Sample records for febrile children implications

  1. Antibiotic susceptibility of Gram-negatives isolated from bacteremia in children with cancer. Implications for empirical therapy of febrile neutropenia. (United States)

    Castagnola, Elio; Caviglia, Ilaria; Pescetto, Luisa; Bagnasco, Francesca; Haupt, Riccardo; Bandettini, Roberto


    Monotherapy is recommended as the first choice for initial empirical therapy of febrile neutropenia, but local epidemiological and antibiotic susceptibility data are now considered pivotal to design a correct management strategy. To evaluate the proportion of Gram-negative rods isolated in bloodstream infections in children with cancer resistant to antibiotics recommended for this indication. The in vitro susceptibility to ceftazidime, piperacillin-tazobactam, meropenem and amikacin of Gram-negatives isolated in bacteremic episodes in children with cancer followed at the Istituto "Giannina Gaslini", Genoa, Italy in the period of 2001-2013 was retrospectively analyzed using the definitions recommended by EUCAST in 2014. Data were analyzed for any single drug and to the combination of amikacin with each β-lactam. The combination was considered effective in absence of concomitant resistance to both drugs, and not evaluated by means of in vitro analysis of antibiotic combinations (e.g., checkerboard). A total of 263 strains were evaluated: 27% were resistant to piperacillin-tazobactam, 23% to ceftazidime, 12% to meropenem and 13% to amikacin. Concomitant resistance to β-lactam and amikacin was detected in 6% of strains for piperacillin-tazobactam, 5% for ceftazidime and 5% for meropenem. During the study period there was a nonsignificant increase in the proportions of strains resistant to β-lactams indicated for monotherapy, and also increase in the resistance to combined therapies. in an era of increasing resistance to antibiotics guideline-recommended monotherapy could be not appropriate for initial empirical therapy of febrile neutropenia. Strict local survey on etiology and antibiotic susceptibility is mandatory for a correct management of this complication in cancer patients.

  2. Serum endocan levels in children with febrile neutropenia

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    Eylem Kiral


    Full Text Available Endocan is an endotelial cell specific molecule; previous studies have shown that serum endocan levels increased in cancer and sepsis and are also related to the severity of sepsis. There are no clinical study about serum endocan levels in children with febrile neutropenia. The aim of this study was to evaluate serum endocan levels in pediatric leukemia patients with febrile neutropenia (n=33 and compare them with children with leukemia without fever (n=33 and also with healthy children (n=24. The median serum endocan level in the first group (children with febrile neutropenia was statistically significantly higher compared to the leukemic children without febrile neutropenia and also control group (P<0.01 for both. No difference was determined between the serum endocan levels of the leukaemia patients without febrile neutropenia and the healthy control group (P>0.05. Serum endocan levels were also similar with febrile neutropenia due to bacterial causes comparing with the idiopathic febril neutropenia. The results of this study showed increased serum endocan in children with leukemia during the febrile neutropenia episode, and no changes of serum endocan levels in children without leukemia without infection/fever. The monitoring of a series of serum endocan levels would be helpful for the course of febrile neutropenia.

  3. Recognition Memory Is Impaired in Children after Prolonged Febrile Seizures (United States)

    Martinos, Marina M.; Yoong, Michael; Patil, Shekhar; Chin, Richard F. M.; Neville, Brian G.; Scott, Rod C.; de Haan, Michelle


    Children with a history of a prolonged febrile seizure show signs of acute hippocampal injury on magnetic resonance imaging. In addition, animal studies have shown that adult rats who suffered febrile seizures during development reveal memory impairments. Together, these lines of evidence suggest that memory impairments related to hippocampal…

  4. Respiratory alkalosis in children with febrile seizures. (United States)

    Schuchmann, Sebastian; Hauck, Sarah; Henning, Stephan; Grüters-Kieslich, Annette; Vanhatalo, Sampsa; Schmitz, Dietmar; Kaila, Kai


    Febrile seizures (FS) are the most common type of convulsive events in children. FS are suggested to result from a combination of genetic and environmental factors. However, the pathophysiologic mechanisms underlying FS remain unclear. Using an animal model of experimental FS, it was demonstrated that hyperthermia causes respiratory alkalosis with consequent brain alkalosis and seizures. Here we examine the acid-base status of children who were admitted to the hospital for FS. Children who were admitted because of gastroenteritis (GE), a condition known to promote acidosis, were examined to investigate a possible protective effect of acidosis against FS. We enrolled 433 age-matched children with similar levels of fever from two groups presented to the emergency department. One group was admitted for FS (n = 213) and the other for GE (n = 220). In the FS group, the etiology of fever was respiratory tract infection (74.2%), otitis media (7%), GE (7%), tonsillitis (4.2%), scarlet fever (2.3%) chickenpox (1.4%), urinary tract infection (1.4%), postvaccination reaction (0.9%), or unidentified (1.4%). In all patients, capillary pH and blood Pco(2) were measured immediately on admission to the hospital. Respiratory alkalosis was found in children with FS (pH 7.46 ± 0.04, [mean ± standard deviation] Pco(2) 29.5 ± 5.5 mmHg), whereas a metabolic acidosis was seen in all children admitted for GE (pH 7.31 ± 0.03, Pco(2) 37.7 ± 4.3 mmHg; p respiratory alkalosis, irrespective of the severity of the underlying infection as indicated by the level of fever. The lack of FS in GE patients is attributable to low pH, which also explains the fact that children with a susceptibility to FS do not have seizures when they have GE-induced fever that is associated with acidosis. The present demonstration of a close link between FS and respiratory alkalosis may pave the way for further clinical studies and attempts to design novel therapies for the treatment of FS by controlling the

  5. Serum zinc and copper levels in children with febrile convulsion

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    Mohammad Shokrzadeh


    Full Text Available Febrile convulsions (FC are the most common neurologic disorder in children 6-60 months of age. Zinc (Zn and copper (Cu play role as cofactors in more than 300 enzymatic activities significantly. The aim of this study was to evaluate the relationship serum levels of Zn and Cu with seizure occurrence in febrile children. In this case-control study, 270 children with 6 month to 6 years were evaluated. The patients were enrolled in three groups: a children with febrile convulsion, b febrile children without convulsion and c healthy ones. After recording of all patients’ characteristics, 5 mL blood was taken from peripheral vessels at the first 12 hours of hospitalization. Absorption of all samples was read by BRAIC (Rayleigh instrument company, WFX-130 model with calibration diagram, considering samples dilution levels. The mean of serum Zn levels in children with FC were significantly lower than other two groups. Mean serum Cu levels in children with FC and non-FC patients were significantly higher than healthy children. No meaningful differences were observed in serum levels of Zn and Cu among the girl or boy cases. This study showed significant lower serum zinc level in children with febrile seizure and meaningful higher serum copper level than control group cases. There was no significant difference in level of serum zinc and copper in term of sex.

  6. Predictors of Recurrent Febrile Seizures in Iranian Children

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    Yousef Veisani


    Full Text Available A few factors appear to boost a child's risk of having recurrent febrile seizures, including young age during the first seizure, seizure type, and having immediate family members with a history of febrile seizures. The present study aimed to provide reliable information about recurrent febrile seizure in Iranian children. On the computerized literature valid on valid keyword with search in valid database PubMed, Scientific Information Databases (SID (, Global medical article limberly (Medlib, Iranian Biomedical Journals (Iran Medex, Iranian Journal Database (Magiran, and Google Scholar recruited in different geographic areas. To explore heterogeneity in studies I2 index was used. Meta-analysis used to data analysis with random effects model.Hospital data of 4,599 children with febrile seizure. Overall, 21 studies met our inclusion criteria. Febrile seizure in 2 age groups (<2 and 2-6 years were 55.8% (95% CI: 50.4-61.2 and 44.2% (95% CI: 38.8-61.2 respectively. Pooled recurrent rate of febrile seizure in Iran was 20.9% (95% CI: 12.3-29.5. In 28.8 (95% CI: 19.3-38.4, children there was positive family history. The mean prevalence of simple and complex seizures was 69.3% (95% CI: 59.5-79.0 and 28.3% (95% CI: 19.6-31.0 respectively. The rates in different geographical regions of central, east, and west of Iran, 25, 20.8 and 27.1% were estimated, respectively.According to the data the prevalence febrile seizure is higher in males and children under two years. Recurrence rate in Iran, similar to other studies performed in other regions of the world.

  7. Prophylactic drug management for febrile seizures in children

    NARCIS (Netherlands)

    Offringa, Martin; Newton, Richard


    Febrile seizures occurring in a child older than one month during an episode of fever affect 2% to 4% of children in Great Britain and the United States and recur in 30%. Rapid-acting antiepileptics and antipyretics given during subsequent fever episodes have been used to avoid the adverse effects

  8. Prophylactic drug management for febrile seizures in children

    NARCIS (Netherlands)

    Offringa, Martin; Newton, Richard


    BACKGROUND Febrile seizures occurring in a child older than one month during an episode of fever affect 2% to 4% of children in Great Britain and the United States and recur in 30%. Rapid-acting antiepileptics and antipyretics given during subsequent fever episodes have been used to avoid the

  9. Malaria parasitaemia among febrile under-five children at Nnamdi ...

    African Journals Online (AJOL)

    Malaria parasitaemia among febrile under-five children at Nnamdi Azikiwe University Teaching Hospital, Nnewi, South-East, Nigeria. C.E. Ezeudu, J.C. Ebenebe, J.O. Chukwuka, E.F. Ugochukwu, G.I. Amilo, O.I. Okorie ...

  10. Serious bacterial infections in febrile young children: Lack of value ...

    African Journals Online (AJOL)

    Fever is both a marker of insignificant viral infection, as well as more serious bacterial sepsis. Therefore ... febrile children under the age of 5 years (with an axillary temperature ≥38°C) who presented to Steve Biko Academic Hospital, Pretoria, with signs and symptoms of pneumonia, meningitis and/or generalised sepsis.

  11. Typhoid fever among hospitalized febrile children in Siem Reap, Cambodia. (United States)

    Wijedoru, Lalith P M; Kumar, Varun; Chanpheaktra, Ngoun; Chheng, Kheng; Smits, Henk L; Pastoor, Rob; Nga, Tran Vu Thieu; Baker, Stephen; Wuthiekanun, Vanaporn; Peacock, Sharon J; Putchhat, Hor; Parry, Christopher M


    Typhoid fever was confirmed by positive blood culture in 5 (3.7%) of 134 febrile children hospitalized in Cambodia. Typhoid was suspected in an additional 25 (18.7 %) blood culture-negative children based on: a positive immunoglobulin M lateral flow assay (IgMFA) (16); a positive polymerase chain reaction (PCR) for Salmonella typhi (2); or clinical assessment (7). The specificity of the IgMFA and PCR assays requires further study.

  12. Renal scintigraphy in children with first febrile urinary tract infection

    International Nuclear Information System (INIS)

    Duarte Perez, Maria Caridad; Guillen Dosal, Ana; Martinez Silva, Magaly; Hernandez Robledo, Ernesto


    The urinary tract infection is one of the most frequent bacterial infections in the childhood. Two hundred eleven children diagnosed as first febrile urinary tract infection patients were studied and performed Tc-DMSA renal scintigraphy in the acute phase of infection. The results were correlated to the duration and intensity of the fever before the diagnosis, to the acute phase reactants (hemogram, erythrosedimentation and reactive-C protein) and to the results of imaging studies (renal ultrasound and mictional uretrocystography)

  13. Prophylactic drug management for febrile seizures in children

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    Martin Offringa

    Full Text Available BACKGROUND Febrile seizures occurring in a child older than one month during an episode of fever affect 2% to 4% of children in Great Britain and the United States and recur in 30%. Rapid-acting antiepileptics and antipyretics given during subsequent fever episodes have been used to avoid the adverse effects of continuous antiepileptic drugs. OBJECTIVE To evaluate the effectiveness and safety of antiepileptic and antipyretic drugs used prophylactically to treat children with febrile seizures. METHODS Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL (The Cochrane Library 2011. Issue 3; MEDLINE (1966 to May 2011; EMBASE (1966 to May 2011; Database of Abstracts of Reviews of Effectiveness (DARE (May 2011. No language restrictions were imposed. We also contacted researchers in the field to identify continuing or unpublished studies. Selection criteria: Trials using randomized or quasi-randomized patient allocation that compared the use of antiepileptic or antipyretic agents with each other, placebo or no treatment. Data collection and analysis: Two review authors (RN and MO independently applied pre-defined criteria to select trials for inclusion and extracted the pre-defined relevant data, recording methods for randomization, blinding and exclusions. Outcomes assessed were seizure recurrence at 6, 12, 18, 24, 36 months and at age 5 to 6 years in the intervention and non-intervention groups, and adverse medication effects. The presence of publication bias was assessed using funnel plots. MAIN RESULTS Thirty-six articles describing 26 randomized trials with 2740 randomized participants were included. Thirteen interventions of continuous or intermittent prophylaxis and their control treatments were analyzed. Methodological quality was moderate to poor in most studies. We could not do a meta-analysis for 8 of the 13 comparisons due to insufficient numbers of trials. No significant benefit for valproate, pyridoxine

  14. Chlamydiae in febrile children with respiratory tract symptoms and age-matched controls, Ghana

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    H. Bühl


    Full Text Available Members of the Chlamydiales order are obligate intracellular pathogens causing acute and chronic infectious diseases. Chlamydiaceae are established agents of community- and zoonotically acquired respiratory tract infections, and emerging pathogens among the Chlamydia-related bacteria have been implicated in airway infections. The role of both in airway infections in Africa is underexplored. We performed a case -control study on the prevalence of Chlamydiaceae and Chlamydia-related emerging pathogens in children with febrile respiratory tract infections in West Africa, Ghana. Using a pan-Chlamydiales broad-range real-time PCR, we detected chlamydial DNA in 11 (1.9% of 572 hospitalized febrile children with respiratory tract symptoms and in 24 (4.3% of 560 asymptomatic age-matched controls (p 0.03. Chlamydiaceae were found to be common among both symptomatic and healthy Ghanaian children, with Chlamydia pneumoniae being the most prevalent species. Parachlamydiaceae were detected in two children without symptoms but not in the symptomatic group. We identified neither Chlamydia psittaci nor Simkania negevensis but a member of a new chlamydial family that shared 90.2% sequence identity with the 16S rRNA gene of the zoonotic pathogen Chlamydia pecorum. In addition, we found a new Chlamydia-related species that belonged to a novel family sharing 91.3% 16S rRNA sequence identity with Candidatus Syngnamydia venezia. The prevalence and spectrum of chlamydial species differed from previous results obtained from children of other geographic regions and our study indicates that both, Chlamydiaceae and Chlamydia-related bacteria, are not clearly linked to clinical symptoms in Ghanaian children. Keywords: Children, Chlamydia, Chlamydia-related bacteria, febrile respiratory tract infection, Ghana

  15. Triage of febrile children at a GP cooperative : determinants of a consultation

    NARCIS (Netherlands)

    Monteny, Miriam; Berger, Marjolein Y.; van der Wouden, Johannes C.; Broekman, Berth J.; Koes, Bart W.

    Background Most febrile children contacting a GP cooperative are seen by a GP, although the incidence of serious illness is low. The guidelines for triage might not be suitable in primary care. Aim To investigate the determinants related to the outcome of triage in febrile children. Design of study

  16. The relationship between iron deficiency anemia and simple febrile convulsion in children. (United States)

    Yousefichaijan, Parsa; Eghbali, Aziz; Rafeie, Mohammad; Sharafkhah, Mojtaba; Zolfi, Mohaddeseh; Firouzifar, Mohammadreza


    Simple febrile convulsion is the most common disease of the nervous system in children. There are hypotheses that iron deficiency may affect febrile convulsion and the threshold of neuron excitation. This study was conducted with the objective of finding the effects of iron deficiency anemia on simple febrile convulsion episodes. The study was conducted at AmirKabir Hospital of Arak Medical Sciences University, Arak, Iran. This is a case-control study. In this study, 382 children who were selected according to our inclusion and exclusion factors, were divided into two groups of case (febrile convulsion) and control (other factors causing fever) by their cause of hospitalization. After fever subsided, 5 ml blood sample was taken from each child and complete blood count and iron profile tests were performed. The results were interpreted using descriptive statistics and independent t-test. The prevalence of anemia in the group with febrile convulsion was significantly less than that in the control group: 22.5% of the children in the group with febrile convulsion and 34% in the control group exhibited anemia (P < 0.001). Moreover, the group with febrile convulsion had significantly higher blood indices, such as Hb, Hct, MCV, MCH, and MCHC, compared to the control group (P < 0.001). Iron deficiency can prevent febrile convulsion in children and probably increases the threshold of neuron excitation in fever.

  17. pre-hospital management of febrile seizures in children seen

    African Journals Online (AJOL)

    INTRODUCTION. A febrile seizure refers to a seizure occurring in infancy or childhood usually between three months and five years of age as a result of elevated body temperature in the absence of pathology in the brain.1 Febrile seizures are commonly encountered in emergency paediatric practice and have been ...

  18. Food-borne bacteremic illnesses in febrile neutropenic children

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    Anselm Chi-wai Lee


    Full Text Available Bacteremia following febrile neutropenia is a serious complication in children with malignancies. Preventive measures are currently targeted at antimicrobial prophylaxis, amelioration of drug-induced neutropenia, and nosocomial spread of pathogens, with little attention to community-acquired infections. A retrospective study was conducted at a pediatric oncology center during a 3-year period to identify probable cases of food-borne infections with bacteremia. Twenty-one bacteremic illnesses affecting 15 children receiving chemotherapy or hematopoietic stem cell transplantation were reviewed. Three (14% episodes were highly suspected of a food-borne origin: a 17-year-old boy with osteosarcoma contracted Sphingomonas paucimobilis septicemia after consuming nasi lemak bought from a street hawker; a 2-year-old boy with acute lymphoblastic leukemia developed Chryseobacterium meningosepticum septicemia after a sushi dinner; a 2-year-old girl was diagnosed with acute lymphoblastic leukemia and Lactobacillus bacteremia suspected to be of probiotic origin. All of them were neutropenic at the time of the infections and the bacteremias were cleared with antibiotic treatment. Food-borne sepsis may be an important, but readily preventable, cause of bloodstream infections in pediatric oncology patients, especially in tropical countries with an abundance of culinary outlets.

  19. Iron deficiency anaemia -a risk factor for febrile seizures in children

    International Nuclear Information System (INIS)

    Sherjil, A.; Saeed, Z.U.; Shehzad, S.; Amjad, R.


    Background: Iron deficiency anaemia and febrile seizures are two common diseases in children worldwide as well as in our country. Iron insufficiency is known to cause neurological symptoms like behavioural changes, poor attention span and learning deficits in children. Therefore, it may also be associated with other neurological disturbances like febrile seizures in children. Objective of our case-control study was to find association between iron deficiency anaemia and febrile seizures in children. Methods: This multicentre study was conducted in Department of Paediatrics HIT Hospital Taxila Cantt, Department of Paediatrics CMH Mangla and Department of Paediatrics POF Hospital Wah Cantt, from June 2008 to June 2010. Three hundred and ten children aged between 6 months to 6 years were included in the study. One hundred and fifty-seven children who presented with febrile seizures were our cases, while, 153 children who presented with febrile illnesses without seizures were recruited as controls. All patients were assessed for iron deficiency anaemia by measuring haemoglobin level, serum ferritin level, Mean Corpuscular Haemoglobin Concentration (MCHC) and Mean Corpuscular Volume (MCV). Patients with iron deficiency anaemia amongst controls and cases were documented. Percentages and Odds ratio were derived from the collected data. Results: 31.85% of cases (50 out of 157) had iron deficiency anaemia whereas, 19.6% of controls (30 out of 153) were found to have iron deficiency anaemia as revealed by low levels of haemoglobin level, serum ferritin level, Mean Corpuscular Haemoglobin Concentration and Mean Corpuscular Volume. Odds ratio was 1.93. Conclusion: Patients with febrile seizures are 1.93 times more likely to have iron deficiency anaemia compared to febrile patients without seizures. (author)

  20. Prenatal stress and risk of febrile seizures in children: a nationwide longitudinal study in Denmark

    DEFF Research Database (Denmark)

    Li, Jiong; Olsen, Jørn; Obel, Carsten


    We aimed to examine whether exposure to prenatal stress following maternal bereavement is associated with an increased risk of febrile seizures. In a longitudinal population-based cohort study, we followed 1,431,175 children born in Denmark. A total of 34,777 children were born to women who lost...... a close relative during pregnancy or within 1 year before the pregnancy and they were included in the exposed group. The exposed children had a risk of febrile seizures similar to that of the unexposed children (hazard ratio (HR) 1.00, 95% CI 0.94-1.06). The HRs did not differ according to the nature...... or timing of bereavement. Our data do not suggest any causal link between exposure to prenatal stress and febrile seizures in childhood....

  1. Distribution of risk factors among children with febrile convulsions in ...

    African Journals Online (AJOL)

    The proximal risk factors are male gender, age < 2 years, 2nd birth order and positive family nd history. The social status of families is a distal risk factor. The second year of life and 2 birth order are the strongest predisposing factors to the development of FC. Key words: Febrile convulsions, Risk factors, Benin City, Nigeria ...

  2. Translation of clinical prediction rules for febrile children to primary care practice : an observational cohort study

    NARCIS (Netherlands)

    van Ierland, Yvette; Elshout, Gijs; Berger, Marjolein Y.; Vergouwe, Yvonne; de Wilde, Marcel; van der Lei, Johan; Mol, Henritte A.; Oostenbrink, Rianne

    Background Clinical prediction rules (CPRs) to identify children with serious infections lack validation in low-prevalence populations, which hampers their implementation in primary care practice. Aim To evaluate the diagnostic value of published CPRs for febrile children in primary care. Design and

  3. Urinary tract infection in febrile under five children in Enugu, South ...

    African Journals Online (AJOL)

    Background: Fever is a common symptom of urinary tract infection (UTI) in children less than 5 years of age. Little attention is however paid to UTI as a cause of fever in this age group. Objective: The objective of the following study is to determine the prevalence of UTI in febrile children less than 5 years of age and relate it to ...

  4. [Imaging and follow-up of children with first febrile Urinary Tract Infection (UTI)]. (United States)

    Grossman, Zachi; Miron, Dan


    Urinary tract infection (UTI) in children might, in a minority of cases, cause renal scarring and permanent damage. Known risk factors for renal damage are: obstruction to urinary flow, vesicoureteric reflux and recurrent infections. The current recommendations for imaging and follow-up of children with first febrile UTI include renal ultrasound to rule out anatomic abnormalities, particularly obstruction, cystography for possible diagnosis of vesicoureteric reflux, and prophylactic antibiotic therapy to prevent recurrent infections in children with detected reflux. DMSA renal scanning for the detection of renal scars is recommended as part of the imaging protocol by some institutions. Recently, published data doubts the importance of the various imaging techniques, as well as the effectiveness of prophylactic antibiotic therapy. In the current review, the role of renal ultrasound is examined, especially with regards to familiar data from fetal ultrasound. The complex relationship between vesicoureteric reflux and renal scarring is presented, with the possible implications on the importance of performing routine cystography and DMSA scanning after UTI. Studies questioning the effectiveness of prophylactic antibiotic therapy emphasize the importance of rapid diagnosis and therapy of suspected recurrent UTI as the preferred approach to prevent renal damage. Imaging studies are only recommended for high risk groups and not as a routine following UTI.

  5. Two-Step Process for ED UTI Screening in Febrile Young Children: Reducing Catheterization Rates. (United States)

    Lavelle, Jane M; Blackstone, Mercedes M; Funari, Mary Kate; Roper, Christine; Lopez, Patricia; Schast, Aileen; Taylor, April M; Voorhis, Catherine B; Henien, Mira; Shaw, Kathy N


    Urinary tract infection (UTI) screening in febrile young children can be painful and time consuming. We implemented a screening protocol for UTI in a high-volume pediatric emergency department (ED) to reduce urethral catheterization, limiting catheterization to children with positive screens from urine bag specimens. This quality-improvement initiative was implemented using 3 Plan-Do-Study-Act cycles, beginning with a small test of the proposed change in 1 ED area. To ensure appropriate patients received timely screening, care teams discussed patient risk factors and created patient-specific, appropriate procedures. The intervention was extended to the entire ED after providing education. Finally, visual cues were added into the electronic health record, and nursing scripts were developed to enlist family participation. A time-series design was used to study the impact of the 6-month intervention by using a p-chart to determine special cause variation. The primary outcome measure for the study was defined as the catheterization rate in febrile children ages 6 to 24 months. The ED reduced catheterization rates among febrile young children from 63% to UTIs among those followed within the hospital's network. A 2-step less-invasive process for screening febrile young children for UTI can be instituted in a high-volume ED without increasing length of stay or missing cases of UTI. Copyright © 2016 by the American Academy of Pediatrics.

  6. Duration of Fever and Course of Symptoms in Young Febrile Children Presenting with Uncomplicated Illness

    NARCIS (Netherlands)

    Kool, M.; Elshout, G.; Moll, H.A.; Koes, B.W.; van der Wouden, J.C.; Berger, M.Y.


    Purpose: It is important to advise parents when to consult a doctor when their child has fever. To provide evidence-based, safety-net advice for young febrile children, we studied the risk of complications, the occurrence of alarm symptoms, the duration of fever. Methods: In a 7-day prospective

  7. Alarm signs and antibiotic prescription in febrile children in primary care : an observational cohort study

    NARCIS (Netherlands)

    Elshout, Gijs; van Ierland, Yvette; Bohnen, Arthur M.; de Wilde, Marcel; Oostenbrink, Rianne; Moll, Henriette A.; Berger, Marjolein Y.

    Background Although fever in children is often self-limiting, antibiotics are frequently prescribed for febrile illnesses. GPs may consider treating serious infections by prescribing antibiotics. Aim To examine whether alarm signs and/or symptoms for serious infections are related to antibiotic

  8. Alarm signs and antibiotic prescription in febrile children in primary care: An observational cohort study

    NARCIS (Netherlands)

    G. Elshout (Gijs); Y. van Ierland (Yvette); A.M. Bohnen (Arthur); M. de Wilde (Marcel); R. Oostenbrink (Rianne); H.A. Moll (Henriëtte); M.Y. Berger (Marjolein)


    textabstractBackground Although fever in children is often self-limiting, antibiotics are frequently prescribed for febrile illnesses. GPs may consider treating serious infections by prescribing antibiotics. Aim To examine whether alarm signs and/or symptoms for serious infections are related to

  9. Technical report—Diagnosis and management of an initial UTI in febrile infants and young children. (United States)

    Finnell, S Maria E; Carroll, Aaron E; Downs, Stephen M


    The diagnosis and management of urinary tract infections (UTIs) in young children are clinically challenging. This report was developed to inform the revised, evidence-based, clinical guideline regarding the diagnosis and management of initial UTIs in febrile infants and young children, 2 to 24 months of age, from the American Academy of Pediatrics Subcommittee on Urinary Tract Infection. The conceptual model presented in the 1999 technical report was updated after a comprehensive review of published literature. Studies with potentially new information or with evidence that reinforced the 1999 technical report were retained. Meta-analyses on the effectiveness of antimicrobial prophylaxis to prevent recurrent UTI were performed. Review of recent literature revealed new evidence in the following areas. Certain clinical findings and new urinalysis methods can help clinicians identify febrile children at very low risk of UTI. Oral antimicrobial therapy is as effective as parenteral therapy in treating UTI. Data from published, randomized controlled trials do not support antimicrobial prophylaxis to prevent febrile UTI when vesicoureteral reflux is found through voiding cystourethrography. Ultrasonography of the urinary tract after the first UTI has poor sensitivity. Early antimicrobial treatment may decrease the risk of renal damage from UTI. Recent literature agrees with most of the evidence presented in the 1999 technical report, but meta-analyses of data from recent, randomized controlled trials do not support antimicrobial prophylaxis to prevent febrile UTI. This finding argues against voiding cystourethrography after the first UTI.

  10. Epilepsy and febrile seizures in children of treated and untreated subfertile couples

    DEFF Research Database (Denmark)

    Sun, Yuelian; Vestergaard, Mogens; Christensen, Jakob


    BACKGROUND: Only few studies have addressed the long-term neurological outcomes of children born by subfertile couples. We studied the risk of epilepsy and febrile seizures in children of treated and untreated subfertile couples. METHODS: The study included 83 194 live singletons born by mothers...... who took part in the Danish National Birth Cohort (DNBC). Information on time to pregnancy (TTP) and infertility treatment was reported by the mothers in computer-assisted telephone interviews. Data on epilepsy and febrile seizures were extracted from the Danish National Hospital Register. RESULTS......: Overall, children of subfertile couples (TTP > 12 months) had a 51% higher risk of epilepsy [incidence rate ratio (IRR): 1.51; 95% confidence interval (95% CI): 1.17-1.94] compared with children of couples with a TTP of 0-5 months. The corresponding estimates were 1.71 (95% CI: 1.21-2.42) if the couples...

  11. Outpatient parenteral antimicrobial therapy in children with febrile urinary tract infection: a prospective randomized clinical trial

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    Nasiri Kalmarzi R


    Full Text Available "nBackground: Acute pyelonephritis may lead to permanent renal scarring. The standard recommendation for treatment of febrile children with urinary tract infection (UTI is hospitalization for intravenous antibiotics. The purpose of this study was to compare the efficacy of outpatient intravenous ceftriaxone and cefixime versus inpatient of the same regimen for children with febrile UTI.   "nMethods: In a randomized clinical trial, we compared the efficacy of administration two days intravenous ceftriaxone followed by an oral cefixime for eight days (as outpatient group versus four days intravenous ceftriaxone followed by an oral cefixime for six days (as inpatient group, in 203 children (99 cases in outpatient group and 104 cases in inpatient group 3 months to 15 years of age with febrile UTI, in terms of short-term clinical outcomes (sterilization of the urine and defeverescence and long-term morbidity (incidence of reinfection and renal scarring documented by DMSA scintigraphy. "nResults: Repeat urine cultures were sterile within 48 hours in all children, mean time to defeverescence was 27.58 (SD=±12.62 and 31.44 (SD=±17.06 hours for children in outpatient and inpatient groups, respectively (P=0.067. Reinfection occurred in 9.1% of outpatient and 13.4% of inpatient group (P=0.326. Renal scarring developed in 11% of children of outpatient and 7.6% of children of inpatient group (P=0.884. There was no significant difference between the two groups in respect of renal scarring. "nConclusions: Outpatient ceftriaxone for two days followed by cefixime to complete a 10 days course can be recommended as a safe and effective treatment for children with febrile UTI.

  12. Principles, practices and knowledge of clinicians when assessing febrile children: a qualitative study in Kenya. (United States)

    Hooft, Anneka M; Ripp, Kelsey; Ndenga, Bryson; Mutuku, Francis; Vu, David; Baltzell, Kimberly; Masese, Linnet N; Vulule, John; Mukoko, Dunstan; LaBeaud, A Desiree


    Clinicians in low resource settings in malaria endemic regions face many challenges in diagnosing and treating febrile illnesses in children. Given the change in WHO guidelines in 2010 that recommend malaria testing prior to treatment, clinicians are now required to expand the differential when malaria testing is negative. Prior studies have indicated that resource availability, need for additional training in differentiating non-malarial illnesses, and lack of understanding within the community of when to seek care play a role in effective diagnosis and treatment. The objective of this study was to examine the various factors that influence clinician behavior in diagnosing and managing children presenting with fever to health centres in Kenya. A total of 20 clinicians (2 paediatricians, 1 medical officer, 2 nurses, and 15 clinical officers) were interviewed, working at 5 different government-sponsored public clinic sites in two areas of Kenya where malaria is prevalent. Clinicians were interviewed one-on-one using a structured interview technique. Interviews were then analysed qualitatively for themes. The following five themes were identified: (1) Strong familiarity with diagnosis of malaria and testing for malaria; (2) Clinician concerns about community understanding of febrile illness, use of traditional medicine, delay in seeking care, and compliance; (3) Reliance on clinical guidelines, history, and physical examination to diagnose febrile illness and recognize danger signs; (4) Clinician discomfort with diagnosis of primary viral illness leading to increased use of empiric antibiotics; and (5) Lack of resources including diagnostic testing, necessary medications, and training modalities contributes to the difficulty clinicians face in assessing and treating febrile illness in children. These themes persisted across all sites, despite variation in levels of medical care. Within these themes, clinicians consistently expressed a need for reliable basic testing

  13. Beliefs and expectations of Canadian parents who bring febrile children for medical care. (United States)

    Enarson, Mark C; Ali, Samina; Vandermeer, Ben; Wright, Robert B; Klassen, Terry P; Spiers, Judith A


    The purpose of this survey was to study the beliefs, expectations, and satisfaction of Canadian parents regarding fever and the treatment of their febrile children. A survey was developed exploring caregiver beliefs and treatment strategies, as well as expectations and satisfaction with medical care. Some items were modeled after previous studies to allow comparison. Caregivers with febrile children were recruited from 2005 to 2007 at 3 urgent care centers and emergency departments in Edmonton, Canada: a pediatric emergency department (n = 376), an urban urgent care center (n = 227), and a suburban urgent care clinic (n = 173). High and rapidly rising temperature, as well as physical symptoms associated with fever, caused concern in most parents surveyed. Seventy-four percent of parents felt that the elevated temperature from fever was dangerous and 90.3% always try to treat it. Forty degrees Celsius was the most commonly sited threshold for danger. Identifying the cause (80.6%) and seriousness (87.4%) of fever were the most com-mon stressors identified. Caregivers expected to receive information about the child's illness and appropriate treatment. The parents most often wanted information about febrile seizures and the potential dangers of febrile illness. Only 16.7% of caregivers expected anti-biotics. Nearly 92% of subjects were usually satisfied with medical care. Fever phobia continues to be a significant issue for Canadian parents. As a result, they treat fever aggressively and often seek medical attention. Good communication is important for medical staff caring for febrile children and typically leads to satisfied parents.

  14. Urinary YKL-40 as a Candidate Biomarker for Febrile Urinary Tract Infection in Young Children. (United States)

    Kim, Hyun Hee; Chung, Mi Hae; Bin, Joong Hyun; Cho, Kyoung Soon; Lee, Juyoung; Suh, Jin Soon


    Given that YKL-40 is a known marker of inflammation, we sought to determine its association with urinary tract infection (UTI) in febrile children. In total, 44 children aged 0 to 24 months with febrile UTI and 35 age- and sex-matched controls with fever from other causes were enrolled in the study. ELISA was performed to determine the level of YKL-40 in urine collected from each child. The ratio of urinary YKL-40 to creatinine (Cr) was higher in the children with a UTI than in the controls (PUTI was 0.88 for the urinary YKL-40/Cr ratio, 0.86 for pyuria, and 0.71 for positive nitrite on urinalysis. We applied a cut-off value of 125.23 pg/mg to urinary YKL-40/Cr for detecting UTI. Eight of nine children in the control group with pyuria had urinary YKL-40/Cr levels lower than 125.23 pg/mg, and the one child in the UTI group without pyuria or positive nitrite had a urinary YKL-40/Cr level greater than 125.23 pg/mg. Determining the levels of urinary YKL-40/Cr may help identify true cases of UTI in febrile young children, especially when they have pyuria but not nitrite, or have neither pyuria nor nitrite in the urine. © The Korean Society for Laboratory Medicine

  15. Urinary tract infection in febrile under five children in Enugu, South Eastern Nigeria. (United States)

    Ibeneme, C A; Oguonu, T; Okafor, H U; Ikefuna, A N; Ozumba, U C


    Fever is a common symptom of urinary tract infection (UTI) in children less than 5 years of age. Little attention is however paid to UTI as a cause of fever in this age group. The objective of the following study is to determine the prevalence of UTI in febrile children less than 5 years of age and relate it to demographic and clinical characteristics. Urine specimen of febrile children aged 1-59 months obtained by suprapubic or midstream methods were analyzed using standard laboratory methods of microscopy, culture and sensitivity. A total of 200 children were enrolled; nearly 56% (112/200) were males. The mean age of the subjects was 31.14 ± 17.96 months. The prevalence of UTI was 11% and was significantly higher in females than in males ( P = 0.049). Children below 12 months of age had a higher rate of UTI than those 12 months and above ( P = 0.028). The common clinical features were vomiting, abdominal pain, diarrhea, urinary frequency and urgency but none had a significant association with UTI. UTI is common in febrile under-fives especially among females and infants. No association was apparent between the occurrence of UTI and clinical parameters.

  16. Urinary YKL-40 as a Candidate Biomarker for Febrile Urinary Tract Infection in Young Children (United States)

    Kim, Hyun Hee; Chung, Mi Hae; Bin, Joong Hyun; Cho, Kyoung Soon; Lee, Juyoung


    Background Given that YKL-40 is a known marker of inflammation, we sought to determine its association with urinary tract infection (UTI) in febrile children. Methods In total, 44 children aged 0 to 24 months with febrile UTI and 35 age- and sex-matched controls with fever from other causes were enrolled in the study. ELISA was performed to determine the level of YKL-40 in urine collected from each child. Results The ratio of urinary YKL-40 to creatinine (Cr) was higher in the children with a UTI than in the controls (Purinary YKL-40/Cr ratio, 0.86 for pyuria, and 0.71 for positive nitrite on urinalysis. We applied a cut-off value of 125.23 pg/mg to urinary YKL-40/Cr for detecting UTI. Eight of nine children in the control group with pyuria had urinary YKL-40/Cr levels lower than 125.23 pg/mg, and the one child in the UTI group without pyuria or positive nitrite had a urinary YKL-40/Cr level greater than 125.23 pg/mg. Conclusions Determining the levels of urinary YKL-40/Cr may help identify true cases of UTI in febrile young children, especially when they have pyuria but not nitrite, or have neither pyuria nor nitrite in the urine. PMID:29071817

  17. Anticonvulsive effect of paeoniflorin on experimental febrile seizures in immature rats: possible application for febrile seizures in children.

    Directory of Open Access Journals (Sweden)

    Hitomi Hino

    Full Text Available Febrile seizures (FS is the most common convulsive disorder in children, but there have been no clinical and experimental studies of the possible treatment of FS with herbal medicines, which are widely used in Asian countries. Paeoniflorin (PF is a major bioactive component of Radix Paeoniae alba, and PF-containing herbal medicines have been used for neuromuscular, neuropsychiatric, and neurodegenerative disorders. In this study, we analyzed the anticonvulsive effect of PF and Keishikashakuyaku-to (KS; a PF-containing herbal medicine for hyperthermia-induced seizures in immature rats as a model of human FS. When immature (P5 male rats were administered PF or KS for 10 days, hyperthermia-induced seizures were significantly suppressed compared to control rats. In cultured hippocampal neurons, PF suppressed glutamate-induced elevation of intracellular Ca(2+ ([Ca(2+](i, glutamate receptor-mediated membrane depolarization, and glutamate-induced neuronal death. In addition, PF partially suppressed the elevation in [Ca(2+](i induced by activation of the metabotropic glutamate receptor 5 (mGluR5, but not that mediated by α-amino-3-hydroxy-5-methyl-4-isoxazolpropionic acid (AMPA or N-methyl-D-aspartate (NMDA receptors. However, PF did not affect production or release of γ-aminobutyric acid (GABA in hippocampal neurons. These results suggest that PF or PF-containing herbal medicines exert anticonvulsive effects at least in part by preventing mGluR5-dependent [Ca(2+](i elevations. Thus, it could be a possible candidate for the treatment of FS in children.

  18. Alternating ibuprofen and acetaminophen in the treatment of febrile children: a pilot study [ISRCTN30487061

    Directory of Open Access Journals (Sweden)

    Sabra Ramzi


    Full Text Available Abstract Background Alternating ibuprofen and acetaminophen for the treatment of febrile children is a prevalent practice among physicians and parents, despite the lack of evidence on effectiveness or safety. This randomized, double-blind and placebo-controlled clinical trial aims at comparing the antipyretic effectiveness and safety of a single administration of alternating ibuprofen and acetaminophen doses to that of ibuprofen mono-therapy in febrile children. Methods Seventy febrile children were randomly allocated to receive either a single oral dose of 10 mg/kg ibuprofen and 15 mg/kg oral acetaminophen after 4 hours, or a similar dose of ibuprofen and placebo at 4 hours. Rectal temperature was measured at baseline, 4, 5, 6, 7 and 8 hours later. Endpoints included proportions of afebrile children at 6, 7 and 8 hours, maximum decline in temperature, time to recurrence of fever, and change in temperature from baseline at each time point. Intent-to-treat analysis was planned with statistical significance set at P Results A higher proportion of subjects in the intervention group (83.3% became afebrile at 6 hours than in the control group (57.6%; P = 0.018. This difference was accentuated at 7 and 8 hours (P Conclusion A single dose of alternating ibuprofen and acetaminophen appears to be a superior antipyretic regimen than ibuprofen mono-therapy. Further studies are needed to confirm these findings.

  19. Chronological Evolution of Magnetic Resonance Imaging Findings in Children With Febrile Infection-Related Epilepsy Syndrome. (United States)

    Rivas-Coppola, Marianna S; Shah, Namrata; Choudhri, Asim F; Morgan, Robin; Wheless, James W


    To describe and analyze the chronological evolution of the radiological findings in seven children with febrile infection-related epilepsy syndrome. This is a retrospective study describing the radiological findings and evolution in seven children with febrile infection-related epilepsy syndrome who presented from 2009 to 2013. The children all fit the defined clinical criteria for febrile infection-related epilepsy syndrome; all had a history of normal psychomotor development who presented with acute-onset catastrophic partial status epilepticus associated with a febrile illness or unspecific infectious process. The children were identified from the author's weekly review of the pediatric inpatient service, and then the data were collected and analyzed retrospectively. Six males and one female ranging from 3 months to 9 years of age presented with status epilepticus preceded by a febrile illness. Extensive investigations for infectious, autoimmune, and metabolic etiologies were unremarkable. Multiple antiepileptic medications were attempted, including drug-induced coma in all of them, with poor response. Immunotherapy with intravenous steroids or intravenous immunoglobulin (three patients had both) was tried in six of seven patients with a poor response. Ketogenic diet was initiated in four of seven patients with limited response. Serial magnetic resonance imaging studies, done from the initial presentation through 18 months of follow-up, showed evolution from normal imaging to severe cerebral atrophy. Progressive cytotoxic edema involving mostly bilateral hippocampi and temporal lobes was appreciated in one to three weeks. At one month from seizure onset, mild to moderate cerebral atrophy and hippocampal sclerosis was appreciated that continued to progress over the next year. After six to twelve months, most of the patients showed moderate to severe cerebral atrophy and by one year, cerebellar atrophy was also appreciated. Febrile infection-related epilepsy

  20. Quantitative Evaluation of Medial Temporal Lobe Morphology in Children with Febrile Status Epilepticus: Results of the FEBSTAT Study. (United States)

    McClelland, A C; Gomes, W A; Shinnar, S; Hesdorffer, D C; Bagiella, E; Lewis, D V; Bello, J A; Chan, S; MacFall, J; Chen, M; Pellock, J M; Nordli, D R; Frank, L M; Moshé, S L; Shinnar, R C; Sun, S


    The pathogenesis of febrile status epilepticus is poorly understood, but prior studies have suggested an association with temporal lobe abnormalities, including hippocampal malrotation. We used a quantitative morphometric method to assess the association between temporal lobe morphology and febrile status epilepticus. Brain MR imaging was performed in children presenting with febrile status epilepticus and control subjects as part of the Consequences of Prolonged Febrile Seizures in Childhood study. Medial temporal lobe morphologic parameters were measured manually, including the distance of the hippocampus from the midline, hippocampal height:width ratio, hippocampal angle, collateral sulcus angle, and width of the temporal horn. Temporal lobe morphologic parameters were correlated with the presence of visual hippocampal malrotation; the strongest association was with left temporal horn width (P status epilepticus, encompassing both the right and left sides. This association was statistically strongest in the right temporal lobe, whereas hippocampal malrotation was almost exclusively left-sided in this cohort. The association between temporal lobe measurements and febrile status epilepticus persisted when the analysis was restricted to cases with visually normal imaging findings without hippocampal malrotation or other visually apparent abnormalities. Several component morphologic features of hippocampal malrotation are independently associated with febrile status epilepticus, even when complete hippocampal malrotation is absent. Unexpectedly, this association predominantly involves the right temporal lobe. These findings suggest that a spectrum of bilateral temporal lobe anomalies are associated with febrile status epilepticus in children. Hippocampal malrotation may represent a visually apparent subset of this spectrum. © 2016 by American Journal of Neuroradiology.

  1. Urinary Tract Infection in Febrile Children with Sickle Cell Anaemia ...

    African Journals Online (AJOL)

    Eastern Nigeria. Children with this disease have increased tendency to develop frequent and severe infections especially of the urinary tract, bones and lungs. The prevalence of urinary tract infection (UTI) has however not been reported in this part ...

  2. Characterization of Dengue Virus Infections Among Febrile Children Clinically Diagnosed With a Non-Dengue Illness, Managua, Nicaragua. (United States)

    Waggoner, Jesse J; Gresh, Lionel; Mohamed-Hadley, Alisha; Balmaseda, Angel; Soda, K James; Abeynayake, Janaki; Sahoo, Malaya K; Liu, Yuanyuan; Kuan, Guillermina; Harris, Eva; Pinsky, Benjamin A


    We sought to characterize dengue virus (DENV) infections among febrile children enrolled in a pediatric cohort study who were clinically diagnosed with a non-dengue illness ("C cases"). DENV infections were detected and viral load quantitated by real-time reverse transcription-polymerase chain reaction in C cases presenting between January 2007 and January 2013. One hundred forty-one of 2892 C cases (4.88%) tested positive for DENV. Of all febrile cases in the study, DENV-positive C cases accounted for an estimated 52.0% of patients with DENV viremia at presentation. Compared with previously detected, symptomatic dengue cases, DENV-positive C cases were significantly less likely to develop long-lasting humoral immune responses to DENV, as measured in healthy annual serum samples (79.7% vs 47.8%; P dengue. These findings have important implications for DENV transmission modeling, immunology, and epidemiologic surveillance. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail:

  3. Comparison of procalcitonin and different guidelines for first febrile urinary tract infection in children by imaging. (United States)

    Liao, Pei-Fen; Ku, Min-Sho; Tsai, Jeng-Dau; Choa, Yu-Hua; Hung, Tung-Wei; Lue, Ko-Huang; Sheu, Ji-Nan


    We examined the ability of a procalcitonin (PCT) protocol to detect vesicoureteral reflux (VUR) and renal scarring (RS), evaluated procedural costs and radiation burden, and compared four representative guidelines for children with their first febrile urinary tract infection (UTI). Children aged ≤2 years with their first febrile UTI who underwent renal ultrasonography (US), acute and late technetium-99m ((99m)Tc)-dimercaptosuccinic acid scan, and voiding cystourethrography were prospectively studied. The representative guidelines applied in a retrospective simulation included the American Academy of Pediatrics (AAP), National Institute of Clinical Excellence, top-down approach (TDA), and Italian Society of Pediatric Nephrology (ISPN). These were compared in terms of ability to detect abnormalities, procedural costs and radiation. Of 278 children analyzed, 172 (61.9%) had acute pyelonephritis. There was VUR in 101 (36.3%) children, including 73 (26.3%) with grades III-V VUR. RS was identified in 75 (27.0%) children. To detect VUR, TDA and PCT had the highest sensitivity for grades I-V VUR (80.2%) and III-V VUR (94.5%), respectively, whereas AAP had the highest specificity for I-V VUR (77.4%) and III-V VUR (78.0%), respectively. TDA and PCT had the highest sensitivity (100%) for detecting RS. The highest cost and radiation dose was associated with TDA, whereas AAP had the least expenditure and radiation exposure. By multivariate analysis, PCT and VUR, especially grades III-V, were independent predictors of RS. There is no perfect guideline for first febrile UTI children. The PCT protocol has good ability for detecting high-grade VUR and RS. If based on available imaging modalities and reducing cost and radiation burden, clinical suggestions in the AAP guidelines represent a considerable protocol.

  4. Accuracy of early DMSA scan for VUR in young children with febrile UTI. (United States)

    Zhang, Xin; Xu, Hong; Zhou, Lijun; Cao, Qi; Shen, Qian; Sun, Li; Fang, Xiaoyan; Guo, Wei; Zhai, Yihui; Rao, Jia; Pa, Mier; Zhao, Ruifang; Bi, Yunli


    To evaluate the accuracy of an acute (99m)Tc-dimercaptosuccinic acid (DMSA) scan in predicting dilating vesicoureteral reflux (VUR) among young children with a febrile urinary tract infection (UTI). The medical records of children (≤ 2 years of age), presenting with febrile UTI between January 2000 and December 2011, were retrospectively reviewed. A total of 523 children were included in this study, of whom 397 children (75.9%) had abnormal DMSA results and 178 children (34.0%) were identified as VUR on micturating cystourethrography (MCU). Among all the patients, the number of children with dilating VUR was 151 (28.9%). The rate of abnormal results on DMSA for the dilating VUR group was significantly higher than the rates for the non-VUR and low-grade VUR groups (P UTI, an acute DMSA scan is valuable in the exclusion of dilating VUR. The likelihood of the presence of dilating VUR on MCU is rather low when the result of DMSA is negative. DMSA should be conducted to assess the need for an MCU.

  5. Serious bacterial infections in febrile young children: Lack of value ...

    African Journals Online (AJOL)

    Young children often attend primary care institutions and emergency departments with ... Three-quarters (~1 000) are admitted for subspecialist care and tend to be afebrile on ..... occurred after the first 3 days of hospitalisation, with the median time to death .... are extremely useful markers to aid in diagnosis, whereas there.

  6. A prospective study of the causes of febrile illness requiring hospitalization in children in Cambodia.

    Directory of Open Access Journals (Sweden)

    Kheng Chheng

    Full Text Available Febrile illnesses are pre-eminent contributors to morbidity and mortality among children in South-East Asia but the causes are poorly understood. We determined the causes of fever in children hospitalised in Siem Reap province, Cambodia.A one-year prospective study of febrile children admitted to Angkor Hospital for Children, Siem Reap. Demographic, clinical, laboratory and outcome data were comprehensively analysed. Between October 12(th 2009 and October 12(th 2010 there were 1225 episodes of febrile illness in 1180 children. Median (IQR age was 2.0 (0.8-6.4 years, with 850 (69% episodes in children <5 years. Common microbiological diagnoses were dengue virus (16.2%, scrub typhus (7.8%, and Japanese encephalitis virus (5.8%. 76 (6.3% episodes had culture-proven bloodstream infection, including Salmonella enterica serovar Typhi (22 isolates, 1.8%, Streptococcus pneumoniae (13, 1.1%, Escherichia coli (8, 0.7%, Haemophilus influenzae (7, 0.6%, Staphylococcus aureus (6, 0.5% and Burkholderia pseudomallei (6, 0.5%. There were 69 deaths (5.6%, including those due to clinically diagnosed pneumonia (19, dengue virus (5, and melioidosis (4. 10 of 69 (14.5% deaths were associated with culture-proven bloodstream infection in logistic regression analyses (odds ratio for mortality 3.4, 95% CI 1.6-6.9. Antimicrobial resistance was prevalent, particularly in S. enterica Typhi, (where 90% of isolates were resistant to ciprofloxacin, and 86% were multi-drug resistant. Comorbid undernutrition was present in 44% of episodes and a major risk factor for acute mortality (OR 2.1, 95% CI 1.1-4.2, as were HIV infection and cardiac disease.We identified a microbiological cause of fever in almost 50% of episodes in this large study of community-acquired febrile illness in hospitalized children in Cambodia. The range of pathogens, antimicrobial susceptibility, and co-morbidities associated with mortality described will be of use in the development of rational guidelines

  7. A prospective study of the causes of febrile illness requiring hospitalization in children in Cambodia. (United States)

    Chheng, Kheng; Carter, Michael J; Emary, Kate; Chanpheaktra, Ngoun; Moore, Catrin E; Stoesser, Nicole; Putchhat, Hor; Sona, Soeng; Reaksmey, Sin; Kitsutani, Paul; Sar, Borann; van Doorn, H Rogier; Uyen, Nguyen Hanh; Van Tan, Le; Paris, Daniel H; Paris, Daniel; Blacksell, Stuart D; Amornchai, Premjit; Wuthiekanun, Vanaporn; Parry, Christopher M; Day, Nicholas P J; Kumar, Varun


    Febrile illnesses are pre-eminent contributors to morbidity and mortality among children in South-East Asia but the causes are poorly understood. We determined the causes of fever in children hospitalised in Siem Reap province, Cambodia. A one-year prospective study of febrile children admitted to Angkor Hospital for Children, Siem Reap. Demographic, clinical, laboratory and outcome data were comprehensively analysed. Between October 12(th) 2009 and October 12(th) 2010 there were 1225 episodes of febrile illness in 1180 children. Median (IQR) age was 2.0 (0.8-6.4) years, with 850 (69%) episodes in children <5 years. Common microbiological diagnoses were dengue virus (16.2%), scrub typhus (7.8%), and Japanese encephalitis virus (5.8%). 76 (6.3%) episodes had culture-proven bloodstream infection, including Salmonella enterica serovar Typhi (22 isolates, 1.8%), Streptococcus pneumoniae (13, 1.1%), Escherichia coli (8, 0.7%), Haemophilus influenzae (7, 0.6%), Staphylococcus aureus (6, 0.5%) and Burkholderia pseudomallei (6, 0.5%). There were 69 deaths (5.6%), including those due to clinically diagnosed pneumonia (19), dengue virus (5), and melioidosis (4). 10 of 69 (14.5%) deaths were associated with culture-proven bloodstream infection in logistic regression analyses (odds ratio for mortality 3.4, 95% CI 1.6-6.9). Antimicrobial resistance was prevalent, particularly in S. enterica Typhi, (where 90% of isolates were resistant to ciprofloxacin, and 86% were multi-drug resistant). Comorbid undernutrition was present in 44% of episodes and a major risk factor for acute mortality (OR 2.1, 95% CI 1.1-4.2), as were HIV infection and cardiac disease. We identified a microbiological cause of fever in almost 50% of episodes in this large study of community-acquired febrile illness in hospitalized children in Cambodia. The range of pathogens, antimicrobial susceptibility, and co-morbidities associated with mortality described will be of use in the development of rational

  8. Premarketing surveillance of ibuprofen suppositories in febrile children. (United States)

    Hadas, Dan; Youngster, Ilan; Cohen, Avner; Leibovitch, Eugene; Shavit, Itai; Erez, Ilan; Uziel, Yosef; Berkovitch, Matitiahu


    In many countries, ibuprofen is available only in oral formulations. The authors aimed to investigate parental satisfaction and possible adverse reactions among children receiving newly marketed ibuprofen suppositories, prior to their arrival at the pharmaceutical points of distribution. Children needing antipyretic medication were recruited from 11 pediatric wards and clinics in Israel. Each patient received ibuprofen suppositories (5-10 mg/kg/dose) after completing a data collection form. After 3 to 7 days of treatment, information regarding parent satisfaction, possible adverse reactions, and concomitant use of drugs was obtained. Overall, 490 children completed the study. Parents' satisfaction was high (4.5 ± 0.47 on a scale of 1-5), and 92.2% reported that they would use the medication in the future. Adverse reactions were reported in 8 patients (1.63%, 95% confidence interval = 1.77-3.25), the most common being diarrhea. Rectal administration of ibuprofen suppositories is well tolerated and overall satisfaction and the repeated expected use were high.

  9. Malaria and Chikungunya Detected Using Molecular Diagnostics Among Febrile Kenyan Children. (United States)

    Waggoner, Jesse; Brichard, Julie; Mutuku, Francis; Ndenga, Bryson; Heath, Claire Jane; Mohamed-Hadley, Alisha; Sahoo, Malaya K; Vulule, John; Lefterova, Martina; Banaei, Niaz; Mukoko, Dunstan; Pinsky, Benjamin A; LaBeaud, A Desiree


    In sub-Saharan Africa, malaria is frequently overdiagnosed as the cause of an undifferentiated febrile illness, whereas arboviral illnesses are presumed to be underdiagnosed. Sera from 385 febrile Kenyan children, who presented to 1 of 4 clinical sites, were tested using microscopy and real-time molecular assays for dengue virus (DENV), chikungunya virus (CHIKV), malaria, and Leptospira . Malaria was the primary clinical diagnosis for 254 patients, and an arboviral infection (DENV or CHIKV) was the primary diagnosis for 93 patients. In total, 158 patients (41.0%) had malaria and 32 patients (8.3%) had CHIKV infections. Compared with real-time polymerase chain reaction, microscopy demonstrated a percent positive agreement of 49.7%. The percentage of malaria cases detected by microscopy varied significantly between clinical sites. Arboviral infections were the clinical diagnosis for patients on the Indian Ocean coast (91 of 238, 38.2%) significantly more often than patients in the Lake Victoria region (2 of 145, 1.4%; P < .001). However, detection of CHIKV infections was significantly higher in the Lake Victoria region (19 of 145 [13.1%] vs 13 of 239 [5.4%]; P = .012). The clinical diagnosis of patients with an acute febrile illness, even when aided by microscopy, remains inaccurate in malaria-endemic areas, contributing to inappropriate management decisions.

  10. Prevalence of malaria, typhoid, toxoplasmosis and rubella among febrile children in Cameroon. (United States)

    Achonduh-Atijegbe, Olivia A; Mfuh, Kenji O; Mbange, Aristid H E; Chedjou, Jean P; Taylor, Diane W; Nerurkar, Vivek R; Mbacham, Wilfred F; Leke, Rose


    The current roll-out of rapid diagnostic tests (RDTs) in many endemic countries has resulted in the reporting of fewer cases of malaria-attributed illnesses. However, lack of knowledge of the prevalence of other febrile illnesses and affordable diagnostic tests means that febrile patients are not managed optimally. This study assessed the prevalence of commonly treatable or preventable febrile illnesses in children between 6 months and 15 years using rapid diagnostic tests at the point-of-care. Febrile children were enrolled between February-April 2014 at a health facility after obtaining informed consent from parent. Eligible participants were aged 6 months-15 years with a history of fever in the last 24 h or axillary temperature ≥38 °C at consultation. All participants were tested using RDTs for malaria, typhoid, toxoplasmosis and rubella. Malaria parasites were further identified by microscopy and PCR. Clinical and household characteristics were recorded and association with pathogens determined. Of the 315 children enrolled, the mean age was 5.8 ± 3.8 years. Stomach pain (41.2 %) was the most reported symptom. Prior to attending the health facility, 70.8 % had taken antipyretics, 27.9 % antimalarials, 11.4 % antibiotics and 13.3 % antifungal drugs. Among 315 children with fever, based on RDTs, 56.8 % were infected with malaria, 4.4 % with typhoid, 3.2 % with acute toxoplasmosis, and 1.3 % with rubella (all positive for rubella were in the same family and not vaccinated). All non-malarial infections were co-infections and approximately 30 % of the fever cases went un-diagnosed. Malaria prevalence by microscopy and PCR was 43.4 and 70.2 % respectively. The sensitivity and specificity of RDTs for the diagnosis of malaria were 75.98 and 100 % respectively, with 0.73 measurement agreement between RDTs and microscopy while that of RDT and PCR were 81 and 100 % respectively with a K value of 0.72. The use of Insecticide Treated Bednets was

  11. Very early discharge versus early discharge versus non-early discharge in children with cancer and febrile neutropenia

    NARCIS (Netherlands)

    Loeffen, Erik A. H.; te Poele, Esther M.; Tissing, Wim J. E.; Boezen, H. Marike; de Bont, Eveline S. J. M.


    Background Chemotherapy-induced neutropenia is a common adverse effect in children with cancer. Due to the high relative risk of infections and infectious complications, standard care for children with cancer and febrile neutropenia consists of routine hospitalization and parenteral administration

  12. Aetiologies of non-malaria febrile episodes in children under 5 years in sub-Saharan Africa

    NARCIS (Netherlands)

    Kiemde, Francois; Spijker, René; Mens, Petra F.; Tinto, Halidou; Boele, Michael; Schallig, Henk D. F. H.


    ObjectivesTo provide an overview of the most frequent aetiologies found in febrile episodes of children under 5 years from sub-Saharan Africa. MethodsMEDLINE and EMBASE were searched for publications in English and French on non-malaria fever episodes in African children under 5 years of age, which

  13. Can procalcitonin reduce unnecessary voiding cystoureterography in children with first febrile urinary tract infection? (United States)

    Halimi-Asl, Aliasghar; Hosseini, Amir Hossein; Nabavizadeh, Pooneh


    Recently, new predictors of vesicoureteral reflux (VUR) in children with a first febrile UTI such as Procalcitonin (PCT) were introduced as selective approaches for cystography. This study wants to show the capability of PCT in predicting presence of VUR at the first febrile UTI in children. Patients between 1 month and 15 years of age with febrile UTI were included in this prospective study. PCT values were measured through a semi-quantitative method in four grades comprising values less than 0.5, 0.5-2.0, 2.0-10.0 and above 10.0 ng/ml. The independence of PCT levels in predicting VUR were assessed after adjustment for all potential confounders using a logistic-regression model. A total of 68 patients, 54 (79.4%) girls and 14 (20.6%) boys were evaluated. PCT level demonstrated a significant difference between patients with positive VUR and those with negative VUR (P=0.012). To calculate the independent factors that may predict the presence of VUR, all included variables were adjusted for age and sex. Results of logistic regression showed that a PCT level between 2.0 and 10.0 ng/mL could independently predict presence of VUR (Odds ratio=6.11, CI 95%= 1.22-30.77, P=0.03). Our finding in this study showed that readily available semi-quantitative measures for PCT are feasible for detecting patients with VUR. We suggest that in semi-quantitative measurements of PCT, levels between 2.0 and 10.0 ng/ml could be an independent predictor of positive VUR.

  14. Assessment of the Level of GABA and Some Trace Elements in Blood in Children who Suffer from Familial Febrile Convulsions

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    Osama N. Salah


    Full Text Available Febrile seizure is one of the most common neurological problems during childhood. The etiology and pathogenesis of febrile seizure remain unknown. However, several factors such as vitamin B6 deficiency, electrolyte disturbances, and reduction in serum zinc, selenium, magnesium levels, and low gamma - aminobutyric acid (GABA levels are thought to play a role in the pathogenesis of febrile seizure. The present study included twenty children from 10 families, 11 were male and 9 were female. Each family has at least 2 members with a history of febrile convulsion. All cases were subjected to the following: Determination of serum levels of copper, zinc, magnesium, selenium level in serum, and plasma level of γ-aminobytaric acid (GABA. Serum levels of selenium and GABA were statistically significantly low in comparison with controls. Serum copper was statistically significantly higher in cases than controls, while serum zinc showed no significant changes in the cases of febrile convulsion compared with the control group. The mean Zn level in the serum of febrile convulsion was found to be at lower level than in the control group. The serum magnesium was significantly low in cases than controls. The logistic regression model in our study shows that Selenium and Magnesium have protective effects, while Copper has causative effect.

  15. Clinical profile and treatment outcome of febrile infection-related epilepsy syndrome in South Indian children

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    Sandeep B Patil


    Full Text Available Purpose: To describe the clinical features and outcome of febrile infection-related epilepsy syndrome (FIRES, a catastrophic epileptic encephalopathy, in a cohort of South Indian children. Materials and Methods: We performed a retrospective chart review of a cohort of children with previously normal development who presented with status epilepticus or encephalopathy with recurrent seizures following a nonspecific febrile illness during the period between January 2007 and January 2012. They were divided into two groups super refractory status epilepticus (SRSE and refractory status epilepticus (RSE depending on the duration and severity of the seizures. Key Findings: Fifteen children who met the inclusion criteria were included for the final analysis. The age of the children at presentation ranged 3-15 years (median 6.3 years. All the children presented with prolonged or recurrent seizures occurring 1-12 days (median 4 days after the onset of fever. Eight children had SRSE while seven children had refractory seizures with encephalopathy. Cerebrospinal fluid (CSF analysis was done in all the children in the acute phase, and the cell count ranged 0-12 cells/μL (median 2 cells/μL with normal sugar and protein levels. Initial neuroimaging done in all children (MRI in 10 and CT in 5, and it was normal in 13 children. Treatment modalities included multiple antiepileptic drugs (AEDs (4-9 drugs (median 5 drugs. Midazolam (MDZ infusion was administered in seven patients. Eight patients required barbiturate coma to suppress the seizure activity. The duration of the barbiturate coma ranged 2-90 days (median 3 days. Steroids were used in 14 children and intravenous immunoglobulin (2 g/kg in 7 children. Three children died in the acute phase. All children were maintained on multiple AEDs till the last follow-up, the number of AEDs ranged 1-6 (median 5 AEDs. The patients with super refractory status in the acute phase were found to be more severely disabled

  16. Unsuspected Dengue as a Cause of Acute Febrile Illness in Children and Adults in Western Nicaragua.

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    Megan E Reller


    Full Text Available Dengue is an emerging infectious disease of global significance. Suspected dengue, especially in children in Nicaragua's heavily-urbanized capital of Managua, has been well documented, but unsuspected dengue among children and adults with undifferentitated fever has not.To prospectively study dengue in semi-urban and rural western Nicaragua, we obtained epidemiologic and clinical data as well as acute and convalescent sera (2 to 4 weeks after onset of illness from a convenience sample (enrollment Monday to Saturday daytime to early evening of consecutively enrolled patients (n = 740 aged ≥ 1 years presenting with acute febrile illness. We tested paired sera for dengue IgG and IgM and serotyped dengue virus using reverse transcriptase-PCR. Among 740 febrile patients enrolled, 90% had paired sera. We found 470 (63.5% were seropositive for dengue at enrollment. The dengue seroprevalance increased with age and reached >90% in people over the age of 20 years. We identified acute dengue (serotypes 1 and 2 in 38 (5.1% patients. Only 8.1% (3/37 of confirmed cases were suspected clinically.Dengue is an important and largely unrecognized cause of fever in rural western Nicaragua. Since Zika virus is transmitted by the same vector and has been associated with severe congenital infections, the population we studied is at particular risk for being devastated by the Zika epidemic that has now reached Central America.

  17. Algorithms imaging tests comparison following the first febrile urinary tract infection in children. (United States)

    Tombesi, María M; Alconcher, Laura F; Lucarelli, Lucas; Ciccioli, Agustina


    To compare the diagnostic sensitivity, costs and radiation doses of imaging tests algorithms developed by the Argentine Society of Pediatrics in 2003 and 2015, against British and American guidelines after the first febrile urinary tract infection (UTI). Inclusion criteria: children ≤ 2 years old with their first febrile UTI and normal ultrasound, voiding cystourethrography and dimercaptosuccinic acid scintigraphy, according to the algorithm established by the Argentine Society of Pediatrics in 2003, treated between 2003 and 2010. The comparisons between algorithms were carried out through retrospective simulation. Eighty (80) patients met the inclusion criteria; 51 (63%) had vesicoureteral reflux (VUR); 6% of the cases were severe. Renal scarring was observed in 6 patients (7.5%). Cost: ARS 404,000. Radiation: 160 millisieverts. With the Argentine Society of Pediatrics' algorithm developed in 2015, the diagnosis of 4 VURs and 2 cases of renal scarring would have been missed. The cost of this omission would have been ARS 301,800 and 124 millisieverts of radiation. British and American guidelines would have missed the diagnosis of all VURs and all cases of renal scarring, with a related cost of ARS 23,000 and ARS 40,000, respectively and 0 radiation. Intensive protocols are highly sensitive to VUR and renal scarring, but they imply high costs and doses of radiation, and result in questionable benefits. Sociedad Argentina de Pediatría

  18. Febrile Seizure Simulation

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    Victor Cisneros


    Full Text Available Audience: This simulation session is appropriate for medical students, community physicians, or residents in emergency medicine, neurology, pediatrics, or family medicine. Introduction: Febrile seizures are the most common form of seizures in childhood; they are thought to occur in 2-5% of all children.1-3 Febrile seizures are defined as a seizure in association with a febrile illness in children without a central nervous system infection, previous afebrile seizure, known brain disorder, or electrolyte abnormalities. 1,2 They typically occur between 6 months and 18 months of age though they can occur up to 5 years of age.3 Febrile seizures are categorized as: simple (generalized seizure lasting less than 15 minutes in a child aged 6 months to 5 years, and less than 1 in a 24 hour period or complex (a focal seizure or generalized seizure lasting greater than 15 minutes, or multiple seizures in a 24 hour period. 1,3 Treatment for febrile seizures is based on treating the underlying cause of the fever and giving reassurance and education to the parents.2 Mortality is extremely rare, and there is no difference in the patient’s cognitive abilities after a febrile seizure, even when the seizure is prolonged.1 Objectives: At the end of this simulation session, the learner will be able to: 1 discuss the management of febrile seizures 2 discuss when placement of an advanced airway is indicated in the management of a febrile seizure 3 list the risk factors for febrile seizures 4 prepare a differential diagnosis for the causes of febrile seizures 5 educate family members on febrile seizures. Methods: This educational session is a high-fidelity simulation.

  19. Prevalence of non-febrile seizures in children with idiopathic autism spectrum disorder and their unaffected siblings: a retrospective cohort study. (United States)

    McCue, Lena M; Flick, Louise H; Twyman, Kimberly A; Xian, Hong; Conturo, Thomas E


    Autism spectrum disorder (ASD) is a heterogeneous disorder characterized not only by deficits in communication and social interactions but also a high rate of co-occurring disorders, including metabolic abnormalities, gastrointestinal and sleep disorders, and seizures. Seizures, when present, interfere with cognitive development and are associated with a higher mortality rate in the ASD population. To determine the relative prevalence of non-febrile seizures in children with idiopathic ASD from multiplex and simplex families compared with the unaffected siblings in a cohort of 610 children with idiopathic ASD and their 160 unaffected siblings, participating in the Autism Genetic Resource Exchange project, the secondary analysis was performed comparing the life-time prevalence of non-febrile seizures. Statistical models to account for non-independence of observations, inherent with the data from multiplex families, were used in assessing potential confounding effects of age, gender, and history of febrile seizures on odds of having non-febrile seizures. The life-time prevalence of non-febrile seizures was 8.2% among children with ASD and 2.5% among their unaffected siblings. In a logistic regression analysis that adjusted for familial clustering, children with ASD had 5.27 (95%CI: 1.51-18.35) times higher odds of having non-febrile seizures compared to their unaffected siblings. In this comparison, age, presence of gastrointestinal dysfunction, and history of febrile seizures were significantly associated with the prevalence of non-febrile seizures. Children with idiopathic ASD are significantly more likely to have non-febrile seizures than their unaffected siblings, suggesting that non-febrile seizures may be ASD-specific. Further studies are needed to determine modifiable risk factors for non-febrile seizures in ASD.

