Article Abstract:
Exposure to sunlight is associated with the development of skin cancer (basal cell and squamous cell carcinomas), and it has been estimated that if children routinely used sunscreens with a sun protection factor of 15, 78 percent of the cases of skin cancer (not including melanoma) could be prevented. To learn more about the best ways of educating parents concerning their children's sun exposure, a study was carried out to compare two educational interventions. Two hundred seventy-five mothers of newborn infants were enrolled in either a low-level intervention group (96 infants), a high-level intervention group (94), or a control group (85). The low-level intervention consisted of a sheet of simple guidelines concerning ways to minimize sun exposure (such as using sunscreens after the age of six months, decreasing exposure between 11 AM and 3 PM), and a postcard sent in August 1989 reminding members to limit sun exposure. The high-level intervention group received the guidelines, plus two instructive pamphlets, sunscreen samples, a baby sun hat, and a sun umbrella; they were also sent the reminder postcard. Members of the control group received only an invitation to take part in the study. Interviews were carried out in the latter part of 1989 to determine the amount of sun exposure the infants and mothers had had, the extent of sunscreen use, and related variables. Results showed that subjects in the two intervention groups spent less time outdoors than control subjects. Comparisons of exposure patterns before the study (based on information obtained at enrollment) and afterwards revealed that mothers in the intervention groups had reduced their exposure more than mothers in the control group. The three groups did not differ in their use of infant hats (the majority of mothers used hats), stroller hoods, umbrellas, or loose-fitting clothing. While all mothers in the study used sunscreen approximately the same amount of time, the time spent in the sun without protection was lower for mothers in the intervention groups. This reflected the fact that these mothers spent less time outside during the summer months. A discussion is presented of the importance of early education concerning sun protection. (Consumer Summary produced by Reliance Medical Information, Inc.)
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Article Abstract:
Improving the health care of neonates (infants within the first six weeks of life) requires improvements in maternal health care and the entire health care delivery system. The United States spends the largest portion of the gross national product on health care, yet quality of life does not reflect that expenditure; the US ranks 19th in infant mortality, 7th in female life expectancy, and 15th in male life expectancy. Health resources are inequitably distributed, finances are inappropriately applied, and costs are excessively high. Changes must be implemented, and preventive health care must be given high priority. Good health practices and attitudes begin with pregnant mothers, infants and children. The necessary improvements in health care can not be achieved without addressing social issues related to teenage pregnancies and infants with low birth weights. Effective birth control and contraception have not been encouraged. The use of extreme procedures to maintain the viable, but obviously borderline, high-risk infant must be carefully evaluated. The adoption of regionalization of intensive care and technology in the 1970s was an important milestone in providing high quality neonatal care. The tendency now appears to be in the other direction, deregionalization. The potential of high profits from operating neonatal intensive care units (NICU) has induced many hospitals to leave regional networks and set up their own facilities. Quality and efficient care have taken a second place to economic gain for physicians, hospitals, and third parties. These practices may lead to a two-tier system of health care; minimal and basic care for the poor and uninsured, but all the advantages of modern medicine for those with insurance and the ability to pay. Attitudinal changes are in order to reverse these trends and recall that the patient, no matter how young, must come first. (Consumer Summary produced by Reliance Medical Information, Inc.)
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Article Abstract:
Premature infants often require several transfusions of red blood cells and have an increased risk of developing transfusion-associated diseases. About 300,000 infants undergo transfusions each year. Studies show that a premature infant requiring blood transfusions will receive blood or blood products from 6 to 10 different donors. Hence, exposure to multiple donors and several transfusions increases the potential for complications of transfusion. A standard approach for transfusion therapy in newborns has not been established, and transfusion practices for newborns are inconsistent and based on limited scientific data. Well-designed studies are needed to develop criteria for transfusing blood components to newborns. Recommendations are presented for transfusing newborns with red blood cells; platelets, cells involved in blood clotting; and neutrophils, a type of white blood cell. Transfusion of blood components should only be given to newborns who will benefit from this treatment and should be donated from as few donors as possible. Donation of blood components from directed or designated donors, such as biological parents, is less safe than donation from volunteers and should be avoided. Donations from biological parents may cause immunological problems. For example, immune factors from the mother may attack blood cell antigens inherited by the infant from the father. (Antigens are components of the cell that can provoke an immune response.) The mechanisms underlying disorders of blood cell production in the fetus and newborn, the effects of a reduction in blood cell numbers, and the risks and benefits of transfusion require further study for developing an optimal approach to transfusion therapy in newborns. (Consumer Summary produced by Reliance Medical Information, Inc.)
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