CONFERENCE REPORTS
Vancouver children's conference outcome predictable and obvious, yet under-the-surface action could have major effect GLENNIS ZILM More emphasis on prevention of through reading or other similar disorders and greater integration of conferences. A few papers would children's services seem to be the give them extra background with an major conclusions of a conference area - say educational testing of pediatricians, psychologists, psy- with which they might be relatively chiatrists and other members of the unfamiliar. For the British Columbia delhealth professions concerned with however, it was the hidden egates, services for children with special that offered considerably agenda Vancouver in needs when they met greater scope. recently. The conference likely will make Yet while such outcomes may seem predictable and obvious, the a fair impact on political leaders Vancouver conference illustrated the and, to some extent, on the public principle that academics now are and provide impetus for changes calling "the hidden agenda". As a that health professionals would like result, the conference could have to see occur in the province. That major effects on the future of health Victoria was aware of the concare for children in British Colum- ference and its topics was witnessed by the attendence of Dr. Pat bia. The multidisciplinary interna- McGeer, minister of education and tional conference on "advances in a strong cabinet spokesman on alresearch and services for children locations for research in the provwith special needs" brought together ince. Health Minister Robert Mcabout 250 people involved with Clelland also was planning to attend diagnosis, care and treatment of but was delayed by conflicting plane handicapped and disabled children. schedules, and Deputy Health MinisDelegates came mainly from Can- ter Tommy Tucker spoke at the ada and the United States but also opening sessions. Delegates from included a sprinkling of represent- both ministries and from the Minisatives and speakers from France, try of Human Resources attended Britain, Australia and Japan. Spon- the full meeting, and pediatricians, sored by the Children's Hospital, in particular, made good use of Vancouver, with special funding breaks between sessions to point out from the Woodward Foundation, the the application of certain speakers' 2-day conference aimed at helping remarks to British Columbia. professionals broaden the scope of their approaches through greater Culture and child-rearing understanding of research and adOne session that offered informavances in allied fields. Information for MDs seemed tion that might be less well known rather limited and it would be sur- to doctors concerned the research prising if most of the eminent pedia- findings about cultural effects on tricians in the audience were not cognitive development and on childfamiliar with the general back- rearing practices. Doctors, for examground of the presentations, either ple, need to be aware of just how
strongly ethnic practices can affect development and even cause misreading of tests in common use. In this and other sessions, speakers such as Harry Triandis, professor of psychology, University of Illinois, stressed that intelligence tests now are generally considered failures because cultural backgrounds strongly affect the outcomes of these supposedly universal tests. For example, some cultures stress a "slow but certain" approach, but most tests used in North America are based on speed; incorrect answers are considered unimportant, allowing for some guessing at answers. Children who have been culturally conditioned to work slowly and not to guess therefore do poorly. Dr. Triandis also described aspects of his current research that indicate ties between the scarcity or abundance of resources and the amount of warmth and permissivencss or coldness and strictness used in the child-rearing. For example, in cultures and in situations where there are abundant resources (food, fuel, housing and so on) children likely will be raised in an atmosphere of warmth and trust and will develop autonomous, independent qualities (although he mentioned some overprotectiveness may also be common). In situations of extreme scarcity, children are not shown much affection and, in extreme situations, arc abandoned (which may be either physical or emotional deprivation). "In interventions, it is important to look at the availability of resources," said Triandis. "You may