  20. To identify the factors affecting the risk of recurrent febrile seizures in saudi children

    International Nuclear Information System (INIS)

    Jamal, M.M.; Ahmed, W.


    Objective: To identify the risk factors of recurrent febrile seizures (FS) in Saudi children in a Northern Province of Hail in Saudi Arabia. Study Design: Descriptive prospective study. Place and Duration of Study: Pediatric department, King Khalid Hospital Hail, Kingdom of Saudi Arabia from 01 October 2010 to 30 September 2011. Patients and Methods: A total of 132 children (age ranges from 03 months to 60 months) were included in the study, while they were admitted with the diagnosis of FS during the study period, in the Pediatric department of the King Khalid University Hospital, Hail. A predesigned study proforma was utilized for data collection. All the children included in the study were followed for a period of 01 year after discharge from the pediatric ward for any recurrence of FS. Results: During the study period 132 children were admitted for FS, the mean age of children in our sample was 16 months. There was a preponderance of male children. Among the causes of fever, mostly 63(47.73%) had symptoms of viral prodrome. Recurrent febrile seizure was found in 46 (34.85%) children. There was a statistically significant association between low temperature at onset of seizure and recurrent FS in 65.22% cases p-value= 0.001). Similarly, the association of duration of fever (= 6 hour) prior to onset of FS and recurrence was found to be significant in 56.52% (p-value= 0.001). Moreover it was found that lower age <12 months at onset of first FS and complex FS had a statistically significant association with its recurrence in 65.22% and 69.57% cases respectively p-value= 0.01 and 0.001). Non significant factors were sex and family history. Conclusion: FS is a common paediatric problem predominantly seen in males. Almost one third of these children are at risk for recurrence in later dates. The risk factors for these recurrences are modest rise in body temperature at the onset of seizure, younger age at presentation, onset of seizure within 6 hours of fever and

  1. Computer model predicting breakthrough febrile urinary tract infection in children with primary vesicoureteral reflux. (United States)

    Arlen, Angela M; Alexander, Siobhan E; Wald, Moshe; Cooper, Christopher S


    Factors influencing the decision to surgically correct vesicoureteral reflux (VUR) include risk of breakthrough febrile urinary tract infection (fUTI) or renal scarring, and decreased likelihood of spontaneous resolution. Improved identification of children at risk for recurrent fUTI may impact management decisions, and allow for more individualized VUR management. We have developed and investigated the accuracy of a multivariable computational model to predict probability of breakthrough fUTI in children with primary VUR. Children with primary VUR and detailed clinical and voiding cystourethrogram (VCUG) data were identified. Patient demographics, VCUG findings including grade, laterality, and bladder volume at onset of VUR, UTI history, presence of bladder-bowel dysfunction (BBD), and breakthrough fUTI were assessed. The VCUG dataset was randomized into a training set of 288 with a separate representational cross-validation set of 96. Various model types and architectures were investigated using neUROn++, a set of C++ programs. Two hundred fifty-five children (208 girls, 47 boys) diagnosed with primary VUR at a mean age of 3.1 years (±2.6) met all inclusion criteria. A total 384 VCUGs were analyzed. Median follow-up was 24 months (interquartile range 12-52 months). Sixty-eight children (26.7%) experienced 90 breakthrough fUTI events. Dilating VUR, reflux occurring at low bladder volumes, BBD, and history of multiple infections/fUTI were associated with breakthrough fUTI (Table). A 2-hidden node neural network model had the best fit with a receiver operating characteristic curve area of 0.755 for predicting breakthrough fUTI. The risk of recurrent febrile infections, renal parenchymal scarring, and likelihood of spontaneous resolution, as well as parental preference all influence management of primary VUR. The genesis of UTI is multifactorial, making precise prediction of an individual child's risk of breakthrough fUTI challenging. Demonstrated risk factors for

  2. Value of Ultrasound in Detecting Urinary Tract Anomalies After First Febrile Urinary Tract Infection in Children. (United States)

    Ghobrial, Emad E; Abdelaziz, Doaa M; Sheba, Maha F; Abdel-Azeem, Yasser S


    Background Urinary tract infection (UTI) is an infection that affects part of the urinary tract. Ultrasound is a noninvasive test that can demonstrate the size and shape of kidneys, presence of dilatation of the ureters, and the existence of anatomic abnormalities. The aim of the study is to estimate the value of ultrasound in detecting urinary tract anomalies after first attack of UTI. Methods This study was conducted at the Nephrology Clinic, New Children's Hospital, Faculty of Medicine, Cairo University, from August 2012 to March 2013, and included 30 children who presented with first attack of acute febrile UTI. All patients were subjected to urine analysis, urine culture and sensitivity, serum creatinine, complete blood count, and imaging in the form of renal ultrasound, voiding cysto-urethrography, and renal scan. Results All the patients had fever with a mean of 38.96°C ± 0.44°C and the mean duration of illness was 6.23 ± 5.64 days. Nineteen patients (63.3%) had an ultrasound abnormality. The commonest abnormalities were kidney stones (15.8%). Only 2 patients who had abnormal ultrasound had also vesicoureteric reflux on cystourethrography. Sensitivity of ultrasound was 66.7%, specificity was 37.5%, positive predictive value was 21.1%, negative predictive value was 81.8%, and total accuracy was 43.33%. Conclusion We concluded that ultrasound alone was not of much value in diagnosing and putting a plan of first attack of febrile UTI. It is recommended that combined investigations are the best way to confirm diagnosis of urinary tract anomalies. © The Author(s) 2015.

  3. Role of procalcitonin in predicting dilating vesicoureteral reflux in young children hospitalized with a first febrile urinary tract infection. (United States)

    Sun, Hai-Lun; Wu, Kang-Hsi; Chen, Shan-Ming; Chao, Yu-Hua; Ku, Min-Sho; Hung, Tong-Wei; Liao, Pen-Fen; Lue, Ko-Huang; Sheu, Ji-Nan


    The aim of this article was to assess the usefulness of procalcitonin (PCT) as a marker for predicting dilating (grades III-V) vesicoureteral reflux (VUR) in young children with a first febrile urinary tract infection. Children ≤2 years of age with a first febrile urinary tract infection were prospectively evaluated. Serum samples were tested for PCT at the time of admission to a tertiary hospital. All children underwent renal ultrasonography (US), Tc-dimercaptosuccinic acid renal scan, and voiding cystourethrography. The diagnostic characteristics of PCT test for acute pyelonephritis and dilating VUR were calculated. Of 272 children analyzed (168 boys and 104 girls; median age, 5 months), 169 (62.1%) had acute pyelonephritis. There was VUR demonstrated in 97 (35.7%), including 70 (25.7%) with dilating VUR. The median PCT value was significantly higher in children with VUR than in those without (P predictors of dilating VUR. PCT is useful for diagnosing acute pyelonephritis and predicting dilating VUR in young children with a first febrile urinary tract infection. A voiding cystourethrography is indicated only in children with high PCT values (≥1.0 ng/mL) and/or abnormalities found on a US.

  4. Febrile seizures (United States)

    ... proper care. Occasionally, a provider will prescribe a medicine called diazepam to prevent or treat febrile seizures that occur more than once. However, no drug is completely effective in preventing febrile seizures. Alternative Names Seizure - fever induced; Febrile convulsions Patient Instructions ...

  5. Incidence and Predictors of Bacterial infection in Febrile Children with Sickle Cell Disease. (United States)

    Morrissey, Benita J; Bycroft, Thomas P; Almossawi, Ofran; Wilkey, Olufunke B; Daniels, Justin G


    Children with sickle cell disease are at increased risk of developing bacteremia and other serious bacterial infections. Fever is a common symptom in sickle cell disease and can also occur with sickle cell crises and viral infections. We aimed to evaluate the incidence and predictors of bacteremia and bacterial infection in children with sickle cell disease presenting with fever to a district hospital and sickle cell center in London. A retrospective analysis was performed on all attendances of children (aged under 16 years) with sickle cell disease presenting with a fever of 38.5 °C or higher over a 1-year period. Confirmed bacterial infection was defined as bacteremia, bacterial meningitis, urinary tract infection (UTI), pneumonia, osteomyelitis or other bacterial infection with positive identification of organism. Children were defined as having a suspected bacterial infection if a bacterial infection was suspected clinically, but no organism was identified. Over a 1-year period there were 88 episodes analyzed in 59 children. Bacteremia occurred in 3.4% of episodes and confirmed bacterial infection in 7.0%. Suspected bacterial infection occurred in 33.0%. One death occurred from Salmonella typhirium septicemia. C-reactive protein (CRP) level and white blood cell (WBC) count were both significantly associated with bacterial infection (p = 0.004 and 0.02, respectively.) In conclusion, bacterial infections continue to be a significant problem in children with sickle cell disease. C-reactive protein was significantly associated with bacterial infections, and could be included in clinical risk criteria for febrile children with sickle cell disease.

  6. Duration of fever and markers of serious bacterial infection in young febrile children. (United States)

    Pratt, Amanda; Attia, Magdy W


    Despite the drastic change in the evaluation of the febrile young child due to the decreased incidence of serious bacterial infections (SBI) effected by Haemophilus influenza type B and pneumococcal vaccine, there remains a small role for blood work in the evaluation of these patients. Bacterial markers including white blood cell (WBC) count, absolute neutrophil count (ANC) and C-reactive protein (CRP) have been studied and are widely used as predictors of SBI in febrile children. It has been suggested that CRP values should be interpreted cautiously when fever has been present predictors of SBI in relation to duration of fever. Patients who presented to a pediatric emergency department between the ages of 1 and 36 months, with fever > or =39 degrees C and no source of infection had a complete blood count (CBC) blood culture, and CRP level drawn. A urinalysis and/or urine culture was obtained when age and gender appropriate. A chest X-ray was performed at the discretion of the treating physician. The study subjects were enrolled prospectively and then divided into two groups based on duration of fever of 12 h, and compared. One hundred and twenty-eight patients were originally enrolled. Nine patients were excluded. Seventeen patients (14%) had SBI. One patient (urinary tract infections. Forty-five patients presented with fever 12 h. Area under the curve (AUC) for WBC, ANC and CRP was significantly larger in patients with SBI presenting with fever >12 h (0.85, 0.83, 0.92 respectively) compared to patients with SBI who presented with fever for 12 h as shown by the AUC. CRP performed better than WBC and ANC in both scenarios.

  7. Renal damage detected by DMSA, despite normal renal ultrasound, in children with febrile UTI. (United States)

    Bush, N C; Keays, M; Adams, C; Mizener, K; Pritzker, K; Smith, W; Traylor, J; Villanueva, C; Snodgrass, W T


    2011 American Academy of Pediatrics guidelines recommended renal-bladder ultrasound (RBUS) as the only evaluation after febrile urinary tract infection (FUTI) in infants aged 2-24 months. We determined the sensitivity, specificity, and false negative rate of RBUS to identify DMSA-detected renal damage in this age group as well as in older children. Consecutive patients referred to pediatric urology with a history of FUTI underwent DMSA ≥ 3 months after FUTI. Abnormal RBUS was defined as: Society of Fetal Urology hydronephrosis grades I-IV; hydroureter ≥ 7 mm; renal scar defined as focal parenchymal thinning; and/or size discrepancy ≥ 1 cm between kidneys. Abnormal DMSA was presence of any focal uptake defects and/or split renal function 24 months. RBUS had poor sensitivity (34%) and low positive predictive value (47%) to identify patients with renal damage. 99/149 (66%) children with renal damage on DMSA had normal RBUS. After FUTI, 66% of children with reduced renal function and/or renal cortical defects found by DMSA scintigraphy had a normal RBUS. Since abnormal DMSA may correlate with increased risk for VUR, recurrent FUTI and renal damage, our data suggest RBUS alone will fail to detect a significant proportion of patients at risk. The data suggest that imaging after FUTI should include acute RBUS and delayed DMSA, reserving VCUG for patients with abnormal DMSA and/or recurrent FUTI. Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  8. Salmonella enterica serovars Typhimurium and Enteritidis causing mixed infections in febrile children in Mozambique

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    García V


    Full Text Available Vanesa García,1 Inácio Mandomando,2,3 Joaquim Ruiz,4 Silvia Herrera-León,5 Pedro L Alonso,3,4 M Rosario Rodicio1 1Departamento de Biología Funcional, Área de Microbiología, Universidad de Oviedo, Oviedo, Spain; 2Centro de Investigação em Saúde de Manhiça, 3Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique; 4ISGlobal, Barcelona Centre for International Health Research, Hospital Clínic, Universitat de Barcelona, Barcelona, 5Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain Background and purpose: Invasive nontyphoidal salmonellosis, mostly caused by serovars Typhimurium and Enteritidis of Salmonella enterica, has emerged as a major public health problem in sub-Saharan Africa. The aim of this study was the clinical and microbiological characterization of nontyphoidal salmonellosis episodes affecting febrile children in Mozambique. Patients and methods: The clinical records of the patients were evaluated, and S. enterica isolates were characterized with regard to serovar, phage type, antimicrobial resistance (phenotype/responsible genes, plasmid content, pulsed-field gel electrophoresis, and multilocus sequence typing. Results: Fifteen S. Typhimurium and 21 S. Enteritidis isolates were recovered from blood samples of 25 children, the majority with underlying risk factors. With regard to phage typing, most isolates were either untypeable or reacted but did not conform, revealing that a number of previously unrecognized patterns are circulating in Mozambique. Most isolates were multidrug-resistant, with nearly all of the responsible genes located on derivatives of serovar-specific virulence plasmids. ST313 and ST11 were the predominant sequence types associated with S. Typhimurium and S. Enteritidis, respectively, and the uncommon ST1479 was also detected in S. Enteritidis. A distinct XbaI fragment of ~350 kb was associated with pulsed-field gel electrophoresis patterns of

  9. Serum interleukin -8 is not a reliable marker for prediction of vesicoureteral reflux in children with febrile urinary tract infection

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    Abolfazl Mahyar


    Full Text Available Objective: In view of the side effects of voiding cystourethrography (VCUG, identification of noninvasive markers predicting the presence of vesicoureteral reflux (VUR is important. This study was conducted to determine the predictive value of serum interleukin-8 (IL-8 in diagnosis of VUR in children with first febrile urinary tract infection (UTI. Materials and Methods: Eighty children with first febrile UTI were divided into two groups, with and without VUR, based on the results of VCUG. The sensitivity, specificity, positive and negative predictive value positive and negative likelihood ratio, and accuracy of IL-8 for prediction of VUR were investigated. Results: Of the 80 children with febrile UTI, 30 (37.5% had VUR. There was no significant difference between the children with and without VUR and also between low and high-grade VUR groups in terms of serum concentration of IL-8 (P>0.05. Based on ROC curve, the sensitivity, specificity, likelihood ratio positive, and accuracy of serum IL-8 was lower than those of erythrocyte sedimentation rate and C-reactive protein. Multivariate logistic regression analysis showed significant positive correlation only between erythrocyte sedimentation rate and VUR. Conclusions: This study showed no significant difference between the children with and without VUR in terms of the serum concentration of IL-8. Therefore, it seems that serum IL-8 is not a reliable marker for prediction of VUR.

  10. High prevalence and antimicrobial resistance of urinary tract infection isolates in febrile young children without localizing signs in Taiwan. (United States)

    Wu, Chang-Teng; Lee, Hao-Yuan; Chen, Chyi-Liang; Tuan, Pao-Lan; Chiu, Cheng-Hsun


    Antimicrobial susceptibility and prevalence of pediatric urinary tract infection (UTI) is very useful for pediatricians in selecting effective antibiotics in time to improve outcomes in patients. This study aimed to determine the prevalence rate, bacterial distribution, and antimicrobial susceptibility of UTI in febrile young children at a teaching hospital in northern Taiwan. From January 2011 to December 2011, all urinary isolates from suspected cases of UTI in febrile young children aged from 1 day to 36 months visiting the Pediatric Emergency Room of Chang Gung Children's Hospital, Taoyuan, Taiwan were identified by conventional methods. Antibiotic susceptibility was determined according to the Clinical and Laboratory Standards Institute. A total of 5470 (78%) from 7009 eligible children were enrolled in the study, and 619 (11.3%) had a diagnosis of UTI. The most prevalent bacterium was Escherichia coli (68%) followed by Klebsiella pneumoniae (8.1%) and Proteus mirabilis (6.8%). Ampicillin, piperacillin, and trimethoprim-sulfamethoxazole (TMP-SMX) showed a higher resistance rate in the three predominant bacteria. All tested bacteria showed higher resistance to ampicillin (79.3%) and TMP-SMX (44.1%), and lower resistance to cefazolin (17.7%) and gentamicin (13.0%). Fourteen percent of the isolates produced extended spectrum β-lactamase (ESBL), among which 93.33% were E. coli isolates. The overall prevalence of UTI in this study was higher than previously reported in febrile children. Higher antimicrobial resistance was found in ampicillin and TMP-SMX. Among commonly used antibiotics, cefazolin and gentamicin are recommended to treat UTI in febrile children aged < 3 years without localizing signs. Copyright © 2015. Published by Elsevier B.V.

  11. Molecular Detection of Streptococcus pneumoniae on Dried Blood Spots from Febrile Nigerian Children Compared to Culture.

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    Pui-Ying Iroh Tam

    Full Text Available Nigeria has one of the highest burdens of pneumococcal disease in the world, but accurate surveillance is lacking. Molecular detection of infectious pathogens in dried blood spots (DBS is an ideal method for surveillance of infections in resource-limited settings because of its low cost, minimal blood volumes involved, and ease of storage at ambient temperature. Our study aim was to evaluate a Streptococcus pneumoniae real-time polymerase chain reaction (rt-PCR assay on DBS from febrile Nigerian children on Whatman 903 and FTA filter papers, compared to the gold standard of culture.Between September 2011 to May 2015, blood was collected from children 5 years of age or under who presented to six hospital study sites throughout northern and central Nigeria with febrile illness, and inoculated into blood culture bottles or spotted onto Whatman 903 or FTA filter paper. Culture and rt-PCR were performed on all samples.A total of 537 DBS specimens from 535 children were included in the study, of which 15 were culture-positive for S. pneumoniae. The rt-PCR assay detected S. pneumoniae in 12 DBS specimens (2.2%. One positive rt-PCR result was identified in a culture-negative specimen from a high-risk subject, and two positive rt-PCR results were negative on repeat testing. Six culture-confirmed cases of S. pneumoniae bacteremia were missed. Compared to culture, the overall sensitivities of Whatman 903 and FTA DBS for detection of S. pneumoniae were 57.1% (95% CI 18.4-90.1% and 62.5% (95% CI 24.5-91.5%, respectively. Nonspecific amplification was noted in an additional 22 DBS (4.1%. Among these, six were positive for a non-S. pneumoniae pathogen on culture.Rt-PCR was able to detect S. pneumoniae from clinical DBS specimens, including from a culture-negative specimen. Our findings show promise of this approach as a surveillance diagnostic, but also raise important cautionary questions. Several DBS specimens were detected as S. pneumoniae by rt-PCR despite

  12. Molecular Detection of Streptococcus pneumoniae on Dried Blood Spots from Febrile Nigerian Children Compared to Culture. (United States)

    Iroh Tam, Pui-Ying; Hernandez-Alvarado, Nelmary; Schleiss, Mark R; Hassan-Hanga, Fatimah; Onuchukwu, Chuma; Umoru, Dominic; Obaro, Stephen K


    Nigeria has one of the highest burdens of pneumococcal disease in the world, but accurate surveillance is lacking. Molecular detection of infectious pathogens in dried blood spots (DBS) is an ideal method for surveillance of infections in resource-limited settings because of its low cost, minimal blood volumes involved, and ease of storage at ambient temperature. Our study aim was to evaluate a Streptococcus pneumoniae real-time polymerase chain reaction (rt-PCR) assay on DBS from febrile Nigerian children on Whatman 903 and FTA filter papers, compared to the gold standard of culture. Between September 2011 to May 2015, blood was collected from children 5 years of age or under who presented to six hospital study sites throughout northern and central Nigeria with febrile illness, and inoculated into blood culture bottles or spotted onto Whatman 903 or FTA filter paper. Culture and rt-PCR were performed on all samples. A total of 537 DBS specimens from 535 children were included in the study, of which 15 were culture-positive for S. pneumoniae. The rt-PCR assay detected S. pneumoniae in 12 DBS specimens (2.2%). One positive rt-PCR result was identified in a culture-negative specimen from a high-risk subject, and two positive rt-PCR results were negative on repeat testing. Six culture-confirmed cases of S. pneumoniae bacteremia were missed. Compared to culture, the overall sensitivities of Whatman 903 and FTA DBS for detection of S. pneumoniae were 57.1% (95% CI 18.4-90.1%) and 62.5% (95% CI 24.5-91.5%), respectively. Nonspecific amplification was noted in an additional 22 DBS (4.1%). Among these, six were positive for a non-S. pneumoniae pathogen on culture. Rt-PCR was able to detect S. pneumoniae from clinical DBS specimens, including from a culture-negative specimen. Our findings show promise of this approach as a surveillance diagnostic, but also raise important cautionary questions. Several DBS specimens were detected as S. pneumoniae by rt-PCR despite growth of

  13. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. (United States)

    Roberts, Kenneth B


    To revise the American Academy of Pediatrics practice parameter regarding the diagnosis and management of initial urinary tract infections (UTIs) in febrile infants and young children. Analysis of the medical literature published since the last version of the guideline was supplemented by analysis of data provided by authors of recent publications. The strength of evidence supporting each recommendation and the strength of the recommendation were assessed and graded. Diagnosis is made on the basis of the presence of both pyuria and at least 50,000 colonies per mL of a single uropathogenic organism in an appropriately collected specimen of urine. After 7 to 14 days of antimicrobial treatment, close clinical follow-up monitoring should be maintained to permit prompt diagnosis and treatment of recurrent infections. Ultrasonography of the kidneys and bladder should be performed to detect anatomic abnormalities. Data from the most recent 6 studies do not support the use of antimicrobial prophylaxis to prevent febrile recurrent UTI in infants without vesicoureteral reflux (VUR) or with grade I to IV VUR. Therefore, a voiding cystourethrography (VCUG) is not recommended routinely after the first UTI; VCUG is indicated if renal and bladder ultrasonography reveals hydronephrosis, scarring, or other findings that would suggest either high-grade VUR or obstructive uropathy and in other atypical or complex clinical circumstances. VCUG should also be performed if there is a recurrence of a febrile UTI. The recommendations in this guideline do not indicate an exclusive course of treatment or serve as a standard of care; variations may be appropriate. Recommendations about antimicrobial prophylaxis and implications for performance of VCUG are based on currently available evidence. As with all American Academy of Pediatrics clinical guidelines, the recommendations will be reviewed routinely and incorporate new evidence, such as data from the Randomized Intervention for Children

  14. Recent Studies on the Care of First Febrile Urinary Tract Infection in Infants and Children for the Pediatric Hospitalist. (United States)

    Sutton, Ashley G; Chandler, Nicole; Roberts, Kenneth B


    Urinary Tract Infection (UTI) is a common cause of bacterial infection in young children, and accounts for a significant number of pediatric hospitalizations. To review recent publications focusing on the care of children hospitalized with their first febrile UTI. A PubMed search was performed including publications from 2011-2016 on first febrile UTI in childhood. Abstracts were reviewed for being relevant to the care of hospitalized children and their follow-up. Relevant articles underwent full review by all authors and articles excluded from results included those without novel data analysis, primary improvement-based reports and studies with poor design or analysis. Included articles were categorized as "diagnosis", "management", "imaging" or "follow-up". Of 406 articles initially identified, 40 studies were included. One technical report with a systematic review was also included. Major topics addressed included the role of urinalysis in screening for UTI, use of parenteral antimicrobial therapy, the role of antimicrobial prophylaxis in prevention of recurrent UTI, and ideal follow-up and imaging approach following diagnosis of febrile UTI. Recent literature on first febrile UTI addresses a broad range of areas regarding the care of hospitalized children, though some questions remain unanswered. Overall, studies support increased attention to the potential risks, expense and invasiveness of various approaches for evaluation. Proposed updates to practice included: utilization of urinalysis for screening and diagnosis, transitioning to oral antimicrobials based on clinical improvement and limiting the routine use of voiding cystourethrogram and antimicrobial prophylaxis. Copyright© Bentham Science Publishers; For any queries, please email at

  15. Role of Antineuronal Antibodies in Children with Encephalopathy and Febrile Status Epilepticus

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    Kuang-Lin Lin


    Full Text Available Status epilepticus in childhood is more common, with a different range of causes and a lower risk of death, than convulsive status epilepticus in adults. Acute central nervous system infections appear to be markers for morbidity and mortality. Nevertheless, central nervous infection is usually presumed in these conditions. Many aspects of the pathogenesis of acute encephalitis and acute febrile encephalopathy with status epilepticus have been clarified in the past decade. The pathogenesis is divided into direct pathogens invasion or immune-mediated mechanisms. Over the past few decades, the number of antineuronal antibodies to ion channels, receptors, and other synaptic proteins described in association with central nervous system disorders has increased dramatically, especially their role in pediatric encephalitis and status epilepticus. These antineuronal antibodies are divided according to the location of their respective antigens: (1 intracellular antigens, including glutamic acid decarboxylase and classical onconeural antigens such as Hu (antineuronal nuclear antibody 1, ANNA1, Ma2, Yo (Purkinje cell autoantibody, PCA1, Ri (antineuronal nuclear antibody 2, ANNA2, CV2/CRMP5, and amphiphysin; and (2 cell membrane ion channels or surface antigens including voltage-gated potassium channel receptor, N-methyl-d-aspartate receptor, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor, γ-aminobutyric acid(B receptor, leucine-rich glioma-inactivated protein 1, and contactin-associated protein-like 2. Identifying the mechanism of the disease may have important therapeutic implications.

  16. Febrile convulsions and sudden infant death syndrome

    DEFF Research Database (Denmark)

    Vestergaard, Mogens; Basso, Olga; Henriksen, Tine Brink


    It has been suggested that sudden infant death syndrome (SIDS) and febrile convulsions are related aetiologically. We compared the risk of SIDS in 9877 siblings of children who had had febrile convulsions with that of 20.177 siblings of children who had never had febrile convulsions. We found...

  17. Scintigraphy findings in children presenting the first febrile infection of urinary tract

    International Nuclear Information System (INIS)

    Duarte Perez, Maria Caridad; Piedra Bello, Misleidys; Guillen Dosal, Ana


    Urinary tract infection (UTI) is one of the more frequent bacterial infections in childhood. The aim of present research was to know the acute phase renal alterations of the first febrile infection of urinary tract

  18. Prevalence and risk factors for renal scars in children with febrile UTI and/or VUR: a cross-sectional observational study of 565 consecutive patients. (United States)

    Snodgrass, Warren T; Shah, Anjana; Yang, Mary; Kwon, Jeannie; Villanueva, Carlos; Traylor, Janelle; Pritzker, Karen; Nakonezny, Paul A; Haley, Robert W; Bush, Nicol Corbin


    To determine prevalence and risk factors for renal scar in children referred for urologic assessment of febrile UTI and/or VUR. Pre-determined risk factors for renal scar were prospectively recorded in consecutive patients referred for UTI/VUR. Age, gender, VUR grade, and reported number of febrile and non-febrile UTIs were analyzed with logistic regression to determine risk for focal cortical defects on non-acute DMSA. Of 565 consecutive children, 24 (4%) had congenital renal dysplasia and 84 (15.5%) had focal defect(s). VUR, especially grades IV-V, recurrent febrile UTI, and older age increased risk. For any age child with the same number of UTIs, VUR increased odds of renal defect 5.4-fold (OR = 5.4, 95% CI = 2.7-10.6, AUC = 0.759). Focal DMSA defects were present in 15.5% of 565 consecutive children referred for febrile UTI and/or VUR; 4% had presumed congenital reflux nephropathy without cortical defect. All VUR grades increased risk for these defects, as did recurrent febrile UTIs and older age. However, 43% with grades IV-V VUR and 76% with recurrent UTI had normal DMSA. Published by Elsevier Ltd.


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    Lidija Kitanovski


    Full Text Available Background. The results of the study conducted to determine whether procalcitonin (PCT and interleukin-6 (IL-6 are more sensitive and specific markers of severe infection in children with febrile neutropenia (FN than routinelly used C-reactive protein (CRP are presented in the article. 68 episodes of FN experienced by 32 patients were divided into three groups according to the site of infection. Group 1: episodes of bacteraemia and/or clinical sepsis (n = 16, group 2: episodes of focal infection (n = 16 and group 3: episodes of fever of unknown origin (FUO (n = 36. Blood samples for further PCT and IL-6 determination were collected on three consecutive days. CRP concentrations were measured daily in each patient until the resolution of fever. PCT, IL-6 and CRP concentrations were measured on one occassion in each of the 18 afebrile patients with malignant disase forming the reference group. Serum PCT and IL-6 concentrations were measured by immunochemiluminometric and immunoenzymatic assay. Receiver Operating Characteristic (ROC curves were used to determine optimum sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of the studied parameters.Conclusions. PCT and IL-6 were found to be earlier and more sensitive markers of severe infection in neutropenic patients than CRP. The erliest one was IL-6, followed by PCT and CRP. Sequential determination of PCT up to 72 hours improved its diagnostic value, which was not the case for IL-6.In patients with gramnegative bacteraemias PCT concentracions were 3–5 times higher comparing to grampositive, whereas IL-6 concentrations were comparable in both groups.

  20. [Children less than 3 months hospitalised due to acute febrile syndrome. 5 years clinical experience]. (United States)

    Méndez Espinola, Benigno Miguel; Herrera Labarca, Patricio


    Acute fever of unknown origin (AFUO) is established when the anamnesis and physical examination cannot identify the cause. In infants less than 3 months-old this is situation for concern, due to the risk of a serious bacterial infection. To describe the clinical and laboratory variable of patients with AFUO, in order to look for clues in order to base studies on the decisions arising drom this problem. A report is presented on a retrospective study conducted on a cohort of children less than three months-old admitted to the Hospital Roberto del Río (2007-2011) due to an AFUO. Clinical histories were reviewed and the patients were grouped, according to the severity of the admission diagnosis, into severe and non-severe. They were compared in strata determined by the variables of clinical interest. A total of 550 children were admitted with AFUO during the study period. There was low agreement between the severity on admission and at discharge (kappa=0.079; P=.26). There were 23.8% of children in the severe group and 76.2% in the non-severe group. Urinary tract infection predominated in the severe group (68.7%) and 40.7% with acute febrile syndrome in the non-severe group. The cut-off levels for C-reactive protein, white cells, and neutrophils per mm(3), to calculate the fixed and variable indices, only showed negative predictive values of some use for ruling out serious bacterial infection. The ROC curves with white cell and neutrophil counts and C-reactive protein, did not provide andy fixed indices of clinical use. More than one-third (34.6%) of lumbar punctures were traumatic or failures. According to the results of this study, there is an obvious excess of hospital admissions, little usefulness in the examinations to identify serious bacterial infection, a high percentage lumbar punctures traumatic and lumbar punctures failures, and an excess of antibiotic treatments. A review of clinical criteria and procedures is needed. Copyright © 2015 Sociedad Chilena de

  1. Plasmodium falciparum infection in febrile Congolese children: prevalence of clinical malaria 10 years after introduction of artemisinin-combination therapies. (United States)

    Etoka-Beka, Mandingha Kosso; Ntoumi, Francine; Kombo, Michael; Deibert, Julia; Poulain, Pierre; Vouvoungui, Christevy; Kobawila, Simon Charles; Koukouikila-Koussounda, Felix


    To investigate the proportion of malaria infection in febrile children consulting a paediatric hospital in Brazzaville, to determine the prevalence of submicroscopic malaria infection, to characterise Plasmodium falciparum infection and compare the prevalence of uncomplicated P. falciparum malaria according to haemoglobin profiles. Blood samples were collected from children aged <10 years with an axillary temperature ≥37.5 °C consulting the paediatric ward of Marien Ngouabi Hospital in Brazzaville. Parasite density was determined and all samples were screened for P. falciparum by nested polymerase chain reaction (PCR) using the P. falciparum msp-2 marker to detect submicroscopic infections and characterise P. falciparum infection. Sickle cell trait was screened by PCR. A total of 229 children with fever were recruited, of whom 10% were diagnosed with uncomplicated malaria and 21% with submicroscopic infection. The mean parasite density in children with uncomplicated malaria was 42 824 parasites/μl of blood. The multiplicity of infection (MOI) was 1.59 in children with uncomplicated malaria and 1.69 in children with submicroscopic infection. The mean haemoglobin level was 10.1 ± 1.7 for children with uncomplicated malaria and 12.0 ± 8.6 for children with submicroscopic infection. About 13% of the children harboured the sickle cell trait (HbAS); the rest had normal haemoglobin (HbAA). No difference in prevalence of uncomplicated malaria and submicroscopic infection, parasite density, haemoglobin level, MOI and P. falciparum genetic diversity was observed according to haemoglobin type. The low prevalence of uncomplicated malaria in febrile Congolese children indicates the necessity to investigate carefully other causes of fever. © 2016 John Wiley & Sons Ltd.

  2. Alarming signs and symptoms in febrile children in primary care: an observational cohort study in The Netherlands.

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    Gijs Elshout

    Full Text Available CONTEXT: Febrile children in primary care have a low risk for serious infection. Although several alarming signs and symptoms are proposed to have predictive value for serious infections, most are based on research in secondary care. The frequency of alarming signs/symptoms has not been established in primary care; however, in this setting differences in occurrence may influence their predictive value for serious infections. OBJECTIVE: To determine the frequency of alarming signs/symptoms in febrile children in primary care. DESIGN: Observational cohort study. Clinical information was registered in a semi-structured way and manually recoded. SETTING: General practitioners' out-of-hours service. SUBJECTS: Face-to-face patient contacts concerning children (aged ≤16 years with fever were eligible for inclusion. MAIN OUTCOME MEASURES: Frequency of 18 alarming signs and symptoms as reported in the literature. RESULTS: A total of 10,476 patient contacts were included. The frequency of alarming signs/symptoms ranged from n = 1 (ABC instability; 40°C as reported by the parents; 12.9% to 8,647 contacts (parental concern; 82.5%. CONCLUSION: Although the prevalence of specific alarming signs/symptoms is low in primary care, ≥50% of children have one or more alarming signs/symptoms. There is a need to determine the predictive value of alarming signs/symptoms not only for serious infections in primary care, but as well for increased risk of a complicated course of the illness.

  3. Use of alarm features in referral of febrile children to the emergency department : an observational study

    NARCIS (Netherlands)

    van Ierland, Yvette; Elshout, Gijs; Moll, Henritte A.; Nijman, Ruud G.; Vergouwe, Yvonne; van der Lei, Johan; Berger, Marjolein Y.; Oostenbrink, Rianne

    Background The diagnostic value of alarm features of serious infections in low prevalence settings is unclear. Aim To explore to what extent alarm features play a role in referral to the emergency department (ED) by GPs who face a febrile child during out-of-hours care. Design and setting

  4. Prevalence of malaria, prevention measures, and main clinical features in febrile children admitted to the Franceville Regional Hospital, Gabon

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    Maghendji-Nzondo Sydney


    Full Text Available Recently, major progress has been made in controlling malaria in Africa. However, in Gabon, little information is available on the role of malaria in childhood febrile syndromes, the use and efficacy of preventive measures, and Plasmodium species distribution. Here, we characterized malaria in febrile children in Franceville, Gabon through a cross-sectional study at the pediatric unit of the Franceville Regional Hospital. We registered 940 febrile children. Their general condition was markedly altered in 11.7% of cases (n = 89/760; among them 19 (21.4% had a severely altered condition. Malaria was the second most frequent etiology (22.0%; n = 162/738, after respiratory tract infections (37.3%; n = 275/738. Children with malaria (63 ± 39 months were older than children without malaria (40 ± 37 months (p = 0.0013. Hemoglobin, red blood cell, white blood cell, and platelet values were lower in children with malaria than in those without malaria (p < 0.0001. Anemia was the most common feature of severe malaria (70.6%; n = 12/17, followed by neurological involvement (23.5%; n = 4/17. The prevalence of malaria was significantly higher in children older than 60 months than in younger children (40% vs. 15.5%; p < 0.0001. Plasmodium falciparum accounted for 97.5% of cases (158/162, followed by Plasmodium malariae (2.5%; n = 4/162. Bed net use was high (74.4%; n = 697/936 and contributed to malaria prevention (p = 0.001. Good basic knowledge of malaria also had a preventive effect (p < 0.0001. The prevalence of malaria in children in Franceville did not decrease significantly from 2009 to 2012, remaining at about 20%, highlighting that preventive measures should be reinforced.

  5. Risk factors for febrile urinary tract infection in children with prenatal hydronephrosis: a prospective study. (United States)

    Braga, Luis H; Farrokhyar, Forough; D'Cruz, Jennifer; Pemberton, Julia; Lorenzo, Armando J


    We prospectively investigated the impact of risk factors for febrile urinary tract infection in infants with postnatally confirmed prenatal hydronephrosis. Patients seen for prenatal hydronephrosis from 2010 to 2013 were prospectively followed. Those with ectopic ureters and ureteroceles, posterior urethral valves and neuropathic bladders were excluded. The primary outcome was febrile catheter specimen urinary tract infection. We performed univariate analysis of 7 a priori risk factors, including age, hydronephrosis grade (low-I or II vs high-III or IV), type (isolated hydronephrosis vs hydroureteronephrosis), continuous antibiotic prophylaxis, vesicoureteral reflux grade, gender and circumcision status. Time to febrile urinary tract infection curves analyzed by Cox proportional regression were generated to adjust for confounders. We collected data on 334 patients, of whom 78% were male. A febrile urinary tract infection developed in 65 patients (19%) at a median of 4 months (range 1 to 31). High grade hydronephrosis was present in 192 infants (57%). Continuous antibiotic prophylaxis was prescribed in 96 cases (29%). Of patients on continuous antibiotic prophylaxis 69% had high grade hydronephrosis. Vesicoureteral reflux was identified in 57 of 238 patients in whom voiding cystourethrogram was done. Reflux was grade I to III in 14 cases and grade IV or V in 43. Two-thirds of the patients with reflux were on continuous antibiotic prophylaxis. Circumcision was performed in 95 males (36%). Cox proportional regression identified female gender (HR 3.3, p = 0.02), uncircumcised males (HR 3.2, p = 0.02), hydroureteronephrosis (HR 10.9, p hydronephrosis was also a significant risk factor (HR 3.0, p = 0.04). After patients with vesicoureteral reflux were excluded from the study, females and uncircumcised males with high grade hydroureteronephrosis had significantly higher febrile urinary tract infection rates. Therefore, those patients may benefit from continuous

  6. The method of urine sampling is not a valid predictor for vesicoureteral reflux in children after febrile urinary tract infections. (United States)

    Haid, Bernhard; Roesch, Judith; Strasser, Christa; Oswald, Josef


    The likelihood of detecting vesicoureteral reflux (VUR) after febrile urinary tract infections (UTI) in children logically should correlate with the correct diagnosis of the UTI. Beneath the unspecific symptoms of fever urine analysis is the main diagnostic criterion for the exact diagnosis of febrile UTIs in children. Use of inadequate urine sampling techniques during diagnosis may lead to impaired accuracy in UTI diagnosis. This could lead to the assumption that children, having diagnosed their UTI by the use of possibly inadequate urine sampling techniques should not be evaluated as consequently compared to those, where the diagnosis relied on sterile urine sampling techniques. We hypothesized that children with possibly contaminated urine samples during the initial diagnosis may show a lower rate of VUR in subsequent VCUGs because of a wrong diagnosis initially compared to children, where accurate urine sampling techniques were used. Between 2009 and 2014, a total of 555 patients underwent a primary VCUG at our department indicated because of febrile UTIs. Patients with urine collection methods other than bag urine and catheter/suprapubic aspiration (SPA) were excluded from this study (mid-stream urine, potty urine, n = 149). We evaluated 402 patients (male/female 131/271, mean age 1.91 years), VUR rates and grades were compared between patients where urine was sampled by the use of a urine bag only at the time of diagnosis (n = 296, 73.6%) and those where sterile urine sampling (catheter, suprapubic puncture) was performed (n = 106, 26.3%). 4 patients were excluded due to equivocal data on urine sampling. VUR rate in children after sterile urine sampling using a catheter or SPA accounted to 31.1%. In those where urine samples acquired by the use of urine bags were used, 33.7% showed VUR on subsequent VCUG (p = 0.718). There were no significant differences as to VUR grades or gender, although VUR was much more commonly diagnosed in female patients (37

  7. Microorganisms isolated from cultures and infection focus and antibiotic treatments in febrile neutropenic children from Şanlıurfa, Turkey. (United States)

    Özdemir, Z Canan; Koç, Ahmet; Ayçiçek, Ali


    Chemotherapy induced febrile neutropenia predisposes patients to life threatening infections. We aimed to determine the causative microorganisms, infection focus and antibiotic treatment success in febrile neutropenic children with leukemia. A total of 136 febrile neutropenic episodes in 48 leukemic children were reviewed retrospectively from records. Among 136 febrile neutropenic episodes, 68 (50%) episodes were microbiologically documented. Methicillin sensitive coagulase (-) Staphylococcus aureus were the most common isolates from hemoculture (20.5%). The most frequently documented infection focus was mucositis (31.9%). Ceftazidime plus amikacin was the most commonly used antimicrobial treatment for the empirical therapy (52.9%). The overall response rates were 70.5%, 86.9%, and 66.6% of first line, second line and third line therapies, respectively. The spectrum of isolates among febrile neutropenic children in our hematology clinic appears to be gram positive pathogens which are the most common agents. Therefore the, documentation of the flora in each unit could help to decide appropriate empirical therapy which is life saving.

  8. The impact of therapeutic delay time on acute scintigraphic lesion and ultimate scar formation in children with first febrile UTI. (United States)

    Oh, Mi Mi; Kim, Jin Wook; Park, Min Gu; Kim, Je Jong; Yoo, Kee Hwan; Moon, Du Geon


    We assessed the role of therapeutic delay time (TDT) in acute renal cortical scintigraphic lesion (ASL) and ultimate scar formation (USF) in children with first febrile UTI and whether it is affected by the presence of vesico-ureteral reflux (VUR). 230 children, 90 girls and 140 boys with first febrile UTI were included. Radiologic (USG, DMSA, and VCUG), clinical (age, gender, peak fever, therapeutic delay time) and laboratory (CBC with differential count, ANC (absolute neutrophil count), BUN, Creatinine, urine analysis, gram stain, culture, CRP and ESR) variables were analysed. DMSA was performed within 5 days and after six months. VCUG was performed after acute phase of UTI. The differences in TDT according to the presence of ASL, USF and VUR were assessed. And the correlation between ASL or USF with the duration of TDT was assessed. Of 230 patients enrolled, 142 patients had refluxing UTI and 88 patients had non-refluxing UTI. TDT was the risk factor associated with ASL and USF along with presence of VUR. TDT was longer in ASL positive group compared with the ASL negative group. Also USF group showed longer TDT compared with those without USF in both refluxing UTI and non refluxing UTI. The TDT was significantly shorter in USF group with the presence of VUR. Positive linear association was noted between prevalence of ASL and USF and duration of TDT. In conclusion, the impact of UTI on formation of USF may be enhanced by the presence of VUR with shorter duration of TDT.

  9. Continuous antibiotic prophylaxis reduces the risk of febrile UTI in children with asymptomatic antenatal hydronephrosis with either ureteral dilation, high-grade vesicoureteral reflux, or ureterovesical junction obstruction. (United States)

    Herz, Daniel; Merguerian, Paul; McQuiston, Leslie


    The efficacy and utility of continuous antibiotic prophylaxis (CAP) in children with congenital antenatal hydronephrosis (ANH) is uncertain. The literature has both supportive and contradictory evidence. The growing trend not to place children with ANH on CAP has created varied clinical practice based on anecdotal individual case characteristics. Our goal was to compare individual infant characteristics between those children who were maintained on CAP to those that were not to try to determine predisposing risk factors to febrile. All electronic medical records (EMRs) of children referred to our institution for congenital ANH over a period from 2001 to 2011 were examined. We excluded those referred for urinary tract infection (UTI) who had a history of congenital ANH. We also excluded those with incomplete records, or follow-up less than 2 years. Children were divided into two groups: those maintained on CAP (YCAP) and those not maintained on CAP (NCAP). Our primary endpoint was febrile UTI. Follow-up was at least 24 months. Demographic, perinatal and postnatal clinical data were recorded. Statistical analysis was performed using STATA Version 11.1. Of the 405 children fitting inclusion criteria, 278 (68.6%) children were maintained on CAP and 127 (31.4%) were not on CAP. The incidence of prematurity, oligohydramnios, perinatal respiratory complications, use of perinatal antibiotics, circumcision status, renal anomalies, associated medical diagnoses, and low birth weight did not differ between the two groups. Overall the incidence of febrile UTI during the follow-up period was 22.2%. The incidence of febrile UTI between the YCAP and NCAP groups was significant (YCAP = 7.9% and NCAP 18.7%, p = 0.021). Multivariate logistic regression using CAP as the dichotomous dependent variable revealed that ureteral dilation, high-grade vesicoureteral reflux (VUR), and ureterovesical junction (UVJ) obstruction were independent risk factors for febrile UTI. More specifically

  10. Randomized comparative trial of efficacy of paracetamol, ibuprofen and paracetamol-ibuprofen combination for treatment of febrile children

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    Falgun Indravadan Vyas


    Full Text Available Objective: Paracetamol and ibuprofen are widely used for fever in children as monotherapy and as combined therapy. None of the treatments is proven clearly superior to others. Hence, the study was planned to compare the efficacy of paracetamol, ibuprofen and paracetamol-ibuprofen combination for treatment of febrile children. Materials and Methods: This was an investigator blind, randomized, comparative, parallel clinical trial conducted in 99 febrile children, 6 months to 12 years of age, allocated to three groups. First group received paracetamol 15 mg/kg, second group received ibuprofen 10 mg/kg and third group received both paracetamol and ibuprofen, all as a single dose by the oral route. Patients were followed-up at intervals of 1, 2, 3 and 4 h post dose by tympanic thermometry. Results: Mean tympanic temperature after 4 h of drug administration was significantly lower in the combination group compared with paracetamol group (P < 0.05; however, the difference was not clinically significant (<1΀C. The rate of fall of temperature was highest in the combination group. Number of afebrile children any time post dose until 4 h was highest in the combination group. Difference between combination and paracetamol was significant for the 1 st h (P = 0.04. Highest fall of temperature was noted in the 1 st h of drug administration in all the groups. No serious adverse events were observed in any of the groups. Conclusion: Paracetamol and ibuprofen combination caused quicker temperature reduction than either paracetamol or ibuprofen alone. If quicker reduction of body temperature is the desired goal of therapy, the use of combination of paracetamol + ibuprofen may be advocated.

  11. Development and Validation of a Calculator for Estimating the Probability of Urinary Tract Infection in Young Febrile Children. (United States)

    Shaikh, Nader; Hoberman, Alejandro; Hum, Stephanie W; Alberty, Anastasia; Muniz, Gysella; Kurs-Lasky, Marcia; Landsittel, Douglas; Shope, Timothy


    Accurately estimating the probability of urinary tract infection (UTI) in febrile preverbal children is necessary to appropriately target testing and treatment. To develop and test a calculator (UTICalc) that can first estimate the probability of UTI based on clinical variables and then update that probability based on laboratory results. Review of electronic medical records of febrile children aged 2 to 23 months who were brought to the emergency department of Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania. An independent training database comprising 1686 patients brought to the emergency department between January 1, 2007, and April 30, 2013, and a validation database of 384 patients were created. Five multivariable logistic regression models for predicting risk of UTI were trained and tested. The clinical model included only clinical variables; the remaining models incorporated laboratory results. Data analysis was performed between June 18, 2013, and January 12, 2018. Documented temperature of 38°C or higher in children aged 2 months to less than 2 years. With the use of culture-confirmed UTI as the main outcome, cutoffs for high and low UTI risk were identified for each model. The resultant models were incorporated into a calculation tool, UTICalc, which was used to evaluate medical records. A total of 2070 children were included in the study. The training database comprised 1686 children, of whom 1216 (72.1%) were female and 1167 (69.2%) white. The validation database comprised 384 children, of whom 291 (75.8%) were female and 200 (52.1%) white. Compared with the American Academy of Pediatrics algorithm, the clinical model in UTICalc reduced testing by 8.1% (95% CI, 4.2%-12.0%) and decreased the number of UTIs that were missed from 3 cases to none. Compared with empirically treating all children with a leukocyte esterase test result of 1+ or higher, the dipstick model in UTICalc would have reduced the number of treatment delays by 10.6% (95% CI

  12. Contribution of urinary tract infection to the burden of febrile illnesses in young children in rural Kenya. (United States)

    Masika, Wechuli Geoffrey; O'Meara, Wendy Prudhomme; Holland, Thomas L; Armstrong, Janice


    The clinical features of UTI in young children may not localize to the urinary tract and closely resemble other febrile illnesses. In malaria endemic areas, a child presenting with fever is often treated presumptively for malaria without investigation for UTI. Delayed or inadequate treatment of UTI increases the risk of bacteremia and renal scarring in young children and subsequently complications as hypertension and end stage renal disease in adulthood. A cross-sectional study was carried out in a hospital in western Kenya. Inpatients and outpatients 2 months to five years with axillary temperature ≥37.5°C and no antibiotic use in the previous week were enrolled between September 2012 and April 2013. Urine dipstick tests, microscopy, and cultures were done and susceptibility patterns to commonly prescribed antibiotics established. UTI was defined as presence of pyuria (a positive urine dipstick or microscopy test) plus a positive urine culture. A total of 260 subjects were recruited; 45.8% were female and the median age was 25months (IQR: 13, 43.5). The overall prevalence of UTI was 11.9%. Inpatients had a higher prevalence compared to outpatients (17.9% v 7.8%, p = 0.027). UTI co-existed with malaria but the association was not significant (OR 0.80, p = 0.570). The most common organisms isolated were Escherichia coli (64.5%) and Staphylococcus aureus (12.9%) and were sensitive to ciproflaxin, cefuroxime, ceftriaxone, gentamycin and nitrofurantoin but largely resistant to more commonly used antibiotics such as ampicillin (0%), amoxicillin (16.7%), cotrimoxazole (16.7%) and amoxicillin-clavulinate (25%). Our study demonstrates UTI contributes significantly to the burden of febrile illness in young children and often co-exists with other infections. Multi-drug resistant organisms are common therefore choice of antimicrobial therapy should be based on local sensitivity pattern.

  13. Risk factor for febrile seizures

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    Odalović Dragica


    Full Text Available Febrile seizures are the most frequent neurological disorder in the childhood. According to American Academy of Pediatrics (AAP, they have been defined as seizures provoked by high temperature in children aged between 6 months and 5 years, without previous history of afebrile seizures, intracranial infections and other possible causes of seizures. Seizures can be typical and atypical, according to the characteristics. Pathogenesis of this disorder has not been clarified yet, and it is believed to be a combination of genetic factors, high body temperature and brain maturation. The risk factors for recurrence of febrile seizures are: age in which seizures appeared for the first time, epilepsy in the first degree relative, febrile seizures in the first degree relative, frequent diseases with fever and low body temperature on the beginning of seizures. The frequency of recurrent seizures The risk for occurrence of epilepsy in children with simple seizures is about 1-1.5%, which is slightly higher compared to general population, while it increases to 4-15% in patients with complex seizures. However, there is no evidence that therapy prevents occurrence of epilepsy. When the prevention of recurrent seizures is considered, it is necessary to separate simple from complex seizures. The aim of this paper was to analyze the most important risk factors for febrile seizures, and to evaluate their impact on occurrence of recurrent seizures. Our study included 125 children with febrile seizures, aged from 6 months to 5 years. The presence of febrile seizures and epilepsy in the first degree relative has been noted in 22% of children. Typical febrile seizures were observed in 76% of cases, and atypical in 24%. Most patients had only one seizure (73.6%. Children, who had seizure earlier in life, had more frequent recurrences. Both risk factors were present in 25% of patients, while 68% of patients had only one risk factor. For the children with febrile disease

  14. Diagnostic Test Accuracy of a 2-Transcript Host RNA Signature for Discriminating Bacterial vs Viral Infection in Febrile Children. (United States)

    Herberg, Jethro A; Kaforou, Myrsini; Wright, Victoria J; Shailes, Hannah; Eleftherohorinou, Hariklia; Hoggart, Clive J; Cebey-López, Miriam; Carter, Michael J; Janes, Victoria A; Gormley, Stuart; Shimizu, Chisato; Tremoulet, Adriana H; Barendregt, Anouk M; Salas, Antonio; Kanegaye, John; Pollard, Andrew J; Faust, Saul N; Patel, Sanjay; Kuijpers, Taco; Martinón-Torres, Federico; Burns, Jane C; Coin, Lachlan J M; Levin, Michael

    Because clinical features do not reliably distinguish bacterial from viral infection, many children worldwide receive unnecessary antibiotic treatment, while bacterial infection is missed in others. To identify a blood RNA expression signature that distinguishes bacterial from viral infection in febrile children. Febrile children presenting to participating hospitals in the United Kingdom, Spain, the Netherlands, and the United States between 2009-2013 were prospectively recruited, comprising a discovery group and validation group. Each group was classified after microbiological investigation as having definite bacterial infection, definite viral infection, or indeterminate infection. RNA expression signatures distinguishing definite bacterial from viral infection were identified in the discovery group and diagnostic performance assessed in the validation group. Additional validation was undertaken in separate studies of children with meningococcal disease (n = 24) and inflammatory diseases (n = 48) and on published gene expression datasets. A 2-transcript RNA expression signature distinguishing bacterial infection from viral infection was evaluated against clinical and microbiological diagnosis. Definite bacterial and viral infection was confirmed by culture or molecular detection of the pathogens. Performance of the RNA signature was evaluated in the definite bacterial and viral group and in the indeterminate infection group. The discovery group of 240 children (median age, 19 months; 62% male) included 52 with definite bacterial infection, of whom 36 (69%) required intensive care, and 92 with definite viral infection, of whom 32 (35%) required intensive care. Ninety-six children had indeterminate infection. Analysis of RNA expression data identified a 38-transcript signature distinguishing bacterial from viral infection. A smaller (2-transcript) signature (FAM89A and IFI44L) was identified by removing highly correlated transcripts. When this 2-transcript

  15. Atypical febrile seizures, mesial temporal lobe epilepsy, and dual pathology. (United States)

    Sanon, Nathalie T; Desgent, Sébastien; Carmant, Lionel


    Febrile seizures occurring in the neonatal period, especially when prolonged, are thought to be involved in the later development of mesial temporal lobe epilepsy (mTLE) in children. The presence of an often undetected, underlying cortical malformation has also been reported to be implicated in the epileptogenesis process following febrile seizures. This paper highlights some of the various animal models of febrile seizures and of cortical malformation and portrays a two-hit model that efficiently mimics these two insults and leads to spontaneous recurrent seizures in adult rats. Potential mechanisms are further proposed to explain how these two insults may each, or together, contribute to network hyperexcitability and epileptogenesis. Finally the clinical relevance of the two-hit model is briefly discussed in light of a therapeutic and preventive approach to mTLE.

  16. Seasonal and geographic differences in treatment-seeking and household cost of febrile illness among children in Malawi

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    Roca-Feltrer Arantxa


    Full Text Available Abstract Background Households in malaria endemic countries experience considerable costs in accessing formal health facilities because of childhood malaria. The Ministry of Health in Malawi has defined certain villages as hard-to-reach on the basis of either their distance from health facilities or inaccessibility. Some of these villages have been assigned a community health worker, responsible for referring febrile children to a health facility. Health facility utilization and household costs of attending a health facility were compared between individuals living near the district hospital and those in hard-to-reach villages. Methods Two cross-sectional household surveys were conducted in the Chikhwawa district of Malawi; one during each of the wet and dry seasons. Half the participating villages were located near the hospital, the others were in areas defined as hard-to-reach. Data were collected on attendance to formal health facilities and economic costs incurred due to recent childhood febrile illness. Results Those living in hard-to-reach villages were less likely to attend a formal health facility compared to those living near the hospital (Dry season: OR 0.35, 95%CI0.18-0.67; Wet season: OR 0.46, 95%CI0.27-0.80. Analyses including community health workers (CHW as a source of formal health-care decreased the strength of this relationship, and suggested that consulting a CHW may reduce attendance at health facilities, even if indicated. Although those in hard-to-reach villages were still less likely to attend in both the dry (OR 0.53, 95%CI 0.25-1.11 and wet (OR 0.60, 95%CI 0.37-0.98 seasons. Household costs for those who attended a health facility were greater for those in HTR villages (Dry: USD5.24; Wet: USD5.60 than for those living near the district hospital (Dry: USD3.45; Wet: USD4.46. Conclusion Those living in hard-to-reach areas were less likely to attend a health facility for a childhood febrile event and experienced greater

  17. Frequency of human bocavirus (HBoV) infection among children with febrile respiratory symptoms in Argentina, Nicaragua and Peru (United States)

    Salmón‐Mulanovich, Gabriela; Sovero, Merly; Laguna‐Torres, V. Alberto; Kochel, Tadeusz J.; Lescano, Andres G.; Chauca, Gloria; Sanchez, J. Felix; Rodriguez, Francisco; Parrales, Eduardo; Ocaña, Victor; Barrantes, Melvin; Blazes, David L.; Montgomery, Joel M.


    Please cite this paper as: Salmón‐Mulanovich et al. (2010) Frequency of human bocavirus (HBoV) infection among children with febrile respiratory symptoms in Argentina, Nicaragua and Peru. Influenza and Other Respiratory Viruses 5(1), 1–5. Background  Globally, respiratory infections are the primary cause of illness in developing countries, specifically among children; however, an etiological agent for many of these illnesses is rarely identified. Objectives  Our study aimed to estimate the frequency of human bocavirus (HBoV) infection among pediatric populations in Argentina, Nicaragua and Peru. Methods  We conducted a cross‐sectional study using stored samples of an influenza‐like illness surveillance program. Irrespective of previous diagnosis, nasopharyngeal or nasal swab specimens were randomly selected and tested using real‐time PCR from three sites during 2007 from patients younger than 6 years old. Results  A total of 568 specimens from Argentina (185), Nicaragua (192) and Peru (191) were tested. The prevalence of HBoV was 10·8% (95% CI: 6·3; 15·3) in Argentina, 33·3% in Nicaragua (95% CI: 26·6; 40·1) and 25·1% in Peru (95% CI: 18·9; 31·3). Conclusions  These findings demonstrate circulation of HBoV in Argentina, Nicaragua and Peru among children with influenza‐like symptoms enrolled in a sentinel surveillance program. PMID:21138534

  18. Association Between IL1B and SCN1A Polymorphism and Febrile Seizures in Children in Siberia

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    Maria A. Stroganova


    Full Text Available Background: Febrile seizures (FS are a benign, age-dependent, genetically determined state, in which the child’s brain is susceptible to epileptic seizures occurring in response to hyperthermia. We assessed whether polymorphisms of IL1B and SCN1A genes, encoding the proinflammatory cytokine IL1B and SCN1A, respectively, could help to predict FS development and find a new way to treat FS. Methods: We examined 121 children with FS and 30 children with HTS aged from 3 to 36 months. SNPs rs1143634 and rs16944 of IL1B gene, and rs3812718 and rs16851603 of SCN1A gene were determined by quantitative real-time PCR. Results: The analysis for rs1143634 revealed an association between the CC genotype and increased risk of FS development (OR 6.56; P=0.0008 against the background of acute respiratory viral infection. The same result was obtained for rs16944 (OR 3.13; P=0.04 and an association of two homozygous genotypes CC/CC. For rs3812718, the carriage of heterozygous genotype CT demonstrated a direct relationship with FS development (OR 44.95; P=0.000. Conclusion: Children with high FS risk need preventive treatment and joint observation of a pediatrician, pediatric infectionist, and a neurologist-epileptologist.

  19. Post-immunization leucocytosis and its implications for the management of febrile infants. (United States)

    Prentice, Sarah; Kamushaaga, Zephyrian; Nash, Stephen B; Elliott, Alison M; Dockrell, Hazel M; Cose, Stephen


    Clinical guidelines for management of infants with fever but no evident focus of infection recommend that those aged 1-3 months with a white cell count >15 × 10 9 /l have a full septic screen and be admitted for parenteral antibiotics. However, there is limited information about leucocyte changes following routine immunization, a common cause of fever. We investigated white cell counts shortly after routine immunization in Ugandan infants under 3 months of age. White cell counts were measured in 212 healthy infants following routine immunizations (DTwP-HepB-Hib, oral polio and pneumococcal conjugate 7 vaccines) received prior to 3 months of age. Mean leucocyte counts increased from 9.03 × 10 9 /l (95% confidence interval 8.59-9.47 × 10 9 /l) pre-immunizations to 16.46 × 10 9 /l (15.4-17.52 × 10 9 /l) at one-day post-immunizations at 6 weeks of age, and 15.21 × 10 9 /l (14.07-16.36 × 10 9 /l) at one-day post-immunizations at 10 weeks of age. The leucocytosis was primarily a neutrophilia, with neutrophil percentages one-day post-immunization of 49% at 6 weeks of age and 46% at 10 weeks of age. White cell parameters returned to baseline by two-days post-immunization. No participant received antibiotics when presenting with isolated fever post-immunization and all remained well at follow-up. In our study almost half the children immunization met commonly used criteria for full septic screen and admission for parenteral antibiotics, despite having no serious bacterial infection. These findings add to the growing body of literature that questions the utility of white blood cell measurement in identification of young infants at risk of serious bacterial infections, particularly in the context of recent immunizations, and suggest that further exploration of the effect of different immunization regimes on white cell counts is needed. This observational work was nested within a clinical trial, registration number ISRCTN

  20. Epilepsy after Febrile Seizures

    DEFF Research Database (Denmark)

    Seinfeld, S. A.; Pellock, J M; Kjeldsen, Lone Marianne Juel


    to evaluate genetic associations of different febrile seizure subtypes. Results Histories of febrile seizures were validated in 1051 twins in 900 pairs. The febrile seizure type was classified as simple, complex, or febrile status epilepticus. There were 61% simple, 12% complex, and 7% febrile status...... epilepticus. There were 78 twins who developed epilepsy. The highest rate of epilepsy (22.2%) occurred in the febrile status epilepticus group. Concordance was highest in simple group. Conclusion A twin with febrile status epilepticus is at the highest risk of developing epilepsy, but simple febrile seizures...

  1. Increased Nasopharyngeal Density and Concurrent Carriage of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis Are Associated with Pneumonia in Febrile Children. (United States)

    Chochua, Sopio; D'Acremont, Valérie; Hanke, Christiane; Alfa, David; Shak, Joshua; Kilowoko, Mary; Kyungu, Esther; Kaiser, Laurent; Genton, Blaise; Klugman, Keith P; Vidal, Jorge E


    We assessed nasopharyngeal (NP) carriage of five pathogens in febrile children with and without acute respiratory infection (ARI) of the upper (URTI) or lower tract, attending health facilities in Tanzania. NP swabs collected from children (N = 960) aged 2 months to 10 years, and with a temperature ≥38°C, were utilized to quantify bacterial density of S. pneumoniae (Sp), H. influenzae (Hi), M. catarrhalis (Mc), S. aureus (Sa), and N. meningitidis (Nm). We determined associations between presence of individual species, densities, or concurrent carriage of all species combination with respiratory diseases including clinical pneumonia, pneumonia with normal chest radiography (CXR) and endpoint pneumonia. Individual carriage, and NP density, of Sp, Hi, or Mc, but not Sa, or Nm, was significantly associated with febrile ARI and clinical pneumonia when compared to febrile non-ARI episodes. Density was also significantly increased in severe pneumonia when compared to mild URTI (Sp, p<0.002; Hi p<0.001; Mc, p = 0.014). Accordingly, concurrent carriage of Sp+, Hi+, and Mc+, in the absence of Sa- and Nm-, was significantly more prevalent in children with ARI (p = 0.03), or clinical pneumonia (p<0.001) than non-ARI, and in children with clinical pneumonia (p = 0.0007) than URTI. Furthermore, Sp+, Hi+, and Mc+ differentiated children with pneumonia with normal CXR, or endpoint pneumonia, from those with URTI, and non-ARI cases. Concurrent NP carriage of Sp, Hi, and Mc was a predictor of clinical pneumonia and identified children with pneumonia with normal CXR and endpoint pneumonia from those with febrile URTI, or non-ARI episodes.

  2. Increased Nasopharyngeal Density and Concurrent Carriage of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis Are Associated with Pneumonia in Febrile Children.

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    Sopio Chochua

    Full Text Available We assessed nasopharyngeal (NP carriage of five pathogens in febrile children with and without acute respiratory infection (ARI of the upper (URTI or lower tract, attending health facilities in Tanzania.NP swabs collected from children (N = 960 aged 2 months to 10 years, and with a temperature ≥38°C, were utilized to quantify bacterial density of S. pneumoniae (Sp, H. influenzae (Hi, M. catarrhalis (Mc, S. aureus (Sa, and N. meningitidis (Nm. We determined associations between presence of individual species, densities, or concurrent carriage of all species combination with respiratory diseases including clinical pneumonia, pneumonia with normal chest radiography (CXR and endpoint pneumonia.Individual carriage, and NP density, of Sp, Hi, or Mc, but not Sa, or Nm, was significantly associated with febrile ARI and clinical pneumonia when compared to febrile non-ARI episodes. Density was also significantly increased in severe pneumonia when compared to mild URTI (Sp, p<0.002; Hi p<0.001; Mc, p = 0.014. Accordingly, concurrent carriage of Sp+, Hi+, and Mc+, in the absence of Sa- and Nm-, was significantly more prevalent in children with ARI (p = 0.03, or clinical pneumonia (p<0.001 than non-ARI, and in children with clinical pneumonia (p = 0.0007 than URTI. Furthermore, Sp+, Hi+, and Mc+ differentiated children with pneumonia with normal CXR, or endpoint pneumonia, from those with URTI, and non-ARI cases.Concurrent NP carriage of Sp, Hi, and Mc was a predictor of clinical pneumonia and identified children with pneumonia with normal CXR and endpoint pneumonia from those with febrile URTI, or non-ARI episodes.

  3. Impact of a clinical decision model for febrile children at risk for serious bacterial infections at the emergency department: a randomized controlled trial.

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    Evelien de Vos-Kerkhof

    Full Text Available To assess the impact of a clinical decision model for febrile children at risk for serious bacterial infections (SBI attending the emergency department (ED.Randomized controlled trial with 439 febrile children, aged 1 month-16 years, attending the pediatric ED of a Dutch university hospital during 2010-2012. Febrile children were randomly assigned to the intervention (clinical decision model; n = 219 or the control group (usual care; n = 220. The clinical decision model included clinical symptoms, vital signs, and C-reactive protein and provided high/low-risks for "pneumonia" and "other SBI". Nurses were guided by the intervention to initiate additional tests for high-risk children. The clinical decision model was evaluated by 1 area-under-the-receiver-operating-characteristic-curve (AUC to indicate discriminative ability and 2 feasibility, to measure nurses' compliance to model recommendations. Primary patient outcome was defined as correct SBI diagnoses. Secondary process outcomes were defined as length of stay; diagnostic tests; antibiotic treatment; hospital admission; revisits and medical costs.The decision model had good discriminative ability for both pneumonia (n = 33; AUC 0.83 (95% CI 0.75-0.90 and other SBI (n = 22; AUC 0.81 (95% CI 0.72-0.90. Compliance to model recommendations was high (86%. No differences in correct SBI determination were observed. Application of the clinical decision model resulted in less full-blood-counts (14% vs. 22%, p-value < 0.05 and more urine-dipstick testing (71% vs. 61%, p-value < 0.05.In contrast to our expectations no substantial impact on patient outcome was perceived. The clinical decision model preserved, however, good discriminatory ability to detect SBI, achieved good compliance among nurses and resulted in a more standardized diagnostic approach towards febrile children, with less full blood-counts and more rightfully urine-dipstick testing.Nederlands Trial Register NTR2381.

  4. Accuracy of Automated Flow Cytometry-Based Leukocyte Counts To Rule Out Urinary Tract Infection in Febrile Children: a Prospective Cross-Sectional Study (United States)

    Duong, Hong Phuoc; Wissing, Karl Martin; Tram, Nathalie; Mascart, Georges; Lepage, Philippe


    Automated flow cytometry of urine remains an incompletely validated method to rule out urinary tract infection (UTI) in children. This cross-sectional analytical study was performed to compare the predictive values of flow cytometry and a dipstick test as initial diagnostic tests for UTI in febrile children and prospectively included 1,106 children (1,247 episodes). Urine culture was used as the gold standard test for diagnosing UTI. The performance of screening tests to diagnose UTI were established using receiver operating characteristic (ROC) analysis. Among these 1,247 febrile episodes, 221 UTIs were diagnosed (17.7% [95% confidence interval {CI}, 15.6 to 19.8%]). The area under the ROC curve for flow cytometry white blood cell (WBC) counts (0.99 [95% CI, 0.98 to 0.99]) was significantly superior to that for red blood cell (0.74 [95% CI, 0.70 to 0.78]) and bacterial counts (0.89 [95% CI, 0.87 to 0.92]) (P UTI in febrile children. PMID:27682127

  5. Antibiotic Prescription in Febrile Children : A Cohort Study during Out-of-Hours Primary Care

    NARCIS (Netherlands)

    Elshout, Gijs; Kool, Marijke; Van der Wouden, Johannes C.; Moll, Henriette A.; Koes, Bart W.; Berger, Marjolein Y.


    Background: Fever is common in children and often self-limiting, nevertheless antibiotics are frequently prescribed. We determined how often antibiotics were prescribed in children presenting with fever at a family physicians' out-of-hours service and established the children's signs and symptoms

  6. Performance of rapid diagnostic test, blood-film microscopy and PCR for the diagnosis of malaria infection among febrile children from Korogwe District, Tanzania

    DEFF Research Database (Denmark)

    Mahende, Coline; Ngasala, Billy; Lusingu, John


    with fever and/or history of fever in the previous 48 h attending outpatient clinics. Blood samples were collected for identification of Plasmodium falciparum infection using histidine-rich-protein-2 (HRP-2)-based malaria RDT, light microscopy and conventional PCR. Results: A total of 867 febrile patients......Background: Rapid diagnostic tests (RDT) and light microscopy are still recommended for diagnosis to guide the clinical management of malaria despite difficult challenges in rural settings. The performance of these tests may be affected by several factors, including malaria prevalence and intensity...... of transmission. The study evaluated the diagnostic performance of malaria RDT, light microscopy and polymerase chain reaction (PCR) in detecting malaria infections among febrile children at outpatient clinic in Korogwe District, northeastern Tanzania. Methods: The study enrolled children aged 2-59 months...

