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Against a background of falling marriage and rising divorce rates the Family Law Act 1996, which is expected to be fully implemented by October 1997, revises current divorce law (National Children’s Bureau 1996. Highlight No 146). The act introduces two new court orders, the divorce order which will replace the decreesnisi and absolute, and the separation order which will replace the decree of judicial separation. There will be a ‘period for reflection and consideration’ lasting nine months (15 months if there are children under 16) before an application for either order may be made and this period can be extended for six months on request. Three conditions need to be satisfied before an order may be granted; the marriage must have broken down irretrievably (in the opinion of either party), there must have been an ‘information meeting’, and future arrangements must have been decided. At the ‘information meeting’ the couple will be given information about marriage support services, mediation, finance and legal matters, and the importance of the children’s views and welfare, and ways of helping them. The act repeats certain provisions of the Children Act 1989 with regard to the welfare of the children. It also updates the law relating to domestic violence.
Workers at Stanford University, California claim to have produced a rapid and sensitive test for Prader-Willi syndrome (Lancet 1996;348:1068-9). The gene for the small nuclear ribonucleoprotein polypeptide N (SNRPN) is expressed only on the paternally derived chromosome 15. Using the polymerase chain reaction they were able to demonstrate SNRPN expression in all of 47 people without Prader-Willi syndrome but in none of 13 with the syndrome.
In south east Connecticut 201 children with Lyme disease were seen over a period of 20 months (New England Journal of Medicine 1996;335:1270-4). They were aged 1–21 years (they have some fairly old children in America), all recovered satisfactorily and only four were admitted to hospital. The presenting feature was a single erythema migrans (EM) lesion in 66% and multiple EM lesions in 23%. Thirteen children with late Lyme disease all had arthritis. Eleven presented with facial palsy, seven with aseptic meningitis, and two with carditis. Borrelia burgdorferi serology was positive at presentation in only 37% of those with a single EM lesion and 89% of those with multiple EM lesions. Later serology was positive in 39 and 69% respectively. Treatment, usually with amoxycillin or doxycyline, was rapidly effective (two children whose parents refused treatment also recovered rapidly). None of the patients developed chronic or recurrent Lyme disease.
Tinea capitis was common in British schoolchildren until school surveillance and the use of griseofulvin caused a large decline in the 1960s. The dermatophytes may be contracted from animals (zoophilic), people (anthropophilic), or (rarely) soil (geophilic). Zoophilic organisms were common in the UK in the 1970s but there has been a recent change to anthropophilic. In 14 schools in Lambeth, London in 1995 (British Journal of Dermatology 1996;135:955-8) scalp ringworm was found in up to 12% of pupils and another 5% had subclinical infections. All of the fungi were anthropophilic, the most common being Trichophyton tonsurans and Microsporum rivalieri. The presence of more than one carrier in a school class predisposed to the spread of clinical ringworm within the class. School surveillance and the use of griseofulvin or newer oral antifungals such as terbinafine or itraconazole may be necessary to prevent the spread of ringworm in schools.
A French study of 152 patients, including 27 children, with type 1 neurofibromatosis (Archives of Dermatology 1996;132:1333-6) has confirmed that routine investigations, such as chest radiography, abdominal ultrasound, brain scans, and urine catecholamines, are by and large unhelpful in asymptomatic patients. The possible exception is magnetic resonance imaging to detect optic gliomas in young children.
Car airbags inflate within 0.05 seconds at inflation speeds of up to 200 miles an hour. From 1993 up to November 1996, 34 children in the USA died from airbag injuries (Journal of the American Medical Association 1997;277:11-2). In all but two cases seat restraints were either incorrectly used or not used at all. Moves are afoot to produce ‘smart’ airbags appropriate for all ages of passenger but in the meantime children should not be exposed to airbags.
Seventeen Japanese children with pertussis were treated with either clarithromycin (9) or azithromycin (8). After a week cultures were negative in all of them whereas five of 34 historical controls had still been culture positive at that time (Journal of Pediatrics1996;129:761-4).
The results of surgery for congenital diaphragmatic hernia in Finland have got worse over the last 30 years and this may be because more babies have severe pulmonary hyperplasia (British Journal of Surgery 1996;83:1758-62). Thirty day postoperative mortality increased from 25% in 1948–62 to 49% in 1983–92 and at the same time mean postmortem lung weight fell from 70% to 40% of expected. There was no change in the proportion of preoperative deaths.
A 34 year old man had had diarrhoea from birth due to congenital chloridorrhoea. His symptoms had resulted in him being abandoned by his family at the age of 4 and he had had difficulty keeping a job because of his diarrhoea and faecal incontinence and needed frequent hospital admission for intravenous fluid replacement. After being treated with a proton-pump inhibitor (omeprazole) his diarrhoea was much less troublesome, he was no longer incontinent of faeces, and was able to return to work (New England Journal of Medicine 1997;336:106-9).
A Toronto study of 80 children whose mothers had taken a tricyclic antidepressant during pregnancy (half of them during the first trimester only and most of the rest throughout pregnancy), 55 whose mothers had taken fluoxetine (37 first trimester, 18 throughout), and 84 controls (New England Journal of Medicine 1997;336:258-62) has shown no effect of the drugs on IQ, language development, or behavioural development on assessment at between 16 and 86 months of age.
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