Johns Hopkins Gazette: July 7 1997

In Brief
Medical News

Dialysis center chosen determines treatment

A study published in the June issue of Archives of Pediatric and Adolescent Medicine revealed that pediatric patients with end stage renal disease received one of two kinds of dialysis. One kind, less invasive than the other, is more often given when the center serves greater numbers of pediatric patients.

Children treated at facilities with more than 10 percent pediatric patients were 60 percent more likely to be treated using peritoneal dialysis. At facilities that had 1 to 5 percent pediatric patients, children were less likely to receive peritoneal dialysis in favor of hemodialysis.

Peritoneal dialysis uses the lining of the abdomen to filter blood when a cleansing solution is introduced into the abdomen by catheter. Fluid, wastes and chemicals pass from the peritoneal membrane into the solution, which is then drained and replaced with new. This procedure can be carried out in the home. Hemodialysis, which uses a filter attached to a machine to cleanse the blood, is generally done at a treatment center. It is more invasive and requires more time.

"Peritoneal dialysis is widely considered the treatment of choice for children with kidney failure who require dialysis," said Susan Furth, who along with her Hopkins colleagues analyzed data on more than 1,200 pediatric dialysis patients. "There are large differences in the dialysis treatment choices made for children with renal failure, and these differences depend on the treating facilities' experience with children."

The study found that hospital-based not-for-profit facilities had more pediatric experience than their for-profit counterparts. Consequently, the facilities with more experience were more likely to use the less invasive procedure, which was described as preferable for psychological reasons as well.

"Several studies have shown that children treated with peritoneal dialysis have better coping skills and less depression than those on hemodialysis," Furth said. These children, she added, can also attend school more regularly.

Bad approaches to health take root in childhood

It's no surprise. Recent research has shown that some of the most costly and disabling adult health conditions have their roots in childhood.

The surprise for Christopher Forrest, assistant professor of health policy and management at the School of Public Health, is in just how short-sighted, and ultimately costly, the approach traditionally taken to fund research into child health services has been. We finance health care without putting nearly enough dollars into growing healthy kids, he argues, so how can we expect a nation of healthy adults?

"With the U.S. health system undergoing unprecedented changes, the impact on children's health could be substantial simply because children are vulnerable," Forrest says. "Unfortunately, child health services lack the tools to adequately monitor the impact on child health, especially when it comes to assessing the quality of care delivered."

Forrest and his colleagues, publishing in a recent issue of the Journal of the American Medical Association, say that because childhood is a unique developmental stage of life, and the continuity between child health and adult health so critical, there should be a national focus on child health services. Their study found that children were being "shortchanged" in medical care delivery. Forrest points out that during the last five years, employer-based insurance coverage for dependent children has steadily eroded, while the number of children covered by Medicare has increased.

"During 1992, 12 percent of children under the age of 18 were uninsured. Additionally, we found that 25 percent of children are not covered by medical insurance for at least one month during their first three years," Forrest says. "Gaps in health insurance increase the chance that a child will receive health care at multiple sites. This leads to fragmentation of services and poor monitoring not only of developmental progress, but of chronic and acute conditions as well."

High risk behaviors--such as smoking, poor eating habits and a sedentary lifestyle--often have their roots in childhood. From these roots spring adults who are prone to heart disease, obesity and a host of other health risks.

"The nation's health care delivery services continue to devote research dollars to the treatment of chronic adult illnesses, many of which are preventable," Forrest says. "We recommend a national effort to expand the field of child health services research. This will help lay the foundation for the future health and well-being of the entire nation."

Other News

Nominations sought for 1997 Schweitzer Prize

The university invites nominations for the 1997 Albert Schweitzer Prize for Humanitarianism, a $15,000 award recognizing exemplary contributions in the United States to humanity or the environment.

The prize was established in 1986 by Alfred Toepfer, an international grain merchant from Germany, to advance the cause of humanitarianism. It is given under the auspices of the Alexander von Humboldt Foundation in New York, and administered by Johns Hopkins.

Past recipients include the National Parks and Conservation Association; former president Jimmy Carter; Marian Wright Edelman, president of the Children's Defense Fund; missionary Sister M. Isolina Ferre; author Norman Cousins; former surgeon general C. Everett Koop; Bill Frank Jr., chairman of the Northwest Indian Fisheries Commission; and pediatrician D. Holmes Morton, for his work with Amish and Mennonite children. The most recent recipient was Edgar Wayburn, physician and environmentalist.

Individuals or organizations who have made a significant contribution in service to humanity or the environment in the United States are eligible to be nominated. The contribution may be in fields such as education, environmental preservation, health, and human rights.

For information on how to submit a nomination, write The Board of Trustees for the Albert Schweitzer Prize, c/o the President's Office, 242 Garland Hall, Homewood. The same information is available on JHUniverse at

The deadline for nominations is Aug. 15, 1997.

Blood donors needed July 15

Although an estimated 95 percent of us who live to the age of 72 will need to use blood or blood products at least once, only 5 percent of the population donates blood. Summer months in particular are usually slow times for blood donation. Last year, in Maryland, platelet supplies ran critically low for several weeks during the summer.

The university, in association with the Red Cross, will host a blood drive at the Glass Pavilion on the Homewood campus July 15 from 9 a.m. to 3 p.m. Regular donors are welcome and first-time donors are especially encouraged to participate.

For more information, and to make an appointment for a donation time, call Peggy Jones at 410-516-8039.

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