  7. Efficacy of a diazepam suppository at preventing febrile seizure recurrence during a single febrile illness. (United States)

    Hirabayashi, Yu; Okumura, Akihisa; Kondo, Taiki; Magota, Miyuki; Kawabe, Shinji; Kando, Naoyuki; Yamaguchi, Hideaki; Natsume, Jun; Negoro, Tamiko; Watanabe, Kazuyoshi


    To assess the efficacy of diazepam suppositories at preventing febrile seizure recurrence during a single febrile illness to determine how to treat children with a febrile seizure on presentation at the hospital. We studied 203 children with febrile seizures from December 2004 through March 2006. On admission between December 2004 and May 2005, a diazepam suppository was administered to the patients. Patients seen between June 2005 and March 2006 were not treated with antiepileptic drugs on admission. We saw a significant difference in the rate of recurrence of febrile seizures between children treated with diazepam and those who were not. Recurrences were observed in 2 (2.1%) of 95 children treated with diazepam and in 16 (14.8%) of 108 untreated children. For the 108 untreated patients, the median age was 22.8 months in those with recurrences and 30.6 months in those without, confirming that a younger age was related to a recurrence. A diazepam suppository after a febrile seizure will reduce the incidence of recurrent febrile seizures during the same febrile illness. However, a diazepam suppository after a febrile seizure should be used after carefully considering the benefits and potential adverse effects.

  8. Febrile neutropenia and refeeding syndrome. (United States)

    Jahn, H K; Barraclough, S; Currell, S; Tighe, M P


    We describe the management of a 4-year-old child with acute lymphoblastic leukaemia (ALL) who presented with febrile neutropenia, Cryptosporidium and subsequently developed refeeding syndrome. Febrile neutropenia is common and can be life-threatening and we highlight the identification of well low-risk neutropenic children with resolved febrile illnesses suitable for early discharge. We also discuss the potential management strategies for Cryptosporidium Refeeding syndrome is not common, but should be considered as a cause of acute inpatient deterioration and is a significant risk, with potential morbidity, in children who have undergone a period of catabolism. This article reviews the current literature and provides useful guidance on these issues. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  9. Management of uncomplicated malaria in febrile under five-year-old children by community health workers in Madagascar: reliability of malaria rapid diagnostic tests

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    Ratsimbasoa Arsène


    Full Text Available Abstract Background Early diagnosis, as well as prompt and effective treatment of uncomplicated malaria, are essential components of the anti-malaria strategy in Madagascar to prevent severe malaria, reduce mortality and limit malaria transmission. The purpose of this study was to assess the performance of the malaria rapid diagnostic tests (RDTs used by community health workers (CHWs by comparing RDT results with two reference methods (microscopy and Polymerase Chain Reaction, PCR. Methods Eight CHWs in two districts, each with a different level of endemic malaria transmission, were trained to use RDTs in the management of febrile children under five years of age. RDTs were performed by CHWs in all febrile children who consulted for fever. In parallel, retrospective parasitological diagnoses were made by microscopy and PCR. The results of these different diagnostic methods were analysed to evaluate the diagnostic performance of the RDTs administered by the CHWs. The stability of the RDTs stored by CHWs was also evaluated. Results Among 190 febrile children with suspected malaria who visited CHWs between February 2009 and February 2010, 89.5% were found to be positive for malaria parasites by PCR, 51.6% were positive by microscopy and 55.8% were positive by RDT. The performance accuracy of the RDTs used by CHWs in terms of sensitivity, specificity, positive and negative predictive values was greater than 85%. Concordance between microscopy and RDT, estimated by the Kappa value was 0.83 (95% CI: 0.75-0.91. RDTs stored by CHWs for 24 months were capable of detecting Plasmodium falciparum in blood at a level of 200 parasites/μl. Conclusion Introduction of easy-to-use diagnostic tools, such as RDTs, at the community level appears to be an effective strategy for improving febrile patient management and for reducing excessive use of anti-malarial drugs.

  10. White blood cell count, absolute neutrophil count, as predictors of hidden bacterial infections in febrile children 1-18 months of age without focus

    International Nuclear Information System (INIS)

    AL-Majali, R.M.


    Objectives: To study the relationship between White Blood Cell (WBC), Absolute Neutrophil Count (ANC) in febrile children 1-18 months of age as predictor of bacterial infection, so as to improve our predictability of bacterial infections in emergency room to decrease unnecessary admissions and antibiotic use. Methods: Retrospective review was performed on febrile patients 1-18 months of age that were admitted to hospital between August 2002 and March 2003 on the presumptive diagnosis of fever without focus, Complete septic work up was done for all patients according to local hospital protocol including Complete blood count (CBC), blood culture, urine culture, Chest X-Ray (CXR) and lumbar puncture, Patients who had history of antibiotics use within 48 hours of admission were excluded from the study, History, physical examination, laboratory and radiology data were reviewed. Data about the age, sex, temperature, presence or absence of focal bacterial infection, WBC, ANC, CXR report and body fluid culture results were collected and analyzed. Results: Thirty-four patients were reviewed in this study, Eight patients (23.5%) had bacterial infection: classified as group (2 patchy pneumonia, 3 Urinary tract infection (UTI), 2 meningitis, 1 Occult bacteremia (OB) and 26 patients (76.5%) had no evidence of bacterial infection, classified as group 2, No significant difference was found between the two groups in respect to age, sex, temperature and WBC P>0.05, while there was a significant difference between the two groups in respect to the ANC P = 0.02, also ANC had better sensitivity (78%) and specificity (89%) than WBC (sensitivity 77%, specificity 62%). Conclusion: ANC is a good predictive test for determining bacterial infection in young febrile children without focus, However there is need for other more reliable rapid cost effective measures in dealing with young febrile children at emergency department. (author)

  11. The clinical impact of the radiology report in wheezing and nonwheezing febrile children: a survey of clinicians

    International Nuclear Information System (INIS)

    Spottswood, Stephanie E.; Hernanz-Schulman, Marta; Hilmes, Melissa A.; Kan, J.H.; Liaw, Kevin; Moore, Paul E.; Patterson, Barron; Chen, Heidi


    The chest radiograph is commonly used in the diagnosis and management of patients presenting with respiratory illness. The language used to describe the findings is important to ensure appropriate communication with the referring clinician and thereby optimize patient management. In this study we attempted to determine how clinicians interpret specific terms commonly used in a chest radiograph report, and to assess how these terms impact the management of children with respiratory symptoms. An online survey was distributed to 562 pediatric practitioners asking their interpretation of the terms ''peripheral airway disease (PAD),'' ''focal airspace consolidation,'' and ''focal infiltrate'' in a febrile child with or without wheezing. There were 112 respondents. Most practitioners defined the term ''PAD'' as viral pneumonia (61.5%) or asthma (56.9%), ''consolidation'' as atelectasis (83%) followed by pneumonia (69.6%), and ''infiltrate'' as pneumonia (100%), followed by atelectasis (22.3%). Practitioners were more likely to treat a nonwheezing child with antibiotics if the report stated ''focal airspace consolidation'' (80%) or ''focal infiltrate'' (100%; P=0.001). Some radiologic descriptors may lead to diverse and sometimes unintended diagnostic conclusions. Our findings support continued effort to structure and standardize the radiology report and our descriptive terminology. (orig.)

  12. The clinical impact of the radiology report in wheezing and nonwheezing febrile children: a survey of clinicians

    Energy Technology Data Exchange (ETDEWEB)

    Spottswood, Stephanie E.; Hernanz-Schulman, Marta; Hilmes, Melissa A.; Kan, J.H. [Vanderbilt University, Department of Radiology and Radiological Sciences, Monroe Carell Jr. Children' s Hospital, Nashville, TN (United States); Liaw, Kevin [Vanderbilt University School of Medicine, Nashville, TN (United States); Moore, Paul E. [Vanderbilt University, Department of Pediatric Pulmonary, Allergy and Immunology, Monroe Carell Jr. Children' s Hospital, Nashville, TN (United States); Patterson, Barron [Vanderbilt University, Department of Pediatrics, Monroe Carell Jr. Children' s Hospital, Nashville, TN (United States); Chen, Heidi [Vanderbilt University Medical Center, Department of Biostatistics, Nashville, TN (United States)


    The chest radiograph is commonly used in the diagnosis and management of patients presenting with respiratory illness. The language used to describe the findings is important to ensure appropriate communication with the referring clinician and thereby optimize patient management. In this study we attempted to determine how clinicians interpret specific terms commonly used in a chest radiograph report, and to assess how these terms impact the management of children with respiratory symptoms. An online survey was distributed to 562 pediatric practitioners asking their interpretation of the terms ''peripheral airway disease (PAD),'' ''focal airspace consolidation,'' and ''focal infiltrate'' in a febrile child with or without wheezing. There were 112 respondents. Most practitioners defined the term ''PAD'' as viral pneumonia (61.5%) or asthma (56.9%), ''consolidation'' as atelectasis (83%) followed by pneumonia (69.6%), and ''infiltrate'' as pneumonia (100%), followed by atelectasis (22.3%). Practitioners were more likely to treat a nonwheezing child with antibiotics if the report stated ''focal airspace consolidation'' (80%) or ''focal infiltrate'' (100%; P=0.001). Some radiologic descriptors may lead to diverse and sometimes unintended diagnostic conclusions. Our findings support continued effort to structure and standardize the radiology report and our descriptive terminology. (orig.)

  13. Frequency of fever episodes related to febrile seizure recurrence

    NARCIS (Netherlands)

    M. van Stuijvenberg (Margriet); N.E. Jansen (Nichon); E.W. Steyerberg (Ewout); G. Derksen-Lubsen (Gerarda); H.A. Moll (Henriëtte)


    textabstractThe aim of this study was to assess the number of fever episodes as a risk factor for febrile seizure recurrence during the first 6 months after the last previous febrile seizure. In a 6-month follow-up study of 155 children, aged 3 months to 5 y, with a first or a recurrent febrile

  14. Febrile seizures and risk of schizophrenia

    DEFF Research Database (Denmark)

    Vestergaard, Mogens; Pedersen, Carsten Bøcker; Christensen, Jakob


    BACKGROUND: Febrile seizure is a benign condition for most children, but experiments in animals and neuroimaging studies in humans suggest that some febrile seizures may damage the hippocampus, a brain area of possible importance in schizophrenia. METHODS: A population-based cohort of all children...... with schizophrenia. A history of febrile seizures was associated with a 44% increased risk of schizophrenia [relative risk (RR)=1.44; 95% confidence interval (CI), 1.07-1.95] after adjusting for confounding factors. The association between febrile seizures and schizophrenia remained virtually unchanged when...... restricting the analyses to people with no history of epilepsy. A history of both febrile seizures and epilepsy was associated with a 204% increased risk of schizophrenia (RR=3.04; 95% CI, 1.36-6.79) as compared with people with no such history. CONCLUSIONS: We found a slightly increased risk of schizophrenia...

  15. The impact of obesity on febrile urinary tract infection and renal scarring in children with vesicoureteral reflux. (United States)

    Byun, H J; Ha, J Y; Jung, W; Kim, B H; Park, C H; Kim, C I


    It has become clear that obesity is associated with a variety of infectious diseases, including urinary tract infection (UTI) and renal scarring. The aim of this study was to evaluate the association between obesity and the degree of febrile UTI (fUTI) and renal scarring in children with vesicoureteral reflux (VUR), and to stratify the results into obesity subcategories. A total of 186 patients were diagnosed with VUR between January 2002 and December 2008. This study retrospectively reviewed the medical records of 72 children with primary VUR who had recurrent fUTI (more than twice). Overweight or obese status of the patients aged children, body mass index (BMI) percentile-for-age was used. They were divided into three groups as follows; standard (obese (≥95%). The following clinical variables were compared: age at diagnosis of primary VUR (months), sex, VUR grade, hydronephrosis grade, presence of renal scarring, surgical treatment, and degree of inflammation during fUTI. In the overweight and obese groups, VUR was diagnosed at a young age (P = 0.05), the degree of renal scarring was more severe (P = 0.006), and serum white blood cell count, C-reactive protein, and erythrocyte sedimentation rate (ESR) levels were significantly higher (P children (35%). Cortical defects occurred more frequently in children with obesity, and they were associated with a higher grade of reflux and serum ESR levels (P = 0.007, P = 0.042, and P = 0.021, respectively). Among these risk factors, high-grade VUR (OR = 9.93, 95% CI = 1.13-86.71), and being overweight and obese (OR = 5.26, 95% CI = 1.75-15.82) were associated with increased renal scarring. However, ESR was not associated with renal scarring (OR = 1.01, 95% CI = 0.95-1.07). The relationships between obesity and UTI are controversial. Some studies have shown positive results; however, other studies have shown opposite results. The main limitations of this study were the retrospective data collection

  16. Alternating Acetaminophen and Ibuprofen versus Monotherapies in Improvements of Distress and Reducing Refractory Fever in Febrile Children: A Randomized Controlled Trial. (United States)

    Luo, Shuanghong; Ran, Mengdong; Luo, Qiuhong; Shu, Min; Guo, Qin; Zhu, Yu; Xie, Xiaoping; Zhang, Chongfan; Wan, Chaomin


    No evidence can be found in the medical literature about the efficacy of alternating acetaminophen and ibuprofen treatment in children with refractory fever. Our objective was to assess the effect of alternating acetaminophen and ibuprofen therapy on distress and refractory fever compared with acetaminophen or ibuprofen as monotherapy in febrile children. A total of 474 febrile children with axillary temperature ≥38.5 °C and fever history ≤3 days in a tertiary hospital were randomly assigned to receive either (1) alternating acetaminophen and ibuprofen (acetaminophen 10 mg/kg per dose with shortest interval of 4 h and ibuprofen 10 mg/kg per dose with shortest interval of 6 h and the shortest interval between acetaminophen and ibuprofen ≥2 h; n = 158), (2) acetaminophen monotherapy (10 mg/kg per dose with shortest interval of 4 h; n = 158), or (3) ibuprofen monotherapy (10 mg/kg per dose with shortest interval of 6 h; n = 158). The mean Non-Communicating Children's Pain Checklist (NCCPC) score was measured every 4 h, and axillary temperatures were measured every 2 h. In total, 471 children were included in an intention-to-treat analysis. No significant clinical or statistical difference was found in mean NCCPC score or temperature during the 24-h treatment period in all febrile children across the three groups. Although the proportion of children with refractory fever for 4 h and 6 h was significantly lower in the alternating group than in the monotherapy groups (4 h: 11.54% vs. 26.58% vs. 21.66%, respectively [p = 0.003]; 6 h: 3.85% vs. 10.13% vs. 17.83%, respectively [p ibuprofen can reduce the proportion of children with refractory fever, but if one cycle of alternating therapy cannot reduce febrile distress as defined by NCCPC score, two or more cycles of alternating therapy may have minimal to no clinical efficacy in some cases. The trial was registered with the Chinese Clinical Trial Registry as ChiCTR-TRC-13003440 and the WHO

  17. Aetiologies of non-malaria febrile episodes in children under 5 years in sub-Saharan Africa. (United States)

    Kiemde, Francois; Spijker, René; Mens, Petra F; Tinto, Halidou; Boele, Michael; Schallig, Henk D F H


    To provide an overview of the most frequent aetiologies found in febrile episodes of children under 5 years from sub-Saharan Africa. MEDLINE and EMBASE were searched for publications in English and French on non-malaria fever episodes in African children under 5 years of age, which were published between January 1990 and July 2015. Case reports and conference abstracts were excluded. In total, 3851 titles and abstracts were reviewed, and 153 were selected for full screening of which 18 were included in the present review. Bloodstream infection (BSI) was most commonly investigated (nine of 18) followed by urinary tract infection (UTI) (four of 18) and respiratory tract infection (RTI) (two of 18). Few studies investigated BSI and UTI in the same children (two of 18), or BSI and gastrointestinal infection (GII) (one of 18). As for BSI, the most frequently isolated bacteria were E. coli (four of 12), Streptococcus pneumonia (four of 12), Salmonella spp (three of 12) and Staphylococcus aureus (two of 12) with a positive identification rate of 19.7-33.3%, 5.2-27.6%, 11.7-65.4% and 23.5-42.0%, respectively. As for UTI, the main bacteria isolated were E. coli (six of six) and Klebsiella spp (six of six) with a positive rate of 20.0-72.3% and 10.0-28.5%, respectively. No bacterium was isolated in RTI group, but Human influenzae A and B were frequently found, with the highest positive identification rate in Tanzania (75.3%). Dengue virus (two of 12) was the most frequently reported viral infection with a positive identification rate of 16.7-30.8%. Finally, only rotavirus/adenovirus (69.2% positive identification rate) was found in GII and no bacterium was isolated in this group. The high prevalence of treatable causes of non-malaria fever episodes requires a proper diagnosis of the origin of fever followed by an appropriate treatment, thereby reducing the under-5 mortality in sub-Saharan Africa and preventing the overprescription of antibiotics and thus circumventing the

  18. Gammagrafía renal en niños con primera infección febril del tracto urinario Renal scintigraphy in children with first febrile urinary tract infection

    Directory of Open Access Journals (Sweden)

    María Caridad Duarte Pérez


    the first febrile urinary tract infection, and to relate them to the studied variables. Methods: two hundred eleven children diagnosed as first febrile urinary tract infection patients were studied and performed Tc-DMSA renal scintigraphy in the acute phase of infection. The results were correlated to the duration and intensity of the fever before the diagnosis, to the acute phase reactants (hemogram, erythrosedimentation and reactive-C protein and to the results of imaging studies (renal ultrasound and mictional uretrocystography. Results: females prevailed and 82.4 % of patients were under one year-old. In the study group, 54 % presented with scintigraphic alterations and the hypocapture pattern of the radiopharmaceutical was the predominant finding in 70 % of patients. There was significant association between the duration and intensity of the fever, and the renal alterations. Regarding the lab parameters, leukocytosis above 15 000, accelerated erythrosedimentation and raised reactive-C protein were statistically significant and related to the renal alterations, whereas the radiological findings observed in renal ultrasound and mictional urethrocystography were statistically correlated to the renal lesion detected in the scintigraphy. Conclusions: high percentage of patients suffered the spread of infection over the renal parenchyma; additionally the studied clinical, lab and imaging variables indicated renal injure.

  19. Rare severe mycotic infections in children receiving empirical caspofungin treatment for febrile neutropenia

    Directory of Open Access Journals (Sweden)

    Deniz Yilmaz Karapinar


    Full Text Available Empirical antifungal therapy is most often given to patients with leukemia. However breakthrough fungal infections under antifungal therapy are not uncommon. Four children, with hematologic malignant disease developed mycotic breakthrough infections while on empirical caspofungin treatment for a median of 14 (range 11–19 days. Trichosporon asahii was detected in the blood culture of two patients and Geotrichum capitatum in the other two (one patient also had positive cerebrospinal fluid culture. Because the patients’ clinical situation worsened, voriconazole was empirically added for two patients three and five days before the agent was detected. The first sterile blood culture was obtained 3–7 days of voriconazole treatment. All patients reached clear cultures but one patient died. One patient with central nervous system infection with G. capitatum had severe neurological sequelae. Very severe fungal infections can occur during empirical caspofungin therapy. Therefore, patients should be followed closely.

  20. The “Top-Down” Approach to the Evaluation of Children with Febrile Urinary Tract Infection

    Directory of Open Access Journals (Sweden)

    Hans G. Pohl


    Full Text Available The evaluation of children presenting with urinary tract infection (UTI has long entailed sonography and cystography to identify all urological abnormalities that might contribute to morbidity. The identification of vesicoureteral reflux (VUR has been of primary concern since retrospective studies from the 1930s to 1960s established a strong association between VUR, recurrent UTI, and renal cortical scarring. It has been proposed that all VUR carries a risk for renal scarring and, therefore, all VUR should be identified and treated. We will not discuss the controversies surrounding VUR treatment in this review focusing instead on a new paradigm for the evaluation of the child with UTI that is predicated on identifying those at risk for scarring who are most deserving of further evaluation by cystography.

  1. Out-of-pocket costs and other determinants of access to healthcare for children with febrile illnesses: a case-control study in rural Tanzania.

    Directory of Open Access Journals (Sweden)

    Joëlle Castellani

    Full Text Available To study private costs and other determinants of access to healthcare for childhood fevers in rural Tanzania.A case-control study was conducted in Tanzania to establish factors that determine access to a health facility in acute febrile illnesses in children less than 5 years of age. Carers of eligible children were interviewed in the community; cases were represented by patients who went to a facility and controls by those who did not. A Household Wealth Index was estimated using principal components analysis. A multivariable logistic regression analysis was performed to understand the factors which influenced attendance of healthcare facility including severity of the illness and household wealth/socio-demographic indicators. To complement the data on costs from community interviews, a hospital-based study obtained details of private expenditures for hospitalised children under the age of 5.Severe febrile illness is strongly associated with health facility attendance (OR: 35.76, 95%CI: 3.68-347.43, p = 0.002 compared with less severe febrile illness. Overall, the private costs of an illness for patients who went to a hospital were six times larger than private costs of controls ($5.68 vs. $0.90, p<0.0001. Household wealth was not significantly correlated with total costs incurred. The separate hospital based cost study indicated that private costs were three times greater for admissions at the mission versus public hospital: $13.68 mission vs. $4.47 public hospital (difference $ 9.21 (95% CI: 7.89 -10.52, p<0.0001. In both locations, approximately 50% of the cost was determined by the duration of admission, with each day in hospital increasing private costs by about 12% (95% CI: 5% - 21%.The more severely ill a child, the higher the probability of attending hospital. We did not find association between household wealth and attending a health facility; nor was there an association between household wealth and private cost.

  2. The choice of healthcare providers for febrile children after introducing non-professional health workers in a malaria endemic area in Papua New Guinea

    Directory of Open Access Journals (Sweden)

    Takahiro eTsukahara


    Full Text Available Background: Disease burden of malaria in Papua New Guinea (PNG is the highest in Asia and the Pacific, and prompt access to effective drugs is the key strategy for controlling malaria. Despite the rapid economic growth, primary healthcare services have deteriorated in rural areas; the introduction of non-professional health workers [village health volunteers (VHVs] is expected to improve antimalarial drug deliveries. Previous studies on PNG suggested that distance from households negatively affected the utilization of health services; however, price effect on healthcare demand decisions has not been explored. Empirical studies on household’s affordability as well as accessibility of healthcare services contribute to policy implications such as efficient introduction of out-of-pocket costs and effective allocation of health facilities. Therefore, we investigate price responsiveness and other determinants of healthcare provider choice for febrile children in a malaria endemic rural area wherein VHVs were introduced.Methods: Cross-sectional surveys were conducted using a structured questionnaire distributed in a health center’s catchment area of East Sepik Province in the 2011/2012 rainy seasons. Caretakers were interviewed and data on fever episodes of their children in the preceding two weeks were collected. Mixed logit model was employed to estimate the determinants of healthcare provider choice.Results: Among 257 fever episodes reported, the main choices of healthcare providers were limited to self-care, VHV, and a health center. Direct cost and walking distance negatively affected the choice of a VHV and the health center. An increase of VHV’s direct cost or walking distance did not much affect predicted probability of the health center, but rather that of self-care. While, drug availability and illness severity increased the choice probability of a VHV and the health center. Conclusion: The results suggest that the net healthcare demand

  3. Similar Occurrence of Febrile Episodes Reported in Non-Atopic Children at Three to Five Years of Age after Prebiotics Supplemented Infant Formula. (United States)

    van Stuijvenberg, Margriet; Stam, José; Grüber, Christoph; Mosca, Fabio; Arslanoglu, Sertac; Chirico, Gaetano; Braegger, Christian P; Riedler, Josef; Boehm, Günther; Sauer, Pieter J J


    This is a follow up study of a multicenter randomised placebo-controlled trial in seven centres in five West European countries. The RCT assessed the effect of infant formula supplemented with a mixture of prebiotics (with neutral short-chain and long-chain oligosaccharides and pectin-derived acidic oligosaccharides) during infancy in term-born children (n=1130). In the follow-up study 672 children (60% of the study population) participated: 232 (56%) from the prebiotics group (PG), 243 (58%) from the control group (CG), and 197 (66%) from the non-randomised breast-fed group (BG). The primary outcome was the occurrence of febrile episodes at three to five years of age prospectively documented by the parents: in the PG 1.17 (interquartile range 0.50-2.08) episodes per year versus 1.20 (0.52-2.57) in the CG; and 1.48 (0.65-2.60) in the BG. This specific prebiotics mixture given during infancy in healthy non-atopic subjects does not decrease febrile episodes and therefore seems not to prevent infection between their third and fifth birthday.

  4. A Study to Determine the Incidence of Urinary Tract Infections in Infants and Children Ages 4 Months to 6 Years With Febrile Diarrhea. (United States)

    Nibhanipudi, Kumara V


    To determine the incidence of urinary tract infections (UTIs) in infants and children (4 months to 6 years of age) with febrile diarrhea, as outpatients. This was a prospective institutional review board-approved study. patients (between 4 months and 6 years of age) were enrolled in the study who presented to the pediatric emergency room with a complaint of fever (rectal temperature 101°F or more) and diarrhea (watery stools >3 in number). The patients were evaluated for state of hydration, and also urine samples were collected. For those children not toilet trained, urine specimens were collected by bladder catheterization, and for those children toilet trained, urine specimens were obtained by midstream collection method. The urine samples obtained were sent for analysis and culture. Eighty patients were enrolled in the study. The number of specimens obtained by clean catch midstream was 20, and by bladder catheterization was 60. None of the urine specimens obtained by both methods of collection grew any organism. There was no increased incidence of infections in male children whether circumcised (10/60) or uncircumcised (50/60). The mean temperature was 102.8°F (range = 101°F to 105°F). Using in silico online 2 × 2 χ(2) test by comparing both the positive and negative urine culture results, 2-tailed P value is <.0001. Our prospective randomized study concluded that there is no increased incidence of UTIs in infants and children (4 months to 6 years of age) with febrile diarrhea.

  5. A Study to Determine the Incidence of Urinary Tract Infections in Infants and Children Ages 4 Months to 6 Years With Febrile Diarrhea

    Directory of Open Access Journals (Sweden)

    Kumara V. Nibhanipudi MD, FAAP, FAAEM


    Full Text Available Objective: To determine the incidence of urinary tract infections (UTIs in infants and children (4 months to 6 years of age with febrile diarrhea, as outpatients. Methods: This was a prospective institutional review board–approved study. patients (between 4 months and 6 years of age were enrolled in the study who presented to the pediatric emergency room with a complaint of fever (rectal temperature 101°F or more and diarrhea (watery stools >3 in number. The patients were evaluated for state of hydration, and also urine samples were collected. For those children not toilet trained, urine specimens were collected by bladder catheterization, and for those children toilet trained, urine specimens were obtained by midstream collection method. The urine samples obtained were sent for analysis and culture. Results: Eighty patients were enrolled in the study. The number of specimens obtained by clean catch midstream was 20, and by bladder catheterization was 60. None of the urine specimens obtained by both methods of collection grew any organism. There was no increased incidence of infections in male children whether circumcised (10/60 or uncircumcised (50/60. The mean temperature was 102.8°F (range = 101°F to 105°F. Statistics: Using in silico online 2 × 2 χ2 test by comparing both the positive and negative urine culture results, 2-tailed P value is <.0001. Conclusions: Our prospective randomized study concluded that there is no increased incidence of UTIs in infants and children (4 months to 6 years of age with febrile diarrhea.

  6. Infusion-related febrile reaction after haploidentical stem cell transplantation in children is associated with higher rates of engraftment syndrome and acute graft-versus-host disease. (United States)

    Chen, Yao; Huang, Xiao-Jun; Liu, Kai-Yan; Chen, Huan; Chen, Yu-Hong; Zhang, Xiao-Hui; Wang, Feng-Rong; Han, Wei; Wang, Jing-Zhi; Wang, Yu; Yan, Chen-Hua; Zhang, Yuan-Yuan; Sun, Yu-Qian; Xu, Lan-Ping


    The clinical significance and prognostic impact of IRFR in pediatric recipients of haploidentical SCT are not clearly understood. Therefore, we attempted to determine how IRFR affects clinical outcomes in children. Clinical data from 100 consecutive pediatric patients (60 boys and 40 girls; median age, 12 yr [range, 2-18 yr] after haploidentical SCT between January 2010 and December 2012 were collected retrospectively. IRFR was described as unexplained fever (>38 °C) within 24 h after the infusion of haploidentical PBSCs. Thirty-eight (38.0%) cases met the criteria for IRFR. ES was found in 24 (63.2%) of the 38 children with IRFR, with the median time of developing ES of +9 (7-16) days, while only 15 (25.4%) of the 59 children without IRFR were found with ES (p children after haploidentical SCT. Thirty-eight children comprised the IRFR group, and 59 were in the control (non-IRFR) group. High incidence of ES was observed in children with the occurrence of IRFR. Similarly, the incidence of stage I-IV and II-IV aGVHD was significantly higher in the febrile group. Multivariate analysis showed IRFR to be the risk factor for ES and aGVHD. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  7. Profile of C-reactive protein, white cells and neutrophil populations in febrile children from rural north-eastern Tanzania

    DEFF Research Database (Denmark)

    Mahende, Coline; Ngasala, Billy; Lusingu, John


    ) guidelines and laboratory investigations (blood and urine cultures). RESULTS: A total of 867 patients were enrolled, out of which 691 (79.7%) had complete clinical and laboratory data available for analysis. Acute upper respiratory tract infection 284 (41.1%), acute gastroenteritis 127 (18.4%) and pneumonia...... with upper respiratory tract infection, pneumonia, acute gastroenteritis and non-specific febrile illness. Only serum CRP levels were positively correlated with positive blood cultures at a calculated cut-off value of 37.3 mg/L, giving a specificity of 77.8% and sensitivity of 74.2%. CONCLUSION: CRP...

  8. Treatment duration and prognostics in febrile urinary tract infection

    NARCIS (Netherlands)

    Starre, Willy Elizabeth van der (Willize)


    Aim of this thesis was to provide evidence for the clinical implication of biomarkers in blood and urine, as well as genetic markers, for the prediction of the severity and course of febrile UTI. Furthermore, this thesis focused on optimization of antimicrobial treatment of febrile UTI. The main

  9. Febrile urinary-tract infection due to extended-spectrum beta-lactamase-producing Enterobacteriaceae in children: A French prospective multicenter study. (United States)

    Madhi, Fouad; Jung, Camille; Timsit, Sandra; Levy, Corinne; Biscardi, Sandra; Lorrot, Mathie; Grimprel, Emmanuel; Hees, Laure; Craiu, Irina; Galerne, Aurelien; Dubos, François; Cixous, Emmanuel; Hentgen, Véronique; Béchet, Stéphane; Bonacorsi, Stéphane; Cohen, Robert


    To assess the management of febrile urinary-tract infection (FUTIs) due to extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) in children, the Pediatric Infectious Diseases Group of the French Pediatric Society set up an active surveillance network in pediatric centers across France in 2014. We prospectively analysed data from 2014 to 2016 for all children < 18 years old who received antibiotic treatment for FUTI due to ESBL-E in 24 pediatric centers. Baseline demographic, clinical features, microbiological data and antimicrobials prescribed were collected. 301 children were enrolled in this study. The median age was 1 year (IQR 0.02-17.9) and 44.5% were male. These infections occurred in children with history of UTIs (27.3%) and urinary malformations (32.6%). Recent antibiotic use was the main associated factor for FUTIs due to ESBL-E, followed by a previous hospitalization and travel history. Before drug susceptibility testing (DST), third-generation cephalosporins (3GC) PO/IV were the most-prescribed antibiotics (75.5%). Only 13% and 24% of children received amikacine alone for empirical or definitive therapy, respectively, whereas 88.7% of children had isolates susceptible to amikacin. In all, 23.2% of children received carbapenems in empirical and/or definitive therapy. Cotrimoxazole (24.5%), ciprofloxacin (15.6%) and non-orthodox clavulanate-cefixime combination (31.3%) were the most frequently prescribed oral options after obtaining the DST. The time to apyrexia and length of hospital stay did not differ with or without effective empirical therapy. We believe that amikacin should increasingly take on a key role in the choice of definitive therapy of FUTI due to ESBL-E in children by avoiding the use of carbapenems.

  10. Interactive Electronic Decision Trees for the Integrated Primary Care Management of Febrile Children in Low Resource Settings - Review of existing tools. (United States)

    Keitel, Kristina; D'Acremont, Valérie


    The lack of effective, integrated diagnostic tools pose a major challenge to the primary care management of febrile childhood illnesses. These limitations are especially evident in low-resource settings and are often inappropriately compensated by antimicrobial over-prescription. Interactive electronic decision trees (IEDTs) have the potential to close these gaps: guiding antibiotic use and better identifying serious disease. This narrative review summarizes existing IEDTs, to provide an overview of their degree of validation, as well as to identify gaps in current knowledge and prospects for future innovation. Structured literature review in PubMed and Embase complemented by google search and contact with developers. Six integrated IEDTs were identified: three (eIMCI, REC, and Bangladesh digital IMCI) based on Integrated Management of Childhood Illnesses (IMCI); four (SL eCCM, MEDSINC, e-iCCM, and D-Tree eCCM) on Integrated Community Case Management (iCCM); two (ALMANACH, MSFeCARE) with a modified IMCI content; and one (ePOCT) that integrates novel content with biomarker testing. The types of publications and evaluation studies varied greatly: the content and evidence-base was published for two (ALMANACH and ePOCT), ALMANACH and ePOCT were validated in efficacy studies. Other types of evaluations, such as compliance, acceptability were available for D-Tree eCCM, eIMCI, ALMANACH. Several evaluations are still ongoing. Future prospects include conducting effectiveness and impact studies using data gathered through larger studies to adapt the medical content to local epidemiology, improving the software and sensors, and Assessing factors that influence compliance and scale-up. IEDTs are valuable tools that have the potential to improve management of febrile children in primary care and increase the rational use of diagnostics and antimicrobials. Next steps in the evidence pathway should be larger effectiveness and impact studies (including cost analysis) and

  11. Increasing understanding of the relationship between geographic access and gendered decision-making power for treatment-seeking for febrile children in the Chikwawa district of Malawi

    Directory of Open Access Journals (Sweden)

    Victoria L. Ewing


    Full Text Available Abstract Background This study used qualitative methods to investigate the relationship between geographic access and gendered intra-household hierarchies and how these influence treatment-seeking decision-making for childhood fever within the Chikwawa district of Malawi. Previous cross-sectional survey findings in the district indicated that distance from facility and associated costs are important determinants of health facility attendance in the district. This paper uses qualitative data to add depth of understanding to these findings by exploring the relationship between distance from services, anticipated costs and cultural norms of intra-household decision-making, and to identify potential intervention opportunities to reduce challenges experienced by those in remote locations. Qualitative data collection included 12 focus group discussions and 22 critical incident interviews conducted in the local language, with primary caregivers of children who had recently experienced a febrile episode. Results Low geographic accessibility to facilities inhibited care-seeking, sometimes by extending the ‘assessment period’ for a child’s illness episode, and led to delays in seeking formal treatment, particularly when the illness occurred at night. Although carers attempted to avoid incurring costs, cash was often needed for transport and food. Whilst in all communities fathers were normatively responsible for treatment costs, mothers generally had greater access to and control over resources and autonomy in decision-making in the matrilineal and matrilocal communities in the central part of the district, which were also closer to formal facilities. Conclusions This study illustrates the complex interplay between geographic access and gender dynamics in shaping decisions on whether and when formal treatment is sought for febrile children in Chikwawa District. Geographic marginality and cultural norms intersect in remote areas both to increase the

  12. Value of imaging studies after a first febrile urinary tract infection in young children: data from Italian renal infection study 1. (United States)

    Montini, Giovanni; Zucchetta, Pietro; Tomasi, Lisanna; Talenti, Enrico; Rigamonti, Waifro; Picco, Giorgio; Ballan, Alberto; Zucchini, Andrea; Serra, Laura; Canella, Vanna; Gheno, Marta; Venturoli, Andrea; Ranieri, Marco; Caddia, Valeria; Carasi, Carla; Dall'amico, Roberto; Hewitt, Ian


    We examined the diagnostic accuracy of routine imaging studies (ultrasonography and micturating cystography) for predicting long-term parenchymal renal damage after a first febrile urinary tract infection. This study addressed the secondary objective of a prospective trial evaluating different antibiotic regimens for the treatment of acute pyelonephritis. Data for 300 children urinary tracts were mostly normal. The acute technetium-99m-dimercaptosuccinic acid scans showed pyelonephritis in 54% of cases. Renal scarring developed in 15% of cases. The ultrasonographic and cystographic findings were poor predictors of long-term damage, showing minor sonographic abnormalities for 12 and reflux for 23 of the 45 children who subsequently developed scarring. The benefit of performing ultrasonography and scintigraphy in the acute phase or cystourethrography is minimal. Our findings support (1) technetium-99m-dimercaptosuccinic acid scintigraphy 6 months after infection to detect scarring that may be related to long-term hypertension, proteinuria, and renal function impairment (although the degree of scarring was generally minor and did not impair renal function) and (2) continued surveillance to identify recurrent urinary tract infections that may warrant further investigation.

  13. Hippocampal Abnormalities after Prolonged Febrile Convulsions

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    J Gordon Millichap


    Full Text Available Hippocampal volume and T2 relaxation times were determined in an MRI study of 14 children with prolonged febrile convulsions (PFC who were investigated, 1 within 5 days of a PFC, and 2 at follow-up 4-8 months after the acute study, at the Institute of Child Health, University College, and Great Ormond Street Hospital, London, UK.

  14. febrile seizures, Tripoli, Libya, knowledge, attitude

    African Journals Online (AJOL)


    the knowledge, attitude and practice of mothers regarding febrile seizures in Tripoli, Libya. ... aim of the audit is to assess the attitude and knowledge of parents of children with .... The following exclusion criteria were used: child who has fever due CNS ... department after giving prior first aid-a similar results was reported.

  15. Sustained reductions in time to antibiotic delivery in febrile immunocompromised children: results of a quality improvement collaborative. (United States)

    Dandoy, Christopher E; Hariharan, Selena; Weiss, Brian; Demmel, Kathy; Timm, Nathan; Chiarenzelli, Janis; Dewald, Mary Katherine; Kennebeck, Stephanie; Langworthy, Shawna; Pomales, Jennifer; Rineair, Sylvia; Sandfoss, Erin; Volz-Noe, Pamela; Nagarajan, Rajaram; Alessandrini, Evaline


    Timely delivery of antibiotics to febrile immunocompromised (F&I) paediatric patients in the emergency department (ED) and outpatient clinic reduces morbidity and mortality. The aim of this quality improvement initiative was to increase the percentage of F&I patients who received antibiotics within goal in the clinic and ED from 25% to 90%. Using the Model of Improvement, we performed Plan-Do-Study-Act cycles to design, test and implement high-reliability interventions to decrease time to antibiotics. Pre-arrival interventions were tested and implemented, followed by post-arrival interventions in the ED. Many processes were spread successfully to the outpatient clinic. The Chronic Care Model was used, in addition to active family engagement, to inform and improve processes. The study period was from January 2010 to January 2015. Pre-arrival planning improved our F&I time to antibiotics in the ED from 137 to 88 min. This was sustained until October 2012, when further interventions including a pre-arrival huddle decreased the median time to antibiotics within 60 min to >90%. In September 2014, we implemented a rapid response team to improve reliable venous access in the ED, which increased our mean percentage of patients receiving timely antibiotics to its highest rate (95%). This stepwise approach with pre-arrival planning using the Chronic Care Model, followed by standardisation of processes, created a sustainable improvement of timely antibiotic delivery in F&I patients. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to



    Rahul; Haricharan; Venkatamurthy


    ABSTRACT: OBJECTIVES: Estimation of Iron status in children with first f ebrile seizure (FFS). Iron status was evaluated by including Hemoglobin, Mean Corpuscular Volume (MCV), Mean Corpuscular Haemoglobin (MCH), Serum ferritin. MATERIALS AND METHODS : Study was conducted all children with first febrile seizures and febrile illnesses (FI) in Pediatrics Intensive Care Unit and Pediatrics Wards of Sri Adichunchanag iri Institute of Medical Sciences, B.G. Nagara ...

  17. La neutropenia severa febril en niños con cáncer: Estudio descriptivo en el Hospital Universitario de Santander Severe febrile neutropenia in children with cancer: A descriptive study at the Hospital Universitario de Santander

    Directory of Open Access Journals (Sweden)

    Ernesto Rueda


    Full Text Available Objetivos: Describir una población oncológica afectada por neutropenia severa febril, sus características demográficas, nutricionales, microbiológicas, de tratamiento y severidad de la enfermedad. Materiales y métodos: Esta es una serie de casos prospectiva de los pacientes atendidos en el Hospital Universitario de Santander entre enero/2007 y enero/2008. Resultados: Veintiun (21 pacientes aportaron 35 episodios de neutropenia febril; 65,7% eran hombres, la edad promedio 5,6 años; 38,3% vivían en el Área Metropolitana de Bucaramanga y 91,4% en estrato socioeconómico bajo. El diagnóstico oncológico más frecuente fue leucemia linfocítica aguda. Ninguno presentó dolor abdominal o síntomas neurológicos. La neutropenia se detectó 8,5 días en promedio posterior a la última quimioterapia. El 31,4% no tuvieron neutrófilos absolutos, 54,2% plaquetas Objective: To describe an oncological population affected with severe febrile neutropenia, its demographic, nutritional, and microbiological features, their treatment and severity of the illness. Materials and methods: A descriptive-prospective clinical chart review from attended patients at the Hospital Universitario de Santander, from January/2007 to January/2008. Results: Twenty (21 patients contributed with 35 febrile neutropenia episodes; 65.7% were male; they aged average was 5.6-years; 38.37% lived in Bucaramanga Metropolitan Area; 91.4% had low economic status. The most frequent oncological diagnosis was acute lumphocytic leukemia. No one presented abdominal pain or neurological symptoms. The neutropenia was detected 8.5 days after the last chemotherapy cycle. 31.4% patients had no absolute neutrophils; 54.2% blood platelets <50,000/mm3, 45.7% had reactive C protein <90 mg|/dL. The bloodculture was positive only in 7 patients. It was found the infection focus in 88.6% of the episodes and the most frequently diagnosis were related with the gastrointestinal tract. The most used

  18. Comparison of the Efficacy and Safety of 2 Acetaminophen Dosing Regimens in Febrile Infants and Children: A Report on 3 Legacy Studies. (United States)

    Temple, Anthony R; Zimmerman, Brenda; Gelotte, Cathy; Kuffner, Edwin K


    Compare efficacy and safety of 10 to 15 mg/kg with 20 to 30 mg/kg acetaminophen in febrile children 6 months to ≤ 11 years from 3 double-blind, randomized, single or multiple dose studies. Doses were compared on sum of the temperature differences (SUMDIFF), maximum temperature difference (MAXDIFF), temperature differences at each time point, and dose by time interactions. Alanine aminotransferase (ALT) was evaluated in the 72-hour duration study. A single dose of acetaminophen 20 to 30 mg/kg produced a greater effect on temperature decrement and duration of antipyretic effect over 8 hours than a single dose of 10 to 15 mg/kg. When equivalent total doses (i.e., 2 doses of 10 to 15 mg/kg given at 4-hour intervals and 1 dose of 20 to 30 mg/kg) were given over the initial 8-hour period, there were no significant temperature differences. Over a 72-hour period, 10 to 15 mg/kg acetaminophen administered every 4 hours maintained a more consistent temperature decrement than 20 to 30 mg/kg acetaminophen administered every 8 hours. Following doses of 60 to 90 mg/kg/day for up to 72 hours, no child had a clinically important increase in ALT from baseline. The number of children with reported adverse events was similar between doses. Data demonstrate the antipyretic effect of acetaminophen is dependent on total dose over a given time interval. These 3 studies provide clinical evidence that the recommended standard acetaminophen dose of 10 to 15 mg/kg is a safe and effective dose for treating fever in pediatric patients when administered as a single dose or as multiple doses for up to 72 hours.

  19. Diagnostic Value of Technetium-99m-Dimercaptosuccinic Acid Scintigraphy in Prediction of Vesicoureteral Reflux in Children with First-time Febrile Urinary Tract Infection

    Directory of Open Access Journals (Sweden)

    Fatemeh Ataei


    Full Text Available Background: Imaging modalities such as voiding cystourethrography (VCUG, direct radionuclide cystography (DRNC, and renal cortical scintigraphy (RCS with technetium-99m dimercaptosuccinic acid (Tc-99mDMSA, are helpful in detecting possible abnormalities of urinary tract such as vesicoureteral reflux (VUR. However, there are confounding data regarding the preference of these modalities. In the present study, we aimed to assess the role of Tc-99mDMSA scan in prediction of possible VUR and the subsequent need for VCUG or DRNC. Materials and Methods: Three hundred fifty seven children under 14 years old with first-time febrile urinary tract infection (UTI who were admitted between April 2004 and February 2017 were enrolled. Data regarding to VCUG or DRNC in order to evaluate the presence of possible VUR were recorded. Finally, accuracy of Tc-99mDMSA scans in prediction of VUR were assessed. Results: Analyses showed a sensitivity and specificity of 95.65% and 14.72%, respectively for Tc-99mDMSA scan in detection of VUR. Patients with mild renal involvement in Tc-99mDMSA scans had a 3.5-fold greater risk of having VUR than those with a normal scans (odds ratio=3.5; 95% confidence interval [CI]: 1.4-8.58; p=0.007. In addition, the risk of VUR is up to 7.0-fold greater in children with moderate renal involvement (odds ratio=7.0; 95% CI: 2.6-13.2; p

  20. Introducing the concept of a new pre-referral treatment for severely ill febrile children at community level: a sociological approach in Guinea-Bissau. (United States)

    Vermeersch, Audrey; Libaud-Moal, Anaëlle; Rodrigues, Amabelia; White, Nicholas J; Olliaro, Piero; Gomes, Melba; Ashley, Elizabeth A; Millet, Pascal


    Innovative strategies are needed to tackle childhood mortality in the rural tropics. Artesunate suppositories were developed to bring emergency treatment closer to severely ill children with malaria in rural areas where injectable treatment is not possible for several hours. Adding an antibacterial rectal drug would extend this strategy to treat non-malarial febrile illness as well. The objective of these studies was to assess acceptability of such a new pre-referral strategy by healthcare providers and likely uptake by the population. Two qualitative studies were conducted between May and July 2009. Study 1 investigated the acceptability of introducing a combined antimalarial-antibacterial suppository by interviewing 27 representatives of the three administrative levels (central government, regional, local) of the health sector; Study 2 investigated treatment-seeking behaviour and acceptability of this intervention at community level by interviewing 74 mothers in 2 villages. Up to 92% of health representatives were in favour of introducing a new pre-referral strategy to tackle both malaria and non-malaria related severe illnesses in Guinea-Bissau, provided it was endorsed by international health authorities. The main obstacles to implementation were the very limited human and financial resources. In the two villages surveyed, 44% of the mothers associated severe illness with fever only, or fever plus one additional symptom. Mothers' judgement of severity and ensuing decisions were not specific for serious illness, indicating that initial training to recognize signs of severe disease and treatment availability for non-severe, fever-associated symptoms will be required to prevent overuse of a new intervention designed as a pre-referral treatment for severely ill children. Level C health centres were the first resort in both villages (50% and 87% of respondents respectively). This information is encouraging for the implementation of a pre-referral treatment.

  1. Clinical prediction model to aid emergency doctors managing febrile children at risk of serious bacterial infections: diagnostic study (United States)

    Nijman, Ruud G; Vergouwe, Yvonne; Thompson, Matthew; van Veen, Mirjam; van Meurs, Alfred H J; van der Lei, Johan; Steyerberg, Ewout W; Moll, Henriette A


    Objective To derive, cross validate, and externally validate a clinical prediction model that assesses the risks of different serious bacterial infections in children with fever at the emergency department. Design Prospective observational diagnostic study. Setting Three paediatric emergency care units: two in the Netherlands and one in the United Kingdom. Participants Children with fever, aged 1 month to 15 years, at three paediatric emergency care units: Rotterdam (n=1750) and the Hague (n=967), the Netherlands, and Coventry (n=487), United Kingdom. A prediction model was constructed using multivariable polytomous logistic regression analysis and included the predefined predictor variables age, duration of fever, tachycardia, temperature, tachypnoea, ill appearance, chest wall retractions, prolonged capillary refill time (>3 seconds), oxygen saturation rule out the presence of other SBIs. Discriminative ability (C statistic) to predict pneumonia was 0.81 (95% confidence interval 0.73 to 0.88); for other SBIs this was even better: 0.86 (0.79 to 0.92). Risk thresholds of 10% or more were useful to identify children with serious bacterial infections; risk thresholds less than 2.5% were useful to rule out the presence of serious bacterial infections. External validation showed good discrimination for the prediction of pneumonia (0.81, 0.69 to 0.93); discriminative ability for the prediction of other SBIs was lower (0.69, 0.53 to 0.86). Conclusion A validated prediction model, including clinical signs, symptoms, and C reactive protein level, was useful for estimating the likelihood of pneumonia and other SBIs in children with fever, such as septicaemia/meningitis and urinary tract infections. PMID:23550046

  2. Comparison of the Effects of Acetaminophen Plus Ibuprofen to Treat Fever Than any of the Two Alone in Febrile Children

    Directory of Open Access Journals (Sweden)

    Noor Mohammad Noori


    Full Text Available Background Fever is a natural response of the host to infection and a normal part of children's infectious disease. Objectives The purpose of the study was comparison of the combined treatment of acetaminophen and ibuprofen compact with each treatment alone. Methods This Double-blind clinical trial study was done on 540 children with 38°C to 41°C as body temperature. Eligible children after considering inclusion criteria divided in three groups randomly. First group of 183 patients administrated with acetaminophen, the second and the third groups of 178 and 179 patients with ibuprofen and combination. The first dose of antipyretic drug was administered to the patient under the supervision of a physician or nurse. After explanation of benefits and marginal effects to the parents if they accepted the conditions their children were admitted to the study. Parents were free if they wish to withdraw the study before completing. Information of each patient was recorded on a form. The data were analyzed by descriptive statistic, one-way ANOVA and SPSS software version 16. Results Out of sample 60.6% were boy. The mean age of children treated with acetaminophen, ibuprofen and combination therapy was 2.21 ± 2.49, 3.00 ± 2.92 and 2.22 ± 2.33 years in the order given. The results showed statistical difference in two (F = 4.45 and P = 0.012 and four hours (F = 3.11 and P = 0.045 after taking drug. A significant difference not observed in the value of temperature decrease within 2 - 4 hours after drug intake, (F = 2.49, P=0.084 but in the time of 0-2 (P = 0.012 and 4-6 hours (P = 0.001 was observed. Conclusions The findings of this study showed that acetaminophen is more effective for a short time but the combination in the long time when ibuprofen placed in the middle position with the respect of time.

  3. Systematic review and meta-analysis of the value of clinical features to exclude radiographic pneumonia in febrile neutropenic episodes in children and young people. (United States)

    Phillips, Bob; Wade, Ros; Westwood, Marie; Riley, Richard; Sutton, Alex J


    Children and young people who present with febrile neutropenia (FNP) secondary to malignancies or their treatment frequently do not undergo routine chest radiography. With shorter courses of antibiotic therapy, failure to recognise pneumonia and consequent under-treatment could produce significant problems.   The review was conducted determine the value of the absence of clinical features of lower respiratory tract infection in excluding radiographic pneumonia at presentation of FNP using Centre for Reviews and Dissemination methods. It was registered with the HTA Registry of systematic reviews, CRD32009100453. Ten bibliographic databases, conference proceedings, reference lists and citations were searched. Cohort studies which compared clinical examination to radiographic findings were included. Results were summarised by random-effects meta-analysis.   Four studies were included. Synthesis of the three higher-quality studies gave imprecise estimates of the average sensitivity (75%; 95% CI 52% to 89%) and average specificity (69%; 95% CI 57% to 78%) for clinical examination in the detection of radiographic pneumonia. If the prevalence of pneumonia is 5%, these estimates produce a negative predictive value of 98% (95% CI 96% to 99%). Alternatively, there remains a 1.9% probability of pneumonia (95% CI 0.7% to 4.2%).   Signs and symptoms of lower respiratory infection have only moderate sensitivity and specificity for pneumonia; the low prevalence of the condition justifies the routine withholding of chest radiographs. However, for those with a predisposition to pneumonia, or re-presenting after a short course of antibiotic therapy, a chest X-ray should be performed despite an absence of signs. © 2011 The Authors. Journal of Paediatrics and Child Health © 2011 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  4. Randomized, controlled trial of ibuprofen syrup administered during febrile illnesses to prevent febrile seizure recurrences

    NARCIS (Netherlands)

    M. van Stuijvenberg (Margriet); G. Derksen-Lubsen (Gerarda); E.W. Steyerberg (Ewout); J.D.F. Habbema (Dik); H.A. Moll (Henriëtte)


    textabstractOBJECTIVES: Febrile seizures recur frequently. Factors increasing the risk of febrile seizure recurrence include young age at onset, family history of febrile seizures, previous recurrent febrile seizures, time lapse since previous seizure <6 months,

  5. A Putative Role of Apolipoprotein L1 Polymorphism in Renal Parenchymal Scarring Following Febrile Urinary Tract Infection in Nigerian Under-Five Children: Proposal for a Case-Control Association Study. (United States)

    Anigilaje, Emmanuel Ademola


    Although urinary tract infection (UTI) resolves with prompt treatment in a majority of children, some children, especially those aged less than 5 years, also develop renal parenchymal scarring (RPS). RPS causes high blood pressure that may lead to severe chronic kidney disease and end-stage renal disease (ESRD). Although the risk of UTI is higher in white children than in black children, it is unknown whether RPS is more common in white children than in black children as data are scarce in this regard. A common genetic predisposition to kidney disease in African Americans and the sub-Saharan African blacks is the possession of apolipoprotein L1 (APOL1). APOL1 risk variants regulate the production of APOL1. APOL1 circulates in the blood, and it is also found in the kidney tissue. While circulating, APOL1 kills the trypanosome parasites; an increased APOL1 in kidney tissues, under the right environmental conditions, can also result in the death of kidney tissue (vascular endothelium, the podocytes, proximal tubules, and arterial cells), which, ultimately, is replaced by fibrous tissue. APOL1 may influence the development of RPS, as evidence affirms that its expression is increased in kidney tissue following UTI caused by bacteria. Thus, UTI may be a putative environmental risk factor responsible for APOL1-induced kidney injury. The aim of this proposal was to outline a study that seeks to determine if the possession of two copies of either G1 or G2 APOL1 variant increases the risk of having RPS, 6 months following a febrile UTI among Nigerian under-five children. This case-control association study seeks to determine whether the risk of RPS from febrile UTI is conditional on having 2 APOL1 risk alleles (either G1 or G2). Cases will be children with a confirmed RPS following a febrile UTI. Controls will be age-, gender-, and ethnic-matched children with a febrile UTI but without RPS. Children with vesicoureteral reflux and other congenital anomalies of the urinary

  6. Incidence of abnormal imaging and recurrent pyelonephritis after first febrile urinary tract infection in children 2 to 24 months old. (United States)

    Juliano, Trisha M; Stephany, Heidi A; Clayton, Douglass B; Thomas, John C; Pope, John C; Adams, Mark C; Brock, John W; Tanaka, Stacy T


    The AAP (American Academy of Pediatrics) no longer recommends voiding cystourethrogram in children 2 to 24 months old who present with a first urinary tract infection if renal-bladder ultrasound is normal. We identified factors associated with abnormal imaging and recurrent pyelonephritis in this population. We retrospectively evaluated children diagnosed with a first episode of pyelonephritis at age 2 to 24 months using de-identified electronic medical record data from an institutional database. Data included age at first urinary tract infection, gender, race/ethnicity, need for hospitalization, intravenous antibiotic use, history of abnormal prenatal ultrasound, renal-bladder ultrasound and voiding cystourethrogram results, urinary tract infection recurrence and surgical intervention. Risk factors for abnormal imaging and urinary tract infection recurrence were analyzed by univariate logistic regression, the chi-square test and survival analysis. We identified 174 patients. Of the 154 renal-bladder ultrasounds performed 59 (38%) were abnormal. Abnormal prenatal ultrasound (p = 0.01) and the need for hospitalization (p = 0.02) predicted abnormal renal-bladder ultrasound. Of the 95 patients with normal renal-bladder ultrasound 84 underwent voiding cystourethrogram. Vesicoureteral reflux was more likely in patients who were white (p = 0.003), female (p = 0.02) and older (p = 0.04). Despite normal renal-bladder ultrasound, 23 of 84 patients (24%) had dilating vesicoureteral reflux. Of the 95 patients with normal renal-bladder ultrasound 14 (15%) had recurrent pyelonephritis and 7 (7%) went on to surgical intervention. Despite normal renal-bladder ultrasound after a first pyelonephritis episode, a child may still have vesicoureteral reflux, recurrent pyelonephritis and the need for surgical intervention. If voiding cystourethrogram is deferred, parents should be counseled on these risks. Copyright © 2013 American Urological Association Education and Research, Inc

  7. S100B proteins in febrile seizures

    DEFF Research Database (Denmark)

    Mikkonen, Kirsi; Pekkala, Niina; Pokka, Tytti


    S100B protein concentrations correlate with the severity and outcome of brain damage after brain injuries, and have been shown to be markers of blood-brain barrier damage. In children elevated S100B values are seen as a marker of damage to astrocytes even after mild head injuries. S100B proteins...... may also give an indication of an ongoing pathological process in the brain with respect to febrile seizures (FS) and the likelihood of their recurrence. To evaluate this, we measured S100B protein concentrations in serum and cerebrospinal fluid from 103 children after their first FS. 33 children...

  8. The Long-term Risk of Epilepsy after Febrile Seizures in susceptible subgroups

    DEFF Research Database (Denmark)

    Vestergaard, Mogens; Pedersen, Carsten Bøcker; Sidenius, Per Christian


    A family history of seizures, preexisting brain damage, or birth complications may modify the long-term risk of epilepsy after febrile seizures. The authors evaluated the association between febrile seizures and epilepsy in a population-based cohort of 1.54 million persons born in Denmark (1978......-2002), including 49,857 persons with febrile seizures and 16,481 persons with epilepsy. Overall, for children with febrile seizures compared with those without such seizures, the rate ratio for epilepsy was 5.43 (95% confidence interval: 5.19, 5.69). The risk remained high during the entire follow.......3). In conclusion, persons with a history of febrile seizures had a higher rate of epilepsy that lasted into adult life, but less than 7 percent of children with febrile seizures developed epilepsy during 23 years of follow-up. The risk was higher for those who had a family history of epilepsy, cerebral palsy...

  9. Childhood Epilepsy, Febrile Seizures, and Subsequent Risk of ADHD. (United States)

    Bertelsen, Elin Næs; Larsen, Janne Tidselbak; Petersen, Liselotte; Christensen, Jakob; Dalsgaard, Søren


    Epilepsy, febrile seizures, and attention-deficit/hyperactivity disorder (ADHD) are disorders of the central nervous system and share common risk factors. Our goal was to examine the association in a nationwide cohort study with prospective follow-up and adjustment for selected confounders. We hypothesized that epilepsy and febrile seizures were associated with subsequent ADHD. A population-based cohort of all children born in Denmark from 1990 through 2007 was followed up until 2012. Incidence rate ratios (IRRs) and 95% confidence intervals (95% CIs) for ADHD were estimated by using Cox regression analysis, comparing children with epilepsy and febrile seizure with those without these disorders, adjusted for socioeconomic and perinatal risk factors, as well as family history of neurologic and psychiatric disorders. A total of 906 379 individuals were followed up for 22 years (∼10 million person-years of observation); 21 079 individuals developed ADHD. Children with epilepsy had a fully adjusted IRR of ADHD of 2.72 (95% CI, 2.53-2.91) compared with children without epilepsy. Similarly, in children with febrile seizure, the fully adjusted IRR of ADHD was 1.28 (95% CI, 1.20-1.35). In individuals with both epilepsy and febrile seizure, the fully adjusted IRR of ADHD was 3.22 (95% CI, 2.72-3.83). Our findings indicate a strong association between epilepsy in childhood and, to a lesser extent, febrile seizure and subsequent development of ADHD, even after adjusting for socioeconomic and perinatal risk factors, and family history of epilepsy, febrile seizures, or psychiatric disorders. Copyright © 2016 by the American Academy of Pediatrics.

  10. Folate deficiency in north Indian children undergoing maintenance chemotherapy for acute lymphoblastic leukemia-Implications and outcome. (United States)

    Roy Moulik, Nirmalya; Kumar, Archana; Agrawal, Suraksha; Mahdi, Abbas Ali


    Treatment-related toxicity and mortality are not uncommon during maintenance chemotherapy for childhood acute lymphoblastic leukemia (ALL), especially in the low- and middle-income countries (LMIC). Undernutrition and micronutrient deficiencies are commonly seen in children from LMICs undergoing treatment for ALL. The present study examines the prevalence and clinical implications of folate deficiency in north Indian children with ALL during the maintenance phase of treatment in view of prolonged antifolate treatment and high population prevalence of folate deficiency. Pre-cycle folate levels/deficiency as well as weight for age z-score and serum albumin level were determined and correlated with complications of treatment and mortality encountered during the maintenance phase of treatment. Twenty-nine of 52 children enrolled in the study had folate deficiency at some point during maintenance chemotherapy. Neutropenia (18 of 29 vs. 4 of 23; P = 0.002), thrombocytopenia (17 of 29 vs. 4 of 23; P = 0.005), febrile neutropenia (17 of 29 vs. 4 of 23; P = 0.005), and need for chemotherapy dose reduction (20 of 29 vs. 7 of 21; P = 0.01) were more common in folate-deficient children. Maintenance deaths were higher (8 of 29 vs. 1 of 23; P = 0.03) and survival lower (P = 0.02) in deficient children. In multivariate analysis, hypoalbuminemia (P = 0.02) and folate deficiency (P = 0.01) were associated with febrile neutropenia, and folate deficiency with maintenance deaths (P = 0.03). Folate deficiency was associated with treatment-related complications and adverse outcome in our patients. The risks and benefits of folate supplementation in deficient children during maintenance chemotherapy need to be explored with properly designed randomized studies in similar settings. © 2017 Wiley Periodicals, Inc.

  11. Febrile neutropenia in childhood cancer

    African Journals Online (AJOL)

    To classify and treat patients with febrile neutropenia adequately, one has to have a ... 48 hours.2,4,5. Approach. A child with possible febrile neutropenia should be viewed as a ... treating centre for information on the child's treatment if the family do not have a ... treatment, such as antimicrobial therapy, as well as the nature.

  12. Seroepidemiology of leptospirosis among febrile patients in a rapidly growing suburban slum and a flood-vulnerable rural district in Mozambique, 2012â2014: Implications for the management of fever


    Policarpo Ribeiro; Nilesh Bhatt; Sádia Ali; Vanessa Monteiro; Edmilson da Silva; Ilana Teruszkin Balassiano; Carolina Aquino; Nilsa de Deus; Onelia Guiliche; Argentina Felisbela Muianga; Pascoal Jorge Alho; Virginia Lara Evaristo; Ivan Manhiça; Marco Medeiros; Eduardo Samo Gudo


    Objective: Leptospirosis is one of the most widespread zoonoses in the world and is caused by spirochetes of the genus Leptospira. In Mozambique, the disease is largely ignored and its epidemiology is unknown. The objective of this study was to investigate the occurrence of leptospirosis in febrile patients. Methods: This cross-sectional study was performed between July 2012 and September 2015 among febrile patients. A total of 373 paired serum samples were drawn from febrile patients; 208 we...

  13. Seizure recurrence after a first febrile seizure: a multivariate approach

    NARCIS (Netherlands)

    Offringa, M.; Derksen-Lubsen, G.; Bossuyt, P. M.; Lubsen, J.


    The results are presented of a follow-up study of 155 Dutch children after the first febrile seizure. Of these initially untreated children 37 per cent had had at least one, 30 per cent at least two and 17 per cent at least three subsequent seizures. The vulnerable period for recurrent seizures

  14. Sincronia Cosmopolita Febril

    Directory of Open Access Journals (Sweden)

    Fabio Goulart


    Full Text Available No ano de 2011, pessoas de todo o mundo começaram a indignar através das redes sociais e blogs da internet contra as mais variadas injustiças do mundo. Uns queriam liberdade e democracia, outros criticavam os abusos dos bancos e alguns apenas queriam ter comida digna na mesa todos os dias. Em pouco tempo, o mundo virtual e o real se viram contaminados por uma sincronia cosmopolita febril que levou multidões às praças de todo o mundo e conseguiu, entre outras coisas, derrubar ditaduras opressoras e muito antigas. Com base em estudos, análise de mundo e vivências do autor, este trabalho visa clarificar à luz da filosofia os movimentos do tipo Occupy em suas mais variadas formas.

  15. Poverty and Brain Development in Children: Implications for Learning (United States)

    Dike, Victor E.


    Debates on the effect of poverty on brain development in children and its implications for learning have been raging for decades. Research suggests that poverty affects brain development in children and that the implications for learning are more compelling today given the attention the issue has attracted. For instance, studies in the fields of…

  16. Febrile Urinary Tract Infection after Radical Cystectomy and Ileal Neobladder in Patients with Bladder Cancer. (United States)

    Kim, Kwang Hyun; Yoon, Hyun Suk; Yoon, Hana; Chung, Woo Sik; Sim, Bong Suk; Lee, Dong Hyeon


    Urinary tract infection (UTI) is one of the most common complications after radical cystectomy and orthotopic neobladder reconstruction. This study investigated the incidence and implicated pathogen of febrile UTI after ileal neobladder reconstruction and identify clinical and urodynamic parameters associated with febrile UTI. From January 2001 to May 2015, 236 patients who underwent radical cystectomy and ileal neobladder were included in this study. Fifty-five episodes of febrile UTI were identified in 46 patients (19.4%). The probability of febrile UTI was 17.6% and 19.8% at 6 months and 24 months after surgery, respectively. While, Escherichia coli was the most common implicated pathogen (22/55, 40.0%), Enterococcus spp. were the most common pathogen during the first month after surgery (18/33, 54.5%). In multivariate logistic regression analysis, ureteral stricture was an independent risk factor associated with febrile UTI (OR 5.93, P = 0.023). However, ureteral stricture accounted for only 6 episodes (10.9%, 6/55) of febrile UTI. Most episodes of febrile UTI occurred within 6 months after surgery. Thus, to identify risk factors associated with febrile UTI in the initial postoperative period, we assessed videourodynamics within 6 months after surgery in 38 patients. On videourodyamic examination, vesicoureteral reflux (VUR) was identified in 16 patients (42.1%). The rate of VUR presence in patients who had febrile UTI was not significantly different from those in patients without febrile UTI (50% vs. 39.3%, P = 0.556). Patients with febrile UTI had significantly larger residual urine volume (212.0 ± 193.7 vs. 90.5 ± 148.2, P = 0.048) than those without. E. coli and Enterococcus spp. are common pathogens and ureteral stricture and residual urine are risk factors for UTI after ileal neobladder reconstruction.

  17. Characteristics of the initial seizure in familial febrile seizures

    NARCIS (Netherlands)

    M. van Stuijvenberg (Margriet); E. van Beijeren; N.H. Wils; G. Derksen-Lubsen (Gerarda); C.M. van Duijn (Cornelia); H.A. Moll (Henriëtte)


    textabstractComplex seizure characteristics in patients with a positive family history were studied to define familial phenotype subgroups of febrile seizures. A total of 51 children with one or more affected first degree relatives and 177 without an affected first degree

  18. Epilepsy following simple febrile seizure in a rural community in ...

    African Journals Online (AJOL)

    Objective: To study the outcome of subsequent epilepsy following a single uncomplicated febrile seizure in a cohort of children aged six months to six years followed up for a ten year period. Design: Observational prospective cohort study. Setting: Mahenge epilepsy clinic, Ulanga district, Morogoro region, Tanzania.

  19. Correlation of Serum Zinc Level with Simple Febrile Seizures: A Hospital based Prospective Case Control Study

    Directory of Open Access Journals (Sweden)

    Imran Gattoo


    Full Text Available Background: Febrile seizures are one of the most common neurological conditions of childhood. It seems that zinc deficiency is associated with increased risk of febrile seizures.Aim: To estimate the serum Zinc level in children with simple Febrile seizures and to find the correlation between serum zinc level and simple Febrile seizures.Materials and Methods: The proposed study was a hospital based prospective case control study which included infants and children aged between 6 months to 5 years, at Post Graduate Department of Pediatrics, (SMGS Hospital, GMC Jammu, northern India. A total of 200 infants and children fulfilling the inclusion criteria were included. Patients were divided into 100(cases in Group A with simple febrile seizure and 100(controls in Group B of children with acute febrile illness without seizure. All patients were subjected to detailed history and thorough clinical examination followed by relevant investigations.Results: Our study had slight male prepondance of 62% in cases and 58% in controls . Mean serum zinc level in cases was 61.53±15.87 ugm/dl and in controls it was 71.90+18.50 ugm/dl .Serum zinc level was found significantly low in cases of simple febrile seizures as compaired to controls ,with p value of

  20. Policy Implications of Advertising to Children. (United States)

    Griffin, Emilie

    Since its inception the Children's Advertising Review Unit has turned to research in order to better evaluate children's advertisements, to develop guidelines for children's advertisers and to resolve some perplexing questions about certain types of advertising content. Although some work has been done in advertising directed toward children, most…

  1. Safeguarding and Protecting Children in Maternity Services: Implications for Practice (United States)

    Lazenbatt, Anne; Greer, Jean


    This article debates the issues involved in safeguarding and protecting children in maternity services and offers implications for professional practice. Midwives and other staff who work as members of the maternity team have a safeguarding role to play in the identification of babies and children who have been abused, or are at risk of abuse, and…

  2. The oxidative and antioxidative status of simple febrile seizure patients

    International Nuclear Information System (INIS)

    Abuhandan, M.; Yetkin, I.; Calik, M.; Iscan, A.