CMA JOURNAL/JULY 21, 1979/VOL. 121
221
Septra. DS Scores high against cystitis, pyelitis and pyelonephritis with simple b.i.d. dosage *Septra R Summary
(Tnmethopnm + Sulfamethoxazole) INDICATIONS: Indicated for the following infections when caused by susceptible organisms: UPPER AND LOWER RESPIRATORY TRACT INFECliONS-particularly chronic bronchitis and acute and chronic otitis media. URINARY TRACT INFECTIONS-acute, recurrent and chronic. GENITAL TRACT INFECTIONS-uncomplicated gonococcal urethntis. GASTROINTESTINAL TRACT INFECTIONS. SKIN AND SOFT TISSUE INFECTIONS. SEPTRA is also indicated in the treatment of infants and children with a diagnosis of Pneumocystis cariniipneumonitis, especially if they are immunosuppressed. SEPTRA is not indicated in infections caused by Pseudomonas, Mycoplasma or viruses. This drug has not yet been fully .aluated in streptococcal infections. CONTRAINDICATIONS: Patients with evidence of marked liver parenchymal damage, blood dyscrasias, known hypersensitivity to trimethopnm or sulfonamides, marked renal impairment where repeated serum assays cannot be carried out, premature or newbom babies during the first few weeks of life. For the time being SEPTRA is contraindicated during pregnancy. ADVERSE REACTIONS: Most frequent: nausea; vomiting; gastric intolerance; and rash. Less frequent: diarrhea; constipation; flatulence; anorexia; pyrosis; gastritis; gastroenteritis; urticaria; headache; an liver c anges (a normal elevations in alkaline phosphatase and serum transaminase). Occasionally reported: glossitis; oliguria; hematuria; tremor; ve.igo; alopecia; and elevated BUN, NPN, and serum creatinine. Hematol.ical changes occurring particularly in the elderly, are mostly transient and reversible (primarily, neutropenia and thrombocytopenia; less frequently, leukopenia, aplastic or hemolytic anemia, agranulocytosis, and bone marrow depression). PRECAUTIONS: As with other sulfonamide p reparations, critical appraisal of benefit versus risk should be made in patients with liver damage, renal damage, urinary obstruction, blood dyscrasias, allergies or bronchial asthma. The possibility of a superinfection with a non-sensitive organism should be bome in mind. DOSAGE AND ADMINISTRATION: Aduits and children over 12 years. Standard dosage: 2 Septra tablets or 1 Septra DS tablet twice daily. Minimum dosage and dosage for long-term treatment: I Septra tablet or /2 Septra DS tablet twice daily. Maximum dosage: Overwhelming infections: 3 Septra tablets or 11/2 Septra DS tablets twice daily. Uncomplicated gonorrhea: 2 Septra tablets or I Septra DS tablet four times daily for 2 days. PneumocyA.sa!k.ii pneumonitis: 20 mg/kg/day trimethoprim and 1 mg/kg! day sulfamethoxazole in four divided doses for 14 days. Children 12 years and under.t Young children should receive a dose according to biological age: Children under 2 years: 2.5 ml of suspension twice daily. Children 2 to 5 years: 2.5-5 ml of suspension twice dali y. Children 6 to 12 years: 5-10 ml of suspension twice daily. tln children this corresponds to an approximate dose of 6 mg trimethoprim/kg body weight/day, plus 30 mg sulfamethoxazole/kg body weight/day, divided into two equal doses. DOSAGE FORMS: SEPTRA DS TABLETS, each containing 160 mg trimethoprim and 800 mg sulfamethoxazole, and coded WELLCOME 02C Bottles of 50 and 250. SEPTRA TABLETS, each containing 80 mgtrimethopnm and 400 mg sulfamethoxazole, and coded W.CO. Y2B. Bottles of 100 and 500, and unit dose packs of 100. SEPTRA PEDIATRIC TABLETS, each containing 20 mg trimethoprim and 100 mg sulfamethoxazole, and coded W.LCOME H4B. Bottles of 100. SEPTRA PEDIATRIC SUSPENSION, each teas.nful (5 ml) containin 40 mg trimethoprim and 200mg sulfamethoxazole ..ottles of 100 and 400 ml. Product Monograph available on request. *Trade Mark REFERENCES 1. Data on file, Burroughs Wellcome Ltd. 2. Moorhouse, E.C., Farrell, W.: J. Med. Microbiol. 6:249, 1973. 3. N.ff, H.: Pathol. Microbiol. 37:1, 1971.
