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Anthrax stains

Q What is the best microscopy method for observing anthrax spores? Do the spores fluoresce under ultraviolet light?

A The spores of Bacillus anthracis do not fluoresce under ultraviolet light, but can be visualized by phase contrast microscopy or after staining with a spore stain. Most routine clinical laboratories (Level A) should not attempt to examine environmental samples (unknown powders suspected of containing anthrax spores) because the potential for aerosolization of the material is so great.

Your institution should have an emergency plan for handling reports of suspicious powders. If an emergency plan is not in place, contact your state health laboratory for assistance. However, if the suspected material is examined, the procedure must be performed in a Biological Safety Level 3 containment facility. (1) The suspected material can be suspended in saline or water and used to prepare a wet mount. Seal the edges of the wet mount, decontaminate the slide with bleach, and view under phase contrast microscopy. (2) The spores should be phase bright and regular in shape and size. A spore stain may be used, but often the suspected powder does not adhere to the slide.

Director of Microbiology

Veterans Affairs Medical Center

Portland, OR

References

(1.) Biosafety in Microbiological and Biomedical Laboratories. 4th ed. Washington, D.C. U.S. Dept. of Health and Human Services. CDC-NIH; 1999.

(2.) Logan. NA and PCB Turnbull. Bacillus and recently derived genera, pp. 357-369, in Manual of Clinical Microbiology, eds. Murray PR, Baron EJ, Pfaller MA, Tenover FC and RH Yolken. American Society for Microbiology, Washington, D.C., 1999.

Ergonomic workstation

Q I read your article on lab ergo nomics (MLO Feb. 2001, page with great interest. I wonder if you have a contact who would address the problem of using the microscope, counting on a computer keyboard, and viewing the results on a monitor. There seems to be no satisfactory way to form an ergonomically correct workstation to perform all these tasks. Most of the attainable information is related to secretarial stations, lifting, and pipetting, with little attention to the MT who spends eight hours a day at the scope and the computer.

When your doctor writes a prescription for your child, do you make sure you can read the handwriting?

If you can’t read it, the pharmacist may not be able to read it either. Asking your doctor to write clearly is one of the 20 tips for preventing medical errors in children offered by the American Academy of Pediatrics and the Agency for Healthcare Research and Quality.

* Be an active member of your child’s health care team.

That means taking part in every decision about your child’s health care. Research shows that parents who are more involved with their child’s care tend to get better results.

* Make sure that all of your child’s doctors know about everything your child is taking and his or her weight. This includes prescription and over-the-counter medicines, and dietary supplements such as vitamins and herbs.

At least once a year, bring all of your child’s medicines and supplements with you to the doctor. “Brown bagging” your child’s medicines can help you and your doctor talk about them and find out if there are any problems.

* Make sure your child’s doctor knows about any allergies and how your child reacts to medicines. This can help you avoid getting a medicine that can harm your child.

* When you pick up your child’s medicine from the pharmacy, ask: Is this the medicine that my child’s doctor prescribed?

A study by the Massachusetts College of Pharmacy and Allied Health Sciences found that 88 percent of medicine errors involved the wrong drug or the wrong dose.

* Ask for information about your child’s medicines in terms you can understand — both when the medicines are prescribed and when you receive them at the hospital or pharmacy.

* If you have any questions about the directions on your child’s medicine labels, ask. Medicine labels can be hard to understand. For example, ask if “four doses daily” means taking a dose every six hours around the clock or just during regular waking hours.

Taking good care of your child’s teeth is important because even “baby” teeth help your child chew food and speak clearly. Baby teeth also hold space so permanent teeth can grow in straight. If you start your child off with good dental habits, your child will find it easier to keep those good habits forever.

How should I care for my child’s teeth?

You should start caring for your child’s gums and teeth at birth. Gently wipe your baby’s gums with a soft, wet cloth after each feeding. When baby teeth appear, start cleaning them with a soft, child-sized toothbrush twice a day. In children up to 4 years of age, use a small, pea-sized dab of children’s fluoride toothpaste. It is important to use a small amount of toothpaste so your baby does not swallow too much of it. Swallowing too much fluoride toothpaste can cause spots on your child’s teeth.

What is fluoride?