    Objective: To evaluate the oxidative status following a seizure in children experiencing a simple febrile seizure. Methods: The cross-sectional study was conducted at Harran University, Turkey, between January and September 2011. It comprised 32 paediatric patients who, within the preceding 8 hours, had experienced a seizure due to upper respiratory tract infection and had been diagnosed with simple febrile seizure, and 30 healthy children as the control group. Blood was taken from the patients 8 hours after the seizure. Total oxidant level and Total anti-oxidant level were measured according to the Erel technique and the oxidative stress index was calculated. Data was analysed using SPSS 11.5. Results: The mean values of the total oxidant level and the oxidative stress index of the cases were found to be significantly high compared to the controls and the total anti-oxidant level was found to be significantly low (p<0.01, p<0.01, p<0.03 respectively). Conclusion: The increased total oxidant level and decreased total anti-oxidant level resulting in increased oxidative stress associated with febrile seizure patients may increase the risk of experiencing febrile seizures. (author)

  3. A novel electronic algorithm using host biomarker point-of-care tests for the management of febrile illnesses in Tanzanian children (e-POCT: A randomized, controlled non-inferiority trial.

    Directory of Open Access Journals (Sweden)

    Kristina Keitel


    Full Text Available The management of childhood infections remains inadequate in resource-limited countries, resulting in high mortality and irrational use of antimicrobials. Current disease management tools, such as the Integrated Management of Childhood Illness (IMCI algorithm, rely solely on clinical signs and have not made use of available point-of-care tests (POCTs that can help to identify children with severe infections and children in need of antibiotic treatment. e-POCT is a novel electronic algorithm based on current evidence; it guides clinicians through the entire consultation and recommends treatment based on a few clinical signs and POCT results, some performed in all patients (malaria rapid diagnostic test, hemoglobin, oximeter and others in selected subgroups only (C-reactive protein, procalcitonin, glucometer. The objective of this trial was to determine whether the clinical outcome of febrile children managed by the e-POCT tool was non-inferior to that of febrile children managed by a validated electronic algorithm derived from IMCI (ALMANACH, while reducing the proportion with antibiotic prescription.We performed a randomized (at patient level, blocks of 4, controlled non-inferiority study among children aged 2-59 months presenting with acute febrile illness to 9 outpatient clinics in Dar es Salaam, Tanzania. In parallel, routine care was documented in 2 health centers. The primary outcome was the proportion of clinical failures (development of severe symptoms, clinical pneumonia on/after day 3, or persistent symptoms at day 7 by day 7 of follow-up. Non-inferiority would be declared if the proportion of clinical failures with e-POCT was no worse than the proportion of clinical failures with ALMANACH, within statistical variability, by a margin of 3%. The secondary outcomes included the proportion with antibiotics prescribed on day 0, primary referrals, and severe adverse events by day 30 (secondary hospitalizations and deaths. We enrolled 3

  4. Febrile status epilepticus due to respiratory syncytial virus infection. (United States)

    Uda, Kazuhiro; Kitazawa, Katsuhiko


    Febrile status epilepticus can have neurological sequelae. The type of sequelae, however, depend on the etiology, including infection due to viral agents such as the influenza virus. Respiratory syncytial virus (RSV) infection in childhood may also contribute to this. The aim of this study was therefore to characterize febrile status epilepticus associated with RSV infection, and to determine whether this type of infection is a risk factor for neurological sequelae in febrile status epilepticus. We reviewed the medical records of children aged ≤3 years with febrile status epilepticus who were admitted to a tertiary hospital between January 2007 and December 2011. The differences between the RSV-positive and RSV-negative groups were evaluated according to the demographic and clinical data. A total of 99 patients with febrile status epilepticus who had been tested for RSV infection were identified. Three patients in the RSV-positive group (n = 19) and four in the RSV-negative group (n = 80) presented with bronchiolitis. The incidence of intubation and anti-seizure drug treatment in the RSV-positive group was significantly higher than in the -negative group. While all of the patients in the RSV-negative group recovered completely, six patients in the RSV-positive group developed encephalopathy and profound neurological sequelae. In five of the six patients, diffusion-weighted magnetic resonance imaging showed subcortical white matter lesions. RSV infection in the absence of bronchiolitis can initially present as febrile status epilepticus and subsequently develop into acute encephalopathy with profound neurological sequelae. © 2017 Japan Pediatric Society.

  5. Children of Divorce: Implications for Counselors. (United States)

    Hammond, Janice M.


    School counselors may be the most appropriate people to provide assistance for children whose parents are divorced and to the school staff. Study suggests that school counselors become aware of recent research of the impact of divorce on children. (Author/CMG)

  6. Febrile neutropenia in haematological malignancies

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    Sharma A


    Full Text Available Fever is the principle sign of infection in neutropenic patient and frequently may be the only evidence of infection. The pattern of fever in neutropenia is non-specific and not pathognomonic of any type of infections or non-infectious process and can be suppressed by the antipyretic effects of drugs such as corticosteroids. Neutropenia, resulting from cytotoxic chemotherapy is the most common risk factor for severe infections in hematological malignancies. The duration of neutropenia also contributes significantly to the risk of serious infections. This risk is significantly greater a lower neutrophil counts, such that 100% patients with ANC < 100 cells/µl lasting 3 weeks or more develop documented infections. The prompt initiation of empirical antibiotics in febrile neutropenia has been the most important advance in the management of the immunocompromised host. The initial empirical antibiotic regimen started at presentation of the febrile episode frequently requires modifications especially in high-risk febrile neutropenia. Neutropenic patients who remain febrile despite 4-7 days of broad spectrum antibacterial therapy are at a high risk of invasive fungal infection. Empirical antifungal therapy with Amphotericin B in persistently febrile neutropenic patients and other high risk patients has shown to reduce the risk of invasive fungal infection by 50-80% and the risk of fungal infection related mortality by 23-45% in 1980′s. The IDSA has recommended that amphotericin B at 0.5-0.7 mg/kg/day be administered till marrow recovery. This approach is limited however by the adverse effects caused by drug infusion (fever, chills, myalgias, nausea, hypotension and bronchospasm. Lipid formulations which improve the therapeutic ratio of the traditional formulation are available. The safety and efficacy of these formulations is well established. These formulations have comparable efficacy and are less nephrotoxic than conventional amphotericin B

  7. Alternative Families and Children: Implications for Education. (United States)

    Alexander, Jannette; Eiduson, Bernice T.


    Since 1973, the UCLA Family Styles Project has studied a sample of nontraditional Caucasian families (single mothers, social contract families, communal families) plus a comparison group of conventional nuclear families. Findings are reported on parents' personal/social values and changes in childrearing practices. Implications for education are…

  8. Towards Improving Point-of-Care Diagnosis of Non-malaria Febrile Illness: A Metabolomics Approach.

    Directory of Open Access Journals (Sweden)

    Saskia Decuypere


    Full Text Available Non-malaria febrile illnesses such as bacterial bloodstream infections (BSI are a leading cause of disease and mortality in the tropics. However, there are no reliable, simple diagnostic tests for identifying BSI or other severe non-malaria febrile illnesses. We hypothesized that different infectious agents responsible for severe febrile illness would impact on the host metabolome in different ways, and investigated the potential of plasma metabolites for diagnosis of non-malaria febrile illness.We conducted a comprehensive mass-spectrometry based metabolomics analysis of the plasma of 61 children with severe febrile illness from a malaria-endemic rural African setting. Metabolite features characteristic for non-malaria febrile illness, BSI, severe anemia and poor clinical outcome were identified by receiver operating curve analysis.The plasma metabolome profile of malaria and non-malaria patients revealed fundamental differences in host response, including a differential activation of the hypothalamic-pituitary-adrenal axis. A simple corticosteroid signature was a good classifier of severe malaria and non-malaria febrile patients (AUC 0.82, 95% CI: 0.70-0.93. Patients with BSI were characterized by upregulated plasma bile metabolites; a signature of two bile metabolites was estimated to have a sensitivity of 98.1% (95% CI: 80.2-100 and a specificity of 82.9% (95% CI: 54.7-99.9 to detect BSI in children younger than 5 years. This BSI signature demonstrates that host metabolites can have a superior diagnostic sensitivity compared to pathogen-detecting tests to identify infections characterized by low pathogen load such as BSI.This study demonstrates the potential use of plasma metabolites to identify causality in children with severe febrile illness in malaria-endemic settings.

  9. Interleukin-5, interleukin-6, interleukin-8 and tumour necrosis factor-alpha levels obtained within 24-h of admission do not predict high-risk infection in children with febrile neutropenia

    Directory of Open Access Journals (Sweden)

    R Aggarwal


    Full Text Available Purpose: Biomarkers that can predict the severity of febrile neutropenia (FN are potential tools for clinical practice. Objective: The objective of this study is to evaluate the reliability of plasma interleukin (IL levels as indicators of high-risk FN. Materials and Methods: Children with haematological malignancies and FN were enrolled prospectively. A blood sample was obtained within 24-h of admission for estimation of IL-5, IL-6, IL-8 and tumour necrosis factor-alpha (TNF-α level by the enzyme-linked immunosorbent assay. Patients were stratified into three groups. Group I (low-risk: No focus of infection; Group II: Clinical/radiological focus of infection; Group III: Microbiologically proven infection or FN related mortality. Groups II and III were analysed as high-risk. The cytokines were assessed at three different cut-off levels. Results: A total of 52 episodes of FN in 48 patients were evaluated. The mean age was 6 years (range: 2-13. Primary diagnosis included acute lymphoblastic leukaemia (82%, non-Hodgkin′s lymphoma (13% and acute myeloid leukaemia (5%. Absolute neutrophil count was < 200 cells/μl in half and 200-500 in 23%. Majority were categorised as Group I (69%, followed by Group II (16% and III (15%. The range of IL-5 was too narrow and similar in the two risk-groups to be of any relevance. The best sensitivity of TNF-α and IL-6 for high-risk group was 78% and 70%, respectively. The highest specificity observed was 35%. The negative predictive value of IL-6, IL-8 and TNF-α exceeded 80%. Conclusion: IL-5, IL-6, IL-8 and TNF-α failed as predictors of clinically localised or microbiologically documented infection in children with chemotherapy induced FN. However, IL-6, IL-8 and TNF-α could be useful in excluding the possibility of high-risk infection.

  10. Abandoning presumptive antimalarial treatment for febrile children aged less than five years--a case of running before we can walk?

    Directory of Open Access Journals (Sweden)

    Mike English


    Full Text Available Current guidelines recommend that all fever episodes in African children be treated presumptively with antimalarial drugs. But declining malarial transmission in parts of sub-Saharan Africa, declining proportions of fevers due to malaria, and the availability of rapid diagnostic tests mean it may be time for this policy to change. This debate examines whether enough evidence exists to support abandoning presumptive treatment and whether African health systems have the capacity to support a shift toward laboratory-confirmed rather than presumptive diagnosis and treatment of malaria in children under five.

  11. Prenatal exposure to cigarettes, alcohol, and coffee and the risk for febrile seizures

    DEFF Research Database (Denmark)

    Vestergaard, M; Wisborg, K; Henriksen, TB


    of extensive brain growth and differentiation in this period. We evaluated the association between prenatal exposure to cigarettes, alcohol, and coffee and the risk for febrile seizures in 2 population-based birth cohorts. METHODS: The Aarhus Birth Cohort consisted of 25,196 children of mothers who were...... Birth Cohort, but the corresponding association was weak in the Aalborg-Odense cohort. We found no association between maternal alcohol and coffee consumption and the risk for febrile seizures. The results were similar for simple and complex febrile seizures. CONCLUSIONS: Our data suggest that prenatal...... exposure to low to moderate levels of alcohol and coffee has no impact on the risk for febrile seizures, whereas a modest smoking effect cannot be ruled out....

  12. A cross-sectional survey of parental care-seeking behavior for febrile illness among under-five children in Nigeria

    Directory of Open Access Journals (Sweden)

    Mohammed Baba Abdulkadir


    Conclusion: There is poor care-seeking for fever in under-five children by parents in Nigeria. Improved literacy, women empowerment and health education are strategies that may improve care-seeking behavior. Highlighted regional differences are additional considerations for such interventions.

  13. Febrile urinary tract infections: pyelonephritis and urosepsis

    NARCIS (Netherlands)

    Schneeberger, Caroline; Holleman, Frits; Geerlings, Suzanne E.


    Complicated infections of the urinary tract (UTI) including pyelonephritis and urosepsis are also called febrile UTI. This review describes insights from the literature on this topic since July 2014. Recent studies regarding risk factors and consequences of febrile UTI confirmed existing knowledge.

  14. When your child with epilepsy die suddenly: febrile seizures are part of the process?

    Directory of Open Access Journals (Sweden)

    V C Terra


    Full Text Available Febrile seizures (FS affect almost 2-5% of children and factors related to an increase susceptibility of children to FS may involve an imbalance of inflammatory cytokines and genetic factors. FS had low morbidity, but may be associated with the occurrence of late chronic epilepsy. Here we describe factors related to FS and its possible correlation with SUDEP.

  15. Aplicación de un modelo pronóstico para predecir la evolución de la neutropenia febril en niños con leucemias agudas A new model applied in prediction of febrile neutropenia in children with acute leukemias

    Directory of Open Access Journals (Sweden)

    Alberto Arencibia Núñez


    Full Text Available Se realizó estudio analítico retrospectivo de casos controles en 62 episodios de neutropenia febril presentados por pacientes con hemopatías malignas admitidos en el Instituto de Hematología e Inmunología durante los años 2005 y 2006. Los episodios de neutropenia febril se dividieron en 2 grupos a partir de su evolución favorable (56 % o desfavorable (44 % y se compilaron los parámetros clínicos y de laboratorio en ambos grupos. Los factores que mayor asociación mostraron con la evolución desfavorable fueron la presencia de comorbilidad (sepsis, deshidratación, hipoxia, hipovolemia, mucositis severa, el diagnóstico de leucemia aguda no linfoblástica, el uso de quimioterapia en los 7 días previos al inicio de la fiebre, el compromiso del estado general, y el conteo absoluto de neutrófilos menor de 100 x mm³. Los pacientes con neutropenia febril de evolución desfavorable presentaron entre 3 y 5 factores de riesgo, mientras que los de evolución satisfactoria tuvieron menos de 2 factores de mal pronóstico. El valor predictivo positivo del modelo pronóstico fue del 91,4 % y el negativo del 92,6 %, con una sensibilidad y especificidad del 94,1 % y 89,3 %, respectivamente.A retrospective and analytical control cases study was carried out in 62 episodes of febrile neutropenia present in patients with malignant blood disease admitted in Hematology and Immunology Institute during 2005 and 2006. Above episodes were divided in 2 groups from its favorable course (56% or unfavorable (44% as well as the laboratory and clinical parameters compiled in both groups. Factors with higher association related to unfavorable course were the comorbidities presence (sepsis, dehydration, hypoxia, hypovolemia and severe mucositis, diagnosis of non-lymphoblastic, use of chemotherapy during the 7 previous days to fever onset, general status involvement, and the neutrophil absolute count lower than 100 x mm³. Patients presenting with a unfavorable course

  16. A micro-epidemiological analysis of febrile malaria in Coastal Kenya showing hotspots within hotspots. (United States)

    Bejon, Philip; Williams, Thomas N; Nyundo, Christopher; Hay, Simon I; Benz, David; Gething, Peter W; Otiende, Mark; Peshu, Judy; Bashraheil, Mahfudh; Greenhouse, Bryan; Bousema, Teun; Bauni, Evasius; Marsh, Kevin; Smith, David L; Borrmann, Steffen


    Malaria transmission is spatially heterogeneous. This reduces the efficacy of control strategies, but focusing control strategies on clusters or 'hotspots' of transmission may be highly effective. Among 1500 homesteads in coastal Kenya we calculated (a) the fraction of febrile children with positive malaria smears per homestead, and (b) the mean age of children with malaria per homestead. These two measures were inversely correlated, indicating that children in homesteads at higher transmission acquire immunity more rapidly. This inverse correlation increased gradually with increasing spatial scale of analysis, and hotspots of febrile malaria were identified at every scale. We found hotspots within hotspots, down to the level of an individual homestead. Febrile malaria hotspots were temporally unstable, but 4 km radius hotspots could be targeted for 1 month following 1 month periods of surveillance.DOI: Copyright © 2014, Bejon et al.

  17. Technical report: urinary tract infections in febrile infants and young children. The Urinary Tract Subcommittee of the American Academy of Pediatrics Committee on Quality Improvement. (United States)

    Downs, S M


    The Urinary Tract Subcommittee of the American Academy of Pediatrics Committee on Quality Improvement has analyzed alternative strategies for the diagnosis and management of urinary tract infection (UTI) in children. The target population is limited to children between 2 months and 2 years of age who are examined because of fever without an obvious cause. Diagnosis and management of UTI in this group are especially challenging for these three reasons: 1) the manifestation of UTI tends to be nonspecific, and cases may be missed easily; 2) clean voided midstream urine specimens rarely can be obtained, leaving only urine collection methods that are invasive (transurethral catheterization or bladder tap) or result in nonspecific test results (bag urine); and 3) a substantial number of infants with UTI also may have structural or functional abnormalities of the urinary tract that put them at risk for ongoing renal damage, hypertension, and end-stage renal disease (ESRD). To examine alternative management strategies for UTI in infants, a conceptual model of the steps in diagnosis and management of UTI was developed. The model was expanded into a decision tree. Probabilities for branch points in the decision tree were obtained by review of the literature on childhood UTI. Data were extracted on standardized forms. Cost data were obtained by literature review and from hospital billing data. The data were collated into evidence tables. Analysis of the decision tree was used to produce risk tables and incremental cost-effectiveness ratios for alternative strategies. Based on the results of this analysis and, when necessary, consensus opinion, the Committee developed recommendations for the management of UTI in this population. This document provides the evidence the Subcommittee used in the development of its recommendations. The Subcommittee agreed that the objective of the practice parameter would be to minimize the risk of chronic renal damage within reasonable economic

  18. Soluble β-(1,3)-glucans enhance LPS-induced response in the monocyte activation test, but inhibit LPS-mediated febrile response in rabbits: Implications for pyrogenicity tests. (United States)

    Pardo-Ruiz, Zenia; Menéndez-Sardiñas, Dalia E; Pacios-Michelena, Anabel; Gabilondo-Ramírez, Tatiana; Montero-Alejo, Vivian; Perdomo-Morales, Rolando


    In the present study, we aimed to determine the influence of β-(1,3)-d-glucans on the LPS-induced pro-inflammatory cytokine response in the Monocyte Activation Test (MAT) for pyrogens, and on the LPS-induced febrile response in the Rabbit Pyrogen Test (RPT), thus evaluating the resulting effect in the outcome of each test. It was found that β-(1,3)-d-glucans elicited the production of pro-inflammatory cytokines IL-1β, IL-6 and TNF-α, also known as endogenous pyrogens, but not enough to classify them as pyrogenic according to MAT. The same β-(1,3)-d-glucans samples were non-pyrogenic by RPT. However, β-(1,3)-d-glucans significantly enhanced the LPS-induced pro-inflammatory cytokines response in MAT, insomuch that samples containing non-pyrogenic concentrations of LPS become pyrogenic. On the other hand, β-(1,3)-d-glucans had no effect on sub-pyrogenic LPS doses in the RPT, but surprisingly, inhibited the LPS-induced febrile response of pyrogenic LPS concentrations. Thus, while β-(1,3)-d-glucans could mask the LPS pyrogenic activity in the RPT, they exerted an overstimulation of pro-inflammatory cytokines in the MAT. Hence, MAT provides higher safety since it evidences an unwanted biological response, which is not completely controlled and is overlooked by the RPT. Copyright © 2015 Elsevier B.V. All rights reserved.

  19. Febrile seizures prior to sudden cardiac death

    DEFF Research Database (Denmark)

    Stampe, Niels Kjær; Glinge, Charlotte; Jabbari, Reza


    Aims: Febrile seizure (FS) is a common disorder affecting 2-5% of children up to 5 years of age. The aim of this study was to determine whether FS in early childhood are over-represented in young adults dying from sudden cardiac death (SCD). Methods and results: We included all deaths (n = 4595...... with FS was sudden arrhythmic death syndrome (5/8; 62.5%). Conclusion: In conclusion, this study demonstrates a significantly two-fold increase in the frequency of FS prior to death in young SCD cases compared with the two control groups, suggesting that FS could potentially contribute in a risk......) nationwide and through review of all death certificates, we identified 245 SCD in Danes aged 1-30 years in 2000-09. Through the usage of nationwide registries, we identified all persons admitted with first FS among SCD cases (14/245; 5.7%) and in the corresponding living Danish population (71 027/2 369 785...

  20. Temperature, age, and recurrence of febrile seizure

    NARCIS (Netherlands)

    M. van Stuijvenberg (Margriet); E.W. Steyerberg (Ewout); G. Derksen-Lubsen (Gerarda); H.A. Moll (Henriëtte)


    textabstractOBJECTIVE: Prediction of a recurrent febrile seizure during subsequent episodes of fever. DESIGN: Study of the data of the temperatures, seizure recurrences, and baseline patient characteristics that were collected at a randomized placebo controlled trial of ibuprofen

  1. Family ties after divorce: long-term implications for children. (United States)

    Ahrons, Constance R


    Drawing on the data from the longitudinal Binuclear Family Study, 173 grown children were interviewed 20 years after their parents' divorce. This article addresses two basic questions: (1) What impact does the relationship between parents have on their children 20 years after the divorce? and (2) When a parent remarries or cohabits, how does it impact a child's sense of family? The findings show that the parental subsystem continues to impact the binuclear family 20 years after marital disruption by exerting a strong influence on the quality of relationships within the family system. Children who reported that their parents were cooperative also reported better relationships with their parents, grandparents, stepparents, and siblings. Over the course of 20 years, most of the children experienced the remarriage of one or both parents, and one third of this sample remembered the remarriage as more stressful than the divorce. Of those who experienced the remarriage of both of their parents, two thirds reported that their father's remarriage was more stressful than their mother's. When children's relationships with their fathers deteriorated after divorce, their relationships with their paternal grandparents, stepmother, and stepsiblings were distant, negative, or nonexistent. Whether family relationships remain stable, improve, or get worse is dependent on a complex interweaving of many factors. Considering the long-term implications of divorce, the need to emphasize life course and family system perspectives is underscored.

  2. Pediatric febrile urinary tract infections: the current state of play

    Directory of Open Access Journals (Sweden)

    Hewitt Ian K


    Full Text Available Abstract Studies undertaken in recent years have improved our understanding regarding the consequences and management of febrile urinary tract infections (UTIs, which are amongst the most common serious bacterial infections in childhood, with renal scarring a frequent outcome. In the past pyelonephritic scarring of the kidney, often associated with vesico-ureteral reflux (reflux nephropathy was considered a frequent cause of chronic renal insufficiency in children. Increasing recognition as a consequence of improved antenatal ultrasound, that the majority of these children had congenital renal hypo-dysplasia, has resulted in a number of studies examining treatment strategies and outcomes following UTI. In recent years there is a developing consensus regarding the need for a less aggressive therapeutic approach with oral as opposed to intravenous antibiotics, and less invasive investigations, cystourethrography in particular, following an uncomplicated first febrile UTI. There does remain a concern that with this newer approach we may be missing a small subgroup of children more prone to develop severe kidney damage as a consequence of pyelonephritis, and in whom some form of intervention may prove beneficial. These concerns have meant that development of a universally accepted diagnostic protocol remains elusive.

  3. Drug and Alcohol Exposed Children: Implications for Special Education for Students Identified as Behaviorally Disordered. (United States)

    Bauer, Anne M.


    This article reviews the literature on children prenatally exposed to drugs and alcohol, the potential impact on the educational and social services systems, and implications for programing for children identified as behaviorally disordered. (Author/JDD)

  4. A micro-epidemiological analysis of febrile malaria in Coastal Kenya showing hotspots within hotspots

    NARCIS (Netherlands)

    Bejon, P.; Williams, T.N.; Nyundo, C.; Hay, S.I.; Benz, D.; Gething, P.W.; Otiende, M.; Peshu, J.; Bashraheil, M.; Greenhouse, B.; Bousema, T.; Bauni, E.; Marsh, K.; Smith, D.L.; Borrmann, S.


    Malaria transmission is spatially heterogeneous. This reduces the efficacy of control strategies, but focusing control strategies on clusters or 'hotspots' of transmission may be highly effective. Among 1500 homesteads in coastal Kenya we calculated (a) the fraction of febrile children with positive

  5. Intermittent diazepam and continuous phenobarbital to treat recurrence of febrile seizures: a systematic review with meta-analysis

    Directory of Open Access Journals (Sweden)

    Masuko Alice Hatsue


    Full Text Available Convulsions triggered by fever are the most common type of seizures in childhood, and 20% to 30% of them have recurrence. The prophylactic treatment is still controversial, so we performed a systematic review to find out the effectiveness of continuous phenobarbital and intermittent diazepam compared to placebo for febrile seizure recurrence. METHOD: Only randomized, double-blind, placebo-controlled trials were analyzed. The recurrence of febrile seizure was assessed for each drug. RESULTS: Ten eligible clinical trials were included. Febrile seizure recurrence was smaller in children treated with diazepam or phenobarbital than in placebo group. Prophylaxis with either phenobarbital or diazepam reduces recurrences of febrile seizures. The studies were clinical, methodological, and statistically heterogeneous. CONCLUSION: The effectiveness of phenobarbital and diazepam could not be demonstrated because clinical trials were heterogeneous, and the recommendation for treatment recurrence should rely upon the experience of the assistant physician yet.

  6. Association between Iron Deficiency Anemia and Febrile Seizure: a Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Mohammad Mehdi Nasehi


    Full Text Available Febrile seizure is the most common convulsive disorder in children and different studies reported controversial results about the association between this disorder and iron deficiency. In some studies, iron level in children with febrile seizure is higher than control and in some reports it is less than the control group. So, we systematically reviewed all the studies in this field and analyzed their findings using meta-analysis methods. This review and meta-analysis was conducted by iron and fever keywords on articles published in the databases PubMed, Google Scholar and Federated search of medical digital library that includes a variety of international databases. All articles dated at the end of March 2012 were studied. Case-control studies were selected and quality assessment of studies were surveyed by STROB criteria and information requirements, including the status of iron deficiency anemia, iron levels and ferritin level of eligible studies were extracted and analyzed by Comprehensive Meta-Analysis Version 2.0 software and the Forest and Funnel chart was drawn. Finally 11 studies included 1357 children with febrile seizure and 1347 children in the control group were evaluated. The odds ratio of iron deficiency anemia in children with febrile seizure in comparison to the control group was 1.27 (OR = 1.27, CI95%: 1.03 -1.56. Ferritin level was not significant between the two groups (p=0.08, but the iron level in the two groups was significant (p=0.000. Iron deficiency is considered as a risk factor in the incidence of febrile seizure and interventional studies can be helpful to confirm this hypothesis.

  7. DMSA study performed during febrile urinary tract infection: a predictor of patient outcome?

    International Nuclear Information System (INIS)

    Camacho, V.; Estorch, M.; Tembl, A.; Mena, E.; Flotats, A.; Hernandez, Ma.; Fraga, G.; Carrio, I.


    DMSA study is an established method for the assessment of renal sequelae after acute pyelonephritis related to febrile urinary tract infection (UTI). However, at the moment is not established if the DMSA study performed during the acute UTI has any prognostic value for outcome assessment. Objectives: to assess the usefulness of DMSA study performed during febrile UTI as predictor of patient outcome. Methods: One hundred-fifty-two children (74 boys) with mean age 20 months (range 1m-12 y) with first febrile UTI were studied by DMSA planar scintigraphy during the acute illness period (first 5 days). All patients had positive grown bacillus in urine (78% E. coli, 8% P. mirabilis), and all followed the same antibiotic treatment. After acute UTI all patients were explored by voiding cysto urethrography for diagnosis of vesicoureteral reflux (VUR). Fifty-seven patients who had an abnormal DMSA study, VUR, or recurrent UTI underwent a DMSA control study (mean 8m after UTI). Results: DMSA study during febrile UTI was normal in 112 children (74%). In 95 of these children, follow-up DMSA studies were not performed due to a good clinical outcome (no VUR, no recurrent UTI). In the remaining 17 patients, follow-up DMSA studies were normal as well. Forty children (26%), who presented focal or diffuse cortical lesions during acute UTI, underwent a DMSA control study. Twenty-six of them presented a normal control DMSA, and 14 (9% of all patients) presented cortical lesions, 10 associated with a high-grade VUR. Fifty-seven children were followed by control DMSA, and no significant correlation between initial and follow-up study was found (κ= 0.250, p<0.007). Conclusion: These results indicate that DMSA study performed during febrile UTI may not be useful as predictor of patient outcome. Voiding cysto urethrography and control DMSA study seem to be more useful to select patients at risk of development of chronic cortical lesions

  8. The semiology of febrile seizures: Focal features are frequent. (United States)

    Takasu, Michihiko; Kubota, Tetsuo; Tsuji, Takeshi; Kurahashi, Hirokazu; Numoto, Shingo; Watanabe, Kazuyoshi; Okumura, Akihisa


    To clarify the semiology of febrile seizures (FS) and to determine the frequency of FS with symptoms suggestive of focal onset. FS symptoms in children were reported within 24h of seizure onset by the parents using a structured questionnaire consisting principally of closed-ended questions. We focused on events at seizure commencement, including changes in behavior and facial expression, and ocular and oral symptoms. We also investigated the autonomic and motor symptoms developing during seizures. The presence or absence of focal and limbic features was determined for each patient. The associations of certain focal and limbic features with patient characteristics were assessed. Information was obtained on FS in 106 children. Various events were recorded at seizure commencement. Behavioral changes were observed in 35 children, changes in facial expression in 53, ocular symptoms in 78, and oral symptoms in 90. In terms of events during seizures, autonomic symptoms were recognized in 78, and convulsive motor symptoms were recognized in 68 children. Focal features were evident in 81 children; 38 children had two or more such features. Limbic features were observed in 44 children, 9 of whom had two or more such features. There was no significant relationship between any patient characteristic and the numbers of focal or limbic features. The semiology of FS varied widely among children, and symptoms suggestive of focal onset were frequent. FS of focal onset may be more common than is generally thought. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. History of febrile illness and variation in semen quality

    DEFF Research Database (Denmark)

    Carlsen, Elisabeth; Andersson, Anna-Maria; Petersen, Jørgen Holm


    The purpose of this study was to analyse the effect of a history of febrile illness on semen quality.......The purpose of this study was to analyse the effect of a history of febrile illness on semen quality....

  10. Acute febrile encephalopathy in adults from Northwest India

    Directory of Open Access Journals (Sweden)

    Bhalla Ashish


    Full Text Available Background : Acute onset fever with altered mentation is a common problem encountered by the physician practicing in tropical countries. Central nervous system (CNS infections are the most common cause resulting in fever with altered mentation in children. Aim : In this study, we have tried to analyze the cause of encephalopathy following short febrile illness in adults presenting to a tertiary care center in Northwestern part of India. Setting and Design : A prospective observational study carried out in a tertiary care center in the Northwestern India over a period of 1 year. Material and Methods : A total of 127 patients with fever of less than 2 weeks duration along with alteration in mentation were studied prospectively over a period of 12 months. The demographic variables were recorded in detail. In addition to routine investigations, cerebrospinal fluid analysis, noncontrast- and contrast-enhanced computed tomography, along with magnetic resonance imaging were performed in all the subjects. Statistical Analysis : The results were analyzed using SPSS statistical software. The values were expressed as mean with standard deviation for contiguous variable as percentage for the others. Results and Conclusion : Out of these, 70% had primary CNS infection as the etiology. A total of 33% patients had meningitis, 29.9% had evidence of meningoencephalitis, and 12.7% were diagnosed as sepsis-associated encephalopathy. These were followed by cerebral malaria, leptospirosis, and brain abscess as the cause of febrile encephalopathy in adults. Among the noninfectious causes, acute disseminated encephalomyelitis, cortical venous thrombosis, and neuroleptic malignant syndrome were documented in 2.36% each. In 11% of the patients, the final diagnosis could not be made in spite of the extensive investigations. Our study demonstrates that acute febrile encephalopathy in adults is a heterogeneous syndrome with primary CNS infections being the commonest

  11. Distal Ureteral Diameter Ratio is Predictive of Breakthrough Febrile Urinary Tract Infection. (United States)

    Arlen, Angela M; Leong, Traci; Guidos, P Joseph; Alexander, Siobhan E; Cooper, Christopher S


    Distal ureteral diameter ratio is an objective measure that is prognostic of spontaneous resolution of vesicoureteral reflux. Along with likelihood of resolution, improved identification of children at risk for recurrent febrile urinary tract infections may impact management decisions. We evaluated the usefulness of ureteral diameter ratio as a predictive factor for breakthrough febrile urinary tract infections. Children with primary vesicoureteral reflux and detailed voiding cystourethrogram were identified. Ureteral diameter ratio was computed by measuring largest ureteral diameter within the pelvis and dividing by the distance between L1 and L3 vertebral bodies. Demographics, vesicoureteral reflux grade, laterality, presence/absence of bladder-bowel dysfunction, and ureteral diameter ratio were tested in univariate and multivariable analyses. Primary outcome was breakthrough febrile urinary tract infections. We analyzed 112 girls and 28 boys with a mean ± SD age of 2.5 ± 2.3 years at diagnosis. Vesicoureteral reflux was grade 1 to 2 in 64 patients (45.7%), grade 3 in 50 (35.7%), grade 4 in 16 (11.4%) and grade 5 in 10 (7.2%). Mean ± SD followup was 3.2 ± 2.7 years. A total of 40 children (28.6%) experienced breakthrough febrile urinary tract infections. Ureteral diameter ratio was significantly greater in children with (0.36) vs without (0.25) breakthrough febrile infections (p = 0.004). Controlling for vesicoureteral reflux grade, every 0.1 U increase in ureteral diameter ratio resulted in 1.7 times increased odds of breakthrough infection (95% CI 1.24 to 2.26, p urinary tract infections independent of reflux grade. Ureteral diameter ratio provides valuable prognostic information about risk of recurrent pyelonephritis and may assist with clinical decision-making. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  12. Diagnosing Febrile Illness in a Returned Traveler

    Centers for Disease Control (CDC) Podcasts


    This podcast will assist health care providers in diagnosing febrile illness in patients returning from a tropical or developing country.  Created: 3/1/2012 by National Center for Enteric, Zoonotic, and Infectious Diseases (NCEZID).   Date Released: 3/1/2012.

  13. Management of Febrile Neutropenia in Patients receiving ...

    African Journals Online (AJOL)

    BACKGROUND: One in ten patients on anticancer medication will develop febrile neutropenia irrespective of tumour type. There is need to protect our patients from this fatal condition while optimising chemotherapy. This may be difficult for a poor country. OBJECTIVE: To assess the management of cancer patients with

  14. Triagem para o tratamento ambulatorial da neutropenia febril Screening for the outpatient treatment of febrile neutropenia

    Directory of Open Access Journals (Sweden)

    Marcelo Bellesso


    Full Text Available A neutropenia febril (NF é uma complicação frequente e potencialmente fatal nos pacientes em tratamento quimioterápico. Entendemos hoje que a neutropenia febril é considerada uma emergência clínica e que a administração de antibióticos de amplo espectro diminui drasticamente a mortalidade. Estudos sugerem que a neutropenia febril compreende um grupo extremamente heterogêneo e que dados clínicos como febre domiciliar, ausência de hipotensão, ausência de desidratação, ausência de doença pulmonar obstrutiva crônica, ausência de outros sintomas, ausência de infecção fúngica prévia e idade Febrile neutropenia is a frequent and potentially fatal adverse event of chemotherapy. Nowadays, febrile neutropenia is considered an emergency and it is known that prompt infusion of antibiotics decreases mortality. Several studies demonstrated that febrile neutropenia is a heterogeneous group of diseases and that factors such as outpatient status, no hypotension, no dehydration, no chronic obstructive pulmonary disease, no symptoms, no previous fungal infection and age < 60 years are protective factors against serious complications as demonstrated by the Multinational Association for Supportive Care in Cancer (MASCC. These data show that outpatient treatment and early discharge is safer and much research has shown lower costs for outpatient treatment in low-risk patients with febrile neutropenia. The aim of this work is to review and discuss tools (in particular the MASCC index for safe screening of febrile neutropenia for outpatient treatment in addition to demonstrate results of research.

  15. Expression Profiling after Prolonged Experimental Febrile Seizures in Mice Suggests Structural Remodeling in the Hippocampus.

    Directory of Open Access Journals (Sweden)

    Bart C Jongbloets

    Full Text Available Febrile seizures are the most prevalent type of seizures among children up to 5 years of age (2-4% of Western-European children. Complex febrile seizures are associated with an increased risk to develop temporal lobe epilepsy. To investigate short- and long-term effects of experimental febrile seizures (eFS, we induced eFS in highly febrile convulsion-susceptible C57BL/6J mice at post-natal day 10 by exposure to hyperthermia (HT and compared them to normotherm-exposed (NT mice. We detected structural re-organization in the hippocampus 14 days after eFS. To identify molecular candidates, which entrain this structural re-organization, we investigated temporal changes in mRNA expression profiles eFS 1 hour to 56 days after eFS. We identified 931 regulated genes and profiled several candidates using in situ hybridization and histology at 3 and 14 days after eFS. This is the first study to report genome-wide transcriptome analysis after eFS in mice. We identify temporal regulation of multiple processes, such as stress-, immune- and inflammatory responses, glia activation, glutamate-glutamine cycle and myelination. Identification of the short- and long-term changes after eFS is important to elucidate the mechanisms contributing to epileptogenesis.

  16. Comparison of tympanic and rectal temperature in febrile patients. (United States)

    Sehgal, Arvind; Dubey, N K; Jyothi, M C; Jain, Shilpa


    To compare tympanic membrane temperature and rectal temperature in febrile pediatric patients. Sixty febrile children were enrolled as continuous enrollment at initial triage. Two readings of ear temperature were taken in each child with Thermoscan infrared thermometer. Rectal temperature was recorded by a digital electronic thermometer. Comparison of both the techniques was done and co-relation co-efficients calculated. Parental preference for both techniques was assessed. It was observed that mean ear temperature was 38.9+/-0.90 C and that for rectal temperature was 38.8+/-0.80 degrees C. The correlation coefficient between the two was 0.994 (p rays emitted from the surface of tympanic membrane. Ear temperatures correlates well with rectal temperatures which have long been considered as "core" temperatures. Parents prefer the technique of ear thermometry which is quick (2 sec), safe and non-invasive and patient resistance for this is also less. A non-invasive, non-mucous device which is accurate over a wide range of temperature could be very useful.

  17. Febrile seizures: a population-based study

    Directory of Open Access Journals (Sweden)

    Juliane S. Dalbem


    Full Text Available Objectives: To determine the prevalence of benign febrile seizures of childhood and describe the clinical and epidemiological profile of this population. Methods: This was a population-based, cross-sectional study, carried out in the city of Barra do Bugres, MT, Brazil, from August 2012 to August 2013. Data were collected in two phases. In the first phase, a questionnaire that was previously validated in another Brazilian study was used to identify suspected cases of seizures. In the second phase, a neurological evaluation was performed to confirm diagnosis. Results: The prevalence was 6.4/1000 inhabitants (95% CI: 3.8–10.1. There was no difference between genders. Simple febrile seizures were found in 88.8% of cases. A family history of febrile seizures in first-degree relatives and history of epilepsy was present in 33.3% and 11.1% of patients, respectively. Conclusions: The prevalence of febrile seizures in Midwestern Brazil was lower than that found in other Brazilian regions, probably due to the inclusion only of febrile seizures with motor manifestations and differences in socioeconomic factors among the evaluated areas. Resumo: Objetivos: Estabelecer a prevalência das crises febris e descrever o perfil clínico e epidemiológico dessa população. Métodos: Estudo transversal de base populacional realizado na cidade de Barra do Bugres (MT, no período de agosto de 2012 a agosto de 2013. Os dados foram coletados em duas etapas. Na primeira fase utilizamos um questionário validado previamente em outro estudo brasileiro, para identificação de casos suspeitos de crises epilépticas. Na segunda etapa realizamos a avaliação neuroclínica para confirmação diagnóstica. Resultados: A prevalência de crise febril foi de 6,4/1000 habitantes (IC95% 3,8; 10,1. Não houve diferença entre os sexos. As crises febris simples foram encontradas em 88,8% dos casos. A história familiar de crise febril e epilepsia em parentes de 1° grau esteve

  18. Food additives and their health implications on children in Africa: a ...

    African Journals Online (AJOL)

    Food additives and their health implications on children in Africa: a systematic review. ... Research Journal of Health Sciences ... at which many food industries turn out novel 'chemicals' aimed at increasing the acceptability of their products.

  19. Risk of febrile seizures and epilepsy after vaccination with diphtheria, tetanus, acellular pertussis, inactivated poliovirus, and Haemophilus influenzae type B. (United States)

    Sun, Yuelian; Christensen, Jakob; Hviid, Anders; Li, Jiong; Vedsted, Peter; Olsen, Jørn; Vestergaard, Mogens


    Vaccination with whole-cell pertussis vaccine carries an increased risk of febrile seizures, but whether this risk applies to the acellular pertussis vaccine is not known. In Denmark, acellular pertussis vaccine has been included in the combined diphtheria-tetanus toxoids-acellular pertussis-inactivated poliovirus-Haemophilus influenzae type b (DTaP-IPV-Hib) vaccine since September 2002. To estimate the risk of febrile seizures and epilepsy after DTaP-IPV-Hib vaccination given at 3, 5, and 12 months. A population-based cohort study of 378,834 children who were born in Denmark between January 1, 2003, and December 31, 2008, and followed up through December 31, 2009; and a self-controlled case series (SCCS) study based on children with febrile seizures during follow-up of the cohort. Hazard ratio (HR) of febrile seizures within 0 to 7 days (0, 1-3, and 4-7 days) after each vaccination and HR of epilepsy after first vaccination in the cohort study. Relative incidence of febrile seizures within 0 to 7 days (0, 1-3, and 4-7 days) after each vaccination in the SCCS study. A total of 7811 children were diagnosed with febrile seizures before 18 months, of whom 17 were diagnosed within 0 to 7 days after the first (incidence rate, 0.8 per 100,000 person-days), 32 children after the second (1.3 per 100,000 person-days), and 201 children after the third (8.5 per 100,000 person-days) vaccinations. Overall, children did not have higher risks of febrile seizures during the 0 to 7 days after the 3 vaccinations vs a reference cohort of children who were not within 0 to 7 days of vaccination. However, a higher risk of febrile seizures was found on the day of the first (HR, 6.02; 95% CI, 2.86-12.65) and on the day of the second (HR, 3.94; 95% CI, 2.18-7.10), but not on the day of the third vaccination (HR, 1.07; 95% CI, 0.73-1.57) vs the reference cohort. On the day of vaccination, 9 children were diagnosed with febrile seizures after the first (5.5 per 100,000 person-days), 12

  20. The neurobiology of the human febrile response. (United States)

    Biddle, Chuck


    Fever is a normal adaptation in response to a pyrogenic stimulus resulting in the generation of cytokines and prostaglandins. Fever differs from hyperpyrexia and hyperthermia associated with hot environs and pharmacological triggers. Typically, pyrogens are infectious organisms or their direct products (toxins). The body produces a wide array of pyrogenic cytokines such as interleukins (IL-1, IL-6), interferon, and tumor necrosis factor. Tissue trauma can trigger the febrile response, as can infectious organisms, certain medications, and blood products. The circumventricular organ system (CVOS) is neuronal tissues lying outside the blood-brain barrier that has a key role in initiating the communication sequence responsible for the synthesis of febrile prostaglandins. When pyrogenic cytokines are detected by the CVOS, prostaglandin synthesis, especially cyclooxygenase-dependent prostaglandin E2, is induced, activating the febrile response. Once the appropriate signal is received by the hypothalamus, autonomic, endocrine, and behavioral processes are activated until the hypothalamic set-point is reset downward as a consequence of a reduction in pyrogen content or antipyretic therapy, with subsequent heat loss. There is little evidence that fever facilitates recovery from disease or assists the immune system in mounting a response. Antipyretics are used commonly to decrease the distressing manifestations associated with fever.

  1. Bipolar Disorder in Children: Implications for Speech-Language Pathologists (United States)

    Quattlebaum, Patricia D.; Grier, Betsy C.; Klubnik, Cynthia


    In the United States, bipolar disorder is an increasingly common diagnosis in children, and these children can present with severe behavior problems and emotionality. Many studies have documented the frequent coexistence of behavior disorders and speech-language disorders. Like other children with behavior disorders, children with bipolar disorder…

  2. Intermittent diazepam prophylaxis in febrile convulsions. Pros and cons. (United States)

    Knudsen, F U


    Major cohort studies document that the long-term prognosis for most children with febrile convulsions (FC) is excellent. The 2 main treatment alternatives so far have been long-term prophylaxis with phenobarbital or valproate or no prophylaxis at all. Phenobarbital at times of fever is ineffective and obsolete. Consensus has emerged that long-term prophylaxis with antiepileptic drugs is rarely justified in FC considering the side effects and the favourable prognosis. No treatment at all does not appear quite satisfactory either, as FC have a high recurrence rate, disrupt family life and may have emotional consequences for the family. Moreover, all FC children face a risk, although admittedly low, of subsequent long-lasting potentially central nervous system (CNS)-damaging seizures. However, 2 further options exist: treatment with rapid-acting benzodiazepines solely at times of greatest risk, i.e., at high fever or at renewed seizures. Several clinical trials have confirmed that intermittent diazepam prophylaxis by way of a few doses of the drug per year provides effective seizure control and reduces the recurrence rate by one half or two thirds. The treatment is feasible and cheap, well tolerated by the child and well accepted by the parents. Compliance problems are common and only partly abatable. Trivial side effects are frequent. Transient respiratory apnoea does occur, but 15 years' experience substantiates that serious side effects are remarkably rare. Acute anticonvulsant treatment with rectal diazepam in solution given by the parents to stop ongoing seizures and to prevent immediate recurrences is an attractive alternative. It is feasible, is probably effective and minimizes the use of drugs, but compliance problems are common and protracted seizures are not always controlled. The subsequent management should include a risk profile approach considering a combination of risk factors for new FC rather than a single factor. By means of a risk index, based on

  3. Tratamiento al niño febril en atención primaria de salud Treatment of the febrile child in primary health care

    Directory of Open Access Journals (Sweden)

    Rogelio León López


    considerations were made on the importance of training not only the health personnel providing attention to the children, but also the relatives and care givers of the febrile child. Recommendations and suggestions based on the reviewed bibliography and on our experience in clinical practice were also exposed.

  4. Implications of Parental Suicide and Violent Death for Promotion of Resilience of Parentally-Bereaved Children (United States)

    Brown, Ana C.; Sandler, Irwin N.; Tein, Jenn-Yun; Liu, Xianchen; Haine, Rachel A.


    This article considers the implications of suicide and violent deaths (including suicide, homicide, and accidents) for the development of interventions for parentally bereaved children. Analyses of data from the Family Bereavement Program find minimal differences in children's mental health problems, grief or risk and protective factors based on…

  5. Shifting the Focus: Children's Image-Making Practices and Their Implications for Analysis (United States)

    Lomax, Helen Jayne


    This paper provides analytic focus on the productive and editorial contexts of children and young people's image-making, making visible its implications for the analysis of photographs. Drawing on participatory research in which children and young people worked alongside researchers to create a visual narrative of their lived experiences of…

  6. Therapeutic burst-suppression coma in pediatric febrile refractory status epilepticus. (United States)

    Lin, Jainn-Jim; Chou, Cheng-Che; Lan, Shih-Yun; Hsiao, Hsiang-Ju; Wang, Yu; Chan, Oi-Wa; Hsia, Shao-Hsuan; Wang, Huei-Shyong; Lin, Kuang-Lin


    Evidence for the beneficial effect of therapeutic burst-suppression coma in pediatric patients with febrile refractory status epilepticus is limited, and the clinical outcomes of this treatment strategy are largely unknown. Therefore, the aim of this study was to explore the outcomes of therapeutic burst-suppression coma in a series of children with febrile refractory status epilepticus. We retrospectively reviewed consecutive pediatric patients with febrile refractory status epilepticus admitted to our pediatric intensive care unit between January 2000 and December 2013. The clinical characteristics were analyzed. Thirty-five patients (23 boys; age range: 1-18years) were enrolled, of whom 28 (80%) developed super-refractory status epilepticus. All of the patients received the continuous administration of intravenous antiepileptic drugs for febrile refractory status epilepticus, and 26 (74.3%) achieved therapeutic burst-suppression coma. All of the patients received mechanical ventilatory support, and 26 (74.3%) received inotropic agents. Eight (22.9%) patients died within 1month. The neurologically functional outcomes at 6months were good in six (27.3%) of the 22 survivors, of whom two returned to clinical baseline. The patients with therapeutic burst-suppression coma were significantly associated with hemodynamic support than the patients with electrographic seizures control (p=0.03), and had a trend of higher 1-month mortality rate, worse 6months outcomes, and a longer duration of hospitalization. Our results suggest that therapeutic burst-suppression coma to treat febrile refractory status epilepticus may lead to an increased risk of hemodynamic instability and a trend of worse outcomes. Copyright © 2017 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

  7. When Children Face Divorce: Issues and Implications of Research. (United States)

    Freeman, Evelyn B.


    Identifies how divorce affect's children's classroom performance and offers suggestions and resource list for teachers. Particulary discussed are four most common characteristics of children experiencing divorce and teacher's role in promoting an empathetic teacher-student relationship. (DST)

  8. Video and computer games: effect on children and implications for health education. (United States)

    Dorman, S M


    Video and computer-based games have assumed a prominent role in the culture of American children and adolescents. Given the pervasiveness of their influence, it is likely that these games may affect the health and well-being of children. This paper examines the health effects of these games on children, suggests criteria upon which parents and teachers may evaluate the games, and notes some implications for health educators.

  9. Children's Religious Knowledge: Implications for Understanding Satanic Ritual Abuse Allegations. (United States)

    Goodman, Gail S.; Quas, Jodi A.; Bottoms, Bette L.; Qin, Jianjian; Shaver, Phillip R.


    Using a structured interview, 48 3- to 16-year-old children were questioned about their knowledge of religious and satanic concepts. Although few children evinced direct knowledge of ritual abuse, many revealed general knowledge of satanism and satanic worship. Results suggest that most children probably do not generally possess sufficient…

  10. Qualitative Research Interviews of Children with Communication Disorders: Methodological Implications (United States)

    Bedoin, D.; Scelles, R.


    This study focuses on the qualitative research interview, an essential tool frequently used in the human and social sciences, conducted with children having communication disorders. Two distinct populations are addressed--children with intellectual disability and deaf children without related disabilities--with the aim of identifying the main…

  11. Chest radiography for predicting the cause of febrile illness among inpatients in Moshi, Tanzania

    International Nuclear Information System (INIS)

    Fiorillo, S.P.; Diefenthal, H.C.; Goodman, P.C.; Ramadhani, H.O.; Njau, B.N.; Morrissey, A.B.; Maro, V.P.; Saganda, W.; Kinabo, G.D.; Mwako, M.S.; Bartlett, J.A.


    Aim: To describe chest radiographic abnormalities and assess their usefulness for predicting causes of fever in a resource-limited setting. Materials and methods: Febrile patients were enrolled in Moshi, Tanzania, and chest radiographs were evaluated by radiologists in Tanzania and the United States. Radiologists were blinded to the results of extensive laboratory evaluations to determine the cause of fever. Results: Of 870 febrile patients, 515 (59.2%) had a chest radiograph available; including 268 (66.5%) of the adolescents and adults, the remainder were infants and children. One hundred and nineteen (44.4%) adults and 51 (20.6%) children were human immunodeficiency virus (HIV)-infected. Among adults, radiographic abnormalities were present in 139 (51.9%), including 77 (28.7%) with homogeneous and heterogeneous lung opacities, 26 (9.7%) with lung nodules, 25 (9.3%) with pleural effusion, 23 (8.6%) with cardiomegaly, and 13 (4.9%) with lymphadenopathy. Among children, radiographic abnormalities were present in 87 (35.2%), including 76 (30.8%) with homogeneous and heterogeneous lung opacities and six (2.4%) with lymphadenopathy. Among adolescents and adults, the presence of opacities was predictive of Streptococcus pneumoniae and Coxiella burnetii, whereas the presence of pulmonary nodules was predictive of Histoplasma capsulatum and Cryptococcus neoformans. Conclusions: Chest radiograph abnormalities among febrile inpatients are common in northern Tanzania. Chest radiography is a useful adjunct for establishing an aetiologic diagnosis of febrile illness and may provide useful information for patient management, in particular for pneumococcal disease, Q fever, and fungal infections

  12. TLR-4 polymorphisms and leukocyte TLR-4 expression in febrile UTI and renal scarring. (United States)

    Bayram, Meral Torun; Soylu, Alper; Ateş, Halil; Kızıldağ, Sefa; Kavukçu, Salih


    In this study, we aimed to determine the relation of TLR-4 Asp299Gly and Thr399Ile polymorphisms and monocyte/neutrophil TLR-4 expression to febrile urinary tract infection (UTI) and renal scar development in children. The study was performed in children with a history of febrile UTI. Patients with and without renal scarring were classified as group 1 and group 2, respectively, while the control cases in our previous study were used as the control group (group 3). All three groups were compared for the rate of TLR-4 Asp299Gly and Thr399Ile polymorphisms, and for basal and lipopolysaccharide-stimulated monocyte/neutrophil TLR-4 expression levels. There were 168 patients (86 in group 1, 82 in group 2) and 120 control cases. Monocyte/neutrophil TLR-4 expression levels were similar in groups 1 and 2. However, both groups had lower TLR-4 expression than group 3. The rate of TLR-4 Asp299Gly polymorphism was not different in all groups. TLR-4 Thr399Ile polymorphism was higher in groups 1 and 2 than in group 3 (14.0, 12.2, and 2.0 %, respectively), while group 1 and group 2 were not different. Furthermore, monocyte TLR-4 expression level was lower in those having TLR-4 Thr399Ile polymorphism than in those without this polymorphism. Patients with febrile UTI had more frequent TLR-4 Thr399Ile polymorphism and lower monocyte/neutrophil TLR-4 expression. These findings indicate that children carrying TLR-4 Thr399Ile polymorphism and/or having low level of monocyte/neutrophil TLR-4 expression have a tendency to develop febrile UTI. However, we could not show the association of TLR-4 polymorphisms and of TLR-4 expression level to renal scarring.

  13. Maternal use of antibiotics and the risk of childhood febrile seizures: a Danish population-based cohort.

    Directory of Open Access Journals (Sweden)

    Jessica E Miller

    Full Text Available OBJECTIVE: In a large population-based cohort in Denmark to examine if maternal use of antibiotics during pregnancy, as a marker of infection, increases the risk of febrile seizures in childhood in a large population-based cohort in Denmark. METHODS: All live-born singletons born in Denmark between January 1, 1996 and September 25, 2004 and who were alive on the 90(th day of life were identified from the Danish National Birth Registry. Diagnoses of febrile seizures were obtained from the Danish National Hospital Register and maternal use of antibiotics was obtained from the National Register of Medicinal Product Statistics. Hazard ratios (HR and 95% confidence intervals (95% CI were estimated by Cox proportional hazard regression models. RESULTS: We followed 551,518 singletons for up to 5 years and identified a total of 21,779 children with a diagnosis of febrile seizures. Slightly increased hazard ratios were observed among most exposure groups when compared to the unexposed group, ex. HR 1.08 95% CI: 1.05-1.11 for use of any systemic antibiotic during pregnancy. CONCLUSION: We found weak associations between the use of pharmacologically different antibiotics during pregnancy and febrile seizures in early childhood which may indicate that some infections, or causes or effects of infections, during pregnancy could affect the fetal brain and induce susceptibility to febrile seizures.

  14. Impact of Middle East respiratory syndrome outbreak on the use of emergency medical resources in febrile patients. (United States)

    Jeong, Hyunho; Jeong, Sikyoung; Oh, Juseok; Woo, Seon Hee; So, Byung Hak; Wee, Jeong Hee; Kim, Ji Hoon; Im, Ji Yong; Choi, Seung Pill; Park, Kyoungnam; Cho, Byul Nim Hee; Hong, Sungyoup


    Outbreaks of transmissible respiratory infection are suspected to have significant effects on the health of pediatric and geriatric patients. The objective was to assess the impact of the Middle East respiratory syndrome (MERS) outbreak on the use of emergency resources. An ecologic analysis of emergency department (ED) records between September and December 2015, was performed. Data was obtained from the National Emergency Department Information System database for Korea. All demographic and diagnostic data from patients presenting with febrile symptoms as a main complaint were collected. The data were compared to the equivalent period in the three years preceding the MERS outbreak in Korea. Following the MERS outbreak, there was an increase in overall ED visits by febrile patients and the proportion of visits by febrile patients, relative to total ED attendances. This effect was more prominent in the children under five years. The duration of the chief complaint before ED arrival and the length of ED stay were significantly increased among younger pediatric patients. Decreased body temperature on arrival was observed in younger pediatric patients. MERS outbreak appears to have had a significant effects on ED use by febrile patients. The use of emergency care services by pediatric patients makes them more vulnerable to an outbreak of a transmissable disease. An effective strategy to control emergency center visits by non-urgent febrile patients and provide proper medical services is urgently needed.

  15. Febrile Infection-Related Epilepsy Syndrome (FIRES): An Overview of Treatment and Recent Patents. (United States)

    Hon, Kam Lun E Lun; Leung, Alexander K C; Torres, Alcy R


    New-onset refractory status epilepticus (NORSE) refers to a clinical presentation in a patient without active epilepsy or other existing relevant neurological disorder, with new onset of refractory status epilepticus in the absence of a clear acute or active structural, metabolic, or toxic cause. Febrile infection-related epilepsy syndrome (FIRES) is a subset of NORSE that requires a febrile infection between 24 hours and 2 weeks prior to the onset of refractory status epilepticus, with or without fever at the onset of status epilepticus, and with no restriction to the age of the patient. The literature on FIRES is scarce. This article reviews the pathophysiology, clinical features, and various treatment modalities in the treatment of FIRES. A Medline/Pubmed search was conducted using Clinical Queries with the key terms "febrile infection-related epilepsy syndrome", "FIRES", "new-onset refractory status epilepticus" and "NORSE". The search strategy included meta-analyses, randomized controlled trials, clinical trials, reviews and pertinent references. Patents were searched using the key term "FIRES", "NORSE" and "febrile epilepsy syndrome" from,, and FIRES almost invariably begins with a mild nonspecific febrile illness in an otherwise healthy individual. Twenty four hours to two weeks later, seizures begin and quickly become very frequent and worsen, becoming status epilepticus. Seizures can be simple motor, complex partial or secondary generalized. The exact etiology is no known. It is possible that the syndrome is caused by an inflammatory or autoimmune mechanism. Seizures in FIRES are notoriously very difficult to treat. Treatment modalities include, among others, various antiepileptic drugs, ketogenic diet, intravenous corticosteroids, intravenous immunoglobulin, and burst-suppression coma. Outcome is poor; most children are left with significant cognitive disability and refractory epilepsy

  16. Growth and Puberty in Obese Children and Implications of Body Composition

    Directory of Open Access Journals (Sweden)

    Sochung Chung


    Full Text Available Childhood obesity is a major public health concern throughout the world. Nutrition, energy balance and hormones interplay in growth and pubertal development regulation. Frequently overweight and obese children are taller for their age and sex and tend to mature earlier than lean children. The increased leptin and sex hormone levels seen in obese children with excessive adiposity may be implicated in accelerated pubertal growth and accelerated epiphyseal growth plate maturation. Efforts to detect the impact of obesity in children are needed to prevent metabolic and cardiovascular disease in later life. This review aims to cover the process of growth in obese children and implications of body composition on growth and pubertal development and introduce the use of body composition charts in clinical practice.

  17. Early discontinuation of antibiotic prophylaxis in patients with persistent primary vesicoureteral reflux initially detected during infancy: outcome analysis and risk factors for febrile urinary tract infection. (United States)

    Moriya, Kimihiko; Mitsui, Takahiko; Kitta, Takeya; Nakamura, Michiko; Kanno, Yukiko; Kon, Masafumi; Nishimura, Yoko; Shinohara, Nobuo; Nonomura, Katsuya


    We retrospectively assessed the incidence of and risk factors for febrile urinary tract infection in children during active surveillance after early discontinuation of antibiotic prophylaxis. We retrospectively evaluated 9 females and 61 uncircumcised males diagnosed with primary vesicoureteral reflux before age 1 year who had persistent reflux on followup voiding cystourethrogram and were subsequently followed under active surveillance without continuous antibiotic prophylaxis. Patients with secondary vesicoureteral reflux or associated urological abnormality were excluded. Clinical outcomes, including incidence of febrile urinary tract infection and new scar formation, were evaluated. Risk factors for febrile urinary tract infection were also analyzed. Mean age at stopping continuous antibiotic prophylaxis was 21 months, and mean followup was 61 months. During active surveillance 21 patients had febrile urinary tract infection, and the 5-year infection-free rate under active surveillance was 67.5%. One or 2 foci of minimal new scarring developed in 4 of 16 patients who underwent followup dimercapto-succinic acid scan after febrile urinary tract infection. On multivariate analysis dilated vesicoureteral reflux on followup voiding cystourethrogram was the only significant risk factor for febrile urinary tract infection. This study revealed that about two-thirds of patients with persistent vesicoureteral reflux were free of febrile urinary tract infection during 5 years of active surveillance. Those with dilated vesicoureteral reflux on followup voiding cystourethrogram are at significantly greater risk for febrile urinary tract infection. Accordingly active surveillance, especially in patients with nondilated vesicoureteral reflux on followup voiding cystourethrogram, seems to be a safe option even in children who have not yet been toilet trained. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights

  18. Home Management of Febrile Convulsion in Under-fives: an ...

    African Journals Online (AJOL)

    Home Management of Febrile Convulsion in Under-fives: an Assessment of Perceptions and Practices of Caregivers in Ojokoro Local Council Development Area, Lagos. ... Of the 46 respondents that reported previous history of febrile convulsion, 39(84.8%)carried out inappropriate pre-facility management practices.

  19. Postural Control in Children: Implications for Pediatric Practice (United States)

    Westcott, Sarah L.; Burtner, Patricia


    Based on a systems theory of motor control, reactive postural control (RPA) and anticipatory postural control (APA) in children are reviewed from several perspectives in order to develop an evidence-based intervention strategy for improving postural control in children with limitations in motor function. Research on development of postural…

  20. Children's Conflict-Related Emotions: Implications for Morality and Autonomy. (United States)

    Arsenio, William; Cooperman, Sharon


    Investigates the influence of children's affective dispositions and knowledge of emotions on their ability to use nonaggressive conflict resolution strategies, exploring connections between autonomy and socioemotional development. Finds that individual differences in affective dispositions and emotional knowledge influence children's abilities to…

  1. Children Who Are Homeless: Implications for Educational Diagnosticians. (United States)

    Yamaguchi, Barbara J.; Strawser, Sherri; Higgins, Kyle


    Families with children are the fastest growing group of persons who are homeless. To address their needs for education, this article discusses legal mandates, barriers to education presented by school requirements, effects of homelessness on children and youth, and the role of the educational diagnostician in providing services. Offers 14…

  2. Children of Incarcerated Parents: Implications for School Counselors (United States)

    Petsch, Priscilla; Rochlen, Aaron B.


    The recent increase in prison populations has given rise to an unprecedented number of children in the school system with incarcerated parents. To cope with stressors before, during, or after parents' incarceration, children can exhibit a range of problematic and maladaptive behaviors. This article explores the negative behaviors these children…

  3. Exploratory Study of Children's Task Groups: Instructional Implications. (United States)

    Keyton, Joann; Dodson, Nancy L.

    Despite the increasing popularity of cooperative learning techniques in elementary instruction, many educators believe that children do not possess effective group interaction skills and advocate that children be taught the group communication skills necessary for group interaction as a separate instructional component. Unfortunately,…

  4. Children's Lies and Their Detection: Implications for Child Witness Testimony (United States)

    Talwar, Victoria; Crossman, Angela M.


    The veracity of child witness testimony is central to the justice system where there are serious consequences for the child, the accused, and society. Thus, it is important to examine how children's lie-telling abilities develop and the factors that can influence their truthfulness. The current review examines children's lie-telling ability in…

  5. Colony-stimulating factors for chemotherapy-induced febrile neutropenia. (United States)

    Mhaskar, Rahul; Clark, Otavio Augusto Camara; Lyman, Gary; Engel Ayer Botrel, Tobias; Morganti Paladini, Luciano; Djulbegovic, Benjamin


    Febrile neutropenia is a frequent adverse event experienced by people with cancer who are undergoing chemotherapy, and is a potentially life-threatening situation. The current treatment is supportive care plus antibiotics. Colony-stimulating factors (CSFs), such as granulocyte-CSF (G-CSF) and granulocyte-macrophage CSF (GM-CSF), are cytokines that stimulate and accelerate the production of one or more cell lines in the bone marrow. Clinical trials have addressed the question of whether the addition of a CSF to antibiotics could improve outcomes in individuals diagnosed with febrile neutropenia. However, the results of these trials are conflicting. To evaluate the safety and efficacy of adding G-CSF or GM-CSF to standard treatment (antibiotics) when treating chemotherapy-induced febrile neutropenia in individuals diagnosed with cancer. We conducted the search in March 2014 and covered the major electronic databases: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, LILACS, and SCI. We contacted experts in hematology and oncology and also scanned the citations from the relevant articles. We searched for randomized controlled trials (RCTs) that compared CSF plus antibiotics versus antibiotics alone for the treatment of chemotherapy-induced febrile neutropenia in adults and children. We used the standard methodological procedures expected by The Cochrane Collaboration. We performed meta-analysis of the selected studies using Review Manager 5 software. Fourteen RCTs (15 comparisons) including a total of 1553 participants addressing the role of CSF plus antibiotics in febrile neutropenia were included. Overall mortality was not improved by the use of CSF plus antibiotics versus antibiotics alone (hazard ratio (HR) 0.74 (95% confidence interval (CI) 0.47 to 1.16) P = 0.19; 13 RCTs; 1335 participants; low quality evidence). A similar finding was seen for infection-related mortality (HR 0.75 (95% CI 0.47 to 1.20) P = 0.23; 10 RCTs; 897

  6. Microbiology and mortality of pediatric febrile neutropenia in El Salvador. (United States)

    Gupta, Sumit; Bonilla, Miguel; Gamero, Mario; Fuentes, Soad L; Caniza, Miguela; Sung, Lillian


    Febrile neutropenia (FN) and infection-related mortality are major problems for children with cancer in low-income countries. Identifying predictors for adverse outcome of FN in low-income countries permits targeted interventions. We describe the nature and predictors of microbiologically documented infection (MDI) and mortality of FN in children with cancer in El Salvador. We examined Salvadoran pediatric oncology patients admitted with FN over a 1-year period. Data were collected prospectively. Demographic, treatment, and admission-related variables were examined as predictors of outcomes. Hundred six FN episodes among 85 patients were included. Twenty-three of 106 episodes (22%) were microbiologically documented; 13 of 106 episodes (12%) resulted in death. Gram-positive and gram-negative organisms were isolated in 14 of 23 and 11 of 23 specimens; polymicrobial infections were common (11 of 23 episodes of MDI). Older age decreased the MDI risk [odds ratio (OR) per year=0.87, 95% confidence interval (CI), 0.75-0.99; P=0.04] while increasing number of days since the last chemotherapy increased the risk (OR=1.03 per day, 95% CI, 1.01-1.04; P=0.002). Pneumonia diagnosed either clinically (OR=6.6, 95% CI, 1.8-30.0; P=0.005) or radiographically (OR=5.5, 95% CI, 1.7-18.1; P=0.005) was the only predictor of mortality. In El Salvador, polymicrobial infections were common. Pneumonia at admission identified children with FN at high risk of death; these children may benefit from targeted interventions.

  7. Bladder volume at onset of vesicoureteral reflux is an independent risk factor for breakthrough febrile urinary tract infection. (United States)

    Alexander, Siobhan E; Arlen, Angela M; Storm, Douglas W; Kieran, Kathleen; Cooper, Christopher S


    Improved identification of children with vesicoureteral reflux at risk for recurrent febrile urinary tract infection may impact management decisions. We hypothesized that reflux occurring earlier during bladder filling increases the duration of exposure of the kidneys to bacteria, and, therefore, increases the risk of pyelonephritis. Children with vesicoureteral reflux and detailed voiding cystourethrogram data were identified. Bladder volume at onset of reflux was normalized for age. Demographics, reflux grade, laterality, presence/absence of bladder-bowel dysfunction and breakthrough febrile urinary tract infections were assessed. Median followup was 24 months (IQR 12 to 52). A total of 208 girls and 47 boys were analyzed with a mean ± SD age at diagnosis of 3.1 ± 2.6 years. On univariate analysis history of febrile urinary tract infection (HR 2.17, 95% CI 1.33-2.85, p = 0.01), dilating vesicoureteral reflux (HR 1.6, 95% CI 1.05-2.42, p = 0.03) and bladder-bowel dysfunction (HR 1.66, 95% CI 0.99-2.75, p = 0.05) were associated with an increased risk of breakthrough febrile urinary tract infection. Median bladder volume at onset of reflux in children with breakthrough febrile urinary tract infection was significantly less (33.1%) than in those without infection (49.5%, p = 0.003). Reflux onset at 35% predicted bladder capacity or less was associated with a significantly increased risk of breakthrough febrile urinary tract infection on multivariate analysis (HR 1.58, 95% CI 1.05-2.38, p = 0.03). Children with early filling vesicoureteral reflux are at increased risk for breakthrough febrile urinary tract infection independent of reflux grade. Bladder volume at onset of reflux should be recorded during cystograms since it provides additional prognostic information about the risk of pyelonephritis and resolution, and may assist with counseling and clinical decision making. Copyright © 2015 American Urological Association Education and Research, Inc. Published by

  8. Seasonal and locational variations in children's play: implications for wellbeing. (United States)

    Ergler, Christina R; Kearns, Robin A; Witten, Karen


    Physical activity, through independent outdoor play, has come to the fore as a way to improve children's health through it fostering healthy mental and social as well as physiological development. However, in many high-income countries children's autonomous play opportunities have diminished due to urban intensification and declining parental license. Regardless of this trend, children's play varies across countries, cities, cultures and seasons. This paper offers new insights into the complexities of play as a vital aspect of children's wellbeing. Within the context of New Zealand - whose citizens generally regard themselves as outdoor people - this paper explores why 'play' might resonate differently across localities and seasons. We contrast the play affordances provided by Auckland's central city (dominated by apartment living) with Beach Haven, a suburban area. We employed a multi-method approach and included 20 children and their parents who were recruited through school and summer holiday programs embracing different gender and ethnicities to reflect the general cultural mix of the respective neighbourhoods. We advance two arguments. First, we suggest that the rarity of children playing outdoors unsupervised normalises supervised indoor play and reduces children's opportunities to see outdoor play as an alternative to interior or supervised pastimes. Second, we follow Bourdieu's theory of practice to argue that the regard parents and children have towards outdoor play reflects locally constituted beliefs about what is seasonally 'appropriate' children's activity. We found that extra-curricular activities and supervised excursions are undertaken in the central city all year around and only vary between social groups by the type of destination. In the suburb, independent outdoor play in summer represents children's main business after school in ways that enhance their environmental literacy and potential future health gain. For others these symbolic values

  9. Guidelines for children's work in agriculture: implications for the future. (United States)

    Marlenga, Barbara; Lee, Barbara C; Pickett, William


    The North American Guidelines for Children's Agricultural Tasks (NAGCAT) were developed to assist parents in assigning developmentally appropriate and safe farm work to their children aged 7-16 years. Since their release in 1999, a growing body of evidence has accumulated regarding the content and application of these guidelines to populations of working children on farms. The purpose of this paper is to review the scientific and programmatic evidence about the content, efficacy, application, and uptake of NAGCAT and propose key recommendations for the future. The methods for this review included a synthesis of the peer-reviewed literature and programmatic evidence gathered from safety professionals. From the review, it is clear that the NAGCAT tractor guidelines and the manual material handling guidelines need to be updated based upon the latest empirical evidence. While NAGCAT do have the potential to prevent serious injuries to working children in the correct age range (7-16 years), the highest incidence of farm related injuries and fatalities occur to children aged 1-6 years and NAGCAT are unlikely to have any direct effect on this leading injury problem. It is also clear that NAGCAT, as a voluntary educational strategy, is not sufficient by itself to protect children working on farms. Uptake of NAGCAT has been sporadic, despite being geographically widespread and has depended, almost solely, on a few interested and committed professionals. Key recommendations for the future are provided based upon this review.