. Weilcome Medical Division [..] Burroughs Welicome Ltd. ii LaSalle, Q.u6. w-sozo
new "lifestyle problems" do not seem to be decreasing. He showed photographs illustrating the birth defects (and related mental problems) in children of alcoholic mothers. Mental retardation as a result of excessive alcohol intake in the mothers now is averaging about one per 1000 births, while phenylketonuria (PKU), for which there are expensive, widely used tests, occurs in about one per 18 000 births. He pricked at the conscience of the audience with his requests for greater research into ways of reaching the public with present information as he reviewed the impressive and increasing rates of deformities associated with smoking, obesity and drugs (including alcohol). Dr. David Hardwick, chief of staff, Children's Hospital, Vancouver, stressed the need for more social awareness of screening programs. Legal, social, and moral implications are as important as medical ones, he said. These comments and others on prevention throughout the sessions helped pave the way for the final plenary sessions on the development of policies for delivery of services. Speakers there urged interdisciplinary and well-integrated special services for children under a special branch that could bring together education, health (prevention), medical, treatment, and legal services for children and families. In addition, economic considerations would also be dealt with through this kind of integrated approach. Prevention of disabilities Dr. Robert Hagerty, program diIn a session on prevention, espe- rector, Robert Wood Johnson Eouncially primary prevention before, dation, Boston, and editor, Journal during and around birth, all speak- of Pediatrics urged this umbrella apers reviewed both biologic and bio- proach, saying "Integration of services is the major problem." social determinants. Identification of problems is not Doctors know that lifestyle changes could reduce many common the goal in itself, he said, but is only disabilities, and that early diagnosis the first of many steps. "There is inand intervention lead to prevention sufficient communication among the workers and follow-up generally." of secondary problems. Given the integrated approach to However, Dr. Patrick MacLeod of the department of medical gene- the problems on the agenda and the tics, University of British Columbia, wide review of the present "state of added a new dimension to the dis- the art", combined with the commitcussions with his queries on why ment and involvement of those attending to the "hidden agenda", the such knowledge is so little used. "Smoking in women of child- next year or two could see major bearing age is on the increase de- changes in the present system of spite 25 years of knowledge and care for children with special needs teaching," he said. Furthermore, in British Columbia.E
need to change the economics of the situation rather than the psychology of the situation... A second speaker on the same topic, Dr. John Berry, professor of psychology, Queen's University, agreed that ability testing (rather than intelligence testing) is "the least ethnocentric." He, too, stressed that health professionals must be willing to know and accept cultural differences and not assume mainstream values based on one's own experiences and own group background. During this session and at one of the public lectures, Dr. Wallace Lambert, professor of psychology, McGill University, outlined cultural differences in child-rearing in Canada. He and his coworkers have just completed a major study that involved 10 countries. However, Dr. Lambert focused on differences between French-Canadians and English-Canadians in child-rearing practices. Although he described many differences (English-Canadians are much harsher generally toward children), the major factor in all studies was social (or economic) class. His study also confirmed that families in Canada still raise boys to be aggressive and domineering, while girls are raised to be passive and understanding. "Perhaps we should get girls into hockey rinks and boys out," he said. The study was published in June 1979 and now is available in a book.
224 CMA JOURNAL/JULY 21, 1979/VOL. 121
Vancouver children's conference outcome predictable and obvious, yet under-the-surface action could have major effect GLENNIS ZILM More emphasis on prevention of through reading or other similar disorders and greater integration of conferences. A few papers would children's services seem to be the give them extra background with an major conclusions of a conference area - say educational testing of pediatricians, psychologists, psy- with which they might be relatively chiatrists and other members of the unfamiliar. For the British Columbia delhealth professions concerned with however, it was the hidden egates, services for children with special that offered considerably agenda Vancouver in needs when they met greater scope. recently. The conference likely will make Yet while such outcomes may seem predictable and obvious, the a fair impact on political leaders Vancouver conference illustrated the and, to some extent, on the public principle that academics now are and provide impetus for changes calling "the hidden agenda". As a that health professionals would like result, the conference could have to see occur in the province. That major effects on the future of health Victoria was aware of the concare for children in British Colum- ference and its topics was witnessed by the attendence of Dr. Pat bia. The multidisciplinary interna- McGeer, minister of education and tional conference on "advances in a strong cabinet spokesman on alresearch and services for children locations for research in the provwith special needs" brought together ince. Health Minister Robert Mcabout 250 people involved with Clelland also was planning to attend diagnosis, care and treatment of but was delayed by conflicting plane handicapped and disabled children. schedules, and Deputy Health MinisDelegates came mainly from Can- ter Tommy Tucker spoke at the ada and the United States but also opening sessions. Delegates from included a sprinkling of represent- both ministries and from the Minisatives and speakers from France, try of Human Resources attended Britain, Australia and Japan. Spon- the full meeting, and pediatricians, sored by the Children's Hospital, in particular, made good use of Vancouver, with special funding breaks between sessions to point out from the Woodward Foundation, the the application of certain speakers' 2-day conference aimed at helping remarks to British Columbia. professionals broaden the scope of their approaches through greater Culture and child-rearing understanding of research and adOne session that offered informavances in allied fields. Information for MDs seemed tion that might be less well known rather limited and it would be sur- to doctors concerned the research prising if most of the eminent pedia- findings about cultural effects on tricians in the audience were not cognitive development and on childfamiliar with the general back- rearing practices. Doctors, for examground of the presentations, either ple, need to be aware of just how
