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Letter: On prevention and cure.

Letter: On prevention and cure. Bruce H. Heckman, MD Ossining, NY 10562 NOT ALL SMALL NEONATES ARE PREMATURE I was shocked to find that in 1974 an article appearing in this Journal (Terris and Glasser, AJPH, 64:869, September, 1974) still uses the term "prematurity" for a group of neonates defined solely by a birth weight of 2,500 gm or less. It has been known for a long time, and thoroughly appreciated for about 15 years, that even in mixed populations in the United States about one-third or more of these infants are undergrown rather than premature in the true sense. In 1961 the World Health Organization (Tech. Rep. Series 217) suggested that the term "prematurity" be abandoned, and the American Academy of Pediatrics (Pediatrics 39:935, 1967) and the Second European Congress for Perinatal Medicine (Arch. Dis. Child. 45:730, 1970) have made more detailed suggestions for the proper classification of newborn infants, not to mention a large literature on the subject. In Terris and Glasser's own report more than 50 per cent of the "prematures" had a gestational age of 36 weeks or more (an awkward cutoff point not usually used). It is deplorable that a paper using prematurity by weight is still written in 1972, and accepted for publication thereafter. This is particularly disturbing since we have learned that the neonatal and late sequels of preterm and small-for-dates birth are quite different. Peter Gruenwald, MD Departments of Pathology and Director Kalamazoo County Health Dept. Kalamazoo, MI 49006 ON PREVENTION AND CURE The Editorial, "There Is More to Health Than Just Paying Bills," in the September, 1974, issue of your journal, made many valuable and valid points. However, perhaps because of space limitations or rhetorical necessity, one glaring omission was made. No mention was made of where the already sick patient fits into the picture. Though I definitely agree that prevention is medically, humanistically, and economically desirable, I would fear that the present hierarchy would only be reversed. In other words, if prevention became more important than cure-oriented intervention, much suffering and death would be perpetuated. If there is a working, constructive denial of the need for hierarchy, then both prevention and cure would assume "equal" importance in our planning, financial appropriations, and actions. This does not mean a dollar-fordollar equality, but a more rational eclectic approach developed through the cooperation of medical, government, and lay planners. ON CONTINUITY OF CARE The article, "Prisons, Adolescents, and the Right to Quality Medical Care: The Time is Now" (September, 1974) was read with great interest by me since I was Project Director for the after-care program which was briefly alluded to in the article. With respect to treating this specifilc target group of high risk patients, a total comprehensive delivery of care is essential, due to the rapid turnover of the offenders. Continuity of care is an essential underpinning in establishing a treatment plan for these adolescents. The objective of the after-care program was to have a cadre of family health technicians follow up on each enrollee and link them up with an appropriate health resource in their community. This involved a summary being sent by the Medical Consultant to the resource which was identified by the adolescent and the worker as the optimal locus in the area. Pediatrics Hahnemann Medical College and Hospital Philadelphia, PA 19102 AJPH NOVEMBER, 1974, Vol. 64, No. 11 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Public Health American Public Health Association

Letter: On prevention and cure.

B H Heckman
American Journal of Public Health , Volume 64 (11) – Nov 1, 1974
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American Public Health Association
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Copyright © by the American Public Health Association
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0090-0036
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1541-0048
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Abstract

Bruce H. Heckman, MD Ossining, NY 10562 NOT ALL SMALL NEONATES ARE PREMATURE I was shocked to find that in 1974 an article appearing in this Journal (Terris and Glasser, AJPH, 64:869, September, 1974) still uses the term "prematurity" for a group of neonates defined solely by a birth weight of 2,500 gm or less. It has been known for a long time, and thoroughly appreciated for about 15 years, that even in mixed populations in the United States about one-third or more of these infants are undergrown rather than premature in the true sense. In 1961 the World Health Organization (Tech. Rep. Series 217) suggested that the term "prematurity" be abandoned, and the American Academy of Pediatrics (Pediatrics 39:935, 1967) and the Second European Congress for Perinatal Medicine (Arch. Dis. Child. 45:730, 1970) have made more detailed suggestions for the proper classification of newborn infants, not to mention a large literature on the subject. In Terris and Glasser's own report more than 50 per cent of the "prematures" had a gestational age of 36 weeks or more (an awkward cutoff point not usually used). It is deplorable that a paper using prematurity by weight is still written in 1972, and accepted for publication thereafter. This is particularly disturbing since we have learned that the neonatal and late sequels of preterm and small-for-dates birth are quite different. Peter Gruenwald, MD Departments of Pathology and Director Kalamazoo County Health Dept. Kalamazoo, MI 49006 ON PREVENTION AND CURE The Editorial, "There Is More to Health Than Just Paying Bills," in the September, 1974, issue of your journal, made many valuable and valid points. However, perhaps because of space limitations or rhetorical necessity, one glaring omission was made. No mention was made of where the already sick patient fits into the picture. Though I definitely agree that prevention is medically, humanistically, and economically desirable, I would fear that the present hierarchy would only be reversed. In other words, if prevention became more important than cure-oriented intervention, much suffering and death would be perpetuated. If there is a working, constructive denial of the need for hierarchy, then both prevention and cure would assume "equal" importance in our planning, financial appropriations, and actions. This does not mean a dollar-fordollar equality, but a more rational eclectic approach developed through the cooperation of medical, government, and lay planners. ON CONTINUITY OF CARE The article, "Prisons, Adolescents, and the Right to Quality Medical Care: The Time is Now" (September, 1974) was read with great interest by me since I was Project Director for the after-care program which was briefly alluded to in the article. With respect to treating this specifilc target group of high risk patients, a total comprehensive delivery of care is essential, due to the rapid turnover of the offenders. Continuity of care is an essential underpinning in establishing a treatment plan for these adolescents. The objective of the after-care program was to have a cadre of family health technicians follow up on each enrollee and link them up with an appropriate health resource in their community. This involved a summary being sent by the Medical Consultant to the resource which was identified by the adolescent and the worker as the optimal locus in the area. Pediatrics Hahnemann Medical College and Hospital Philadelphia, PA 19102 AJPH NOVEMBER, 1974, Vol. 64, No. 11

Journal

American Journal of Public Health – American Public Health Association

Published: Nov 1, 1974

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