Fluoride helps make teeth strong and prevents tooth decay. If the water where you live does not have enough fluoride, your doctor may prescribe fluoride supplements (fluoride drops or pills). You would give these drops or pills every day, starting when your child is about 6 months old. Only give as much as the directions say to use, because too much fluoride can cause spots on your child’s teeth. Children should take these drops or pills until they are 12 to 16 years old (or until you move to an area with fluoride in the water).

When should I start taking my child to the dentist?

Take your child for a first dental visit within six months of the first baby tooth and by no later than the first birthday. This gives the dentist a chance to look for early tooth problems and to talk to you about how to care for your baby’s teeth. It also helps your child feel okay in the dentist’s office.

Does anything help teething?

When teeth come through the gums, it can make your baby cross. The gum may be swollen where the tooth is coming in. You can ease the pain by rubbing the gums gently with your finger, letting your child chew on a teething ring or using a pacifier.

How does diet affect my child’s teeth?

Healthy eating habits lead to healthy teeth. Give your child a variety of foods. Sweets (candy or cookies), starchy foods (crackers) and sticky foods (raisins) stay in the mouth longer, so they can easily cause tooth decay. If your child wants a snack between meals, offer fruits or vegetables. They’re better for growing teeth.

PERHAPS your morning ritual involves hitting the snooze button again and again. You eventually pry yourself out of bed, only to feel rushed and frantic because you’re late. Or maybe you stumble out of bed but feel groggy for hours. You may have chalked it up to the fact that you’re just not a morning person. But you can be.

If you have to force yourself out of bed every day, it’s a sure sign of imbalance in your life, says David Simon, M.D., medical director of The Chopra Center for Well Being in La Jolla, Calif. For example, you may be working too hard and not getting the rest you need, he says. Sticking faithfully to our three-part plan can restore your balance and make waking up easier. You’ll need to adopt as many of the following habits as you can, including those related to light, like “Simmer Down” on page 58 and “Create a Sunrise” on page 59, which researchers say can help you wake up earlier and faster in only three days.

Rethink Sleep. Many of us stay up late to cram more into our day. “We tend to view sleep as wasted time and a luxury,” says Scott Campbell, Ph.D., director of the Chronobiology Laboratory at Cornell Medical School in White Plains, N.Y. If sleep is low on your list of priorities, give it the promotion it deserves. Aim for seven to nine hours a night, or whatever amount leaves you feeling fresh and alert the next day.

Choose an Earlier Bedtime. Consider this: Going to bed earlier can help you accomplish more with your mornings. “The benefit to waking up early is that you’ll perform better and be more alert at the time of day that you need to be,” Campbell says.

Look Hard at Your Schedule. Are there any habits you can alter to get to bed earlier? Tape your favorite 10 p.m. television show and watch it on the weekend. If friends call late, offer to call them back in the morning. Or turn off the ringer on your phone.

Don’t Deviate. Hitting the hay at a consistent time is one of the most important changes you can make, sleep experts say. Consistency normalizes your circadian rhythms, your body’s internal clock, so you’re the most deeply asleep in the first half of the night. This makes waking up in the morning easier. Most people benefit from a bedtime between 10 p.m. and midnight and a wake-up time between 6 and 8 a.m., Campbell says. Whatever you choose, stick to it faithfully, even on weekends and holidays.

Q: Does every laboratory need to set its own reference values, or can it use “values” from the literature? Do you know any article about making reference values for blood gas analyses? How many patients need to be included in a study of reference values?

A: The concept of reference intervals is evolving. Although traditionally laboratories have based reference intervals on values obtained from “healthy” individuals, for an increasing number of tests (such as cholesterol, glucose, and PSA), reference limits are based on risk of disease as determined from outcome studies. At present, however, most reference limits are still defined in the traditional fashion.

The most widely accepted document of reference values is that published by the NCCLS (Wayne, PA). (1) To establish reference limits with reasonable accuracy, it is necessary to use a sample size of at least 1120 individuals. If it is necessary to “partition” the reference interval (for example, for children and adults, or for males and females), it is necessary to use 120 individuals for each group. In the United States, regulatory agencies do not require laboratories to establish their own reference intervals, but to validate the values that they use (these can be derived from publications, the manufacturer, or other laboratories in the area). The NCCLS document suggests the use of 20 individuals to validate reference limits; if no more than two are outside the reference interval, then the proposed limits are valid for the laboratory. We have found that in our laboratory, which serves a somewhat unique population, that we can validate most reference limits, but we need to establish our own in about 10 percen t to 20 percent of cases.