strongly ethnic practices can affect development and even cause misreading of tests in common use. In this and other sessions, speakers such as Harry Triandis, professor of psychology, University of Illinois, stressed that intelligence tests now are generally considered failures because cultural backgrounds strongly affect the outcomes of these supposedly universal tests. For example, some cultures stress a "slow but certain" approach, but most tests used in North America are based on speed; incorrect answers are considered unimportant, allowing for some guessing at answers. Children who have been culturally conditioned to work slowly and not to guess therefore do poorly. Dr. Triandis also described aspects of his current research that indicate ties between the scarcity or abundance of resources and the amount of warmth and permissivencss or coldness and strictness used in the child-rearing. For example, in cultures and in situations where there are abundant resources (food, fuel, housing and so on) children likely will be raised in an atmosphere of warmth and trust and will develop autonomous, independent qualities (although he mentioned some overprotectiveness may also be common). In situations of extreme scarcity, children are not shown much affection and, in extreme situations, arc abandoned (which may be either physical or emotional deprivation). "In interventions, it is important to look at the availability of resources," said Triandis. "You may
CMA JOURNAL/JULY 21, 1979/VOL. 121
221
Septra. DS Scores high against cystitis, pyelitis and pyelonephritis with simple b.i.d. dosage *Septra R Summary
(Tnmethopnm + Sulfamethoxazole) INDICATIONS: Indicated for the following infections when caused by susceptible organisms: UPPER AND LOWER RESPIRATORY TRACT INFECliONS-particularly chronic bronchitis and acute and chronic otitis media. URINARY TRACT INFECTIONS-acute, recurrent and chronic. GENITAL TRACT INFECTIONS-uncomplicated gonococcal urethntis. GASTROINTESTINAL TRACT INFECTIONS. SKIN AND SOFT TISSUE INFECTIONS. SEPTRA is also indicated in the treatment of infants and children with a diagnosis of Pneumocystis cariniipneumonitis, especially if they are immunosuppressed. SEPTRA is not indicated in infections caused by Pseudomonas, Mycoplasma or viruses. This drug has not yet been fully .aluated in streptococcal infections. CONTRAINDICATIONS: Patients with evidence of marked liver parenchymal damage, blood dyscrasias, known hypersensitivity to trimethopnm or sulfonamides, marked renal impairment where repeated serum assays cannot be carried out, premature or newbom babies during the first few weeks of life. For the time being SEPTRA is contraindicated during pregnancy. ADVERSE REACTIONS: Most frequent: nausea; vomiting; gastric intolerance; and rash. Less frequent: diarrhea; constipation; flatulence; anorexia; pyrosis; gastritis; gastroenteritis; urticaria; headache; an liver c anges (a normal elevations in alkaline phosphatase and serum transaminase). Occasionally reported: glossitis; oliguria; hematuria; tremor; ve.igo; alopecia; and elevated BUN, NPN, and serum creatinine. Hematol.ical changes occurring particularly in the elderly, are mostly transient and reversible (primarily, neutropenia and thrombocytopenia; less frequently, leukopenia, aplastic or hemolytic anemia, agranulocytosis, and bone marrow depression). PRECAUTIONS: As with other sulfonamide p reparations, critical appraisal of benefit versus risk should be made in patients with liver damage, renal damage, urinary obstruction, blood dyscrasias, allergies or bronchial asthma. The possibility of a superinfection with a non-sensitive organism should be bome in mind. DOSAGE AND ADMINISTRATION: Aduits and children over 12 years. Standard dosage: 2 Septra tablets or 1 Septra DS tablet twice daily. Minimum dosage and dosage for long-term treatment: I Septra tablet or /2 Septra DS tablet twice daily. Maximum dosage: Overwhelming infections: 3 Septra tablets or 11/2 Septra DS tablets twice daily. Uncomplicated gonorrhea: 2 Septra tablets or I Septra DS tablet four times daily for 2 days. PneumocyA.sa!k.ii pneumonitis: 20 mg/kg/day trimethoprim and 1 mg/kg! day sulfamethoxazole in four divided doses for 14 days. Children 12 years and under.t Young children should receive a dose according to biological age: Children under 2 years: 2.5 ml of suspension twice daily. Children 2 to 5 years: 2.5-5 ml of suspension twice dali y. Children 6 to 12 years: 5-10 ml of suspension twice daily. tln children this corresponds to an approximate dose of 6 mg trimethoprim/kg body weight/day, plus 30 mg sulfamethoxazole/kg body weight/day, divided into two equal doses. DOSAGE FORMS: SEPTRA DS TABLETS, each containing 160 mg trimethoprim and 800 mg sulfamethoxazole, and coded WELLCOME 02C Bottles of 50 and 250. SEPTRA TABLETS, each containing 80 mgtrimethopnm and 400 mg sulfamethoxazole, and coded W.CO. Y2B. Bottles of 100 and 500, and unit dose packs of 100. SEPTRA PEDIATRIC TABLETS, each containing 20 mg trimethoprim and 100 mg sulfamethoxazole, and coded W.LCOME H4B. Bottles of 100. SEPTRA PEDIATRIC SUSPENSION, each teas.nful (5 ml) containin 40 mg trimethoprim and 200mg sulfamethoxazole ..ottles of 100 and 400 ml. Product Monograph available on request. *Trade Mark REFERENCES 1. Data on file, Burroughs Wellcome Ltd. 2. Moorhouse, E.C., Farrell, W.: J. Med. Microbiol. 6:249, 1973. 3. N.ff, H.: Pathol. Microbiol. 37:1, 1971.