  10. Characteristics of Incarcerated Fathers and Mothers: Implications for Preventive Interventions Targeting Children and Families. (United States)

    Kjellstrand, Jean; Cearley, Jennifer; Eddy, J Mark; Foney, Dana; Martinez, Charles R


    The number of children of incarcerated parents in the U.S. has grown dramatically in recent years. These children appear to be at risk for various problems, and a number of family-focused preventive efforts have been attempted. The current study examines differences between incarcerated mothers, incarcerated fathers, and their families on factors that might be important to consider when creating the content and process of preventive intervention programs. Participants were 359 inmates (54% women; 41% minority) who were parents of children between the ages of 3 and 11 years and who parented their children prior to imprisonment. Mothers and fathers were similar on a number of dimensions including age, education-level, number and age of children, and family criminal history, but differences were observed on key variables relevant to outcomes for children and families, including employment history and income, substance use, mental health, trauma experiences and criminal history. Implications for prevention programs are discussed.

  11. Is Making Divorce Easier Bad for Children? The Long-Run Implications of Unilateral Divorce


    Jonathan Gruber


    Most states in the U.S. allow for unilateral divorce, which increases the ease of divorce by not requiring the explicit consent of both partners. Such regulations have come under fire for their perceived negative consequences for marital stability and resulting child outcomes, but there is no evidence to date to support the contention that easier divorce regulations are actually bad for children. I assess the long run implications for children of growing up in a unilateral divorce environment...

  12. Evaluating the febrile patient with a rash. (United States)

    McKinnon, H D; Howard, T


    The differential diagnosis for febrile patients with a rash is extensive. Diseases that present with fever and rash are usually classified according to the morphology of the primary lesion. Rashes can be categorized as maculopapular (centrally and peripherally distributed), petechial, diffusely erythematous with desquamation, vesiculobullous-pustular and nodular. Potential causes include viruses, bacteria, spirochetes, rickettsiae, medications and rheumatologic diseases. A thorough history and a careful physical examination are essential to making a correct diagnosis. Although laboratory studies can be useful in confirming the diagnosis, test results often are not available immediately. Because the severity of these illnesses can vary from minor (roseola) to life-threatening (meningococcemia), the family physician must make prompt management decisions regarding empiric therapy. Hospitalization, isolation and antimicrobial therapy often must be considered when a patient presents with fever and a rash.

  13. Assets for Children: Experiences in Asia and Implications for China (United States)

    Zou, Li; Sherraden, Michael


    A growing number of national and local governments view child development accounts (CDAs) as an innovative policy tool for social and economic development. This article reviews the global landscape of CDAs, presents three CDA policy cases from Asia, analyzes main themes and discusses potential implications for China. (Contains 1 table.)

  14. Emergency Department Crowding and Time to Antibiotic Administration in Febrile Infants

    Directory of Open Access Journals (Sweden)

    Jennifer K Light


    Full Text Available Introduction: Early antibiotic administration is recommended in newborns presenting with febrile illness to emergency departments (ED to avert the sequelae of serious bacterial infection. Although ED crowding has been associated with delays in antibiotic administration in a dedicated pediatric ED, the majority of children that receive emergency medical care in the U.S. present to EDs that treat both adult and pediatric emergencies. The purpose of this study was to examine the relationship between time to antibiotic administration in febrile newborns and crowding in a general ED serving both an adult and pediatric population.Methods: We conducted a retrospective chart review of 159 newborns presenting to a general ED between 2005 and 2011 and analyzed the association between time to antibiotic administration and ED occupancy rate at the time of, prior to, and following infant presentation to the ED.Results: We observed delayed and variable time to antibiotic administration and found no association between time to antibiotic administration and occupancy rate prior to, at the time of, or following infant presentation (P > 0.05. ED time to antibiotic administration was not associated with hospital length of stay, and there was no inpatient mortality.Conclusion: Delayed and highly variable time to antibiotic treatment in febrile newborns was common but unrelated to ED crowding in the general ED study site. Guidelines for time to antibiotic administration in this population may reduce variability in ED practice patterns. [West J Emerg Med. 2013;14(5:518-524.

  15. Long-term consequences of a prolonged febrile seizure in a dual pathology model. (United States)

    Gibbs, Steve; Chattopadhyaya, Bidisha; Desgent, Sébastien; Awad, Patricia N; Clerk-Lamalice, Olivier; Levesque, Maxime; Vianna, Rose-Mari; Rébillard, Rose-Marie; Delsemme, Andrée-Anne; Hébert, David; Tremblay, Luc; Lepage, Martin; Descarries, Laurent; Di Cristo, Graziella; Carmant, Lionel


    Clinical evidence suggests that febrile status epilepticus (SE) in children can lead to acute hippocampal injury and subsequent temporal lobe epilepsy. The contribution of febrile SE to the mechanisms underlying temporal lobe epilepsy are however poorly understood. A rat model of temporal lobe epilepsy following hyperthermic SE was previously established in our laboratory, wherein a focal cortical lesion induced at postnatal day 1 (P1), followed by a hyperthermic SE (more than 30 min) at P10, leads to hippocampal atrophy at P22 (dual pathology model) and spontaneous recurrent seizures (SRS) with mild visuospatial memory deficits in adult rats. The goal of this study was to identify the long term electrophysiological, anatomical and molecular changes in this model. Following hyperthermic SE, all cortically lesioned pups developed progressive SRS as adults, characterized by the onset of highly rhythmic activity in the hippocampus. A reduction of hippocampal volume on the side of the lesion preceded the SRS and was associated with a loss of hippocampal neurons, a marked decrease in pyramidal cell spine density, an increase in the hippocampal levels of NMDA receptor NR2A subunit, but no significant change in GABA receptors. These findings suggest that febrile SE in the abnormal brain leads to hippocampal injury that is followed by progressive network reorganization and molecular changes that contribute to the epileptogenesis as well as the observed memory deficits. Copyright © 2011 Elsevier Inc. All rights reserved.

  16. Augmented Reality Video Games: New Possibilities and Implications for Children and Adolescents

    Directory of Open Access Journals (Sweden)

    Prithwijit Das


    Full Text Available In recent years, the video game market has embraced augmented reality video games, a class of video games that is set to grow as gaming technologies develop. Given the widespread use of video games among children and adolescents, the health implications of augmented reality technology must be closely examined. Augmented reality technology shows a potential for the promotion of healthy behaviors and social interaction among children. However, the full immersion and physical movement required in augmented reality video games may also put users at risk for physical and mental harm. Our review article and commentary emphasizes both the benefits and dangers of augmented reality video games for children and adolescents.

  17. Children under Five and Digital Technologies: Implications for Early Years Pedagogy (United States)

    Palaiologou, Ioanna


    This project aimed to investigate the types of digital technologies children under the age of five are using at home and assess the possible implications for early years pedagogy. The research, carried out between 2010 and 2012, was based in four European countries: England, Greece, Malta and Luxemburg. A mixed methods approach was employed to…

  18. Video and Computer Games: Effect on Children and Implications for Health Education. (United States)

    Dorman, Steve M.


    Video and computer games have assumed a prominent role in the culture of U.S. children and adolescents. The paper examines the health effects of these games, suggests criteria upon which parents and teachers may evaluate the games, and notes some implications for health educators. (SM)

  19. Psychosexual Development in Infants and Young Children: Implications for Caregivers. (United States)

    Honig, Alice Sterling


    Discusses preschoolers' interest in and wonder about sexual anatomical differences, and adults' responses to their questions. Presents Freudian stages of psychosexual development, the relationship between sexual identity and gender role, children's preference for single-sex play groups, sex stereotyped toy preferences, and the role of television…

  20. Key informant perceptions of vision loss in children and implications ...

    African Journals Online (AJOL)

    Materials and Methods: A population-based study on the prevalence and causes of childhood blindness and severe visual impairment was conducted using the KI method. KIs were selected by their communities and trained in advocacy, identifi cation and referral of children with visual impairment. Prior to the KI training, ...

  1. Educational Implications of Conductive Hearing Loss in School Children. (United States)

    Lyon, David J.; And Others


    The study investigated specific linguistic abilities/disabilities of 15 children with conductive hearing loss and a history of middle ear dysfunction. Results found significant deficits in verbal intelligence, word recognition, and receptive syntactic skills substantiating the finding that conductive hearing loss due to otitis media is deleterious…

  2. Children's Memories for Painful Cancer Treatment Procedures: Implications for Distress. (United States)

    Chen, Edith; Zeltzer, Lonnie K.; Craske, Michelle G.; Katz, Ernest R.


    Examined memory of 3- to 18-year-olds with leukemia regarding lumbar punctures (LP). Found that children displayed considerable accuracy for event details, with accuracy increasing with age. Use of Versed (anxiolytic medication described as a "memory blocker") was not related to recall. Higher distress predicted greater exaggerations in…

  3. Children's Theory Of Mind: Educational And Instructional Implications

    African Journals Online (AJOL)

    The theoretical framework was theory theory which postulates that children collect evidence about the relation between mental states and action, much as scientists collect data to form a theory. The paper concludes that theory of mind is a significant social and cognitive development in the preschoolers years.

  4. Implications of diadochokinesia in children with speech sound disorder. (United States)

    Wertzner, Haydée Fiszbein; Pagan-Neves, Luciana de Oliveira; Alves, Renata Ramos; Barrozo, Tatiane Faria


    To verify the performance of children with and without speech sound disorder in oral motor skills measured by oral diadochokinesia according to age and gender and to compare the results by two different methods of analysis. Participants were 72 subjects aged from 5 years to 7 years and 11 months divided into four subgroups according to the presence of speech sound disorder (Study Group and Control Group) and age (6 years and 5 months). Diadochokinesia skills were assessed by the repetition of the sequences 'pa', 'ta', 'ka' and 'pataka' measured both manually and by the software Motor Speech Profile®. Gender was statistically different for both groups but it did not influence on the number of sequences per second produced. Correlation between the number of sequences per second and age was observed for all sequences (except for 'ka') only for the control group children. Comparison between groups did not indicate differences between the number of sequences per second and age. Results presented strong agreement between the values of oral diadochokinesia measured manually and by MSP. This research demonstrated the importance of using different methods of analysis on the functional evaluation of oro-motor processing aspects of children with speech sound disorder and evidenced the oro-motor difficulties on children aged under than eight years old.

  5. Interviewing children in custody cases: implications of research and policy for practice. (United States)

    Saywitz, Karen; Camparo, Lorinda B; Romanoff, Anna


    Research on child interviewing has burgeoned over the past 25 years as expectations about children's agency, competence, and participation in society have changed. This article identifies recent trends in research, policy, and theory with implications for the practice of interviewing children in cases of contested divorce and for the weight to be given the information children provide. A number of fields of relevant research are identified, including studies of families who have participated in the family law system, studies of child witnesses in the field, experimental studies of the effects of interview techniques on children's memory and suggestibility, and ethnographic methods that elicit children's views of their own experiences. Finally, a set of 10 principles for practice are delineated based on the best available science. Copyright 2010 John Wiley & Sons, Ltd.

  6. Effects of Prestorage Leukoreduction on the Rate of Febrile ...

    African Journals Online (AJOL)

    Febrile nonhemolytic transfusion reactions (FNHTRs) are common ... Department of Immunohaematology and Blood Transfusion, Dayanand Medical College and Hospital, Ludhiana, Punjab, India ... antigen (HLA) or WBC‑specific antigens located on donor .... though increasing awareness and reporting about adverse.

  7. Thermoregulatory Responses of Febrile Monkeys During Microwave Exposure

    National Research Council Canada - National Science Library

    Adair, E


    .... In a controlled ambient temperature of 26 degrees C, autonomic mechanisms of heat production and heat loss were measured in febrile squirrel monkeys during 30-min exposures to 450 or 2450 MHz CW MW...

  8. Listening to Children as a Way to Reconstruct Knowledge about Children: Some Methodological Implications (United States)

    Formosinho, Julia; Araujo, Sara Barros


    In recent years, some researchers have been turning to children's views as a way to better construct knowledge about children and childhood issues. This article presents, firstly, a brief reflection on the image of child underlying this new perspective in research with children, an image that assumes, first and above all, a strong belief in…

  9. Treatment of febrile neutropenia with cefepime monotherapy. (United States)

    Jándula, B M; Martino, R; Gurgi, M; Manteiga, R; Sierra, J


    The empirical administration of a broad-spectrum beta-lactam antibiotic, either as monotherapy or in combination with an aminoglycoside, is an essential component of the initial management of patients with fever and severe neutropenia. Multiple antibiotics have been tested for this indication. Cefepime is a fourth-generation cephalosporin with in vitro activity against most gram-negative and many gram-positive bacteria. We have studied the use of this agent as monotherapy in this indication. One hundred and twenty-six episodes of febrile neutropenia in 98 adults with hematological malignancies were treated with cefepime monotherapy. Cefepime was given at a dose of 2 g every 8 h i.v. Most episodes (49%) were fever of unexplained origin, while a microbiologically documented and clinically documented infection occurred in 25% episodes each. Seventy-six (61%) episodes occurred after conventional chemotherapy, while 51 (41%) after a hematopoietic stem cell transplantation. Twelve episodes (10%) were not evaluable for response. Among the 114 evaluable episodes, 69 (55% of the initial sample and 61% of those evaluable) responded to cefepime monotherapy, while therapy failed in 45 cases (36% of the initial sample and 39% of those evaluable), including 14 cases who developed breakthrough bacteremia during therapy. There were no deaths due to bacterial infection. At the end of all antibiotic therapy (final outcome) 69 episodes were cured only with monotherapy, 47 were cured with modification of therapy and 10 patients died from an unrelated cause. The only variable that appeared to correlate with response to therapy was the duration of neutropenia, which was longer among patients who failed or developed breakthrough bacteremia than among those who responded to monotherapy. Initial empirical antibiotic therapy with cefepime as a single agent in patients with febrile neutropenia and a hematological malignancy is effective, but patients with prolonged neutropenia appear to be

  10. Effect of Taurine on Febrile Episodes in Acute Lymphoblastic Leukemia

    Directory of Open Access Journals (Sweden)

    Mina Islambulchilar


    Full Text Available Purpose: The purpose of our study was to evaluate the effect of oral taurine on the incidence of febrile episodes during chemotherapy in young adults with acute lymphoblastic leukemia. Methods: Forty young adults with acute lymphoblastic leukemia, at the beginning of maintenance course of their chemotherapy, were eligible for this study. The study population was randomized in a double blind manner to receive either taurine or placebo (2 gram per day orally. Life quality and side effects including febrile episodes were assessed using questionnaire. Data were analyzed using Pearson’s Chi square test. Results: Of total forty participants, 43.8% were female and 56.3 % were male. The mean age was 19.16±1.95 years (ranges: 16-23 years. The results indicated that the levels of white blood cells are significantly (P<0.05 increased in taurine treated group. There was no elevation in blasts count. A total of 70 febrile episodes were observed during study, febrile episodes were significantly (P<0.05 lower in taurine patients in comparison to the control ones. Conclusion: The overall incidence of febrile episodes and infectious complications in acute lymphoblastic leukemia patients receiving taurine was lower than placebo group. Taurine’s ability to increase leukocyte count may result in lower febrile episodes.


    Directory of Open Access Journals (Sweden)



    Full Text Available The influence of experimentally Escherichia coli-induced fever (EEIF on the pharmacokinetics of ofloxacin was evaluated. Ofloxacin was administered @ 20 body weight intravenously to a group of eight healthy rabbits and compared these results to values in same eight rabbits with EEIF. Pharmacokinetic parameters of ofloxacin in normal and febrile rabbits were determined by using two compartment open kinetic model. Peak plasma level (Cmax and area under the plasma concentration-time curve (AUC0-α in normal and febrile rabbits did not differ (P>0.05. However, area under first moment of plasma concentration-time curve (AUMC0-α in febrile rabbits was significantly (P<0.05 higher than that in normal rabbits. Mean values for elimination rate constant (Ke, elimination half life (t1/2β and apparent volume of distribution (Vd were significantly (P<0.05 lower in febrile rabbits compared to normal rabbits, while mean residence time (MRT and total body clearance (Cl of ofloxacin did not show any significant difference in the normal and febrile rabbits. Clinical significance of the above results can be related to the changes in the volume of distribution and elimination half life that illustrates an altered steady state in febrile condition; hence, the need for an adjustment of dosage regimen in EEIF is required.

  12. Behavior modification therapy in hyperactive children. Research and clinical implications. (United States)

    Wolraich, M L


    One hundred fifty-seven studies employing behavior modification in the management of hyperactive and disruptive children were reviewed. The studies were analyzed against standards of scientific validity. The review found: (1) behavior modification was effective in alleviating problem behaviors; (2) token programs were the most commonly used; (3) both positive reinforcement and punishment were effective; positive reinforcement, however, had the advantage of improving self-esteem; (4) behavioral problems occurring in the home most likely require a home-based program; (5) behavior modification and stimulant medication can be used simultaneously, often with additive effects; and (6) long-term benefits beyond one year have not been assessed.

  13. C-reactive protein velocity to distinguish febrile bacterial infections from non-bacterial febrile illnesses in the emergency department


    Paran, Yael; Yablecovitch, Doron; Choshen, Guy; Zeitlin, Ina; Rogowski, Ori; Ben-Ami, Ronen; Katzir, Michal; Saranga, Hila; Rosenzweig, Tovit; Justo, Dan; Orbach, Yaffa; Halpern, Pinhas; Berliner, Shlomo


    Introduction C-reactive protein (CRP) is a real-time and low-cost biomarker to distinguish febrile bacterial infections from non-bacterial febrile illnesses. We hypothesised that measuring the velocity of the biomarker instead of its absolute serum concentration could enhance its ability to differentiate between these two conditions. Methods We prospectively recruited adult patients (age ? 18 years) who presented to the emergency department with fever. We recorded their data regarding the ons...

  14. Infección bacteriana severa en niños febriles: Parámetros predictivos

    Directory of Open Access Journals (Sweden)

    Alicia Álvarez Rodríguez


    Full Text Available Diferentes investigadores han realizado estudios sobre el manejo del niño febril y plantean que es un dilema al que se enfrenta a diario el médico que atiende niños. Motivados por este tema se efectuó un estudio descriptivo retrospectivo de los niños febriles, sin causa aparente en su valoración inicial, que asistieron al servicio de urgencias en un período de 9 meses, con el objetivo de identificar el diagnóstico definitivo al egreso y se precisó el tipo de infección bacteriana severa y relacionó la presencia de éstos con parámetros clínicos y de laboratorios. El mayor número de niños febriles valorados e ingresados mostraron edades desde 91 días hasta 36 meses. El menor porcenaje de ellos ingresaron y desarrollaron alguna infección bacteriana severa principalmente neumonía, y fue mayor el porcentaje de niños con esta patología a menos edad con predominio del aspecto tóxico y de la temperatura 39 EC. Resultó el manejo ambulatorio del niño febril mayor de 90 días y bajo riesgo de infección bacteriana severa un ahorro en vidas y dinero, por lo que se recomienda generalizar el flujograma propuesto para la evaluación y manejo del niño febril de 3 a 36 meses de edad.Different researches have performed studies on the management of the febrile infant and they point out that this is a dilemma faced by every physician who takes care of children. Motivated by this subject, a descriptive and retrospective study of febrile infants was conducted. The study was carried out to evaluate febrile infants without evident cause at the baseline evaluation who attended the emergency service during a period of 9 months with the objective of identifying the definite diagnosis at admission. The type of bacterial infection was accurately assessed and the presence of this was related to clinical and laboratory parameters. The greatest number of febrile infants evaluated and admitted to hospital were 91 days-36 months old. The lowest percentage

  15. Fluoxetine Administration in Juvenile Monkeys: Implications for Pharmacotherapy in Children

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    Mari S. Golub


    Full Text Available Fluoxetine therapy has been approved for children with major depressive disorder and obsessive compulsive disorder for over 14 years and has expanded to other childhood behavior disorders. As use increases, more detail on fluoxetine effects during juvenile brain development can help maintain safe and effective use of this therapy. Here, a narrative review is provided of previously published findings from a large nonhuman primate project. Fluoxetine was administered to juvenile male rhesus monkeys for an extended period (2 years prior to puberty. Compared to controls, treated monkeys showed sleep disruption, facilitated social interaction, greater impulsivity, and impaired sustained attention during treatment. No effects on growth were seen. Metabolomics assays characterized a distinctive response to fluoxetine and demonstrated individual differences that were related to the impulsivity measure. Fluoxetine interactions with monoamine oxidase A polymorphisms that influenced behavior and metabolomics markers were an important, previously unrecognized finding of our studies. After treatment was discontinued, some behavioral effects persisted, but short-term memory and cognitive flexibility testing did not show drug effects. This detailed experimental work can contribute to clinical research and continued safe and effective fluoxetine pharmacotherapy in children.

  16. A Cross-cultural Exploration of Children's Everyday Ideas: Implications for science teaching and learning (United States)

    Wee, Bryan


    Children's everyday ideas form critical foundations for science learning yet little research has been conducted to understand and legitimize these ideas, particularly from an international perspective. This paper explores children's everyday ideas about the environment across the US, Singapore and China to understand what they reveal about children's relationship to the environment and discuss its implications for science teaching and learning. A social constructivist lens guides research, and a visual methodology is used to frame children's realities. Participants' ages range from elementary to middle school, and a total of 210 children comprized mainly of Asians and Asian Americans were sampled from urban settings. Drawings are used to elicit children's everyday ideas and analyzed inductively using open coding and categorizing of data. Several categories support existing literature about how children view the environment; however, novel categories such as affect also emerged and lend new insight into the role that language, socio-cultural norms and perhaps ethnicity play in shaping children's everyday ideas. The findings imply the need for (a) a change in the role of science teachers from knowledge providers to social developers, (b) a science curriculum that is specific to learners' experiences in different socio-cultural settings, and (c) a shift away from inter-country comparisons using international science test scores.

  17. Evaluation of malnutrition as a predictor of adverse outcomes in febrile neutropenia associated with paediatric haematological malignancies. (United States)

    Chaudhuri, Jasodhara; Biswas, Tamoghna; Datta, Jyotishka; Sabui, Tapas Kumar; Chatterjee, Sukanta; Ray, Somosri; Raychaudhuri, Dibyendu; Mandal, Kalyanbrata; Chatterjee, Kaushani; Chakraborty, Swapna


    Malnutrition has been reported in the literature to be adversely associated with outcomes in paediatric malignancies. Our objective in this paper was to evaluate malnutrition as a potential predictor for adverse outcomes in febrile neutropenia associated with haematological malignancies. A prospective observational study was performed in a tertiary care teaching hospital of Kolkata, India. Forty-eight participants, suffering from haematological malignancy, were included. Participants were included if they experienced at least one episode of febrile neutropenia. For children aged malnutrition, while body mass index for age was used in children ≥5 years. A total of 162 episodes of febrile neutropenia were studied. Thirty patients (30/48, 62.5%) included in the study had malnutrition. In bivariate analyses at patient level, there is a strong association between malnutrition and death (odds ratio (OR) 7.286, 95% confidence interval (CI) 0.838-63.345, one-tailed P = 0.044), and life-threatening complications show a moderate trend towards significance (OR 3.333, 95% CI 0.791-14.052, one-tailed P = 0.084). Survival functions were significantly different between malnourished and non-malnourished children (log rank test χ(2)  = 4.609, degree of freedom = 1, P = 0.032). Wasting was associated with life-threatening complications in children aged malnutrition was not. Malnutrition may be a potential predictor of mortality in febrile neutropenia. © 2016 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

  18. The association between aerobic fitness and language processing in children: implications for academic achievement. (United States)

    Scudder, Mark R; Federmeier, Kara D; Raine, Lauren B; Direito, Artur; Boyd, Jeremy K; Hillman, Charles H


    Event-related brain potentials (ERPs) have been instrumental for discerning the relationship between children's aerobic fitness and aspects of cognition, yet language processing remains unexplored. ERPs linked to the processing of semantic information (the N400) and the analysis of language structure (the P600) were recorded from higher and lower aerobically fit children as they read normal sentences and those containing semantic or syntactic violations. Results revealed that higher fit children exhibited greater N400 amplitude and shorter latency across all sentence types, and a larger P600 effect for syntactic violations. Such findings suggest that higher fitness may be associated with a richer network of words and their meanings, and a greater ability to detect and/or repair syntactic errors. The current findings extend previous ERP research explicating the cognitive benefits associated with greater aerobic fitness in children and may have important implications for learning and academic performance. Published by Elsevier Inc.

  19. Treatment of febrile seizures with intermittent clobazam Tratamento de convuslsões febris com clobazam intermitente

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    Maria Luiza G. Manreza


    Full Text Available Fifty children, 24 female and 26 male, with ages varying from 6 to 72 months (mean=23.7 m. that experienced at least one febrile seizure (FS entered a prospective study of intermittent therapy with clobazam. Cases with severe neurological abnormalities, progressive neurological disease, afebrile seizures, symptomatic seizures of other nature, or seizures during a central nervous system infection were excluded. Seizures were of the simple type in 25 patients, complex in 20 and unclassified in 5. The mean follow-up period was 7.9 months (range=l to 23 m., and the age at the first seizure varied from 5 to 42 months (mean=16.8 m.. Clobazam was administered orally during the febrile episode according to the child's weight: up to 5 kg, 5 mg/day; from 5 to 10 kg, 10 mg/day; from 11 to 15 kg, 15 mg/day, and over 15 kg, 20 mg/day. There were 219 febrile episodes, with temperature above 37.8 °C, in 40 children during the study period. Twelve children never received clobazam and 28 received the drug at least once. Drug efficacy was measured by comparing FS recurrence in the febrile episodes that were treated with clobazam with those in which only antipyretic measures were taken. Ten children (20% experienced a FS during the study period. Of the 171 febrile episodes treated with clobazam there were only 3 recurrences (1.7%, while of the 48 episodes treated only with antipyretic measures there were 11 recurrences (22.9%, a difference highly significant (pAvaliamos prospectivamente o uso intermitente do clobazam na profilaxia de convulsão febril em 50 crianças, 24 do sexo feminino e 26 do masculino, com idades entre 6 e 72 meses (média = 23,7 meses que haviam apresentado pelo menos um episódio de convulsão febril. Foram excluídas crianças com anormalidades neurológicas severas, doença neurológica progressiva, crises durante infecção do SNC e crises epilépticas sintomáticas outras. As convulsões febris foram classificadas como simples em 25

  20. Implications of parental affiliate stigma in families of children with ADHD. (United States)

    Mikami, Amori Yee; Chong, Gua Khee; Saporito, Jena M; Na, Jennifer Jiwon


    This study examined parents' perceptions/awareness and internalization of public courtesy stigma (affiliate stigma) about their children's inattentive and hyperactive/impulsive symptoms, and associations between parental affiliate stigma, parental negativity expressed toward the child, and child social functioning. Participants were families of 63 children (ages 6-10; 42 boys) with attention-deficit/hyperactivity disorder, assessed in a cross-sectional design. After statistical control of children's severity of inattentive and hyperactive/impulsive symptoms (as reported by parents and teachers), parents' self-reports of greater affiliate stigma were associated with more observed negative parenting. The associations between high parental affiliate stigma and children's poorer adult informant-rated social skills and greater observed aggression were partially mediated by increased parental negativity. As well, the positive association between children's adult informant-rated aggressive behavior and parental negativity was partially mediated by parents' increased affiliate stigma. Parental affiliate stigma about their children's inattentive and hyperactive/impulsive symptoms may have negative ramifications for parent-child interactions and children's social functioning. Clinical implications for parent training interventions are discussed.

  1. Experience and policy implications of children presenting with dental emergencies to US pediatric dentistry training programs. (United States)

    Edelstein, Burton; Vargas, Clemencia M; Candelaria, Devanie; Vemuri, Maryen


    The purpose of this study was to describe and substantiate the experience of children, their families, and their caregivers with children's dental pain and to explore implications of these experiences for public policy. Data for 301 children presenting to 35 pediatric dentistry training programs during a 1-week period in 2000 for pain relief were collected with a questionnaire asking for: (1) sociodemographic characteristics; (2) oral health status; (3) dental care history; (4) presenting problem; (5) clinical findings; and (6) clinical disposition. Descriptive statistics are presented. Among children presenting to training programs with oral pain, 28% were under age 6, 57% were on Medicaid, and 38% were regarded by their dentists to have "likely or obvious" functional impairment-with 22% reporting the highest pain level. Parents reported that 59% had "poor or fair oral health" and 29% had a prior dental emergency in the previous year. Pain, experienced for several days by 73% of children, was associated with difficulty: (1) eating; (2) sleeping; (3) attending school; and (4) playing. Parent-reported barriers to seeking dental care included: (1) missed work (24%); (2) transportation costs (12%); and (3) arranging child care (10%). In this study of children with dental pain, many suffered significant pain: (1) duration; (2) intensity; (3) recurrence; and (4) consequences. This study demonstrates the ongoing need for public policies that assure timely, comprehensive, and affordable dental care for vulnerable children.

  2. Advances in Children's Rights and Children's Well-Being Measurement: Implications for School Psychologists (United States)

    Kosher, Hanita; Jiang, Xu; Ben-Arieh, Asher; Huebner, E. Scott


    Recent years have brought important changes to the profession of school psychology, influenced by larger social, scientific, and political trends. These trends include the emergence of children's rights agenda and advances in children's well-being measurement. During these years, a growing public attention and commitment to the notion of…

  3. Body fat percentage of urban South African children: implications for health and fitness. (United States)

    Goon, D T; Toriola, A L; Shaw, B S; Amusa, L O; Khoza, L B; Shaw, I


    To explore gender and racial profiling of percentage body fat of 1136 urban South African children attending public schools in Pretoria Central. This is a cross-sectional survey of 1136 randomly selected children (548 boys and 588 girls) aged 9-13 years in urban (Pretoria Central) South Africa. Body mass, stature, skinfolds (subscapular and triceps) were measured. Data were analysed using descriptive statistics (means and standard deviations). Differences in the mean body fat percentage were examined for boys and girls according to their age group/race, using independent t-test samples. Girls had a significantly (p = 0.001) higher percentage body fat (22.7 ± 5.7%, 95% CI = 22.3, 23.2) compared to boys (16.1 ± 7.7%, 95% CI = 15.5, 16.8). Percentage body fat fluctuated with age in both boys and girls. Additionally, girls had significantly (p = 0.001) higher percentage body fat measurements at all ages compared to boys. Viewed racially, black children (20.1 ± 7.5) were significantly (p = 0.010) fatter than white children (19.0 ± 7.4) with a mean difference of 4.0. Black children were fatter than white children at ages 9, 10, 12 and 13 years, with a significant difference (p = 0.009) observed at age 12 years. There was a considerably higher level of excessive percentage body fat among school children in Central Pretoria, South Africa, with girls having significantly higher percentage body fat compared to boys. Racially, black children were fatter than white children. The excessive percentage body fat observed among the children in this study has implications for their health and fitness. Therefore, an intervention programme must be instituted in schools to prevent and control possible excessive percentage body fat in this age group.

  4. Validación de nuevos parámetros predictivos de infecciones bacterianas severas en niños febriles menores de 36 meses de edad

    Directory of Open Access Journals (Sweden)

    Alicia Álvarez Rodríguez


    Full Text Available Se realizó una investigación descriptiva-prospectiva con el objetivo de validar nuestros criterios de riesgos en la identificación de la infección bacteriana severa (IBS en niños febriles, para lo cual se establecieron las categorías de riesgos y se aplicaron en 215 niños febriles que habían ingresado por esta causa en un período de 12 meses. Se obtuvo que el 54,9 % de los niños se clasificaron como bajo riesgo y el 71,6 % sin IBS. No obstante, la frecuencia de dicha afección resultó elevada, 28,4 %, con predominio de las infecciones urinarias. Se triplicó el riesgo de padecer IBS en los niños con aspecto tóxico, temperatura mayor o igual a 39°C, test clínico de Bonadio mayor que 8, cituria mayor o igual a 10 000 células/mm³, con diferencias significativas entre las categorías de riesgo y la IBS, y fue mayor la frecuencia en los niños tóxicos y de riesgos, 92,8 y 54,3 %, respectivamente. Uno de cada 4 niños febriles presentó IBS. Se introdujo la categoría "Riesgo" y se recomienda un flujograma de evaluación.A descriptive-prospective research study was carried out to validate our risk criteria in the identification of severe bacterial infection in febrile young children. For this purpose, risk categories were set and applied in 215 febrile children who had been admitted in a period of 12 months. 54.9 % of febrile children were at low risk for serious bacterial infections whereas 71.6 % presented no risk at all. Nevertheless, the frequency of this affection was high, accounting for 28.4 % with predominance of urinary infections. The risk of getting SBI trippled in children who shared toxic look, temperature greater than or equal to 39 °C, Bonadium clinical test higher than 8, cyturia values over or equal to 10 000 cell/mm³, significant differences between risk and SBI categories and the highest frequency of such affection found in toxic children and in children at low risk (92.8 vs 54.3 %. One in every four febrile

  5. Smoking within the Household: Spousal Peer Effects and Children's Health Implications


    Canta, Chiara; Dubois, Pierre


    This paper studies spousal peer effects on the smoking behaviour and their implication for the health of children through passive smoking. Smoking decisions are modeled as equilibrium strategies of an incomplete information game within the couple. Using data from the French Health Survey 2002-2003, we identify two distinct effects linked to spousal behaviour: a smoking enhancing effect of smoking partners and a smoking deterring effect of non smoking partners. On the one hand, ...

  6. Health Care Autonomy in Children with Chronic Conditions: Implications for Self Care and Family Management (United States)

    Beacham, Barbara L.; Deatrick, Janet A.


    Synopsis Health care autonomy typically occurs during late adolescence but health care providers and families often expect children with chronic health conditions to master self-care earlier. Few studies have examined the development of health care autonomy as it pertains to self-care and family management. This review will link the three concepts and discuss implications for families and health care providers. Case studies are provided as exemplars to highlight areas where intervention and research is needed. PMID:23659815

  7. Classification of venous malformations in children and implications for sclerotherapy

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    Puig, Stefan [Department of Radiology, University of Vienna, Waehringer Guertel 18-20, 1090 Vienna (Austria); Department of Paediatric Radiology, Hopital Necker-Enfants Malades, Paris (France); Aref, Hussein [Department of Paediatric Radiology, Hopital Necker-Enfants Malades, Paris (France); Department of Radiology, Alexandria Faculty of Medicine, Alexandria (Egypt); Chigot, Valerie; Brunelle, Francis [Department of Paediatric Radiology, Hopital Necker-Enfants Malades, Paris (France); Bonin, Beatrice [Paediatric Maxillofacial Surgery, Trousseau Hospital, Tours (France)


    The purpose of this work is to present a simple and descriptive classification system for venous malformations (VMs) that may serve as a basis for interventional therapy, and to test its usefulness in a sample of consecutively referred paediatric patients. The classification system we developed includes four types: type I, isolated malformation without peripheral drainage; type II, malformation that drains into normal veins; type III, malformation that drains into dilated veins; and type IV, malformation that represents dysplastic venous ectasia. The system was prospectively tested using phlebography in a sample of 43 children and adolescents with VMs who were referred for treatment during a 10-month period. Our hypothesis was that the type of VM would determine whether low-risk sclerotherapy was indicated. Thirteen (30%) patients had a type-I VM, 16 (37%) had a type-II, 9 (21%) had a type-III, and 5 (12%) had a type-IV malformation. In more than 90% of patients with a type-I or type-II lesion, sclerotherapy could be performed without any problems. In one third of patients with a type-III VM, sclerotherapy had to be withheld and one of nine (11%) developed a severe complication after therapy. Of the five patients with type-IV lesions, three (60%) had to be excluded from sclerotherapy. Our initial results indicate that sclerotherapeutic intervention in patients with type-III and type-IV VMs must be carefully considered, while it can be safely performed in low-risk patients with type-I and type-II lesions. (orig.)

  8. Crisis febriles simples y complejas, epilepsia generalizada con crisis febriles plus, FIRES y nuevos síndromes

    Directory of Open Access Journals (Sweden)

    Noris Moreno de Flagge


    Full Text Available Las convulsiones febriles representan la mayoría de las convulsiones en el niño. Se ha descrito que 2-5% de los niños experimentan convulsiones febriles antes de los 5 años de edad, aunque en algunas poblaciones se ha descrito hasta un 15%. Es una causa común de admisión en pediatría y de preocupación de los padres. Puede ser la primera manifestación de una epilepsia. Un 13% de pacientes que desarrollan epilepsia tienen antecedente de convulsiones febriles y 30% de estos pacientes se presentan con convulsiones recurrentes. Sus características fenotípicas nos permiten, en su gran mayoría, clasificarlas, tomar una actitud terapéutica y elaborar un pronóstico. Se puede describir un espectro de su gravedad desde las convulsiones febriles simples hasta las más complejas como las convulsiones febriles plus que comprenden los síndromes de Dravet y FIRES. En los últimos años se han hecho descubrimientos importantes que definen su carácter genético, entrelazándose cada vez más con diferentes afecciones de tipo epiléptico que nos obliga a un seguimiento neurológico más estrecho de muchos de estos niños con convulsiones febriles. Hacemos una revisión bibliográfica con el objetivo de actualizar los conocimientos sobre las convulsiones febriles, su pronóstico y su relación con los nuevos síndromes epilépticos.

  9. Roultella ornithinolytica infection in infancy: a case of febrile urinary tract infection. (United States)

    De Petris, Laura; Ruffini, Ermanno


    Raoultella ornithinolytica is a Gram-negative, non-motile, encapsulated, aerobic bacillus belonging to the Enterobacteriaceae family. R. ornithinolytica is a not very common, but emergent causal agent of human infection, and its expression of beta-lactamase provides resistance to commonly used antibiotics. The pathogenetic potential of R. ornithinolytica isolates in human disease has become increasingly important. Several cases of hospital-acquired infection, mostly associated with invasive procedures, or in patients with co-morbidity caused by R. ornithinolytica, have been previously reported in the adult population. In pediatric population, two cases in immunocompromised children, one case in an infant with visceral heterotaxy and one case of catheter-related bacteraemia are described. Here, we present the first case of febrile urinary tract infection due to R. ornithinolytica in an 8-month-old infant, recovered from a previous febrile UTI caused by E. coli and without co-morbidity. The empiric therapy with ceftriaxone, followed by cefpodoxime proxetil, resolved symptoms: the clinical condition of the infant improved rapidly and the treatment eradicated urine from the R. ornithinolytica infection. Since other pathogens rather than R. ornithinolytica are usually identified in children with urinary tract infections, including Escherichia coli, Proteus, Klebsiella and Pseudomonas, the identification of this microorganism in our patient's urine was also unexpected.

  10. Cyclooxygenase-2 mediates the febrile response of mice to interleukin-1beta. (United States)

    Li, S; Ballou, L R; Morham, S G; Blatteis, C M


    Various lines of evidence have implicated cyclooxygenase (COX)-2 as a modulator of the fever induced by the exogenous pyrogen lipopolysaccharide (LPS). Thus, treatment with specific inhibitors of COX-2 suppresses the febrile response without affecting basal body (core) temperature (T(c)). Furthermore, COX-2 gene-ablated mice are unable to develop a febrile response to intraperitoneal (i.p.) LPS, whereas their COX-1-deficient counterparts produce fevers not different from their wild-type (WT) controls. To extend the apparently critical role of COX-2 for LPS-induced fevers to fevers produced by endogenous pyrogens, we studied the thermal responses of COX-1- and COX-2 congenitally deficient mice to i.p. and intracerebroventricular (i.c.v.) injections of recombinant murine (rm) interleukin (IL)-1beta. We also assessed the effects of one selective COX-1 inhibitor, SC-560, and two selective COX-2 inhibitors, nimesulide (NIM) and dimethylfuranone (DFU), on the febrile responses of WT and COX-1(-/-) mice to LPS and rmIL-1beta, i.p. Finally, we verified the integrity of the animals' responses to PGE2, i.c.v. I.p. and i.c.v. rmIL-1beta induced similar fevers in WT and COX-1 knockout mice, but provoked no rise in the T(c)s of COX-2 null mutants. The fever produced in WT mice by i.p. LPS was not affected by SC-560, but it was attenuated and abolished by NIM and DFU, respectively, while that caused by i.p. rmIL-1beta was converted into a T(c) fall by DFU. There were no differences in the responses to i.c.v. PGE2 among the WT and COX knockout mice. These results, therefore, further support the notion that the production of PGE2 in response to pyrogens is critically dependent on COX-2 expression.

  11. Tratamiento ambulatorio del paciente con neutropenia febril Outpatient therapy in patients with febrile neutropenia

    Directory of Open Access Journals (Sweden)

    Andrés Londoño Gallo


    Full Text Available

    El tratamiento de los pacientes con neoplasia y neutropenia febril plantea muchas dudas. Una de ellas, que genera ansiedad en el personal de la salud, el paciente y sus familiares, es la necesidad de hospitalización porque ésta implica exponer a gérmenes intrahospitalarios potencialmente resistentes a un paciente cuyo sistema inmune puede no estar en las mejores condiciones; incluso con un aislamiento óptimo existe el riesgo de adquirir una infección nosocomial. Muchos estudios han tratado de validar métodos para clasificar a los pacientes con fiebre y neutropenia en grupos de diferente riesgo, como fundamento para implementar estrategias de tratamiento selectivo; así se ha abierto la posibilidad de utilizar medidas más conservadoras para el tratamiento de los episodios de bajo riesgo, entre ellas la administración de regímenes orales ambulatorios de antibióticos de amplio espectro; ello sin demeritar la necesidad de aplicar un juicio clínico adecuado, hacer un buen seguimiento y tener acceso a la atención médica inmediata. La neutropenia es una de las consecuencias graves de la quimioterapia para el cáncer, y se ha demostrado que el tratamiento del paciente neutropénico febril con antibióticos intravenosos reduce la mortalidad. La terapia oral podría ser una alternativa aceptable para pacientes bien seleccionados. Ella puede mejorar la calidad de vida de los pacientes con cáncer, evitar las complicaciones asociadas con la terapia intravenosa y disminuir los costos del tratamiento.

    Treatment of patients with neoplasia and febrile neutropenia, as a consequence of chemotherapy, poses many doubts, among them the need for hospitalization, since this implies exposure to potentially resistant nosocomial microorganisms. Even under the best isolation techniques, there may

  12. Dipstick screening for urinary tract infection in febrile infants. (United States)

    Glissmeyer, Eric W; Korgenski, E Kent; Wilkes, Jacob; Schunk, Jeff E; Sheng, Xiaoming; Blaschke, Anne J; Byington, Carrie L


    This study compares the performance of urine dipstick alone with urine microscopy and with both tests combined as a screen for urinary tract infection (UTI) in febrile infants aged 1 to 90 days. We queried the Intermountain Healthcare data warehouse to identify febrile infants with urine dipstick, microscopy, and culture performed between 2004 and 2011. UTI was defined as >50 000 colony-forming units per milliliter of a urinary pathogen. We compared the performance of urine dipstick with unstained microscopy or both tests combined ("combined urinalysis") to identify UTI in infants aged 1 to 90 days. Of 13 030 febrile infants identified, 6394 (49%) had all tests performed and were included in the analysis. Of these, 770 (12%) had UTI. Urine culture results were positive within 24 hours in 83% of UTIs. The negative predictive value (NPV) was >98% for all tests. The combined urinalysis NPV was 99.2% (95% confidence interval: 99.1%-99.3%) and was significantly greater than the dipstick NPV of 98.7% (98.6%-98.8%). The dipstick positive predictive value was significantly greater than combined urinalysis (66.8% [66.2%-67.4%] vs 51.2% [50.6%-51.8%]). These data suggest 8 febrile infants would be predicted to have a false-positive combined urinalysis for every 1 infant with UTI initially missed by dipstick screening. Urine dipstick testing compares favorably with both microscopy and combined urinalysis in febrile infants aged 1 to 90 days. The urine dipstick test may be an adequate stand-alone screen for UTI in febrile infants while awaiting urine culture results. Copyright © 2014 by the American Academy of Pediatrics.

  13. Fluconazole Therapy in Febrile Granulocytopenic Cancer Patients

    International Nuclear Information System (INIS)

    Faris, L.; Al-Shaarawy, I.; Abd Al-Karim, K.; Iskandar, N.A.


    This study was conducted to evaluate the efficacy and safety of fluconazole oral or IV solution in the treatment of systemic fungal infections. Thirty-two febrile granulocytopenic patients with hematologic malignancies were included. They were 21 males (65.6%) and 11 females (34.4%). Their ages ranged between 21.5 to 72 years with a mean age of 44.8 ±13.1 years. Primary diagnosis was Lymphoma in 28 patients (87.5%), Acute Lymphocytic Leukemia in 3 patients (9.4%) and Acute Myeloid Leukemia in 1 patient (3.1%). Duration of fever and neutropenia ranged between 3-20 days and 3-50 days respectively. Fever of unknown origin (FUO)was reported in 25 patients (78.1%). Following initial assessment all patients received broad-spectrum antibiotics. Persistence of fever and neutropenia for 4 days while on broad-spectrum antibiotics necessitated addition of fluconaz-ole. At baseline visit body temperature and leucocyte count measures ranged between 38.2-40.1 degree with a mean of 39.3 degree 110-1800/cm 3 with a mean of 1080/cm 3 respectively. Besides, clinical picture of infection included most commonly cough and expectoration, and moniliasis. Mycological cultures showed positive fungal growth of all collected specimens (100%). All patients were assigned to receive 400-800 mg of fluconazole once daily either orally or parentally. Marked clinical improvement in signs and symptoms of infection was achieved as early as second visit (day-4). Significant reduction in number of growing colonies of fungi was reported by the first follow-up mycological culture (day-8). At final visit (day-14-21) complete clinical cure was achieved in 26 patients (81.3%) and improvement in 4 patients (18.7%). Mycological cultures showed complete eradication of growing colonies in 21 patients (70%) and significant reduction in number of growing colonies in 9 patients (30%). Duration of therapy ranged between 14 and 21 days with a mean of 15 days

  14. Naturally acquired antibodies target the glutamate-rich protein on intact merozoites and predict protection against febrile malaria

    DEFF Research Database (Denmark)

    Kana, Ikhlaq Hussain; Adu, Bright; Tiendrebeogo, Régis Wendpayangde


    febrile malaria. Similarly, GLURP-specific antibodies previously shown to be protective against febrile malaria in this same cohort were significantly associated with OP activity in this study. GLURP-specific antibodies recognized merozoites and also mediated OP activity. Conclusions.: These findings......Background.: Plasmodium species antigens accessible at the time of merozoite release are likely targets of biologically functional antibodies. Methods.: Immunoglobulin G (IgG) antibodies against intact merozoites were quantified in the plasma of Ghanaian children from a longitudinal cohort using...... a novel flow cytometry-based immunofluorescence assay. Functionality of these antibodies, as well as glutamate-rich protein (GLURP)-specific affinity-purified IgG from malaria hyperimmune Liberian adults, was assessed by the opsonic phagocytosis (OP) assay. Results.: Opsonic phagocytosis activity...

  15. The Effects of Poverty on the Mental, Emotional, and Behavioral Health of Children and Youth: Implications for Prevention (United States)

    Yoshikawa, Hirokazu; Aber, J. Lawrence; Beardslee, William R.


    This article considers the implications for prevention science of recent advances in research on family poverty and children's mental, emotional, and behavioral health. First, we describe definitions of poverty and the conceptual and empirical challenges to estimating the causal effects of poverty on children's mental, emotional, and behavioral…

  16. Leadership in the Era of the Trump Presidency: Implications for the Education of American Indian Children and Youth (United States)

    Faircloth, Susan C.


    In this manuscript, I outline what I perceive to be the potential implications of the Trump presidency for the education of American Indian children and youth. In doing so, I argue that failure to provide adequate educational programs and services for American Indian children and youth represents an abrogation of the federal government's trust…


    Directory of Open Access Journals (Sweden)

    Enz P


    Full Text Available El hiperparatiroidismo secundario es uno de los principales disturbios causados por la insuficiencia renal crónica, y la paratohormona es considerada una de las toxinas del sindrome urémico. El sindrome febril prolongado secundario a hiperparatiroidismo primario ya ha sido descripto en la literatura, aunque no lo ha sido aun el inducido por hiperparatiroidismo secundario. En el presente reporte se presenta un caso de eritema nodoso y sindrome febril prolongado asociado a hiperparatiroidismo secundario y que resolvió luego de efectuada una paratiroidectomía subtotal.

  18. [Aetiology and outcomes of potentially serious infections in febrile infants less than 3 months old]. (United States)

    de la Torre, Mercedes; de Lucas, Nieves; Velasco, Roberto; Gómez, Borja; Mintegi, Santiago


    Recent studies have shown changes in the aetiology of serious bacterial infections in febrile infants ≤ 90 days of age. The aim of this study was to describe the current microbiology and outcomes of these infections in Spain. Sub-analysis of a prospective multicentre study focusing on febrile infants of less than 91 days of life, admitted between October 2011 and September 2013 to Emergency Departments of 19 Spanish hospitals, members of the Spanish Paediatric Emergency Research Group of the Spanish Society of Paediatric Emergencies (RISeuP/SPERG). The analysis included 3,401 febrile infants ≤90 days of age with fever without source. There were 896 positive cultures: 766 urine (85.5%), 100 blood (11.2%), 18 cerebrospinal fluid (2%), 10 stool, and 2 umbilical cultures. Among the 3,401 infants included, 784 (23%) were diagnosed with a serious bacterial infection, and 107 of them (3.1%) with an invasive infection. E. coli was the most common pathogen isolated from urine (628; 82%), blood (46; 46%), and cerebrospinal fluid cultures (7; 38.9%), followed by S. agalactiae that was isolated from 24 (24%) blood cultures and 3 (16.7%) cerebrospinal fluid cultures. There were only 2 L. monocytogenes infections. Four children died, and seven had severe complications. Among infants ≤ 90 days of age with fever without source, E. coli was the most common pathogen isolated from urine, blood, and cerebrospinal fluid cultures. Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Measles-mumps-rubella-varicella combination vaccine and the risk of febrile seizures. (United States)

    Klein, Nicola P; Fireman, Bruce; Yih, W Katherine; Lewis, Edwin; Kulldorff, Martin; Ray, Paula; Baxter, Roger; Hambidge, Simon; Nordin, James; Naleway, Allison; Belongia, Edward A; Lieu, Tracy; Baggs, James; Weintraub, Eric


    In February 2008, we alerted the Advisory Committee on Immunization Practices to preliminary evidence of a twofold increased risk of febrile seizures after the combination measles-mumps-rubella-varicella (MMRV) vaccine when compared with separate measles-mumps-rubella (MMR) and varicella vaccines. Now with data on twice as many vaccine recipients, our goal was to reexamine seizure risk after MMRV vaccine. Using 2000-2008 Vaccine Safety Datalink data, we assessed seizures and fever visits among children aged 12 to 23 months after MMRV and separate MMR + varicella vaccines. We compared seizure risk after MMRV vaccine to that after MMR + varicella vaccines by using Poisson regression as well as with supplementary regressions that incorporated chart-review results and self-controlled analyses. MMRV vaccine recipients (83,107) were compared with recipients of MMR + varicella vaccines (376,354). Seizure and fever significantly clustered 7 to 10 days after vaccination with all measles-containing vaccines but not after varicella vaccination alone. Seizure risk during days 7 to 10 was higher after MMRV than after MMR + varicella vaccination (relative risk: 1.98 [95% confidence interval: 1.43-2.73]). Supplementary analyses yielded similar results. The excess risk for febrile seizures 7 to 10 days after MMRV compared with separate MMR + varicella vaccination was 4.3 per 10,000 doses (95% confidence interval: 2.6-5.6). Among 12- to 23-month-olds who received their first dose of measles-containing vaccine, fever and seizure were elevated 7 to 10 days after vaccination. Vaccination with MMRV results in 1 additional febrile seizure for every 2300 doses given instead of separate MMR + varicella vaccines. Providers who recommend MMRV should communicate to parents that it increases the risk of fever and seizure over that already associated with measles-containing vaccines.

  20. [Pharmaceutical analysis and clinical efficacy of Kampo medicine, maoto, extract suppository against pediatric febrile symptoms]. (United States)

    Nishimura, Nobuhiro; Doi, Norio; Uemura, Tomochika; Taketani, Takeshi; Hayashi, George; Kasai, Takeshi; Kanai, Rie; Yamaguchi, Seiji; Iwamoto, Kikuo; Naora, Kohji


    A traditional Chinese herbal medicine, Kampo medicine, maoto, has been widely used in the treatment of febrile symptoms caused by viral infection. This herbal extract granule for oral use, however, is not well accepted by infants or young children due to its unpleasant taste and odor. Therefore, we prepared Kampo medicine, maoto, suppository and investigated the pharmaceutical and clinical efficacy of the suppository. Kampo medicine, maoto, granules were micro-pulverized and homogeneously dispersed into Hosco-H15 to prepare suppositories containing 0.25 to 1.0 g herbal extract by the conventional fusion method. Content of l-ephedrine, an index compound of Kampo medicine, maoto, in the extract granules and suppositories was determined by using a high performance liquid chromatographic method. Physicochemical experiments revealed that the suppository containing 0.5 g herbal extract had the most suitable melting point of 34 degrees C. Contents of l-ephedrine in the suppository were constant, 93-96% of those in the same amount of the extract granules in different three lots. Upper and lower portions of the suppository had the same content of l-ephedrine. The suppository maintained more than 95% of l-ephedrine content through 6 months at 4 degrees C, room temperature and 40 degrees C, although maldistribution of the extract constituent was observed after storage at 40 degrees C. The suppository was administered to 21 pediatric febrile patients at a dose of 1/3 to 2 full pieces depending on their body weight and physical status. Significant reduction (pchildren with viral febrile symptoms without any adverse effects.

  1. Risk factors for febrile urinary tract infection in infants with prenatal hydronephrosis: comprehensive single center analysis. (United States)

    Zareba, Piotr; Lorenzo, Armando J; Braga, Luis H


    We assessed risk factors for urinary tract infection in children with prenatal hydronephrosis We identified 376 infants with prenatal hydronephrosis in an institutional database. The occurrence of febrile urinary tract infection in the first 2 years of life was ascertained by chart review. Febrile urinary tract infection was defined as a positive culture from a catheterized urine specimen in a patient with a fever of 38.0C or greater. Multivariate logistic regression was used to assess gender, circumcision status, hydronephrosis grade, vesicoureteral reflux grade and antibiotic prophylaxis as predictors of the risk of urinary tract infection. Included in analysis were 277 males and 99 females. Hydronephrosis was high grade in 128 infants (34.0%) and vesicoureteral reflux was present in 79 (21.0%). Antibiotic prophylaxis was prescribed in 60.4% of patients, preferentially to females vs males (70.7% vs 56.7%), those with high vs low grade hydronephrosis (70.3% vs 55.2%) and those with vs without vesicoureteral reflux (96.2% vs 50.8%). On multivariate analysis there was an association between high grade hydronephrosis and an increased risk of urinary tract infection (adjusted OR 2.40, 95% CI 1.26-4.56). Females (adjusted OR 3.16, 95% CI 0.98-10.19) and uncircumcised males (adjusted OR 3.63, 95% CI 1.18-11.22) were also at higher risk than circumcised males. Antibiotic prophylaxis was not associated with a decreased risk of urinary tract infection (adjusted OR 0.93, 95% CI 0.45-1.94). High grade hydronephrosis, female gender and uncircumcised status in males are independent risk factors for febrile urinary tract infection in infants with prenatal hydronephrosis. Antibiotic prophylaxis did not reduce the risk of urinary tract infection in the study group. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  2. A study of Taiwanese children's conceptions of and relation to nature: Curricular and policy implications (United States)

    Dai, Amy Hsin-I.

    The present study investigated children's conceptions of and relations to nature. Understanding the factors that influence them was the goal. The study used the Contextual Model of Learning as the theoretical framework to structure the research questions and data analysis to understand children's nature learning in the personal, sociocultural, and physical contexts that change over time. Twelve children aged 5 and 6 were prompted to draw a picture of themselves in nature. They were interviewed about the sources of those ideas and living experiences, and if they thought photographs of scenery were nature. These twelve children's parents also participated in a survey to study the family influence. I used interpretational analysis to seek for common patterns and themes. Scoring rubrics, coaxial comparison, constant comparison, and the theoretical framework were used to triangulate and investigate influential factors of children's ideas of nature. The study showed that children at this age already had developed a basic conception of what is nature, but also need to learn about the role of human beings in nature and the interrelations of nature in order to develop environmental education ideas. Most children also had a positive feeling toward nature. Children's definitions of nature were developed mainly from what parents and grandparents had told them and their firsthand exposure to nature. Only during the weekend did the children's families have time to visit nature. It was found that most parents in this study stated that they were inspired by nature and were very willing to take their children to nature settings. The most visited natural places that were reported visited were parks in the city and the mountains surrounding the city. However, very often parents missed teachable opportunities to make the experiences with nature meaningful to children. Implications of the study apply to curriculum designers, educators, urban planners, and parents. It is recommended

  3. Acute Febrile Illness and Complications Due to Murine Typhus, Texas, USA1,2. (United States)

    Afzal, Zeeshan; Kallumadanda, Sunand; Wang, Feng; Hemmige, Vagish; Musher, Daniel


    Murine typhus occurs relatively commonly in southern Texas, as well as in California. We reviewed records of 90 adults and children in whom murine typhus was diagnosed during a 3-year period in 2 hospitals in southern Texas, USA. Most patients lacked notable comorbidities; all were immunocompetent. Initial signs and symptoms included fever (99%), malaise (82%), headache (77%), fatigue (70%), myalgias (68%), and rash (39%). Complications, often severe, in 28% of patients included bronchiolitis, pneumonia, meningitis, septic shock, cholecystitis, pancreatitis, myositis, and rhabdomyolysis; the last 3 are previously unreported in murine typhus. Low serum albumin and elevated procalcitonin, consistent with bacterial sepsis, were observed in >70% of cases. Rash was more common in children; thrombocytopenia, hyponatremia, elevated hepatic transaminases, and complications were more frequent in adults. Murine typhus should be considered as a diagnostic possibility in cases of acute febrile illness in southern and even in more northern US states.

  4. An outbreak of febrile gastroenteritis associated with corn contaminated by Listeria monocytogenes. (United States)

    Aureli, P; Fiorucci, G C; Caroli, D; Marchiaro, G; Novara, O; Leone, L; Salmaso, S


    On May 21, 1997, numerous cases of febrile gastrointestinal illness were reported among the students and staff of two primary schools in northern Italy, all of whom had eaten at cafeterias served by the same caterer. We interviewed people who ate at the cafeterias about symptoms and foods consumed on May 20. There were no samples of foods left at the cafeterias, but we tested routine samples taken on May 20 by the caterer and environmental specimens at the catering plant. The hospitalized patients were tested for common enteropathogens and toxins. Of the 2189 persons interviewed (82 percent of those exposed), 1566 (72 percent) reported symptoms; of these, 292 (19 percent) were hospitalized. Among samples obtained from hospitalized patients, all but two of the stool specimens and all blood specimens were negative for common enteropathogens. Listeria monocytogenes was isolated from one blood specimen and from 123 of the 141 stool specimens. Consumption of a cold salad of corn and tuna was associated with the development of symptoms (relative risk, 6.19; 95 percent confidence interval, 4.81 to 7.98; Pcaterer's sample of the salad and from environmental specimens collected from the catering plant. All listeria isolates were serotype 4b and were found to be identical on DNA analysis. Experimental contamination of sterile samples of the implicated foods showed that L. monocytogenes grew on corn when kept for at least 10 hours at 25 degrees C. Food-borne infection with L. monocytogenes can cause febrile illness with gastroenteritis in immunocompetent persons.

  5. Reading and Reinterpreting Picture Books on Children's Television: Implications for Young Children's Narrative Literacy (United States)

    Zhang, Kunkun; Djonov, Emilia; Torr, Jane


    "Bookaboo" is a television programme aiming to promote literacy and reading among young children. In each episode, a celebrity reads a book to Bookaboo, a dog who plays the drums in a rock band, in order to help him overcome stage fright. Using the episode featuring the picture book (Cowell and Layton in "That Rabbit Belongs to…

  6. An Overview of Existing Research about Children's Singing and the Implications for Teaching Children to Sing (United States)

    Hedden, Debra


    The purpose of this investigation was to identify the findings of the studies devoted to the child voice, most of which have occurred in the past 25 years, and to present a synthesis of these findings with respect to the pedagogy, or art and science, of teaching children to sing. The data suggest that a philosophical disparity exists about…

  7. A review of cognitive impairments in children with intellectual disabilities: Implications for cognitive behaviour therapy. (United States)

    Hronis, Anastasia; Roberts, Lynette; Kneebone, Ian I


    Nearly half of children with intellectual disability (ID) have comorbid affective disorders. These problems are chronic if left untreated and can significantly impact upon future vocational, educational, and social opportunities. Despite this, there is a paucity of research into effective treatments for this population. Notably, one of the most supported of psychological therapies, cognitive behaviour therapy (CBT), remains largely uninvestigated in children with ID. The current review considers the neuropsychological profile of children and adolescents with mild to moderate ID, with a view to informing how CBT might best be adapted for children and adolescents with ID. Narrative review of literature considering the neuropsychological profiles of children and adolescents with ID, with specific focus upon attention, memory, learning, executive functioning, and communication. Studies were identified through SCOPUS, PsycINFO, and PubMed databases, using combinations of the key words 'intellectual disability', 'learning disability', 'neuropsychology', 'attention', 'learning', 'memory', 'executive function', 'language', and 'reading'. Children with ID have significant deficits in attention, learning, memory, executive functions, and language. These deficits are likely to have a negative impact upon engagement in CBT. Suggestions for adapting therapy to accommodate these wide ranging deficits are proposed. There are multiple cognitive factors which need to be considered when modifying CBT for children who have ID. Furthermore, research is required to test whether CBT so modified is effective in this population. Clinical implications Effective ways of providing cognitive behavioural therapy (CBT) to children with intellectual disability (ID) is unclear. This study provides a framework of potential adaptations for clinical practice As rates of mental illness for children with intellectual disability are high, and rates of treatment provision low, it is hoped that the

  8. Evaluation of new American Academy of Pediatrics guideline for febrile urinary tract infection (United States)

    Choi, Da Min; Heo, Tae Hoon; Yoo, Kee Hwan


    Purpose To evaluate the practical applications of the diagnosis algorithms recommended by the American Academy of Pediatrics urinary tract infection (UTI) guideline. Methods We retrospectively reviewed the medical records of febrile UTI patients aged between 2 and 24 months. The patients were divided into 3 groups: group I (patients with positive urine culture and urinalysis findings), group II (those with positive urine culture but negative urinalysis findings), and group III (those with negative urine culture but positive urinalysis findings). Clinical, laboratory, and imaging results were analyzed and compared between the groups. Results A total of 300 children were enrolled. The serum C-reactive protein level was lower in children in group II than in those in groups I and III (P<0.05). Children in group I showed a higher frequency of hydronephrosis than those in groups II and III (P<0.05). However, the frequencies of acute pyelonephritis (APN), vesicoureteral reflux (VUR), renal scar, and UTI recurrence were not different between the groups. In group I, recurrence of UTI and presence of APN were associated with the incidence of VUR (recurrence vs. no recurrence: 40% vs.11.4%; APN vs. no APN: 23.3% vs. 9.2%; P<0.05). The incidence of VUR and APN was not related to the presence of hydronephrosis. Conclusion UTI in febrile children cannot be ruled out solely on the basis of positive urinalysis or urine culture findings. Recurrence of UTI and presence of APN may be reasonable indicators of the presence of VUR. PMID:26512260

  9. Children's understanding of the selling versus persuasive intent of junk food advertising: implications for regulation. (United States)

    Carter, Owen B J; Patterson, Lisa J; Donovan, Robert J; Ewing, Michael T; Roberts, Clare M


    Evidence suggests that until 8 years of age most children are cognitively incapable of appreciating the commercial purpose of television advertising and are particularly vulnerable to its persuasive techniques. After this age most children begin to describe the 'selling' intent of advertising and it is widely assumed this equips them with sufficient cognitive defences to protect against advertisers' persuasion attempts. However, much of the previous literature has been criticised for failing to differentiate between children's awareness of 'selling' versus 'persuasive' intent, the latter representing a more sophisticated understanding and superior cognitive defence. Unfortunately there is little literature to suggest at what age awareness of 'persuasive intent' emerges; our aim was to address this important issue. Children (n = 594) were recruited from each grade from Pre-primary (4-5 years) to Grade 7 (11-12 years) from ten primary schools in Perth, Western Australia and exposed to a McDonald's television advertisement. Understanding the purpose of television advertising was assessed both nonverbally (picture indication) and verbally (small discussion groups of 3-4), with particular distinction made between selling versus persuasive intent. Consistent with previous literature, a majority of children described the 'selling' intent of television advertising by 7-8 years both nonverbally and verbally, increasing to 90% by 11-12 years. Awareness of 'persuasive' intent emerged slowly as a function of age but even by our oldest age-group was only 40%. Vulnerability to television advertising may persist until children are far older than previously thought. These findings have important implications regarding the debate surrounding regulation of junk food (and other) advertising aimed at children. Copyright © 2011 Elsevier Ltd. All rights reserved.

  10. Cost of dengue and other febrile illnesses to households in rural Cambodia: a prospective community-based case-control study

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    Margolis Harold S


    Full Text Available Abstract Background The average annual reported dengue incidence in Cambodia is 3.3/1,000 among children Methods In 2006, active fever surveillance was conducted among a cohort of 6,694 children aged ≤ 15 years in 16 villages in Kampong Cham province, Cambodia. Subsequently, a case-control study was performed by individually assigning one non-dengue febrile control from the cohort to each laboratory-confirmed dengue case. Parents of cases and controls were interviewed using a standardized questionnaire to determine household-level, illness-related expenditures for medical and non-medical costs, and estimated income loss (see Additional file 1. The household socio-economic status was determined and its possible association with health seeking behaviour and the ability to pay for the costs of a febrile illness. Additional File 1 2006 cost study survey questionnaire, Cambodia. the questionnaire represents the data collection instrument that was developed and used during the present study. Click here for file Results Between September and November 2006, a total of 60 household heads were interviewed: 30 with dengue-positive and 30 with dengue-negative febrile children. Mean total dengue-related costs did not differ from those of other febrile illnesses (31.5 vs. 27.2 US$, p = 0.44. Hospitalization almost tripled the costs of dengue (from 14.3 to 40.1 US$ and doubled the costs of other febrile illnesses (from 17.0 to 36.2 US$. To finance the cost of a febrile illness, 67% of households incurred an average debt of 23.5 US$ and higher debt was associated with hospitalization compared to outpatient treatment (US$ 23.1 vs. US$ 4.5, p Conclusion In Cambodia, dengue and other febrile illnesses pose a financial burden to households. A possible reason for a lower rate of hospitalization among children from poor households could be the burden of higher illness-related costs and debts.

  11. Microscopy 'AIDS' in diagnosing a febrile infant | Crous | Southern ...

    African Journals Online (AJOL)

    Southern African Journal of HIV Medicine. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 12, No 3 (2011) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Microscopy 'AIDS' in diagnosing a febrile infant.

  12. Evaluation of febrile neutropenic patients hospitalized in a hematology clinic

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    Mücahit Görük


    Conclusions: Febrile neutropenia is still a problem in patients with hematological malignancies. The documentation of the flora and detection of causative agents of infections in each unit would help to decide appropriate empirical therapy. Infection control procedures should be applied for preventing infections and transmissions.

  13. Two cases of Kawasaki disease presented with acute febrile jaundice. (United States)

    Kaman, Ayşe; Aydın-Teke, Türkan; Gayretli-Aydın, Zeynep Gökçe; Öz, Fatma Nur; Metin-Akcan, Özge; Eriş, Deniz; Tanır, Gönül


    Kawasaki disease is an acute, systemic vasculitis of unknown etiology. Although gastrointestinal involvement does not belong to the classic diagnostic criteria; diarrhea, abdominal pain, hepatic dysfunction, hydrops of gallbladder, and acute febrile cholestatic jaundice are reported in patients with Kawasaki disease. We describe here two cases presented with fever, and acute jaundice as initial features of Kawasaki disease.

  14. epilepsy following simple febrile seizure in a rural community in ...

    African Journals Online (AJOL)


    Dec 12, 2011 ... family history of epilepsy did not significantly influence the development of later epilepsy X2 ... following a single simple febrile seizure. MATERIALS ANd ... If the parent did not witness the seizure, an adult who witnessed the ...


    NARCIS (Netherlands)



    The connection between hippocampal sclerosis and childhood febrile seizures (CFS) is a contentious issue in the study of epilepsy. We investigated 107 patients with drug-resistant epilepsy by high-resolution volumetric magnetic resonance imaging (MRI). 20 had a history of CFS, 45 had focal (26) or

  16. Health care autonomy in children with chronic conditions: implications for self-care and family management. (United States)

    Beacham, Barbara L; Deatrick, Janet A


    Health care autonomy typically occurs during late adolescence but health care providers and families often expect children with chronic health conditions to master self-care earlier. Few studies have examined the development of health care autonomy as it pertains to self-care and family management. This review links the 3 concepts and discusses the implications for families and health care providers. Case studies are provided as exemplars to highlight areas where intervention and research is needed. Copyright © 2013 Elsevier Inc. All rights reserved.

