Pardo Crespo, M R; Pérez Iglesias, R; Llorca, J; Rodrigo Calabia, E; Alvarez Granda, L; Delgado-Rodríguez, M
To determine whether the structure of primary care teams on carrying out the healthy child health programme leads to a drop in the risk of admission to hospital of children under two, in comparison with the traditional clinic or out-clinic health system. Case-reference epidemiological study. 40% of the children under 24 months admitted to paediatric or neonate floors of the Marqués de Valdecilla University Hospital. Reference: 15% of the recently born children alive in this hospital. Information was gathered through face-to-face interview and by examining health cards. The study ran from April 1995 to May 1996. Children under two monitored habitually by a doctor belonging to a primary care team showed a drop in risk of hospital admission for all clinical diagnoses of 0.57 (95% CI, 0.35-0.93), after adjustment due to various confusion factors such as maternal education, social class, ethnic background, mother's age, mother's tobacco consumption, natural breast-feeding at birth, admission at birth. There was a drop of risk of hospital admission for high temperature without apparent cause in those children monitored habitually by a team doctor (adjusted RR = 0.41; 95% CI, 0.19-0.90). The advantages of the paediatric health care reform with the structuring of the primary care teams and the accompanying activities performed lead to a drop in the risk of hospital admission of those children under two years old who are habitually monitored by a doctor belonging to a primary care team.
Y. van Ierland (Yvette)
markdownabstract__Abstract__ Children constitute a substantial part of the workload of physicians in primary care and hospital emergency care. In the Netherlands, about 70% of the 3.9 million inhabitants less than 20 years of age had one or more contacts with their general practitioner (GP) in 2011
Juliana Coelho Pina
Full Text Available OBJECTIVE: to analyze the presence and extent of the primary health care attributes among children hospitalized for pneumonia.METHOD: observational and retrospective study with hospital-based case-control design, developed in three hospitals associated to the Brazilian Unified Health System, located in a city of the State of São Paulo, Brazil. The study included 690 children under five years old, with 345 cases and 345 controls.RESULTS: both groups scored high for access to health services. In contrast, high scores for attributes such as longitudinality and coordination of care were observed for the controls. Despite low scores, integrality and family counseling were also high for the controls.CONCLUSION: knowledge of the aspects involving the primary health care attributes and its provision for child care are very important because they have the potential to support professionals and managers of the Brazilian Unified Health System in the organization of health services.
Bruijn, J; Arts, W-F; Duivenvoorden, H; Dijkstra, N; Raat, H; Passchier, J
Knowledge on the quality of life of children with headache is lacking. Until now only a few studies in this field have provided information on a limited number of life domains. The aim of this study was to assess the quality of life in a comprehensive number of life domains in children with primary headache presenting at an out-patient paediatric department in a general hospital. From October 2003 to October 2005 all children referred to the out-patient paediatric department of the Vlietland Hospital because of primary headache were investigated by protocol. A thorough history was taken and a general physical and neurological examination was performed. The International Headache Society criteria were used for classification. Quality of life (QoL) was measured using the Dutch version of the Child Health Questionnaire (CHQ-PF50 Dutch edition) and compared with data from a previously investigated cohort of healthy children from the same region, and with data from a cohort of children from the USA with asthma or with attention deficit hyperactivity disorder (ADHD), investigated with the CHQ-PF50. A total of 70 primary headache patients were included in the study (25 with tension-type headache, 36 with migraine, seven with chronic tension-type headache, two with both tension-type headache and migraine). Their mean age was 10.6 years (range 4-17 years); 37 children were male. On all but one subscale (self-esteem) the QoL of the children with primary headache was decreased compared with the cohort of healthy children, especially on the domains of mental health, parental impact time and family cohesion. Compared with the cohort of children with asthma the QoL was significantly worse for our headache group on seven subscales and significantly better on one subscale (general health perception). Compared with the cohort of children with ADHD, the QoL was significantly worse on six subscales but significantly better on three subscales. There were no significant differences on
Ana Paula Scoleze Ferrer
Full Text Available Introduction: Hospitalizations for ambulatory care-sensitive conditions (HACSC are considered an indicator of the effectiveness of primary health care (PHC. High rates of HACSC represent problems in the access or the quality of health care. In Brazil, HACSC rates are high and there are few studies on the factors associated with it. Objective: To evaluate the access to PHC offered to children and adolescents hospitalized due to ACSC and analyze the conditioning factors. Method: Cross-sectional study with a quantitative and qualitative approach. Five hundred and one (501 users (guardians/caregivers and 42 professionals of PHC units were interviewed over one year. Quantitative data were obtained using Primary Care Assessment Tool validated in Brazil (PCATool-Brazil, while qualitative data were collected by semi-structured interview. The independent variables were: age, maternal education, family income, type of diagnosis, and model of care offered, and the dependent variables were access and its components (accessibility and use of services. Results: Sixty-five percent (65.2% of hospitalizations were ACSC. From the perspective of both users and professionals, access and its components presented low scores. Age, type of diagnosis, and model of care affected the results. Conclusion: The proportion of HACSC was high in this population. Access to services is inappropriate due to: barriers to access, appreciation of the emergency services, and attitude towards health needs. Professional attitudes and opinions reinforce inadequate ideas of users reflecting on the pattern of service use.
Cuvellier, Jean-Christophe; Donnet, Anne; Guégan-Massardier, Evelyne; Nachit-Ouinekh, Fatima; Parain, Dominique; Vallée, Louis
The aim of this 6-month, prospective, multicenter study of 398 children and adolescents with primary headaches was to collect data on headache treatment in neuropediatric departments. Treatments were compared before and after consultation. Prior to consultation, the acute treatments that had been prescribed most frequently were paracetamol (82.2% of children) and non-steroidal anti-inflammatory drugs treatment (53.5%); 10.3% had received a prophylactic treatment. No differences in either acute or prophylactic treatment with respect to headache diagnosis were observed. After the neuropediatric consultation, paracetamol was replaced by a non-steroidal anti-inflammatory drug in about three-quarters of cases and by triptan in about one-quarter of cases. The number of children prescribed a prophylactic treatment nearly doubled, whereas there was a 5-fold and 23-fold increase in psychotherapy and relaxation training, respectively, between pre-referral and referral. We conclude that specific treatments were underused for primary headache.
Cuvellier, J-C; Donnet, A; Guégan-Massardier, E; Nachit-Ouinekh, F; Parain, D; Vallée, L
The aim of this study was to evaluate the concordance between clinical diagnosis and the International Classification of Headache Disorders, 2nd edn (ICHD-II) in children and adolescents with primary headaches. This 6-month prospective multicentre study of 486 patients (mean 9.8 +/- 3.1 years; 52.6% girls) assessed the headache features through a structured questionnaire. In 398 patients with a single type of headache, headaches were bilateral (78.1%), frontal (62.4%), pulsatile (56.1%), with associated symptoms in 84.4%. The most frequently assigned diagnoses were migraine without aura (50.8%), probable migraine (14.1%), migraine with aura (11.1%) and frequent episodic tension-type headache (7.5%). For most of the diagnostic categories, the consistency of the investigator's diagnosis with the ICHD-II criteria was good (kappa > 0.6 and 0.8). We conclude that migraine was predominant with regard to headache diagnoses repartition and that the ICHD-II seems usable in practice for evaluation of primary headache in French children and adolescents.
Topp, Sofie Kathrine; Rosenfeldt, Vibeke; Vestergaard, Hanne
BACKGROUND: Epstein-Barr virus (EBV) positive infectious mononucleosis (IM) is a common disease in adolescents. However, IM is often considered a rare disease in early childhood. We aimed to describe the classical presentation of adolescent EBV-associated IM compared to EBV infection at younger age....... Dividing the children into three age groups (0-4 years, 5-10 years and 11-15 years) revealed that the oldest age groups significantly more often suffered from headache, tonsillitis, sore throat, abdominal pain and nausea. Young children typically presented with a runny nose, fever, fatigue and cervical...
Statiev S. I.
Full Text Available The paper suggests a child with asthma. They may be present functional disorders of the central nervous system and cardiac activity, frequent violations of posture, scoliosis, and this in turn worsens the condition of all internal organs and systems. There is a problem of adaptation of these children to normal life. Therefore, the study of physical rehabilitation and its features in bronchial asthma is very important. The study with sequential decision tasks, it was analyzed the effect of physical rehabilitation on the respiratory system of children with bronchial asthma.
Gibson, Gerusa; Souza-Santos, Reinaldo; Brasil, Patrícia; Pacheco, Antonio Guilherme; Cruz, Oswaldo G; Honório, Nildimar Alves; Kubelka, Claire; Carvalho, Marilia Sá
We analyzed factors associated with severe cases of dengue in children and adolescents hospitalized during the 2007/2008 epidemic in Rio de Janeiro, Brazil. This is a retrospective case-control study that covers 88 cases of severe dengue in patients admitted to four tertiary care children's hospitals. Controls consisted of 22 children with non-severe dengue living in the same neighborhood as the patients with severe dengue. Differences in prevalence of the clinical signs - abdominal pain, breathing difficulty, drowsiness or irritability - emerged on the third day after the onset of symptoms, in the febrile stage. Cases and controls received first medical care at the same clinical stage of disease. However, hospital admission of severe cases occurred later, on average between the third and fourth day after the onset of the disease. Early discharge of patients with fever whose condition could have progressed to severe dengue may have been a consequence of the type of medical assistance provided by primary care units, suggesting deficiencies both in the use of the risk classification protocol and patient triage.
A description is provided of a 15-month, in-service nursing education program at Childrens Hospital (Los Angeles, California). The first sections of the paper describe Childrens Hospital and provide a rationale for the hospital-based program. A listing of program goals and objectives is also provided, indicating that the curriculum is designed to…
Pradubwong, Suteera; Mongkholthawornchai, Siriporn; Keawkhamsean, Natda; Patjanasoontorn, Niramol; Chowchuen, Bowornsilp
Cleft lips and cleft palates are common congenital anomalies, which affects facial appearance, speech, hearing, teeth alignment and other structures. Craniofacial anomalies and speech disorders are crucial problems in the preschool-aged children (5-6 years old), when they start attending school and become more engaged in the community. This condition, which differentiates them from other students, can lead to teasing or mocking which can cause low-self esteem, an inferiority complex, andfoster bad relationships with friends. Missing class in order to receive treatment and other additional care can affect a student's learning, development and overall-quality of life. The purpose of this research was to study the quality of life in preschool-aged cleftpalate children and satisfaction with their level of speech. This was a retrospective, descriptive study. The data were collected by reviewing medical records of patients with cleft lip and cleft palate aged 5-6 years old who underwent operation and treatment with the Tawanchai Center at Srinagarind Hospital. There were 39patients in this study. Data collection was conducted for 5 months (June to October 2013). The research instruments were: (1) General Demographic Questionnaire, (2) Quality of Life Questionnaire with 5 Domains, and (3) the Satisfaction of Speech Questionnaire. The descriptive statistics, percentages and the standard deviation were analyzed in the present study. The findings revealedfamily information pertaining to CLP treatment and the impact it has on consumption, speech training, hearing test, development, dental treatment, communication skills, participation, referral treatment as well as the quality ofcoordinationfor advanced treatment. The present study revealed that all ofthe aforementioned criteria were met at a high level. Moreover the child's sickness had only a moderate impact on family life. In conclusion, the overall satisfaction was at a very high level. It was concluded that the
Full Text Available ABSTRACT: OBJECTIVE: To determine the proportion of primary vesicoureteric reflux in children between 1 month and 12 years with urinary tract infection admitted in a tertiary care hospital. METHODOLOGY: A Hospital based descriptive cross sectional study was conducted between May 2010 and October 2011 in the Department of pediatrics, Chennai Medical College Hospital, Trichy. Convenient sampling technique was a pplied to select the study subjects. Renal ultrasound and voiding cystourethrography (VCUG exa minations were performed in all confirmed cases of first UTI under 5 years of age a nd recurrent UTI at any age. Any children with underlying anatomic abnormalities of urinary t ract or neurogenic abnormalities were excluded from the study. The severity of reflux expressed as a grade, which is based on the system established by the International Reflux Stud y in Children. The data was analyzed by proportions and chi – square test using SPSS statisti cal package version 11 at 95% confidence interval. P value Grade 2 were not seen. The sensitivity and specificity of ultrasound in detecting VUR were 36.4% and 100% res pectively. CONCLUSION: Since the Vesicoureteric Reflux appears to be more common in the recurrent UTI, Voiding cystourethrogram (VCUG is recommended in all the cases of recurrent UTI, so that prophylaxis can be entertained to prevent renal scarring and chronic glomerular insuf ficiency. Even in the first UTI, if the child is no t ORIGINAL ARTICLE Journal of Evolution of Medical and Dental Sciences/ Volume 2/ Issue 14/ April 8, 2013 Page- 2406 shown improvement as expected, VCUG can be done. Si nce USG is safe noninvasive it is recommended in all confirmed cases of UTI
Kucine, Nicole; Chastain, Katherine M.; Mahler, Michelle B.; Bussel, James B.
Myeloproliferative neoplasms are uncommon disorders in children, for which we have limited understanding of the pathogenesis and optimal management. JAK2 and MPL mutations, while common drivers of myeloproliferative neoplasms in adult patients, are not clearly linked to pediatric disease. Management and clinical outcomes in adults have been well delineated with defined recommendations for risk stratification and treatment. This is not the case for pediatric patients, for whom there is neither a standard approach to workup nor any consensus regarding management. This review will discuss thrombocytosis in children, including causes of thrombocytosis in children, the limited knowledge we have regarding pediatric primary thrombocytosis, and our thoughts on potential risk stratification and management, and future questions to be answered by laboratory research and collaborative clinical study. PMID:24688110
Walther-Larsen, S; Pedersen, M T; Friis, S M
BACKGROUND: Pain management in hospitalized children is often inadequate. The prevalence and main sources of pain in Danish university hospitals is unknown. METHODS: This prospective mixed-method cross-sectional survey took place at four university hospitals in Denmark. We enrolled 570 pediatric...... pain in the previous 24 hours. One hundred and thirty four (24%) indicated moderate to severe pain and 43% would have preferred an intervention to alleviate the pain. In children hospitalized for more than 24 hours, the prevalence of moderate/severe pain was significantly higher compared to children...... patients who we asked to report their pain experience and its management during the previous 24 hours. For patients identified as having moderate to severe pain, patient characteristics and analgesia regimes were reviewed. RESULTS: Two hundred and thirteen children (37%) responded that they had experienced...
Tan, Lay Ong; Lim, Soo Yen; Vasanwala, Rashida Farhad
Osteoporosis in childhood is uncommon, and it may be secondary to a spectrum of diverse conditions. Idiopathic juvenile osteoporosis is a primary osteoporosis of unknown aetiology present in previously well children and is a diagnosis of exclusion. We describe a 10-year-old prepubertal boy who presented with back pain of 1-week duration. His spinal X-ray showed generalised loss of vertebral body heights in keeping with osteoporosis. Endocrine and haematological work-up were normal. He was treated with vitamin D supplement and intravenous pamidronate. This case illustrates the general work-up and causes for paediatric osteoporosis, and the management for idiopathic juvenile osteoporosis. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Children's rights are nowadays an important social, pedagogic, legal and moral problem. Practical respecting of resolutions included in the Convention on the Rights of the Child is far from perfect and requires changing social way of thinking. To attain this, the contents and essence of children's rights have to be disseminated and consequently enforced. The aim of my research was to answer the question: "What are the conditions for upholding children's right to respect at children wards?". The subject of my analysis was nurses' value hierarchy and individual conditions influencing respecting children rights. Research procedures were directed towards finding the answer to the following question: "What is the range of upholding children's right to respect?". I defined children's right to respect on the basis of analysis of Janusz Korczak's scientific output and the provisions of the Convention on the Rights of the Child. The rights being the subject of my research are classified either as "soft" or "hard" rights. "Soft" rights are defined in articles no. 12-16 and 31. Rights defined in articles no. 6, 7, 9 and 24 are referred to as "hard" rights. The synthesis of research results leads to the following solution of the research problem: The assumption of a strong influence of the most important values on mental life-thinking, perception, emotional-motivation processes, attitude and behavior of questioned nurses did not have proper empirical confirmation. Nurses' value hierarchy does not ensure upholding of children's right to respect in hospitals. Nurses' awareness of children rights reaches average level, while their knowledge and activity are at low level, and understanding of essence of children's rights and valuation of the rights--at average level. Average level of awareness of respecting children's rights makes children's existence in hospital imperiled by intuitive, often routine activities of nurses. The level of nurses' awareness is differentiated by age
Full Text Available Introduction & Objective: There is a need to study the outcomes of admitted patients with primary varicella infections especially for immunocompromised cases like patients with various cancers in our country in which there is no routine vaccination against such a virus.Materials & Methods: We performed a retrospective descriptive-analytic study on the admitted cases with primary varicella infections in Aliasghar children hospital, Tehran, since 1996 to 2009;The patients were put in two different groups for comparison:1Immunosuppressed patients including patients with acute lymphoblastic leukemia ,patients with other types of cancers ,and patients who were receiving high doses of corticosteroids 2previously healthy patients. Demographic as well as some indicators of poor general condition on admission like respiratory distress ,hypotension and decreased level of consciousness were compared within the groups; we also looked for ataxia as an important indication of admission and the time period since the onset of disease up to admission in each group; appropriate statistical methods were used for statistical analysis.Results: 88 cases including 24 cases of ALL (27%,9 cases with various types of cancers (10.5%,and 13 cases who were receiving high dose of corticosteroid were included. Mean age of the patients was 6 years(SD=3.5.47 cases(53.4%were male. Hypotension on admission was significantly more common in patients under four years of age(P=0.006; The patients in the first 3 groups were admitted significantly earlier(P=0.027; Hypotension and ataxia were more significantly seen in the previously healthy group(P=0.01 and 0.04 respectively. Just one case of mortality occurred in a case of ALL during the study period.Conclusion: We concluded that immunocompromised cases comprise more than half of the admissions due to primary varicella infections in our referral center; interestingly ,however, in comparison with previously healthy cases they have been
Kozlowski, K.; Beluffi, G.; Masel, J.; Diard, F.; Ferrari-Ciboldi, F.; Le Dosseur, P.; Labatut, J.
20 cases of primary benign and malignant bone tumours in children were reported. The most common tumours were Ewing's sarcoma, aneurismal bone cyst, benign osteoblastoma and osteoid osteoma. Some rare primary bone tumours in children (osteochondroma, chondroblastoma 6F, primary lymphoma of bone and neurofibromatosis with unusual cervical spinal changes) were also reported. The authors believe that radiographic findings together with clinical history and clinical examination may yield a high percentage of accurate diagnoses. Although microscopy is essential in the final diagnosis, the microscopic report should be also accepted with caution.
Ohye, Richard G; Maniker, Robert B; Graves, Holly L; Devaney, Eric J; Bove, Edward L
Mediastinitis affects approximately 1% of children undergoing median sternotomy. Conventional therapy involves debridement followed by open wound care with delayed closure, days to weeks of closed suction or antimicrobial irrigation, and vacuum-assisted closure or muscle flap closure. We hypothesized that primary closure without prolonged suction or irrigation is an effective, less traumatic treatment for mediastinitis in children. From January 1986 to July 2002, 6705 procedures involving median sternotomy were performed at the C. S. Mott Children's Hospital, resulting in 57 cases of mediastinitis (0.85%). Cases were divided into 2 groups, with 42 cases treated with primary closure and 15 cases treated with delayed or muscle flap closure. The 42 cases of primary closure comprised the primary study group of this institutional review board-approved, retrospective analysis. Patient demographics, surgical variables, mediastinitis-related parameters, and outcomes were evaluated. One patient had recurrent mediastinitis for an overall infection eradication rate of 97% (40/41). Three patients (7%) required re-exploration for suspected ongoing infection. Of these re-explorations, 1 patient had evidence of continued mediastinitis. The remaining 2 patients with sepsis of unclear cause had no clinical or culture evidence of recurrent infection. One of these patients ultimately died of sepsis without active mediastinitis for a hospital survival of 97% (41/42). No significant differences could be detected between the treatment successes and failures in this small cohort of patients. Simple primary closure is an effective means to treat selected cases of postoperative mediastinitis in children. The results compare favorably with other more lengthy or debilitating treatments.
Factors predicting antibiotic prescription and referral to hospital for children with respiratory symptoms: secondary analysis of a randomised controlled study at out-of-hours services in primary care
Rebnord, Ingrid Keilegavlen; Sandvik, Hogne; Mjelle, Anders Batman; Hunskaar, Steinar
Objectives Acute respiratory infections and fever among children are highly prevalent in primary care. It is challenging to distinguish between viral and bacterial infections. Norway has a relatively low prescription rate of antibiotics, but it is still regarded as too high as the antimicrobial resistance is increasing. The aim of the study was to identify predictors for prescribing antibiotics or referral to hospital among children. Design Secondary analysis of a randomised controlled study. Setting 4 out-of-hours services and 1 paediatric emergency clinic in Norwegian primary care. Participants 401 children aged 0–6 years with respiratory symptoms and/or fever visiting the out-of-hours services. Outcomes 2 main outcome variables were registered: antibiotic prescription and referral to hospital. Results The total prescription rate of antibiotics was 23%, phenoxymethylpenicillin was used in 67% of the cases. Findings on ear examination (OR 4.62; 95% CI 2.35 to 9.10), parents' assessment that the child has a bacterial infection (OR 2.45; 95% CI 1.17 to 5.13) and a C reactive protein (CRP) value >20 mg/L (OR 3.57; 95% CI 1.43 to 8.83) were significantly associated with prescription of antibiotics. Vomiting in the past 24 hours was negatively associated with prescription (OR 0.26; 95% CI 0.13 to 0.53). The main predictors significantly associated with referral to hospital were respiratory rate (OR 1.07; 95% CI 1.03 to 1.12), oxygen saturation 20 mg/L, findings on ear examination, use of paracetamol and no vomiting in the past 24 hours were significantly associated with antibiotic prescription. Affected respiration was a predictor for referral to hospital. The parents' assessment was also significantly associated with the outcomes. Trial registration number NCT02496559; Results. PMID:28096254
Tan, Chee Chun; McDowell, Karen M; Fenchel, Matthew; Szczesniak, Rhonda; Kercsmar, Carolyn M
Asthma is the most common chronic disorder of childhood and continues to be a leading cause of pediatric hospital admission. The National Asthma Education and Prevention Program (NAEPP) recommends that spirometry be obtained for asthma patients upon hospital admission, after bronchodilation during the acute phase of asthma symptoms, and at least one additional time before discharge from the hospital. The objectives of this study were to describe the use of spirometry in children hospitalized with asthma and to determine association of pulmonary function with future exacerbations. A retrospective cohort study design was utilized involving review of medical records of children ≥5 years old admitted with asthma to Cincinnati Children's Hospital Medical Center from September 1, 2009 to March 31, 2011. Hospitalization or emergency department (ED) visits were identified by the ICD-9-CM codes of having either a primary diagnosis of asthma (493) or a respiratory illness (460-496) plus a secondary diagnosis of asthma. Asthma re-exacerbation was defined as either having an ED visit or hospitalization for asthma that occurred within 3 months after the index hospitalization. All spirometries were performed in a pediatric pulmonary function laboratory. Among 1,037 admissions included in this study, 89 (8.6%) had spirometry that was recommended by a consulting asthma specialist and usually performed on the day of discharge. Spirometries for forty-five of these patients (54.9%) met all acceptability and repeatability criteria of the American Thoracic Society. Patients who performed acceptable spirometry were significantly older (12.4 ± 3.8 vs. 10.7 ± 3.0 years; P = 0.041). The average forced expiratory volume in the first second (FEV1 ) was 84.4 ± 19.7% predicted; forced vital capacity (FVC) was 98.1 ± 16.0% predicted; FEV1 /FVC was 74.6 ± 9.6%; forced expiratory flow at 25-75% (FEF25-75 ) was 61.2 ± 30.1% predicted. Ten patients (22%) who
李光勇; 邱晓明; 康迎新
Objective:To investigate the efficacy and safety of laparoscopic high ligation of hernia sac in the treatment of children with inguinal hernia in primary hospital.Methods:40 cases of children with inguinal hernia were selected.They were treated with laparoscopic high ligation of hernia sac.We observed the treatment effect.Results:All patients were successfully completed;unilateral operation time was 12 to 16 minutes;bilateral operation time was 20 to 24 minutes.After 2 to 3 days,the patients were discharged from the hospital;all wounds were healed by first intention;there was no serious complication.Conclusion:The efficacy of laparoscopic high ligation of hernia sac in the treatment of children with inguinal hernia in primary hospital was significant,and the security was high.%目的：探讨基层医院腹腔镜下疝囊高位结扎治疗儿童腹股沟疝的疗效及安全性。方法：收治腹股沟疝患儿40例，采用腹腔镜下疝囊高位结扎手术治疗，观察治疗效果。结果：所有患者手术均顺利完成，单侧手术时间12～16 min，双侧手术时间20～24 min。术后2～3 d出院，随访伤口均一期愈合，未见严重并发症。结论：基层医院腹腔镜下疝囊高位结扎治疗儿童腹股沟疝的疗效显著，安全性高。
Full Text Available Children with Down syndrome present with multiple medical problems in a higher prevalence compared with the general population, which may lead to hospitalizations. Methods: Analysis of 560 hospitalizations of 162 children aged 0-16 years with Down syndrome at Hadassah Medical Center during the years 1988-2007 compared with data on children in the general population, hospitalized at the same period. Data was collected from patient files and statistical data from the Ministry of Health. Results: Respiratory infections were the leading cause for hospitalization of children with Down syndrome. The number of hospitalizations of children with Down syndrome compared to the number of all children, who were hospitalized was surprisingly similar to their proportion in the general population. Eleven children died during their hospitalization (five heart failure, three sepsis, one respiratory tract infection and one due to complication after surgery. Nine of the eleven had a congenital heart anomaly. Conclusions: Children with Down syndrome can present with complex medical issues and we support the concept of a multidisciplinary team that has experience and knowledge to serve as a one stop shop for these individuals and their families, with timely visits in which a comprehensive evaluation is performed, problems attended to and prevention plans applied. In this way we may prevent morbidity, hospitalizations and mortality.
Bender, A D; Geoghegan, S S; Lundquist, S H; Cantone, J M; Krasnick, C J
With increasing competition among hospitals, primary care referral development and management programs offer an opportunity for hospitals to increase their admissions. Such programs require careful development, the commitment of the hospital staff to the strategy, an integration of hospital activities, and an understanding of medical practice management.
