The Journal of family practice
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The acute onset of stridor in a young child usually represents viral croup, particularly during the fall and early winter. If the clinical picture is entirely consistent with this diagnosis and gas exchange is maintained, management with cool mist at home is appropriate. Rapid deterioration is unusual in viral croup; however, if obstruction is prolonged or becomes unusually severe, racemic epinephrine aerosols, hospitalization for careful observation, a brief course of corticosteroid therapy, and, rarely, endotracheal intubation may be required. ⋯ Chronic stridor in infancy most often represents laryngomalacia, a developmental abnormality of the laryngeal cartilage which usually resolves by the second year of life and rarely requires specific treatment. Other causes of chronic stridor in childhood include subglottic hemangioma, vocal cord paralysis, and a long list of abnormalities. In the older child with chronic stridor or in the infant whose clinical picture is unusual for laryngomalacia, airway roentgenograms, barium studies, or laryngoscopy/bronchoscopy should be obtained to establish the definitive diagnosis.
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Thirteen cases of epiglottitis are reviewed in this paper. Fever and respiratory distress were the most common presenting symptoms. ⋯ Epiglottitis must be distinguished from viral croup and other causes of upper airway obstruction so that prompt treatment can be instituted. A suggested protocol for management of epiglottitis emphasizes the importance of establishing an artificial airway and administering intravenous antibiotics effective against Hemophilus influenzae type B.
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This study was designed to identify differences in parental behaviors and the availability of food between undernourished and well-nourished inner-city children of early school age. Children with a constellation of measurements of height below the 25th percentile, midarm muscle circumference below the 50th percentile, and hemoglobin concentration below 11.5 g/dL were considered undernourished. ⋯ Families of undernourished children were found to have significantly less variety of nutritious foods requiring preparation by an adult available in the home (P less than .01), to have greater variety of convenience foods of low nutritional value (P less than .01), and to prefer fewer vegetables (P less than .04) and dairy products (P less than .01). The Polansky Child Level of Living Scale showed that mothers of undernourished children were less likely to prepare meals regularly for their children (P less than .05) and that they were less effective in providing general parental support to their children (P less than .03).
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Of the more than 350 family practice residency programs in the United States, 72 are affiliated with a medical school. Seventy-eight percent of these university programs hospitalize all or some of their patients at a university hospital. ⋯ Only one program does not use the university hospital because of difficulty in obtaining privileges. Family physicians are unable to obtain various hospital privileges because of political reasons at the following percentages of university hospitals: general medicine (2 percent), adult intensive care (33 percent), coronary care (40 percent), general pediatrics (8 percent), pediatric intensive care (31 percent), newborn nursery (8 percent), intensive care nursery (29 percent), routine obstetrics (13 percent), and high-risk obstetrics (17 percent).