  17. Secondary Infections in Cancer Patients with Febrile Neutropenia

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    Alpay Azap


    Full Text Available OBJECTIVE: Patients with neutropenia due to cancer chemotherapy are prone to severe infections. Cancer patients can experience >1 infectious episode during the same period of neutropenia. This study aimed to determine the etiological and clinical characteristics of secondary infectious episodes in cancer patients with febrile neutropenia and to identify the factors associated with the risk of secondary infectious episodes. METHODS: All cancer patients that received antineoplastic chemotherapy at Ankara University, School of Medicine, Department of Hematology between May 2004 and May 2005 and developed neutropenia were included in the study. Data were collected using survey forms that were completed during routine infectious diseases consultation visits. Categorical data were analyzed using the chi-square test, whereas Student’s t-test was used for continuous variables. Multivariate logistic regression analysis was performed to identify independent predictors of secondary infections (SIs. RESULTS: SIs were observed during 138 (53% of 259 febrile neutropenic episodes. Of the 138 episodes, 89 (64.5% occurred in male patients with a mean age of 40.9 years (range: 17-76 years. In total, 80% of the SIs were clinically or microbiologically documented. Factors on d 4 of the initial febrile episode were analyzed via a logistic regression model. The presence of a central intravenous catheter (OR: 3.01; P < 0.001, acute myeloid leukemia (AML as the underlying disease (OR: 2.12; P = 0.008, diarrhea (OR: 4.59; P = 0.005, and invasive aspergillosis (IA during the initial febrile episode (OR: 3.96; P = 0.009 were statistically significant risk factors for SIs. CONCLUSION: Among the cancer patients with neutropenia in the present study, AML as the underlying disease, the presence of a central venous catheter, diarrhea, and IA during the initial febrile episode were risk factors for the development of SIs.

  18. Circulating Chemokine Levels in Febrile Infants With Serious Bacterial Infections

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    Hsiu-Lin Chen


    Full Text Available Early diagnosis of serious bacterial infections (SBI in febrile young infants based on clinical symptoms and signs is difficult. This study aimed to evaluate the diagnostic values of circulating chemokines and C-reactive protein (CRP levels in febrile young infants < 3 months of age with suspected SBI. We enrolled 43 febrile young infants < 3 months of age with clinically suspected SBI who were admitted to the neonatal intensive care unit or complete nursing unit of the pediatric department of Kaohsiung Medical University Hospital between December 2006 and July 2007. Blood was drawn from the patients at admission, and complete blood counts, plasma levels of CRP, granulocyte colony-stimulating factor (G-CSF, and chemokines, including interleukin-8 (IL-8, macrophage inflammatory protein-1α, macrophage inflammatory protein-1β, monokine induced by interferon-γ, and monocyte chemotactic protein-1 were measured. Patients’ symptoms and signs, length of hospital stay, main diagnosis, and results of routine blood tests and microbiological culture results were recorded. Twenty-six infants (60.5% were diagnosed with SBI, while 17 (39.5% had no evidence of SBI based on the results of bacterial cultures. CRP, IL-8 and G-CSF levels were significantly higher in the infants with SBI than in those without SBI. Plasma levels of other chemokines were not significantly different between the groups. The area under the receiver-operating characteristic (ROC curve for differentiating between the presence and absence of SBI was 0.79 for CRP level. Diagnostic accuracy was further improved by combining CRP and IL-8, when the area under the ROC curve increased to 0.91. CRP levels were superior to IL-8 and G-CSF levels for predicting SBI in febrile infants at initial survey. IL-8 levels could be used as an additional diagnostic tool in the initial evaluation of febrile young infants, allowing clinicians to treat these patients more appropriately.

  19. Original Research Clinical outcomes among febrile children aged 2 ...

    African Journals Online (AJOL)

    diagnostic test (mRDT) or microscopy.1 As a result, mRDTs are now being ... guidelines. In 2014, the district implemented a pilot project ... Details of the pilot have been reported .... feeding well), still sick (defined as persistence or worsening of.

  20. malaria parasitaemia among febrile children infected with human

    African Journals Online (AJOL)


    Jan 1, 2014 ... PhD, Department of Behavioural Sciences (Biostat), F. Esamai, MBChB, MMed, MPH, PhD, Department of Child .... The study seeks to answer the question is malaria ... stored on a password-protected study computer for.

  1. Empiric antibiotic prescription among febrile under-five Children in ...

    African Journals Online (AJOL)

    limiting viral infection and therefore, would not require antibiotics. Over prescription of antibiotics increases antibiotics exposure and development of resistance among patients. There is need to evaluate empiric antibiotic prescription in order to limit ...

  2. Home Management of Febrile Children Under-Five Years in ...

    African Journals Online (AJOL)

    The self-administered drugs were antimalarials 45%, antipyretics 34%, antidiarrhoeals 26%, cough syrups 23% and analgesics 17%. The drugs used were obtained from drug stores (68%) while left-overs from previous supplies accounted for 15%. Univariate analysis revealed that diarrhoeal diseases, shortness of breath, ...

  3. Factors associated with bacteraemia in febrile, non- neonatal children

    African Journals Online (AJOL)

    would also assist in rationalising antibiotic use, so as to prevent overprescription of broad-spectrum antibiotics. ... deemed to be likely contaminants (coagulase-. negativeStaphylococcus and Bacillus spp.).Blood cultures .... References. 1. Graneto JW. Emergent management of pediatric patients with fever. 30 January 2014.

  4. Serious bacterial infections in febrile young children: Lack of value ...

    African Journals Online (AJOL)

    avoidance of unnecessary antibiotic use should also be considered important in this time of emerging ... In addition, the avoidance of unnecessary antibiotics is important in this time of emerging ..... conjugate vaccine era. Acad Emerg Med ...

  5. Factors associated with bacteraemia in febrile, non- neonatal children

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    38.5°C or 2SD (standard deviations) above normal for age; (iii) respiratory rate >2SD above ... Immune function starts to deteriorate when weight loss exceeds ..... sickle cell anaemia are at higher risk of bacterial infection.

  6. Anatomic distribution of renal artery stenosis in children: implications for imaging. (United States)

    Vo, Nghia J; Hammelman, Ben D; Racadio, Judy M; Strife, C Frederic; Johnson, Neil D; Racadio, John M


    Renal artery stenosis (RAS) causes significant hypertension in children. Frequently, pediatric RAS occurs with systemic disorders. In these cases, stenoses are often complex and/or include long segments. We believed that hypertensive children without comorbid conditions had a different lesion distribution and that the difference might have implications for imaging and treatment. To identify locations of RAS lesions in these hypertensive children without comorbid conditions. Patients who had renal angiography for hypertension from 1993 to 2005 were identified. Patients with systemic disorders, renovascular surgery, or normal angiograms were excluded. The angiograms of the remaining patients were reviewed for number, type, and location of stenoses. Eighty-seven patients underwent renal angiography for hypertension; 30 were excluded for comorbid conditions. Twenty-one of the remaining 57 patients had abnormal angiograms; 24 stenoses were identified in those patients. All were focal and distributed as follows: 6 (25%) main renal artery, 12 (50%) 2nd order branch, 3 (12.5%) 3rd order branch, and 3 (12.5%) accessory renal artery. Hypertensive children without comorbid conditions who have RAS usually have single, focal branch artery stenoses. This distribution supports angiography in these patients because of its superior sensitivity in detecting branch vessel disease and its therapeutic role in percutaneous transluminal renal angioplasty.

  7. Anatomic distribution of renal artery stenosis in children: implications for imaging

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    Vo, Nghia J.; Racadio, Judy M.; Johnson, Neil D. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Division of Pediatric Interventional Radiology, Cincinnati, OH (United States); Hammelman, Ben D. [University of Cincinnati College of Medicine, Cincinnati, OH (United States); Strife, C.F. [Cincinnati Children' s Hospital Medical Center, Department of Pediatrics, Division of Nephrology and Hypertension, Cincinnati, OH (United States); Racadio, John M. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Division of Pediatric Interventional Radiology, Cincinnati, OH (United States); Cincinnati Children' s Hospital, Department of Radiology, Cincinnati, OH (United States)


    Renal artery stenosis (RAS) causes significant hypertension in children. Frequently, pediatric RAS occurs with systemic disorders. In these cases, stenoses are often complex and/or include long segments. We believed that hypertensive children without comorbid conditions had a different lesion distribution and that the difference might have implications for imaging and treatment. To identify locations of RAS lesions in these hypertensive children without comorbid conditions. Patients who had renal angiography for hypertension from 1993 to 2005 were identified. Patients with systemic disorders, renovascular surgery, or normal angiograms were excluded. The angiograms of the remaining patients were reviewed for number, type, and location of stenoses. Eighty-seven patients underwent renal angiography for hypertension; 30 were excluded for comorbid conditions. Twenty-one of the remaining 57 patients had abnormal angiograms; 24 stenoses were identified in those patients. All were focal and distributed as follows: 6 (25%) main renal artery, 12 (50%) 2nd order branch, 3 (12.5%) 3rd order branch, and 3 (12.5%) accessory renal artery. Hypertensive children without comorbid conditions who have RAS usually have single, focal branch artery stenoses. This distribution supports angiography in these patients because of its superior sensitivity in detecting branch vessel disease and its therapeutic role in percutaneous transluminal renal angioplasty. (orig.)

  8. Anatomic distribution of renal artery stenosis in children: implications for imaging

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    Vo, Nghia J.; Racadio, Judy M.; Johnson, Neil D.; Hammelman, Ben D.; Strife, C.F.; Racadio, John M.


    Renal artery stenosis (RAS) causes significant hypertension in children. Frequently, pediatric RAS occurs with systemic disorders. In these cases, stenoses are often complex and/or include long segments. We believed that hypertensive children without comorbid conditions had a different lesion distribution and that the difference might have implications for imaging and treatment. To identify locations of RAS lesions in these hypertensive children without comorbid conditions. Patients who had renal angiography for hypertension from 1993 to 2005 were identified. Patients with systemic disorders, renovascular surgery, or normal angiograms were excluded. The angiograms of the remaining patients were reviewed for number, type, and location of stenoses. Eighty-seven patients underwent renal angiography for hypertension; 30 were excluded for comorbid conditions. Twenty-one of the remaining 57 patients had abnormal angiograms; 24 stenoses were identified in those patients. All were focal and distributed as follows: 6 (25%) main renal artery, 12 (50%) 2nd order branch, 3 (12.5%) 3rd order branch, and 3 (12.5%) accessory renal artery. Hypertensive children without comorbid conditions who have RAS usually have single, focal branch artery stenoses. This distribution supports angiography in these patients because of its superior sensitivity in detecting branch vessel disease and its therapeutic role in percutaneous transluminal renal angioplasty. (orig.)

  9. The Dynamics of Intra-Family Relationships During Incarceration and the Implications for Children of Incarcerated Parents. (United States)

    Song, Hyojong; Woo, Youngki; Lee, Heeuk D; Cochran, John K


    The current study examines effects of changes in intra-family relationships after parental incarceration on internalizing behaviors of the children of incarcerated parents. Using data from a sample of 249 incarcerated parents with minor children in South Korea, the present study found that perceived degradation of family relationships among inmate parents, their non-incarcerated spouses, and children was a significant risk factor of internalizing behaviors of children of incarcerated parents. The current study also found that inmate parents who had more frequent family contact were more likely to perceive improvements of all forms of intra-family relationships during incarceration. The implications of these findings are discussed.

  10. Factors affecting computer mouse use for young children: implications for AAC. (United States)

    Costigan, F Aileen; Light, Janice C; Newell, Karl M


    More than 12% of preschoolers receiving special education services have complex communication needs, including increasing numbers of children who do not have significant motor impairments (e.g., children with autism spectrum disorders, Down syndrome, etc.). In order to meet their diverse communication needs (e.g., face-to-face, written, Internet, telecommunication), these children may use mainstream technologies accessed via the mouse, yet little is known about factors that affect the mouse performance of young children. This study used a mixed factorial design to investigate the effects of age, target size, and angle of approach on accuracy and time required for accurate target selection with a mouse for 20 3-year-old and 20 4-year-old children. The 4-year-olds were generally more accurate and faster than the 3-year-olds. Target size and angle mediated differences in performance within age groups. The 3-year-olds were more accurate and faster in selecting the medium and large targets relative to the small target, were faster in selecting the large relative to the medium target, and were faster in selecting targets along the vertical relative to the diagonal angle. The 4-year-olds were faster in selecting the medium and large targets relative to the small target. Implications for improving access to AAC include the preliminary suggestion of age-related threshold target sizes that support sufficient accuracy, the possibility of efficiency benefits when target size is increased up to an age-related threshold, and identification of the potential utility of the vertical angle as a context for training navigational input device use.

  11. Poverty and Children Health Care: Implication for Teaching and Learning of Science and Technology

    Directory of Open Access Journals (Sweden)

    L.A. Keswet


    Full Text Available This paper reviewed literature on poverty and children’s health care and its implication for teaching and learning of science and technology. It looked at the importance of education and its achievements to the Nigerian citizens. The paper was restricted to the differences seen in the education of the poor children across generations. The paper also identified how poverty and ill health can be destructive to the teaching and learning of science and technology. Poor and healthy children all face a lot of challenges relating to academic success. Some of these challenges could include chronic stress, exposure to lead and other dangerous substances. The importance of science among other things is not only to respond to the needs of the society, but also to be used by all citizens. The study presented some important strategies for reducing poverty and ill health in children by increasing social assistance to poor families, subsidy in housing and more attention to healthcare centers. It suggested among others, that government should sought advice from local, state and federal government and international researchers on how to reduce the menace in the country.

  12. Delaware Longitudinal Study of Fraction Learning: Implications for Helping Children With Mathematics Difficulties. (United States)

    Jordan, Nancy C; Resnick, Ilyse; Rodrigues, Jessica; Hansen, Nicole; Dyson, Nancy

    The goal of the present article is to synthesize findings to date from the Delaware Longitudinal Study of Fraction Learning. The study followed a large cohort of children ( N = 536) between Grades 3 and 6. The findings showed that many students, especially those with diagnosed learning disabilities, made minimal growth in fraction knowledge and that some showed only a basic grasp of the meaning of a fraction even after several years of instruction. Children with low growth in fraction knowledge during the intermediate grades were much more likely to fail to meet state standards on a broad mathematics measure at the end of Grade 6. Although a range of general and mathematics-specific competencies predicted fraction outcomes, the ability to estimate numerical magnitudes on a number line was a uniquely important marker of fraction success. Many children with mathematics difficulties have deep-seated problems related to whole number magnitude representations that are complicated by the introduction of fractions into the curriculum. Implications for helping students with mathematics difficulties are discussed.

  13. Children with co-occurring anxiety and externalizing disorders: family risks and implications for competence. (United States)

    Yoo, Joan P; Brown, Pamela J; Luthar, Suniya S


    This study used data from 340 mother-child dyads to examine characteristics of children with co-occurring diagnoses of anxiety and externalizing disorders and compared them with children with a sole diagnosis or no diagnosis. Comparisons were made using 4 child-diagnostic groups: anxiety-only, externalizing-only, co-occurrence, and no-problem groups. Most mothers were characterized by low income and histories of psychiatric diagnoses during the child's lifetime. Analyses using multinomial logistic regressions found the incidence of co-occurring childhood disorders to be significantly linked with maternal affective/anxiety disorders during the child's lifetime. In exploring implications for developmental competence, we found the co-occurrence group to have the lowest level of adaptive functioning among the 4 groups, faring significantly worse than the no-problem group on both academic achievement and intelligence as assessed by standardized tests. Findings underscore the importance of considering co-occurring behavior problems as a distinct phenomenon when examining children's developmental outcomes. (c) 2009 APA, all rights reserved.

  14. Management of acute colorectal diseases in febrile neutropenic patients

    Directory of Open Access Journals (Sweden)

    Camila Perazzoli


    Full Text Available Patients with hematologic malignancies are susceptible to serious complications due to immunosuppression. Neutropenic-related infection is one of the major causes of morbidity and mortality in this group of diseases. Febrile neutropenia is a common complication of the hematologic neoplasm itself or chemotherapy, and has worse prognosis if prolonged (lasting more than 7 days or severe (neutrophil count below 500 cells per μL. Among the usual sites of infection, we highlight the neutropenic enterocolitis and perianal infection as gastrointestinal complications of greater interest to the colorectal surgeon. Although most cases respond to conservative treatment, a portion of patients will need surgery for complete recovery. Resumo: Os pacientes com neoplasias hematológicas estão sujeitos a uma séria de complicações devido à imunossupressão. Infecção é umas das principais causas de morbidade e mortalidade nesse grupo de doenças. A neutropenia febril é uma complicação frequente da própria doença onco-hematológica ou da quimioterapia, e apresenta pior prognóstico se prolongada (duração acima de 7 dias ou severa (contagem de neutrófilos inferior a 500 células por microlitro. Dentre os focos de infecção mais comuns destacamos a enterocolite neutropênica e a infecção perianal como complicações de maior interesse para o cirurgião colorretal. Apesar de grande parte dos casos apresentar boa resposta ao tratamento conservador, uma parcela de pacientes necessitará de cirurgia para completa recuperação. Keywords: Febrile neutropenia, Typhlitis, Anal canal, Palavras-chave: Neutropenia febril, Tiflite, Canal anal

  15. Investigating febrile UTI in infants: is a cystogram necessary? (United States)

    Soccorso, G; Wagstaff, J; Blakey, K; Moss, G D; Broadley, P; Roberts, J P; Godbole, P


    Current imaging recommendations for investigating any infantile febrile urinary tract infection (UTI) are ultrasound scan (US), micturating cystourethrogram (MCUG) and dimercaptosuccinic acid (DMSA) scan. The aim of this retrospective cohort study was to determine the need and indications for MCUG in the investigation of a first febrile infantile UTI, as doubts have been raised over its benefit. Information on 427 infants who had undergone US, MCUG and DMSA following a first febrile UTI was prospectively recorded. The infants were divided into two groups: A (354) with normal renal US and B (73) with abnormal US. DMSA findings were correlated with findings on MCUG. Main outcome measures were incidence of recurrent UTIs, change in management or intervention as a result of MCUG, and outcome at discharge. Only 21/354 (6%) infants in Group A had both scarring on DMSA and vesicoureteric reflux (VUR), predominantly low-grade on MCUG. In Group B (abnormal US), 23/73 (32%) had scarring on DMSA and vesicoureteric reflux, predominantly high grade on MCUG. Of the infants with non-scarred kidneys, 73% had dilating reflux. Successful conservative treatment was performed in 423 infants, and 4 infants in Group B required surgery. We recommend US and DMSA in all infantile febrile UTI cases. Where US is normal, MCUG should be reserved for those cases with abnormal DMSA. Where US is abnormal, MCUG should be performed irrespective of findings on DMSA scan. A randomized prospective study is necessary to evaluate this further. Copyright © 2009 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  16. Young Chinese children's beliefs about the implications of subtypes of social withdrawal: A first look at social avoidance. (United States)

    Ding, Xuechen; Coplan, Robert J; Sang, Biao; Liu, Junsheng; Pan, Tingting; Cheng, Chen


    The goal of this study was to examine young Chinese children's beliefs about the implications of different subtypes of social withdrawal (e.g., shyness, unsociability), including for the first time, social avoidance. Participants were 133 children in kindergarten (n = 58, Mage  = 70.85 months) and grade 1 (n = 75, Mage  = 83.49 months). Children were presented with vignettes describing hypothetical peers displaying shy, unsociable, avoidant, and socially competent behaviours and were then asked a series of questions to assess their beliefs about the implications of these different behaviours. Young children made distinctions between social withdrawal subtypes in terms of underlying motivations and emotions. Children also appeared to hold differential beliefs about the implications of different forms of social withdrawal: Of note, they anticipated that socially avoidant peers would experience the most negative outcomes. These findings provide some of the first evidence to suggest that social avoidance represents a distinct form of social withdrawal among young Chinese children. Results are discussed in terms of the importance of distinguishing between different subtypes of social withdrawal in Chinese culture. © 2015 The British Psychological Society.

  17. Causes of non-malarial febrile illness in outpatients in Tanzania. (United States)

    Hildenwall, Helena; Amos, Ben; Mtove, George; Muro, Florida; Cederlund, Kerstin; Reyburn, Hugh


    In sub-Saharan Africa, the use of malaria rapid diagnostic tests (mRDT) has raised awareness of alternative fever causes in children but few studies have included adults. To address this gap, we conducted a study of mRDT-negative fever aetiologies among children and adults in Tanzania. A total of 1028 patients aged 3 months to 50 years with a febrile illness and negative mRDT were enrolled from a Tanzanian hospital outpatient department. All had a physical examination and cultures from blood, nasopharynx/throat and urine. Patients were followed on Days 7 and 14 and children meeting WHO criteria for pneumonia were followed on Day 2 with chest radiology. Respiratory symptoms were the most frequent presenting complaint, reported by 20.3% of adults and 64.0% (339/530) of children. Of 38 X-rayed children meeting WHO pneumonia criteria, 47.4% had a normal X-ray. Overall, only 1.3% of 1028 blood cultures were positive. Salmonella typhi was the most prevalent pathogen isolated (7/13, 53.8%) and S. typhi patients reported fever for a median of 7 days (range 2-14). Children with bacteraemia did not present with WHO symptoms requiring antibiotic treatment. Young children and adults had similar prevalences of positive urine cultures (24/428 and 29/498, respectively). Few outpatient fevers are caused by blood stream bacterial infection, and most adult bacteraemia would be identified by current clinical guidelines although paediatric bacteraemia may be more difficult to diagnose. While pneumonia may be overdiagnosed, urinary tract infection was relatively common. Our results emphasise the difficulty in identifying African children in need of antibiotics among the majority who do not. © 2015 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

  18. Informed consent instead of assent is appropriate in children from the age of twelve: Policy implications of new findings on children's competence to consent to clinical research. (United States)

    Hein, Irma M; De Vries, Martine C; Troost, Pieter W; Meynen, Gerben; Van Goudoever, Johannes B; Lindauer, Ramón J L


    For many decades, the debate on children's competence to give informed consent in medical settings concentrated on ethical and legal aspects, with little empirical underpinnings. Recently, data from empirical research became available to advance the discussion. It was shown that children's competence to consent to clinical research could be accurately assessed by the modified MacArthur Competence Assessment Tool for Clinical Research. Age limits for children to be deemed competent to decide on research participation have been studied: generally children of 11.2 years and above were decision-making competent, while children of 9.6 years and younger were not. Age was pointed out to be the key determining factor in children's competence. In this article we reflect on policy implications of these findings, considering legal, ethical, developmental and clinical perspectives. Although assessment of children's competence has a normative character, ethics, law and clinical practice can benefit from research data. The findings may help to do justice to the capacities children possess and challenges they may face when deciding about treatment and research options. We discuss advantages and drawbacks of standardized competence assessment in children on a case-by-case basis compared to application of a fixed age limit, and conclude that a selective implementation of case-by-case competence assessment in specific populations is preferable. We recommend the implementation of age limits based on empirical evidence. Furthermore, we elaborate on a suitable model for informed consent involving children and parents that would do justice to developmental aspects of children and the specific characteristics of the parent-child dyad. Previous research outcomes showed that children's medical decision-making capacities could be operationalized into a standardized assessment instrument. Recommendations for policies include a dual consent procedure, including both child as well as parents



    Dr. Gangadhar Rao Gundapu; M. Bhavani; Myle Akshay Kiran; Naveen Kumar Bathula; Dr. Ashok kumar


    To observe the management and treatment of febrile seizures in children that is to prevent the condition from becoming worse and to prevent it from causing other complications. A Perform was designed to collect data related to the patient’s treatment . when patients are administration of drugs then we(Doctor of pharmacy) identified new adverse drug reactions like drowsiness, vomiting etc. and also identified new side effects due to antiepiliptic drugs in piadiatric patients with seizures li...

  20. Acquisition of Picture Exchange-Based vs. Signed Mands and Implications to Teach Functional Communication Skills to Children with Autism (United States)

    Nam, Sang S.; Hwang, Young S.


    A literature review was conducted to describe important concepts involved in functional analysis of verbal behavior as well as to evaluate empirical research findings on acquisition of picture exchange-based vs. signed mands to suggest instructional implications for teachers and therapists to teach functional communication skills to children with…

  1. Hospital readmission after management of appendicitis at freestanding children's hospitals: contemporary trends and financial implications. (United States)

    Rice-Townsend, Samuel; Hall, Matthew; Barnes, Jeff N; Baxter, Jessica K; Rangel, Shawn J


    The purpose of this study was to characterize epidemiologic trends and cost implications of hospital readmission after treatment of pediatric appendicitis. We conducted a 5-year retrospective cohort analysis of 30-day readmission rates for 52,054 patients admitted with appendicitis at 38 children's hospitals participating in the Pediatric Health Information System database. Patients were categorized as "uncomplicated" (postoperative length of stay [LOS] ≤ 2 days) or "complicated" (LOS ≥ 3 days and ≥ 4 consecutive days of antibiotics) and analyzed for demographic data, treatment received during the index admission, readmission rates, and excess LOS and hospital-related costs attributable to readmission encounters. The aggregate 30-day readmission rate was 8.7%, and this varied significantly by disease severity and management approach (uncomplicated appendectomy, 5.6%; complicated appendectomy, 12.8%; drainage, 22.6%; antibiotics only, 24.6%; P management approach (uncomplicated appendectomy, $1946 [31% relative increase]; complicated appendectomy, $6524 [53% increase]; drainage, $6827 [48% increase]; antibiotics only, $5835 [58% increase]; P < .0001). In freestanding children's hospitals, readmission after treatment of pediatric appendicitis is a relatively common and costly occurrence. Collaborative efforts are needed to characterize patient, treatment, and hospital-related risk factors as a basis for developing preventative strategies. Copyright © 2012 Elsevier Inc. All rights reserved.

  2. Reevaluation of Meta-analysis on prophylactic drug management for recurrence of febrile seizures

    Directory of Open Access Journals (Sweden)

    Huan LIAO


    Full Text Available Objective To explore the efficiency and safety of drugs to prevent the recurrence of febrile seizures (FS.  Methods Relevant literatures were searched via PubMed, EMBASE/SCOPUS, EBSCO-CINAHL, Web of Science, Cochrane Database of Systematic Reviews from December 1997 to November 2014 using the following keywords: febrile seizure OR febrile convulsion, recurrence, prevention OR prophylaxis, medicine OR medication. Publication type was limited to Meta-analysis. Extract the relevant information of Meta-analysis, such as characteristics of objects, types of study design, number of clinical trials, number of cases, search strategies, databases, information of methodology (methods of randomization, concealment, blinding, withdrawal and exit, follow-up time, heterogeneity analysis, subgroup analysis and outcome assessment, etc. Quality of Reporting of Meta-analyses (QUOROM and Oxman-Guyatt Overview Quality Assessment Questionnaire (OQAQ were used to assess the quality of included Meta-analyses. Jadad decision was used to assess inclusion and exclusion criteria, search strategies, effectiveness evaluation, data extraction and data analysis, to explore reliable evidence of evidence-based medicine.  Results Eventually, four Meta-analyses were included after screening of all the literatures that can be searched out. Among those Meta-analyses, the Meta-analysis of Offringa and Newton (2012 was relatively more reliable. The results suggesed that no clinically important benefits were found in administering intermittent oral or rectal diazepam, oral phenobarbitone, phenytoin, valproate, pyridoxine, buprofen, diclofenac and acetominophen to children with FE. Only one clinical trial reported that intermittent oral clobazam could reduce the recurrence of FE in comparing with placebo at 6-month follow-up (RR = 0.360, 95% CI: 0.200-0.640; P = 0.000, but it should be verified by more randomized controlled trials (RCTs. Among 4 Meta-analyses included in this study

  3. Extending the construct of psychopathy to youth: implications for understanding, diagnosing, and treating antisocial children and adolescents. (United States)

    Frick, Paul J


    This paper reviews several attempts to extend the construct of psychopathy to children and adolescents. The research suggests that the presence of callous-unemotional (CU) traits may be particularly important. Specifically, the presence of these traits designates a clinically important subgroup of youth with childhood-onset conduct problems who show a particularly severe, aggressive, and stable pattern of antisocial behaviour. Also, children with CU traits show numerous emotional, cognitive, and personality features that are distinct from other antisocial youth that are similar to features found in adults with psychopathy. The research on CU traits has important implications for understanding the different causal pathways through which children develop severe antisocial and aggressive behaviour, as well as implications for diagnosing and intervening with antisocial youth.

  4. Neurobiological mechanisms for nonverbal IQ tests: implications for instruction of nonverbal children with autism

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    Andrey Vyshedskiy


    Full Text Available Traditionally, the neurological correlates of IQ test questions are characterized qualitatively in terms of ‘control of attention’ and ‘working memory.’ In this report we attempt to characterize each IQ test question quantitatively by two factors: a the number of disparate objects that have to be imagined in concert in order to solve the problem and, b the amount of recruited posterior cortex territory. With such a classification, an IQ test can be understood on a neuronal level and a subject’s IQ score could be interpreted in terms of specific neurological mechanisms available to the subject. Here we present the results of an analysis of the three most popular nonverbal IQ tests: Test of Nonverbal Intelligence (TONI-4, Standard Raven's Progressive Matrices, and Wechsler Intelligence Scale for Children (WISC-V. Our analysis shows that approximately half of all questions (52±0.02% are limited to mental computations involving only a single object; these easier questions are found towards the beginning of each test. More difficult questions located towards the end of each test rely on mental synthesis of several disparate objects and the number of objects involved in computations gradually increases with question difficulty. These more challenging questions require the organization of wider posterior cortex networks by the lateral prefrontal cortex (PFC. This conclusion is in line with neuroimaging studies showing that activation level of the lateral PFC and the posterior cortex positively correlates with task difficulty. This analysis has direct implications for brain pathophysiology and, specifically, for therapeutic interventions for children with language impairment, most notably for children with Autism Spectrum Disorder (ASD and other developmental disorders.

  5. [Neuroprotective effect of naloxone in brain damage caused by repeated febrile seizure]. (United States)

    Shan, Ying; Qin, Jiong; Chang, Xing-zhi; Yang, Zhi-xian


    The brain damage caused by repeated febrile seizure (FS) during developing age is harmful to the intellectual development of children. So how to decrease the related damage is a very important issue. The main purpose of the present study was to find out whether the non-specific opiate antagonist naloxone at low dose has the neuroprotective effect on seizure-induced brain damage. Warm water induced rat FS model was developed in this study. Forty-seven rats were randomly divided into two groups: normal control group (n = 10) and hyperthermic seizure groups (n = 37). The latter was further divided into FS control group (n = 13) and naloxone-treated group (n = 24). The dose of naloxone is different in two naloxone-treated groups (12/each group), in one group the dose was 1 mg/kg, in the other one 2 mg/kg. Seven febrile seizures were induced in each rat of hyperthermic seizure groups with the interval of 2 days. The rats were weighed and injected intraperitoneally with naloxone once the FS occurred in naloxone-treated group, while the rats of the other groups were injected with 0.9% sodium chloride. Latency, duration and grade of FS in different groups were observed and compared. HE-staining and the electron microscopy (EM) were used to detect the morphologic and ultrastructural changes of hippocampal neurons. In naloxone-treated group, the rats' FS duration and FS grade (5.02 +/- 0.63, 2.63 +/- 0.72) were significantly lower (t = 5.508, P seizure, it could lighten the brain damage resulted from repeated FS to some extent.

  6. Urinary Colorimetric Sensor Array and Algorithm to Distinguish Kawasaki Disease from Other Febrile Illnesses.

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    Zhen Li

    Full Text Available Kawasaki disease (KD is an acute pediatric vasculitis of infants and young children with unknown etiology and no specific laboratory-based test to identify. A specific molecular diagnostic test is urgently needed to support the clinical decision of proper medical intervention, preventing subsequent complications of coronary artery aneurysms. We used a simple and low-cost colorimetric sensor array to address the lack of a specific diagnostic test to differentiate KD from febrile control (FC patients with similar rash/fever illnesses.Demographic and clinical data were prospectively collected for subjects with KD and FCs under standard protocol. After screening using a genetic algorithm, eleven compounds including metalloporphyrins, pH indicators, redox indicators and solvatochromic dye categories, were selected from our chromatic compound library (n = 190 to construct a colorimetric sensor array for diagnosing KD. Quantitative color difference analysis led to a decision-tree-based KD diagnostic algorithm.This KD sensing array allowed the identification of 94% of KD subjects (receiver operating characteristic [ROC] area under the curve [AUC] 0.981 in the training set (33 KD, 33 FC and 94% of KD subjects (ROC AUC: 0.873 in the testing set (16 KD, 17 FC. Color difference maps reconstructed from the digital images of the sensing compounds demonstrated distinctive patterns differentiating KD from FC patients.The colorimetric sensor array, composed of common used chemical compounds, is an easily accessible, low-cost method to realize the discrimination of subjects with KD from other febrile illness.

  7. Clinical and demographic factors associated with urinary tract infection in young febrile infants. (United States)

    Zorc, Joseph J; Levine, Deborah A; Platt, Shari L; Dayan, Peter S; Macias, Charles G; Krief, William; Schor, Jeffrey; Bank, David; Shaw, Kathy N; Kuppermann, Nathan


    Previous research has identified clinical predictors for urinary tract infection (UTI) to guide urine screening in febrile children or =38 degrees C) infants who were pediatric emergency departments from October through March 1999-2001 were eligible. Clinical appearance was evaluated using the Yale Observation Scale. UTI was defined as growth of a known bacterial pathogen from a catheterized specimen at a level of (1) > or =50000 cfu/mL or (2) > or =10000 cfu/mL in association with a positive dipstick test or urinalysis. We used bivariate tests and multiple logistic regression to identify demographic and clinical factors that were associated with the likelihood of UTI. A total of 1025 (67%) of 1513 eligible patients were enrolled; 9.0% of enrolled infants received a diagnosis of UTI. Uncircumcised male infants had a higher rate of UTI (21.3%) compared with female (5.0%) and circumcised male (2.3%) infants. Infants with maximum recorded temperature of > or =39 degrees C had a higher rate of UTI (16.3%) than other infants (7.2%). After multivariable adjustment, UTI was associated with being uncircumcised (odds ratio: 10.4; bias-corrected 95% confidence interval: 4.7-31.4) and maximum temperature (odds ratio: 2.4 per degrees C; 95% confidence interval: 1.5-3.6). Factors that were reported previously to be associated with risk for UTI in infants and toddlers, such as white race and ill appearance, were not significantly associated with risk for UTI in this cohort of young infants. Being uncircumcised and height of fever were associated with UTI in febrile infants who were < or =60 days of age. Uncircumcised male infants were at particularly high risk and may warrant a different approach to screening and management.

  8. Utility of screening ultrasound after first febrile UTI among patients with clinically significant vesicoureteral reflux. (United States)

    Massanyi, Eric Z; Preece, Janae; Gupta, Angela; Lin, Susan M; Wang, Ming-Hsien


    To assess the sensitivity and negative predictive value (NPV) of screening renal and bladder ultrasound (RBUS) after initial febrile urinary tract infection (UTI) among patients with clinically significant vesicoureteral reflux (VUR). A retrospective review was performed of all children UTI between 2004 and 2011. The sensitivity and NPV of initial RBUS was calculated among patients who were found to have high-grade (IV-V) VUR. Additionally, initial RBUS among patients with evidence of photopenia on dimercaptosuccinic acid (DMSA) scan or who underwent surgical intervention were reviewed. One hundred forty-four patients with febrile UTI were identified; available RBUS, voiding cystourethrogram (VCUG), and DMSA results for each kidney were reviewed. One hundred fifty-eight kidneys had evidence of VUR on VCUG, and initial RBUS demonstrated abnormality in 25 (sensitivity 0.17). Forty-five kidneys had high-grade VUR and RBUS revealed abnormality in 16 (sensitivity 0.36). One hundred seventy-eight kidneys had no evidence of abnormality on initial RBUS, and 136 (76%) were found to have VUR (NPV 0.24), of which 31 had high-grade VUR (NPV 0.83). Seven kidneys had scarring on DMSA and initial RBUS was normal in 4 (57%). Twelve of 19 patients (63%) who eventually underwent surgical intervention had a normal initial RBUS. RBUS has poor sensitivity and NPV for detecting high-grade VUR in patients UTI. A significant number of patients who were diagnosed with high-grade VUR, renal scarring, or underwent surgical correction of VUR had a negative screening RBUS. Copyright © 2013 Elsevier Inc. All rights reserved.

  9. [Association of IL-1β-511T gene rs16944 polymorphism with febrile seizures]. (United States)

    Ren, Xiao-Tun; Sun, Su-Zhen; Liu, Fang; Wang, Xiao-Ming


    Despite substantial research efforts worldwide, the role of inflammatory cytokine IL-1β in the onset of febrile seizures (FS) remains controversial. The aim of this study was to assess the relationship between rs16944 polymorphism of the IL-1β-511T gene and occurrence of simple FS in a sample of Han children in northern China. The IL-1β-511T gene rs16944 was genotyped by SNaPshot SNP technique in 141 FS children and 130 healthy control subjects. The genotypic and allelic frequencies in the two groups were comparatively analyzed. There were no significant differences in genotypic and allelic frequencies of rs16944 polymorphism of the IL-1β-511T gene between FS patients and control subjects (P>0.05).When the clinical data on A/A, A/G and G/G genotypes of the rs16944 polymorphism in FS patients, there was statistically significant difference in age of first onset (χ(2)=19.491, Prs16944 polymorphism of the IL-1β-511T gene and the incidence of FS in Han children in Northern China. However, the differences in genotypes of this polymorphism might be associated with pathogenesis and prognosis of simple FS in the population studied.

  10. Mediadores envolvidos na resposta febril induzida pela RANTES


    Renes de Resende Machado


    Em estudo anterior, observamos que o Met-RANTES, antagonista de receptores CCR1 e CCR5 para quimiocinas, injetado pela via endovenosa (i.v.) reduziu a resposta febril induzida pelo lipopolissacarídeo (LPS) de E. coli, demonstrando o envolvimento da quimiocina RANTES (Regulada sob ativação, expressa e secretada por células T normais) nesta resposta. Além disso, a injeção intrahipotalâmica (i.h.) da RANTES dose-dependentemente aumentou a temperatura corporal de ratos, o qual foi caracterizado c...

  11. The recognition of autism in children with Down syndrome--implications for intervention and some speculations about pathology. (United States)

    Howlin, P; Wing, L; Gould, J


    Although autism can occur in conjunction with a range of other conditions, the association with Down syndrome is generally considered to be relatively rare. Four young boys with Down syndrome are described who were also autistic. All children clearly fulfilled the diagnostic criteria for autism required by the ICD-10 or DSM-III-R, but in each case the parents had faced considerable difficulties in obtaining this diagnosis. Instead, the children's problems had been attributed to their cognitive delays, despite the fact that their behaviour and general progress differed from other children with Down syndrome in many important aspects. The implications, for both families and children, of the failure to diagnose autism when it co-occurs with other conditions such as Down syndrome are discussed. Some speculations about possible pathological associations are also presented.

  12. Changes in circulating inflammatory markers following febrile non-haemolytic transfusion reactions to leucoreduced red cells

    DEFF Research Database (Denmark)

    Larsen, R; Sandhu, N; Heegaard, N H H


    It would be desirable to be able to distinguish fever as a result of febrile non-haemolytic transfusion reactions (FNHTR) from other febrile conditions. To further characterize the inflammatory feature of FNHTR, we measured a large panel of inflammatory markers in pre- and posttransfusion plasma...

  13. The Long-term Risk of Epilepsy after Febrile Seizures in susceptible subgroups

    DEFF Research Database (Denmark)

    Vestergaard, Mogens; Pedersen, Carsten Bøcker; Sidenius, Per Christian


    A family history of seizures, preexisting brain damage, or birth complications may modify the long-term risk of epilepsy after febrile seizures. The authors evaluated the association between febrile seizures and epilepsy in a population-based cohort of 1.54 million persons born in Denmark (1978-2......, or low Apgar scores at 5 minutes....

  14. A predictive model to estimate the risk of serious bacterial infections in febrile infants

    NARCIS (Netherlands)

    Berger, RMF; Berger, MY; vanSteenselMoll, HA; DzoljicDanilovic, G; DerksenLubsen, G

    Low risk criteria have been defined to identify febrile infants unlikely to have serious bacterial infection (SBI). Using these criteria approximately 40% of all febrile infants can be defined as being at low risk. Of the remaining infants (60%) only 10%-20% have an SBI. No adequate criteria exists

  15. Acute febrile illness in cirrhosis - thinking beyond spontaneous bacterial peritonitis! (United States)

    Jain, Ajay K; Sircar, Shohini; Jain, Mayank; Adkar, Sagar; Waghmare, Chandrashekhar; Chahwala, Fatema


    The aim of this study was to look at the aetiological factors presenting as acute febrile illness in cirrhotic patients. The study group included all cirrhotic patients admitted as inpatients between January and December 2011 with a history of fever of less than seven days duration. Detailed history, clinical examination and investigations, as required, were noted. The data collected were analysed. A total of 42 patients formed the study group. The male-to-female ratio was 9.5:1. The mean age at presentation was 45.09 years (24-77 years). The aetiological factors for fever were: spontaneous bacterial peritonitis (20), lower respiratory tract infection (8), urinary tract infection (6), lower limb cellulitis (4), acute cholecystitis (2) and malaria (2). The mean MELD (model for end-stage liver disease) score at presentation was 20.4. Three patients with spontaneous bacterial peritonitis (SBP) and a mean MELD score of 31 died during the hospital admission. Febrile illness in cirrhosis is attributable to multiple causes. Outcome is dependent on the severity of underlying liver disease.

  16. Leptospirosis among Hospitalized Febrile Patients in Northern Tanzania (United States)

    Biggs, Holly M.; Bui, Duy M.; Galloway, Renee L.; Stoddard, Robyn A.; Shadomy, Sean V.; Morrissey, Anne B.; Bartlett, John A.; Onyango, Jecinta J.; Maro, Venance P.; Kinabo, Grace D.; Saganda, Wilbrod; Crump, John A.


    We enrolled consecutive febrile admissions to two hospitals in Moshi, Tanzania. Confirmed leptospirosis was defined as a ≥ 4-fold increase in microscopic agglutination test (MAT) titer; probable leptospirosis as reciprocal MAT titer ≥ 800; and exposure to pathogenic leptospires as titer ≥ 100. Among 870 patients enrolled in the study, 453 (52.1%) had paired sera available, and 40 (8.8%) of these met the definition for confirmed leptospirosis. Of 832 patients with ≥ 1 serum sample available, 30 (3.6%) had probable leptospirosis and an additional 277 (33.3%) had evidence of exposure to pathogenic leptospires. Among those with leptospirosis the most common clinical diagnoses were malaria in 31 (44.3%) and pneumonia in 18 (25.7%). Leptospirosis was associated with living in a rural area (odds ratio [OR] 3.4, P < 0.001). Among those with confirmed leptospirosis, the predominant reactive serogroups were Mini and Australis. Leptospirosis is a major yet underdiagnosed cause of febrile illness in northern Tanzania, where it appears to be endemic. PMID:21813847

  17. Brucellosis among Hospitalized Febrile Patients in Northern Tanzania (United States)

    Bouley, Andrew J.; Biggs, Holly M.; Stoddard, Robyn A.; Morrissey, Anne B.; Bartlett, John A.; Afwamba, Isaac A.; Maro, Venance P.; Kinabo, Grace D.; Saganda, Wilbrod; Cleaveland, Sarah; Crump, John A.


    Acute and convalescent serum samples were collected from febrile inpatients identified at two hospitals in Moshi, Tanzania. Confirmed brucellosis was defined as a positive blood culture or a ≥ 4-fold increase in microagglutination test titer, and probable brucellosis was defined as a single reciprocal titer ≥ 160. Among 870 participants enrolled in the study, 455 (52.3%) had paired sera available. Of these, 16 (3.5%) met criteria for confirmed brucellosis. Of 830 participants with ≥ 1 serum sample, 4 (0.5%) met criteria for probable brucellosis. Brucellosis was associated with increased median age (P = 0.024), leukopenia (odds ratio [OR] 7.8, P = 0.005), thrombocytopenia (OR 3.9, P = 0.018), and evidence of other zoonoses (OR 3.2, P = 0.026). Brucellosis was never diagnosed clinically, and although all participants with brucellosis received antibacterials or antimalarials in the hospital, no participant received standard brucellosis treatment. Brucellosis is an underdiagnosed and untreated cause of febrile disease among hospitalized adult and pediatric patients in northern Tanzania. PMID:23091197

  18. Immunoadjuvants enhance the febrile responses of rats to endogenous pyrogen. (United States)

    Stitt, J T; Shimada, S G


    The febrile responses of male Sprague-Dawley rats to a semipurified endogenous pyrogen produced from human monocytes were characterized by establishing fever dose-response curves. The animals were then injected intravenously with a number of substances that possessed the common properties of stimulating the phagocytic activity of the cells of the reticuloendothelial system and of acting as immunoadjuvants. The substances used were zymosan, lipopolysaccharide endotoxin, and muramyl dipeptide. Three days after any of these immunoadjuvants were injected, the fever sensitivity of the rats was remeasured. In each case, the slope of the fever dose-response curve tripled, and in some instances the response threshold for fever response was reduced by factors of three to eight. Furthermore, the maximum increase in body temperature produced by the endogenous pyrogen was more than doubled after immunoadjuvant treatment. By contrast latex beads, which are also phagocytized by the cells of the reticuloendothelial system but do not subsequently increase their phagocytic index nor do they enhance immune responses, had no effect on the fever sensitivity of rats in response to endogenous pyrogen. In the light of these findings, it is suggested that the febrile responses of rats to endogenous pyrogen are mediated in some manner by cells that possess some of the properties of reticuloendothelial cells. The location of these putative cells must be close to the circulation, because the immunoadjuvants used in this study were, for the most part, large molecular weight molecules that could not cross the blood-brain barrier easily.

  19. [A pilot study of antibiotic cycling for the treatment of febrile neutropenia patients with hematological diseases]. (United States)

    Ikegaya, Satoshi; Iwasaki, Hiromichi; Kinoshita, Keiichi; Urasaki, Yoshimasa; Tsutani, Hiroshi; Ueda, Takanori


    Two antibiotics recommended by the guideline of Infectious Diseases Society of America (IDSA) were selected for treatment of febrile neutropenia, and these paired antibiotics were changed periodically three times. The clinical efficacy of each antibiotic was retrospectively evaluated at the end of the final period. There was no significant difference about efficacy rate between two kinds of antibiotics in the same sequential period. However, the efficacy rate has been rising and febrile duration has been shortening by degrees. Only a few drug resistant bacteria were recognized by the surveillance culture during antibiotic cycling. Recently, antibiotic cycling therapy has attracted attention especially in the ICU. However, a clinical study of treatment for febrile neutropenia has not been reported. Our trial suggests that cycling therapy may be useful for febrile neutropenia. However, Some deviation in the patients characteristics of each period may affect the result. It seems that further examination is necessary about usefullness of the cycling therapy for febrile neutropenia.

  20. Nutrition and HIV/AIDS in infants and children in South Africa: implications for food-based dietary guidelines. (United States)

    Hendricks, Michael K; Eley, Brian; Bourne, Lesley T


    The implications for food-based dietary guidelines (FBDGs) that are being developed in South Africa are reviewed in relation to HIV-exposed and -infected children. The nutritional consequences of HIV infection and nutritional requirements along with programmes and guidelines to address undernutrition and micronutrient deficiency in these children are also investigated. Based on studies for HIV-infected children in South Africa, more than 50% are underweight and stunted, while more than 60% have multiple micronutrient deficiencies. Nutritional problems in these children are currently addressed through the Prevention-of-Mother-to-Child Transmission Programme (PMTCT), the Integrated Nutrition Programme and Guidelines for the Management of HIV-infected Children which include antiretroviral (ARV) therapy in South Africa. Evaluations relating to the implementation of these programmes and guidelines have not been conducted nationally, although certain studies show that coverage of the PMTCT and the ARV therapy programmes was low. FBDGs for infants and young children could complement and strengthen the implementation of these programmes and guidelines. However, FBDGs must be in line with national and international guidelines and address key nutritional issues in these infants and young children. These issues and various recommendations are discussed in detail in this review.

  1. Exploring the relationship between quality of life and mental health problems in children: implications for measurement and practice. (United States)

    Sharpe, Helen; Patalay, Praveetha; Fink, Elian; Vostanis, Panos; Deighton, Jessica; Wolpert, Miranda


    Quality of life is typically reduced in children with mental health problems. Understanding the relationship between quality of life and mental health problems and the factors that moderate this association is a pressing priority. This was a cross-sectional study involving 45,398 children aged 8-13 years from 880 schools in England. Self-reported quality of life was assessed using nine items from the KIDSCREEN-10 and mental health was assessed using the Me and My School Questionnaire. Demographic information (gender, age, ethnicity, socio-economic status) was also recorded. Quality of life was highest in children with no problems and lowest in children with both internalising and externalising problems. There was indication that quality of life may be reduced in children with internalising problems compared with externalising problems. Approximately 12 % children with mental health problems reported high quality of life. The link between mental health and quality of life was moderated by gender and age but not by socio-economic status or ethnicity. This study supports previous work showing mental health and quality of life are related but not synonymous. The findings have implications for measuring quality of life in child mental health settings and the need for approaches to support children with mental health problems that are at particular risk of poor quality of life.


    Directory of Open Access Journals (Sweden)

    Aleksandra Karovska Ristovska


    Full Text Available Educational policy for children with intellectual disability in Republic of Macedonia is not always consistent with the practical implications. The subject of this research was to gain an insight into the current condition of the persons with intellectual disabilities in Macedonia, before all an insight into the barriers that they are facing in their attempts to access educational information and services. This was done through conducting a qualitative (desk-top analyses of the national legislations; semi-structured interviews with parents of persons with intellectual disabilities and focus groups with relevant stakeholders and a quantitative research (quality of life research for the disabled persons. In the research a total number of 213 examinees were included. As in many other cases, and in many other countries, policy and practice are not always coherent. Legislation in the area of education in our country has to be modified and accommodated to the needs of the persons with disabilities and their parents or care-givers. The final conclusion from our research is that the persons with ID are still on the margins of society, and they lead everyday battles to prove that their needs must be taken into consideration in context of their human rights. Although awareness for the importance of the rightful treatment of this problem is not on a satisfactory level, still we can notice a shift in perception and liberation of prejudice.

  3. Home based care practices by caregivers of under five children with ...

    African Journals Online (AJOL)

    Background: Home treatment for childhood febrile illness is a common practice among caregivers in Nigeria as well as some other countries in sub- Saharan Africa. The aim of the study was to assess the home based care practices of caregivers of under- five children with febrile illnesses as seen in the general paediatric ...

  4. Substance Use Disorders in Children and Adolescents With Attention-Deficit/Hyperactivity Disorder: Implications for Treatment and the Role of the Primary Care Physician


    Upadhyaya, Himanshu P.


    Objectives: Review the association between attention-deficit/hyperactivity disorder (ADHD) and substance use disorder (SUD) in children and adolescents. Discuss treatment implications and the role of the primary care physician in the management of this comorbidity.

  5. Successful emergency department interventions that reduce time to antibiotics in febrile pediatric cancer patients (United States)

    Spencer, Sandra; Nypaver, MIchele; Hebert, Katherine; Benner, Christopher; Stanley, Rachel; Cohen, Daniel; Rogers, Alexander; Goldstick, Jason; Mahajan, Prashant


    Children with cancer and fever are at high risk for sepsis related death. Rapid antibiotic delivery ( 38.0 C). A secondary objective was to identify interventions amenable to translation to other centers. We conducted a post project analysis of prospectively collected observational data from children < 18 years visiting these EDs during independently conducted QI projects. Comparisons were made pre to post intervention periods within each institution. All interventions were derived independently using QI methods by each institution. Successful as well as unsuccessful interventions were described and common interventions adopted by all sites identified. A total of 1032 ED patient visits were identified from the three projects. Improvement in median TTA delivery (min) pre to post intervention(s) was 118.5–57.0 at site 1, 163.0–97.5 at site 2, and 188.0–111.5 at site 3 (p<.001 all sites). The eight common interventions were 1) Triage application of topical anesthetic 2) Rapid room placement & triage 3) Resuscitation room placement of ill appearing children 4) Close proximity to central line equipment 5) Antibiotic administration before laboratory analyses 6) Consensus clinical practice guideline establishment 7) Family pre-ED education for fever and 8) Staff project updates. This core set of eight low cost, high yield QI interventions were developed independently by the three ED's which led to substantial reduction in time to antibiotic delivery in children with cancer presenting with fever. These interventions may inform future QI initiatives in other settings caring for febrile pediatric oncology patients. PMID:28321299

  6. Children's Perspectives on Their Relationships with Their Nonresident Fathers: Influences, Outcomes and Implications (United States)

    Dunn, Judy; Cheng, Helen; O'Connor, Thomas G.; Bridges, Laura


    Background: Children's relationships with their nonresident fathers, and associations between these relationships, children's relationships with mothers and stepfathers, and the children's adjustment were studied in 162 children from single-parent and stepfamilies, selected from a representative community sample in the UK, studied at 2 time points…

  7. Size and modality effects in Braille learning: Implications for the blind child from pre-reading sighted children. (United States)

    Barlow-Brown, Fiona; Barker, Christopher; Harris, Margaret


    Beginning readers are typically introduced to enlarged print, and the size of this print decreases as readers become more fluent. In comparison, beginning blind readers are expected to learn standard-sized Braille from the outset because past research suggests letter knowledge cannot be transferred across different sizes of Braille. The study aims to investigate whether learning Braille using an oversized pegboard leads to faster, transferable, letter learning and whether performance is mediated by either tactile or visual learning. Sixty-eight children participated in the study. All children were sighted pre-readers with no previous knowledge of Braille. The children came from two nursery schools with an average age of 47.8 months. Children were taught specific Braille letters using either an enlarged pegboard or standard Braille. Two other groups of children were taught using visually presented Braille characters in either an enlarged or standard size and a further control group mirrored the experience of blind children in receiving non-specific tactile training prior to being introduced to Braille. In all tactile conditions it was ensured that the children did not visually experience any Braille for the duration of the study. Results demonstrated that initially training children with large Braille tactually led to the best subsequent learning of standard Braille. Despite the fact that both initial visual and large tactual learning were significantly faster than learning standard Braille, when transferring letter knowledge to standard tactile Braille, previous tactile experience with the large pegboard offered the most efficient route. Braille letter knowledge can be transferred across size and modality particularly effectively with large tactile Braille. This has significant implications for the education of blind children. © 2018 The British Psychological Society.

  8. The relationship between mathematics and language: academic implications for children with specific language impairment and English language learners. (United States)

    Alt, Mary; Arizmendi, Genesis D; Beal, Carole R


    The present study examined the relationship between mathematics and language to better understand the nature of the deficit and the academic implications associated with specific language impairment (SLI) and academic implications for English language learners (ELLs). School-age children (N = 61; 20 SLI, 20 ELL, 21 native monolingual English [NE]) were assessed using a norm-referenced mathematics instrument and 3 experimental computer-based mathematics games that varied in language demands. Group means were compared with analyses of variance. The ELL group was less accurate than the NE group only when tasks were language heavy. In contrast, the group with SLI was less accurate than the groups with NE and ELLs on language-heavy tasks and some language-light tasks. Specifically, the group with SLI was less accurate on tasks that involved comparing numerical symbols and using visual working memory for patterns. However, there were no group differences between children with SLI and peers without SLI on language-light mathematics tasks that involved visual working memory for numerical symbols. Mathematical difficulties of children who are ELLs appear to be related to the language demands of mathematics tasks. In contrast, children with SLI appear to have difficulty with mathematics tasks because of linguistic as well as nonlinguistic processing constraints.

  9. Parents' Involvement in Children's Learning in the United States and China: Implications for Children's Academic and Emotional Adjustment


    Cheung, Cecilia Sin-Sze; Pomerantz, Eva M.


    This research examined parents' involvement in children's learning in the United States and China. Beginning in seventh grade, 825 American and Chinese children (mean age = 12.74 years) reported on their parents' involvement in their learning as well as their parents' psychological control and autonomy support every six months until the end of eighth grade. Information on children's academic and emotional adjustment was obtained. American (vs. Chinese) parents' involvement was associated less...

  10. Iron deficiency and acute seizures: results from children living in rural Kenya and a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Richard Idro


    , weighted OR 1.79(95%CI 1.03-3.09.Iron deficiency is not associated with an increased risk of all acute seizures in children but of febrile seizures. Further studies should examine mechanisms involved and the implications for public health.

  11. The Importance of Serum Cytokine Levels in Febrile Neutropenia

    Directory of Open Access Journals (Sweden)

    Nuray Buyukberber


    Full Text Available The most important evaluation of the neutropenic patients is to determine the risk group. The desired approach to patients with low risks should be either not to hospitalize or to hospitalize for a short period of time which both decreases the cost and exposure to the resistant flora. The early diagnosis of sepsis in patients with high risk may be life saving. Recently, the determination of low and high-risk groups only by the clinical variables is not found to be a reliable method. The laboratory parameters supported by the clinical variables may be more practical. The determination of serum cytokines levels in febrile neutropenia may be helpful for the early risk diagnosis, new treatment approaches, and prognosis. [Archives Medical Review Journal 2003; 12(1.000: 12-19

  12. Localized Subcutaneous Acute Febrile Neutrophilic Dermatosis in a Dog

    Directory of Open Access Journals (Sweden)

    Karolin Schoellhorn


    Full Text Available A two-year-old spayed female mixed-breed dog was presented with a five-day history of hemorrhagic gastroenteritis and fever. On physical examination, the dog was lethargic and clinically dehydrated. The skin of the entire ventral abdomen extending to both flanks was erythematous, swollen and painful on palpation. Histopathological examination of skin biopsies revealed a severe diffuse neutrophilic dermatitis and panniculitis, resembling the subcutaneous form of Sweet’s syndrome in humans. A large part of the skin lesion developed full-thickness necrosis. After intensive care, three surgical wound debridements and wound adaptations, the wound healed by secondary intention within ten weeks. In the absence of infection of the skin or neoplasia, a diagnosis of neutrophilic dermatosis and panniculitis, resembling the subcutaneous form of acute febrile neutrophilic dermatosis, was made.

  13. Attention Mechanisms in Children with Anxiety Disorders and in Children with Attention Deficit Hyperactivity Disorder: Implications for Research and Practice (United States)

    Weissman, Adam S.; Chu, Brian C.; Reddy, Linda A.; Mohlman, Jan


    Inattention is among the most commonly referred problems for school-aged youth. Research suggests distinct mechanisms may contribute to attention problems in youth with anxiety disorders versus youth with attention deficit hyperactivity disorder (ADHD). This study compared children (8-17 years) with anxiety disorders (n = 24) and children (8-16…

  14. Parents' Involvement in Children's Learning in the United States and China: Implications for Children's Academic and Emotional Adjustment (United States)

    Cheung, Cecilia Sin-Sze; Pomerantz, Eva M.


    This research examined parents' involvement in children's learning in the United States and China. Beginning in seventh grade, 825 American and Chinese children (mean age = 12.74 years) reported on their parents' involvement in their learning as well as their parents' psychological control and autonomy support every 6 months until the end of 8th…

  15. Educational Implications of Psychopathology for Brain-Injured Children; Lesley College Annual Graduate Symposium (3rd, Cambridge, Massachusetts, May 13, 1967). (United States)

    Gertz, Boris, Ed.

    The symposium report includes the text of an illustrated lecture given by William M. Cruickshank on "Psychopathology and Implications for Educating Brain-Injured Children." Considered in the lecture are hyperactivity, the needs of hyperative children, and educational setting and curriculum. Panel reactions are provided by E.F. Rabe, a pediatric…

  16. Observation of patients with vesicoureteral reflux off antibiotic prophylaxis: physician bias on patient selection and risk factors for recurrent febrile urinary tract infection. (United States)

    Drzewiecki, Beth A; Thomas, John C; Pope, John C; Adams, Mark C; Brock, John W; Tanaka, Stacy T


    Observation off continuous antibiotic prophylaxis is an option for vesicoureteral reflux. We evaluated the characteristics of patients observed off continuous antibiotic prophylaxis and risk factors for febrile urinary tract infection. We identified children 1 to 18 years old with primary vesicoureteral reflux between January 1, 2010 and December 31, 2010. We excluded patients with prior surgical correction from analysis. We recorded age, gender, race/ethnicity, primary language, insurance carrier, age at vesicoureteral reflux diagnosis, initial presentation and vesicoureteral reflux severity. We quantified bladder and bowel dysfunction with a validated questionnaire if toilet trained. We compared patients off vs on continuous antibiotic prophylaxis with the chi-square test for categorical variables and the Mann-Whitney U test for continuous variables. We used a univariate Cox proportional hazards model to assess predictors of febrile urinary tract infection during observation off continuous antibiotic prophylaxis. Of 529 eligible patients 224 were observed off continuous antibiotic prophylaxis. Patients off continuous antibiotic prophylaxis tended to be older (p urinary tract infection (p = 0.05), to have nondilating vesicoureteral reflux on most recent cystogram (p urinary tract infection developed in 19 (8.5%). Risk factors associated with febrile urinary tract infection included initial presentation of multiple febrile urinary tract infections (p = 0.03), older age at diagnosis (p = 0.03) and older age starting observation off continuous antibiotic prophylaxis (p = 0.0003). Criteria to select patients with vesicoureteral reflux for observation off continuous antibiotic prophylaxis remain poorly defined in the literature. Observation will fail in a subset of patients with vesicoureteral reflux. Physician biases regarding patient selection for observation off continuous antibiotic prophylaxis should be considered when interpreting studies that evaluate treatment

  17. Efficacy of Early Intervention with Liskantin or Primidone to Decrease Developmental Delay in Children with Drowet and GEFS+ Syndrome

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Koushesh


    Full Text Available Objective: Febrile seizure (FS occurs between 6 months and 6 years of age. Febrile seizure is a common disease in pediatrics. Some patients are retarded with recurrent febrile seizure. For example Drawet syndrome was started with febrile seizure and progress into the intractable seizure and finally are retarded. Materials & Methods: This article is the clinical trial study. Population in this study are 86 children whit febrile seizure refer to pediatrics’ medical central. This study was carried out in 2013. In this study evaluated patients with febrile seizure’s criteria and included in the population. Children statistics with febrile seizure refer to pediatrics’ medical center registered and compared with other statistics. Data enter the SPSS program 18 version (SPSS Inc, Chicago, USA and used analysis statistical tests and also T-test, Chi Square tests. Finally evaluated total parameters by MIN+SD and reported significant difference (P-value<0.05. Numbers of patients determined according to previous study. Results: In this study 46 patients with complex febrile seizure and early initiation of treatment were not retarded and haven’t any complications. Conclusion: Early initiation of treatment in the patient whit febrile seizure very important to prophylaxis of developmental delay and developmental regression.

  18. Understanding of thought bubbles as mental representations in children with autism: implications for theory of mind. (United States)

    Kerr, Sharyn; Durkin, Kevin


    Standard false belief tasks indicate that normally developing children do not fully develop a theory of mind until the age of 4 years and that children with autism have an impaired theory of mind. Recent evidence, however, suggests that children as young as 3 years of age understand that thought bubbles depict mental representations and that these can be false. Twelve normally developing children and 11 children with autism were tested on a standard false belief task and a number of tasks that employed thought bubbles to represent mental states. While the majority of normally developing children and children with autism failed the standard false belief task, they understood that (i) thought bubbles represent thought, (ii) thought bubbles can be used to infer an unknown reality, (iii) thoughts can be different, and (iv) thoughts can be false. These results indicate that autistic children with a relatively low verbal mental age may be capable of understanding mental representations.

  19. Working Memory and Reinforcement Schedule Jointly Determine Reinforcement Learning in Children: Potential Implications for Behavioral Parent Training

    Directory of Open Access Journals (Sweden)

    Elien Segers


    Full Text Available Introduction: Behavioral Parent Training (BPT is often provided for childhood psychiatric disorders. These disorders have been shown to be associated with working memory impairments. BPT is based on operant learning principles, yet how operant principles shape behavior (through the partial reinforcement (PRF extinction effect, i.e., greater resistance to extinction that is created when behavior is reinforced partially rather than continuously and the potential role of working memory therein is scarcely studied in children. This study explored the PRF extinction effect and the role of working memory therein using experimental tasks in typically developing children.Methods: Ninety-seven children (age 6–10 completed a working memory task and an operant learning task, in which children acquired a response-sequence rule under either continuous or PRF (120 trials, followed by an extinction phase (80 trials. Data of 88 children were used for analysis.Results: The PRF extinction effect was confirmed: We observed slower acquisition and extinction in the PRF condition as compared to the continuous reinforcement (CRF condition. Working memory was negatively related to acquisition but not extinction performance.Conclusion: Both reinforcement contingencies and working memory relate to acquisition performance. Potential implications for BPT are that decreasing working memory load may enhance the chance of optimally learning through reinforcement.

  20. Technological Funds of Knowledge in Children's Play: Implications for Early Childhood Educators (United States)

    Mawson, Brent


    The technological knowledge the children bring with them into early childhood settings is not well documented or understood. This article discusses the technological knowledge and understanding of the nature of technology present within children's collaborative play in two New Zealand early childhood settings. The children incorporated a wide…

  1. The Consequences of Witnessing Family Violence on Children and Implications for Family Counselors (United States)

    Adams, Christopher M.


    Although a large number of children are directly abused, an even larger number may indirectly experience the effects of abuse as witnesses of family violence. However, the effects on children who witness such violence have long been unaddressed, although a growing body of research indicates that these children are affected in various domains,…

  2. The Effects of Divorce on Children and Implications for Court Custody Cases. (United States)

    Khoe, Lynn

    In the last decade, the rising number of divorces has resulted in large numbers of children lviing in one-parent homes. A review of the literature on the impact of divorce on children's psychosocial adjustment, cognitive development, school peformance, and sex role development revealed several interesting findings. Age of children at time of…

  3. Mentoring Children with Incarcerated Parents: Implications for Research, Practice, and Policy (United States)

    Shlafer, Rebecca J.; Poehlmann, Julie; Coffino, Brianna; Hanneman, Ashley


    We investigated children and families who were participating in a mentoring program targeting children with incarcerated parents. Using multiple methods and informants, we explored the development of the mentoring relationship, challenges and benefits of mentoring children with incarcerated parents, and match termination in 57 mentor-child dyads.…

  4. The natural environment and human development: implications for handicapped children in urban settings (United States)

    Dennis A. Vinton; Donald E. Hawkins


    This review of literature is intended to promote awareness of the needs of the 15 percent of the nation's children and youth who are afflicted with some form of handicap. It is imperative that those who design children's programs that utilize natural environments understand the special problems of handicapped children.

  5. The Psychosocial Development of Children: Implications for Education and Society--Erik Erikson in Context (United States)

    Batra, Sunil


    How do schooling years impact children's lives, in rural and urban settings? Why do some children have lower self-esteem than others? What kinds of conflicts do adolescents experience in their search for identity? Why are some teachers able to understand the importance of ensuring the well-being of children while others do not? Does the emotional…

  6. WISC-R Analysis: Implications for Diagnosis and Educational Intervention of LD Children. (United States)

    Stevenson, Lillian P.

    The study investigated the functional patterns of intellectual performance on the Wechsler Intelligence Scale for Children-Revised (WISC-R) of 55 children (ages 5-to-18 years) referred to a child center to determine if the WISC-R profiles could help identify the children as learning disabled. Secondarily the study utilized the factor-score…

  7. Use of over-the-counter malaria medicines in children and adults in three districts in Kenya: implications for private medicine retailer interventions. (United States)

    Abuya, Timothy O; Mutemi, Wilfred; Karisa, Baya; Ochola, Sam A; Fegan, Greg; Marsh, Vicki


    antimalarial medicines than febrile children were to receive them, and less likely to use them in recommended ways. Government health centres were the most common second resort for treatment and were often used within 72 hours. In view of these practices, more research is needed to assess the impact on the popularity of private medicine sellers of strengthened public sector policies on access to malaria treatment and insecticide-treated bed nets. Improved targeting of OTC antimalarials to high risk groups, better communication strategies regarding adult as well as children's dosages, and facilitating more rapid referral to trained health workers where needed are important challenges to private medicine seller programmes.

  8. Febrile urinary tract infection after pediatric kidney transplantation: a multicenter, prospective observational study. (United States)

    Weigel, Friederike; Lemke, Anja; Tönshoff, Burkhard; Pape, Lars; Fehrenbach, Henry; Henn, Michael; Hoppe, Bernd; Jungraithmayr, Therese; Konrad, Martin; Laube, Guido; Pohl, Martin; Seeman, Tomáš; Staude, Hagen; Kemper, Markus J; John, Ulrike


    Febrile urinary tract infections (fUTIs) are common after kidney transplantation (KTx); however, prospective data in a multicenter pediatric cohort are lacking. We designed a prospective registry to record data on fUTI before and after pediatric KTx. Ninety-eight children (58 boys and 40 girls) ≤ 18 years from 14 mid-European centers received a kidney transplant and completed a 2-year follow-up. Posttransplant, 38.7% of patients had at least one fUTI compared with 21.4% before KTx (p = 0.002). Before KTx, fUTI was more frequent in patients with congenital anomalies of kidneys and urinary tract (CAKUT) vs. patients without (38% vs. 12%; p = 0.005). After KTx, fUTI were equally frequent in both groups (48.7% vs. 32.2%; p = 0.14). First fUTI posttransplant occurred earlier in boys compared with girls: median range 4 vs. 13.5 years (p = 0.002). Graft function worsened (p pediatric KTx, which is not restricted to patients with CAKUT; fUTIs have a negative impact on graft function during the infectious episode but not on 2-year graft outcome.

  9. Cost Minimization Analysis of the Use of Meropenem and Ceftazidime in Febrile Neutropenia Therapy

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    Rizky Abdulah


    Full Text Available Use of antibiotics is required in febrile neutropenia therapy. The variety choice on the use of antibiotics has increased the role of pharmacoeconomics study to determine the most effective and efficient antibiotic in a specific area. The purpose of this study was to investigate the lowest cost antibiotic between meropenem and ceftazidime that were used as one of febrile neutropenia treatments at one of referral hospitals in West Java province during 2011–2013. This study was a retrospective, observational and analytical study that was performed on February 2014 by collecting medical record data related to febrile neutropenia inpatient who received meropenem or ceftazidime therapy. The result showed that although it was not statistically significant, the total cost for ceftazidime therapy was IDR7,082,523, which was lower than meropenem therapy (IDR11,094,147. Hopefully, this result can assist the health professionals in the management of febrile neutropenia therapy.