Willemsen Sten P
Full Text Available Abstract Background Population-based data on hospital admissions for children aged 0-17 years concerning all respiratory diseases are scarce. This study examined hospital admissions in relation to the preceding consultations in general practice in this age group. Methods Data on children aged 0-17 years with respiratory diseases included in the Second Dutch National Survey of General Practice (DNSGP-2 were linked to all hospital admissions in the Dutch National Medical Registration. Admission rates for respiratory diseases were calculated. Data were analysed using multivariate logistic regression. Results Of all 79,272 children within the DNSGP-2, 1.8% were admitted to hospital for any respiratory diagnosis. The highest admission rates per 1000 children were for chronic disease of tonsils and adenoids (12.9; pneumonia and influenza (0.97; and asthma (0.92. Children aged 0-4 years and boys were admitted more frequently. Of children with asthma, 2.3% were admitted for respiratory diseases. For asthma, admission rates varied by urbanisation level: 0.47/1000 children/year in cities with ≤ 30,000 inhabitants, 1.12 for cities with ≥ 50,000 inhabitants, and 1.73 for the three largest cities (p = 0.002. Multivariate logistic regression showed that within two weeks after a GP consultation, younger age (OR 0.81, 95% CI 0.76-0.88 and more severe respiratory diseases (5.55, 95% CI 2.99-8.11 predicted hospital admission. Conclusions Children in the general population with respiratory diseases (especially asthma had very low hospital admission rates. In urban regions children were more frequently admitted due to respiratory morbidity. For effectiveness studies in a primary care setting, hospital admission rates should not be used as quality end-point.
Varela, Patricio; Pio, Luca; Torre, Michele
Primary tracheobronchial tumors are rare lesions that can be benign or malignant, with different location along the airway tree. Symptoms may include wheezing, chronic pneumonia, asthma, chest pain, recurrent cough, atelectasis, haemoptysis, and weight loss. Due to the heterogeneity of symptoms, diagnosis can be difficult and the airway involvement can lead progressively to a bronchial or tracheal obstruction. Due to the rarity of primary tracheobronchial tumors in children, there are not any oncological guidelines on pre-operative work-up, treatment, and follow-up. Only few reports and multicentric studies are reported. In most cases, surgical resection seems to be the treatment of choice. Brachytherapy, endoscopic treatment, and chemotherapy are rarely described. In this article we present an overview on these rare tumors, including pathological aspects, clinical presentation, imaging assessment, and endoscopic or open surgical treatments. We discuss different surgical approaches, according with tumor location. Copyright © 2016 Elsevier Inc. All rights reserved.
Hankard, R; Bloch, J; Martin, P; Randrianasolo, H; Bannier, M F; Machinot, S; Cézard, J P
A few studies report malnutrition in hospitalized patients. This one-day cross-sectional survey performed in January 1999 assessed nutritional status and protein-energy intake in a pediatric population hospitalized in medicine or surgery units. Every child older than six months, hospitalized for more than 48 h and free of nutritional support (parenteral, enteral, or special regimens for metabolic diseases) was included. Fifty-eight children among the 183 present the day of the study met the inclusion criteria and were included in the statistical analysis. They were hospitalized in medicine (48%), psychiatry (31%) and surgery (21%). The body mass index (BMI) was below -2 standard deviations (DS) in 21% of them. Excluding patients with anorexia nervosa, BMI was +2 SD, or in between these limits in respectively 12, 14 and 74%. Energy intake measured at the hospital was below 75% of the recommended dietary allowances in two-thirds of the children whether malnourished or not. Fifty percent of the malnourished children had been referred to a dietician the day of the study. Malnutrition is frequent in a population of hospitalized children. Energy intake and referral to a dietician are insufficient.
Full Text Available We combined hospital-based surveillance and health utilization survey data to estimate the incidence of respiratory viral infections associated hospitalization among children aged < 5 years in Bangladesh.Surveillance physicians collected respiratory specimens from children aged <5 years hospitalized with respiratory illness and residing in the primary hospital catchment areas. We tested respiratory specimens for respiratory syncytial virus, parainfluenza viruses, human metapneumovirus, influenza, adenovirus and rhinoviruses using rRT-PCR. During 2013, we conducted a health utilization survey in the primary catchment areas of the hospitals to determine the proportion of all hospitalizations for respiratory illness among children aged <5 years at the surveillance hospitals during the preceding 12 months. We estimated the respiratory virus-specific incidence of hospitalization by dividing the estimated number of hospitalized children with a laboratory confirmed infection with a respiratory virus by the population aged <5 years of the catchment areas and adjusted for the proportion of children who were hospitalized at the surveillance hospitals.We estimated that the annual incidence per 1000 children (95% CI of all cause associated respiratory hospitalization was 11.5 (10-12. The incidences per 1000 children (95% CI per year for respiratory syncytial virus, parainfluenza, adenovirus, human metapneumovirus and influenza infections were 3(2-3, 0.5(0.4-0.8, 0.4 (0.3-0.6, 0.4 (0.3-0.6, and 0.4 (0.3-0.6 respectively. The incidences per 1000 children (95%CI of rhinovirus-associated infections among hospitalized children were 5 (3-7, 2 (1-3, 1 (0.6-2, and 3 (2-4 in 2010, 2011, 2012 and 2013, respectively.Our data suggest that respiratory viruses are associated with a substantial burden of hospitalization in children aged <5 years in Bangladesh.
刘春艳; 申昆玲; 王树欣; 刘亚谊; 照日格图
Background This study was to assess certain epidemiological and clinical characteristics of astrovirus infection in children with diarrhea below 5 years old hospitalized at the Beijing Children's Hospital. Methods From September 1999 to August 2001, a total of 288 children with diarrhea below 5 years old hospitalized at Beijing Children's Hospital were studied. Fecal specimens collected from each patient were tested for astrovirus by using enzyme immunoassay (EIA) and further serotyped by reverse-transcription polymerase chain reaction (RT-PCR) using serotype-specific primers. Results Astrovirus antigen was positive in 9.0% of the patients, and the rate of coinfection with rotavirus was 19.2% among the astrovirus positive patients. The patients with astrovirus infection were at the age of 7 days to 17 months, most (92.3%) of them were less than 12 months. Astrovirus infection occurred mainly between October and March of the following year. Main symptoms included watery stool, vomiting, fever, and dehydration. Increased activity of myocardial enzyme was seen in 4 patients. Of the 22 astrovirus positive specimens, 14 were successfully serotyped by RT-PCR and they were all serotype 1. Conclusions The overall incidence of astrovirus infection in young children with diarrhea hospitalized at the Beijing Children's Hospital was 9.0%. The predominant serotype was type 1. Astrovirus may play an important role in viral diarrhea in young children in Beijing, China.
G. Elshout (Gijs)
markdownabstractFever in children is a common symptom. Frequently,the underlying illness is self-limiting and medical intervention is seldom needed. However, general practitioners need to be alert on those children who are at risk for serious infections. In this thesis, we studied the natural course
Shrot, Shai; Soudack, Michalle [Sheba Medical Center, Department of Diagnostic Imaging, Ramat-Gan (Israel); Tel Aviv University, Sackler School of Medicine, Tel Aviv (Israel); Barkai, Galia [Sheba Medical Center, Pediatric Infectious Diseases Unit, Safra Children' s Hospital, Tel-Hashomer (Israel); Ben-Shlush, Aviva [Sheba Medical Center, Department of Diagnostic Imaging, Ramat-Gan (Israel)
When administered to an immune-compromised patient, BCG (Bacille Calmette-Guerin) can cause disseminated and life-threatening infections. To describe the imaging findings in children with primary immunodeficiency and BCG-related infections. We reviewed the imaging findings of children with primary immunodeficiency treated at a children's hospital during 2012-2014 with localized or disseminated BCG infection. Imaging modalities included US, CT and radiography. Nine children with primary immunodeficiency had clinical signs of post-vaccination BCGitis; seven of these children showed disseminated disease and two showed only regional lesions with characteristic ipsilateral lymphadenopathy. Overall, lymphadenopathy was the most prevalent feature (n = 8) and characteristically appeared as a ring-enhancing hypodense (CT) or hypoechoic (US) lesion. Visceral involvement with multiple abscesses appeared in the spleen (n = 2), liver (n = 1) and bones (n = 1). All lesions regressed following appropriate anti-tuberculosis treatment. BCG infection needs to be considered in children with typical findings and with suspected primary immunodeficiency. (orig.)
M F, Ahmad; Narwani, Hussin; Shuhaila, Ahmad
Endometriosis is a complex disease primarily affecting women of reproductive age worldwide. The management goals are to improve the quality of life (QoL), alleviate the symptoms and prevent severe disease. This prospective cohort study was to assess the QoL in women with endometriosis that underwent primary surgery. A pre- and post-operative questionnaire via ED-5Q and general VAS score used for the evaluation for endometrial-like pain such as dysmenorrhoea and dyspareunia. A total of 280 patients underwent intervention; 224 laparoscopically and 56 via laparotomy mostly with stage II disease with ovarian endometriomas. Improvements in dysmenorrhoea pain scores from 5.7 to 4.15 and dyspareunia from 4.05 to 2.17 (p improved; 6.66-4.68 post-operatively (p intervention. There was no correlation between the stage of disease and endometrial pain; (p = .289), method of intervention (p = .290) and usage of post-operative hormonal therapy (p = .632). This study concluded that surgical treatment improved the QoL with added hormonal therapy post-intervention, despite not reaching statistical significance, showed a promising result. Impact statement Surgical intervention does improve the QoL for women with endometriosis however post interventional hormonal therapy is remain inconclusive.
The life-time prevalence of visual height intolerance in adults is 28 percent, whereas in primary school children, as recently shown, it develops in 34 percent. Triggers and symptoms are similar in children and adults. A significant difference in visual height intolerance of prepubertal children compared to adults is the good prognosis with mostly spontaneous remission within a few years, possibly facilitated by repeated exposure to the triggering situations. © Georg Thieme Verlag KG Stuttgart · New York.
Helmuth, Ida Glode; Broccia, Marcella Ditte; Glenthøj, Jonathan Peter
BACKGROUND: Varicella, common in childhood and most often self-limiting, may cause complications including bacterial superinfection, pneumonia and encephalitis. Universal childhood varicella vaccination has been introduced in several countries, but is controversial in Europe. In Denmark, varicella...... of the Danish National Patient Register. METHODS: Active surveillance of children hospitalized with varicella was carried out at four pediatric departments. In the Danish National Patient Register we identified all children discharged with an ICD10 code of varicella from the four departments. We used a capture...
Agueda Cabral de Souza Pereira
Full Text Available Abstract Objective: Study the use of magistral oral solutions and suspensions in infants and children at a university hospital. Methods: This is a descriptive study based on the analysis of the assessed hospital's magistral drug request forms regarding the patients in the neonatal ICU, Obstetrics, Pediatrics and Pediatric Emergency from January 2012 to December 2013. The frequency of drug requests and dispensation was evaluated and the consumption of each active ingredient of the preparations was expressed as number of “infant defined daily dose” (iDDD and of iDDD/100 bed-days. Results: A total of 657 forms were analyzed - a monthly average of 27 pediatric preparations. The neonatal ICU accounted for 69.6% of these requests. Twenty-one drug items were used, of which the most common were folinic acid (88 requests, sulfadiazine (85 and captopril (73. The consumption of the active principle in these preparations varied in number of iDDD, from 7.5 (hydralazine to 16,520.0 (folic acid, and in number of iDDD/100 bed-days in the neonatal ICU, from 0.1 (zinc sulfate to 146.1 (folic acid. Conclusions: The constant consumption of magistral oral solutions and suspensions by newborns and children of the assessed hospital indicates the need for such preparations as a pediatric therapeutic alternative in this hospital.
Pereira, Agueda Cabral de Souza; Miranda, Elaine Silva; de Castilho, Selma Rodrigues; Futuro, Débora Omena; Teixeira, Lenise Arneiro; de Paula, Geraldo Renato
Abstract Objective: Study the use of magistral oral solutions and suspensions in infants and children at a university hospital. Methods: This is a descriptive study based on the analysis of the assessed hospital's magistral drug request forms regarding the patients in the neonatal ICU, Obstetrics, Pediatrics and Pediatric Emergency from January 2012 to December 2013. The frequency of drug requests and dispensation was evaluated and the consumption of each active ingredient of the preparations was expressed as number of “infant defined daily dose” (iDDD) and of iDDD/100 bed-days. Results: A total of 657 forms were analyzed - a monthly average of 27 pediatric preparations. The neonatal ICU accounted for 69.6% of these requests. Twenty-one drug items were used, of which the most common were folinic acid (88 requests), sulfadiazine (85) and captopril (73). The consumption of the active principle in these preparations varied in number of iDDD, from 7.5 (hydralazine) to 16,520.0 (folic acid), and in number of iDDD/100 bed-days in the neonatal ICU, from 0.1 (zinc sulfate) to 146.1 (folic acid). Conclusions: The constant consumption of magistral oral solutions and suspensions by newborns and children of the assessed hospital indicates the need for such preparations as a pediatric therapeutic alternative in this hospital. PMID:27131897
Mohamed S. Al Riyami
Full Text Available Background. Primary hyperoxaluria belongs to a group of rare metabolic disorders with autosomal recessive inheritance. It results from genetic mutations of the AGXT gene, which is more common due to higher consanguinity rates in the developing countries. Clinical features at presentation are heterogeneous even in children from the same family; this study was conducted to determine the clinical characteristics, type of AGXT mutation, and outcome in children diagnosed with PH1 at a tertiary referral center in Oman. Method. Retrospective review of children diagnosed with PH1 at a tertiary hospital in Oman from 2000 to 2013. Result. Total of 18 children were identified. Females composed 61% of the children with median presentation age of 7 months. Severe renal failure was initial presentation in 39% and 22% presented with nephrocalcinosis and/or renal calculi. Family screening diagnosed 39% of patients. Fifty percent of the children underwent hemodialysis. 28% of children underwent organ transplantation. The most common mutation found in Omani children was c.33-34insC mutation in the AGXT gene. Conclusion. Due to consanguinity, PH1 is a common cause of ESRD in Omani children. Genetic testing is recommended to help in family counseling and helps in decreasing the incidence and disease burden; it also could be utilized for premarital screening.
Mansbach, Jonathan M.; Stevenson, Michelle; Macias, Charles G.; Fisher, Erin Stucky; Barcega, Besh; Sullivan, Ashley F.; Espinola, Janice A.; Piedra, Pedro A.; Camargo, Carlos A.
OBJECTIVE: To identify risk factors for inpatient apnea among children hospitalized with bronchiolitis. METHODS: We enrolled 2207 children, aged bronchiolitis at 16 sites during the winters of 2007 to 2010. Nasopharyngeal aspirates (NPAs) were obtained on all subjects, and real-time polymerase chain reaction was used to test NPA samples for 16 viruses. Inpatient apnea was ascertained by daily chart review, with outcome data in 2156 children (98%). Age was corrected for birth bronchiolitis episode (OR 3.63); preadmission respiratory rates of 70 (OR 2.26), compared with 40 to 49; and having a preadmission room air oxygen saturation bronchiolitis, inpatient apnea was associated with younger corrected age, lower birth weight, history of apnea, and preadmission clinical factors including low or high respiratory rates and low room air oxygen saturation. Several bronchiolitis pathogens were associated with apnea, with similar apnea risk across the major viral pathogens. PMID:24101759
Bertini, Mario; Isola, Elena; Paolone, Giuseppe; Curcio, Giuseppe
The study aims at evaluating health-generating function of humor therapy in a hospital ward hosting children suffering from respiratory pathologies. The main scope of this study is to investigate possible positive effects of the presence of a clown on both the clinical evolution of the on-going disease, and on some physiological and pain parameters. Forty-three children with respiratory pathologies participated in the study: 21 of them belonged to the experimental group (EG) and 22 children to the control group (CG). During their hospitalization, the children of the EG interacted with two clowns who were experienced in the field of pediatric intervention. All participants were evaluated with respect to clinical progress and to a series of physiological and pain measures both before and after the clown interaction. When compared with the CG, EG children showed an earlier disappearance of the pathological symptoms. Moreover, the interaction of the clown with the children led to a statistically significant lowering of diastolic blood pressure, respiratory frequency and temperature in the EG as compared with the control group. The other two parameters of systolic pressure and heart frequency yielded results in the same direction, without reaching statistical significance. A similar health-inducing effect of clown presence was observed on pain parameters, both by self evaluation and assessment by nurses. Taken together, our data indicate that the presence of clowns in the ward has a possible health-inducing effect. Thus, humor can be seen as an easy-to-use, inexpensive and natural therapeutic modality to be used within different therapeutic settings. PMID:21785637
Bertini, Mario; Isola, Elena; Paolone, Giuseppe; Curcio, Giuseppe
The study aims at evaluating health-generating function of humor therapy in a hospital ward hosting children suffering from respiratory pathologies. The main scope of this study is to investigate possible positive effects of the presence of a clown on both the clinical evolution of the on-going disease, and on some physiological and pain parameters. Forty-three children with respiratory pathologies participated in the study: 21 of them belonged to the experimental group (EG) and 22 children to the control group (CG). During their hospitalization, the children of the EG interacted with two clowns who were experienced in the field of pediatric intervention. All participants were evaluated with respect to clinical progress and to a series of physiological and pain measures both before and after the clown interaction. When compared with the CG, EG children showed an earlier disappearance of the pathological symptoms. Moreover, the interaction of the clown with the children led to a statistically significant lowering of diastolic blood pressure, respiratory frequency and temperature in the EG as compared with the control group. The other two parameters of systolic pressure and heart frequency yielded results in the same direction, without reaching statistical significance. A similar health-inducing effect of clown presence was observed on pain parameters, both by self evaluation and assessment by nurses. Taken together, our data indicate that the presence of clowns in the ward has a possible health-inducing effect. Thus, humor can be seen as an easy-to-use, inexpensive and natural therapeutic modality to be used within different therapeutic settings.
Full Text Available The study aims at evaluating health-generating function of humor therapy in a hospital ward hosting children suffering from respiratory pathologies. The main scope of this study is to investigate possible positive effects of the presence of a clown on both the clinical evolution of the on-going disease, and on some physiological and pain parameters. Forty-three children with respiratory pathologies participated in the study: 21 of them belonged to the experimental group (EG and 22 children to the control group (CG. During their hospitalization, the children of the EG interacted with two clowns who were experienced in the field of pediatric intervention. All participants were evaluated with respect to clinical progress and to a series of physiological and pain measures both before and after the clown interaction. When compared with the CG, EG children showed an earlier disappearance of the pathological symptoms. Moreover, the interaction of the clown with the children led to a statistically significant lowering of diastolic blood pressure, respiratory frequency and temperature in the EG as compared with the control group. The other two parameters of systolic pressure and heart frequency yielded results in the same direction, without reaching statistical significance. A similar health-inducing effect of clown presence was observed on pain parameters, both by self evaluation and assessment by nurses. Taken together, our data indicate that the presence of clowns in the ward has a possible health-inducing effect. Thus, humor can be seen as an easy-to-use, inexpensive and natural therapeutic modality to be used within different therapeutic settings.
de Las Salas, Roxana; Díaz-Agudelo, Daniela; Burgos-Flórez, Francisco Javier; Vaca, Claudia; Serrano-Meriño, Dolores Vanessa
The occurrence of adverse drug reactions is an important issue due to the lack of drug safety data in children. To describe the Adverse Drug Reactions in inpatient children under 6 years of age in two general pediatrics wards located in Barranquilla, Colombia. A prospective cohort study based on intensive pharmacovigilance was conducted during six months in order to monitor the emergence of Adverse Drug Reactions in inpatients children under 6 years of age with at least one medication prescribed. The study was conducted in two pediatric wards of two hospitals located in Barranquilla, Colombia. Naranjo´s Algorithm was used to evaluate imputability, the modified Hartwig and Siegel assessment scale to establish severity and the Schumock and Thornton criteria to determine preventability. Of a total of 772 monitored patients, 156 Adverse Drug Reactions were detected on 147 children. The cumulative incidence of Adverse Drug Reactions was 19.0% (147/772); the incidence density was 37.6 Adverse Drug Reactions per 1,000 patients-days (147/3,913). The frequency was higher in children under 2 years of age (12.7%). Emergence of Adverse Drug Reactions was higher in male patients (RR= 1.66; 95% CI= 1.22-2.22, p= 0.001) and in those who used systemic antibiotics (RR= 1.82; 95% CI= 1.17-2.82, p= 0.005). Adverse Drug Reactions are common among hospitalized children and represent an additional burden of morbidity and risk, particularly in those who used several medicines, including antibiotics.
... Recommendations Screening for Primary Hypertension in Children and Adolescents The U.S. Preventive Services Task Force (Task Force) ... on Screening for Primary Hypertension in Children and Adolescents . This final recommendation statement applies to children and ...
Zerr, Danielle M; Englund, Janet A; Robertson, Andrea S; Marcuse, Edgar K; Garrison, Michelle M; Christakis, Dimitri A
We performed this study to determine the frequency of previous hospitalization among children hospitalized with influenza. The Pediatric Health Information System database (discharges that occurred between January 1, 2001, and December 31, 2006) was used to determine the proportion of children hospitalized with influenza or respiratory illness who had a previous hospitalization during the most recent influenza-vaccination season. Subjects included pediatric patients (through 18 years of age). The index hospitalization was defined as the first influenza or respiratory illness hospitalization for a child that occurred during the study period and between November 1 and April 30. A previous hospitalization during the most recent influenza-vaccination season was defined as a hospitalization for any reason in the 0.5 to 6 months before the index hospitalization but not before September 1 or on or after March 1. Overall, 16% of children hospitalized with influenza and 12% of children hospitalized with influenza or a respiratory illness had a previous hospitalization during the most recent influenza-vaccination season. Approximately 23% of the children hospitalized with influenza and a comorbidity had a previous hospitalization during the most recent influenza-vaccination season. Hospital-based programs for influenza vaccination have the potential to reach children at highest risk of influenza complications and to reduce the rates of pediatric hospitalization for treatment of influenza-related illness.
Moler, Frank W; Silverstein, Faye S; Holubkov, Richard; Slomine, Beth S; Christensen, James R; Nadkarni, Vinay M; Meert, Kathleen L; Browning, Brittan; Pemberton, Victoria L; Page, Kent; Gildea, Marianne R; Scholefield, Barnaby R; Shankaran, Seetha; Hutchison, Jamie S; Berger, John T; Ofori-Amanfo, George; Newth, Christopher J L; Topjian, Alexis; Bennett, Kimberly S; Koch, Joshua D; Pham, Nga; Chanani, Nikhil K; Pineda, Jose A; Harrison, Rick; Dalton, Heidi J; Alten, Jeffrey; Schleien, Charles L; Goodman, Denise M; Zimmerman, Jerry J; Bhalala, Utpal S; Schwarz, Adam J; Porter, Melissa B; Shah, Samir; Fink, Ericka L; McQuillen, Patrick; Wu, Theodore; Skellett, Sophie; Thomas, Neal J; Nowak, Jeffrey E; Baines, Paul B; Pappachan, John; Mathur, Mudit; Lloyd, Eric; van der Jagt, Elise W; Dobyns, Emily L; Meyer, Michael T; Sanders, Ronald C; Clark, Amy E; Dean, J Michael
Targeted temperature management is recommended for comatose adults and children after out-of-hospital cardiac arrest; however, data on temperature management after in-hospital cardiac arrest are limited. In a trial conducted at 37 children's hospitals, we compared two temperature interventions in children who had had in-hospital cardiac arrest. Within 6 hours after the return of circulation, comatose children older than 48 hours and younger than 18 years of age were randomly assigned to therapeutic hypothermia (target temperature, 33.0°C) or therapeutic normothermia (target temperature, 36.8°C). The primary efficacy outcome, survival at 12 months after cardiac arrest with a score of 70 or higher on the Vineland Adaptive Behavior Scales, second edition (VABS-II, on which scores range from 20 to 160, with higher scores indicating better function), was evaluated among patients who had had a VABS-II score of at least 70 before the cardiac arrest. The trial was terminated because of futility after 329 patients had undergone randomization. Among the 257 patients who had a VABS-II score of at least 70 before cardiac arrest and who could be evaluated, the rate of the primary efficacy outcome did not differ significantly between the hypothermia group and the normothermia group (36% [48 of 133 patients] and 39% [48 of 124 patients], respectively; relative risk, 0.92; 95% confidence interval [CI], 0.67 to 1.27; P=0.63). Among 317 patients who could be evaluated for change in neurobehavioral function, the change in VABS-II score from baseline to 12 months did not differ significantly between the groups (P=0.70). Among 327 patients who could be evaluated for 1-year survival, the rate of 1-year survival did not differ significantly between the hypothermia group and the normothermia group (49% [81 of 166 patients] and 46% [74 of 161 patients], respectively; relative risk, 1.07; 95% CI, 0.85 to 1.34; P=0.56). The incidences of blood-product use, infection, and serious adverse
Nayfack, Aaron M.; Huffman, Lynne C.; Feldman, Heidi M.; Chan, Jia; Saynina, Olga; Wise, Paul H.
We performed a retrospective analysis of hospital discharges for children with autism, in comparison to children with cerebral palsy, Down syndrome, mental retardation/intellectual disability, and the general population. Hospitalizations for autism increased nearly threefold over 10 years, especially at the oldest ages, while hospitalizations for…
Patrizia Gallo MD
Full Text Available Background: Epidemiologic evidences suggest a strong association between low birth weight and some diseases in adult life ( hypertension, diabetes, cardiovascular diseases.Aim of this study was to evaluate the obesity/overweight prevalence in a population of children born small for gestation age, SGA children 400, 208 males and 192 females compared to a population of children born appropriate for gestational age 6818 AGA children, 3502 males and 3316 females, during childhood. Our intention was also to build the natural history of weight gain during prepubertal age in children born SGA and AGA. Design and Methods: Observational prospective longitudinal study. We followed our patients from January2001 up to December 2010; weight, height and body mass index (BMI were evaluated in all the SGA and AGA children. BMI z-score range for defining overweight and obesity was, respectively, 1.13 to 1.7 and >1.7 according to CDC growth charts. Results: In transversal evaluation, we prove that 10-year-old SGA females are twice obese and more overweight compared to equal age AGA females. In longitudinal evaluation, we highlight different observations: SGA children obese at 2 years are still obese at 10 years; the number of obese SGA children increases gradually until the age of 10; AGA children, appear to be less obese than SGA children at 10 years. Conclusion: SGA males and females are more obese at 5 and 10 years compared to the AGA population. Primary care pediatricians, through early detection of the children at risk, can carry out an effective obesity prevention project in SGA children.