With respect to blood gases, there have been relatively few studies cited over the last 30 years in Index Medicus covering reference values in populations other than neonates. One recent study by Crapo, et al. compared values at sea level and at an altitude of 1,400 m, using a total sample of 339 adults. (2) They found that partial pressure of oxygen declines gradually with increasing age.

Another study by Dong, et al. of arterialized capillary blood gases evaluated 712 normal individuals between the ages of 1 month and 24 years. (3) They found that partial pressures of oxygen and carbon dioxide were lower in infants and young children, reaching adult levels by 7 to 12 years of age.

A WHOLESOME DIET, regular exercise, and other long-term good habits lay the foundation for a healthy glow. But sometimes you need to shine right away. The following expert-recommended fixes can help you turn back the clock in just 24 hours. Try them–you’ll look and feel more youthful and vibrant. (For lasting youthfulness, see “Fight the Effects of Aging with These Habits,” page 81.)

1 Touch Your Feet. Reflexology, or stimulating the pressure points on your feet, reduces stress, says New York City reflexologist Nancy Alfaro, and if you’re relaxed, you look younger. To relieve stress instantly, press your thumb into your solar plexus point, located just below the ball of your foot. Hold for one minute and repeat on your other foot.

2 Elevate, Your Head. Propping your head up with an extra pillow reduces the eye puffiness that can add years to your face. Gravity drains fluid so it doesn’t pool around your eyes, explains Janice Cox, a Medford, Ore.-based author of several beauty books, including Natural Beauty at Home (Henry Holt, 2002). Simply slip an extra pillow under your head 15 minutes before you get out of bed.

3 Chill Out. Cooling your eyelids also helps eliminate puffiness, says Cox. On each closed lid, place a cold tea bag (any type will do), a refrigerated cucumber or potato slice, or the secret weapon of many makeup artists–a chilled teaspoon (put spoons in the fridge the night before), “[Spoons] fit into the contour of the eye, and the metal retains cold long enough to be effective,” says Tamara Marcus, an esthetician in Brooklyn, N.Y. In 10 to 15 minutes, any of these items will reduce puffy eyes.

4 Heal Hands. Rough hands are a dead giveaway of age. To rejuvenate them, right before bedtime slather on a generous coat of sesame oil, canola oil, or sunflower oil, suggests Cox. Slip on cotton gloves (or you can use socks), and sleep with them on. The oil barrier prevents moisture loss from your skin, she explains. By morning, your hands will be baby soft and smooth.

Recent media coverage of missing or kidnapped children may have scared parents into thinking such horrible events are commonplace.

They are not. Federal studies have shown about 150 to 200 cases annually of “stranger” abductions.

Yet most of those cases involve people who either knew the children or who lived nearby, while others were babysitters or family friends.

Actual numbers of children suddenly taken by complete strangers range between 20 to 50 children a year.

And since there are approximately 4.1 million babies born in America each year, this means there are presently more than 40 mllion children age ten and below living in this country right now.

But, still, parents and caretakers can learn from such tragedies by knowing how to prevent them.

A few, simple common sense tips, which most parents realize, can help: don’t leave children unattended; know about people who live in local neighborhoods; recognize individuals who might threaten children (and don’t let them into your home); always know where children are and who is caring for them; and remember to give as many details about a child’s age and clothing and the last whereabouts of any children who suddenly vanish when calling 911.

However, parents must realize ALL dangers to children.

Accidents, mainly with cars, bicycles, and walking or playing near streets take far more children than kidnappers—about 6,000 children a year, according to the Washington, D. C.-based National Safe Kids Campaign.

Approximately 4,000 children age 18 and under lose their lives annually because of guns, reports the Children’s Defense Fund; also in Washington, D.C. Most of these children are victims of accidental handling of guns in the home.

Officials of the Center for Disease Control (CDC) report that about the same number of children perish each year from disease.

Slightly more than 1,000 children die annually from child abuse, reports the National Clearinghouse on Child Abuse and Neglect. This agency is part of the U.S. Department of Health and Human Services.

And a new, neglected danger to children, is just now getting public attention:Leaving children locked in overheated cars during hot summer months.

No parent wants to believe that his or her child is using drugs. But studies show that the rates of drug use among young people remain at high levels in the United States.