  10. Sleep patterns of Japanese preschool children and their parents: implications for co-sleeping. (United States)

    Iwata, Sachiko; Iwata, Osuke; Matsuishi, Toyojiro


    The aim of this study was to investigate the direct relationship of sleep schedule and sleep quality variables between healthy preschool children and their parents, focusing on the influence of the difference in bedtime between each other. Forty-seven Japanese 5-year-old children and their primary parent were studied. The parents completed questionnaires including the Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index. The children wore an actigraph for one week. Although sleep patterns of children were generally independent of their parents, late sleep end time and bedtime of children were associated with parents' late sleep end time on weekends. For 87% of children and parents who shared a bedroom, sleep quality was negatively affected by a shorter difference in bedtimes between child and parent, but not by co-sleeping. Sleep behaviours of parents can influence those of their children. For parents and children who share a bedroom, the timing of bedtime rather than co-sleeping may be a key factor in modulating sleep patterns. Trying to get children asleep and subsequently falling asleep at a similar time may disturb parents' sleep quality, which may subsequently affect that of their children. ©2013 Foundation Acta Paediatrica. Published by Blackwell Publishing Ltd.

  11. Treatment of Febrile Neutropenia and Prophylaxis in Hematologic Malignancies: A Critical Review and Update

    Directory of Open Access Journals (Sweden)

    Paola Villafuerte-Gutierrez


    Full Text Available Febrile neutropenia is one of the most serious complications in patients with haematological malignancies and chemotherapy. A prompt identification of infection and empirical antibiotic therapy can prolong survival. This paper reviews the guidelines about febrile neutropenia in the setting of hematologic malignancies, providing an overview of the definition of fever and neutropenia, and categories of risk assessment, management of infections, and prophylaxis.

  12. Children and political violence from a social ecological perspective: implications from research on children and families in Northern Ireland. (United States)

    Cummings, E Mark; Goeke-Morey, Marcie C; Schermerhorn, Alice C; Merrilees, Christine E; Cairns, Ed


    The effects on children of political violence are matters of international concern, with many negative effects well-documented. At the same time, relations between war, terrorism, or other forms of political violence and child development do not occur in a vacuum. The impact can be understood as related to changes in the communities, families and other social contexts in which children live, and in the psychological processes engaged by these social ecologies. To advance this process-oriented perspective, a social ecological model for the effects of political violence on children is advanced. This approach is illustrated by findings and methods from an ongoing research project on political violence and children in Northern Ireland. Aims of this project include both greater insight into this particular context for political violence and the provision of a template for study of the impact of children's exposure to violence in other regions of the world. Accordingly, the applicability of this approach is considered for other social contexts, including (a) another area in the world with histories of political violence and (b) a context of community violence in the US.

  13. Mothers' daily person and process praise: implications for children's theory of intelligence and motivation. (United States)

    Pomerantz, Eva M; Kempner, Sara G


    This research examined if mothers' day-to-day praise of children's success in school plays a role in children's theory of intelligence and motivation. Participants were 120 children (mean age = 10.23 years) and their mothers who took part in a 2-wave study spanning 6 months. During the first wave, mothers completed a 10-day daily interview in which they reported on their use of person (e.g., "You are smart") and process (e.g., "You tried hard") praise. Children's entity theory of intelligence and preference for challenge in school were assessed with surveys at both waves. Mothers' person, but not process, praise was predictive of children's theory of intelligence and motivation: The more person praise mothers used, the more children subsequently held an entity theory of intelligence and avoided challenge over and above their earlier functioning on these dimensions.

  14. Health implications of social networks for children living in public housing. (United States)

    Kennedy-Hendricks, Alene; Schwartz, Heather L; Griffin, Beth Ann; Burkhauser, Susan; Green, Harold D; Kennedy, David P; Pollack, Craig Evan


    This study sought to examine whether: (1) the health composition of the social networks of children living in subsidized housing within market rate developments (among higher-income neighbors) differs from the social network composition of children living in public housing developments (among lower-income neighbors); and (2) children's social network composition is associated with children's own health. We found no significant differences in the health characteristics of the social networks of children living in these different types of public housing. However, social network composition was significantly associated with several aspects of children's own health, suggesting the potential importance of social networks for the health of vulnerable populations. Copyright © 2015 Elsevier Ltd. All rights reserved.

  15. Reading fluency: implications for the assessment of children with reading disabilities. (United States)

    Meisinger, Elizabeth B; Bloom, Juliana S; Hynd, George W


    The current investigation explored the diagnostic utility of reading fluency measures in the identification of children with reading disabilities. Participants were 50 children referred to a university-based clinic because of suspected reading problems and/or a prior diagnosis of dyslexia, where children completed a battery of standardized intellectual, reading achievement, and processing measures. Within this clinical sample, a group of children were identified that exhibited specific deficits in their reading fluency skills with concurrent deficits in rapid naming speed and reading comprehension. This group of children would not have been identified as having a reading disability according to assessment of single word reading skills alone, suggesting that it is essential to assess reading fluency in addition to word reading because failure to do so may result in the under-identification of children with reading disabilities.

  16. Assessment and Implications of Social Withdrawal Subtypes in Young Chinese Children: The Chinese Version of the Child Social Preference Scale. (United States)

    Li, Yan; Zhu, Jing-Jing; Coplan, Robert J; Gao, Zhu-Qing; Xu, Pin; Li, Linhui; Zhang, Huimin


    The authors' goals were to evaluate the psychometric properties of the Chinese version of the Child Social Preference Scale (CSPS; R. J. Coplan, K. Prakash, K. O'Neil, & M. Armer, 2004) and examine the links between both shyness and unsociability and indices of socioemotional functioning in young Chinese children. Participants included of two samples recruited from kindergarten classes in two public schools in Shanghai, China. Both samples included children 3-5 years old (Sample 1: n = 350, Mage = 4.72 years, SD = 0.58 years; Sample 2: n = 129, Mage = 4.40 years, SD = 0.58 years). In both samples, mothers rated children's social withdrawal using the newly created Chinese version of the CSPS, and in Sample 2, teachers also provided ratings of socioemotional functioning. Consistent with previous findings from other cultures, results from factor analyses suggested a 2-factor model for the CSPS (shyness and unsociability) among young children in China. In contrast to findings from North America, child shyness and unsociability were associated with socioemotional difficulties in kindergarten. Some gender differences were also noted. Results are discussed in terms of the assessment and implications of social withdrawal in early childhood in China.

  17. Time-varying and time-invariant dimensions of depression in children and adolescents: Implications for cross-informant agreement. (United States)

    Cole, David A; Martin, Joan M; Jacquez, Farrah M; Tram, Jane M; Zelkowitz, Rachel; Nick, Elizabeth A; Rights, Jason D


    The longitudinal structure of depression in children and adolescents was examined by applying a Trait-State-Occasion structural equation model to 4 waves of self, teacher, peer, and parent reports in 2 age groups (9 to 13 and 13 to 16 years old). Analyses revealed that the depression latent variable consisted of 2 longitudinal factors: a time-invariant dimension that was completely stable over time and a time-varying dimension that was not perfectly stable over time. Different sources of information were differentially sensitive to these 2 dimensions. Among adolescents, self- and parent reports better reflected the time-invariant aspects. For children and adolescents, peer and teacher reports better reflected the time-varying aspects. Relatively high cross-informant agreement emerged for the time-invariant dimension in both children and adolescents. Cross-informant agreement for the time-varying dimension was high for adolescents but very low for children. Implications emerge for theoretical models of depression and for its measurement, especially when attempting to predict changes in depression in the context of longitudinal studies. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  18. Frequency of Usher syndrome in two pediatric populations: Implications for genetic screening of deaf and hard of hearing children. (United States)

    Kimberling, William J; Hildebrand, Michael S; Shearer, A Eliot; Jensen, Maren L; Halder, Jennifer A; Trzupek, Karmen; Cohn, Edward S; Weleber, Richard G; Stone, Edwin M; Smith, Richard J H


    Usher syndrome is a major cause of genetic deafness and blindness. The hearing loss is usually congenital and the retinitis pigmentosa is progressive and first noticed in early childhood to the middle teenage years. Its frequency may be underestimated. Newly developed molecular technologies can detect the underlying gene mutation of this disorder early in life providing estimation of its prevalence in at risk pediatric populations and laying a foundation for its incorporation as an adjunct to newborn hearing screening programs. A total of 133 children from two deaf and hard of hearing pediatric populations were genotyped first for GJB2/6 and, if negative, then for Usher syndrome. Children were scored as positive if the test revealed > or =1 pathogenic mutations in any Usher gene. Fifteen children carried pathogenic mutations in one of the Usher genes; the number of deaf and hard of hearing children carrying Usher syndrome mutations was 15/133 (11.3%). The population prevalence was estimated to be 1/6000. Usher syndrome is more prevalent than has been reported before the genome project era. Early diagnosis of Usher syndrome has important positive implications for childhood safety, educational planning, genetic counseling, and treatment. The results demonstrate that DNA testing for Usher syndrome is feasible and may be a useful addition to newborn hearing screening programs.

  19. Stability of children's insurance coverage and implications for access to care: evidence from the Survey of Income and Program Participation. (United States)

    Buchmueller, Thomas; Orzol, Sean M; Shore-Sheppard, Lara


    Even as the number of children with health insurance has increased, coverage transitions--movement into and out of coverage and between public and private insurance--have become more common. Using data from 1996 to 2005, we examine whether insurance instability has implications for access to primary care. Because unobserved factors related to parental behavior and child health may affect both the stability of coverage and utilization, we estimate the relationship between insurance and the probability that a child has at least one physician visit per year using a model that includes child fixed effects to account for unobserved heterogeneity. Although we find that unobserved heterogeneity is an important factor influencing cross-sectional correlations, conditioning on child fixed effects we find a statistically and economically significant relationship between insurance coverage stability and access to care. Children who have part-year public or private insurance are more likely to have at least one doctor's visit than children who are uninsured for a full year, but less likely than children with full-year coverage. We find comparable effects for public and private insurance. Although cross-sectional analyses suggest that transitions directly between public and private insurance are associated with lower rates of utilization, the evidence of such an effect is much weaker when we condition on child fixed effects.

  20. Service system finance: implications for children with depression and manic depression. (United States)

    Glied, S; Neufeld, A


    An estimated 6.2% of children in the United States satisfy the criteria for a depression diagnosis, but approximately half of this group do not receive necessary treatment. Thus it is important to consider potential barriers to use through service system finance. This article reviews three major types of changes affecting access: parity legislation, managed care, and public contracting. How these developments will affect children with depression and manic depression (DMD) is unclear. To better understand the potential effects on children with DMD, this review uses new data from the Medical Expenditure Panel Survey to describe the service use patterns of this population. These children have higher levels of expenditures, higher rates of inpatient use, and higher rates of Medicaid payment than do other children with mental health diagnoses; they also are overrepresented among the costliest cases of mental illness in children. Children with DMD pay a relatively low out-of-pocket share, suggesting that parity efforts focusing only on copayments and deductibles will have little effect on the absolute out-of-pocket burden for these children. Because children with DMD are overrepresented among high utilizers of health services, health care rationing arrangements or techniques, such as utilization review and capitation, may place this population at particular risk.

  1. Clinical efficacy of cycling empirical antibiotic therapy for febrile neutropenia in pediatric cancer patients. (United States)

    Teranishi, Hideto; Koga, Yuhki; Nishio, Hisanori; Kato, Wakako; Ono, Hiroaki; Kanno, Shunsuke; Nakashima, Kentaro; Takada, Hidetoshi


    Febrile neutropenia (FN) is the main treatment-related cause of mortality among children with cancer, as the prolonged use of broad-spectrum antibiotics can lead to antibiotic resistance in these patients. Antibiotic cycling has been reported to limit the emergence of antibiotic-resistant bacteria among adult patients. However, no studies have evaluated pediatric patients with FN. Between September 2011 and February 2014, 126 pediatric cancer patients were admitted to our center for chemotherapy and/or hematopoietic stem cell transplantation and were included in this study. Retrospective and prospective data collection were performed before and after antibiotic cycling, respectively. Between September 2011 and November 2012 (before antibiotic cycling was implemented), intravenous cefpirome was used as the empirical therapy for FN. Between December 2012 and February 2014 (after antibiotic cycling was implemented), the monthly antibiotic cycling involved intravenous piperacillin-tazobactam (PIPC/TAZ), intravenous meropenem or ciprofloxacin (CPFX), and intravenous cefepime in that order. For children aged ≥13 years, the monthly cycling involved intravenous PIPC/TAZ, and CPFX was administered. The detection rates for extended-spectrum β-lactamase producers in blood and stool culture samples decreased significantly after the implementation of antibiotic cycling (0.33/1000 patient-days vs 0/1000 patient-days, p = 0.03; 1.00/1000 patient-days vs 0/1000 patient-days, p Antibiotic cycling was associated with a decreased emergence of multidrug-resistant microbes. Copyright © 2017 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  2. Suitability of asthma education materials for school-age children: Implications for health literacy. (United States)

    Tzeng, Yu-Fen; Gau, Bih-Shya


    To investigate the suitability of asthma education materials for school-age children with asthma and elucidate how these children used their health-literacy abilities to identify whether the materials can be accepted, comprehended and applied. Effective asthma self-management education is influenced by the suitability of materials and an individual's health literacy. A mixed-method research design was developed using quantitative and qualitative surveys. The suitability of the materials was assessed on the basis of the Chinese version of the Suitability Assessment of Materials by five experts. In addition, five school-age children (age: 8-12 years) were recruited and interviewed. In total, 25 pieces of asthma education material for children were collected. On the basis of their type, the materials were categorised as nine brochures, 11 leaflets and five videos. Of the 25 materials, 17 were rated as superior materials, whereas eight were rated as adequate materials. The suitability scores of the video-based materials were significantly higher than those of the brochures and leaflets (p = .006). One print material was considered to have a reading level suitable for fifth-grade or younger children, whereas the remaining materials were considered suitable for sixth-grade or older children. The following six health-literacy domains were identified: recognising asthma through body knowledge, posing reflective questions, identifying self-care difficulties, receiving adult guidance, learning with enjoyment and addressing learning requirements. The video-based materials had integrated content and were appealing to children. Cartoon animations, interactive computer games, and skill demonstrations may enhance learning stimulation and motivation and increase learning effects in children. The present results may help healthcare providers to understand children's capacities to manage their disease, effectively address children's requirements and function as a key resource for

  3. Can absence of pyuria exclude urinary tract infection in febrile infants? About 2011 AAP guidelines on UTI. (United States)

    Kim, Seong Heon; Lyu, Soo Young; Kim, Hye Young; Park, Su Eun; Kim, Su Young


    The aim of this study was to describe clinical and laboratory characteristics of urinary tract infection (UTI) without significant pyuria in young children aged 2-24 months. The subjects consisted of infants and young children with febrile UTI treated at Pusan National University Children's Hospital, Korea. Group A included 283 patients with definite UTI who fulfilled the revised American Academy of Pediatrics diagnostic criteria, and group B included 19 patients with presumed UTI who had significant culture of uropathogens without pyuria, bacteriuria or other focus of infection. Duration of fever before hospital visit in group B was significantly shorter than in group A (17.7 ± 14.0 vs 34.5 ± 30.7 h). Most patients in group B (17/19, 89.5%) came to the hospital within 24 h of onset of fever. Acute scintigraphic lesions were found in 47.8% of patients in group A and 50% in group B. Underlying urological abnormalities such as vesicoureteral reflux and obstructive uropathy were found in 24.5% of patients in group A and in 33.3% of patients in group B (P = 0.74). Clinicians cannot exclude UTI on the absence of pyuria in young children aged 2-24 months. © 2015 Japan Pediatric Society.

  4. Empirical Implications of Matching Children with Specific Language Impairment to Children with Typical Development on Nonverbal IQ (United States)

    Earle, F. Sayako; Gallinat, Erica L.; Grela, Bernard G.; Lehto, Alexa; Spaulding, Tammie J.


    This study determined the effect of matching children with specific language impairment (SLI) and their peers with typical development (TD) for nonverbal IQ on the IQ test scores of the resultant groups. Studies published between January 2000 and May 2012 reporting standard nonverbal IQ scores for SLI and age-matched TD controls were categorized…

  5. Children and Political Violence from a Social Ecological Perspective: Implications from Research on Children and Families in Northern Ireland (United States)

    Cummings, Mark E.; Goeke-Morey, Marcie C.; Schermerhorn, Alice C.; Merrilees, Christine E.; Cairns, Ed


    The effects on children of political violence are matters of international concern, with many negative effects well-documented. At the same time, relations between war, terrorism, or other forms of political violence and child development do not occur in a vacuum. The impact can be understood as related to changes in the communities, families and…

  6. Murine Typhus: An Important Consideration for the Nonspecific Febrile Illness

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    Gurjot Basra


    Full Text Available Murine typhus is a widely distributed flea-borne infection caused by Rickettsia typhi. Symptoms of murine typhus are nonspecific and mimic a variety of other infectious diseases. We herein report a case of murine typhus in an area where the broad use of DDT in the mid-20th century has now made it a rare disease. The patient described presented with headache, fever, and a faint macular rash. Initial laboratory studies revealed a slight transaminase elevation. Further questioning revealed exposure to opossums, prompting the consideration of murine typhus as a diagnosis. Although typhus group antibodies were not present during the patient’s acute illness, empiric therapy with doxycycline was initiated, and the patient defervesced. One month after convalescence, the patient returned to clinic with serum that contained typhus group antibodies with an IgG titer of 1 : 1024. Murine typhus is an important consideration during the workup of a patient with a nonspecific febrile illness. Exposure to reservoir hosts and the flea vector place humans at risk for this disease. Clinician recognition of this entity is required for diagnosis and effective therapy.

  7. The role of gallium-67 scanning in febrile patients

    International Nuclear Information System (INIS)

    Mouratidis, B.; Lomas, F.


    The source of sepsis in febrile patients can be a difficult diagnostic problem. Gallium-67 has been utilized as a diagnostic tool in the evaluation of these patients. A retrospective review was done of 47 patients who presented with pyrexia of unknown origin (27 patients), postoperative fever (11 patients), septicaemia (4 patients) and miscellaneous sepsis (5 patients). Whole body imaging with Gallium-67 gave an overall sensitivity and specificity of 86 and 77%, respectively, which compares favourably with previous studies. The sensitivity and specificity was similar in all patient subgroups. Gallium-67 allowed for more effective and directed use of organ-specific imaging modalities, such as computed tomography, ultrasound and guided intervention, in localizing and defining the source of sepsis. Where more than one possible source of fever was present, Gallium-67 scanning correctly identified the activity of the different foci. Gallium-67 scanning should be used early in the evaluation of patients presenting with fever of uncertain origin. 9 refs., 5 tabs., 2 figs

  8. Novel GABRG2 mutations cause familial febrile seizures (United States)

    Boillot, Morgane; Morin-Brureau, Mélanie; Picard, Fabienne; Weckhuysen, Sarah; Lambrecq, Virginie; Minetti, Carlo; Striano, Pasquale; Zara, Federico; Iacomino, Michele; Ishida, Saeko; An-Gourfinkel, Isabelle; Daniau, Mailys; Hardies, Katia; Baulac, Michel; Dulac, Olivier; Leguern, Eric; Nabbout, Rima


    Objective: To identify the genetic cause in a large family with febrile seizures (FS) and temporal lobe epilepsy (TLE) and subsequently search for additional mutations in a cohort of 107 families with FS, with or without epilepsy. Methods: The cohort consisted of 1 large family with FS and TLE, 64 smaller French families recruited through a national French campaign, and 43 Italian families. Molecular analyses consisted of whole-exome sequencing and mutational screening. Results: Exome sequencing revealed a p.Glu402fs*3 mutation in the γ2 subunit of the GABAA receptor gene (GABRG2) in the large family with FS and TLE. Three additional nonsense and frameshift GABRG2 mutations (p.Arg136*, p.Val462fs*33, and p.Pro59fs*12), 1 missense mutation (p.Met199Val), and 1 exonic deletion were subsequently identified in 5 families of the follow-up cohort. Conclusions: We report GABRG2 mutations in 5.6% (6/108) of families with FS, with or without associated epilepsy. This study provides evidence that GABRG2 mutations are linked to the FS phenotype, rather than epilepsy, and that loss-of-function of GABAA receptor γ2 subunit is the probable underlying pathogenic mechanism. PMID:27066572

  9. Challenging the Stereotypes about Only Children: A Review of the Literature and Implications for Practice (United States)

    Mancillas, Adriean


    The negative stereotypes of only children are pervasive despite a growing trend toward single-child families and evidence of the only child's strengths. People maintain definite beliefs about the characteristics of each ordinal position in a family, typically viewing only children as lonely, spoiled, and maladjusted. The author reviewed the…

  10. Children with Down Syndrome: Implications for Assessment and Intervention in the School (United States)

    Davis, Andrew S.


    Down syndrome is the most common genetic cause of mental retardation and one of the most frequently occurring neurodevelopmental genetic disorders in children. Children with Down syndrome typically experience a constellation of symptomology that includes developmental motor and language delay, specific deficits in verbal memory, and broad…

  11. The Challenges of Imitation for Children with Autism Spectrum Disorders with Implications for General Music Education (United States)

    Scott, Sheila


    With emphasis on inclusive education, many music teachers interact with children on the autism spectrum within regular classroom settings. Many of these teachers rely on rote learning to teach a variety of musical skills. This creates difficulties for children on the autism spectrum who respond differently to imitation than their typically…

  12. Mother-child conversations about safety: implications for socializing safety values in children. (United States)

    O'Neal, Elizabeth E; Plumert, Jodie M


    This study examined how mothers socialize their children about safety through conversations about potentially unsafe activities. Mothers and their 8- and 10-year-old children discussed and rated the safety of 12 photographs depicting another same-gender child engaged in potentially dangerous activities. Conversations usually unfolded with children giving the first rating or rationale, followed by additional discussion between the mother and child. Mothers and children relied on 2 main types of rationales to justify their ratings: potential outcomes of the activity and specific features of the situation (dangerous and nondangerous). Mothers (but not children) used dangerous feature rationales more often than dangerous outcome rationales. When disagreements arose, mothers typically guided children to adopt their own rating rather than the child's rating. Additionally, children who used more nondangerous feature and outcome rationales had experienced more injuries requiring medical attention. Mothers' focus on dangerous features appears to reflect their efforts to help children make causal connections between dangerous elements of the situation and adverse outcomes that might result.

  13. Unselective Overimitators: The Evolutionary Implications of Children's Indiscriminate Copying of Successful and Prestigious Models (United States)

    Chudek, Maciej; Baron, Andrew S.; Birch, Susan


    Children are both shrewd about whom to copy--they selectively learn from certain adults--and overimitators--they copy adults' obviously superfluous actions. Is overimitation also selective? Does selectivity change with age? In two experiments, 161 two- to seven-year-old children saw videos of one adult receiving better payoffs or more bystander…

  14. Evidence-Based Counseling Interventions with Children of Divorce: Implications for Elementary School Counselors (United States)

    Connolly, Marianne E.; Green, Eric J.


    Parental divorce has become increasingly common for large numbers of families in schools (Lamden, King, & Goldman, 2002). This article addresses the effects of divorce on children and protective factors supporting their adjustment. Evidence-based interventions for children of divorce in elementary school counseling programs are discussed.…

  15. Saturday Morning at the Jail: Implications of Incarceration for Families and Children. (United States)

    Arditti, Joyce A.; Lambert-Shute, Jennifer; Joest, Karen


    Using a conceptual framework that acknowledges the losses associated with a parent's incarceration, 56 caregivers visiting an incarcerated family member during children's visiting hours were interviewed. Problems believed to be created by incarceration included parenting strain, emotional stress, and concerns about children's loss of involvement…

  16. Children's Rights and School Psychology: Historical Perspective and Implications for the Profession (United States)

    Hart, Stuart N.; Hart, Brannon W.


    School psychology and children's rights have great potential, well beyond what has been realized, for advancing the best interests of children, their communities, and societies. A child rights approach infused into school psychology can significantly contribute to the fulfillment of this potential. To respect and illuminate these factors and…

  17. Children's Perceptions of Sharks and Understanding of Its Ecological Significance for Educational Implications (United States)

    Tsoi, Kwok Ho


    Global shark populations are seriously declining and many species are now threatened by anthropogenic stresses. Their extinction would cause devastating consequences to the marine biodiversity and ecosystems. However some children describe the sharks as bad guys, "we should kill them all!" Such children's view motivates my study…

  18. Sugar sweetened beverage consumption by Australian children: Implications for public health strategy

    Directory of Open Access Journals (Sweden)

    Hafekost Katherine


    Full Text Available Abstract Background High consumption of sugar sweetened beverages (SSBs has been linked to unhealthy weight gain and nutrition related chronic disease. Intake of SSB among children remains high in spite of public health efforts to reduce consumption, including restrictions on marketing to children and limitations on the sale of these products in many schools. Much extant literature on Australian SSB consumption is out-dated and lacks information on several key issues. We sought to address this using a contemporary Australian dataset to examine purchase source, consumption pattern, dietary factors, and demographic profile of SSB consumption in children. Methods Data were from the 2007 Australian National Children's Nutrition and Physical Activity Survey, a representative random sample of 4,834 Australian children aged 2-16 years. Mean SSB intake by type, location and source was calculated and logistic regression models were fitted to determine factors associated with different levels of consumption. Results SSB consumption was high and age-associated differences in patterns of consumption were evident. Over 77% of SSB consumed was purchased via supermarkets and 60% of all SSB was consumed in the home environment. Less than 17% of SSB was sourced from school canteens and fast food establishments. Children whose parents had lower levels of education consumed more SSB on average, while children whose parents had higher education levels were more likely to favour sweetened juices and flavoured milks. Conclusions SSB intake by Australian children remains high and warrants continued public health attention. Evidence based and age-targeted interventions, which also recognise supermarkets as the primary source of SSB, are recommended to reduce SSB consumption among children. Additionally, education of parents and children regarding the health consequences of high consumption of both carbonated and non-carbonated SSBs is required.

  19. Sugar sweetened beverage consumption by Australian children: implications for public health strategy. (United States)

    Hafekost, Katherine; Mitrou, Francis; Lawrence, David; Zubrick, Stephen R


    High consumption of sugar sweetened beverages (SSBs) has been linked to unhealthy weight gain and nutrition related chronic disease. Intake of SSB among children remains high in spite of public health efforts to reduce consumption, including restrictions on marketing to children and limitations on the sale of these products in many schools. Much extant literature on Australian SSB consumption is out-dated and lacks information on several key issues. We sought to address this using a contemporary Australian dataset to examine purchase source, consumption pattern, dietary factors, and demographic profile of SSB consumption in children. Data were from the 2007 Australian National Children's Nutrition and Physical Activity Survey, a representative random sample of 4,834 Australian children aged 2-16 years. Mean SSB intake by type, location and source was calculated and logistic regression models were fitted to determine factors associated with different levels of consumption. SSB consumption was high and age-associated differences in patterns of consumption were evident. Over 77% of SSB consumed was purchased via supermarkets and 60% of all SSB was consumed in the home environment. Less than 17% of SSB was sourced from school canteens and fast food establishments. Children whose parents had lower levels of education consumed more SSB on average, while children whose parents had higher education levels were more likely to favour sweetened juices and flavoured milks. SSB intake by Australian children remains high and warrants continued public health attention. Evidence based and age-targeted interventions, which also recognise supermarkets as the primary source of SSB, are recommended to reduce SSB consumption among children. Additionally, education of parents and children regarding the health consequences of high consumption of both carbonated and non-carbonated SSBs is required.

  20. Voxel based morphometry of FLAIR MRI in children with intractable focal epilepsy: Implications for surgical intervention

    International Nuclear Information System (INIS)

    Riney, Catherine J.; Chong, William K.; Clark, Chris A.; Cross, J. Helen


    Purpose: Magnetic resonance imaging (MRI), in particular fluid-attenuated inversion-recovery (FLAIR), has transformed the delineation of structural brain pathology associated with focal epilepsy. However, to date there is no literature on voxel based morphometry (VBM) of FLAIR in children with epilepsy. The aim of this study was to explore the role of visual and VBM assessment of FLAIR in pre-operative investigation of children with intractable focal epilepsy. Methods: Children with intractable epilepsy due to focal cortical dysplasia (FCD) and children with intractable cryptogenic focal epilepsy (CFE) were investigated. FLAIR and T1-weighted MRI were acquired on a 1.5T MRI scanner (Siemens, Erlangen, Germany). VBM was performed using SPM5 (Wellcome Institute of Cognitive Neuroscience, London). Results: Eight children with FCD (M = 5, age 7.9–17.3 years) and 14 children with CFE (M = 8, 7.8–16.8 years) were enrolled. VBM of FLAIR detected 7/8 (88%) of FCD whilst VBM of T1-weighted MRI detected only 3/8 (38%) FCD. VBM of FLAIR detected abnormality in 4/14 children with CFE, in 2/14 (14%) the abnormality was concordant with other data on the epileptogenic zone and with visible abnormality on repeat visual inspection of MR data. VBM of T1-weighed MRI detected abnormality in 2/14 children with CFE, none of which correlated with visible abnormality. Discussion: This study highlights the important role that FLAIR imaging has in the pre-operative assessment of children with intractable epilepsy. VBM of FLAIR may provide important information allowing selection of children with intractable CFE who are likely to benefit from further neuroradiological or neurophysiological evaluation.

  1. Sweet promises: Candy advertising to children and implications for industry self-regulation. (United States)

    Harris, Jennifer L; LoDolce, Megan; Dembek, Cathryn; Schwartz, Marlene B


    Candy advertising illustrates limitations of the Children's Food and Beverage Advertising Initiative (CFBAI) self-regulatory program to improve food marketing to children. Participating companies pledge to not advertise candy in child-directed media. Yet independent analyses show that children viewed 65% more candy ads on U.S. television in 2011 than in 2007, before CFBAI implementation. The present research corroborates these findings, characterizes the increase, and examines how CFBAI-participating and non-participating companies use child-targeted techniques and media placement to advertise candy on U.S. television. Content analysis identified child-targeted messages and techniques in 2011 television candy ads, and Nielsen data (2008-2011) quantified candy advertising viewed on children's and other types of television programming. Differences between brands according to CFBAI status and use of child-targeted techniques in ads are evaluated. Data were obtained and analyzed in 2013. CFBAI-company non-approved brands represented 65% of candy ads viewed by children in 2011, up from 45% in 2008, and 77% of these ads contained child-targeted techniques. Although CFBAI companies only placed ads for approved brands on children's networks, 31% of ads viewed by children for CFBAI non-approved brands appeared on networks with higher-than-average youth audiences. CFBAI non-participating companies placed child-targeted candy ads primarily on children's networks. Despite CFBAI pledges, companies continue to advertise candy during programming with large youth audiences utilizing techniques that appeal to children. Both increased CFBAI participation and a more effective definition of "child-directed advertising" are required to reduce children's exposure to targeted advertising for foods that can harm their health. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. Hair mercury concentrations of children and mothers in Korea: Implication for exposure and evaluation

    International Nuclear Information System (INIS)

    Kim, S.A.; Jeon, C.K.; Paek, D.M.


    Background: Mercury is a global pollutant that affects neurodevelopment of children. Objective: The objectives were to measure and evaluate mercury concentration of children and mothers, and its association with exposure. Methods: A cross-sectional assessment was done using questionnaires and hair mercury were analysed by Cold Vapor Atomic Absorption Spectrometry in the National Institute for Minamata Disease in Japan. Results: A total of 112 children and 111 mothers were included; mean age was 34 months and 32 years, respectively. 17.9 % of children and 34.2 % of mothers had concentrations greater than 1 parts per million (ppm) as reference level. Body weight at birth, feeding methods, maternal age, and maternal education level were significantly different in each group (p < .05). Mean maternal hair mercury level (0.91 ppm) was higher than children (0.74 ppm), and has a positive correlation between them (p < .05). 68.1% of children, 75% of pregnant period, 63.4% of lactating period, and 78.6% of last six months have been consuming fish. With multiple regression analysis, hair mercury levels in children aged less than 6 months had a linear relationship with body weight at birth, gestational weeks, feeding methods (breast- or bottle- feeding) and maternal educational level. While children aged over 6 months significantly differed with gender, frequency of fish servings per week, and frequency of maternal fish consumption in lactation period. And hair mercury levels had inverse linear relationship with maternal monthly income in this age group. Maternal mercury levels had linear relationship with maternal age. Conclusion: Mercury levels in children may be affected by their mothers due to similar dietary patterns. Further long-term large-scale and follow-up studies are needed

  3. Hair mercury concentrations of children and mothers in Korea: Implication for exposure and evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Kim, S.A. [Department of Environmental Health, School of Public Health, Seoul National University, Seoul (Korea, Republic of)], E-mail:; Jeon, C.K.; Paek, D.M. [Department of Environmental Health, School of Public Health, Seoul National University, Seoul (Korea, Republic of)


    Background: Mercury is a global pollutant that affects neurodevelopment of children. Objective: The objectives were to measure and evaluate mercury concentration of children and mothers, and its association with exposure. Methods: A cross-sectional assessment was done using questionnaires and hair mercury were analysed by Cold Vapor Atomic Absorption Spectrometry in the National Institute for Minamata Disease in Japan. Results: A total of 112 children and 111 mothers were included; mean age was 34 months and 32 years, respectively. 17.9 % of children and 34.2 % of mothers had concentrations greater than 1 parts per million (ppm) as reference level. Body weight at birth, feeding methods, maternal age, and maternal education level were significantly different in each group (p < .05). Mean maternal hair mercury level (0.91 ppm) was higher than children (0.74 ppm), and has a positive correlation between them (p < .05). 68.1% of children, 75% of pregnant period, 63.4% of lactating period, and 78.6% of last six months have been consuming fish. With multiple regression analysis, hair mercury levels in children aged less than 6 months had a linear relationship with body weight at birth, gestational weeks, feeding methods (breast- or bottle- feeding) and maternal educational level. While children aged over 6 months significantly differed with gender, frequency of fish servings per week, and frequency of maternal fish consumption in lactation period. And hair mercury levels had inverse linear relationship with maternal monthly income in this age group. Maternal mercury levels had linear relationship with maternal age. Conclusion: Mercury levels in children may be affected by their mothers due to similar dietary patterns. Further long-term large-scale and follow-up studies are needed.

  4. An integrative review of sleep interventions and related clinical implications for obesity treatment in children. (United States)

    Fenton, Kathryn; Marvicsin, Donna; Danford, Cynthia A


    Evidence has shown correlations between obesity and sleep in children. The purpose of this review was to identify sleep interventions that could be utilized in primary care settings to prevent obesity in children. Three themes emerged: bedtime routines and environment; parental presence and graduated extinction; and health education. Effective strategies to improve sleep in children include consistent bedtime routine and self-soothing. Health care professionals can provide innovative and prevention-based sleep education for parents early in a child's development. Education, related to sleep, and appropriate sleep strategies may help prevent obesity and its long-term consequences. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. Malaria Parasitemia in Children Aged less than 5 Years Presenting ...

    African Journals Online (AJOL)

    Fever is the commonest manifestation and Children aged less than 5 years are most vulnerable. An appraisal of this disease among these children is important to reducing the impact of the disease. Objective: To determine the prevalence and identify factors affecting malaria parasitemia in febrile children aged less than 5 ...

  6. Auditory and Visual Electrophysiology of Deaf Children with Cochlear Implants: Implications for Cross-modal Plasticity. (United States)

    Corina, David P; Blau, Shane; LaMarr, Todd; Lawyer, Laurel A; Coffey-Corina, Sharon


    Deaf children who receive a cochlear implant early in life and engage in intensive oral/aural therapy often make great strides in spoken language acquisition. However, despite clinicians' best efforts, there is a great deal of variability in language outcomes. One concern is that cortical regions which normally support auditory processing may become reorganized for visual function, leaving fewer available resources for auditory language acquisition. The conditions under which these changes occur are not well understood, but we may begin investigating this phenomenon by looking for interactions between auditory and visual evoked cortical potentials in deaf children. If children with abnormal auditory responses show increased sensitivity to visual stimuli, this may indicate the presence of maladaptive cortical plasticity. We recorded evoked potentials, using both auditory and visual paradigms, from 25 typical hearing children and 26 deaf children (ages 2-8 years) with cochlear implants. An auditory oddball paradigm was used (85% /ba/ syllables vs. 15% frequency modulated tone sweeps) to elicit an auditory P1 component. Visual evoked potentials (VEPs) were recorded during presentation of an intermittent peripheral radial checkerboard while children watched a silent cartoon, eliciting a P1-N1 response. We observed reduced auditory P1 amplitudes and a lack of latency shift associated with normative aging in our deaf sample. We also observed shorter latencies in N1 VEPs to visual stimulus offset in deaf participants. While these data demonstrate cortical changes associated with auditory deprivation, we did not find evidence for a relationship between cortical auditory evoked potentials and the VEPs. This is consistent with descriptions of intra-modal plasticity within visual systems of deaf children, but do not provide evidence for cross-modal plasticity. In addition, we note that sign language experience had no effect on deaf children's early auditory and visual ERP

  7. Unhealthy food advertising directed to children on New Zealand television: extent, nature, impact and policy implications. (United States)

    Vandevijvere, Stefanie; Soupen, Alanna; Swinburn, Boyd


    To comprehensively assess the extent, nature and impact of unhealthy food advertising targeted to children on New Zealand television. Four weekdays and four weekend days were randomly selected over the period June-August 2015. Programming was recorded from 06.00 to 00.00 hours (midnight), for a total of 432 h. Audience ratings were used to identify children's peak viewing times. New Zealand. The three major free-to-air channels. The majority of foods advertised (n 1807) were unhealthy; 68·5 % of food advertisements included at least one food not permitted to be marketed to children according to the WHO nutrient profiling model. The mean hourly rate of unhealthy food advertising was 9·1 (sd 5·2). One-third of unhealthy food advertisements included a promotional character and one-third a premium offer. About 88 % of unhealthy food advertisements were shown during children's peak viewing times. If unhealthy food advertisements were to be restricted during times when at least 25 % of children are watching television, this would reduce the average unhealthy food advertising impact by 24 % during weekdays and 50 % during weekend days, and if the WHO instead of the current nutrient profiling model were used to restrict unhealthy food advertising to children, the average impact would be reduced by 24 % during weekdays and 29 % during weekend days. Current self-regulation is ineffective in protecting children from exposure to unhealthy food advertising on television. The WHO nutrient profiling model needs to be used to restrict unhealthy food advertising, especially during children's peak viewing times.

  8. Methods of Assessing Body Fatness among Children: Implications for the National Child Measurement Programme (United States)

    Wheeler, Sharon; Twist, Craig


    Body mass index (BMI) is increasingly recognized as an inadequate measure for determining obesity in children. Therefore, the aim within this study was to investigate other indirect methods of body fat assessment that could potentially be used in place of BMI. Twenty-four children (boys: 13.8 [plus or minus] 0.8 yr; girls: 13.3 [plus or minus] 0.5…

  9. Children with classic congenital adrenal hyperplasia have elevated serum leptin concentrations and insulin resistance: potential clinical implications. (United States)

    Charmandari, Evangelia; Weise, Martina; Bornstein, Stefan R; Eisenhofer, Graeme; Keil, Margaret F; Chrousos, George P; Merke, Deborah P


    Leptin is secreted by the white adipose tissue and modulates energy homeostasis. Nutritional, neural, neuroendocrine, paracrine, and autocrine factors, including the sympathetic nervous system and the adrenal medulla, have been implicated in the regulation of leptin secretion. Classic congenital adrenal hyperplasia (CAH) is characterized by a defect in cortisol and aldosterone secretion, impaired development and function of the adrenal medulla, and adrenal hyperandrogenism. To examine leptin secretion in patients with classic CAH in relation to their adrenomedullary function and insulin and androgen secretion, we studied 18 children with classic CAH (12 boys and 6 girls; age range 2-12 yr) and 28 normal children (16 boys and 12 girls; age range 5-12 yr) matched for body mass index (BMI). Serum leptin concentrations were significantly higher in patients with CAH than in control subjects (8.1 +/- 2.0 vs. 2.5 +/- 0.6 ng/ml, P = 0.01), and this difference persisted when leptin values were corrected for BMI. When compared with their normal counterparts, children with CAH had significantly lower plasma epinephrine (7.1 +/- 1.3 vs. 50.0 +/- 4.2, P fasting serum insulin (10.6 +/- 1.4 vs. 3.2 +/- 0.2 microU/ml, P Insulin resistance determined by the homeostasis model assessment method was significantly greater in children with classic CAH than in normal children (2.2 +/- 0.3 vs. 0.7 +/- 0.04, P patients and controls. Gender predicted serum leptin concentrations in controls but not in patients with classic CAH. No association was found between the dose of hydrocortisone and serum leptin (r = -0.17, P = 0.5) or insulin (r = 0.24, P = 0.3) concentrations in children with CAH. Our findings indicate that children with classic CAH have elevated fasting serum leptin and insulin concentrations, and insulin resistance. These most likely reflect differences in long-term adrenomedullary hypofunction and glucocorticoid therapy. Elevated leptin and insulin concentrations in patients

  10. Evaluation of concurrent malaria and dengue infections among febrile patients

    Directory of Open Access Journals (Sweden)

    Parul D Shah


    Full Text Available Context: Despite a wide overlap between endemic areas for two important vector-borne infections, malaria and dengue, published reports of co-infections are scarce till date. Aims: To find the incidence of dengue and malaria co-infection as well as to ascertain the severity of such dengue and malaria co-infection based on clinical and haematological parameters. Setting and Design: Observational, retrospective cross-sectional study was designed including patients who consulted the tertiary care hospital of Ahmedabad seeking treatment for fever compatible with malaria and/or dengue. Subjects and Methods: A total of 8364 serum samples from clinically suspected cases of fever compatible with malaria and/or dengue were collected. All samples were tested for dengue NS-1 antigen before 5 days of onset of illness and for dengue IgM after 5 days of onset of illness. In all samples, malaria diagnosis was based on the identification of Plasmodium parasites on a thin and thick blood films microscopy. Results: Only 10.27% (859 patients with fever were tested positive for dengue and 5.1% (434 were tested positive for malaria. 3.14% (27 dengue cases show concurrent infection with malarial parasites. Hepatomegaly and jaundice 37.03% (10, haemorrhagic manifestations 18.51% (5 and kidney failure 3.7% (1, haemoglobin <12 g/dl 100% (27 and thrombocytopenia (platelet count <150,000/cmm 96.29% (26 were common in malaria and dengue co-infections and were much more common in Plasmodium falciparum infections. Conclusion: All febrile patients must be tested for malaria and dengue, both otherwise one of them will be missed in case of concurrent infections which could lead to severe diseases with complications.

  11. Lead exposures in U.S. Children, 2008: implications for prevention. (United States)

    Levin, Ronnie; Brown, Mary Jean; Kashtock, Michael E; Jacobs, David E; Whelan, Elizabeth A; Rodman, Joanne; Schock, Michael R; Padilla, Alma; Sinks, Thomas


    We reviewed the sources of lead in the environments of U.S. children, contributions to children's blood lead levels, source elimination and control efforts, and existing federal authorities. Our context is the U.S. public health goal to eliminate pediatric elevated blood lead levels (EBLs) by 2010. National, state, and local exposure assessments over the past half century have identified risk factors for EBLs among U.S. children, including age, race, income, age and location of housing, parental occupation, and season. Recent national policies have greatly reduced lead exposure among U.S. children, but even very low exposure levels compromise children's later intellectual development and lifetime achievement. No threshold for these effects has been demonstrated. Although lead paint and dust may still account for up to 70% of EBLs in U.S. children, the U.S. Centers for Disease Control and Prevention estimates that >or=30% of current EBLs do not have an immediate lead paint source, and numerous studies indicate that lead exposures result from multiple sources. EBLs and even deaths have been associated with inadequately controlled sources including ethnic remedies and goods, consumer products, and food-related items such as ceramics. Lead in public drinking water and in older urban centers remain exposure sources in many areas. Achieving the 2010 goal requires maintaining current efforts, especially programs addressing lead paint, while developing interventions that prevent exposure before children are poisoned. It also requires active collaboration across all levels of government to identify and control all potential sources of lead exposure, as well as primary prevention.

  12. Adult Children of Divorce and Relationship Education: Implications for Counselors and Counselor Educators (United States)

    Johnson, Veronica I.


    This article explores the impact of relationship education on young adults' optimism about relationships and attitudes toward marriage whose parents were divorced and offers implications and suggestions for counselors and counselor educators. Previous research in the area of intimate and family relationships has demonstrated that adults who have…

  13. Clinical profile of high-risk febrile neutropenia in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Mohan V Bhojaraja


    Full Text Available Background Infection in the immunocompromised host has been a reason of concern in the clinical setting and a topic of debate for decades. In this study, the aim was to analyse the clinical profile of high-risk febrile neutropenic patients. Aims To study the clinical profile of high risk febrile neutropenia patients with the objective of identifying the most common associated malignancy, most common associated pathogen, the source of infection, to correlate the treatment and management with that of the Infectious Diseases Society of America (IDSA 2010 guidelines and to assess the clinical outcome. Methods A cross-sectional time bound study was carried out and a total of 80 episodes of high-risk febrile neutropenia were recorded among patients with malignancies from September 2011 to July 2013 with each episode being taken as a new case. Results Non-Hodgkin’s lymphoma (30 per cent was the most common malignancy associated, commonest source of infection was due to central venous catheters, the commonest pathogens were gram negative (52 per cent the treatment and management of each episode of high risk febrile neutropenia correlated with that of IDSA 2010 guidelines and the mortality rate was 13.75 per cent. Conclusion Febrile neutropenia is one of the major complications and cause of mortality in patients with malignancy and hence understanding its entire spectrum can help us reduce morbidity and mortality.

  14. Bilateral hippocampal atrophy in temporal lobe epilepsy: Effect of depressive symptoms and febrile seizures (United States)

    Finegersh, Andrey; Avedissian, Christina; Shamim, Sadat; Dustin, Irene; Thompson, Paul M.; Theodore, William H.


    Summary Purpose Neuroimaging studies suggest a history of febrile seizures, and depression, are associated with hippocampal volume reductions in patients with temporal lobe epilepsy (TLE). Methods We used radial atrophy mapping (RAM), a three-dimensional (3D) surface modeling tool, to measure hippocampal atrophy in 40 patients with unilateral TLE, with or without a history of febrile seizures and symptoms of depression. Multiple linear regression was used to single out the effects of covariates on local atrophy. Key Findings Subjects with a history of febrile seizures (n = 15) had atrophy in regions corresponding to the CA1 and CA3 subfields of the hippocampus contralateral to seizure focus (CHC) compared to those without a history of febrile seizures (n = 25). Subjects with Beck Depression Inventory II (BDI-II) score ≥14 (n = 11) had atrophy in the superoanterior portion of the CHC compared to subjects with BDI-II <14 (n = 29). Significance Contralateral hippocampal atrophy in TLE may be related to febrile seizures or depression. PMID:21269286


    Directory of Open Access Journals (Sweden)

    Khairani Omar


    Full Text Available Introduction: Identifying clinical features that differentiate acute febrile thrombocytopaenia from acute febrile illness without thrombocytopaenia can help primary care physician to decide whether to order a full blood count (FBC. This is important because thrombocytopaenia in viral fever may signify more serious underlying aetiology like dengue infection.Objective: The aim of this study was to compare the clinical features of acute febrile patients with thrombocytopaenia and acute febrile patients without thrombocytopaenia.Methodology: This was a clinic-based cross-sectional study from May to November 2003. Consecutive patients presenting with undifferentiated fever of less than two weeks were selected from the Primary Care Centre of Hospital Universiti Kebangsaan Malaysia and Batu 9 Cheras Health Clinic. Clinical features of these patients were recorded and FBC examination was done for all patients. Thrombocytopaenia was defined as platelet count <150X109/L. The odds ratio of thrombocytopaenia for each presenting symptoms was calculated.Result: Seventy-three patients participated in this study. Among them, 45.2% had thrombocytopaenia. Myalgia and headache were common among all patients. However, nausea and vomiting occurred significantly more often among patients with thrombocytopaenia than in patients with normal platelet count (OR 2.2, 95% CI 1.1-4.5.Conclusion: Acute non-specific febrile patients presenting with symptoms of nausea and vomiting may have higher risk of thrombocytopaenia and should be seriously considered for FBC.

  16. Social implications of children's smartphone addiction: The role of support networks and social engagement. (United States)

    Ihm, Jennifer


    Background and aims Most studies have regarded smartphone addiction as a condition stemming from individuals' psychological issues, so research has rarely examined it in relation to a lack of social resources and its social impacts. However, this study reinterprets smartphone addiction as a social problem stemming from a lack of offline social networks and resulting in a decline of social engagement. Methods This study drew on a survey of 2,000 children in Korea consisting of 991 males and 1,009 females with an average age of 12 years old. Using the STATA 14 structural equation modeling program, this study examined the relationships between children's lack of social networks, smartphone addiction, and social engagement. Results Social network variables, such as formal organizational membership, quality of relationship with parents, size of the peer group, and peer support, decrease smartphone addiction. Simply having good relationships and reciprocal feelings with peers do not have any influence on the smartphone addiction. The more the children become addicted to smartphones, the less they participate in social engagement. Discussion and conclusions This study provides a new understanding of smartphone addiction by focusing on its social aspects, augmenting prior studies that have addressed psychological factors. Findings suggest that children's lack of social networks may inhibit comfortable social interactions and feelings of support in the offline environment, which can heighten their desire to escape to smartphones. These children, unlike non-addicts, may not take advantage of the media to enrich their social lives and increase their level of social engagement.

  17. Validation of the French national health insurance information system as a tool in vaccine safety assessment: application to febrile convulsions after pediatric measles/mumps/rubella immunization. (United States)

    Hanf, Matthieu; Quantin, Catherine; Farrington, Paddy; Benzenine, Eric; Hocine, N Mounia; Velten, Michel; Tubert-Bitter, Pascale; Escolano, Sylvie


    In the French national health insurance information system (SNIIR-AM), routine records of health claimed reimbursements are linked to hospital admissions for the whole French population. The main focus of this work is the usability of this system for vaccine safety assessment programme. Self-controlled case series analyses were performed using an exhaustive SNIIR-AM extraction of French children aged less than 3 years, to investigate the relationship between MMR immunization and children hospitalizations for febrile convulsions, a well-documented rare adverse event, over 2009-2010. The results suggest a significant increase of febrile convulsions during the 6-11 days period following any MMR immunization (IRR=1.49, 95% CI=1.22, 1.83; p=0.0001) and no increase 15-35 days post any MMR immunization (IRR=1.03, 95% CI=0.89, 1.18; p=0.72). These results are in accordance with other results obtained from large epidemiologic studies, which suggest the usability of the SNIIR-AM as a relevant database to study the occurrence of adverse events associated with immunization. For future use, results associated with risk of convulsion during the day of vaccination should nevertheless be considered with particular caution. Copyright © 2013 Elsevier Ltd. All rights reserved.

  18. Febrile Seizures and Epilepsy: Association With Autism and Other Neurodevelopmental Disorders in the Child and Adolescent Twin Study in Sweden. (United States)

    Gillberg, Christopher; Lundström, Sebastian; Fernell, Elisabeth; Nilsson, Gill; Neville, Brian


    There is a recently well-documented association between childhood epilepsy and earlysymptomaticsyndromeselicitingneurodevelopmentalclinicalexaminations (ESSENCE) including autism spectrum disorder, but the relationship between febrile seizures and ESSENCE is less clear. The Child and Adolescent Twin Study in Sweden (CATSS) is an ongoing population-based study targeting twins born in Sweden since July 1, 1992. Parents of 27,092 twins were interviewed using a validated DSM-IV-based interview for ESSENCE, in connection with the twins' ninth or twelfth birthday. Diagnoses of febrile seizures (n = 492) and epilepsy (n = 282) were based on data from the Swedish National Patient Register. Prevalence of ESSENCE in individuals with febrile seizures and epilepsy was compared with prevalence in the twin population without seizures. The association between febrile seizures and ESSENCE was considered before and after adjustment for epilepsy. Age of diagnosis of febrile seizures and epilepsy was considered as a possible correlate of ESSENCE in febrile seizures and epilepsy. The rate of ESSENCE in febrile seizures and epilepsy was significantly higher than in the total population without seizures (all P epilepsy, a significant association between febrile seizures and autism spectrum disorder, developmental coordination disorder, and intellectual disability remained. Earlier age of onset was associated with all ESSENCE except attention-deficit/hyperactivity disorder in epilepsy but not with ESSENCE in febrile seizures. In a nationally representative sample of twins, there was an increased rate of ESSENCE in childhood epilepsy and in febrile seizures. Febrile seizures alone could occur as a marker for a broader ESSENCE phenotype. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. On the structural value of children and its implication on intended fertility in Bulgaria

    Directory of Open Access Journals (Sweden)

    Christoph Bühler


    Full Text Available Personal networks are receiving increasing recognition as structural determinants of fertility. However, the network perspective also helps to explain personal motivations for having children. Using theories of interpersonal exchange, social capital, and the value of children, it is argued in this article that children can substantively improve their parents' social networks. Individuals perceive this potential advantageous development as a structural benefit and consider this value in their reproductive decisions. This argument is empirically explored with data from Bulgaria, collected in 2002. The results document the presence of structural evaluations among subjectively perceived child-related benefits. Moreover, structural evaluations matter for the reproductive decision-making of Bulgarian citizens. Women's fertility intentions are supported by the prospect that a child will bring their parents and relatives closer or will improve their security at old age. Males' intentions are closely associated with the expectation that a child will provide support when they are old.

  20. Implications of Combined Exposure to Household Air Pollution and HIV on Neurocognition in Children

    Directory of Open Access Journals (Sweden)

    Megan K. Suter


    Full Text Available Air pollution exposure and HIV infection can each cause neurocognitive insult in children. The purpose of this study was to test whether children with combined high air pollution exposure and perinatal HIV infection have even greater risk of neurocognitive impairment. This was a cross-sectional study of HIV-uninfected unexposed (HUU and HIV-infected children and their caregivers in Nairobi, Kenya. We used a detailed neuropsychological battery to evaluate neurocognitive functioning in several domains. We measured caregiver 24-h personal CO exposure as a proxy for child CO exposure and child urinary 1-hydroxypyrene (1-OHP, a biomarker for exposure to polycyclic aromatic hydrocarbons (PAHs. Median 24-h caregiver CO exposure was 6.1 and 3.7 ppm for 45 HIV-infected (mean age 6.6 years and 49 HUU (mean age 6.7 years, respectively; 48.5% of HIV-infected and 38.6% of HUU had caregiver 24-h CO levels exceeding the WHO recommended level. Median 1-OHP exposure was 0.6 and 0.7 µmol/mol creatinine among HIV-infected and HUU children, respectively. HIV-infected children with high urinary 1-OHP (exceeding 0.68 µmol/mol creatinine had significantly lower global cognition (p = 0.04, delayed memory (p = 0.01, and attention scores (p = 0.003. Among HUU children, urinary 1-OHP and caregiver 24-h caregiver CO were not significantly associated with neurocognitive function. Our findings suggest that combined chronic exposure to air pollutants and perinatal HIV infection may be associated with poorer neurocognitive outcomes. High prevalence of air pollution exposure highlights the need to reduce these exposures.

  1. Individual differences in the shape bias in preschool children with specific language impairment and typical language development: theoretical and clinical implications. (United States)

    Collisson, Beverly Anne; Grela, Bernard; Spaulding, Tammie; Rueckl, Jay G; Magnuson, James S


    We investigated whether preschool children with specific language impairment (SLI) exhibit the shape bias in word learning: the bias to generalize based on shape rather than size, color, or texture in an object naming context ('This is a wek; find another wek') but not in a non-naming similarity classification context ('See this? Which one goes with this one?'). Fifty-four preschool children (16 with SLI, 16 children with typical language [TL] in an equated control group, and 22 additional children with TL included in individual differences analyses but not group comparisons) completed a battery of linguistic and cognitive assessments and two experiments. In Experiment 1, children made generalization choices in object naming and similarity classification contexts on separate days, from options similar to a target object in shape, color, or texture. On average, TL children exhibited the shape bias in an object naming context, but children with SLI did not. In Experiment 2, we tested whether the failure to exhibit the shape bias might be linked to ability to detect systematicities in the visual domain. Experiment 2 supported this hypothesis, in that children with SLI failed to learn simple paired visual associations that were readily learned by children with TL. Analyses of individual differences in the two studies revealed that visual paired-associate learning predicted degree of shape bias in children with SLI and TL better than any other measure of nonverbal intelligence or standard assessments of language ability. We discuss theoretical and clinical implications. © 2014 John Wiley & Sons Ltd.

  2. Outpatient management of febrile neutropenia: time to revise the present treatment strategy

    DEFF Research Database (Denmark)

    Carstensen, M.; Sørensen, Jens Benn


    We reviewed medical literature on the efficacy and safety of outpatient versus hospital-based therapy of low-risk febrile neutropenia in adult cancer patients. A PubMed search for all studies evaluating the outpatient treatment of adults diagnosed with solid tumors who suffered from low......-risk febrile neutropenia was completed; reference lists from identified articles also were used. In all, 10 trials were included in the analysis, which showed no significant difference in clinical failure rates and mortality for ambulatory regimens and standard hospital-based therapy. Subgroup analysis...... treatment failure (P febrile neutropenia is safe, effective, and comparable to standard hospital-based therapy. Patients at low risk are outpatients and are hemodynamically...

  3. Genetic survey of a group of children with clefting: implications for genetic counseling

    NARCIS (Netherlands)

    Hofstee, Y.; Kors, N.; Hennekam, R. C.


    A cleft lip, cleft palate, or both are associated with a high frequency of other anomalies. This study gives an inventory of associated anomalies in a consecutive group of children (n = 36) with clefts, referred to a local multidisciplinary cleft team in the Netherlands. In 47.2% of cleft patients

  4. Researchers' perceptions of the ethical implications of pharmacogenomics research with children. (United States)

    Avard, D; Silverstein, T; Sillon, G; Joly, Y


    This paper presents the results of an exploratory qualitative study that assesses Canadian pediatric researchers' perceptions of a pre-selected group of ethical issues raised by pharmacogenomics research with children. As a pilot study, we conducted semi-structured telephone interviews with Canadian pediatric pharmacogenomic researchers. The interviews were guided by the following themes: (1) benefits and risks of inclusion, (2) the consent/assent process, and (3) the return of research results. Issues about assent, consent, risks and benefits, as well as the communication of results were addressed by the respondents. Some issues, such as the unique vulnerability of children, the long term privacy concerns associated with biobanking, additional core elements that need to be discussed and included in the consent/assent forms, as well as the challenges of communicating research results in a pediatric research were not explicitly identified by the respondents. Further consideration should be given to address the ethical challenges of including children in pharmacogenomics research. This exploratory study indicates that further guidance is needed if children are to be protected and yet benefit from such research. Copyright 2009 S. Karger AG, Basel.

  5. Sleep problems for children with autism and caregiver spillover effects : Implications for cost-effectiveness analysis

    NARCIS (Netherlands)

    J.M. Tilford (John Mick); N. Payakachat (Nalin); K.A. Kuhlthau (Karen); J.M. Pyne (Jeffrey); E. Kovacs (Erica); W.B.F. Brouwer (Werner); R.E. Frye (Richard)


    markdownabstractSleep problems in children with autism spectrum disorders (ASD) are under-recognized and under-treated. Identifying treatment value accounting for health effects on family members (spillovers) could improve the perceived cost-effectiveness of interventions to improve child sleep

  6. Tracheostomy in Young Children: Implications for Assessment and Treatment of Communication and Feeding Disorders. (United States)

    Simon, Bonnie M.; McGowan, Joy Silverman


    The article reviews studies showing that speech and language intervention during the period of cannulation can benefit tracheostomized and ventilator-dependent children by improving their communicative functioning while decreasing their frustration with the tracheostomy placement. Therapeutic interventions with feeding skills are also recommended.…

  7. Television viewing and unhealthy diet: implications for children and media interventions. (United States)

    Harris, Jennifer L; Bargh, John A


    The concern over increasing rates of obesity and associated health issues has led to calls for solutions to the potentially unhealthy influence of television and food advertising on children's diets. Research demonstrates that children's food preferences are acquired through learning processes, and that these preferences have long-lasting effects on diet. We examined food preferences and eating behaviors among college students, and assessed the relative influence of 2 potential contributors: parental communication and television experience. In line with previous studies with children, prior television experience continued to predict unhealthy food preferences and diet in early adulthood, and perceived taste had the most direct relationship to both healthy and unhealthy diets. In addition, both television experience and parenting factors independently influenced preferences and diet. These findings provide insights into the potential effectiveness of alternative media interventions to counteract the unhealthy influence of television on diet, including a) nutrition education; b) parental communication and media literacy education to teach children to defend against unwanted influence; and c) reduced exposure to unhealthy messages.

  8. Obesity-Related Hormones in Low-Income Preschool-Age Children: Implications for School Readiness (United States)

    Miller, Alison L.; Lumeng, Carey N.; Delproposto, Jennifer; Florek, Brian; Wendorf, Kristin; Lumeng, Julie C.


    Mechanisms underlying socioeconomic disparities in school readiness and health outcomes, particularly obesity, among preschool-aged children are complex and poorly understood. Obesity can induce changes in proteins in the circulation that contribute to the negative impact of obesity on health; such changes may relate to cognitive and emotion…

  9. Divergence of fine and gross motor skills in prelingually deaf children: implications for cochlear implantation. (United States)

    Horn, David L; Pisoni, David B; Miyamoto, Richard T


    The objective of this study was to assess relations between fine and gross motor development and spoken language processing skills in pediatric cochlear implant users. The authors conducted a retrospective analysis of longitudinal data. Prelingually deaf children who received a cochlear implant before age 5 and had no known developmental delay or cognitive impairment were included in the study. Fine and gross motor development were assessed before implantation using the Vineland Adaptive Behavioral Scales, a standardized parental report of adaptive behavior. Fine and gross motor scores reflected a given child's motor functioning with respect to a normative sample of typically developing, normal-hearing children. Relations between these preimplant scores and postimplant spoken language outcomes were assessed. In general, gross motor scores were found to be positively related to chronologic age, whereas the opposite trend was observed for fine motor scores. Fine motor scores were more strongly correlated with postimplant expressive and receptive language scores than gross motor scores. Our findings suggest a disassociation between fine and gross motor development in prelingually deaf children: fine motor skills, in contrast to gross motor skills, tend to be delayed as the prelingually deaf children get older. These findings provide new knowledge about the links between motor and spoken language development and suggest that auditory deprivation may lead to atypical development of certain motor and language skills that share common cortical processing resources.

  10. Narrative Abilities of Monolingual and Bilingual Children with and without Language Impairment: Implications for Clinical Practice (United States)

    Boerma, Tessel; Leseman, Paul; Timmermeister, Mona; Wijnen, Frank; Blom, Elma


    Background: Understanding and expressing a narrative's macro-structure is relatively independent of experience in a specific language. A narrative task is therefore assumed to be a less biased method of language assessment for bilingual children than many other norm-referenced tests and may thus be particularly valuable to identify language…

  11. Social and Political Thinking in Children: Implications for Law-Related Education. (United States)

    Wyner, Nancy B.

    The paper reviews literature dealing with children's social and political development and examines how changing orientations in child development research relate to citizenship education. The paper is intended for use by elementary school educators as they develop and implement citizenship education and law-related education programs. The paper is…

  12. Socioeconomic predictors of cognition in Ugandan children: implications for community interventions.

    Directory of Open Access Journals (Sweden)

    Paul Bangirana


    Full Text Available Several interventions to improve cognition in at risk children have been suggested. Identification of key variables predicting cognition is necessary to guide these interventions. This study was conducted to identify these variables in Ugandan children and guide such interventions.A cohort of 89 healthy children (45 females aged 5 to 12 years old were followed over 24 months and had cognitive tests measuring visual spatial processing, memory, attention and spatial learning administered at baseline, 6 months and 24 months. Nutritional status, child's educational level, maternal education, socioeconomic status and quality of the home environment were also measured at baseline. A multivariate, longitudinal model was then used to identify predictors of cognition over the 24 months.A higher child's education level was associated with better memory (p = 0.03, attention (p = 0.005 and spatial learning scores over the 24 months (p = 0.05; higher nutrition scores predicted better visual spatial processing (p = 0.002 and spatial learning scores (p = 0.008; and a higher home environment score predicted a better memory score (p = 0.03.Cognition in Ugandan children is predicted by child's education, nutritional status and the home environment. Community interventions to improve cognition may be effective if they target multiple socioeconomic variables.

  13. Management strategies of mothers of school-age children with autism: implications for practice. (United States)

    Joosten, Annette V; Safe, Anneleise P


    Mothering children with autism results in mothers spending more time on daily tasks as well as managing the disorder. The need for mothers to self-manage often increases when the child is school aged. Mothers develop strategies, and occupational therapists and other health professional rely on or expect mothers to be involved in meeting the extra needs of their children with autism and other family members. Little is known about the strategies adopted by the mothers. The aim of this study was to explore the strategies mothers used to manage their roles and emotions, and their child's behaviours. In-depth individual interviews were conducted with seven mothers and data were analysed in this qualitative study using phenomenological analysis. Findings revealed that the mothers had adopted strategies to manage their roles, their emotions and their child's behaviour. However, the strategies were often shaped by the expectations of others or circumstances beyond their control and at times added further to their stress. Mothers of children with autism developed strategies to self-manage their lives and their child's disorder. However, even when these strategies were effective, they sometimes placed further stress on the mothers. The mothers provided insights to how they coped but need help to consider the support they require and therapists need to consider the pressures of expecting mothers to self-manage their child's disorder, their own lives and their family. Family-centred practice emphasising collaboration with mothers needs to be maintained with school-aged children. © 2014 Occupational Therapy Australia.

  14. Implications of New Marriages and Children for Coparenting in Nonresident Father Families (United States)

    McGene, Juliana; King, Valarie


    Prior research has noted that although cooperative coparenting between resident and nonresident parents is beneficial to children, this form of shared parenting is relatively uncommon. Relying on nationally representative data from two waves of the National Survey of Families and Households (N = 628), this study examines the importance of…

  15. Counseling Gifted Children in Singapore: Implications for Evidence-Based Treatment with a Multicultural Population (United States)

    Yeo, Lay See; Pfeiffer, Steven I.


    Gifted education (GE) in Singapore is entering its third decade. However, local research into the gifted is typically undertaken by graduate students and left as unpublished data. Internationally, there is also very little if any research on counseling models that have been empirically validated for use with gifted children irrespective of their…

  16. Cultural Tourism in Transnational Adoption: "Staged Authenticity" and Its Implications for Adopted Children (United States)

    Quiroz, Pamela Anne


    The discursive practices of adoptive parents in two online transnational adoption forums (2006-2008) and observations of five international adoption workshops suggest that what Heather Jacobson described as "culture keeping", the cultural socialization of children that retains a sense of native group identity, is more aptly characterized as…

  17. Understanding the Contributions of Prosodic Phonology to Morphological Development: Implications for Children with Specific Language Impairment (United States)

    Demuth, Katherine; Tomas, Ekaterina


    A growing body of research with typically developing children has begun to show that the acquisition of grammatical morphemes interacts not only with a developing knowledge of syntax, but also with developing abilities at the interface with prosodic phonology. In particular, a Prosodic Licensing approach to these issues provides a framework for…

  18. Children of Color and Parental Incarceration: Implications for Research, Theory, and Practice (United States)

    Graham, James A.; Harris, Yvette R.


    Practical information about culturally appropriate interventions with children of incarcerated parents (CIPs) of color and their families is notably sparse. This study uses a cultural-ecological perspective to contextualize individual, family, and legal issues inherent in many intervention programs for CIPs of color. The authors highlight…

  19. Revisioning Assessment through a Children's Rights Approach: Implications for Policy, Process and Practice (United States)

    Elwood, Jannette; Lundy, Laura


    The linkage between the impact of assessment and compliance with children's rights is a connection, which although seemingly obvious, is nonetheless rarely made, particularly by governments, which, as signatories to the relevant human rights treaties, have the primary responsibility for ensuring that educational practice is compatible with…

  20. A Phonologically Based Intervention for School-Age Children with Language Impairment: Implications for Reading Achievement (United States)

    Ritter, Michaela J.; Park, Jungjun; Saxon, Terrill F.; Colson, Karen A.


    This study was conducted utilizing a quasi-experimental pre- and postgroup design to examine the effects of a phonologically based intervention aimed to improve phonological awareness (PA) and reading abilities in school-age children with language impairment (LI) in Grades 1 through 3. The intervention included instruction in PA and sound-symbol…

  1. Methodological Implications of the Affect Revolution: A 35-Year Review of Emotion Regulation Assessment in Children (United States)

    Adrian, Molly; Zeman, Janice; Veits, Gina


    This investigation analyzed the methods used over the past 35 years to study emotion regulation (ER) in children. Articles published from 1975 through 2010 were identified in 42 child clinical, developmental, and emotion psychology journals. Overall, 61.1% of published ER articles relied on one method and 23.6% used two methods. Analyses revealed…

  2. Access to Education for Children with Disabilities in Uganda: Implications for Education for All (United States)

    Moyi, Peter


    Since 1990 many countries in Sub-Saharan Africa have witnessed extraordinary progress in school enrollment; however, the progress has slowed in recent years. UNESCO warns that unless new measures are taken, the number of out-of-school children in 2015 will increase from current levels. Inequalities in most developing countries have been found to…

  3. Behavioral Determinants of Brushing Young Children's Teeth: Implications for Anticipatory Guidance (United States)

    Huebner, Colleen E.; Riedy, Christine A.