Purpose: This paper has three objectives. The first is to determine the level of primary school students' career development, the second is to test Super's childhood years career development model, and the third is to determine the level of Turkish children's career development. Design/methodology/approach: Employing qualitative research models,…
Kennedy, Holly P; Doig, Eleanor; Tillman, Stephanie; Strauss, Amanda; Williams, Beth; Pettker, Christian; Illuzzi, Jessica
One in three women will deliver by cesarean, a procedure that can be life saving, but which also carries short- and long-term risks. There is growing interest in preventing primary cesarean deliveries, while optimizing the health of the mother and infant. The primary aim of this study was to use participatory action strategies and ethnographic interview data collected from diverse stakeholders in birth (caregivers, women, policymakers) about facilitators and barriers to the achievement of primary vaginal birth in first-time mothers in hospital settings. The secondary aim was to use the findings to identify strategies to promote primary vaginal birth and future areas of research. Individual and small group interviews were conducted with caregivers and policymakers (N = 79) and first-time mothers (N = 24) at a northeastern hospital. All interviews were audio-recorded, transcribed, and analyzed using Atlas.ti. Four broad themes were identified: 1) preparation for childbirth, 2) early labor management, 3) caregiver knowledge and practice style, and 4) birth environment (physical, cultural/emotional). The first two were closely linked from caregivers' perspectives. If the woman was not prepared for childbirth, it was perceived she would be more likely to present to the hospital in early labor. Once there, it was hard to prevent admission and interventions. A woman's knowledge and confidence were perceived as powerful mediators for vaginal birth. Caregivers and first-time mothers identified early labor management and childbirth preparation as important factors to promote primary vaginal birth in hospital settings. Both deserve further inquiry as potential strategies to decrease rising cesarean delivery rates. © 2016 Wiley Periodicals, Inc.
Webb, Tennille N; Shatat, Ibrahim F; Miyashita, Yosuke
Acute hypertension (HTN) in hospitalized children and adolescents occurs relatively frequently, and in some cases, if not recognized and treated promptly, it can lead to hypertensive crisis with potentially significant morbidity and mortality. In contrast to adults, where acute HTN is most likely due to uncontrolled primary HTN, children and adolescents with acute HTN are more likely to have secondary HTN. This review will briefly cover evaluation of acute HTN and various age-specific etiologies of secondary HTN and provide more in-depth discussion on treatment targets, potential risks of acute HTN therapy, and available pediatric data on intravenous and oral antihypertensive agents, and it proposes treatment schema including unique therapy of specific secondary HTN scenarios.
Webb, Tennille N.; Shatat, Ibrahim F.
Acute hypertension (HTN) in hospitalized children and adolescents occurs relatively frequently and in some cases, if not recognized and treated promptly, it can lead to hypertensive crisis with potentially significant morbidity and mortality. In contrast to adults, where acute HTN is most likely due to uncontrolled primary HTN, children and adolescents with acute HTN are more likely to have secondary HTN. This review will briefly cover evaluation of acute HTN and various age specific etiologies of secondary HTN and provide more in-depth discussion on treatment target, potential risks of acute HTN therapy, available pediatric data on intravenous and oral antihypertensive agents, and propose treatment schema including unique therapy of specific secondary HTN scenarios. PMID:24522943
HASAN TEHRANI, Tayebeh; Haghighi, Mohammad; BAZMAMOUN, Hasan
How to cite this article: Hasan Tehrani T, Haghighi M, Bazmamoun H. Effects of Stress on Mothers of Hospitalized Children in a Hospital in Iran. Iran J Child Neurol Autumn 2012;6(4):39-45.Abstract Objective Hospitalization of a child can cause severe anxiety and stress in the parents, especially for the mother. This stress consequently affects the treatment course of the child. Hereby, we investigate the impact of different stressors in mothers of hospitalized children. Materials & Metho...
Healy, William L; Rana, Adam J; Iorio, Richard
The hospital cost of total knee arthroplasty (TKA) in the United States is a major growing expense for the Centers for Medicare & Medicaid Services (CMS). Many hospitals are unable to deliver TKA with profitable or breakeven economics under the current Diagnosis-Related Group (DRG) hospital reimbursement system. The purposes of the current study were to (1) determine revenue, expenses, and profitability (loss) for TKA for all patients and for different payors; (2) define changes in utilization and unit costs associated with this operation; and (3) describe TKA cost control strategies to provide insight for hospitals to improve their economic results for TKA. From 1991 to 2009, Lahey Clinic converted a $2172 loss per case on primary TKA in 1991 to a $2986 profit per case in 2008. The improved economics was associated with decreasing revenue in inflation-adjusted dollars and implementation of hospital cost control programs that reduced hospital expenses for TKA. Reduction of hospital length of stay and reduction of knee implant costs were the major drivers of hospital expense reduction. During the last 25 years, our economic experience with TKA is concerning. Hospital revenues have lagged behind inflation, hospital expenses have been reduced, and our institution is earning a profit. However, the margin for TKA is decreasing and Managed Medicare patients do not generate a profit. The erosion of hospital revenue for TKA will become a critical issue if it leads to economic losses for hospitals or reduced access to TKA. Level III, Economic and Decision Analyses. See Guidelines for Authors for a complete description of levels of evidence.
Persi, Joe; Sisson, Megan
Although it is generally accepted that foster children are at greater risk for mental health problems than are children in the general population, very little is known about the smaller group of foster children admitted to psychiatric hospitals. The present study sought to determine whether foster children admitted to inpatient care are a distinct…
Tarpgaard, Mona; Hansen, Troels Martin; Rognås, Leif
Pre-hospital advanced airway management has been named one of the top-five research priorities in physician-provided pre-hospital critical care. Few studies have been made on paediatric pre-hospital advanced airway management. The aim of this study was to investigate pre-hospital endotracheal intubation success rate in children, first-pass success rates and complications related to pre-hospital advanced airway management in patients younger than 16 years of age treated by pre-hospital critical care teams in the Central Denmark Region (1.3 million inhabitants). A prospective descriptive study based on data collected from eight anaesthetist-staffed pre-hospital critical care teams between February 1st 2011 and November 1st 2012. Primary endpoints were 1) pre-hospital endotracheal intubation success rate in children 2) pre-hospital endotracheal intubation first-pass success rate in children and 3) complications related to prehospital advanced airway management in children. The pre-hospital critical care anaesthetists attempted endotracheal intubation in 25 children, 13 of which were less than 2 years old. In one patient, a neonate (600 g birth weight), endotracheal intubation failed. The patient was managed by uneventful bag-mask ventilation. All other 24 children had their tracheas successfully intubated by the pre-hospital critical care anaesthetists resulting in a pre-hospital endotracheal intubation success rate of 96 %. Overall first pass success-rate was 75 %. In the group of patients younger than 2 years old, first pass success-rate was 54 %. The total rate of airway management related complications such as vomiting, aspiration, accidental intubation of the oesophagus or right main stem bronchus, hypoxia (oxygen saturation advanced airway management. Compared with the total population of patients receiving pre-hospital advanced airway management in our system, the overall success rate following pre-hospital endotracheal intubations in children is acceptable but
were mothers' education less than graduation [RR (95% CI 1.5 (1.19–1.7], lack of exclusive breast feeding [RR (95% CI 1.77 (1.19–2.09] and oxygen saturation of Conclusion Children hospitalized with severe community acquired pneumonia [as defined by World Health Organization (WHO] who had not received exclusive breast feeding, had stayed in an overcrowded homes and had an abnormal chest radiograph were more likely to fail to respond with primary antibiotic regimen and require change of antibiotics and prolonged hospital stay. In children with radiographically confirmed pneumonia, lack of breast feeding and low birth weight was associated with need for change in antibiotics.
Tesmer, Maja; Frick, Daniel; Gerrits, Ruben; des GFZ-GeoWunderWerkstatt, Schülerlabor
How can you inspire school children for geochemistry, and scientific exploratory urge? The key is to raise their curiosity and make learning new things a hands-on experience. The Fellows of the European Marie Curie Initial Training Network IsoNose designed and established a "Geochemical Treasure Hunt" to excite children for scientific investigations. This workshop explains primary school children the research and scientific methods of isotopic geochemistry, and their use to understand processes on the Earth's surface. From obtaining 'samples', performing various experiments, the school children gather clues leading them to the hidden treasure on the Telegrafenberg (campus of the GFZ Potsdam). The course was designed for school children to learn hands-on the meaning of elements, atoms and isotopes. In small groups the children conduct experiments of simplified methods being indispensable to any isotope geochemist. However, prior to working in any laboratory environment, a security briefing is necessary. For the course, two stages were implemented; firstly the use of harmful substances and dangerous equipment was minimised, and secondly children were equipped with size-matched personal protective equipment (lab coats, gloves, and safety googles). The purification of elements prior to isotopic analysis was visualised using colour chromatography. However, instead of using delicate mass spectrometers for the isotope ratio measurements, the pupils applied flame spectroscopy to analyse their dissolved and purified mineral solutions. Depending on the specific element present, a different colour was observed in the flame. The children plotted their colours of the flame spectroscopy onto a map and by interpreting the emerging colour patterns they localized the treasure on the map. In small teams they swarmed out on the Telegrafenberg to recover the hidden treasure. The project leading to this outreach activity has received funding from the People Programme (Marie Curie
Uijen, J.H.J.M.; Schellevis, F.G.; Bindels, P.J.E.; Willemsen, S.P.; Wouden, J.C. van der
BACKGROUND: Population-based data on hospital admissions for children aged 0-17 years concerning all respiratory diseases are scarce. This study examined hospital admissions in relation to the preceding consultations in general practice in this age group. METHODS: Data on children aged 0-17 years wi
In 2008, for 3 months, a visual artist in residence at the Margency children's hospital (Val d'Oise) made sculptures for the bandstand situated in the hospital's park. By bringing people together this experience helped to create a bond between the artists, the hospitalised children and the healthcare workers.
Hasan Mohamed Aljefri
Full Text Available To determine the prevalence and personal and family risk factors for nocturnal enuresis (NE among primary school children in Al-Mukalla City, Yemen, we conducted a cross-sectional survey using a self-administered, three-part structured questionnaire involving 832 school children aged 6 - 15 years between 2007 and 2008. We assessed participants′ socio-demographic factors, family characteristics and factors related to the presence of NE. The mean age of the children was 11.5 (±2.7 years. The overall prevalence of NE was 28.6%, with a predominance of girls, and the prevalence decreased with increasing age (P 0.002 and a higher number of siblings (P = 0.01. Our findings reveal a high prevalence of NE among children in Al-Mukalla City, Yemen, with a higher prevalence in girls than in boys compared with the other studies. Sleep pattern, stressful life events, family history of NE, large family size and more children in the household may act as a risk factor for NE.
For years, the North Texas Hospital for Children at Medical City in Dallas struggled with its brand awareness. It's long-winded name was largely unknown among the city's 1.2 million residents. The hospital needed a new name and it needed one fast. The year 2005 proved to be both a burden and an opportunity for the 311-bed pediatric hospital. It survived a legal battle with a local competitor for the right to use the word "children's" in its name, created a new identity, and launched a three-year branding initiative to introduce its new name: Medical City Children's Hospital.
Although considerable energy is invested in ensuring that pediatric hospital environments are psychosocially supportive, few researchers have connected the experiences of patients to hospital architecture, a crucial interface between healthcare delivery and patient care. Seeking to uncover children's experiences within a contemporary hospital, I…
Revilla-López, Concha; Calderón-Larrañaga, Amaia; Enríquez-Martín, Natalia; Prados-Torres, Alexandra
To measure the diagnostic agreement between Primary Care (PC) and hospital information systems, in order to assess the usefulness of health care records for research purposes. Cross-sectional retrospective study integrating PC and hospital diagnostic information for the Aragon population admitted to hospital in 2010. 75.176 patients were analysed. Similarities, differences and the kappa index were calculated for each of the diagnoses recorded in both information systems. The studied diseases included COPD, diabetes, hypertension, cerebrovascular disease, ischaemic heart disease, asthma, epilepsy, and heart failure. Diagnostic concordance was higher in men and between 45 and 64 years. Diabetes was the condition showing the highest concordance (kappa index: 0.75), while asthma had the lowest values (kappa index: 0.34). The low concordance between the diagnostic information recorded in PC and in the hospital setting calls for urgent measures to ensure that healthcare professionals have a comprehensive picture of patient's health problems. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.
van Dillen, Jeroen; van der Honing, Anouk
We discuss the diagnostic process of three patients presenting with primary amenorrhoea in Onandjokwe Lutheran Hospital in Northern Namibia. This semirural district hospital also serves as a referral hospital and has both ultrasound and laparoscopy possibilities.
Eneli, Ihuoma; Hampl, Sarah; Mietus-Snyder, Michele; Mirza, Nazrat; Rhodes, Erinn; Sweeney, Brooke; Tinajero-Deck, Lydia; Woolford, Susan J.; Pont, Stephen J.
Abstract Background: Childhood obesity and overweight affect approximately 30% of US children. Many of these children have obesity-related comorbidities, such as hypertension, dyslipidemia, fatty liver disease, diabetes, polycystic ovary syndrome (PCOS), sleep apnea, psychosocial problems, and others. These children need routine screening and, in many cases, treatment for these conditions. However, because primary care pediatric providers (PCPs) often are underequipped to deal with these comorbidities, they frequently refer these patients to subspecialists. However, as a result of the US pediatric subspecialist shortage and considering that 12.5 million children are obese, access to care by subspecialists is limited. The aim of this article is to provide accessible, user-friendly clinical consensus statements to facilitate the screening, interpretation of results, and early treatment for some of the most common childhood obesity comorbidities. Methods: Members of the Children's Hospital Association (formerly NACHRI) FOCUS on a Fitter Future II (FFFII), a collaboration of 25 US pediatric obesity centers, used a combination of the best available evidence and collective clinical experience to develop consensus statements for pediatric obesity-related comorbidities. FFFII also surveyed the participating pediatric obesity centers regarding their current practices. Results: The work group developed consensus statements for use in the evaluation and treatment of lipids, liver enzymes, and blood pressure abnormalities and PCOS in the child with overweight and obesity. The results of the FFFII survey illustrated the variability in the approach for initial evaluation and treatment as well as pattern of referrals to subspecialists among programs. Conclusions: The consensus statements presented in this article can be a useful tool for PCPs in the management and overall care of children with overweight and obesity. PMID:25019404
Reust, Carin E
One in 2,000 children younger than 18 years is thought to have a primary immunodeficiency disease. Antibody, combined B-cell and T-cell, phagocytic, and complement disorders are the most common types. Children with these diseases tend to have bacterial or fungal infections with unusual organisms, or unusually severe and recurrent infections with common organisms. A family history of primary immunodeficiency disease is the strongest predictor of a person having this type of disease. When an immunodeficiency disease is suspected, initial laboratory screening should include a complete blood count with differential and measurement of serum immunoglobulin and complement levels. The presence of lymphocytopenia on complete blood count suggests a T-cell disorder, whereas a finding of neutropenia suggests a phagocytic disorder. Abnormal serum immunoglobulin levels suggest a B-cell disorder. Abnormalities on assay of the classic or alternative complement pathways suggest a complement disorder. If laboratory results are abnormal, or if clinical suspicion continues despite normal laboratory results, children should be referred for further evaluation. Human immunodeficiency virus infection should also be considered, and testing should be performed, if appropriate; this infection often clinically resembles a T-cell disorder.
Waleska Regina Machado Araujo
Full Text Available ABSTRACT OBJECTIVE The objective of this study is to investigate whether the characteristics of the structure of primary health units and the work process of primary care teams are associated with the number of hospitalizations for primary care sensitive conditions. METHODS In this ecological study, we have analyzed data of Brazilian municipalities related to sociodemographic characteristics, coverage of care programs, structure of primary health units, and work process of primary care teams. We have obtained the data from the first cycle of the Brazilian Program for Improving Access and Quality of the Primary Care, of the Department of Information Technology of the Brazilian Unified Health System, the Brazilian Institute of Geography and Statistics, and the United Nations Development Programme. The associations have been estimated using negative binomial regression coefficients (β and respective 95% confidence intervals, with a hierarchical approach in three levels (alpha = 5%. RESULTS In the adjusted analysis for the outcome in 2013, in the distal level, the coverage of the Bolsa Família Program (β = -0.001 and private insurance (β = -0.01 had a negative association, and the human development index (β = 1.13, the proportion of older adults (β = 0.05 and children under the age of five (β = 0.05, and the coverage of the Community Health Agent Strategy (β = 0.002 showed positive association with hospitalizations for primary care sensitive conditions. In the intermediate level, minimum hours (β = -0.14 and availability of vaccines (β = -0.16 showed a negative association, and availability of medications showed a positive association (β = 0.16. In the proximal level, only the variable of matrix support (β = 0.10 showed a positive association. The variables in the adjusted analysis of the number of hospitalizations for primary care sensitive conditions in 2014 presented the same association as in 2013. CONCLUSIONS The characteristics of
Hansson, Helena; Hallström, Inger; Kjaergaard, Hanne
Hospital-based home care (HBHC) is widely applied in Pediatric Oncology. We reviewed the potential effect of HBHC on children's physical health and risk of adverse events, parental and child satisfaction, quality of life of children and their parents, and costs. A search of PubMed, CINAHL...... for children with cancer....
George, Joe; Acharya, Shrikrishna V; Bandgar, Tushar R; Menon, Padma S; Shah, Nalini S
Primary hyperparathyroidism (PHPT) in children and adolescents is a rare condition. Awareness should improve in order to lower threshold for screening and allow intervention before serious and permanent sequelac occur. A retrospective analysis of 15 children and adolescents with PHPT (age multiple endocrine neoplasia (MEN). After biochemical confirmation, tumor was localised in all prior to surgery. Histopathology confirmed adenoma in all cases. Post-operative hungry bone syndrome occurred in 33.3%. PHPT is more common in females. Presentation of the disease is similar to their adult counterparts except for more severe bone disease and less severe renal disease. MEN and familial non-MEN PHPT do not constitute a major cause of pediatric PHPT as against to worldwide data. The incidence of hyperplasia as a cause of PHPT is rare in our pediatric population.
Full Text Available 44 Grade 3 children and 45 Grade 5 children from English primary schools were given the British abilities scales basic number skills subtest, and a Mathematics Attitude and Anxiety Questionnaire, using pictorial rating scales to record their Self-rating for maths, Liking for maths, Anxiety about maths, and Unhappiness about poor performance in mathematics. There were few year group differences in attitudes. Boys rated themselves higher than girls, but did not differ significantly in actual performance. Overall, Anxiety was not related to actual performance, but Self-rating was. This relationship between Self-rating and actual performance seemed to develop between Grade 3 and Grade 5. Implications of the findings are discussed.
Nortvedt, L; Kase, B F
The rights of children in hospitals in Norway are protected by regulations based on Norwegian legislation. These regulations cover matters such as teaching of hospitalized children, housing of parents, economic rights of parents, and information. We did a questionnaire study among hospitalized children and their parents about their views on how hospitals complied with these regulations. 90 of 131 questionnaires (69%) were returned. There was a considerable gap between what the law demands of continuance in health care during treatment, schooling and information, and what children and parents actually experience. The study shows that the present regulations concerning children's rights in hospitals should be changed. The health authorities should demand documentation from the hospitals as to how the rights of children are ensured in hospitals.
Lyle, Kristin C; Milton, Jerrod; Fagbuyi, Daniel; LeFort, Roxanna; Sirbaugh, Paul; Gonzalez, Jacqueline; Upperman, Jeffrey S; Carmack, Tim; Anderson, Michael
Children account for 30 percent of the US population; as a result, many victims of disaster events are children. The most critically injured pediatric victims would be best cared for in a tertiary care pediatric hospital. The Children's Hospital Association (CHA) undertook a survey of its members to determine their level of readiness to respond to a mass casualty disaster. The Disaster Response Task Force constructed survey questions in October 2011. The survey was distributed via e-mail to the person listed as an "emergency manager/disaster contact" at each association member hospital and was designed to take less than 15 minutes to complete. The survey sought to determine how children's hospitals address disaster preparedness, how prepared they feel for disaster events, and how CHA could support their efforts in preparedness. One hundred seventy-nine surveys were distributed with a 36 percent return rate. Seventy percent of respondent hospitals have a structure in place to plan for disaster response. There was a stronger level of confidence for hospitals in responding to local casualty events than for those responding to large-scale regional, national, and international events. Few hospitals appear to interact with nonmedical facilities with a high concentration of children such as schools or daycares. Little commonality exists among children's hospitals in approaches to disaster preparedness and response. Universally, respondents can identify a disaster response plan and routinely participate in drills, but the scale and scope of these plans and drills vary substantially.
Shah, Amy S; Wilson, Don P
Primary disorders of lipid metabolism causing hypertriglyceridemia (HyperTG) result from genetic defects in triglyceride synthesis and metabolism. With the exception of lipoprotein lipase deficiency, these primary HyperTG disorders usually present in adulthood. However, some are unmasked earlier by precipitating factors, such as obesity and insulin resistance, and can be diagnosed in adolescence. Physical findings may be present and can include eruptive, palmer, or tuberoeruptive xanthomas. Triglyceride levels are very high to severe and can occur in the absence or the presence of other lipid abnormalities. Each of the causes of HyperTG is associated with an increased risk to develop recurrent pancreatitis and some may increase the risk of premature cardiovascular disease. Adoption of a healthy lifestyle that includes a low-fat diet, optimizing body weight, smoking avoidance/cessation, and daily physical activity is the first line of therapy. Pharmacologic therapies are available and can be beneficial in select disorders. Here, we review the causes of primary HyperTG in children and adolescents, discuss their clinical presentation and associated complications including the risk of pancreatitis and premature cardiovascular disease, and conclude with management and novel therapies currently in development. The goal of this article is to provide a useful resource for clinicians who may encounter primary HyperTG in the pediatric population. Copyright © 2015 National Lipid Association. Published by Elsevier Inc. All rights reserved.
Lacayo-Leñero, Dennis; Hernández-Hernández, Darinel; Valencia-Martínez, Andrés; Barrales-Benítez, Olga; Vargas-Ruiz, Angel G
Thrombophilia is a complex hypercoagulable state that increases the risk of thrombosis. Most reports in medical literature of the Mexican population with this disease lack statistical validity. Therefore, the aim of this study is to describe the prevalence of primary thrombophilia in a tertiary referral hospital in Mexico. This is a study of patients referred to our hospital because of a hypercoagulable state and who later on were diagnosed with primary thrombophilia. The thrombophilia workup included methylenetetrahydrofolate reductase (MTHFR) C677T, antiphospholipid antibodies, protein C, protein S, antithrombin, factor VIII, factor V Leiden, prothrombin mutation G20210A, activated protein C resistance, JAK2 V617F and homocysteine. Ninety-five individuals were tested. The MTHFR C677T polymorphism was the most frequent anomaly in 84.1% of the tested individuals. There was a relatively low prevalence of factor V Leiden (5.2%) and anticoagulant protein deficiency (8.3%). The MTHFR C677T polymorphism has a very high prevalence compared with the low prevalence of anticoagulant protein deficiency and factor V Leiden mutation in Mexicans.
Craver, Randall; Springer, Jeffery; Begue, Rodolfo
We reviewed our Children's Hospital autopsies (1986-2009, 3-8 year groups) to determine the contribution of infections/inflammation to death and trends over time. Infections were categorized as (1) underlying cause of death, (2) mechanism of death complicating another underlying cause of death, (3) contributing (4) agonal or (5) incidental. Of 608 autopsies (44% of deaths), 401 had 691 infections (66%, 1.72 infections/infected child). In categories 1-5, there were 85 (12.3%), 237(34.3%), 231 (33.4%), 82 (11.9%) and 56(8.1%) infections. Leading infections include bronchopneumonia (188), sepsis (144- Enterococcus most common with 22), meningitis (35- Streptococcus pneumoniae most common with 10), pneumonitis (33), peritonitis (29). Sepsis declined in 2002-2009, attributed to fluid resuscitation standardization. Meningitis declined after 1993, and may be partially attributed to vaccines (Hemophilus influenza, Streptococcus pneumoniae). Despite advances in anti-microbial therapy, 66% of pediatric autopsies had inflammatory lesions, predominately as the mechanism or contributing factor rather than the underlying cause of death.
Biedroń, Agnieszka; Steczkowska, Małgorzata; Zajac, Anna; Stolarska, Urszula; Kroczka, Sławomir
Migraine with aura is characterized by reversible focal neurological symptoms preceding or accompanying headache. Visual aura is the most common type of aura and its patognomic symptoms are scintillating fortification migrating across the visual field or scintillating scotoma. However, the symptoms are not always so typical and clinical doubts are greater when negative symptoms (loss of vision, numbness or paresis) are present. Differential diagnosis of migraine with aura includes in the first place transient ischemic attack (TIA) as well as epilepsy. Diagnosis of migraine in the developmental age is more difficult and associated with unprecise description of the symptoms. Thorough history taking is crucial in migraine diagnosis and following management. Knowledge of migraine with aura symptoms, clinical differences associated with developmental age and features enabling differentiation with other disorders imitating migraine is very important. Description of aura types and characteristics of migraine headache and their accompanying symptoms in children. 30 children were included, aged 8-17 years (mean 13,6 years), hospitalized at Department of Pediatric Neurology Chair of Pediatric and Adolescent Neurology, Jagiellonian University in 14 months of years 2008 and 2009. Clinical analysis was based on inquiry addressed to the patients and their parents. Migraine with visual aura was established in 9 patients, with somatosensory aura in 4, visual and somatosensory in 5, visual and dysphasic in 1, visual, somatosensory and dysphasic in 5, somatosensory and dysphasic in 2 and basilar type migraine in 4 patients. Consequently, symptoms of visual aura were present in 20/30 patients, in 9 of them it was the only type of aura and in 11 coexisted with other aura types. In more than half cases it manifested as simple visual phenomenons (spots, dots, frills, lines). Blurred vision was found in 5 patients (bilateral in 3, unilateral in 3) and hemianopia in 2 (bilateral in aura
Fieldston, Evan S.; Hall, Matthew; Sills, Marion R.; Slonim, Anthony D.; Myers, Angela L.; Cannon, Courtney; Pati, Susmita; Shah, Samir S.
