Faculty Bibliography

Saturday morning, the swelling around the eye looked worse, and he went to the emergency room, where an ophthalmologist diagnosed periorbital cellulitis. Cellulitis means a skin infection, and periorbital cellulitis is an infection of the skin around the eye. If the infection moves past the septum, into the orbital fat or the extraocular muscles that move the eye, it becomes a medical emergency, an orbital cellulitis, also called a septal cellulitis. We don't know exactly why it didn't respond to those first few days of oral antibiotics -- whether it was a drug-resistant bug, or whether it was just hard to reach because it had already taken advantage of that initial conjunctivitis, that whack in the eye with a basketball, to penetrate beyond the skin around the eye and threaten the eye itself

Then the rash on her legs developed. She hadn't had a rash when she first came into the health center. The only thing notable about her skin exam had been the marks left by the common Vietnamese practice of coining, rubbing a sick person's skin with a coin: marks on her neck and around her belly button, regular, recognizable linear striations. But in the hospital she developed strange new marks, four to six small lesions on each ankle. And the endoscopy showed petechiae in her small intestine, small dark red marks that suggest damage to the blood vessels. This confirmed the diagnosis: Henoch-Schonlein purpura. Most types of vasculitis affect some particular set of blood vessels, and Henoch-Schonlein goes for the small vessels, the arterioles and capillaries -- in the skin and often in the kidneys. Most commonly, the illness starts with the rash, raised symmetrical marks usually over the buttocks and on the legs, along with joint pain and, yes, abdominal pain. So who were Henoch and Schonlein? Johann Lukas Schonlein was a German physician-scientist in the 19th century, and personal physician to King Frederick William IV of Prussia. He was well-known as a teacher, and he described Schonlein's purpura, the association between the skin rash and the joint problems. Eduard Heinrich Henoch was a German pediatrician who lived from 1820 to 1910, studied under Schonlein and described the skin lesions associated with abdominal pain. He called it, in that 1868 description, Schonlein-Henoch purpura, crediting his teacher with the initial description

Nothing worrisome about that. Every child's weight and height are traced out in curves on these charts, measured against printed parabolas that express normal weight gain -- you can grow at the 5th percentile, or at the 95th, and still be normal, as long as you grow. And at first, my patient grew nicely. I explained that even a small baby needs to grow and gain weight, that it was not healthy for a 1-year-old to go from month to month adding no weight, that it suggested that the baby was being nutritionally deprived at a critical moment when she ought to be building up her body and her brain. In fact, the nutritional wisdom is that the mother's own weight may reflect nutritional deprivation in her own childhood, but that her baby, if adequately fed, should grow according to the regular normal chart. There have been a few times when her weight gain has lagged so disturbingly -- or when she has actually lost weight -- that the doctors at the clinic have talked about hospitalizing her, but she always managed to gain just enough to keep that from happening. Recently, she's done better: No more nutritional supplements, her weight more proportional to her height

BACKGROUND: One in 4 US adults have poor health literacy, unable to read and understand written medical information. Current tools that assess health literacy skills are too lengthy to be useful in routine clinical encounters. OBJECTIVE: To determine which of 7 screening questions is most useful for identifying parents with adequate health literacy. DESIGN/METHODS: A cross-sectional study of an ethnically diverse sample of 163 parents of children aged 12 to 24 months presenting for routine care at 1 of 6 inner-city clinics. Literacy was measured by performance on the Short Test of Functional Health Literacy for Adults, which was categorized as 'adequate' or 'inadequate or marginal.' The 7 screening questions concerned parents' educational achievement, educational expectations for the child, and home literacy environment. RESULTS: Eighty-three percent of respondents had adequate health literacy, which was highest among those who were African American, were born outside the United States, spoke English primarily at home, and had completed high school. Only 2 factors, however, were independently associated with adequate health literacy: more than 10 adults' books or more than 10 children's books in the home. 'More than 10 children's books' had a positive predictive value of 91%. CONCLUSIONS: Having more than 10 children's books in the home is a useful, independent indicator of adequate parent health literacy. More research is needed, however, to find a better screening tool for identifying parents with increased health literacy needs

Klass provides new golden rules of discipline that she has learned over the course of bringing up her kids. Among other things, she points out that discipline strategies should be age-related