical branch. Treatment therefore has been more empirical and unsatisfactory. The conclusion is, that exophthalmic goitre ends generally in death, usually caused by complications, of which a general nervous exhaustion and marasmus are prominent. Recovery, however, may occur, even without treatment. While we have on record, reports of cures, the treatment by therapeutic means has not been satisfactory. It is conceded that some remedies, like iron and digitalis, have allayed symptoms, but they scarcely cured the disease. The ground of therapeutics is so well covered in reports that this paper will not touch on it and will

In 1882, I published a few cases of stricture of the rectum treated by electrolysis; some had complications. Previous treatment by other means in some of these cases, one even by proctotomy, had given no lasting benefit to the patients. Electrolysis finally cured the stricture; and in one case the permanent cure was demonstrated by the postmortem specimen, presented to the New York Pathological Society—the patient meanwhile having died from some other disease. This latter case was treated in 1871, and I believe was the first application of electrolysis in the treatment of rectal stricture. Recently some successful operations have been reported here as well in London, and that induces me to give a detailed statement of my unpublished cases, in connection with the old report, including what other operators have done. History of the Operation—In 1871 the author first used electrolysis in stricture of the rectum. In 1872 Dr.

It is at present difficult to procure a small sized platinum needle, which is in every respect satisfactory to the operator. The needles on the market are deficient: for instance, the insulation is rough, uneven, and not smooth on an equal plane from the non-insulated point, to and over the beginning of the insulation, the point is too dull, and will not readily pass through cuticle and fascia; the non-insulated part is weak, and breaks off easily; the shaft, or the whole needle is not stiff enough to be easily pushed into the tissues, and on any attempt at use will bend. The shape of the point is also objectionable, and makes a hole at the point of entrance, instead of cutting evenly and pushing through the tissues more by dilatation, than in such a manner, so that on withdrawal of the needle the point of entrance contracts again, without

Hypertrophy of the prostate gland is a disease from which most old men suffer. The gradual advance of the malady and its unavoidable complications, such as spasms of the bladder, retention by mechanical obstruction, cystitis, dilatation of the ureters, pyonephrosis and uraemia, make life a burden. A large majority of these sufferers succumb prematurely. No rational treatment has thus far been adopted for the cure of this disease. Volumes have been written on the subject. Various methods have been suggested for the amelioration of the trouble and allaying of actual pain. A few cases have been reported as cured, either by injections, destruction, incision, enucleation, prostatotomy, etc., but no successful method of cure has been determined. Radical cures by surgery have been very few, most patients having died shortly after the operation. The great importance of establishing a method for theradicalcure of the enlarged prostate no one can