Context High hospital occupancy may lead to overcrowding in emergency departments (ED) and inpatient units, adversely impacting patient care. It is not known how children's hospitals acutely respond to high occupancy. Objective To describe the frequency, direction and magnitude of children's hospitals' acute responses to high occupancy. Design, Setting, and Participants Patients discharged from 39 children's hospitals participating in the Pediatric Health Information System database during 2006 were eligible. Midnight census data were used to construct occupancy levels. Main Outcome Measures Acute response to high occupancy measured by 8 variables, including changes in hospital admissions (4 measures), transfers (2 measures), and length of stay (2 measures). Results Hospitals were frequently at high occupancy, with 28% of midnights at 85–94% occupancy and 42% of midnights at ≥95% occupancy. While half of children's hospitals employed occupancy-mitigating responses, there was variability in responses and magnitudes were small. When occupancy was >95%, no more than 8% of hospitals took steps to reduce admissions, 13% increased transfers out, and up to 58% reduced standardized length of stay. Two-day lag response was more common, but remained of too small a magnitude to make a difference in hospital crowding. Additional modeling techniques also revealed little response. Conclusions We found a low rate of acute response to high occupancy. When there was a response, the magnitude was small. PMID:20403931
Lyren, Anne; Brilli, Richard J; Zieker, Karen; Marino, Miguel; Muething, Stephen; Sharek, Paul J
To determine if an improvement collaborative of 33 children's hospitals focused on reliable best practice implementation and culture of safety improvements can reduce hospital-acquired conditions (HACs) and serious safety events (SSEs). A 3-year prospective cohort study design with a 12-month historical control population was completed by the Children's Hospitals' Solutions for Patient Safety collaborative. Identification and dissemination of best practices related to 9 HACs and SSE reduction focused on key process and culture of safety improvements. Individual hospital improvement teams leveraged the resources of a large, structured children's hospital collaborative using electronic, virtual, and in-person interactions. Thirty-three children's hospitals from across the United States volunteered to be part of the Children's Hospitals' Solutions for Patient Safety collaborative. Thirty-two met all the data submission eligibility requirements for the HAC improvement objective of this study, and 21 participated in the high-reliability culture work aimed at reducing SSEs. Significant harm reduction occurred in 8 of 9 common HACs (range 9%-71%; P hospital-acquired harm. Copyright © 2017 by the American Academy of Pediatrics.
Gaschignard, Jean; Levy, Corinne; Chrabieh, Maya; Boisson, Bertrand; Bost-Bru, Cécile; Dauger, Stéphane; Dubos, François; Durand, Philippe; Gaudelus, Joël; Gendrel, Dominique; Gras Le Guen, Christèle; Grimprel, Emmanuel; Guyon, Gaël; Jeudy, Catherine; Jeziorski, Eric; Leclerc, Francis; Léger, Pierre-Louis; Lesage, Fabrice; Lorrot, Mathie; Pellier, Isabelle; Pinquier, Didier; de Pontual, Loïc; Sachs, Philippe; Thomas, Caroline; Tissières, Pierre; Valla, Frédéric V.; Desprez, Philippe; Frémeaux-Bacchi, Véronique; Varon, Emmanuelle; Bossuyt, Xavier; Cohen, Robert; Abel, Laurent; Casanova, Jean-Laurent; Puel, Anne; Picard, Capucine
Background. About 10% of pediatric patients with invasive pneumococcal disease (IPD) die from the disease. Some primary immunodeficiencies (PIDs) are known to confer predisposition to IPD. However, a systematic search for these PIDs has never been carried out in children presenting with IPD. Methods. We prospectively identified pediatric cases of IPD requiring hospitalization between 2005 and 2011 in 28 pediatric wards throughout France. IPD was defined as a positive pneumococcal culture, polymerase chain reaction result, and/or soluble antigen detection at a normally sterile site. The immunological assessment included abdominal ultrasound, whole-blood counts and smears, determinations of plasma immunoglobulin and complement levels, and the evaluation of proinflammatory cytokines. Results. We included 163 children with IPD (male-to-female ratio, 1.3; median age, 13 months). Seventeen children had recurrent IPD. Meningitis was the most frequent type of infection (87%); other infections included pleuropneumonitis, isolated bloodstream infection, osteomyelitis, endocarditis, and mastoiditis. One patient with recurrent meningitis had a congenital cerebrospinal fluid fistula. The results of immunological explorations were abnormal in 26 children (16%), and a PID was identified in 17 patients (10%), including 1 case of MyD88 deficiency, 3 of complement fraction C2 or C3 deficiencies, 1 of isolated congenital asplenia, and 2 of Bruton disease (X-linked agammaglobulinemia). The proportion of PIDs was much higher in children aged >2 years than in younger children (26% vs 3%; P 2 years, as PIDs may be discovered in up to 26% of cases. PMID:24759830
Cross War Memorial Children's Hospital (RXH) could safely be managed at .... quality and effectiveness of the care provided. The ..... trends and functional costs within the Gauteng health budget. Repon ... Strategic Management Team.
Premature discharge of children from hospital admission at Ahmadu Bello University ... The commonest diagnoses were protein-energy malnutrition and pneumonia and ... Conclusion: Socio-economic factors were significant determinants of ...
Hansson, Eva Helena; Kjaergaard, H; Schmiegelow, K
. Our study highlights the importance of providing hospital-based home care with consideration for the family members' need for the sense of security achieved by home care by experienced paediatric oncology nurses and regular contact with the doctor. In future studies, interviews with children......The study aims to describe the experiences of a hospital-based home care programme in the families of children with cancer. Fourteen parents, representing 10 families, were interviewed about their experiences of a hospital-based home care programme during a 4-month period in 2009 at a university...... hospital in Denmark. Five children participated in all or part of the interview. The interviews were transcribed verbatim and analysed using qualitative content analysis. The findings indicate that hospital-based home care enabled the families to remain intact throughout the course of treatment...
Hyland, P S
Psychiatric hospitalization is sometimes necessary for seriously symptomatic or out-of-control children and adolescents. In the past, individual therapists, hospital therapists, and family therapists thought that family therapy and individual hospital treatment could not be combined effectively. Today, however, family involvement, participation, and therapy are considered essential components of short-term and extended hospital treatment for young people. The author presents Bowen family systems theory as a basis for informed family therapy in a psychiatric hospital setting. Bowen therapy with patients and close family members elicits significant information, reduces tension, expands options, and facilitates solutions for young patients and their families.
Full Text Available Primary hyperparathyroidism (PHPT is a common endocrine disorder in adults in whom the typical presentation is incidentally discovered as asymptomatic hypercalcemia. PHPT is much less common in children and adolescents, but has greater morbidity in this age group, as most young patients with PHPT will have symptomatic hypercalcemia or complications such as kidney stones, abdominal pain, and skeletal fragility. An important feature of PHPT in younger patients is the relatively high prevalence of germline inactivating mutations of the CASR gene, which encodes the calcium-sensing receptor. Biallelic CASR mutations cause neonatal severe hyperparathyroidism, a life-threatening condition that presents within days of life with marked hypercalcemia, respiratory distress, failure to thrive, and skeletal demineralization. By contrast, more common heterozygous CASR mutations are generally associated with a benign variant of PHPT termed familial hypocalciuric hypercalcemia. Appropriate management of PHPT in children and adolescents requires distinction between familial hypocalciuric hypercalcemia, which generally requires no specific treatment, and other forms of PHPT that are best treated by parathyroidectomy.
Bagdure, Dayanand; Rewers, Arleta; Campagna, Elizabeth; Sills, Marion R
Previous studies of hyperglycemic hyperosmolar syndrome (HHS) in children are limited to case series or single-institution reviews, which describe HHS primarily in children with type 2 diabetes mellitus. To estimate the incidence and describe the epidemiologic characteristics of HHS among children in USA. All discharges in the Kids' Inpatient Database - a triennial, nationwide, stratified probability sample of hospital discharges for years 1997-2009 - with age 0-18 yr and a diagnosis of HHS. Using sample weights, we calculated the incidence and population rate of hospitalization with a diagnosis of HHS. Our sample included 1074 HHS hospitalizations; of these, 42.9% were 16-18 yr, 70.6% had type 1 diabetes (T1D), and 53.0% had major or extreme severity of illness. The median length of stay was 2.6 d, 2.7% of hospitalizations ended in death, and median hospital charge was $10 882. When comparing HHS hospitalizations by diabetes type, the proportion with T1D fell steadily with age, from 89.1% among children 0-9 yr, to 65.1% in 16-18 yr olds. Patients with T1D had a shorter length of stay by 0.9 d, and had a lower median charge by $5311. There was no difference in mortality by diabetes type. Population rates for HHS hospitalization rose 52.4% from 2.1 to 3.2 per 1 000 000 children from 1997 to 2009. Hospitalizations for a diagnosis of HHS have high morbidity and are increasing in incidence since 1997. In contrast to prior reports, we found a substantial percentage of HHS hospitalizations occurred among children with T1D. © 2012 John Wiley & Sons A/S.
Gritter, James L.
Building on previous books by the author, "Hospitious Adoption: How Hospitality Empowers Children and Transforms Adoption" examines the next step after open adoption. Gritter takes the approach that practicing goodwill, respect, and courage within the realm of adoption makes the process move smoother and enriches children's lives. Following a…
Aragona, Elena; El-Magbri, Eussra; Wang, Justin; Scheckelhoff, Tessa; Scheckelhoff, Trevor; Hyacinthe, Assata; Nair, Suja; Khan, Amina; Nino, Gustavo; Pillai, Dinesh K
The prevalence of both childhood asthma and obesity remain at historically high levels and disproportionately affect urban children. Asthma is a common and costly cause for pediatric hospitalization. Our objective was to determine the effect of obesity on outcomes among urban children hospitalized with status asthmaticus. A retrospective cohort study was performed by using billing system data and chart review to evaluate urban children admitted for asthma. Demographics, asthma severity, reported comorbidities, and outcomes were assessed. Obesity was defined by BMI percentile (leanobese≥95%). Outcomes were length of stay, hospitalization charges, ICU stay, repeat admissions, and subsequent emergency department (ED) visits. Bivariate analysis assessed for differences between overweight/obese and lean children. Multivariable regression assessed the relationship between overweight status and primary outcomes while controlling for other variables. Post hoc age-stratified analysis was also performed. The study included 333 subjects; 38% were overweight/obese. Overweight/obese children admitted with asthma were more likely than lean children to have subsequent ED visits (odds ratio 1.6, 95% confidence interval 1.0-2.6). When stratified by age, overweight/obese preschool-age children (2 times as likely to have repeat ED visits than lean preschool-age children (odds ratio 2.3, 95% confidence interval 1.0-5.6). There were no differences in the other outcomes between overweight/obese and lean individuals within the entire cohort or within other age groups. Copyright © 2016 by the American Academy of Pediatrics.
Anttila, Pirjo; Sourander, Andre; Metsahonkala, Liisa; Aromaa, Minna; Helenius, Hans; Sillanpaa, Matti
Objective: To examine the association of psychiatric symptoms with migraine and tension-type headache in children. Method: A questionnaire completed by 1,135 Finnish children in the sixth grade identified 154 children with migraine, 138 with tension-type headache, and 407 children who were headache-free. Seventy children were randomly selected…
Anttila, Pirjo; Sourander, Andre; Metsahonkala, Liisa; Aromaa, Minna; Helenius, Hans; Sillanpaa, Matti
Objective: To examine the association of psychiatric symptoms with migraine and tension-type headache in children. Method: A questionnaire completed by 1,135 Finnish children in the sixth grade identified 154 children with migraine, 138 with tension-type headache, and 407 children who were headache-free. Seventy children were randomly selected…
Full Text Available BACKGROUNDTracheomalacia, a disorder of the large airways where the trachea is deformed or malformed during respiration, is commonly seen in tertiary paediatric practice. It is associated with a wide spectrum of respiratory symptoms from life-threatening recurrent apnoea to common respiratory symptoms such as chronic cough and wheeze. Current practice following diagnosis of tracheomalacia includes medical approaches aimed at reducing associated symptoms of tracheomalacia, ventilation modalities of continuous positive airway pressure (CPAP and bi-level positive airway pressure (BiPAP, and surgical approaches aimed at improving the calibre of the airway (airway stenting, aortopexy, tracheopexy.OBJECTIVESTo evaluate the efficacy of medical and surgical therapies for children with intrinsic (primary tracheomalacia.METHODSSearchThe Cochrane Airways Group searched the Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Airways Group's Specialized Register, Medline and Embase databases. The Cochrane Airways Group performed the latest searches in March 2012.Selection criteriaAll randomized controlled trials (RCTs of therapies related to symptoms associated with primary or intrinsic tracheomalacia.Data collection and analysisTwo reviewers extracted data from the included study independently and resolved disagreements by consensus.MAIN RESULTSWe included one RCT that compared nebulized recombinant human deoxyribonuclease (rhDNase with placebo in 40 children with airway malacia and a respiratory tract infection. We assessed it to be a RCT with overall low risk of bias. Data analyzed in this review showed that there was no significant difference between groups for the primary outcome of proportion cough-free at two weeks (odds ratio (OR 1.38; 95% confidence interval (CI 0.37 to 5.14. However, the mean change in night time cough diary scores significantly favoured the placebo group (mean difference (MD 1.00; 95% CI 0.17 to 1.83, P = 0
Healing by the use of humor has become popular over the last few years and it is used not only in alternative medicine but also in conventional medicine in hospitals all over the world, particularly in the USA and Europe. This practice has been well implemented in pediatric wards. It is easier to make a child laugh than an adult. In the framework of healing by humor, use is made of a medical clown who is in fact a person who has undergone special training in acting and clowning, combined with medical knowledge and an understanding of patient behavior. Some medical clowns come from the world of entertainment, and are actors, clowns, and magicians. Some have a paramedical or medical background. Medical research demonstrates that medical clowns and humor have a positive effect on patients. The implementation of medical clowning has been increasing throughout the world from year to year and has, slowly but surely, started a movement to integrate it into formal frameworks in both pediatric and adult wards in hospitals. However, there is still a necessity to conduct larger, well controlled clinical trials regarding the influence of the different programs. Maybe the growing awareness in the world will fill the void that demands resources of both personnel and budgets, both of which are often missing from health budgets.
Schatkoski, Aline Modelski; Wegner, Wiliam; Algeri, Simone; Pedro, Eva Neri Rubim
This narrative-descriptive review is about the safety/protection of hospitalized children who, due to their fragility, vulnerability and peculiar growth and development conditions need special attention from health professionals. This study aimed to identify knowledge production on safety, protection and violence to hospitalized children between 1997 and 2007. In total, 15 national and international articles were analyzed, using the key words: hospitalized child, safety, violence and nursing. This qualitative approach enabled the development of four categories: adverse occurrences; medication errors; notification of adverse occurrences; and safety of pediatric patients. Results indicate the need to develop strategies to reduce the probability of these events occurring during children's hospitalization, so that they do not suffer any problem neither violation of their fundamental rights.
Alrifai, S B; Alsaadi, A; Mahmood, Y A; Ali, A A; Al-Kaisi, L A
A cross-sectional hospital-based study was carried out at Tikrit teaching hospital, Iraq, from October 2004 to September 2005, to identify the prevalence and etiology of nosocomial infectious diarrhoea among children under 5 years of age. Of 259 children admitted to the paediatric ward for reasons other than diarrhoea and hospitalized for more than 3 days, clinical and laboratory analysis of stool samples showed nosocomial diarrhoea in 84 children (32.4%). The most common causative agents were enteropathogenic Escherichia coli (25.9%), Clostridium difficile (21.0%) and rotavirus (18.5%). Single infectious agents caused 63.1% of the cases, while mixed infections were detected in 16.7%; in 20.2% of children the cause remained unknown.
Nelson, Bergen B; Coller, Ryan J; Saenz, Adrianna A; Chung, Paul J; Kaplan, Avery; Lerner, Carlos F; Klitzner, Thomas S
Children with medical complexity (CMC) are a small group that utilizes large amounts of health care resources. Although parents are the primary healthcare decision-makers for their children, little is known from their perspective about why CMC are hospitalized. We sought to understand what parents think about factors leading to hospitalization and whether any recent hospitalizations might have been avoidable. We conducted qualitative, semistructured interviews with 35 parents of hospitalized CMC who receive care in the Pediatric Medical Home Program, a complex care program at University of California, Los Angeles. Interviews were conducted in English and in Spanish, audio-recorded, transcribed and translated, then coded in ATLAS.ti (Scientific Software Development Gmbh, Berlin, Germany) for qualitative analysis. We sorted qualitative codes into groups with shared concepts, to generate emergent themes. Parents described their experiences leading up to their children's hospitalization, but no one suggested that the hospitalization was potentially avoidable. Most parents perceived their children as having higher susceptibility because of underlying conditions, perceived the symptoms they observed as high-risk, and described seeking emergent care only when they no longer were comfortable at home. Decisions about where to seek care were influenced by health care system factors such as accessibility and continuity of care. Most parents expressed a desire to learn more about their children's conditions and how best to care for them at home. Parents of CMC believe that hospitalizations are largely unavoidable because of higher susceptibility and higher risk. Increasing parents' self-efficacy in caring for children at home might influence their decisions to seek emergent care. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
Salim, Hendra; Karyana, I Putu Gede; Sanjaya-Putra, I Gusti Ngurah; Budiarsa, Soetjiningsih; Soenarto, Yati
Diarrhea is a major public health concern throughout the world because the prevalence of morbidity of diarrhea has not changed significantly in the past decade. It remains the third leading cause of death among children less than 5 years of age. Recent surveillance studies have shown that rotavirus is a significant cause of pediatric hospitalization and death due to diarrhea. Indonesia has limited data on risk factors, disease burden, and deaths in children due to rotavirus diarrhea. The objective of this study was to examine the above mentioned factors related to rotavirus diarrhea in hospitalized children in Sanglah Hospital, Denpasar. A prospective cohort study was conducted at Sanglah Hospital Denpasar from April 2009 to December 2011. The present study was part of a nationwide study on Extension for Hospital-based Surveillance and Strain Characterization of Rotavirus Diarrhea Indonesia involving four hospitals throughout Indonesia as a part of the Asian Rotavirus Surveillance Network. We studied children aged diarrhea, and analyzed their stool samples using an immunoassay that detects the rotavirus antigen. A total of 656 patients met the inclusion criteria for this study. Of 5805 patients under the age of 5 who were hospitalized between April 2009 and December 2011, the prevalence of diarrhea among hospitalized pediatric patients was 11.3% and the prevalence of rotavirus diarrhea was 49.8%. The male to female ratio of those affected by rotavirus was 1.6:1. The occurrence of vomiting was significantly higher in rotavirus diarrhea than in non-rotavirus diarrhea (RR, 1.4; 95% CI, 1.08 to 1.70; p = 0.004). Diarrhea remains an important cause of hospitalization in children, and rotavirus was the most important etiology. We found that boys had a greatest risk of rotavirus infection than girls. Good nutritional status and breastfeeding provided the same protection against rotavirus and non-rotavirus diarrhea.
Krag, Aleksander; Teglbjerg, LS; Malchow-Moller, A
BACKGROUND: Overuse of acid suppressive therapy in the hospital setting and in primary care is well documented. AIM: To describe interactions between prescriptions of acid suppressive therapy in hospital and in primary care. METHODS: All patients admitted to hospital over a 24-month period were...... suppressive therapy within the following 12 months. Of all subjects treated with acid suppressive therapy in the hospital catchment area, 7.8% were seen in our department. CONCLUSIONS: Decisions about acid suppressive therapy prescribing in hospital has little influence on prescribing in primary care....
Full Text Available Abstract Background There is dearth of data on the level of functional impairment and risk factors for psychiatric morbidity in children attending primary care services in developing countries like Nigeria. The risk factors for psychiatric morbidity and functional impairment in children attending the primary care unit of a teaching hospital in Ilorin, Nigeria was therefore investigated to obtain data that could be used in improving service provision by primary care physicians. Methods A cross-sectional two-stage design was employed for the study. The first stage involved administration of the Child Behavior Questionnaire (CBQ to 350 children while the children’s version of the schedule for affective disorders and schizophrenia was used for the second stage involving 157 children, all high scorers on CBQ (score of ≥ 7 and 30% of low scorers (score In addition, the Children Global Assessment Scale was used to assess the functional status of the children (score of ≤ 70 indicates functional impairment while the mothers’ mental health status was assessed with the 12-item version of the General Health Questionnaire, a score of 3 or more on this instrument indicate presence of mental morbidity. Results It was observed that 11.4% of the children had diagnosable psychiatric disorders and 7.1% were functionally impaired; and those with psychiatric disorders were more functionally impaired than those without. Thus, significant negative correlation was noted between CBQ scores and CGAS (r = 0.53; p Conclusions Child psychiatric disorders are prevalent in the primary care unit studied. Many of the risk factors identified in the study population are modifiable. Collaborative efforts between psychiatrists and primary care physicians could therefore help to reduce level of risk and functional impairment and psychiatric morbidity among children attending the primary care unit studied. It could also help improve referral rates of
A. Delpisheh; Y. Kelly; B.J. Brabin
Objective: To assess environmental tobacco smoke (ETS) exposure amongst primary school children. Methods: A descriptive, community-based, cross-sectional study of self-reported parental smoking patterns and children's salivary cotinine concentrations in 245 children aged 5-11 years attending 10 prim
The study investigated the mental models of primary school children related to the day/night cycle. Semi-structure interviews were conducted with 40 fourth-grade and 40 sixth-grade children. Qualitative and quantitative analysis of the data indicated that the majority of the children were classified as having geocentric models. The results also…
The Learning in Science Project (Primary)--LISP(P)--investigated the questions and explanations primary children have about spiders. The data comprise 112 questions and 104 explanations (included in appendices) offered by children after being shown a picture of a spider. Additional data were collected during individual interviews with 18 students.…
Full Text Available Primary antibody deficiencies (PADs are a heterogeneous group of disorders, characterized by hypogammaglobulinemia and increased susceptibility to bacterial infections, leading to hospitalizations. This study was performed to determine the main infectious causes of hospital admissions in selective Iranian patients with PADs. Forty patients with PADs, who were admitted to the Infectious Ward of Children's Medical Center Hospital during a 14-year period, were reviewed in this study. There were 115 documented episodes of hospital admission during a 14-year period. The average length of hospital stay was 33.30 ± 25.72 days. Pneumonia was the most prominent infection leading to hospitalization among these patients (n = 48, followed by gastroenteritis (n = 23. Other less frequent causes of hospitalization were fever and neutropenia, septic arthritis, encephalitis, orbital cellulitis, sepsis, urinary tract infection, meningitis, oral ulcer, and lung abscess. The most common causative organisms of diarrhea were: Giardia lamblia, followed by Candida albicans, and Salmonella sp. Many patients with PADs suffer from repeated infections leading to hospitalization, in spite of immunoglobulin replacement therapy. Respiratory tract infections were the prominent cause of hospitalization among studied patients, followed by gastrointestinal infections.
Full Text Available Primary antibody deficiencies (PADs are a heterogeneous group of disorders, characterized by hypogammaglobulinemia and increased susceptibility to bacterial infections, leading to hospitalizations. This study was performed to determine the main infectious causes of hospital admissions in selective Iranian patients with PADs. Forty patients with PADs, who were admitted to the Infectious Ward of Children's Medical Center Hospital during a 14-year period, were reviewed in this study. There were 115 documented episodes of hospital admission during a 14-year period. The average length of hospital stay was 33.30 ± 25.72 days. Pneumonia was the most prominent infection leading to hospitalization among these patients (n = 48, followed by gastroenteritis (n = 23. Other less frequent causes of hospitalization were fever and neutropenia, septic arthritis, encephalitis, orbital cellulitis, sepsis, urinary tract infection, meningitis, oral ulcer, and lung abscess. The most common causative organisms of diarrhea were: Giardia lamblia, followed by Candida albicans, and Salmonella sp. Many patients with PADs suffer from repeated infections leading to hospitalization, in spite of immunoglobulin replacement therapy. Respiratory tract infections were the prominent cause of hospitalization among studied patients, followed by gastrointestinal infections.
Xun, Yi-Wen; Yang, Jin-Gang; Song, Li; Sun, Yi-Hong; Lu, Chang-Lin; Yang, Yue-Jin; Hu, Da-Yi
Evidence indicates that early reperfusion therapy in patients with ST-elevation myocardial infarction (STEMI) reduces complications. This study was undertaken to compare the in-hospital delay to primary percutaneous coronary intervention (PPCI) for patients with STEMI between specialized hospitals and non-specialized hospitals in Beijing, China. Two specialized hospitals and fifteen non-specialized hospitals capable of performing PPCI were selected to participate in this study. A total of 308 patients, within 12 hours of the onset of symptoms and undergoing PPCI between November 1, 2005 and December 31, 2006 were enrolled. Data were collected by structured interview and review of medical records. The median in-hospital delay was 98 (interquartile range 105 to 180) minutes, and 16.9% of the patients were treated within 90 minutes. Total in-hospital delay and ECG-to-treatment decision-making time were longer in the non-specialized hospitals than in the cardiac specialized hospitals (147 minutes vs. 120 minutes, P hospitals were independently associated with an increased risk of being in the upper median of in-hospital delays. There were substantial in-hospital delays between arrival at the hospital and the administration of PPCI for patients with STEMI in Beijing. Patients admitted to the cardiac specialized hospitals had a shorter in-hospital delay than those to the non-specialized hospitals because of a shorter time of ECG-to-treatment decision-making.
Ana Paula P.C. Fernandes
Full Text Available Abstract Objective: To identify and characterize hospital admissions and readmissions in the Brazilian Unified Public Health System (Sistema Único de Saúde [SUS] in children with sickle cell disease diagnosed by the Minas Gerais Newborn Screening Program between 1999 and 2012. Methods: Hospital Admission Authorizations with the D57 (International Classification of Diseases-10 code in the fields of primary or secondary diagnosis were retrieved from the SUS Databank (1999-2012. There were 2991 hospitalizations for 969 children. Results: 73.2% of children had hemoglobin SS/Sβ0-thalassemia and 48% were girls. The mean age was 4.3 ± 3.2 years, the mean number of hospitalizations, 3.1 ± 3.3, and the hospital length of stay, 5 ± 3.9 days. Hospital readmissions occurred for 16.7% of children; 10% of admissions were associated with readmission within 30 days after discharge; 33% of readmissions occurred within seven days post-discharge. There were 41 deaths, 95% of which were in-hospital. Secondary diagnoses were not recorded in 96% of admissions, making it impossible to know the reason for admission. In 62% of cases, hospitalizations occurred in the child's county of residence. The total number of hospitalizations of children under 14 with sickle cell disease relative to the total of pediatric hospitalizations increased from 0.12% in 1999 to 0.37% in 2012. Conclusions: A high demand for hospital care in children with sickle cell disease was evident. The number of hospitalizations increased from 1999 to 2012, suggesting that the disease has become more "visible." Knowledge of the characteristics of these admissions can help in the planning of care for these children in the SUS.