. Weilcome Medical Division [..] Burroughs Welicome Ltd. ii LaSalle, Q.u6. w-sozo
new "lifestyle problems" do not seem to be decreasing. He showed photographs illustrating the birth defects (and related mental problems) in children of alcoholic mothers. Mental retardation as a result of excessive alcohol intake in the mothers now is averaging about one per 1000 births, while phenylketonuria (PKU), for which there are expensive, widely used tests, occurs in about one per 18 000 births. He pricked at the conscience of the audience with his requests for greater research into ways of reaching the public with present information as he reviewed the impressive and increasing rates of deformities associated with smoking, obesity and drugs (including alcohol). Dr. David Hardwick, chief of staff, Children's Hospital, Vancouver, stressed the need for more social awareness of screening programs. Legal, social, and moral implications are as important as medical ones, he said. These comments and others on prevention throughout the sessions helped pave the way for the final plenary sessions on the development of policies for delivery of services. Speakers there urged interdisciplinary and well-integrated special services for children under a special branch that could bring together education, health (prevention), medical, treatment, and legal services for children and families. In addition, economic considerations would also be dealt with through this kind of integrated approach. Prevention of disabilities Dr. Robert Hagerty, program diIn a session on prevention, espe- rector, Robert Wood Johnson Eouncially primary prevention before, dation, Boston, and editor, Journal during and around birth, all speak- of Pediatrics urged this umbrella apers reviewed both biologic and bio- proach, saying "Integration of services is the major problem." social determinants. Identification of problems is not Doctors know that lifestyle changes could reduce many common the goal in itself, he said, but is only disabilities, and that early diagnosis the first of many steps. "There is inand intervention lead to prevention sufficient communication among the workers and follow-up generally." of secondary problems. Given the integrated approach to However, Dr. Patrick MacLeod of the department of medical gene- the problems on the agenda and the tics, University of British Columbia, wide review of the present "state of added a new dimension to the dis- the art", combined with the commitcussions with his queries on why ment and involvement of those attending to the "hidden agenda", the such knowledge is so little used. "Smoking in women of child- next year or two could see major bearing age is on the increase de- changes in the present system of spite 25 years of knowledge and care for children with special needs teaching," he said. Furthermore, in British Columbia.E
need to change the economics of the situation rather than the psychology of the situation... A second speaker on the same topic, Dr. John Berry, professor of psychology, Queen's University, agreed that ability testing (rather than intelligence testing) is "the least ethnocentric." He, too, stressed that health professionals must be willing to know and accept cultural differences and not assume mainstream values based on one's own experiences and own group background. During this session and at one of the public lectures, Dr. Wallace Lambert, professor of psychology, McGill University, outlined cultural differences in child-rearing in Canada. He and his coworkers have just completed a major study that involved 10 countries. However, Dr. Lambert focused on differences between French-Canadians and English-Canadians in child-rearing practices. Although he described many differences (English-Canadians are much harsher generally toward children), the major factor in all studies was social (or economic) class. His study also confirmed that families in Canada still raise boys to be aggressive and domineering, while girls are raised to be passive and understanding. "Perhaps we should get girls into hockey rinks and boys out," he said. The study was published in June 1979 and now is available in a book.
224 CMA JOURNAL/JULY 21, 1979/VOL. 121