    Purpose The purposes of this study were to identify parents' motivation, support, and barriers to twice daily tooth-brushing of infants and preschool-age children and to discover new approaches to encourage this important health behavior. Methods Qualitative interviews were conducted with 44 rural parents about tooth-brushing habits and experiences. Results Forty of 44 parents reported that they had begun to brush their child's teeth; 24 (55%) reported brushing twice a day or more. Parents who brushed twice a day, vs less often, were more likely to describe specific skills to overcome barriers; they expressed high self-efficacy and held high self-standards for brushing. Parents who brushed their children's teeth less than twice daily were more likely to: hold false beliefs about the benefits of twice daily tooth-brushing; report little normative pressure or social support for the behavior; have lower self-standards; describe more external constraints; and offer fewer ideas to overcome barriers. Conclusions The findings support an integrative framework in which barriers and support for parents' twice daily brushing of their young children's teeth are multiple and vary among individuals. Knowledge of behavioral determinants specific to individual parents could strengthen anticipatory guidance and recommendations about at-home oral hygiene of young children. PMID:20298653

  4. The invisibility of children's paid and unpaid work: implications for Ethiopia's national poverty reduction policy

    NARCIS (Netherlands)

    Woldehanna, T.; Jones, N.; Tefera, B.


    The complexities of intergenerational and gendered intra-household resource allocations are frequently overlooked in poverty reduction policies. To address this lacuna, this article focuses on links between macro-development policies and children's paid and unpaid work burden in Ethiopia. Using a

  5. Acute Undifferentiated Febrile Illness in Rural Cambodia: A 3-Year Prospective Observational Study (United States)

    Mueller, Tara C.; Siv, Sovannaroth; Khim, Nimol; Kim, Saorin; Fleischmann, Erna; Ariey, Frédéric; Buchy, Philippe; Guillard, Bertrand; González, Iveth J.; Christophel, Eva-Maria; Abdur, Rashid; von Sonnenburg, Frank; Bell, David; Menard, Didier


    In the past decade, malaria control has been successfully implemented in Cambodia, leading to a substantial decrease in reported cases. Wide-spread use of malaria rapid diagnostic tests (RDTs) has revealed a large burden of malaria-negative fever cases, for which no clinical management guidelines exist at peripheral level health facilities. As a first step towards developing such guidelines, a 3-year cross-sectional prospective observational study was designed to investigate the causes of acute malaria-negative febrile illness in Cambodia. From January 2008 to December 2010, 1193 febrile patients and 282 non-febrile individuals were recruited from three health centers in eastern and western Cambodia. Malaria RDTs and routine clinical examination were performed on site by health center staff. Venous samples and nasopharyngeal throat swabs were collected and analysed by molecular diagnostic tests. Blood cultures and blood smears were also taken from all febrile individuals. Molecular testing was applied for malaria parasites, Leptospira, Rickettsia, O. tsutsugamushi, Dengue- and Influenza virus. At least one pathogen was identified in 73.3% (874/1193) of febrile patient samples. Most frequent pathogens detected were P. vivax (33.4%), P. falciparum (26.5%), pathogenic Leptospira (9.4%), Influenza viruses (8.9%), Dengue viruses (6.3%), O. tsutsugamushi (3.9%), Rickettsia (0.2%), and P. knowlesi (0.1%). In the control group, a potential pathogen was identified in 40.4%, most commonly malaria parasites and Leptospira. Clinic-based diagnosis of malaria RDT-negative cases was poorly predictive for pathogen and appropriate treatment. Additional investigations are needed to understand their impact on clinical disease and epidemiology, and the possible role of therapies such as doxycycline, since many of these pathogens were seen in non-febrile subjects. PMID:24755844

  6. Exposure to traffic noise and air pollution and risk for febrile seizure: a cohort study. (United States)

    Hjortebjerg, Dorrit; Nybo Andersen, Anne-Marie; Ketzel, Matthias; Raaschou-Nielsen, Ole; Sørensen, Mette


    Objectives Exposure to traffic noise and air pollution is suspected to increase susceptibility to viral infections - the main triggering factor for febrile seizures. No studies have examined these two exposures in relation to febrile seizures. We aimed to investigate whether exposure to road traffic noise and air pollution are associated with risk of febrile seizures in childhood. Methods From our study base of 51 465 singletons from a national birth cohort, we identified 2175 cases with febrile seizures using a nationwide registry. Residential address history from conception to six years of age were found in national registers, and road traffic noise (L den ) and air pollution (NO 2 ) were modeled for all addresses. Analyses were done using Cox proportional hazard model with adjustment for potential confounders, including mutual exposure adjustment. Results An interquartile range (IQR) increase in childhood exposure to road traffic noise and air pollution was associated with an 11% [incidence rate ratio (IRR) 1.11, 95% confidence interval (CI) 1.04-1.19) and 5% (IRR 1.05, 95% CI 1.02-1.07) higher risk for febrile seizures, respectively, after adjustment for potential confounders. Weaker tendencies were seen for pregnancy exposure. In models with mutual exposure adjustment, the estimates were slightly lower, with IRR of 1.08 (95% CI 1.00-1.16) and 1.03 (95% CI 0.99-1.06) per IQR increase in childhood exposure to road traffic noise and air pollution, respectively. Conclusions This study suggests that residential exposure to road traffic noise and air pollution is associated with higher risk for febrile seizures.

  7. When to perform urine cultures in respiratory syncytial virus-positive febrile older infants? (United States)

    Kaluarachchi, Dinushan; Kaldas, Virginia; Erickson, Evelyn; Nunez, Randolph; Mendez, Magda


    Respiratory syncytial virus (RSV) infections are associated with clinically significant rate of urinary tract infections (UTIs) in young infants. Previous research investigating RSV infections and UTIs has been performed mainly in infants younger than 2 to 3 months and has not focused on the risk of UTI in infants 3 to 12 months. This study aimed to assess the rate of UTIs in febrile RSV-positive older infants admitted as inpatients and identify predictors of UTI in febrile RSV-positive older infants. This is a retrospective comparative study of febrile RSV-positive infants 0 to 12 months of age admitted to the inpatient pediatric unit of Lincoln Medical and Mental Health Center, Bronx, from September through April 2006 to 2012. Infants 3 to 12 months were considered the cases, and infants 0 to 3 months were the comparative group. The rate of UTIs between the 2 groups was compared. Univariate tests and multiple logistic regression were used to identify demographic/clinical factors associated with UTI in febrile RSV-positive older infants. A total of 414 RSV-positive febrile infants were enrolled including 297 infants 3 to 12 months of age. The rate of UTI in older infants was 6.1% compared with 6.8% in infants younger than 3 months. Positive urinalysis finding was an independent predictor of UTI (P = 0.003) in older infants. All 11 boys with UTI were uncircumcised, and none of the 51 circumcised boys had UTI. Demographic (race, sex, and age) and clinical factors (temperature, white blood cell count, and absolute neutrophil count) were not associated with UTI. Febrile older infants who are RSV positive have a clinically significant rate of UTIs. It seems prudent to examine the urine of these older infants. Positive urinalysis finding was a predictive factor of UTI. Circumcised boys are at a decreased risk of UTI, compared with uncircumcised boys.

  8. Treatment actions and treatment failure: case studies in the response to severe childhood febrile illness in Mali

    Directory of Open Access Journals (Sweden)

    Ellis Amy A


    Full Text Available Abstract Background Appropriate home management of illness is vital to efforts to control malaria. The strategy of home management relies on caregivers to recognize malaria symptoms, assess severity and promptly seek appropriate care at a health facility if necessary. This paper examines the management of severe febrile illness (presumed malaria among children under the age of five in rural Koulikoro Region, Mali. Methods This research examines in-depth case studies of twenty-five households in which a child recently experienced a severe febrile illness, as well as key informant interviews and focus group discussions with community members. These techniques were used to explore the sequence of treatment steps taken during a severe illness episode and the context in which decisions were made pertaining to pursing treatments and sources of care, while incorporating the perspective and input of the mother as well as the larger household. Results Eighty-one participants were recruited in 25 households meeting inclusion criteria. Children's illness episodes involved multiple treatment steps, with an average of 4.4 treatment steps per episode (range: 2–10. For 76% of children, treatment began in the home, but 80% were treated outside the home as a second recourse. Most families used both traditional and modern treatments, administered either inside the home by family members, or by traditional or modern healers. Participants’ stated preference was for modern care, despite high rates of reported treatment failure (52%, n=12, however, traditional treatments were also often deemed appropriate and effective. The most commonly cited barrier to seeking care at health facilities was cost, especially during the rainy season. Financial constraints often led families to use traditional treatments. Conclusions Households have few options available to them in moments of overlapping health and economic crises. Public health research and policy should focus on

  9. The Relationship between Poverty and Healthcare Seeking among Patients Hospitalized with Acute Febrile Illnesses in Chittagong, Bangladesh.

    Directory of Open Access Journals (Sweden)

    M Trent Herdman

    Full Text Available Delays in seeking appropriate healthcare can increase the case fatality of acute febrile illnesses, and circuitous routes of care-seeking can have a catastrophic financial impact upon patients in low-income settings. To investigate the relationship between poverty and pre-hospital delays for patients with acute febrile illnesses, we recruited a cross-sectional, convenience sample of 527 acutely ill adults and children aged over 6 months, with a documented fever ≥38.0 °C and symptoms of up to 14 days' duration, presenting to a tertiary referral hospital in Chittagong, Bangladesh, over the course of one year from September 2011 to September 2012. Participants were classified according to the socioeconomic status of their households, defined by the Oxford Poverty and Human Development Initiative's multidimensional poverty index (MPI. 51% of participants were classified as multidimensionally poor (MPI>0.33. Median time from onset of any symptoms to arrival at hospital was 22 hours longer for MPI poor adults compared to non-poor adults (123 vs. 101 hours rising to a difference of 26 hours with adjustment in a multivariate regression model (95% confidence interval 7 to 46 hours; P = 0.009. There was no difference in delays for children from poor and non-poor households (97 vs. 119 hours; P = 0.394. Case fatality was 5.9% vs. 0.8% in poor and non-poor individuals respectively (P = 0.001-5.1% vs. 0.0% for poor and non-poor adults (P = 0.010 and 6.4% vs. 1.8% for poor and non-poor children (P = 0.083. Deaths were attributed to central nervous system infection (11, malaria (3, urinary tract infection (2, gastrointestinal infection (1 and undifferentiated sepsis (1. Both poor and non-poor households relied predominantly upon the (often informal private sector for medical advice before reaching the referral hospital, but MPI poor participants were less likely to have consulted a qualified doctor. Poor participants were more likely to attribute delays in

  10. A brucellosis case presenting with vesicular and maculopapular rash and febrile neutropenia

    Directory of Open Access Journals (Sweden)

    Selmin Dirgen Çaylak


    Full Text Available Brucellosis is a systemic disease in which all kind of tissues and organs can be affected. Brucellosis may present with different symptoms and symptoms are non-specific. A broad spectrum of clinical manifestations can be seen, therefore diagnosis can be difficult. Cutaneous complications and febrile neutropenia have been rarely reported. Here, a rare brucellosis case was reported that he applied with fever, skin eruption and neutropenia. We emphasized that especially in endemic areas brucellosis should always be kept on mind in the differential diagnosis of patient with skin eruption and febril neutropenia.J Microbiol Infect Dis 2014;4(1: 39-41

  11. Is the addition of aminoglycosides to beta-lactams in cancer patients with febrile neutropenia needed? (United States)

    Contreras, Valeria; Sepúlveda, Sebastián; Heredia, Ana


    It is still controversial if the combined use of beta-lactam antibiotics and aminoglycosides has advantages over broad-spectrum beta-lactam monotherapy for the empirical treatment of cancer patients with febrile neutropenia. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified three systematic reviews including 14 pertinent randomized trials. We combined the evidence using meta-analysis and generated a summary of findings table following the GRADE approach. We concluded the combination of beta-lactam antibiotics and aminoglycosides probably does not lead to a reduced mortality in febrile neutropenic cancer patients and it might increase nephrotoxicity.

  12. [Origin exploration of "the fifty-nine acupoints for febrile disease"]. (United States)

    Li, Guangyi


    Fifty-nine acupoints for febrile disease is recorded in Huangdi Neijing ( Huangdi's Internal Classics ). By analyzing the combination of these acupoints, the writer discovered the acupoint composition and detected their origins from Huangdi's Internal Classics , in which the terms biaoben, qijie and beishu are involved in the theoretic evidence. The writer thought the "fifty-nine acupoints for febrile disease" implied the self-evolution of some acupuncture school in ancient time, which was formed by absorbing the theoretic experiences of the other schools. It is necessary to analyze and interpret the other literatures besides Huangdi's Internal Classics and probably obtain the further reorganization on it.

  13. Developmental Origins of Health and Disease (DOHaD): Implications for health and nutritional issues among rural children in China. (United States)

    Feng, Aihua; Wang, Lijie; Chen, Xiang; Liu, Xiaoyan; Li, Ling; Wang, Baozhen; Luo, Huiwen; Mo, Xiuting; Tobe, Ruoyan Gai


    In China, with fast economic growth, health and nutrition status among the rural population has shown significant improvement in the past decades. On the other hand, burden of non-communicable diseases and prevalence of related risk factors such as overweight and obesity has also increased. Among rural children, the double burden of malnutrition and emerging overweight and obesity has been neglected so far. According to the theory of Developmental Origin of Health and Diseases (DOHaD), malnutrition, including both undernutrition (stunting and wasting) and over-nutrition (overweight and obesity) during childhood is closely related to worsened health outcomes during adulthood. Such a neglected problem is attributable to a complicated synergy of social and environmental factors such as parental migration, financial situation of the household, child-rearing knowledge and practices of the primary caregivers, and has implications for public health. Based on literature review of lessons from the field, intervention to address malnutrition among rural children should be a comprehensive package, with consideration of their developmental environment and geographical and socioeconomic diversity. The scientific evidence on DOHaD indicates the probability and necessity of prevention of adult disease by promotion of maternal and child health and reducing malnutrition by provision of high-quality complementary foods, promotion of a well-balanced dietary pattern, and promotion of health literacy in the public would bring a potential benefit to reduce potential risk of diseases.

  14. The clinical implication of drug dependency in children and adults with inflammatory bowel disease: a review

    DEFF Research Database (Denmark)

    Duricova, Dana; Pedersen, Natalia; Lenicek, Martin


    Drug dependency in adult and paediatric patients with inflammatory bowel disease (IBD) is described and the significance of this response pattern in clinical practice discussed in this review. Dependent patients maintain remission while on the treatment, but they relapse shortly after drug...... corticosteroid dependency. Infliximab dependency was described in 42-66% of children and 29% of adults with Crohn's disease. The risk of surgery 50 and 40 months after treatment start was 10% and 23% in infliximab dependent children and adults, respectively. Maintenance of infliximab in dependent patients...... was suggested to postpone if not avoid the need of surgery. Lastly, mesalazine dependency was identified in 23% of adults with Crohn's disease. These patients were characterized by mild disease course and lower surgical risk compared to non-responders to mesalazine (32 vs. 61%). Identification of drug...

  15. Healthcare Access for Iraqi Refugee Children in Texas: Persistent Barriers, Potential Solutions, and Policy Implications. (United States)

    Vermette, David; Shetgiri, Rashmi; Al Zuheiri, Haidar; Flores, Glenn


    To identify access barriers to healthcare and potential interventions to improve access for Iraqi refugee children. Four focus groups were conducted using consecutive sampling of Iraqi refugee parents residing in the US for 8 months to 5 years. Eight key-informant interviews also were conducted with employees of organizations serving Iraqi refugee families, recruited using snowball sampling. Focus groups and interviews were audiotaped, transcribed, and analyzed using margin coding and grounded theory. Iraqi refugees identified provider availability, Medicaid maintenance and renewal, language issues, and inadequate recognition of post-traumatic stress disorder as barriers to care for their children. Interviewees cited loss of case-management services and difficulties in understanding the Medicaid renewal process as barriers. Potential interventions to improve access include community-oriented efforts to educate parents on Medicaid renewal, obtaining services, and accessing specialists. Given the enduring nature of language and Medicaid renewal barriers, policies addressing eligibility alone are insufficient.

  16. Use of over-the-counter malaria medicines in children and adults in three districts in Kenya: implications for private medicine retailer interventions

    Directory of Open Access Journals (Sweden)

    Ochola Sam A


    , adults were more likely to self-treat with OTC antimalarial medicines than febrile children were to receive them, and less likely to use them in recommended ways. Government health centres were the most common second resort for treatment and were often used within 72 hours. In view of these practices, more research is needed to assess the impact on the popularity of private medicine sellers of strengthened public sector policies on access to malaria treatment and insecticide-treated bed nets. Improved targeting of OTC antimalarials to high risk groups, better communication strategies regarding adult as well as children's dosages, and facilitating more rapid referral to trained health workers where needed are important challenges to private medicine seller programmes.

  17. Children and youth with 'unspecified injury to the head': implications for traumatic brain injury research and surveillance. (United States)

    Chan, Vincy; Mann, Robert E; Pole, Jason D; Colantonio, Angela


    The case definition for traumatic brain injury (TBI) often includes 'unspecified injury to the head' diagnostic codes. However, research has shown that the inclusion of these codes leads to false positives. As such, it is important to determine the degree to which inclusion of these codes affect the overall numbers and profiles of the TBI population. The objective of this paper was to profile and compare the demographic and clinical characteristics, intention and mechanism of injury, and discharge disposition of hospitalized children and youth aged 19 years and under using (1) an inclusive TBI case definition that included 'unspecified injury to the head' diagnostic codes, (2) a restricted TBI case definition that excluded 'unspecified injury to the head 'diagnostic codes, and (3) the 'unspecified injury to the head' only case definition. The National Ambulatory Care Reporting System and the Discharge Abstract Database from Ontario, Canada, were used to identify cases between fiscal years 2003/04 and 2009/10. The rate of TBI episodes of care using the inclusive case definition for TBI (2,667.2 per 100,000) was 1.65 times higher than that of the restricted case definition (1,613.3 per 100,000). 'Unspecified injury to the head' diagnostic codes made up of 39.5 % of all cases identified with the inclusive case definition. Exclusion of 'unspecified injury to the head' diagnostic code in the TBI case definition resulted in a significantly higher proportion of patients in the intensive care units (p definition of TBI for the children and youth population is important, as it has implications for the numbers used for policy, resource allocation, prevention, and planning of healthcare services. This paper can inform future work on reaching consensus on the diagnostic codes for defining TBI in children and youth.

  18. Prevalence and associated factors of Schistosomiasis among children in Yemen: implications for an effective control programme.

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    Hany Sady

    Full Text Available Schistosomiasis, one of the most prevalent neglected tropical diseases, is a life-threatening public health problem in Yemen especially in rural communities. This cross-sectional study aims to determine the prevalence and associated risk factors of schistosomiasis among children in rural Yemen.Urine and faecal samples were collected from 400 children. Urine samples were examined using filtration technique for the presence of Schistosoma haematobium eggs while faecal samples were examined using formalin-ether concentration and Kato Katz techniques for the presence of S. mansoni. Demographic, socioeconomic and environmental information were collected via a validated questionnaire. Overall, 31.8% of the participants were found to be positive for schistosomiasis; 23.8% were infected with S. haematobium and 9.3% were infected with S. mansoni. Moreover, 39.5% of the participants were anaemic whereas 9.5% had hepatosplenomegaly. The prevalence of schistosomiasis was significantly higher among children aged >10 years compared to those aged ≤ 10 years (P<0.05. Multivariate analysis confirmed that presence of other infected family member (P<0.001, low household monthly income (P = 0.003, using unsafe sources for drinking water (P = 0.003, living nearby stream/spring (P = 0.006 and living nearby pool/pond (P = 0.002 were the key factors significantly associated with schistosomiasis among these children.This study reveals that schistosomiasis is still highly prevalent in Yemen. These findings support an urgent need to start an integrated, targeted and effective schistosomiasis control programme with a mission to move towards the elimination phase. Besides periodic drug distribution, health education and community mobilisation, provision of clean and safe drinking water, introduction of proper sanitation are imperative among these communities in order to curtail the transmission and morbidity caused by schistosomiasis. Screening and treating other infected

  19. Connections between children's speaking and singing behaviours : implications for education and therapy


    Rinta, Tiija Elisabet


    Abstract The putpose of the study was to investigate potential connections between children's speaking and singing behaviouts, as well as to explore the potential use of such connections in speech or voice therapy and in educational settings. The objectives of the study were addressed through an exploratory approach. In the literature review, potential connections between the two vocal behaviours were investigated theoretically from the physiological (including neurological)...

  20. Children's school readiness: implications for eliminating future disparities in health and education. (United States)

    Pagani, Linda S; Fitzpatrick, Caroline


    School-entry characteristics predict adult educational attainment, which forecasts dispositions toward disease prevention. Health and education risks can also be transmitted from one generation to the next. As such, school readiness forecasts a set of intertwined biopsychosocial trajectories that can influence the developmental antecedents to health and disease prevalence in society. To predict children's health behaviors and academic adjustment at the end of fourth grade from their kindergarten entry math, vocabulary, and attention skills. We use a subsample of 614 girls and 541 boys from the Quebec Longitudinal Study of Child Development (Canada). Children were individually assessed for cognitive skills and teachers rated their classroom attention skills at 65 months. Outcome measures include health behaviors, psychosocial, and academic outcomes at 122 months. Multiple regression analyses were used. Receptive vocabulary in kindergarten exclusively predicted fourth-grade dietary habits. Unstandardized coefficients predicted decreases in sweet snack intake (β = -.009, 95% confidence interval [CI] = -.011 to -.006) and dairy product intake (β = .009, 95% CI = .005 to .013). Conversely, higher kindergarten math skills predicted increases in activities requiring physical effort (β = .030, 95% CI = .011 to .056). Although vocabulary and attention skills were found important, kindergarten math skills were stronger and more consistent predictors of later academic outcomes. From a population-health perspective, the skills children bring to the kindergarten classroom might reduce a host of lifestyle risks from childhood through adulthood. Early promotion of such skills also offers possibilities for ultimately reducing later disparities in health and education.

  1. Learning Experiences and Strategies of Parents of Young Children with Developmental Disabilities: Implications for Rehabilitation Professionals. (United States)

    Hurtubise, Karen; Carpenter, Christine


    To better understand the learning experiences of parents of children with developmental disabilities and the strategies they develop to support their caregiving role. A qualitative secondary analysis of in-depth interviews with parents of children with developmental disability was conducted to better understand parents' learning experiences and the strategies they developed to use this learning in supporting their children. A foundational thematic analysis process was used to identify the main themes, and the interpretive process was influenced by adult education theories. Findings suggest that participants are highly motivated to learn by a need to understand, to do, and to belong. They also demonstrated varying levels of cognitive, affective, and psychomotor learning. Learning style preferences are evident in participants' narratives and in their self-reported learning strategies. Conceptualizing parents, as adult learners, can be helpful in designing clinical interactions and education initiatives. Knowledge of adult learning principles may enable pediatric therapists to better meet the needs of parents and fulfill their information sharing responsibilities.

  2. Attempt of differentiation acute encephalopathy with febrile convulsive status epilepticus from febrile convulsive status epilepticus induced by human herpesvirus 6 at early stage

    International Nuclear Information System (INIS)

    Ishikawa, Junichi; Yamamuro, Miho; Togawa, Masao; Shiomi, Masashi


    It is difficult for clinicians to predict the subsequent development of acute encephalopathy with febrile convulsive status epilepticus (AEFCSE), when febrile convulsive status epilepticus (FCSE) develops. Comparing clinical and laboratory characteristics between patients with AEFCSE and those with FCSE, we investigated the factors which predict the later development of febrile convulsive status caused by human herpesvirus 6 (HHV6). The subjects of this study were patients treated for FCSE or AEFCSE due to HHV6 in our hospital between April 2004 and January 2008. The AEFCSE group included 5 patients, and the FCSE group included 6 patients. There were few differences in clinical characteristics or brain images on admission between the 2 groups. Disturbance of consciousness persisted for 24 hours or more in all patients in the AEFCSE group and in 2 patients in the FCSE group. The serum creatinine concentration was significantly higher in the AEFCSE group. Serum creatinine concentration could be a good indicator for the prediction of AEFCSE in patients with FCSE. (author)

  3. Attempt of differentiation acute encephalopathy with febrile convulsive status epilepticus from febrile convulsive status epilepticus induced by human herpesvirus 6 at early stage

    Energy Technology Data Exchange (ETDEWEB)

    Ishikawa, Junichi; Yamamuro, Miho; Togawa, Masao; Shiomi, Masashi [Osaka City General Hospital, Osaka, Osaka (Japan)


    It is difficult for clinicians to predict the subsequent development of acute encephalopathy with febrile convulsive status epilepticus (AEFCSE), when febrile convulsive status epilepticus (FCSE) develops. Comparing clinical and laboratory characteristics between patients with AEFCSE and those with FCSE, we investigated the factors which predict the later development of febrile convulsive status caused by human herpesvirus 6 (HHV6). The subjects of this study were patients treated for FCSE or AEFCSE due to HHV6 in our hospital between April 2004 and January 2008. The AEFCSE group included 5 patients, and the FCSE group included 6 patients. There were few differences in clinical characteristics or brain images on admission between the 2 groups. Disturbance of consciousness persisted for 24 hours or more in all patients in the AEFCSE group and in 2 patients in the FCSE group. The serum creatinine concentration was significantly higher in the AEFCSE group. Serum creatinine concentration could be a good indicator for the prediction of AEFCSE in patients with FCSE. (author)

  4. Clinical dissection of early onset absence epilepsy in children and prognostic implications. (United States)

    Agostinelli, Sergio; Accorsi, Patrizia; Beccaria, Francesca; Belcastro, Vincenzo; Canevini, Maria Paola; Capovilla, Giuseppe; Cappanera, Silvia; Dalla Bernardina, Bernardo; Darra, Francesca; Del Gaudio, Luigi; Elia, Maurizio; Falsaperla, Raffaele; Giordano, Lucio; Gobbi, Giuseppe; Minetti, Carlo; Nicita, Francesco; Parisi, Pasquale; Pavone, Piero; Pezzella, Marianna; Sesta, Michela; Spalice, Alberto; Striano, Salvatore; Tozzi, Elisabetta; Traverso, Monica; Vari, Stella; Vignoli, Aglaia; Zamponi, Nelia; Zara, Federico; Striano, Pasquale; Verrotti, Alberto


    To investigate whether patients with typical absence seizures (TAS) starting in the first 3 years of life, conformed to Panayiotopoulos's definition of childhood absence epilepsy (CAE), show different electroclinical course than those not fulfilling CAE criteria. In this multicenter retrospective study, we choose a fixed duration follow-up of 36 months to examine the electroclinical course of epilepsy in all children with TAS starting before 3 years of age. The probands who fulfilled Panayiotopoulos's criteria for CAE were classified as having pure early onset absence epilepsy (P-EOAE), whereas those who did not as nonpure EOAE (NP-EOAE). In addition, these two groups of patients were further stratified according to the number of antiepileptic drugs taken to obtain initial seizure control (mono-, bi-, and tritherapy). Patients with P-EOAE (n = 111) showed earlier initial seizure control (p = 0.030) and better seizure-free survival curve (p = 0.004) than those with NP-EOAE (n = 77). No mutation in SLC2A1 gene or abnormal neuroimaging was observed in P-EOAE. Among patients with NP-EOAE, those receiving tritherapy showed increased risk of structural brain abnormalities (p = 0.001) or SLC2A1 mutations (p = 0.001) but fewer myoclonic features (p = 0.031) and worse seizure-free survival curve (p = 0.047) than those treated with mono- and bitherapy. Children with NP-EOAE had 2.134 the odds of having relapse during the follow-up compare to those with P-EOAE. Children with early onset TAS who did meet Panayiotopoulos's criteria showed a favorable course of epilepsy, whereas patients not fulfilling Panayiotopoulos's criteria showed increased risk of relapse at long-term follow-up. Wiley Periodicals, Inc. © 2013 International League Against Epilepsy.

  5. Auditory pathways and processes: implications for neuropsychological assessment and diagnosis of children and adolescents. (United States)

    Bailey, Teresa


    Neuroscience research on auditory processing pathways and their behavioral and electrophysiological correlates has taken place largely outside the field of clinical neuropsychology. Deviations and disruptions in auditory pathways in children and adolescents result in a well-documented range of developmental and learning impairments frequently referred for neuropsychological evaluation. This review is an introduction to research from the last decade. It describes auditory cortical and subcortical pathways and processes and relates recent research to specific conditions and questions neuropsychologists commonly encounter. Auditory processing disorders' comorbidity with ADHD and language-based disorders and research addressing the challenges of assessment and differential diagnosis are discussed.

  6. [Construction of a diagnostic prediction model of severe bacterial infection in febrile infants under 3 months old]. (United States)

    Villalobos Pinto, Enrique; Sánchez-Bayle, Marciano


    Fever is a common cause of paediatric admissions in emergency departments. An aetiological diagnosis is difficult to obtain in those less than 3 months of age, as they tend to have a higher rate of serious bacterial infection (SBI). The aim of this study is to find a predictor index of SBI in children under 3 months old with fever of unknown origin. A study was conducted on all children under 3 months of age with fever admitted to hospital, with additional tests being performed according to the clinical protocol. Rochester criteria for identifying febrile infants at low risk for SBI were also analysed. A predictive model for SBI and positive cultures was designed, including the following variables in the maximum model: C-reactive protein (CRP), procalcitonin (PCT), and meeting not less than four of the Rochester criteria. A total of 702 subjects were included, of which 22.64% had an SBI and 20.65% had positive cultures. Children who had SBI and a positive culture showed higher values of white cells, total neutrophils, CRP and PCT. A statistical significance was observed with less than 4 Rochester criteria, CRP and PCT levels, an SBI (area under the curve [AUC] 0.877), or for positive cultures (AUC 0.888). Using regression analysis a predictive index was calculated for SBI or a positive culture, with a sensitivity of 87.7 and 91%, a specificity of 70.1 and 87.7%, an LR+ of 2.93 and 3.62, and a LR- of 0.17 and 0.10, respectively. The predictive models are valid and slightly improve the validity of the Rochester criteria for positive culture in children less than 3 months admitted with fever. Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Trends in the patterns of IgM and IgG antibodies in febrile persons with suspected dengue in Barbados, an English-speaking Caribbean country, 2006–2013

    Directory of Open Access Journals (Sweden)

    Alok Kumar


    Full Text Available Summary: Long-term seroprevalence studies of dengue have provided a measure of the degree of endemicity and future trends in disease prevalence and severity. In this study, we describe the seroprevalence of dengue antibodies in febrile persons with suspected acute dengue in Barbados. It is a retrospective population-based study of all febrile persons with suspected dengue from 2006 to 2013. All of the cases had IgM and IgG antibodies in the blood sample drawn between days 3 and 5 of their illness. Among the 8296 cases that were tested for IgM antibodies, 3037 (36.6% had recent dengue infection. In the age groups 20 years, 23.3%, 39.6% and 35.5% had acute infection, respectively. Of the 7227 cases with documented IgG results, 5473 (75.7% were positive and had a past infection. In the age groups 20 years, 31.2%, 65.2% and 86.6%, respectively, had a past infection (IgG positive. During the first 5 years of life, 10–20% of febrile persons investigated for dengue had a positive IgM and a negative IgG titer, between 5 and 10% had a positive IgM and IgG titer, 5% had a positive IgG and a negative IgM titer, and between 45% and 65% had a negative IgM and a negative IgG titer. Throughout the study period, between 12% and 20% of febrile persons failed to show any evidence of current or previous dengue. In the age groups 20 years, 45.0%, 18.8% and 7.2%, respectively, had no evidence of recent or past dengue (both IgM and IgG negative. Between 37% and 59% of the febrile persons had serological evidence of past dengue in the absence of any current dengue. In conclusion, the pattern of IgG antibodies in this study was comparable to those in countries known to be hyperendemic for dengue. The age of infection is likely to shift to younger adults and children who are more likely to have severe dengue in the future. Keywords: Dengue, Seroprevalence, Febrile, Caribbean

  8. Etiology of Acute, Non-Malaria, Febrile Illnesses in Jayapura, Northeastern Papua, Indonesia (United States)


    resistance and unnecessary mor- bidity and mortality. There are limited data on the epidemiology of other febrile illnesses in Papua. Scrub typhus ...World War. 4, 5 In the Dutch colonial era, there were descriptions of several infections, including scrub typhus , leptospirosis, gran- uloma inguinale...paired serologic samples analysis for dengue, Japanese encephalitis, leptospirosis, scrub typhus , murine typhus , and spotted fever group rickettsia

  9. [Complex febrile seizures: study of the associated pathology and practical use of complementary tests]. (United States)

    Berzosa López, R; Ramos Fernández, J M; Martínez Antón, J; Espinosa Fernández, M G; Urda Cardona, A


    Although one third of febrile seizures are complex, a consensus has still not been reached on how to manage them, as is the case with simple febrile seizures. The objective of this study is to estimate the usefulness of complementary examinations and the risk of associated serious intracranial pathology. A retrospective review was conducted from 2003 until 2011 on patients from 6 months to 6 years presenting with a complex febrile seizure admitted to a tertiary care hospital, excluding the cases with previous neurological disease. Epidemiological and clinic variables were collected, as well as complementary tests and complications. We found 65 patients (31 females and 34 males), of whom 44 had repeated seizures in the first 24 hours, with 15 having focal seizures. The vast majority (90%) of the recurrences occurred before 15 hours. The mean age was 20.7 months and temperature was 39.1 ± 0.12°C. None of the patients had severe intracranial pathology. The electroencephalogram gave no helpful information for the diagnosis. Neuroimaging was normal in all studied cases. The incidence of complications in complex febrile seizure in our series did not justify the systematic admission or the systematic study with complementary tests when the neurological examination was normal. The routine electroencephalogram does not appear to be justified. Copyright © 2012 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  10. Cost Effectiveness of Primary Pegfilgrastim Prophylaxis in Patients With Breast Cancer at Risk of Febrile Neutropenia

    NARCIS (Netherlands)

    Aarts, Maureen J.; Grutters, Janneke P.; Peters, Frank P.; Mandigers, Caroline M.; Dercksen, M. Wouter; Stouthard, Jacqueline M.; Nortier, Hans J.; van Laarhoven, Hanneke W.; van Warmerdam, Laurence J.; van de Wouw, Agnes J.; Jacobs, Esther M.; Mattijssen, Vera; van der Rijt, Carin C.; Smilde, Tineke J.; van der Velden, Annette W.; Temizkan, Mehmet; Batman, Erdogan; Muller, Erik W.; van Gastel, Saskia M.; Joore, Manuela A.; Borm, George F.; Tjan-Heijnen, Vivianne C.


    Purpose Guidelines advise primary granulocyte colony-stimulating factor (G-CSF) prophylaxis during chemotherapy if risk of febrile neutropenia (FN) is more than 20%, but this comes with considerable costs. We investigated the incremental costs and effects between two treatment strategies of primary

  11. Cost effectiveness of primary pegfilgrastim prophylaxis in patients with breast cancer at risk of febrile neutropenia

    NARCIS (Netherlands)

    Aarts, M.J.; Grutters, J.P.C.; Peters, F.P.; Mandigers, C.M.P.W.; Dercksen, M.W.; Stouthard, J.M.; Nortier, H.J.; Laarhoven, H.W.M. van; Warmerdam, L.J. van; Wouw, A.J. van de; Jacobs, E.M.G.; Mattijssen, V.; Rijt, C.C. van der; Smilde, T.J.; Velden, A.W. van der; Temizkan, M.; Batman, E.; Muller, E.W.; Gastel, S.M. van; Joore, M.A.; Borm, G.F.; Tjan-Heijnen, V.C.


    PURPOSE: Guidelines advise primary granulocyte colony-stimulating factor (G-CSF) prophylaxis during chemotherapy if risk of febrile neutropenia (FN) is more than 20%, but this comes with considerable costs. We investigated the incremental costs and effects between two treatment strategies of primary

  12. Pattern of self-medication for acute febrile illness in the outpatient ...

    African Journals Online (AJOL)

    Pattern of self-medication for acute febrile illness in the outpatient clinic of an urban tertiary hospital in Jos. ... cross-sectional study at the GOPD of BHUTH, Jos from October 2012 to February 2013. The participants were drawn from all patients with fever or history of fever of not more than two weeks duration at presentation.

  13. Detection of bacterial DNA in blood samples from febrile patients: underestimated infection or emerging contamination?

    NARCIS (Netherlands)

    Peters, Remco P. H.; Mohammadi, Tamimount; Vandenbroucke-Grauls, Christina M. J. E.; Danner, Sven A.; van Agtmael, Michiel A.; Savelkoul, Paul H. M.


    We applied real-time broad-range polymerase chain reaction (PCR) to detect bacteraemia in blood from febrile patients. Interpretation of amplification results in relation to clinical data and blood culture outcome was complex, although the reproducibility of the PCR results was good. Sequencing

  14. Parental perspectives on inpatient versus outpatient management of pediatric febrile neutropenia. (United States)

    Diorio, Caroline; Martino, Julia; Boydell, Katherine Mary; Ethier, Marie-Chantal; Mayo, Chris; Wing, Richard; Teuffel, Oliver; Sung, Lillian; Tomlinson, Deborah


    To describe parent preference for treatment of febrile neutropenia and the key drivers of parental decision making, structured face-to-face interviews were used to elicit parent preferences for inpatient versus outpatient management of pediatric febrile neutropenia. Parents were presented with 4 different scenarios and asked to indicate which treatment option they preferred and to describe reasons for this preference during the face-to-face interview. Comments were recorded in writing by research assistants. A consensus approach to thematic analysis was used to identify themes from the written comments of the research assistants. A total of 155 parents participated in the study. Of these, 80 (51.6%) parents identified hospital-based intravenous treatment as the most preferred treatment scenario for febrile neutropenia. The major themes identified included convenience/disruptiveness, physical health, emotional well-being, and modifiers of parental decision making. Most parents preferred hospital-based treatment for febrile neutropenia. An understanding of issues that influence parental decision making may assist health care workers in planning program implementation and further support families in their decision-making process.

  15. Appearance of febrile neutropenia episodes after cytostatic therapy on oncology patients

    International Nuclear Information System (INIS)

    Lami Casaus, Leonardo; Arbesu Michelena, Maria Antonieta; Sarmiento, Sofia Alsina; Brito Iglesia, Rosario


    Treatment of oncology patient using cytotoxic drugs has the neutropenia and its infectious complications as the commonest dose-limiting toxicity. Its appearance provokes dose delays and reduction during post-chemotherapy cycles, as well as the quality of life deterioration of patients. Oncology Medicine Group including the Pharmacy Service carried out a study to analyze the appearance of febrile neutropenia after cytotoxic therapy administration, and the presence of other factors that may to increase the risk to these reactions. A total of 42 patients were studied admitted with febrile neutropenia after above therapy from February to August, 2007. Biomedical variables from included patient group were achieved and the previously applied cytostatic therapy. The prevalent age-group was those patients aged over 50 and predominance of male sex and advanced stages with associated affections. The more frequent tumor locations were in breast, lung, and non-Hodgkin lymphoma. The cytostatic agent more used in cases of febrile neutropenia was Adriamycin (71.4 %) followed by Cyclophosphamide (52.4 %). The factors more associated with febrile neutropenia appearance were: Anthracycline chemotherapy, age over 50, advanced stages, and presence of associated diseases

  16. Chikungunya as a cause of acute febrile illness in southern Sri Lanka.

    Directory of Open Access Journals (Sweden)

    Megan E Reller

    Full Text Available Chikungunya virus (CHIKV re-emerged in Sri Lanka in late 2006 after a 40-year hiatus. We sought to identify and characterize acute chikungunya infection (CHIK in patients presenting with acute undifferentiated febrile illness in unstudied rural and semi-urban southern Sri Lanka in 2007.We enrolled febrile patients ≥ 2 years of age, collected uniform epidemiologic and clinical data, and obtained serum samples for serology, virus isolation, and real-time reverse-transcriptase PCR (RT-PCR. Serology on paired acute and convalescent samples identified acute chikungunya infection in 3.5% (28/797 patients without acute dengue virus (DENV infection, 64.3% (18/28 of which were confirmed by viral isolation and/or real-time RT-PCR. No CHIKV/DENV co-infections were detected among 54 patients with confirmed acute DENV. Sequencing of the E1 coding region of six temporally distinct CHIKV isolates (April through October 2007 showed that all isolates posessed the E1-226A residue and were most closely related to Sri Lankan and Indian isolates from the same time period. Except for more frequent and persistent musculoskeletal symptoms, acute chikungunya infections mimicked DENV and other acute febrile illnesses. Only 12/797 (1.5% patients had serological evidence of past chikungunya infection.Our findings suggest CHIKV is a prominent cause of non-specific acute febrile illness in southern Sri Lanka.

  17. Risk factors of leptospirosis among febrile hospital admissions in northeastern Malaysia. (United States)

    Rafizah, A A Noor; Aziah, B D; Azwany, Y N; Imran, M Kamarul; Rusli, A Mohamed; Nazri, S Mohd; Nikman, A Mohd; Nabilah, I; Asma', H Siti; Zahiruddin, W M; Zaliha, I


    Leptospirosis is a worldwide zoonotic disease. Risk factors for the disease may vary among countries. This study was conducted to determine the risk factors of leptospirosis among febrile cases. A hospital-based cross-sectional study was conducted among 999 febrile patients admitted to 10 hospitals in northeastern Malaysia, from August 2010 to February 2011. An interviewer-guided proforma sheet on sociodemography, type of occupation and social history data was distributed to all adult patients with fever on admission. Serum sample for leptospirosis was screened by IgM Enzyme-linked Immunosorbent Assay (IgM ELISA) test and confirmed by Microscopic Agglutination Test (MAT). The cut-off point for positive MAT was ≥ 1:400 titer in single acute specimens. Seroprevalence of leptospirosis was 8.4% (95% CI: 6.8, 10.3) (n=84/999) by MAT. Multiple logistic regression analysis showed that the high risk occupation group (OR: 1.95, 95% CI: 1.22, 3.13) (p=0.005) and history of recent recreational activity (OR: 2.36, 95% CI: 1.46, 3.85) (pMalaysia. Identification of high risk occupational group and history of recent recreational activity will help to increase the index of suspicion to diagnose leptospirosis among febrile inpatients due to its mimicking other common febrile illnesses in Malaysia. Copyright © 2013 Elsevier Inc. All rights reserved.

  18. An evaluation of the use of reported febrile illness in predicting malaria in pregnancy. (United States)

    Nnaji, G A; Ikechebelu, J I


    The object of this study was to evaluate the sensitivity and specificity of reported febrile illness in predicting malaria in pregnant women at booking in NAUTH, Nnewi. This was a case control prospective survey using a structured questionnaire to collect data from pregnant women attending antenatal clinic of Nnamdi Azikiwe University Teaching Hospital between April and September 2001. Peripheral blood smears were examined in 420 pregnant women during their first antenatal visit. This study showed that 57.4% of parasitaemic pregnant women and 54% of aparasitaemic pregnant women reported fever before their first antenatal visit. The sensitivity and specificity of reported febrile illness in predicting malaria were 57.4% and 46%, respectively. However, the predictive value of a positive test was as high as 80.25%, while it was only 22% for the predictive value of a negative test. The efficiency of reported febrile illness as a screening device was 55%. Reliance on reported febrile illness will not be adequate to identify parasitaemic pregnant women because many of those with heavy placental parasitisation may not report fever. This justifies the place of the intermittent presumptive therapy using sulphadoxine-pyrimethamine in pregnant women living in malaria endemic areas such as sub-Saharan Africa.

  19. Chikungunya Virus as Cause of Febrile Illness Outbreak, Chiapas, Mexico, 2014 (United States)

    Kautz, Tiffany F.; Díaz-González, Esteban E.; Erasmus, Jesse H.; Malo-García, Iliana R.; Langsjoen, Rose M.; Patterson, Edward I.; Auguste, Dawn I.; Forrester, Naomi L.; Sanchez-Casas, Rosa Maria; Hernández-Ávila, Mauricio; Alpuche-Aranda, Celia M.; Fernández-Salas, Ildefonso


    Since chikungunya virus (CHIKV) was introduced into the Americas in 2013, its geographic distribution has rapidly expanded. Of 119 serum samples collected in 2014 from febrile patients in southern Mexico, 79% were positive for CHIKV or IgM against CHIKV. Sequencing results confirmed CHIKV strains closely related to Caribbean isolates. PMID:26488312

  20. Clinical Implications of Oscillatory Lung Function during Methacholine Bronchoprovocation Testing of Preschool Children (United States)

    Choi, Sun Hee; Sheen, Youn Ho; Kim, Mi Ae; Baek, Ji Hyeon; Baek, Hey Sung; Lee, Seung Jin; Yoon, Jung Won; Rha, Yeong Ho


    Objective To investigate the repeatability and safety of measuring impulse oscillation system (IOS) parameters and the point of wheezing during bronchoprovocation testing of preschool children. Methods Two sets of methacholine challenge were conducted in 36 asthma children. The test was discontinued if there was a significant change in reactance (Xrs5) and resistance (Rrs5) at 5 Hz (Condition 1) or respiratory distress due to airway obstruction (Condition 2). The repeatability of PC80_Xrs5, PC30_Rrs5, and wheezing (PCw) was assessed. The changes in Z-scores and SD-indexes from prebaseline (before testing) to postbaseline (after bronchodilator) were determined. Results For PC30_Rrs5, PC80_Xrs5, and PCw for subjects, PC80_Xrs5 showed the highest repeatability. Fifteen of 70 tests met Condition 2. The changes from pre- and postbaseline values varied significantly for Rrs5 and Xrs5. Excluding subjects with Z-scores higher than 2SD, we were able to detect 97.1% of bronchial hyperresponsiveness during methacholine challenge based on the change in Rrs5 or Xrs5. A change in IOS parameters was associated with wheezing at all frequencies. Conclusion Xrs5 and Rrs5 have repeatability comparable with FEV1, and Xrs5 is more reliable than Rrs5. Clinicians can safely perform a challenge test by measuring the changes in Rrs5, Xrs5, and Z-scores from the prebaseline values. PMID:28740854

  1. Relating Pitch Awareness to Phonemic Awareness in Children: Implications for Tone-Deafness and Dyslexia

    Directory of Open Access Journals (Sweden)

    Psyche eLoui


    Full Text Available Language and music are complex cognitive and neural functions that rely on awareness of one’s own sound productions. Information on the awareness of vocal pitch, and its relation to phonemic awareness which is crucial for learning to read, will be important for understanding the relationship between tone-deafness and developmental language disorders such as dyslexia. Here we show that phonemic awareness skills are positively correlated with pitch perception-production skills in children. Children between the ages of 7 and 9 were tested on pitch perception and production, phonemic awareness, and IQ. Results showed a significant positive correlation between pitch perception-production and phonemic awareness, suggesting that the relationship between musical and linguistic sound processing is intimately linked to awareness at the level of pitch and phonemes. Since tone-deafness is a pitch-related impairment and dyslexia is a deficit of phonemic awareness, we suggest that dyslexia and tone-deafness may have a shared and/or common neural basis.

  2. GPs should evaluate all children following UTI. (United States)

    Hutchings, Frances; Jadresić, Lyda


    Ten per cent of girls and 3% of boys will have had a UTI by 16 years of age. The majority are acute, isolated illnesses that resolve quickly, with no long-term implications for the patient. However, UTIs may be associated with underlying congenital abnormalities, and recurrent infections can lead to renal scarring. UTI is defined as bacteriuria in the presence of symptoms. Asymptomatic bacteriuria does not require treatment or investigation. The presentation of UTI is extremely variable. The only way to differentiate a UTI from a viral infection is by testing the urine and this should be carried out within 24 hours in children with non-specific fever. UTIs can also present with vomiting, failure to thrive or persistent irritability. A urine infection in the presence of any of the above symptoms is a pyelonephritis (upper UTI). Children may also present with classical symptoms of cystitis (lower UTI) such as urinary frequency, dysuria and abdominal pain. Most children with UTI, even if febrile, can be managed in the community. If the initial assessment shows a high risk of serious illness, there should be an urgent referral to a paediatrician. The same applies to infants under three months with suspected UTI. It is better to obtain a urine sample by the clean catch method, rather than using urine pads or bags. Leucocyte esterase and nitrite dipsticks are not reliable in children under three, so a negative dipstick does not rule out UTI. Not every child needs to be referred after a first UTI. However, they should all be evaluated to help determine which require renal imaging as well as identifying triggers for recurrence. GPs are central to the identification of children at risk of renal pathology. All children who are diagnosed and treated for a UTI must be assessed for risk of renal abnormalities and/or recurrence.

  3. Health-related quality of life for pediatric emergency department febrile illnesses: an Evaluation of the Pediatric Quality of Life Inventory™ 4.0 generic core scales

    Directory of Open Access Journals (Sweden)

    Stevens Molly W


    Full Text Available Abstract Objective We sought to assess the validity and short-term responsiveness of the Pediatric Quality of Life Inventory™ 4.0 Generic Core Scales (PedsQL™ for febrile illnesses evaluated in the pediatric emergency department (ED. Design Prospective cohort study of children 2–18 years discharged after ED evaluation for fever (≥ 38°C. Self-administered, parent-report of health-related quality of life (HRQOL was assessed using the PedsQL™ Acute Version, a validated HRQOL instrument. HRQOL was measured on ED presentation and at 7–10 day follow-up. At follow-up, duration of fever, child functional impairment, missed daycare/school, and disrupted family unit functioning, were assessed. Results Of 160 subjects enrolled, 97 (61% completed the study; mean follow-up was 8.7 days. Mean total HRQOL score on ED presentation was 76.4; mean follow-up score was 86.3. Compared to subjects that returned to baseline, statistically significant differences in HRQOL were noted for those with prolonged fever, child functional impairment, and relapse. Significant correlation was observed between HRQOL at follow-up and days of daycare/school missed (r = -0.35, p = .003 and days of family disruption (r = -0.43, p Conclusion The PedsQL™ appears to be a valid and responsive indicator of HRQOL for short-term febrile illnesses evaluated in the ED.

  4. Association of RNA Biosignatures With Bacterial Infections in Febrile Infants Aged 60 Days or Younger (United States)

    Mahajan, Prashant; Kuppermann, Nathan; Mejias, Asuncion; Suarez, Nicolas; Chaussabel, Damien; Casper, T. Charles; Smith, Bennett; Alpern, Elizabeth R.; Anders, Jennifer; Atabaki, Shireen M.; Bennett, Jonathan E.; Blumberg, Stephen; Bonsu, Bema; Borgialli, Dominic; Brayer, Anne; Browne, Lorin; Cohen, Daniel M.; Crain, Ellen F.; Cruz, Andrea T.; Dayan, Peter S.; Gattu, Rajender; Greenberg, Richard; Hoyle, John D.; Jaffe, David M.; Levine, Deborah A.; Lillis, Kathleen; Linakis, James G.; Muenzer, Jared; Nigrovic, Lise E.; Powell, Elizabeth C.; Rogers, Alexander J.; Roosevelt, Genie; Ruddy, Richard M.; Saunders, Mary; Tunik, Michael G.; Tzimenatos, Leah; Vitale, Melissa; Dean, J. Michael; Ramilo, Octavio


    IMPORTANCE Young febrile infants are at substantial risk of serious bacterial infections; however, the current culture-based diagnosis has limitations. Analysis of host expression patterns (“RNA biosignatures”) in response to infections may provide an alternative diagnostic approach. OBJECTIVE To assess whether RNA biosignatures can distinguish febrile infants aged 60 days or younger with and without serious bacterial infections. DESIGN, SETTING, AND PARTICIPANTS Prospective observational study involving a convenience sample of febrile infants 60 days or younger evaluated for fever (temperature >38° C) in 22 emergency departments from December 2008 to December 2010 who underwent laboratory evaluations including blood cultures. A random sample of infants with and without bacterial infections was selected for RNA biosignature analysis. Afebrile healthy infants served as controls. Blood samples were collected for cultures and RNA biosignatures. Bioinformatics tools were applied to define RNA biosignatures to classify febrile infants by infection type. EXPOSURE RNA biosignatures compared with cultures for discriminating febrile infants with and without bacterial infections and infants with bacteremia from those without bacterial infections. MAIN OUTCOMES AND MEASURES Bacterial infection confirmed by culture. Performance of RNA biosignatures was compared with routine laboratory screening tests and Yale Observation Scale (YOS) scores. RESULTS Of 1883 febrile infants (median age, 37 days; 55.7%boys), RNA biosignatures were measured in 279 randomly selected infants (89 with bacterial infections—including 32 with bacteremia and 15 with urinary tract infections—and 190 without bacterial infections), and 19 afebrile healthy infants. Sixty-six classifier genes were identified that distinguished infants with and without bacterial infections in the test set with 87%(95%CI, 73%-95%) sensitivity and 89% (95%CI, 81%-93%) specificity. Ten classifier genes distinguished

  5. Families with children with diabetes: implications of parent stress for parent and child health. (United States)

    Helgeson, Vicki S; Becker, Dorothy; Escobar, Oscar; Siminerio, Linda


    To examine the relation of parent stress to parent mental health and child mental and physical health. We interviewed children with type 1 diabetes (n = 132; mean age 12 years) annually for 5 years and had one parent complete a questionnaire at each assessment. Parents completed measures of general life stress, stress related to caring for a child with diabetes, benefit finding, and mental health. Child outcomes were depressive symptoms, self-care behavior, and glycemic control. Multilevel modeling was used to examine concurrent and longitudinal relations. Greater parent general stress and greater parent diabetes-specific stress were associated with poorer parent mental health. Overall, greater parent general stress was associated with poorer child outcomes, whereas greater parent diabetes-specific stress was associated with better child outcomes. Families with high levels of general life stress should be identified as they are at risk for both poor parent and child health outcomes.

  6. Paid carers' experiences of caring for mechanically ventilated children at home: implications for services and training. (United States)

    Maddox, Christina; Pontin, David


    UK survival rates for long-term mechanically ventilated children have increased and paid carers are trained to care for them at home, however there is limited literature on carers' training needs and experience of sharing care. Using a qualitative abductive design, we purposively sampled experienced carers to generate data via diaries, semi-structured interviews, and researcher reflexive notes. Research ethics approval was granted from NHS and University committees. Five analytical themes emerged - Parent as expert; Role definition tensions; Training and Continuing Learning Needs; Mixed Emotions; Support Mechanisms highlighting the challenges of working in family homes for carers and their associated learning needs. Further work on preparing carers to share feelings with parents, using burnout prevention techniques, and building confidence is suggested. Carers highlight the lack of clinical supervision during their night-working hours. One solution may be to provide access to registered nurse support when working out-of-office hours.

  7. Mental health, attachment and breastfeeding: implications for adopted children and their mothers

    Directory of Open Access Journals (Sweden)

    Gribble Karleen D


    Full Text Available Abstract Breastfeeding an adopted child has previously been discussed as something that is nice to do but without potential for significant benefit. This paper reviews the evidence in physiological and behavioural research, that breastfeeding can play a significant role in developing the attachment relationship between child and mother. As illustrated in the case studies presented, in instances of adoption and particularly where the child has experienced abuse or neglect, the impact of breastfeeding can be considerable. Breastfeeding may assist attachment development via the provision of regular intimate interaction between mother and child; the calming, relaxing and analgesic impact of breastfeeding on children; and the stress relieving and maternal sensitivity promoting influence of breastfeeding on mothers. The impact of breastfeeding as observed in cases of adoption has applicability to all breastfeeding situations, but may be especially relevant to other at risk dyads, such as those families with a history of intergenerational relationship trauma; this deserves further investigation.

  8. Discussion Paper Social and emotional learning for children with Learning Disability: Implications for inclusion.

    Directory of Open Access Journals (Sweden)

    Valeria Cavioni


    Full Text Available This paper discusses the key role of social and emotional learning programmes for children with Learning Disability (LD. The first part of the paper discusses the difficulties students with learning disability may encounter in their education, such as issues related to peer group acceptance, friendship and social isolation, low self-efficacy and self-esteem, and externalized and internalized behavior problems. The relationship between social and emotional learning programmes and learning disability is then discussed, underlining the benefits of social and emotional learning for students with LD. The paper concludes by highlighting the need for universal social and emotional learning as a vehicle for the academic and social inclusion of students with LD.

  9. Cotrimoxazole for childhood febrile illness in Malaria-endemic regions

    African Journals Online (AJOL)

    ren younger than 5 years of age was evaluated in. Malawi. ... limitations in diagnostic technology and personnel, disease-specific clinical ... In practice, the World. Health Organisation (WHO) recommends that in highly endemic areas all young children with fever should be treated for malaria, because of the likeli- hood of ...

  10. Approaches to describing inter-rater reliability of the overall clinical appearance of febrile infants and toddlers in the emergency department

    Directory of Open Access Journals (Sweden)

    Paul Walsh


    Full Text Available Objectives. To measure inter-rater agreement of overall clinical appearance of febrile children aged less than 24 months and to compare methods for doing so.Study Design and Setting. We performed an observational study of inter-rater reliability of the assessment of febrile children in a county hospital emergency department serving a mixed urban and rural population. Two emergency medicine healthcare providers independently evaluated the overall clinical appearance of children less than 24 months of age who had presented for fever. They recorded the initial ‘gestalt’ assessment of whether or not the child was ill appearing or if they were unsure. They then repeated this assessment after examining the child. Each rater was blinded to the other’s assessment. Our primary analysis was graphical. We also calculated Cohen’s κ, Gwet’s agreement coefficient and other measures of agreement and weighted variants of these. We examined the effect of time between exams and patient and provider characteristics on inter-rater agreement.Results. We analyzed 159 of the 173 patients enrolled. Median age was 9.5 months (lower and upper quartiles 4.9–14.6, 99/159 (62% were boys and 22/159 (14% were admitted. Overall 118/159 (74% and 119/159 (75% were classified as well appearing on initial ‘gestalt’ impression by both examiners. Summary statistics varied from 0.223 for weighted κ to 0.635 for Gwet’s AC2. Inter rater agreement was affected by the time interval between the evaluations and the age of the child but not by the experience levels of the rater pairs. Classifications of ‘not ill appearing’ were more reliable than others.Conclusion. The inter-rater reliability of emergency providers’ assessment of overall clinical appearance was adequate when described graphically and by Gwet’s AC. Different summary statistics yield different results for the same dataset.

  11. Q Fever, Scrub Typhus, and Rickettsial Diseases in Children, Kenya, 2011-2012. (United States)

    Maina, Alice N; Farris, Christina M; Odhiambo, Antony; Jiang, Ju; Laktabai, Jeremiah; Armstrong, Janice; Holland, Thomas; Richards, Allen L; O'Meara, Wendy P


    To increase knowledge of undifferentiated fevers in Kenya, we tested paired serum samples from febrile children in western Kenya for antibodies against pathogens increasingly recognized to cause febrile illness in Africa. Of patients assessed, 8.9%, 22.4%, 1.1%, and 3.6% had enhanced seroreactivity to Coxiella burnetii, spotted fever group rickettsiae, typhus group rickettsiae, and scrub typhus group orientiae, respectively.

  12. Novas diretrizes na abordagem clínica da neutropenia febril e da sepse em oncologia pediátrica New guidelines for the clinical management of febrile neutropenia and sepsis in pediatric oncology patients

    Directory of Open Access Journals (Sweden)

    Ana Verena Almeida Mendes


    Full Text Available OBJETIVOS: Fornecer subsídios à abordagem diagnóstica, profilática e terapêutica da neutropenia febril e da sepse em criança com doença oncológica, dando especial atenção aos novos protocolos e diretrizes. FONTES DE DADOS: Revisão de literatura científica utilizando uma busca bibliográfica eletrônica nas páginas do MEDLINE, Medscape, SciELO, Google, Cochrane e PubMED com as palavras-chave febrile, neutropenic, cancer, children, sepse, intensive, care. Foram selecionados artigos publicados entre 1987 e 2007, preferencialmente artigos de revisão, protocolos, revisões sistemáticas, estudos epidemiológicos, recomendações de força-tarefa e ensaios clínicos fase III. Foram revistos os consensos publicados pela Infectious Diseases Society of America, Center for Diseases Control e Infectious Diseases Working Party da German Society of Hematology and Oncology, além de recomendações da World Federation of Pediatric Intensive and Critical Care Societies e da Society of Critical Care Medicine. SÍNTESE DOS DADOS: A utilização de esquemas quimioterápicos agressivos, transplante de medula óssea e recursos de terapia intensiva aumentaram a sobrevida nas crianças com câncer e também a morbidade infecciosa, sendo as complicações sépticas a principal causa de mortalidade. Diversos fatores de risco têm sido identificados, como neutropenia, tipo oncológico, sinais clínicos e marcadores de resposta inflamatória (reação em cadeia da polimerase, procalcitonina, assim como a maior resistência aos antimicrobianos e antifúngicos. Protocolos de classificação de risco, de diagnóstico e tratamento devem ser estabelecidos em cada serviço, respeitando a flora microbiológica da população estudada. A terapia intensiva pediátrica tem aumentado a sobrevida a curto e longo prazo nestes pacientes. CONCLUSÕES: Pacientes oncológicos são particularmente vulneráveis a complicações infecciosas. A identificação e o tratamento

  13. The Contemporary Socio-Economic Crisis Situation and the Implementation of Inclusive Education for Nomadic Children with Disabilities in Nigeria: Implications for Guidance and Counselling

    Directory of Open Access Journals (Sweden)

    Sylvester MwandarYakwal


    Full Text Available The present socio-economic crisis situation in Nigeria has affected so many facets of life of the people generally not least of all the life of nomadic children with disabilities. Presently, a lot of focus is being directed at the provision of educational services for children with special needs (including nomadic children through inclusive education. This paper attempts to identify some of the ways that teaching and learning can be effectively carried out for nomadic children with disabilities in Nigeria with particular emphasis on its implications for guidance and counseling. The paper will attempt to identify the methods that can be used in the nomadic education classroom as well as establish the expected roles that guidance and counselling can play in the provision of such programmes for the enhancement of better quality of life for nomadic children with disabilities in the Nigerian educational system. Furthermore, it will strive to identify the problems emanating from the socio-economic crisis situation and how it affects nomadic children with disabilities. In particular, it will attempt to identify the counseling strategies that can be used for the insurance of better quality of life for nomadic children with disabilities generally and make far reaching recommendations to that effect.

  14. A Cross-Continental Study on Children's Drawings of Football Players: Implications for Understanding Key Issues and Controversies in Human Figure Drawings. (United States)

    Baluch, Bahman; Duffy, Linda J; Badami, Rokhsareh; Pereira, Elisangela C Ap


    Professionals examine various aspects of girls' and boys' drawings as a way of understanding their intelligence, personality and emotional state. However, the extent to which such measures could be universally generalised or attributed to a specific cultural norm is still a debatable issue. In the present study five key features of children's drawings namely: the size (height) of the drawings, profile or full face, figure in action or static, shaded or non-shaded and the nature of additional details were examined from a cross-cultural perspective, and by providing a topic (football) for which children's drawing of a human figure could provide opportunities for the latter indices to manifest and flourish. Children from three countries; England, Iran and Brazil, representing three continents took part in this study. The participants were asked to draw a football player from their own country and from the other participating countries. The results showed that Brazilian children differ from Iranian and English children by drawing significantly smaller figures and putting more football action in the drawings. Shading of the figure drawn was more prevalent amongst English children. Such findings have implications for the interpretation of key aspects of children's drawings in educational, clinical and therapeutic settings and from a universal vs. culturally-specific viewpoint.

  15. Epidemiological investigation of suspected autism in children and implications for healthcare system: a mainstream kindergarten-based population study in Longhua District, Shenzhen. (United States)

    Yang, Weikang; Xia, Hui; Wen, Guoming; Liu, Li; Fu, Xiaoyuan; Lu, Junqiang; Li, Haitao


    Individuals with autism put a heavy demand on medical services, and prevalence estimates are needed for the planning of such services. Screening for autism in children has important implications for individuals and policy makers. This study aimed to estimate prevalence of suspected autism in children in Longhua District, Shenzhen, and to investigate risk factors for autism. A cross-sectional study was conducted in Longhua District, Shenzhen in October 2014. A total of 141 kindergartens were approached and consented to participate in the current study. All children who met the inclusion criteria were screened for autism by using the Autism Behavior Checklist (ABC). 15,200 children in total completed the survey and were included in the final analysis. 2.6 % (95 % CI 2.3-2.9) respondents had a high probability of autism, while 4.0 % (95 % CI 3.7-4.3) respondents had questionable autism. Male children were more likely to develop autism when compared with their female counterparts (P autism in children which suggests an urgent need of early detection of autism with ABC across the Shenzhen city, or even around China. Further studies with diagnostic procedure are warranted. Maternal age and education level, and gender of children are possible factors related to autism.

  16. Mismatch between asthma symptoms and spirometry: implications for managing asthma in children. (United States)

    Schifano, Elizabeth D; Hollenbach, Jessica P; Cloutier, Michelle M


    To examine the concordance between spirometry and asthma symptoms in assessing asthma severity and beginning therapy by the general pediatrician. Between 2008 and 2012, spirometry testing was satisfactorily performed in 894 children (ages 5-19 years) whose asthma severity had been determined by their pediatrician using asthma guideline-based clinical criteria. Spirometry-determined asthma severity using national asthma guidelines and clinician-determined asthma severity were compared for concordance using weighted Kappa coefficients. Thirty percent of participants had clinically determined intermittent asthma; 32%, 33%, and 5% had mild, moderate, and severe, persistent asthma, respectively. Increasing disease severity was associated with decreases in the forced expiratory volume in 1 second/forced vital capacity (FVC) ratio (P spirometry-determined severity. Concordance was 0.16 (95% CI 0.10, 0.23), and when adjusted for bias and prevalence, was 0.20 (95% CI 0.17, 0.23). When accounting for age, sex, exposure to smoke, and insurance type, only spirometry-determined asthma severity was a significant predictor of agreement (P spirometry-determined severity increased. Concordance between spirometry and asthma symptoms in determining asthma severity is low even when guideline-based clinical assessment tools are used. Because appropriate therapy reduces asthma morbidity and is guided by disease severity, results from spirometry testing could better guide pediatricians in determining appropriate therapy for their patients with asthma. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. Legacy and alternative halogenated flame retardants in human milk in Europe: Implications for children's health. (United States)

    Čechová, Eliška; Vojta, Šimon; Kukučka, Petr; Kočan, Anton; Trnovec, Tomáš; Murínová, Ľubica Palkovičová; de Cock, Marijke; van de Bor, Margot; Askevold, Joakim; Eggesbø, Merete; Scheringer, Martin


    In this study, 10 polybrominated diphenyl ethers (PBDEs) and 19 alternative halogenated flame retardants (AFRs) were determined in >450 human milk samples across three European countries, representing northern, western and eastern Europe. This study provides first insights into the occurrence of selected AFRs in mother milk samples and compares them among three European countries. Sums of median concentrations of the most frequently detected PBDEs were 2.16, 0.88 and 0.45ngg -1 lipid weight (lw) in Norway, the Netherlands and Slovakia, respectively. The sum of the concentrations of AFRs ranged from 0.14 to 0.25ngg -1 lw in all countries, which was 2 to 15 times less compared to Σ 7 PBDEs. The Penta-BDE replacement, bis(2-ethylhexyl) tetrabromophthalate, BEH-TEBP, was present at the greatest concentrations of any of the AFRs and in some samples exceeded concentrations of BDE 47 and BDE 153. Four AFRs including bromobenzenes (hexabromobenzene, pentabromobenzene, pentabromotoluene) and another Penta-BDE replacement (2-ethylhexyl-2,3,4,5-tetrabromobenzoate, EH-TBB) were detected in >42% of all human milk samples. Because of the potential developmental neurotoxicity of the halogenated flame retardants, infant dietary intakes via breastfeeding were estimated; in four cases the intakes of BDE 47 exceeded the reference dose indicating that the present concentrations may pose a risk for children. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. Brain Cancer Stem Cells in Adults and Children: Cell Biology and Therapeutic Implications. (United States)

    Abou-Antoun, Tamara J; Hale, James S; Lathia, Justin D; Dombrowski, Stephen M


    Brain tumors represent some of the most malignant cancers in both children and adults. Current treatment options target the majority of tumor cells but do not adequately target self-renewing cancer stem cells (CSCs). CSCs have been reported to resist the most aggressive radiation and chemotherapies, and give rise to recurrent, treatment-resistant secondary malignancies. With advancing technologies, we now have a better understanding of the genetic, epigenetic and molecular signatures and microenvironmental influences which are useful in distinguishing between distinctly different tumor subtypes. As a result, efforts are now underway to identify and target CSCs within various tumor subtypes based on this foundation. This review discusses progress in CSC biology as it relates to targeted therapies which may be uniquely different between pediatric and adult brain tumors. Studies to date suggest that pediatric brain tumors may benefit more from genetic and epigenetic targeted therapies, while combination treatments aimed specifically at multiple molecular pathways may be more effective in treating adult brain tumors which seem to have a greater propensity towards microenvironmental interactions. Ultimately, CSC targeting approaches in combination with current clinical therapies have the potential to be more effective owing to their ability to compromise CSCs maintenance and the mechanisms which underlie their highly aggressive and deadly nature.

  19. Psychosocial consequences of head injury in children and adolescents: implications for rehabilitation. (United States)

    Livingston, M G; McCabe, R J


    Studies measuring psychosocial outcome in children and adolescents have shown that head injury leads to cognitive impairment which is directly related to the severity of injury in those with very severe head injury. Psychiatric disorders are also related to the severity of injury but here the relationship suggests that mediating factors are involved. No specific pattern of post-traumatic psychological/psychiatric dysfunction emerges from the studies, but it is clear that, as with adults, psychosocial recovery lags behind physical. Head injury affects the functioning of the young person in the family, at school, and within the wider community, often resulting in a secondary handicap of low self-esteem. The multitude of deficits which are a consequence of severe head injury present a challenge for rehabilitation specialists. A multi-disciplinary, multi-specialist, and multi-agency response is required. As a result, families are often presented with a bewildering array of treatments and programmes at different agencies. A case manager can be helpful in ensuring the appropriate use of available resources and can be the one professional in charge of a coordinating case record.

  20. Factors associated with children being driven to school: implications for walk to school programs. (United States)

    Wen, Li Ming; Fry, Denise; Rissel, Chris; Dirkis, Helen; Balafas, Angela; Merom, Dafna


    In this study, we examined factors associated with children being driven to school. Participants were 1603 students (aged 9-11 years) and their parents from 24 public primary schools in inner western Sydney, Australia. Students recorded their modes of travel to and from school for 5 days in a student survey. Parents recorded their demographic data, their attitudes to travel, and their modes of travel to work, using a self-administered survey. An analysis of the two linked data sets found that 41% of students travelled by car to or from school for more than 5 trips per week. Almost a third (32%) of students walked all the way. Only 1% of students rode a bike and 22% used more than one mode of travel. Of those who were driven, 29% lived less than 1 km and a further 18% lived between 1 and 1.5 km from school. Factors associated with car travel (after adjusting for other potential confounders) were mode of parents' travel to work, parent attitudes, number of cars in the household, and distance from home to school. To be effective, walk to school programs need to address the link between parent journey to work and student journey to school.