Hasegawa, Kohei; Mansbach, Jonathan M.; Teach, Stephen J.; Fisher, Erin S.; Hershey, Daniel; Koh, Joyce Y.; Clark, Sunday; Piedra, Pedro A.; Sullivan, Ashley F.; Camargo, Carlos A.
Background It is unclear whether the infectious etiology of severe bronchiolitis affects short-term outcomes, such as post-hospitalization relapse. We tested the hypothesis that children hospitalized with rhinovirus (RV) bronchiolitis, either as a sole pathogen or in combination with respiratory syncytial virus (RSV), are at increased risk of relapse. Methods We performed a 16-center, prospective cohort study of hospitalized children age bronchiolitis. During the winters of 2007 to 2010, researchers collected clinical data and nasopharyngeal aspirates from study participants; the aspirates were tested using real-time polymerase chain reaction. The primary outcome was bronchiolitis relapse (urgent bronchiolitis visit or scheduled visit at which additions to the bronchiolitis medications were made) during the 2 weeks after hospital discharge. Results Among 1836 enrolled children with 2-week follow-up data, the median age was 4 months and 60% were male. Overall, 48% had sole RSV infection, 8% had sole RV infection, and 13% had RSV/RV co-infection. Compared with children with sole RSV infection, and adjusting for 10 demographic and clinical characteristics and clustering of patients within hospitals, children with sole RV infection did not differ in their likelihood of relapse (OR, 0.99; 95%CI, 0.52–1.90; P=0.98), whereas those with RSV/RV co-infection were more likely to have relapse (OR, 1.54; 95%CI, 1.03–2.30; P=0.03). Conclusions In this prospective, multicenter, multiyear study of children hospitalized with bronchiolitis, we found that RSV/RV co-infection was independently associated with a higher likelihood of bronchiolitis relapse. Present data support the concept that the infectious etiology of severe bronchiolitis affects short-term outcomes. PMID:24577039
Thelen, Peggy; Cameron, Elizabeth Ann
Food-allergy awareness and management have only lately come to the forefront in early childhood settings, although advocacy organizations have been working on the issue for more than a decade. A national poll (C.S. Mott Children's Hospital 2009) asked parents with children in early education settings if they were aware of what their program does…
Full Text Available Introduction: The expected therapeutic response may be affected by the presence of drug interactions. With the high number of reports on new drug interactions, it has been difficult for health professionals to keep constantly updated. For this reason, computer systems have helped identify such interactions.Objectives: To verify the rate and profile of drug interactions in medical prescriptions to hospitalized pediatric patients.Methods: A descriptive study investigated prescriptions to hospitalized pediatric patients. The study included patients between 0 and 12 years old, containing 4 or more drugs in their prescriptions. The analysis of interaction and incompatibility possibilities in prescribed drugs used Micromedex / Drug-Reax® program.Results: From 2005 to 2006, 3,170 patients were investigated, and 11,181 prescriptions were analyzed, a mean value of 3.5 prescriptions/patient. In total, 6,857 drug interactions were found, which corresponds to 1.9 interaction/prescription. Among them, relevance to ampicillin and gentamicin, found in 220 (3.2% prescriptions. In total, 2,411 drug incompatibilities in via y were found, a mean value of 0.5/prescription, with emphasis on vancomycin and cefepime, found in 243 (10.0% prescriptions.Conclusion: The presence of drug interactions is a permanent risk in hospitals. This way, the utilization of computer programs, pharmacotherapy monitoring of patients and the pharmacist presence in the multidisciplinary team are some manners of contributing to hospitalized patients’ treatment.
Do, Hien Quoc; Steinmetz, Jacob; Rasmussen, Lars S
BACKGROUND: Although trauma remains a major cause of morbidity and mortality in children, less attention has been directed to this group of patients. Whilst there is considerable literature on trauma in adults, only few studies describe paediatric trauma. The aim of this study was to describe the...... of stay =72h, were admitted to the intensive care unit (regardless of length of stay), or died in hospital. Logistic regression analysis was performed to assess independent predictors for in-hospital mortality. p...
Pohl, Christine D
In many ancient cultures, hospitality was a significant moral and religious practice in responding to the needs of strangers. Although largely trivialized in contemporary society, the practice of hospitality continues to create contexts that contribute to individual and communal flourishing and that resist several dehumanizing social trends. A recovery of the practice can help faith communities connect their moral and theological commitments to the needs of children, families, and neighborhoods. © 2011 American Orthopsychiatric Association.
Full Text Available BACKGROUND & AIMS: Among children hospitalized for pneumonia, those with parapneumonic effusion (PPE are at particular risk for nutritional deterioration. This study aimed to 1 investigate the evolution of the nutritional status during hospitalization and at outpatient follow-up; 2 determine clinical risk factors for weight loss during hospitalization; 3 describe the nutritional interventions for these children. METHODS: Retrospective chart review (January '07 - September '12 of 56 children with pneumonia, complicated by PPE in two Belgian hospitals for data on body weight and height at admission (t0 and discharge (t1, and two weeks (t2 and one month (t3 after discharge. Length of hospitalization (LoS, length of stay in paediatric intensive care (LoSPICU and maximal in-hospital weight loss (tmax were calculated and nutritional interventions were recorded. RESULTS: The median (range age was 3.5 (1.0-14.8 years. Weight or height was lacking in five (8.9% children at t0 and in 28 (50% at t1; 21.4% was weighed only once during hospitalization. At tmax, respectively 17/44 and 5/44 children lost ≥ 5% and ≥ 10% of their weight. Median (range LoS and LoSPICU were 18.0 (10-41 and 4.0 (0-23 days. One-fourth received a nutritional intervention. Weight for height at admission (WFH(t0 significantly predicted maximal weight loss (β (95% CI = -0.34 (-2.0--0.1; p = 0.03. At t2 and t3, 13/32 and 5/22 of the children with available follow-up data did not reach WFH(t0, whilst in 4/35 and 5/26 body weight remained ≥ 5% under the weight(t0. CONCLUSIONS: One-third of children with pneumonia complicated by PPE and monitored for weight and height, lost ≥ 5% of their body weight during hospitalization. One-fourth did not reach initial WFH one month after discharge. Those with a higher WFH at admission were at higher risk of weight loss. More attention for monitoring of weight loss and the nutritional policy during and after hospitalization is warranted.
Velandia, Silvia; Hodgson, Maria Isabel; Le Roy, Catalina
Malnutrition in hospitalized children is associated with increased morbidity and mortality. To determine the nutritional status in children admitted to the Hospital Clínico de la Universidad Católica de Chile. A retrospective, cross-sectional study was conducted on hospital patients less than 17 years old within the period from November 2010 to April 2011. A record was made of the demographic data, admission diagnosis, biochemistry results (albumin, haemoglobin, haematocrit), hospital stay, and anthropometry data. Nutritional diagnosis was expressed as standard deviation (SD) for weight-for-height (WFH) by WHO in children younger than 5 y, and body mass index (BMI) by CDC-NCHS in older children. Height-for-age (HFA) ≤-2SD indicated stunted growth. A total of 365 children, including 201 boys (55.1%), were evaluated. The median age was 3.35 years (IQR: 1.2-8.2). The most frequent reason for admission was heart disease (30.4%). The median hospital stay was 2 days (IQR: 2.0-4.0). Undernutrition was observed in 3.3% of the children, 8% were nutritionally at risk, 15% were overweight, and 10.9% were obese. As regards HFA, short stature was reported in 12.9%. There was a significant relationship between lower age and heart disease, and higher age with gastrointestinal and neurological diseases. By ordinal logistic regression for each year of age, the weight/height ratio (ZP/T) increases by 6.9% (OR=1.07). The biochemistry results (albumin, haemoglobin and haematocrit levels) were not associated with nutritional status. A high percentage of children at risk of undernutrition was found. The percentage overweight was similar to the general Chilean paediatric population. Early detection will allow an opportune intervention, and nutritional monitoring at discharge. Copyright © 2016 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.
Griffin, Ruth A; Polit, Denise F; Byrne, Mary W
The purpose of this study was to examine whether nurses' recommendations for managing children's pain were influenced by stereotypes based on children's personal attributes. Three vignettes, in which hospitalized children's sex, race, and attractiveness were experimentally manipulated, were mailed to a national random sample of 700 pediatric nurses; 334 nurses responded. Responses to vignette questions indicated little evidence of stereotyping. Nurses perceived similar levels of pain and recommended similar pain treatments, regardless of sex, race, and attractiveness. Nurses, on average, perceived children's pain at levels consistent with the children's self-reports and recommended assertive analgesic and non-pharmacologic pain management strategies. The results appear consistent with prevailing views on providing adequate pain treatment for children.
Bsiri-Moghaddam, Kokab; Basiri-Moghaddam, Mahdi; Sadeghmoghaddam, Leila; Ahmadi, Fazlollah
Disease and hospitalization can be the first crisis that a child encounters. The aim of this study is to reveal a clear picture of the meaning of hospitalization in children, to show the experience and behavior of hospitalized children and to discover the meaning and understanding of hospitalization in them. This study is a phenomenology study of qualitative research within the framework of Husserl Eidetic phenomenology through comprehensive interviewing. The objective group consisted of children 7-11 years old - and their parents - hospitalized in the children's ward of 22 Bahman Hospital and the surgery ward of 15 Khordad Hospital during the study (2008). Method of selection of participants was as follows: having experience of hospitalization, having ability to answer the questions, and being volunteered. Sample size was detected by data saturation. In the method of sampling, an object group of 20 (12 children and 8 parents) were chosen and interviewed. The Seven Colaizzi Stages were used for analysis of data. The analysis of the interviews and the written narrations of the participants led to the extraction of 6 inner themes consisting of sickness, environment, reciprocal relationship, parents' personal problems, mental and emotional matters and a spiritual dimension; all of which define a specific aspect of the experience of hospital in children and parents. The experience of hospitalization in children can be considered as a process of effort for returning to health and, on the whole, the regaining of the individual's status in the world. Nurses can ease this process by showing the importance of experience and feelings of individuals at the time of hospitalization and help people to adapt themselves to their new surroundings. This matter can enable the nurses to utilize methods of helping in the adaptation of individuals and thus guide the unique powers present in every individual to ease and quicken recovery.
Full Text Available Upload poisoning is one of the most dangerous and common poisoning in Iranian children. Depression of the respiratory and central nervous systems may lead to significant toxicity. Even low doses of uploads are dangerous in pediatrics under 6 years old. Methadone is the most toxic of the uploads; small doses as low as a single tablet can lead to death. According to this information we decided to evaluate methadone poisoning in Hospitalized Children
Full Text Available Many hospitalized children are suffered from medical errors that may cause serious injuries. The aim of this study was to evaluate medical errors in hospitalized children in khorramabad Madani hospital in the first half of 2008. Materials and Methods: This study was a cross sectional that was performed for all medical errors in hospitalized children in khorramabad Madani hospital from 21/3/2008 to 21/9/2008. The sampling method was census. Studied variables included: age, sex, weight, kinds of errers, education of parents, job of parents. Data was collected by questionnaire and analyzed by SPSS software. Results: In this study out of 2250 records, 151 (6/3% had medical errors. 53%were girls and 47% were boys that there was a significant relation between sex and medical errors. 46/4%were related to age group lower than 2 years old. Most of the errors were occurred in weight group of 6kg. Types of medical errors included drug ordering 46/3% (involved incorrect dosage of drug (37%, frequency 28%, rout 19% and others 16%, transcribing10%, administering32/4%, dispensing11/3%. Most errors related to liquid therapy 76/2% and intravenous rout 85/4%. Most errors were occurred during night 47% and during weekend 56/6%. Conclusion: Medical errors are common in hospitalized patients, and in our study the rate of medical errors was 6/3%. So further efforts are needed to reduce them.
Zaghloul, Mohamed S
A wide gathering of scientists, clinicians, pharmacists and nurses specialized in pediatric oncology practice met to celebrate the second anniversary of Children's Cancer Hospital, Egypt (CCHE). The celebration was in the form of high-brow teaching lectures and reports presented by international experts in the fields of pediatric CNS tumors, solid tumors (neuroblastoma, nephroblastoma, soft tissue and bone tumors, lymphoma, leukemia and pediatric oncology nursing. The conference extends its activities to hospital management, clinical pharmacy and telemedicine. Furthermore, CCHE experts presented the efforts performed to establish a state-of-the-art pediatric oncology hospital equipped with all needed facilities to raise the standard of care to the highest levels.
Hoffer, V; Scheuerman, O; Marcus, N; Levy, Y; Segal, N; Lagovsky, I; Monselise, Y; Garty, B Z
Little is known about the courses, causes, and clinical features of anaphylaxis in children outside the USA and Europe. Our objective was to evaluate the events of anaphylaxis in children admitted to the Schneider Children's Medical Center of Israel, a major tertiary facility, over a 12-year period. Ninety-two children with anaphylaxis (50 boys, 42 girls) aged 14 days to 18 yr (mean, 7.4 yr) were hospitalized during the study period. The event occurred at home in 52 children (56%), in a medical institution in 24 (26%), outdoors in 13 (15%), at school in 2 (2%), and in an unspecified location in 1 (1%). The main causes were foods (43%), mainly milk and nuts, medications (22%), and hymenoptera venom (11%); in five children, anaphylaxis occurred during general anesthesia, and in 5, the causative agent could not be determined. Food-induced anaphylaxis tended to occur in younger children. Forty-eight children (52%) had a history of atopy (mainly asthma). Hospital treatment consisted of corticosteroids (85%), antihistamines (75%), epinephrine (72%), and β2 agonists (42%). Seven patients were admitted to intensive care units. There were no fatalities. EpiPen was used by only one of the 16 patients with more than one episode of anaphylaxis, indicating that patient and parent education in the application of the EpiPen needs to be improved.
Ahad, Azainorsuzila; Ming Khoo, Ee
Children with uncontrolled asthma have high risk of poor health outcomes. The aim of this study was to assess asthma control and care in primary school children with reported asthma. A total of 6441 primary school children were first screened for parent-reported physician-diagnosed asthma and 448 (8.9%) children were reported to have asthma. Of these, 311 (69.4%) parents agreed to participate in assessment of asthma control study using Global Initiative for Asthma 2009 guidelines. Only 161 (51.8%) children were found to have good asthma control, 99 (31.8%) had partly controlled asthma, and 51 (16.4%) had uncontrolled asthma in the past one week. In the past 1 year, 157 (50.5%) children had asthma exacerbations, 21 (6.8%) had hospitalizations, and 104 (33.4%) had received emergency asthma care. Only 108 (34.7%) asthmatic children received regular follow-up care. Controller medications were underutilized (12.2%) compared to reliever medications (35.0%). Asthma control among primary school children was poor indicating suboptimal care.
Meiri, Noam; Schnapp, Zeev; Ankri, Amichi; Nahmias, Itay; Raviv, Amnon; Sagi, Omer; Hamad Saied, Mohamad; Konopnicki, Muriel; Pillar, Giora
Medical clowns (MC) have become an integral part of the pediatric staff of hospital wards. While several studies have demonstrated the huge benefits of MC, there are almost no data regarding fear of clowns, a known phenomenon that means an irrational fear of clowns. In the current study, we sought to examine the prevalence of fear of clowns in pediatrics wards, and to characterize the affected children. The clinical work of three certified MCs was prospectively assessed. Every child with fear of clowns was noted, data were retrieved from the medical records, and the parents/child completed a specific questionnaire with a research assistant. Fear of clowns was defined as crying, anxiety response or effort to avoid contact with the MCs in small children, while in older children, it was determined if the child either reported fear of MCs or made actions to avoid clowns' intervention. A total of 1160 children participated in the study. All were hospitalized in the department of pediatrics or the pediatric emergency medicine department at Carmel Medical Center, and were exposed to a MC intervention session. Of the 1160 children, 14 children experienced fear of clowns (1.2%). The average age of children who experienced fear of clowns was 3.5 years (range 1-15). Interestingly, most of the children demonstrating fear of clowns were girls (12 out of 14, 85.7%). We found no association between fear of clowns and specific diagnosis, fever, clinical appearance, religion, or ethnicity. The prevalence of fear of clowns in the general pediatric hospitalized population was 1.2%, with a significant predominance of girls (85.7%). Children who experienced significant fear of clowns also experienced significant fear of encountering or thinking about a MC visit. Fear of clowns can affect children at any age (range 1-15), any ethnicity, religion, or degree of illness. Further large scale studies are required to better understand this unique phenomenon of fear of clowns. What is Known
Full Text Available This study was conducted in 1985-86 amongst non-hospitalized children of jaipur city in33 investigative units having 3791 families with 6183 children in the 0-9 years age group. Measles vaccine coverage was only 21.7% Measles developed in 189 cases. Maximum incidence occurred in the 1-2 years olds and during the first half of the years (January to June. Complication developed in 50 (26.5% children. The most frequent was diarrohea (14.3% followed by respiratory infection (6.9%. No case fatality was reported.
Ali Khaji; Mousa Zargar; Mojgan Karbakhsh
Objective: Although long bone fracture in children is not life-threatening, it may cause major disability, loss of working days and severe psychological distress. We conducted this study to determine the pattern of extremity fracture due to trauma in children.Methods: During one year in six general hospitals in Tehran, trauma patients who were hospitalized for more than 24 hours and sustained injuries within seven days before admission were included in the study. The records of children (≤16 years old) hospitalized in six general hospitals in Tehran due to trauma were reviewed prospectively.Results: During the study period, 1274 children had sustained extremity fractures. Male to female ratio was 3.6/1, with the mean age of (10.3±4.2) years. Falls and traffic crashes were the main causes of injuries, with the percentages of 57.3% and 37.1%, respectively. Simple fall (falling on the ground) consisted 60% of patients that sustained fall-related injuries. Pedestrians and bicycle riders comprised most of the cases that were injured due to traffic crashes. Of our cases, 56.8% sustained fractures in the upper extremities and 43.2% in the lower extremities. Forearm was the most common fracture site (34.1%). Comparing our results in preschool and school-age children, falls were the main cause of injuries in both groups, but fractures of lower extremities were significantly more common in preschool children.Conclusions:Improvement of physical condition of sidewalks and crossings in roads will be necessary for prevention of injuries. More attention to safety of home environment should be paid for control of preschools' injury at home. Education of children and adults is necessary to reduce injuries resulting from road traffic crashes.
de Lima, Regina Aparecida Garcia; Azevedo, Eliete Farias; Nascimento, Lucila Castanheira; Rocha, Semiramis Melani Melo
Hospitalization can be a very traumatic experience for children and their family members. The purpose of this study was to explore the experience of using clown theater art in the care for hospitalized children, starting with an activity developed by undergraduate students in the healthcare area. Data were obtained by observing 20 children and 11 students, characters in the clown theater interacting in the pediatric clinic in a school hospital in the state of São Paulo. The empirical data were analyzed with the thematic content analysis, which were grouped around the following themes: artistic expressions as a form of communication, participation of the binomial child and accompanying partner, and the clown as a therapeutic resource. The results show that this experience was a concrete intervention, emphasizing the children's development process, since it opens up a space for fantasy, laughter, happiness and the appropriation of the hospital routine; it is an example of widening the diagnostic and therapeutic process with the incorporation of intervention focusing on the affective, emotional and cultural necessities of the child and the family, in the search for non-traumatic care.
Grineski, Sara E.
Asthma is the number one chronic health condition facing children today; however, little is known about rural-urban inequalities in asthma. This "area effects on health" study examines rural-urban differences in childhood asthma hospitalizations within the state of Texas using negative binomial regression models. Effects associated with…
Grineski, Sara E.
Asthma is the number one chronic health condition facing children today; however, little is known about rural-urban inequalities in asthma. This "area effects on health" study examines rural-urban differences in childhood asthma hospitalizations within the state of Texas using negative binomial regression models. Effects associated with…
Alonso-Floriano, F. J.; Cortés-Contreras, M.; Pereira, V.
Atachi is an educational project aimed to disclose the Astronomy among hospitalized children between 3 and 16 years old, who remain for short and long periods in the Niño Jesús and 12 de Octubre hospitals of Madrid. With the financial support of the Sociedad Española de Astronomía (SEA) and the help provided by the hospitals, we have introduced Astronomy activities in the educational projects of the hospitals with workshops adapted to the ages and capabilities of the hospitalized children. These workshops have been very welcome from the staff of each center and from the parents, who also showed interest and participated in the activities. But above all, from the children, who tried to take apart their illness and showed great interest and curiosity about Astronomy, which helped to power their imagination and to learn more about our Solar System, the Milky Way and the Universe. On the other hand, this project led to a publication in the ``Astronomía" review, which enhances the divulgation interest of this project, which corresponds to the very positive experience that has resulted for us.
Menezes, Marina; Moré, Carmen Leontina Ojeda Ocampo; Barros, Luísa
To identify and analyze the significant networks of family, social and hospital support described by the family caregivers of hospitalized children 5-12 years during the hospital stay. Descriptive study, exploratory and qualitative study conducted with 20 caregivers of children hospitalized in a hospital in a city in southern Brazil, through semi-structured interviews and significant social networks maps, tailored to the hospital setting. Data analysis showed that the most active social network was comprised of families through emotional support, material aid and services. Relations with hospital health care team and the hospital context were cited as providing support to the caregivers of the hospitalized child. The identification of social networks in the child's hospitalization course enables equip professionals working in the institution aiming at better targeting of actions and care for the family and hospitalized children. Identificar e analisar as redes significativas de suporte familiar, social e hospitalar descritas pelos familiares acompanhantes de crianças hospitalizadas de 5 a 12 anos, durante o período de internação. Estudo descritivo, exploratório e de cunho qualitativo realizado com 20 acompanhantes de crianças hospitalizadas em uma unidade hospitalar em uma cidade do Sul do Brasil, por meio de entrevistas semiestruturadas e dos Mapas de Redes sociais significativas, adaptado para o contexto hospitalar. A análise dos dados demonstrou que a rede social mais atuante foi composta por familiares, através de apoio emocional, ajuda material e de serviços. As relações com a equipe de saúde do hospital e com o contexto hospitalar foram citadas como capazes de fornecer apoio ao acompanhante da criança internada. a identificação das redes sociais no curso da hospitalização da criança possibilita instrumentalizar os profissionais que atuam na instituição objetivando um melhor direcionamento de ações e cuidados destinados à família e a
Keywords: primary male caregivers, Afrikaans, child language skills. 1. ... Children with involved fathers have better cognitive, social and motor .... the child at the time of questionnaire completion, marital status, highest school grade.
Obesity and overweight in South African primary school children - the Health of the ... sampling of schools within each provincial and socio-economic category. ... height (m)2) was calculated for each grouping (age x gender x ethnic group).
Melton, Gary B
Hospitality is an ancient moral practice that was deeply embedded in early Judaism, Christianity, and Islam. Hospitality requires acceptance of, service to, and respect for people who lack a place in the community. The contemporary importance of this practice reflects the social disconnection and economic disadvantage of many young parents and the high frequency of separation of young people, including many young parents, from their communities. Such social deterioration substantially increases the risk of child maltreatment. Building on the proposals of the U.S. Advisory Board on Child Abuse and Neglect, Strong Communities for Children demonstrated the effectiveness of community building in reducing such risk. It further suggested the importance of both relying on and learning from hospitable people in strengthening support for children and their parents.
Tang, Y; Wang, L X; Chen, J J; Liu, J Q; Ren, L C; Liu, X S; Yin, M F; Zhang, D X; Huang, Y S; Zhang, J P
Objective: To analyze the epidemiological characteristics of hospitalized children with severe burn from several regions in China during 3 years, so as to provide evidence for prevention of burns in children. Methods: Relying on the entry system of epidemiology data and biological sample of severe burn from multicenter in clinic, medical records of children with severe burn, aged 18 and under, hospitalized in 6 burn wards from February 2012 to February 2015 were collected. The children were divided into 5 age brackets: less than or equal to 1 year old, more than 1 year old and less than or equal to 3 years old, more than 3 years old and less than or equal to 6 years old, more than 6 years old and less than or equal to 12 years old, more than 12 years old and less than or equal to 18 years old. Meanwhile the children were divided into rural and urban children according to their residences. Data of gender and residence of children in the 5 age brackets, cause of injury, location of injury, total burn area, wound site, inhalation injury and combined injury, and source of hospitalization expenses of children in the 5 age brackets and two types of residence, and outcome and length of hospital stay of the children were analyzed. The cause of injury of children in different location of injury was analyzed. In addition, they were divided into 2 age brackets: less than or equal to 6 years old and more than 6 years old and less than or equal to 18 years old, and then incidences of hand and foot burn injury were compared. Data were processed with chi-square test, and the correlation between age and total burn area was processed with Spearman correlation analysis. Results: Four hundred and forty out of 1 106 inpatients with severe burn were children, accounting for 39.8% who were included in the system. (1) The majority of children were male (270, 61.4%). The number of children more than 1 year old and less than or equal to 3 years old ranked the first (222, 50.5%) in the 5
Full Text Available Purpose: This article reviews the impact of successive experiments in the development of primary care organisations in England and assesses the long-term importance of English primary care groups for the integration of health and community and health and social care and the deinstitutionalisation of hospital care. Theory: Governments in a number of Western countries are attempting to improve the efficiency, appropriateness and equity of their health systems. One of the main ways of doing this is to devolve provision and commissioning responsibility from national and regional organisations to more local agencies based in primary care. Such primary care organisations are allocated budgets that span both primary and secondary (hospital services and also, potentially, social care. Method: This article is based on a systematic review of the literature forthcoming from the UK Government's Department of Health-funded evaluations of successive primary care organisational developments. These include total purchasing pilots, GP commissioning group pilots, personal medical services pilots and primary care groups and trusts. Results: Primary care organisations in England have proved to be a catalyst in facilitating the development of integrated care working between primary and community health services. Conversely, primary care organisations have proved less effective in promoting integration between health and social care agencies where most progress has been made at the strategic commissioning level. The development of primary care trusts in England is heralding an end to traditional community hospitals. Conclusions: The development of primary care groups in England are but an intermediate step of a policy progression towards future primary care-based organisations that will functionally integrate primary and community health services with local authority services under a single management umbrella.
