Bell County Public Health District

Diabetes is the most common diagnosis among home care patients. All patients with type 1 diabetes require insulin, and due to the progressive nature of type 2 diabetes, most will eventually need insulin therapy. The newer analog insulins that have been developed include long-acting, ultra-long-acting, rapid-acting, and ultra-rapid-acting. They mimic the body's natural insulin secretion and allow patients more flexibility in diet and lifestyle while achieving blood glucose control. This article provides an overview of insulin therapy and related patient care and teaching considerations.

Two consecutive outbreaks of group A Streptococcus (GAS) infections occurred from 2015-2016 among residents of a Chicago skilled nursing facility. Evaluation of wound care practices proved crucial for identifying transmission factors and implementing prevention measures. We demonstrated shedding of GAS on settle plates during care of a colonized wound.

Objectives.Changes to the polio vaccination schedule, first to a sequential inactivated poliovirus/oral poliovirus (IPV/OPV) schedule in 1996 and most recently to an all-IPV schedule, require infants to receive additional injections.Some surveys show parental hesitation concerning extra injections, whereas others show that parents prefer multiple simultaneous injections over extra immunization visits.This study describes parental behavior and attitudes about the poliovirus vaccine recommendations and additional injections at the 2-and 4-month immunization visits.Methods.Beginning July 1, 1996, providers in eight public health clinics in Cobb and Douglas Counties, Georgia, informed parents of polio vaccination options and recommended the IPV/OPV sequential schedule.A cross-sectional clinic exit survey was conducted from July 15, 1996, to January 31, 1997, with parents whose infants (younger than 6 months) were eligible for a first poliovirus vaccination.Results.Of approximately 405 eligible infants, parents of 293 infants were approached for an interview, and 227 agreed to participate.Of those 227 participants, 210 (92%) parents chose IPV for their infant and 17 (8%) chose OPV.Of greatest concern to most parents was vaccine-associated paralytic polio (VAPP) (155, or 68.3%); the next greatest concern was an extra injection (22, or 9.7%).These parental concerns were unrelated to the number of injections the infant actually received.Conclusions.After receiving information on polio vaccination options and a provider recommendation, parents overwhelmingly chose IPV over OPV.Concern about VAPP was more common than objection to an extra injection.The additional injection that results from using IPV for an infant's first poliovirus vaccination appears to be acceptable to most parents.

The Blackfan Memorial Lecture by Dr. Cicely Williams1 was read with keen interest and agreement. Pediatrics should be commended for its publication. I trust that the increased rumbling that one hears, reads about and senses in maternal and child health care in our country will gather momentum and volume until we actually do implement the programs that will reduce infant mortality and morbidity and improve maternal care so that infants will be born into a society with far fewer deficiencies, deprivation and dependence.

A pictorial market order helped nurse and nutritionist teach parents what foods their children needed for good health.