A 2001 survey found that about 50 percent of eighth-graders have tried alcohol and about one-third has smoked cigarettes. And a nationwide study by the Centers for Disease Control and Prevention in 2001 found that 42 percent of high school students used marijuana during their lifetime. In fact, marijuana is the most widely used illegal drug by U.S. youth, experts say, and children and teens who experiment with marijuana, alcohol and tobacco are more likely to develop drug problems later in life.

The message is clear: The sooner you educate your children about drugs, the more likely they are to stay away from them. The following tips from the American Academy of Pediatrics will help you keep your child drug-free:

* Talk and listen. Don’t wait to have “the drug talk” with your child. Make discussions about tobacco, alcohol and other drugs part of your daily conversation. Know the facts about how drugs can harm your child and clear up any wrong information, such as “everybody drinks” or “marijuana won’t hurt you.” Don’t give long lectures or do all the talking. Encourage your child to share their questions and concerns.

* Be a good example. Actions speak louder than words. Look at your own habits and thoughts about tobacco, alcohol and drugs.

* Develop your child’s self-confidence. Look for all the good things in your child–then tell your child how proud you are. Praise your child’s efforts as well as successes. If you need to correct your child, criticize the action, not your child.

* Help your child develop strong values. Talk about your family values and teach your child how to make decisions based on these standards of right and wrong. Explain that these are the standards for your family, no matter what other families might decide. Spell out what will happen if your child breaks the rules and be prepared to follow through.

* Teach your child to deal with peer pressure. Help your children understand that they don’t have to do something wrong just to feel accepted. Remind them that a real friend won’t care if they don’t use drugs.

* Encourage healthy activities. Involve your child in athletics, school clubs and hobbies that reduce boredom and excess free time. Look for activities that you and your child can do together.

Several million children throughout the United States are placed within the responsibility of child care facilities. O’Connor and colleagues surveyed licensed child care facilities to identify the safety hazzards present in these settings and the injury prevention practices being used.

A random sample of 130 child care facilities was studied. Facility representatives were interviewed by telephone about the presence of hazards that might contribute to burns, falls, suffocation and poisoning, as well as the extent of safety training and practices of the child care staff.

The survey results showed that these facilities had a significant prevalence of avoidable hazards. Most providers surveyed did not know the temperature setting of their hot-water heater. Among those who did, 27 percent stated that it was over 54.4[degrees]C (130[degrees]F. Tap water scalds can be prevented if hot-water thermostats are kept at 48.9[degrees]C (120[degrees]F). Although unguarded heat sources area a potential hazard to children, 14 percent of providers reported that space heaters were accessible to children.

More than 60 percent of providers reported that their facility did not have impact-absorbing surfaces under outdoor playground equipment. One-third of facilities with stairs accessible to children did not have safety gates. In centers caring for children younger than age three, 17 percent did not have safety straps on highchairs or infant seats.

Nearly two-thirds of child care facilities had regular staff meetings. Of those that had meetings, 75 percent included injury prevention strategies as a topic of discussion. About 44 percent of providers could not locate and report the local poison control center telephone number during the interview. However, 80 percent could easily locate and report the local ambulance number. More than half reported that they had syrup of ipecac on the premises. In half of these cases, the provider could demonstrate possession of the syrup by reading the bottle’s expiration date; one-third of the bottles had passed the expiration date.

The findings demonstrate that many child care facilities not only have several specific safety hazards but also have a lack of knowledge and skill regarding injury prevention. The authors recommend that child care providers and parents of young children be counseled on injury prevention.

Good parenting involves more than just providing for your child’s physical needs. To make sure your children mature into caring, productive and well-adjusted adults, you also need to take care of their mental health. While there is no universal rule for raising happy, healthy children, mental health experts offer the following tips to help nurture your child’s emotional well-being:

* Respect your children. You can’t demand respect from them if you don’t give it. Don’t embarrass, insult or tease your kids. Children take their parents’ words to heart, so if you constantly put them down, they’ll develop low self-esteem. When you are angry or disagree with them, stay calm and keep your voice down. If you hurt your children, apologize.

* Set a good example. You can’t expect your child to live a righteous life if you aren’t. Your lifestyle and behavior serves as a model for your children. The best way to ensure your kids adopt good values is to live by them yourself.