Yamashita, F; Urabe, D; Ito, H; Kondo, S; Hanawa, Y
The experience gained during 7 years of cooperation between the Japan International Cooperation Agency (JICA) and the Islamabad Children's Hospital (JICA-ICH project, July 1986-June 1993) is described. Islamabad Children's Hospital achieved the goals of the project and became a centre for excellence in health care, education and research for children, fulfilling the objectives of the project. This achievement was evaluated as one of the most successful projects in medical cooperation ever performed by JICA by a third party evaluation team. The problems arising and the lessons experienced through the process are discussed. The importance of the role which should be undertaken by pediatricians in international cooperation with developing countries is emphasized.
Warrack, Simone; Duster, Megan; Van Hoof, Sarah; Schmitz, Michelle; Safdar, Nasia
Clostridium difficile infection (CDI) is the most frequent infectious cause of health care-associated diarrhea. Three cases of CDI, in children age 2, 3, and 14 years, occurred in the hematology/oncology ward of our children's hospital over 48 hours. We aimed to assess environmental contamination with C difficile in the shared areas of this unit, and to determine whether person-to-person transmission occurred. C difficile was recovered from 5 of 18 samples (28%). We compared C difficile isolated from each patient and the environment using pulsed-field gel electrophoresis, and found that none of the patient strains matched any of the others, and that none matched any strains recovered from the environment, suggesting that person-to-person transmission had not occurred. We found that C difficile was prevalent in the environment throughout shared areas of the children's hospital unit. Molecular typing to identify mechanisms of transmission is useful for devising appropriate interventions.
Full Text Available Abstract Background Characterization of severe malaria cases on arrival to hospital may lead to early recognition and improved management. Minimum community based-incidence rates (MCBIRs complement hospital data, describing the malaria burden in the community. Methods A retrospective analysis of all admitted malaria cases to a Mozambican rural hospital between June 2003 and May 2005 was conducted. Prevalence and case fatality rates (CFR for each sign and symptom were calculated. Logistic regression was used to identify variables which were independent risk factors for death. MCBIRs for malaria and severe malaria were calculated using data from the Demographic Surveillance System. Results Almost half of the 8,311 patients admitted during the study period had malaria and 13,2% had severe malaria. Children under two years accounted for almost 60% of all malaria cases. CFR for malaria was 1.6% and for severe malaria 4.4%. Almost 19% of all paediatric hospital deaths were due to malaria. Prostration (55.0%, respiratory distress (41.1% and severe anaemia (17.3% were the most prevalent signs among severe malaria cases. Severe anaemia and inability to look for mother's breast were independent risk factors for death in infants younger than eight months. For children aged eight months to four years, the risk factors were malnutrition, hypoglycaemia, chest indrawing, inability to sit and a history of vomiting. MCBIRs for severe malaria cases were highest in children aged six months to two years of age. MCBIRs for severe malaria per 1,000 child years at risk for the whole study period were 27 in infants, 23 in children aged 1 to Conclusion Malaria remains the number one cause of admission in this area of rural Mozambique, predominantly affecting young children, which are also at higher risk of dying. Measures envisaged to protect children during their first two years of life are likely to have a greater impact than at any other age.
Bassat, Quique; Guinovart, Caterina; Sigaúque, Betuel; Aide, Pedro; Sacarlal, Jahit; Nhampossa, Tacilta; Bardají, Azucena; Nhacolo, Ariel; Macete, Eusébio; Mandomando, Inácio; Aponte, John J; Menéndez, Clara; Alonso, Pedro L
Characterization of severe malaria cases on arrival to hospital may lead to early recognition and improved management. Minimum community based-incidence rates (MCBIRs) complement hospital data, describing the malaria burden in the community. A retrospective analysis of all admitted malaria cases to a Mozambican rural hospital between June 2003 and May 2005 was conducted. Prevalence and case fatality rates (CFR) for each sign and symptom were calculated. Logistic regression was used to identify variables which were independent risk factors for death. MCBIRs for malaria and severe malaria were calculated using data from the Demographic Surveillance System. Almost half of the 8,311 patients admitted during the study period had malaria and 13,2% had severe malaria. Children under two years accounted for almost 60% of all malaria cases. CFR for malaria was 1.6% and for severe malaria 4.4%. Almost 19% of all paediatric hospital deaths were due to malaria. Prostration (55.0%), respiratory distress (41.1%) and severe anaemia (17.3%) were the most prevalent signs among severe malaria cases. Severe anaemia and inability to look for mother's breast were independent risk factors for death in infants younger than eight months. For children aged eight months to four years, the risk factors were malnutrition, hypoglycaemia, chest indrawing, inability to sit and a history of vomiting.MCBIRs for severe malaria cases were highest in children aged six months to two years of age. MCBIRs for severe malaria per 1,000 child years at risk for the whole study period were 27 in infants, 23 in children aged 1 to or =5 years. Malaria remains the number one cause of admission in this area of rural Mozambique, predominantly affecting young children, which are also at higher risk of dying. Measures envisaged to protect children during their first two years of life are likely to have a greater impact than at any other age.
This article discusses the strategy repertoires and strategy development of six English children who learned foreign languages at primary school. My study differs from mainstream research, in that it focuses on young children and on the development of their strategies, draws on sociocultural theory and uses ethnographic methods. My findings show…
This article discusses the strategy repertoires and strategy development of six English children who learned foreign languages at primary school. My study differs from mainstream research, in that it focuses on young children and on the development of their strategies, draws on sociocultural theory and uses ethnographic methods. My findings show…
Pollyanna Kássia de Oliveira Borges
Full Text Available Objective: to check the profile of sensitive causes hospitalizations for primary care. Methods: this is an ecological, epidemiological study. Data was collected in the Hospital Information System at the Department of Health System Information, grouped according to the admissions list for Sensitive to Primary Causes of Health System. Results: there were 227,014 hospitalizations, 25.8% of them were sensitive to Primary care. The illnesses which caused sensitive admissions were pneumonia (n=19,832; 33.7%, heart failure (n=6,688, 11.3%, and gastroenteritis (n=6,287, 10.7%. Conclusion: sensitive hospitalizations for primary care have decreasing historical trend in the study area. Primary care services, with guidelines and principles, well conducted could minimize the risk of exacerbation of chronic conditions and also endorse lower rates of infection transmitted diseases.
Full Text Available Objective:The term "Ataxia" refers to disturbances of body posture and movementthat are normally controlled by the cerebellum, frontal lobes and theposterior columns of the spinal cord. The primary symptom and themost prominent feature of ataxia is abnormal gait which is characterizedby lurching and wide base walking.Ataxia was considered acute, if it had occurred within the two precedingweeks. Knowing how frightening acute-onset Ataxia is for the familyis not surprising that the condition prompts an immediate visit to thephysician.Material & Methods:In view of the lack of information in our country, on the etiology ofsudden-onset Ataxia, the authors enrolled 100 children with the chiefcomplaint of acute loss of equilibrium, who came to the attention ofthe Pediatric Neurology Department over a two year duration(Sept.2001-Sept 2003; they were admitted to the Mofid Childrens'Hospital and all necessary investigations were carried out.Results & Conclusion:The results revealed that Acute Cerebellar Ataxia was the most commoncause of the problem, the second most frequent being drug intoxication,which most commonly occurred in patients, 2-4years old. The remainingcausative factors in order of descending frequency consisted ofinfectious polyneuropathy, migraine, opsoclonus-myoclonus, braintumor, acute disseminated encephalomyelitis, multiple sclerosis, andepilepsy.
Mihić, Josip; Rotim, Kresimir; Bitunjac, Milan; Samardzic, Josip; Sapina, Lidija
Traumatic brain injury (TBI) is the most common cause of acquired disability and death in children. Retrospective analysis showed 350 children, 128 (36.6%) girls and 222 (63.4%) boys who were hospitalized for injury of neurocranium in a 5 year-period in Dr. Josip Bencević General Hospital in Slavonski Brod. Most of them had both contusion and commotion (46.8%), followed by just contusion of the head (12.5%) and fractures of the skull (10.5%). The haemorrhages and hemathomas were less common (epidural, subdural, SAH) (3.2%). The procedures performed showed that in almost all children X-rays had been performed (99.7%). The most commonly X-rays performed were those of the head (craniogram) and/or cervical spine, followed by CT, EEG, ultrasound and NMR. The occurence of complications was recorded in only 2% of injured children (seizure, syncopa, febrile convulsions). Analysis of treatment methods showed that in most children (89.6%) therapy was conservative. The injured children were hospitalizated mostly for 2 days (34.5%) or 3 days (32.5%), while longer hospitalization was less common. Regarding extra consultation of other specialists (besides neurosurgeons), the most commonly consulted were pediatrician, surgeon/traumatologist, specialist of ENT/maxilofacial surgery, neuropediatrician, pediatric surgeon, ophthalmologist and others. It can be said that the prognosis of TBI in children depends on the age, neurological status and kind of injury, and on the quality of care, which involves availability of neurosurgeons and other specialists.
Ana Paula do Rego
Full Text Available This qualitative research aimed at identifying the knowledge of the mothers regarding diarrhea. It was conducted with eight mothers of hospitalized children in a university hospital located in Santa Cruz, Rio Grande do Norte, Brazil, in 2012. Data were collected through open interviews and the analysis was based on Bardin. The categories emerging from the analysis were: understanding diarrhea and preventing/treating diarrhea. Regarding the understanding of diarrhea, mothers conceptualize and understand it from the symptoms, habits/eating mistakes and/or cultural beliefs. Concerning the prevention and treatment of the disease, the mothers highlight hygiene and home cleaning as preventive measures, as well the importance of home and hospital care measures. The interviewees have basic knowledge of pathology, further studies are necessary in order to define the current gap between the knowledge of mothers and recurrence of diarrhea cases, resulting in hospitalization and expenses with unnecessary treatment.
Kenny, David J.; Judd, Peter L.
Developmental disabilities and chronic illness can impact the oral health of children in the preeruptive and primary dentition stages. The article covers prevention and management of dental caries; gingival changes; trauma to the primary dentition; sucking, swallowing, and mastication; extraorally fed patients; and factitial injuries. Home-care…
The aim of the present study was to achieve a theoretical understanding of several different-age children's experiences of magic relations with hospital clowns in the context of medical care, and to do so using psychological theory and a child perspective. The method used was qualitative and focused on nine children. The results showed that age was important to consider in better understanding how the children experienced the relation with the hospital clowns, how they described the magical aspects of the encounter and how they viewed the importance of clown encounters to their own well-being. The present theoretical interpretation characterized the encounter with hospital clowns as a magical safe area, an intermediate area between fantasy and reality. The discussion presented a line of reasoning concerning a magical attachment between the child and the hospital clowns, stating that this attachment: a) comprised a temporary relation; b) gave anonymity; c) entailed reversed roles; and d) created an emotional experience of boundary-transcending opportunities. PMID:22371813
Full Text Available The aim of the present study was to achieve a theoretical understanding of several different-age children's experiences of magic relations with hospital clowns in the context of medical care, and to do so using psychological theory and a child perspective. The method used was qualitative and focused on nine children. The results showed that age was important to consider in better understanding how the children experienced the relation with the hospital clowns, how they described the magical aspects of the encounter and how they viewed the importance of clown encounters to their own well-being. The present theoretical interpretation characterized the encounter with hospital clowns as a magical safe area, an intermediate area between fantasy and reality. The discussion presented a line of reasoning concerning a magical attachment between the child and the hospital clowns, stating that this attachment: a comprised a temporary relation; b gave anonymity; c entailed reversed roles; and d created an emotional experience of boundary-transcending opportunities.
XUN Yi-wen; YANG Jin-gang; SONG Li; SUN Yi-hong; LU Chang-lin; YANG Yue-jin; HU Da-yi
Background Evidence indicates that early reperfusion therapy in patients with ST-elevation myocardial infarction (STEMI) reduces complications. This study was undertaken to compare the in-hospital delay to primary percutaneous coronary intervention (PPCI) for patients with STEMI between specialized hospitals and non-specialized hospitals in Beijing, China. Methods Two specialized hospitals and fifteen non-specialized hospitals capable of performing PPCI were selected to participate in this study. A total of 308 patients, within 12 hours of the onset of symptoms and undergoing PPCI between November 1, 2005 and December 31, 2006 were enrolled. Data were collected by structured interview and review of medical records.Results The median in-hospital delay was 98 (interquartile range 105 to 180) minutes, and 16.9% of the patients were treated within 90 minutes. Total in-hospital delay and ECG-to-treatment decision-making time were longer in the non-specialized hospitals than in the cardiac specialized hospitals (147 minutes vs. 120 minutes, P<0.001; 55 minutes vs. 45 minutes, P=0.035). After controlling the confounding factors, the non-specialized hospitals were independently associated with an increased risk of being in the upper median of in-hospital delays.Conclusions There were substantial in-hospital delays between arrival at the hospital and the administration of PPCI for patients with STEMI in Beijing. Patients admitted to the cardiac specialized hospitals had a shorter in-hospital delay than those to the non-specialized hospitals because of a shorter time of ECG-to-treatment decision-making.
Full Text Available Objective: To analyze whether the patients with severe infections, admitted in the Pediatric Intensive Care Unit of the Hospital de Clínicas of the Universidade Federal de Uberlândia, underwent the active screening for primary immunodeficiencies (PID. Methods: Retrospective study that assessed the data records of patients with any severe infections admitted in the Pediatric Intensive Care Unit, covering a period from January 2011 to January 2012, in order to confirm if they performed an initial investigation for PID with blood count and immunoglobulin dosage. Results: In the studied period, 53 children were hospitalized with severe infections in the Pediatric Intensive Care Unit, and only in seven (13.2% the initial investigation of PID was performed. Among these patients, 3/7 (42.8% showed quantitative alterations in immunoglobulin G (IgG levels, 1/7 (14.3% had the diagnosis of cyclic neutropenia, and 1/7 (14.3% presented thrombocytopenia and a final diagnosis of Wiskott-Aldrich syndrome. Therefore, the PID diagnosis was confirmed in 5/7 (71.4% of the patients. Conclusions: The investigation of PID in patients with severe infections has not been routinely performed in the Pediatric Intensive Care Unit. Our findings suggest the necessity of performing PID investigation in this group of patients.
Full Text Available BACKGROUND: Skin disorders are a major cause of morbidity in children. Skin diseases can affect the quality of life of children t o a great extent and can hinder their normal growth and development. AIMS: This study was done with the objective of assessing the frequency and clinical spectrum of primary skin disorders in children less than 10 yrs at ESI model hospital, a tertiary care hospital catering to the working community insured under ESI scheme. METHODS: T his was a prospective study of 1 year duration. All children less than 10 yr of age presenting to our hospital were screened for skin disorders. Diagnosis was made clinically in all cases. RESULTS: A total of 282 children were found to have primary skin lesions. The frequency of primary skin disorders was found to be 5.75%. There was male preponderance (54%. Maximum Cases were seen in 0 to 5 yr age group (50%. 63% of cases were seen in children from families with income< 5000 per month. Infections and infestations was the commonest condition seen in 33.94% cases of which 48.6% were pyodermas, 21.6% were fungal infections, 10.8% were viral infections and 18.9 % were scabies. Next commonest condition was atopic dermatitis at 13.76% followed by pityriasis alba at 8.25% and insect bite reaction at 5.8%. CONCLUSIONS : A low frequency of skin disorders was seen in this population group. Males in the age group of less than 5 years had th e maximum incidence. Lower income group had a greater incidence. Infections and infestations were more common than allergic skin conditions
Ince, Elif E.; Rubin, David; Christian, Cindy W.
Objective: To determine whether a suspicion or diagnosis of child abuse during hospitalization influences parental perceptions of hospital care in families of children admitted with traumatic injuries. Method: Parents of children younger than 6 years of age admitted with traumatic injuries to a large urban children's hospital were recruited to…
Full Text Available Abstract Background & Aim: Rotavirus infection is the most common cause of dehydrating and gastroenteritis among children worldwide. . The aim of this study was to determine the prevalence of rotavirus in children hospitalized with acute gastroenteritis in Imam Sajjad Hospital of Yasuj. Methods: This cross sectional – descriptive study was done on 184 stool samples of children younger than 7 years of age hospitalized at Imam Sajjad hospital of Yasuj in 2011 due to acute gastroenteritis. All samples were routinely analyzed for detection of rotavirus by Enzyme Immunoassay (EIA test. Data was analyzed by SPSS version 16, Chi-square test and Fisher's exact test. Results: Of the 184 samples analyzed, 52(28.26% were positive.The Results showed significant relationship between the seasonal distribution and virus detection (p=0/001. The highest incidence of rotavirus was seen in autumn with frequency of (48.08% and the lowest in spring (5.77%. Conclusions: According to high prevalence of rotavirus infection, continual surveillance is necessary to provide useful data for formulating effective vaccines and perform diarrhea prevention programs. Key words: Rotavirus, Gastroenteritis, Prevalence, Elisa
Pardo-Seco, Jacobo; Gómez-Carballa, Alberto; Martinón-Torres, Nazareth; Martinón-Sánchez, José María; Justicia-Grande, Antonio; Rivero-Calle, Irene; Pinnock, Elli; Salas, Antonio; Fink, Colin
Background The risk of bacteremia is considered low in children with acute bronchiolitis. However the rate of occult bacteremia in infants with RSV infection is not well established. The aim was to determine the actual rate and predictive factors of bacteremia in children admitted to hospital due to confirmed RSV acute respiratory illness (ARI), using both conventional culture and molecular techniques. Methods A prospective multicenter study (GENDRES-network) was conducted between 2011–2013 in children under the age of two admitted to hospital because of an ARI. Among those RSV-positive, bacterial presence in blood was assessed using PCR for Meningococcus, Streptococcus pneumoniae, Haemophilus influenzae, Streptococcus pyogenes, Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, and Staphylococcus aureus, in addition to conventional cultures. Results 66 children with positive RSV respiratory illness were included. In 10.6% patients, bacterial presence was detected: H. influenzae (n = 4) and S. pneumoniae (n = 2). In those patients with bacteremia, there was a previous suspicion of bacterial superinfection and had received empirical antibiotic treatment 6 out of 7 (85.7%) patients. There were significant differences in terms of severity between children with positive bacterial PCR and those with negative results: PICU admission (100% vs. 50%, P-value = 0.015); respiratory support necessity (100% vs. 18.6%, P-value < 0.001); Wood-Downes score (mean = 8.7 vs. 4.8 points, P-value < 0.001); GENVIP scale (mean = 17 vs. 10.1, P-value < 0.001); and length of hospitalization (mean = 12.1 vs. 7.5 days, P-value = 0.007). Conclusion Bacteremia is not frequent in infants hospitalized with RSV respiratory infection, however, it should be considered in the most severe cases. PMID:26872131
Full Text Available In special education and rehabilitation a large number of implemented researches on physical and motor development of children with disabilities have been targeted in comparison to development of standards for children with normal development. It is evident that the overall physical and motor development of children with disabilities is unfolding in various pace and it is achieving a different level compared to children with normal development. The theory and practice of special education and rehabilitation takes into account the specifics of the rhythm of physical development, that is predisposed to the biological development plans (regulated by internal factors, but differences in the pace and level of development of children with disabilities require a special research approach, interpretation and application of the results obtained. It is necessary to explain the specifics of the physical and motor development and the impact of sensory, cognitive and motor development disorders on physical growth and motor development among people of different calendar age and its results to be linked to programs for education and rehabilitation.
Full Text Available Attention deficit hyperactivity disorder (ADHD is one of the most common childhood neurological disorders. The aim of this study was to investigate ADHD in children with primary monosymptomatic nocturnal enuresis (PMNE and compare it with healthy children. A total of 100 five to 16-year-old children with PMNE and 100 healthy children without NE were included in this case-control study as the cases and control groups, respectively. Subjects were selected from children who were referred to the pediatric clinic of the Amir Kabir Hospital of Arak, Iran, based on inclusion and exclusion criteria. ADHD was diagnosed by Conner′s Parent Rating Scale-48 and the Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria and was confirmed by consultation with a psychiatrist. Data were analyzed by binomial test using SPSS18. ADHD inattentive type was observed in 16 cases (16% with PMNE and five controls (5% (P = 0.01. Despite these significant differences in the case and control groups, 25 (25% and 16 (16% children were affected by ADHD hyperactive-impulsive type (P = 0.08 and 15 (15% and 16 (16% children were affected by ADHD mixed type (P = 0.84, respectively. ADHD inattentive type in children with PMNE was significantly more common than that in healthy children. The observed correlation between ADHD inattentive type and PMNE makes psychological counseling mandatory in children with PMNE.
Tayebeh HASAN TEHRANI
Full Text Available How to cite this article: Hasan Tehrani T, Haghighi M, Bazmamoun H. Effects of Stress on Mothers of Hospitalized Children in a Hospital in Iran. Iran J Child Neurol Autumn 2012;6(4:39-45.Abstract Objective Hospitalization of a child can cause severe anxiety and stress in the parents, especially for the mother. This stress consequently affects the treatment course of the child. Hereby, we investigate the impact of different stressors in mothers of hospitalized children. Materials & Methods In this cross-sectional study, 225 mothers of hospitalized children in the pediatric ward of Besat hospital were randomly selected and studied. Data collection tool was a two-part questionnaire gathered by interviewing the mother. The first part included demographic information of the patients. The second part included questions regarding stressors in four different categories; child-related factors, environmental factors, socioeconomic factors and health professional factors. SPSS 16.5 was used for statistical analysis and data were analyzed by one way ANOVA and T test. Results In the child-related factor category, fear of child death (84%; in the socioeconomic factor category, fear of disease in the other siblings (84%; in the environmental factor category, unpleasant odors in the ward (56%; and in the health professional category, not enough explanation about inserting IV lines, (54.2% constituted the most important factors. There was a meaningful correlation between the stressors and the mothers’ age and occupation, child age, days of hospitalization, types of admission and health insurance coverage, but there was no meaningful correlation between stressors and other factors. Conclusion Professional and in depth training programs should be provided for health care providers and nursing staff regarding dealing with mothers of hospitalized children. References: Marilyn JH, David W. Wong's essentials of pediatric nursing. 8th ed. Canada: Mosby; 2008. p. 659
Cartwright, J D; Jukes, C; Wilson, A; Xaba, D
A survey of the prevalence and types of learning disorders among Black primary school children was undertaken on the East Rand. Class teachers were given a questionnaire and asked to identify the number of children in their class with learning problems and the number of those with specific disabilities such as poor eyesight or hearing, epilepsy, physical handicaps or mental retardation. There were 7516 children in the classes surveyed; 1692 (22,4%) of them were identified by their teachers as having learning problems, while 666 (8,7%) had a physical or mental handicap. The prevalence and present status of children with learning disability need to be defined before plans to improve their education can be established. Our data show that at present classes are large and the prevalence of children with learning problems is high. Improving teachers' skills and reducing the number of children per class might improve the education of children with learning problems.
Munns, Ailsa; Shields, Linda
There has been little research into Australian Indigenous families' use of a tertiary paediatric hospital in Western Australia. Scrutiny of existing scientific literature and the reports of government and non-governmental organisations from 1995 onwards did not identify clear referral pathways, health-seeking behaviours or preferences of Indigenous families for a culturally safe hospital model. Family-centred care requires an understanding of how Indigenous children and families arrive at a health service, and the cultural and practical implications of large distances and of leaving other family members behind.
Hospital & Research Center Oakland Clinical Guidelines for Hemodynamic Support of Neonates and Children with Severe Sepsis and Septic Shock. Hypothesis...in part by the CHRCO Neonatal Pediatric Research Group. The terms of this arrangement have been...INVESTIGATOR: Heidi R Flori MD, FAAP CONTRACTING ORGANIZATION: Children’s Hospital and Research Center Oakland Oakland, CA 94609 REPORT DATE: December
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.
Tayebeh HASAN TEHRANI
Full Text Available AbstractObjectiveHospitalization of a child can cause severe anxiety and stress in the parents, especially for the mother. This stress consequently affects the treatment course of the child. Hereby, we investigate the impact of different stressors in mothers of hospitalized children.Materials & MethodsIn this cross-sectional study, 225 mothers of hospitalized children in the pediatric ward of Besat hospital were randomly selected and studied. Data collection tool was a two-part questionnaire gathered by interviewing the mother. The first part included demographic information of the patients. The second part included questions regarding stressors in four different categories; child-related factors, environmental factors, socioeconomic factors and health professional factors. SPSS 16.5 was used for statistical analysis and data were analyzed by one way ANOVA and T test.ResultsIn the child-related factor category, fear of child death (84%; in the socioeconomic factor category, fear of disease in the other siblings (84%; in the environmental factor category, unpleasant odors in the ward (56%; and in the health professional category, not enough explanation about inserting IV lines, (54.2% constituted the most important factors.There was a meaningful correlation between the stressors and the mothers’ age and occupation, child age, days of hospitalization, types of admission and health insurance coverage, but there was no meaningful correlation between stressors and other factors.ConclusionProfessional and in depth training programs should be provided for health care providers and nursing staff regarding dealing with mothers of hospitalized children.
Bian, X; Zhu, Z J; Wang, Y
Objective: To investigate epidemiological characteristics of hospitalized children with burn injury in the author's affiliation, so as to provide theoretical basis for developing prevention strategies of children with burn injury. Methods: Medical records of 384 and 596 hospitalized children with burn injury, aged 0 to 12-year-old, were collected respectively from January 2001 to December 2005 and January 2011 to December 2015. Percentage of children with burn injury to total hospitalized patients with burn injury in the same period of time, age, causes of injury, gender, injury month, residence, condition of first aid measures conforming to medical standard, time of admission post injury, burn degree, and operation condition of children with burn injury were analyzed. Data were processed with Mann-Whitney U test and Chi-square test. Results: From January 2001 to December 2005 and January 2011 to December 2015, percentages of children with burn injury to total hospitalized patients with burn injury in the same period of time were respectively 23.6% (384/1 626) and 25.4% (596/2 346) , with no statistically significant difference (χ(2)=1.653, P>0.05). Age of all children with burn injury was 1.0 (1.0, 2.0) year old from January 2011 to December 2015, obviously lower than that from January 2001 to December 2005[1.0 (1.0, 3.0) year old, Z=-3.257, Pburn caused by hot liquid and electrical burn from January 2011 to December 2015 were obviously lower than those from January 2001 to December 2005 (with Z values respectively -4.248 and -2.040, Pburn caused by flame from January 2011 to December 2015 increased, with no statistically significant difference (Z=1.852, P>0.05). There was no statistically significant difference in gender of children with burn injury between the two periods of time (χ(2)=1.374, P>0.05). Burn injury of children in the two periods of time mainly occurred in Spring, and season of burn injury between the two periods of time was similar (χ(2
Hansson, Eva Helena; Kjaergaard, Hanne; Johansen, Christoffer
BACKGROUND: To assess the feasibility and psychosocial impact of a hospital-based home care (HBHC) program for children with cancer. PROCEDURE: A HBHC program was carried out with 51 children (0-18 years) with cancer to assess its feasibility in terms of satisfaction, care preferences, safety, an...... and the psychosocial burden on the family does not increase. Pediatr Blood Cancer © 2013 Wiley Periodicals, Inc.......BACKGROUND: To assess the feasibility and psychosocial impact of a hospital-based home care (HBHC) program for children with cancer. PROCEDURE: A HBHC program was carried out with 51 children (0-18 years) with cancer to assess its feasibility in terms of satisfaction, care preferences, safety......, and cost. A controlled trial was conducted to assess children's health-related quality of life (HRQOL) using the parent-reported and self-reported PedsQL Generic Core Scale and PedsQL Cancer Module, and the psychosocial impact on the family by PedsQL Family Impact Module comprising a subsample of 28...
Moseholm, Ellen; Helleberg, Marie; Nordly, Sannie B;
: A nationwide register-based cohort study. METHODS: All HEU children born in Denmark from 2000 to 2012 were individually matched to five HIV-unexposed controls. Outcomes were risk of hospital admission (any, because of an infectious disease, observation/nonspecific diagnosis) and use of antibiotics during......OBJECTIVE:: The main objective of this study was, on a national level, to investigate the risk of in-hospital admissions and use of antibiotics during the first 4 years of life among HIV-exposed uninfected (HEU) children compared with a matched control group of HIV-unexposed children. DESIGN...... because of observation/nonspecific diagnosis [excess incidence rate 22.6 (95% CI 18.2-27.0), IRR 6.06 (95% CI 4.84-7.61)]. CONCLUSION: HEU children had an increased risk of overall hospital admission mainly due to an increased risk of admission because of observation/nonspecific diagnosis...
Gilgoff, I S; Helgren, J
Returning ventilator-dependent children to the home environment has become a well-accepted occurrence. The success of a home program depends on careful pre-discharge planning in order to ensure the child's medical safety, and adequate preparation to ensure the child's and family's adjustment to an active community life after discharge. To achieve this, involvement in community activities must begin while the child is still in hospital. As part of a complete rehabilitation program, nine ventilator-dependent children were taken on an inpatient outing to Disneyland. The planning and goals of the outing are described.
Arbus, G S; Sullivan, E K; Tejani, A
Length of hospital stay post-renal transplant was investigated in 2171 North American pediatric patients. Hospitalization for those surviving one year with a functioning graft was 28.8 versus 36.0 days (P < 0.05) for living donor (LD) compared with cadaveric donor (CAD) recipients during the first year post-transplant. Significantly prolonged hospital stays were recorded for LD recipients who (a) were less than one-year-old, (b) were receiving prophylactic ALG/OKT3, and (c) had a history of prior dialysis, and for CAD recipients who (a) were non-White and (b) received kidneys with cold ischemic times over 24 hours. In period II (2 to 6 months post-transplant), 51% and 68% of LD and CAD recipients, respectively were hospitalized while the corresponding values were 27% or 31% in period III (7 to 12 months post-transplant). Hospitalization was due mainly to graft loss or rejection episodes. Prolonged hospital stay coupled with poor graft survival might help to determine which aspects of the clinical practice of transplanting children warrant changes.
Hesselink, G.; Schoonhoven, L.; Barach, P.; Spijker, A.; Gademan, P.; Kalkman, C.; Liefers, J.; Vernooij-Dassen, M.J.F.J.; Wollersheim, H.
BACKGROUND: Evidence shows that suboptimum handovers at hospital discharge lead to increased rehospitalizations and decreased quality of health care. PURPOSE: To systematically review interventions that aim to improve patient discharge from hospital to primary care. DATA SOURCES: PubMed, CINAHL, Psy
Ting, Rudee; Tejpal, Ambika; Finken, Laura
BACKGROUND: In regional systems of ST-segment elevation myocardial infarction (STEMI) care, patients presenting to hospitals without percutaneous coronary intervention (PCI) are transferred to PCI-capable hospitals for primary PCI. Repatriation, a practice whereby such patients are transferred ba...
Ensing, Hendrik T; Koster, Ellen S; Stuijt, Clementine C M; van Dooren, Ad A; Bouvy, Marcel L
Bridging the gap between hospital and primary care is important as transition from one healthcare setting to another increases the risk on drug-related problems and consequent readmissions. To reduce those risks, pharmacist interventions during and after hospitalization have been frequently studied,
Johnson, Kelly; Griffin, Chris
Background: Healthcare is a stressful profession. The executives at Children's Hospital Colorado are well aware of the affects that caring for sick children and the pressure associated with it have on our entire staff. Understanding what compassion fatigue looks like as well as the importance of stress management and its role in overall wellness for each of our employees led to the interest and support of HeartMath/Caritas workshops. Methods: HeartMath/Caritas training transformed into a program to help staff connect with why they got into this profession and provides the tools to help staff members function in the immense stress they are faced with every day. Six-hour workshops are offered to every employee of Children's Hospital Colorado, supported and paid for by the wellness program in the human resource department. These trainings intentionally brought Caritas and HeartMath together with an understanding that the two programs match passion with science, trust with hope, and conviction with confidence. Results: Results illustrate the positive effect the workshops have had on staff. Both qualitative data, in the form of written feedback from participants, and quantitative results (Table) support the continued need for these workshops with more exposure to ensure all employees can attend. Table Quantitative Results of HeartMath/Caritas Workshops at The Children's Hospital, Aurora, Colorado Personal Quality: n = 64 % Pre-Workshop % Post-Workshop % Change My life is deeply fulfilling 56 70 14 Calm 29 45 16 Worried 39 22 17 Cynical 17 6 11 It's difficult for me to calm down after I've been upset 13 4 9 Rapid heartbeats 10 5 5=3ppl Muscle tension 33 23 10 Conclusion: Healthcare providers work in immense levels of stress. HeartMath/Caritas workshops are one way Children's Hospital Colorado supports its staff in dealing with compassion fatigue and burnout. The passion for sustaining this work comes from understanding how these programs have personally affected those
Bae, Donald S; Waters, Peter M
Orthopedic surgical simulation has become an increasing valuable means for optimizing patient care, promoting patient safety, improving education, and fostering clinical research. The purpose of this review was to discuss the rationale for simulation training, describe current simulation efforts within the Department of Orthopaedic Surgery at Boston Children's Hospital, and provide an example of how these simulation efforts touch both patient care and clinical research.
Matar, Amal Khourieh; Kerem, Nogah C; Srugo, Isaac; Genizi, Jacob
Primary headaches are one of the most common disorders of childhood, with migraine and tension type headaches (TTHs) being the most frequent ones. In spite of their prevalence, there is paucity of knowledge regarding the underlying pathophysiological mechanisms that cause headaches and regarding the unique aspects of headaches in children and adolescents. To review the literature and summarize the knowledge regarding clinical features, diagnosis and management of primary headache in children and adolescents, mainly migraine and TTH. Most of our current knowledge regarding primary headaches in children and adolescents is driven from extrapolations from studies that were conducted with adult patients. Therefore, it needs to be validated for the different age groups. Migraines may be diagnosed effectively based on the 2nd edition of the International Classification of Headache Disorders (ICHD-II), however, TTH is diagnosed mainly by the absence of features found in other headache types. Treatment strategies for primary headaches vary according to patient's age, family structure, culture and beliefs, headache diagnosis, and based on the disability the headache imposes on the patient's daily living. It was shown that a multidisciplinary approach, that includes continuing counseling, education, and reassurance, in combination with pharmacological and non-pharmacological treatment, is an effective strategy for children and adolescents suffering from primary headaches. Further studies are needed to enrich our knowledge about the pathophysiological mechanisms that cause headaches in children and adolescents and to develop efficient strategies to alleviate their burden.
Seeman, Tomáš; Pohl, Michael; Palyzova, Daniela; John, Ulrike
Microalbuminuria serves as an early marker of hypertension-related renal damage in adults. However, data on the prevalence of microalbuminuria in paediatric hypertensive patients in general and in children with white-coat hypertension (WCH) specifically are lacking. The aim of our study was to investigate the prevalence of microalbuminuria in children with primary hypertension (PH) and WCH, respectively. This was a retrospective case review of children with PH and WCH treated at three paediatric nephrology centres. Untreated children with either form of hypertension for whom measurements of urinary albumin excretion (UAE) had been performed were enrolled in the study. The study cohort comprised 52 children (39 boys) with hypertension (26 children with PH, 26 with WCH). Microalbuminuria (>3.2 mg/mmol creatinine) was present in 20% of children with PH and none of the children with WCH (p Children with PH had a higher median UAE than those with WCH (1.27 ± 1.92 vs. 0.66 ± 0.46 mg/mmol creatinine, p children with PH have an increased prevalence of microalbuminuria, while children with WCH show no signs of hypertension-related renal damage.
Corten, Lieselotte; Jelsma, Jennifer; Human, Anri; Rahim, Sameer; Morrow, Brenda M
Pneumonia is the most important respiratory problem in low-to-middle income countries. Airway clearance therapy continues to be used in children with pneumonia and secretion retention; however, there is lack of evidence to support or reject this treatment. This study aimed to investigate the feasibility of a randomized controlled trial (RCT) on the efficacy and safety of assisted autogenic drainage (AAD) compared to standard nursing care in children hospitalized with uncomplicated pneumonia. A single-blinded pilot RCT was conducted on 29 children (median age 3.5 months, IQR 1.5-9.4) hospitalized with uncomplicated pneumonia. The intervention group received standard nursing care with additional bi-daily AAD, for 10 to 30 min. The control group only received standard nursing care, unless otherwise deemed necessary by the physician or physiotherapist. The primary outcome measure was duration of hospitalization. The secondary outcome measures included days of fever and supplemental oxygen support; respiratory rate (RR) and heart rate adjusted for age; RR and oxygen saturation pre-, post-, and 1-hr post-treatment; oxygen saturation; adverse events; and mortality. No difference was found for duration of hospitalization (median 7.5 and 7.0 days for the control and intervention groups, respectively); however, Kaplan-Meier analysis revealed a strong tendency towards a shorter time to discharge in the intervention group (p = .06). No significant differences were found for the other outcome measures at time of discharge. No adverse events were reported. Within the intervention group, a significant reduction in RR adjusted for age was found. As no adverse events were reported, and AAD did not prolong hospitalization; AAD might be considered as safe and effective in young children with uncomplicated pneumonia. However, a larger multicentred RCT is warranted to determine the efficacy of AAD compared to standard nursing care. Copyright © 2017 John Wiley & Sons, Ltd.
Macias, Charles G; Mansbach, Jonathan M; Fisher, Erin S; Riederer, Mark; Piedra, Pedro A; Sullivan, Ashley F; Espinola, Janice A; Camargo, Carlos A
To determine the variability between hospitals in diagnostic testing and management interventions for children with bronchiolitis admitted to inpatient wards and identify its association with patient characteristics. A prospective, multicenter (16 hospitals), multiyear (2007-2010) observational study of children (age bronchiolitis. Outcomes included variability in diagnostic testing (complete blood count, chest radiographs) and medications or interventions (bronchodilator, systemic corticosteroid, antibiotic, IV placement) by hospital. A modified Respiratory Distress Severity Score was utilized to assess severity of illness. For all outcomes, intraclass correlation coefficient (ICC) was calculated from a model to estimate the random effects of hospital without added covariates and compared to ICCs from a second model that adjusted for demographic and clinical patient characteristics. A second unadjusted and adjusted model was created for age ≥ 2 months. Of 2207 subjects, 1715 were identified as admitted to inpatient wards. We observed wide variations in the proportion of patients who received diagnostic testing (complete blood count 21-75%, chest radiograph 36-85%) and medications/interventions (bronchodilators 19-91%, systemic corticosteroids 8-44%, antibiotics 17-43%, IV placement 38-93%). Adjusting for demographic and clinical patient characteristics did not materially affect the proportion of variability attributable to hospitals (differences in ICCs with and without model adjustment bronchiolitis treated on the inpatient wards at 16 US hospitals were not attributable to demographic or clinical patient characteristics. These results further support efforts to standardize care for bronchiolitis through active quality improvement strategies. Copyright © 2015 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
Apr 6, 2015 ... Neurosurgery Unit, Department of Surgery, UNTH Enugu, Nigeria. E‑mail: ... systemic effects, treatment and other external factors.. Epilepsy in primary ..... for refractoriness include loss of receptor sensitivity in some .... Localization of breast cancer resistance protein (BCRP) in microvessel endothelium ...
Full Text Available Introduction: The aim of this study was to determine the sociodemographic characteristics of children with constipation, the causes of constipations in these children and the common practices of the parents to solve the problem of constipation.Materials and Methods: The population of the study was comprised of children aged 1 to 16 years followed with the diagnosis of functional constipation in the outpatient clinics of pediatric surgery at a university hospital in Istanbul between 1 June 2009-1 June 2010. A total of 146 children and their parents who agreed to participate in the study were included. The data of this descriptive cross-sectional study were obtained by using a questionnaire which was evaluated by appropriate statistical analysis.Results: About half of the children in the study were between 1-3 years old and females. We detected that in approximately half of the children constipation problem began during transition period from solid foods before age 1. The majority of children experienced abdominal pain, bloating, stool retention, fear and anxiety during bowel movements, hard/painful defecation, increased stool volume and fecal mass; and that though it varied according to age groups, most of the children drank olive oil and fruit juice to overcome constipation. Families of children in all age groups affected in similar proportions by constipation problem and this problem did not affect sibling relations.Discussion: Risk factors for constipation were found to be under 4 years of age, starting additional/solid foods before 6 months, starting school, having family members with constipation, feeling fear and anxiety during defecation and having symptoms arising from stool retention such as abdominal pain, abdominal bloating, and hard and painful defecation. (Journal of Current Pediatrics 2011; 9: 103-9
Gupta, Malini; Kaste, Sue C. [Department of Diagnostic Imaging, St. Jude Children' s Research Hospital, Memphis, TN (United States); Hopkins, Kenneth P. [Department of Surgery, Division of Dentistry, St. Jude Children' s Research Hospital, Memphis, TN (United States)
Background: The jaw (an unusual site of primary tumors in children and adolescents) has lesions often found incidentally by dentists on routine panoramic radiographs or during examination of a child who has swelling or tooth pain. Objective: This pictorial seeks to familiarize pediatric radiologists with the radiographic appearance of a variety of primary jaw lesions. Materials and methods: We retrospectively searched institutional records for cases of primary jaw lesions in children and adolescents. Jaw lesions were characterized as: I, well-circumscribed radiolucent lesions; II, lesions with mixed or variable appearance; III, poorly circumscribed radiolucent lesions; and IV, radiopaque lesions. Results: Although most oral and maxillofacial lesions in children are benign, a broad spectrum of tumors was identified; lesions may occur in patients with unrelated prior malignancy. Conclusion: Because radiologic studies may identify jaw lesions and direct further care, familiarity with the appearance of these entities is prudent. (orig.)
Full Text Available Abstract Background To explore the epidemiologic and clinical features of, and interactions among, multipathogen infections in hospitalized children with acute respiratory tract infection (ARTI. A prospective study of children admitted with ARTI was conducted. Peripheral blood samples were analyzed by indirect immunofluorescence to detect respiratory agents including respiratory syncytial virus; adenovirus; influenza virus (Flu types A and B; parainfluenza virus (PIV types 1, 2, and 3; chlamydia pneumonia; and mycoplasma pneumonia. A medical history of each child was taken. Results Respiratory agents were detected in 164 (51.9% of 316 children with ARTI. A single agent was identified in 50 (15.8% children, and multiple agents in 114 (36.1%. Flu A was the most frequently detected agent, followed by Flu B. Coinfection occurred predominantly in August and was more frequent in children between 3 and 6 years of age. A significantly higher proportion of Flu A, Flu B, and PIV 1 was detected in samples with two or more pathogens per sample than in samples with a single pathogen. Conclusion Our study suggests that there is a high occurrence of multipathogen infections in children admitted with ARTI and that coinfection is associated with certain pathogens.
Most Irish paediatric tertiary care services are centralised in Dublin. Many children are transferred there each year from regional paediatric units around the country. We aimed to quantify and describe all children transferred from one regional tertiary hospital over a two year period. Seventy three out of 75 identified transfers were examined. Sixty nine transfers (94.5%) were sent to the major tertiary centre. Fifteen (20.5%) required intensive care services for transfer. Seventeen seriously ill neonates required transfer, however only 4 (23.5%) of those met both the criteria for and the availability of the National Neonatal Transfer Team (NNTT). Significant events during transfer were only documented in 3 cases. Most transfers arrived in Dublin outside normal working hours. Standards of documentation were found to be very inconsistent. In conclusion, a national transport service for all critically ill children is urgently needed in Ireland.
Escobedo, A A; Almirall, P; Alfonso, M; Salazar, Y; Avila, I; Cimerman, S; Núñez, F A; Dawkins, I V
The medical records of the 185 children who, in 2007, were admitted to the Academic Paediatric Hospital 'Centro Habana', in the Cuban capital of Havana, because of giardiasis were analysed retrospectively. A standardized form was used to collect data on the socio-demographic characteristics, clinical features, laboratory diagnosis, treatment and length of stay of each child. Information on the 15 children who had incomplete medical records was excluded from the data analysis. Of the remaining 170 children, 85 (50·0%) were aged 1-4 years, 97 (57·1%) were male, and 106 (62·4%), 92 (54·1%) and 69 (40·6%) had presented with diarrhoea, vomiting, and/or abdominal pain, respectively. Most (91·2%) of the cases had been diagnosed by the microscopical examination of a duodenal aspirate, and the drugs that had been most used frequently were quinacrine and tinidazole, which had been given to 72 (42·4%) and 62 (36·5%) of the cases, respectively. The mean length of hospital stay was 4·9 days. Such information on the clinical characteristics of giardiasis among children living in an endemic area may be valuable to paediatricians and public-health officials who wish to screen for the disease.
Escobedo, A A; Almirall, P; Alfonso, M; Salazar, Y; Ávila, I; Cimerman, S; Núñez, F A; Dawkins, I V
The medical records of the 185 children who, in 2007, were admitted to the Academic Paediatric Hospital ‘Centro Habana’, in the Cuban capital of Havana, because of giardiasis were analysed retrospectively. A standardized form was used to collect data on the socio–demographic characteristics, clinical features, laboratory diagnosis, treatment and length of stay of each child. Information on the 15 children who had incomplete medical records was excluded from the data analysis. Of the remaining 170 children, 85 (50.0%) were aged 1–4 years, 97 (57.1%) were male, and 106 (62.4%), 92 (54.1%) and 69 (40.6%) had presented with diarrhoea, vomiting, and/or abdominal pain, respectively. Most (91.2%) of the cases had been diagnosed by the microscopical examination of a duodenal aspirate, and the drugs that had been most used frequently were quinacrine and tinidazole, which had been given to 72 (42.4%) and 62 (36.5%) of the cases, respectively. The mean length of hospital stay was 4.9 days. Such information on the clinical characteristics of giardiasis among children living in an endemic area may be valuable to paediatricians and public-health officials who wish to screen for the disease. PMID:21294948
Zirakishvili, D; Chkhaidze, I; Barnabishvili, N
Bronchiolitis is an acute lower respiratory tract infection in early childhood caused mainly by different viruses. Etiology of bronchiolitis have been studied in different environments and populations. Respiratory syncytial virus (RSV), human Metapneumovirus (hMPV), human Bocavirus (hBoV), human Rhinoviruses (hRV) have consistently been shown to predominate. Few studies however have attempted to determine whether other pathogens, particularly Mycoplasma Pneumoniae (MP) and Chlamydophila pneumoniae (CP), are associated with bronchiolitis in children under 2 years of age. The aim of this study was to determine the prevalence and clinical features of MP and CP in children under the age of 2 years presenting to the Iashvili Central Children Hospital in Tbilisi with various severities and clinical manifestations of bronchiolitis. Acute and convalescent serum samples were tested by ELISA for IgM and IgG antibodies to RSV, CP and MP.37 children under two years of age were studied. In 19 patients out of 37 (51.35%) etiological diagnosis were established and in 18 patients (48.65%) no pathogens were found. 11 patients (29.72%) had either CP or MP and 8 patients (21.62%) had RSV. Children infected with CP and MP had less severe bronchiolitis than those infected with RSV. Co-infection was not associated with disease severity. There were no statistically significant differences between groups with respect to length of hospital stay. Our study underlines the importance of atypical bacterial pathogens in acute bronchiolitis in children under 2 years and highlights the complex epidemiology and clinical features of these pathogens in this age group.
Maaskant, Jolanda M; Vermeulen, Hester; Apampa, Bugewa; Fernando, Bernard; Ghaleb, Maisoon A; Neubert, Antje; Thayyil, Sudhin; Soe, Aung
Many hospitalised patients are affected by medication errors (MEs) that may cause discomfort, harm and even death. Children are at especially high risk of harm as the result of MEs because such errors are potentially more hazardous to them than to adults. Until now, interventions to reduce MEs have led to only limited improvements. To determine the effectiveness of interventions aimed at reducing MEs and related harm in hospitalised children. The Effective Practice and Organisation of Care Group (EPOC) Trials Search Co-ordinator searched the following sources for primary studies: The Cochrane Library, including the Cochrane Central Register of Controlled Trials (CENTRAL), the Economic Evaluation Database (EED) and the Health Technology Assessments (HTA) database; MEDLINE, EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Proquest Dissertations & Theses, Web of Science (citation indexes and conference proceedings) and the EPOC Register of Studies. Related reviews were identified by searching the Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effects (DARE). Review authors searched grey literature sources and trial registries. They handsearched selected journals, contacted researchers in the field and scanned reference lists of relevant reviews. They conducted searches in November 2013 and November 2014. They applied neither language nor date limits. Randomised controlled trials, controlled before-after studies and interrupted time series investigating interventions to improve medication safety in hospitalised children (≤ 18 years). Participants were healthcare professionals authorised to prescribe, dispense or administer medications. Outcome measures included MEs, (potential) patient harm, resource utilisation and unintended consequences of the interventions. Two review authors independently selected studies, extracted data and assessed study quality using the EPOC data collection
Grimmer Karen; McEvoy Maureen P
Abstract Background Correct upright posture is considered to be a measure of good musculoskeletal health. Little is known about the usual variability of children's upright standing posture. The aim of this study was to assess differences between repeated measures of upright posture in a group of primary school children. Methods Sagittal plane photographs of usual, relaxed upright standing posture of 38 boys and girls aged 5–12 years were taken twice within an hour. Reflective markers were pla...
Tatiana Yuriko Kobayashi
Full Text Available OBJECTIVE: To determine the timing and sequence of eruption of primary teeth in children with complete bilateral cleft lip and palate. MATERIAL AND METHODS: This cross-sectional study was conducted at the Hospital for Rehabilitation of Craniofacial Anomalies of the University of São Paulo, Bauru, SP, Brazil, with a sample of 395 children (128 girls and 267 boys aged 0 to 48 months, with complete bilateral cleft lip and palate. RESULTS: Children with complete bilateral clefts presented a higher mean age of eruption of all primary teeth for both arches and both genders, compared to children without clefts. This difference was statistically signifcant for all teeth, except for the maxillary first molar. Mean age of eruption of most teeth was lower for girls compared to boys. The greatest delay was found for the maxillary lateral incisor, which was the eighth tooth of children with clefts of both genders. Analyzing by gender, the maxillary lateral incisor was the eighth tooth to erupt in girls and the last in boys. CONCLUSION: The results suggest an interference of the cleft on the timing and sequence of eruption of primary teeth.
Carbone, Paul S; Farley, Megan; Davis, Toby
The earliest sign of autism in children is the delayed attainment of social skill milestones, including joint attention, social orienting, and pretend play. Language impairment is a common, but less specific, sign of autism. Repetitive behaviors and restricted interests may not be noted until after social skill and communication impairments are exhibited. Physicians should perform developmental surveillance at all well-child visits, and the American Academy of Pediatrics recommends administering an autism-specific screening tool at the 18- and 24-month visits. A referral for comprehensive diagnostic evaluation is appropriate if concerns arise from surveillance, screening, or parental observations. The goals of long-term management are to maximize functional independence and community engagement, minimize maladaptive behaviors, and provide family and caregiver support. Physicians play an important role in coordinating care through an interdisciplinary team; referring families for specialized services; and treating children's associated conditions, including sleep disturbances, gastrointestinal problems, anxiety, and hyperactivity. Autism is a lifelong condition, but early recognition, diagnosis, and treatment can improve the prognosis, whereas associated medical conditions, psychiatric conditions, and intellectual disability can worsen the prognosis.
Dann, Phoebe H.; Amodio, John B.; Rivera, Rafael; Fefferman, Nancy R. [New York University School of Medicine, Department of Radiology, New York (United States)
We report the imaging findings of two recent cases of primary bacterial peritonitis in otherwise healthy children with a clinical presentation mimicking acute appendicitis. Primary bacterial peritonitis is rare in the absence of underlying systemic disease. Although it has been described in the pediatric literature, the imaging findings have not been described in the radiological literature to the best of our knowledge. With imaging playing an increasing role in the evaluation of appendicitis in children, it is important for the radiologist to be familiar with this inflammatory process. (orig.)
Kelly Holanda Prezotto
Full Text Available OBJECTIVE to describe hospital admissions for ambulatory care sensitive conditions in children under five years of age in the State of Paraná, Brazil by condition type, age group and health region. METHOD a temporal ecological study was conducted using data from the Unified Health System Hospital Information System for the period 2000 to 2011. Conditions were grouped in accordance with the list of ambulatory care sensitive conditions in Brazil. RESULTS there was an increase in the rate of admissions for ambulatory care sensitive conditions in all age groups in 50% of the health regions, with a marked increase in children under the age of one. Pneumonia, gastroenteritis and asthma were the main causes of admissions. There was an increase in the proportion of overall admissions accounted for by pneumonia and gastroenteritis. CONCLUSION the increase in admissions reveals the need for actions to improve access to primary healthcare and provide effective treatment of the main ambulatory care sensitive conditions in order to prevent hospital admissions among children.
Araujo, Waleska Regina Machado; Queiroz, Rejane Christine de Sousa; Rocha, Thiago Augusto Hernandes; Silva, Núbia Cristina da; Thumé, Elaine; Tomasi, Elaine; Facchini, Luiz Augusto; Thomaz, Erika Barbara Abreu Fonseca
The objective of this study is to investigate whether the characteristics of the structure of primary health units and the work process of primary care teams are associated with the number of hospitalizations for primary care sensitive conditions. In this ecological study, we have analyzed data of Brazilian municipalities related to sociodemographic characteristics, coverage of care programs, structure of primary health units, and work process of primary care teams. We have obtained the data from the first cycle of the Brazilian Program for Improving Access and Quality of the Primary Care, of the Department of Information Technology of the Brazilian Unified Health System, the Brazilian Institute of Geography and Statistics, and the United Nations Development Programme. The associations have been estimated using negative binomial regression coefficients (β) and respective 95% confidence intervals, with a hierarchical approach in three levels (alpha = 5%). In the adjusted analysis for the outcome in 2013, in the distal level, the coverage of the Bolsa Família Program (β = -0.001) and private insurance (β = -0.01) had a negative association, and the human development index (β = 1.13), the proportion of older adults (β = 0.05) and children under the age of five (β = 0.05), and the coverage of the Community Health Agent Strategy (β = 0.002) showed positive association with hospitalizations for primary care sensitive conditions. In the intermediate level, minimum hours (β = -0.14) and availability of vaccines (β = -0.16) showed a negative association, and availability of medications showed a positive association (β = 0.16). In the proximal level, only the variable of matrix support (β = 0.10) showed a positive association. The variables in the adjusted analysis of the number of hospitalizations for primary care sensitive conditions in 2014 presented the same association as in 2013. The characteristics of the structure of primary health units and the work
Sonia Agrawal; Sriram Krishnamurthy; Bijaya Nanda Naik
This study was conducted to assess the quality of life (QOL) in children between 2 and 18 years of age with primary idiopathic nephrotic syndrome (NS) using Pediatric Quality of Life Inventory (PedsQL 4.0 Generic Core Scales). This cross-sectional comparative study was conducted at a tertiary care hospital in South India between December 2014 and February 2015. In this questionnaire-based study, 50 children with primary idiopathic NS and an equal number of age-matched controls with other chro...
Full Text Available Ahmed Ameer,1 Soraya Dhillon,1 Mark J Peters,2 Maisoon Ghaleb11Department of Pharmacy, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK; 2Paediatric Intensive Care Unit, Great Ormond Street Hospital, London, UK Objective: Medication administration is the last step in the medication process. It can act as a safety net to prevent unintended harm to patients if detected. However, medication administration errors (MAEs during this process have been documented and thought to be preventable. In pediatric medicine, doses are usually administered based on the child's weight or body surface area. This in turn increases the risk of drug miscalculations and therefore MAEs. The aim of this review is to report MAEs occurring in pediatric inpatients. Methods: Twelve bibliographic databases were searched for studies published between January 2000 and February 2015 using “medication administration errors”, “hospital”, and “children” related terminologies. Handsearching of relevant publications was also carried out. A second reviewer screened articles for eligibility and quality in accordance with the inclusion/exclusion criteria. Key findings: A total of 44 studies were systematically reviewed. MAEs were generally defined as a deviation of dose given from that prescribed; this included omitted doses and administration at the wrong time. Hospital MAEs in children accounted for a mean of 50% of all reported medication error reports (n=12,588. It was also identified in a mean of 29% of doses observed (n=8,894. The most prevalent type of MAEs related to preparation, infusion rate, dose, and time. This review has identified five types of interventions to reduce hospital MAEs in children: barcode medicine administration, electronic prescribing, education, use of smart pumps, and standard concentration. Conclusion: This review has identified a wide variation in the prevalence of hospital MAEs in children. This is attributed to
Miriam Maribel Vargas Rivas
Full Text Available Introduction: This article recounts the experience of a theater workshop conducted in a hospital school with children under diverse health conditions in 2011. The work became a possibility of art diffusion as a therapeutic tool and an invitation to reflect on disability and its real and/or symbolically constructed limitations. The central problem focused on identifying the presence of Occupational Risk Factors and Occupational Apartheid in the school achievement of the hospital school children and the author. Problems caused by environmental elements as well as by symbolic-social constructions generated by the idea of disability were observed. Objective: To describe the impact generated by a theater workshop as a therapeutic means in a children’s hospital school environment. Method: The autoethnographic methodology was chosen to validate the experience of the investigator as a source of information. Results: The ideas on Occupational Risk Factors, Occupational Apartheid, as well as the concepts developed in the workshop and those used to combat adverse conditions were theoretically analyzed. Conclusion: It is necessary that we experiment contexts that enable spaces free of evaluation and the freedom to use, enjoy and express all our abilities. We must be certain that the body keeps track of past experiences that potentialize the resilience of the soul, which we all deserve to have and which opens the path to the possibility of destroying our predetermined conditions.
Full Text Available Introduction: the obesity is the disease of the new millennium, because it affects about 300 million people in the world, and especially it has a high prevalence in children. obesity is a significant risk factor for cardiovascular disease, diabetes mellitus type ii, hypertension, problems of adaptation and relationship with other, lower self-esteem and depression. Aims: the objective of our study is to identify children at risk of overweight / obesity in order to primary prevention. We have organized meetings with children, families and school’s members where we discussed the results of our investigation about the importance of healthy diet and lifestyle. Patients-Methods: the study was carried out on 545 children (282F, 263M, age 6.-10 years, of two primary schools in Catanzaro, from 2008 to 2010. the valuation parameters were: gender, age, weight, height, blood pressure and waist circumference. to children were also administered a questionnaire about dietary habits and lifestyle. Statistical analysis: Fisher’s test. Results: We had that 62 % of children was normal weight, 27 % overweight, 11 % obese. A particularly relevant datum is that the percentage of overweight-obese boys of 8 and 9 years old was higher (56% than that of normal weight. We found cases of hypertension only in obese children. 98% of obese, 80% of overweight and 24% of normal weight children had a high waist circumference. We did not find differences in food quality among normal weight and overweight/obese children. instead, we found significant differences in behavior between children: 90% of obese, 64% of overweight and 53% of normal weight children passed more than 2 hours in the afternoon watching television, playing computer and video games. 70% of normal weight, 82% of overweight and 95% of obese children practiced physical activity. Discussion/conclusion: our study shows a alarming fact about the increase of the obesity in children. in particular the most important
Nataly Tsumura Inocencio Soares
Full Text Available Objective. To present the experiences of nursing staff working with hospitalized burned children. Methodology. Qualitative study. Data were obtained from semi-structured interviews applied to 16 people of the nursing team (12 professional technicians and 4 working at a burn treatment center. For the analysis, the Method information Interpretation of the Senses was used. The theoretical basis used to support the discussion of the study was proposed by Geertz's interpretive anthropology. Results. The narratives showed that the process of care to burned children is stressful for the participants because they are psychologically involved with the tragic story of a patient who suffered burns, and therefore with the clinical situation. This allows for the development of empathy. On the other hand there cultural involvement facing and accepting the consequences of what happened to the patient, due to the change of body image stigma that the child will suffer hamper the re-socialization of the child after discharge. Conclusion. The nursing team is affected in various ways during the care of hospitalized burned children. There is need for educational programs for their preparation in the care of these patients.
Inocencio Soares, Nataly Tsumura; Grubisich Mendes Tacla, Mauren Teresa
To present the experiences of nursing staff working with hospitalized burned children. Qualitative study. Data were obtained from semi-structured interviews applied to 16 people of the nursing team (12 professional technicians and 4) working at a burn treatment center. For the analysis, the Method information Interpretation of the Senses was used. The theoretical basis used to support the discussion of the study was proposed by Geertz's interpretive anthropology. The narratives showed that the process of care to burned children is stressful for the participants because they are psychologically involved with the tragic story of a patient who suffered burns, and therefore with the clinical situation. This allows for the development of empathy. On the other hand there cultural involvement facing and accepting the consequences of what happened to the patient, due to the change of body image stigma that the child will suffer hamper the re-socialization of the child after discharge. The nursing team is affected in various ways during the care of hospitalized burned children. There is need for educational programs for their preparation in the care of these patients.
Abedipour, Marzieh; Tavasouli, Azita; Sobouti, Behnam; Mansourimanesh, Mahzad; Saeedi Eslami, Nasir; Bodaghy Alny, Mehdi
In this cross-sectional retrospective study, frequency, type, time of occurrence and atiology of seizures in children with burn was investigated. All cases were under 18 years and were hospitalized in Shahid Motahari Burns Hospital during 2006-2011. Extracted data from patients' medical records was reviewed and statistically analyzed. Among 1103 patients, 69 (6.2%) had seizures, more frequently in the first 24 h following burn. Thermal burn, especially with boiling water was the cause of burn in most of the children. Seizures occurred more commonly in children less than 3 years old and was generalized (tonic-clonic). Seizure was found to be primarily associated with febrile seizure, while hyponatremia was diagnosed as the second cause. Previous seizure history and seizure with unknown cause were identified as other etiologies. This paper summarizes the key information about seizure following burn, which health professionals, especially those in burn centers, should be aware. However, since this study was single-center more investigations in other centers are needed. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.
Santiago, B; Guerra, L; García-Morín, M; González, E; Gonzálvez, A; Izquierdo, G; Martos, A; Santos, M; Navarro, M; Hernández-Sampelayo, M T; Saavedra-Lozano, J
Clostridium difficile is the leading cause of nosocomial and antibiotic-associated diarrhea in adults, and its incidence has substantially risen over the last few years. The prevalence of this infection in children is difficult to assess due to the high rates of colonization in this setting. A one-year retrospective study was conducted on children under 15 years admitted to hospital with acute diarrhea. Epidemiological, clinical, laboratory findings and outcome of children with Clostridium difficile infection (CDI) were compared to other causes of diarrhea. Risk factors for CDI were identified by multivariate analysis. Two hundred and fifty children with acute diarrhea were identified. A microbiological pathogen was identified in 79 (45.4%) of 174 patients who underwent complete testing: 19 CDI (25.6%, 13 of which were enterotoxin-producing), 21 other bacteria (28.6%), and 34 viruses (45.8%; rotavirus n=31; adenovirus n=3). The estimated incidence of CDI was 3 cases/1,000 admissions, with 68.4% of them occurring in children younger than 2 years. Overall, 15.8% were community-acquired. Compared to other causes of diarrhea, CDI was associated with comorbidity (P<.0001), recent contact with the health-care system (P<.0001) or intensive care unit stay (P=.003) and exposure to antibiotics in the previous month (P<.0001). The clinical course of children with CDI was less symptomatic. There were no clinical differences between Clostridium difficile toxin-producers and non-toxin producers. Comorbidity was identified as the main risk factor associated with CDI (OR 40.02, 95% CI 6.84-232.32; P<.0001). The isolation of Clostridium difficile is common in hospitalized children with diarrhea in our setting. CDI is more frequent in children with comorbidity and recent contact with the health-care system, presenting a mostly oligosymptomatic clinical course. Further studies are needed to understand the epidemiology of this infection in pediatrics, especially the percentage of
Full Text Available Drug utilization in the in-patient setting can provide mechanisms to assess drug prescribing trends, efficiency and cost-effectiveness of hospital formularies and examine sub-populations such as children for which prescribing habits are different from adults. Objectives: The aim of this descriptive study was to analyze general medication utilization patterns and costs excluding antimicrobials prescriptions and to compare two pediatric admission units in a tertiary care university hospital. Methods: The total number of admitted children was 1,521 and 1,467 for the A and B admission units, respectively. The electronic data from 252 and 253 hospitalized children in the A and B admission unit were prospectively screened for general medication prescriptions, children on antimicrobials were excluded from the analysis. Their electronic charts were viewed once weekly from October 15, 2007 up to April 7, 2008 using the prescription-point prevalence method. One medication was considered to be one prescription. Results: The general medications prescription number was 790 for 94 children (8.4 prescription/patient in A and 959 for 88 children (10.9 prescription/patient in B (p=0.02. The general medications defined daily dose (DDD and drug utilization 90% (DU90% index were 2,509.63, 2,259 for A; and 6,110.35, 5,499 for B, respectively. The DU90% index placed salbutamol inhalation with 835 DDD and sodium heparin with 2,102 DDD in the first place for the A and B admission units, respectively. A net increment in medication cost was registered according to the calculated cost from the depicted DU90% when the A (20,263 NIS and B (6,269 NIS admission units were compared (p=0.04. Conclusions: A significant difference in the prescription utilization of general medications was shown between the A and B admission units. The A admission unit had lower prescriptions measured by the DU90% index with higher medication cost. Potential drug-drug interactions were depicted in
Burnett, Paul C.
Self-esteem has been defined as the "totality of the individual's thoughts and feelings having reference to himself as an object." Self-concept has been defined as the descriptive and evaluative beliefs that a person holds about multidimensional characteristics of the self. As children progress through primary school, general…
Ebert, Kerry Danahy; Rentmeester-Disher, Jill; Kohnert, Kathryn
Substantial evidence points to the presence of subtle weaknesses in the nonlinguistic cognitive processing skills of children with primary (or specific) language impairment (PLI). It is possible that these weaknesses contribute to the language learning difficulties that characterize PLI, and that treating them can improve language skills. To test…
Richter, Tobias; Isberner, Maj-Britt; Naumann, Johannes; Neeb, Yvonne
In a cross-sectional study, we examined the relationship between the quality of lexical representations and text comprehension skill in German primary school children (Grades 1-4). We measured the efficiency and accuracy of orthographical, phonological, and meaning representations by means of computerized tests. Text comprehension skill was…
Annals of Medical and Health Sciences Research | Oct-Dec 2013 | Vol 3 | Issue 4 |. 511. Address ... parasites in urban and rural primary school children of Mthatha and relate ... ++ and 1−≥ 5parasites/hpf as +++), (hpf means high power field).
Talip, Tajidah; Serudin, Rajiah; Noor, Salmah; Tuah, Nik
Childhood obesity is a serious public health issue globally and poor eating habits are an important contributing factor. This study aimed to explore the perceptions, practices and attitudes towards healthy eating in Bruneian primary school children. A qualitative study was conducted among 40 subjects involving 18 children (aged 9-10 years old), 12 parents and 10 teachers, who were recruited from two primary schools using convenience sampling. Five focus group discussion sessions were conducted, and recorded discussions were translated. The transcripts were entered into NVivo10 and thematic analysis was conducted. All participants had differing perceptions of the term 'healthy eating'. Children reported 'healthy eating' by identifying foods or food groups they perceived as healthy and unhealthy. Only a few mentioned fruits and vegetables as essential to a healthy diet. Parents mainly perceived 'healthy eating' as consuming 'any quality food' that contains 'vitamins and minerals'. Teachers described a healthy diet as including balanced and varied dietary practices, having breakfast and eating regularly at the right, set times. They also associated eating healthily with traditional, home-grown and home-cooked food. All participants had positive attitudes towards healthy eating, however most children demonstrated unhealthy eating habits and frequently consumed unhealthy foods. The Bruneian primary school children reported favourable knowledge despite having poor healthy eating habits. The factors influencing participants eating behavior included food preferences, familial factors (parental style and parenting knowledge), food accessibility and availability, time constraints, as well as convenience. These factors hindered them from adopting healthy eating practices.
González-Uribe, Víctor; Pietropaolo-Cienfuegos, Dino Roberto; Del Río-Navarro, Blanca Estela; Del Río-Chivardi, Jaime Mariano; Sienra-Monge, Juan José Luis
Antecedentes: si bien se cuenta con información epidemiológica de las inmunodeficiencias primarias, la información disponible en México es escasa. Objetivos: dar información epidemiológica del retraso del diagnóstico de las inmunodeficiencias primarias y de su correlación con daño pulmonar crónico. Material y método: estudio retrospectivo, analítico, efectuado en pacientes de 0 a 18 años de edad con diagnóstico de inmunodeficiencias primarias durante 11 años en el Hospital Infantil de México Federico Gómez; las variables estudiadas fueron: edad al inicio de los síntomas, edad al diagnóstico, tiempo desde el inicio de los síntomas al diagnóstico, número de neumonías previas y estudios radiográficos con datos de daño pulmonar crónico. Resultados: se incluyeron 48 pacientes que cumplieron los criterios de inclusión; 33 tenían daño pulmonar al diagnóstico, el déficit de anticuerpos fue el grupo con mayor afectación. Al correlacionar la edad de inicio de los síntomas y la diferencia de tiempo del inicio de los síntomas al diagnóstico se obtuvo una fuerte correlación (p 0.80). Se observó una correlación moderada entre la diferencia en tiempo vs número de neumonías (p=0.005, Rho=0.495) y la correlación entre número de neumonías y daño pulmonar mostró significación alta (p <0.001, Rho=0.704). Conclusión: se encontró una relación estrecha entre el tiempo transcurrido desde el inicio de los síntomas y el número de neumonías con el daño pulmonar, por lo que las neumonías de repetición (más de dos) deben hacer sospechar el diagnóstico de inmunodeficiencia primaria, como se recomienda en la bibliografía mundial.
Dulęba, K; Pawłowska, M; Wietlicka-Piszcz, M
The frequency of Clostridium difficile infection (CDI)-related hospitalizations is increasing. The aim of this study was to determine the extent of CDI among children hospitalized with diarrhea, risk factors or predictors for severe CDI, the prevalence of NAP1, and to compare the course of CDI depending on bacteria toxicity profile. A retrospective analysis of case records of 64 children (age range 3 months-16 years, median age 2.12 years) with CDI as defined by diarrheal disease and positive polymerase chain reaction (PCR) test (Xpert C. difficile) was conducted. Modified national adult guidelines were used to assess the severity of CDI. CDIs represented 2.7 % of patients with diarrhea (13.5 cases per 1,000 admissions). Thirty-three CDIs (52 %) were community-associated. Antibacterial use preceded CDI in 61 patients (95 %). Seventeen cases (27 %) were binary toxin-positive (CDT+), 13 of which were NAP1 (20.5 %). Over 75 % of CDIs with NAP1 was hospital-acquired, and more often proceeded with generalized infection (p factors for severe CDI (34 %) included NAP1 [odds ratio (OR), 4.85; 95 % confidence interval (Cl), 1.23, 21.86) and co-morbidities (OR, 4.25; 95 % Cl, 1.34, 14.38). Diarrhea ≥10 stools daily was associated with severe CDI (p = 0.01). Recurrence occurred in three patients (4.5 %). There was no mortality. C. difficile is an important factor of antibiotic-associated diarrhea in children. Co-morbidities and NAP1 predispose to severe CDI.
Full Text Available Introduction: Diphtheria is an important disease in children that could lead to fatal disease. East Java Province was declared to have Diphtheria outbreak in 2011 with increasing morbidity and mortality, including on Soetomo Hospital. Our paper aimed to describe the proﬁ le of diphtheria cases in children admitted at dr Sutomo Hospital. Method: This descriptive study reviewed all medical records of diphtheritic patients admitted to Dr. Soetomo Hospital, January 2004–December 2010, of concerns were clinical presentations, age, sex, immunizations status, complications, and outcomes. Result: From 148 diphtheria cases, 22.3% were bacteriologically proven; 53.4% were male with sex ratio 1.1:1. The age proportion of ≤ 5 years old, 5- ≤ 10 years old, and > 10 years old were 61.5%, 31.8%, and 6.7%. Fever occurred in 99% cases, sore throat, stridor and bullneck occurred respectively in 62.2%, 39.9%, and 29.7% cases. There were 56.8% severe and 41.9% moderate diphtheria. Subjects were immunized in 84%, but none of them have adequate immunization. Myocarditis, being one of the commonest complications occurred in 11.4% cases and tracheostomy was the second (4.0%. All of the death cases (7.9% were unvaccinated and in severe form. Discussion: The mostly prevalent clinical manifestations in diphtheria children were fever and sore throat. Half of the cases came with severe diphtheria and most cases were inadequately vaccinated. Death occurred in the unvaccinated and severe form.
Anosov I. P.
Full Text Available This work addresses the question of primary school age children`s blood microcirculation in dependence on their individual typical features. We examined some 120 healthy children of 6-9 years, which were the students of secondary schools of the city of Melitopol. Anthropometric survey was conducted by the standard measurement scheme of longitudinal chest and weight parameters of the bodies of children. Diagnosis of body type (somatotype was conducted by the method of M. Chernorutskiy. According to the index of physical development - Pine index (PI, the children were divided into three somatic type: asthenic with IP> 30 gipersteni at PI <10 and normostenic type at 10
Mesfin, Firehiwot; Berhane, Yemane; Worku, Alemayehu
Anemia during childhood impairs physical growth, cognitive development and school performance. Identifying the causes of anemia in specific contexts can help efforts to prevent negative consequences of anemia among children. The objective of this study was to assess prevalence and identify correlates of anemia among school children in Eastern Ethiopia. A cross sectional study was conducted from January 2012 to February 2012 in Kersa, Eastern Ethiopia. The study included randomly selected primary school students. Hemoglobin concentration was measured using a Hemocue haemoglobinometer. A child was identified as anemic if the hemoglobin concentration was children (5-11 yrs) and anemia was 27.1% (95% CI: 24.98, 29.14): 13.8% had mild, 10.8% moderate, and 2.3% severe anemia. Children with in the age group of 5-9 years (APR, 1.083; 95% CI, 1.044-1.124) were at higher risk for anemia. Paternal education (Illiterate, 1.109; 1.044-1.178) was positively associated with anemia. Children who had irregular legume consumption (APR, 1.069; 95% CI, 1.022-1.118) were at higher risk for anemia. About a quarter of school children suffer from anemia and their educational potential is likely to be affected especially for those with moderate and severe anemia. Child age, irregular legume consumption, and low paternal schooling were associated with anemia. Intervention programmes aimed to reduce anemia among school children are crucial to ensure proper growth and development of children.
Pro, S; Tarantino, S; Capuano, A; Vigevano, F; Valeriani, M
Although primary headaches are very prevalent also in pediatric age, most neurophysiologic studies in these diseases concerned only the adulthood. The neurophysiologic investigation of the pathophysiological mechanisms subtending migraine and tension-type headache in children and adolescents could be particularly interesting, since during the developmental age the migrainous phenotype is scarcely influenced by many environmental factors that can typically act on adult headache patients. The neurophysiologic abnormality most frequently found in adult migraineurs, that is the reduced habituation of evoked potentials, was confirmed also in migraine children, although it was shown to involve also children with tension-type headache. Some studies showed abnormalities in the maturation of brain functions in migraine children and adolescents. While the visual system maturation seems slowed in young migraineurs, the psychophysiological mechanisms subtending somatosensory spatial attention in migraine children are more similar to those of healthy adults than to those of age-matched controls. There are some still unexplored fields that will have to be subjects of future studies. The nociceptive modality, which has been investigated in adult patients with primary headaches, should be studied also in pediatric migraine. Moreover, the technique of transcranial magnetic stimulation, not yet used in young migraineurs, will possibly provide further elements about brain excitability in migraine children.
Butel, J. S.; Jafar, S.; Wong, C.; Arrington, A. S.; Opekun, A. R.; Finegold, M. J.; Adam, E.
Simian virus 40 (SV40) is known to have contaminated poliovirus vaccines used between 1955 and 1963. Accumulating reports have described the presence of SV40 DNA in human tumors and normal tissues, although the significance of human infections by SV40 is unknown. We investigated whether unselected hospitalized children had evidence of SV40 infections and whether any clinical correlations were apparent. Serum samples were examined for SV40 neutralizing antibody using a specific plaque reduction test; of 337 samples tested, 20 (5.9%) had antibody to SV40. Seropositivity increased with age and was significantly associated with kidney transplants (6 of 15 [40%] positive, P infections in children born after 1980. We conclude that SV40 causes natural infections in humans.
Full Text Available Abdominal mass is one of the commonest clinical findings in children. The purpose of this study was to evaluate abdominal masses in different age groups in a referral children surgical center. We retrospectively reviewed records of 325 patients (57% boys, mean age 37.7 months admitted to Amir Kabir hospital in period of 12 years for abdominal mass surgery. The 4 most common abdominal masses was Wilm's tumor (22.4%, abdominal lymphoma (13.5%, neuroblastoma (12.5% and hydronephrosis (12.3%. These masses composed 60% of abdominal masses and the remaining were: Hydatid cyst of liver, ovarian masses, liver masses, choledochal cyst, mesentery and omental cyst, etc. This results were found to be similar with little differents to results of other centers.
Laulajainen-Hongisto, Anu; Aarnisalo, Antti A; Jero, Jussi
Acute otitis media is a common infection in children. Most acute otitis media episodes can be treated at an outpatient setting with antimicrobials, or only expectant observation. Hospital treatment with parenteral medication, and myringotomy or tympanostomy, may be needed to treat those with severe, prolonged symptoms, or with complications. The most common intratemporal complication of acute otitis media is acute mastoiditis. If a child with acute mastoiditis does not respond to this treatment, or if complications develop, further examinations and other surgical procedures, including mastoidectomy, are considered. Since the treatment of complicated acute otitis media and complicated acute mastoiditis differs, it is important to differentiate these two conditions. This article focuses on the differential diagnostics of acute otitis media and acute mastoiditis in children.
Hoying, Cheryl; Lecher, William T; Mosko, Dee Dee; Roberto, Nancy; Mason, Char; Murphy, Susan Wade; Taylor, Janalee; Cortina, Sandra; Mathison, Elizabeth; Dick, Leaann; Schoettker, Pamela J; Britto, Maria T
Cincinnati Children's Hospital Medical Center is transforming the way it cares for its patients by building a sophisticated model that focuses on accountable care across the continuum. As nurses from different parts of the organization, we act as change agents to develop an integrated structure built around the patient's needs, from prevention to self-management. We demonstrate how organizational structure, fluid staffing, professional practice, and healthy behaviors operationally catalyze the continuum of care, and how we utilize self-management, community-based programs, and care integration to change the outcome for our patients and families. While care coordination is taking on many forms in medical centers around the world, Cincinnati Children's is proud and passionate about sharing its best practices along the way.
Butel, J. S.; Jafar, S.; Wong, C.; Arrington, A. S.; Opekun, A. R.; Finegold, M. J.; Adam, E.
Simian virus 40 (SV40) is known to have contaminated poliovirus vaccines used between 1955 and 1963. Accumulating reports have described the presence of SV40 DNA in human tumors and normal tissues, although the significance of human infections by SV40 is unknown. We investigated whether unselected hospitalized children had evidence of SV40 infections and whether any clinical correlations were apparent. Serum samples were examined for SV40 neutralizing antibody using a specific plaque reduction test; of 337 samples tested, 20 (5.9%) had antibody to SV40. Seropositivity increased with age and was significantly associated with kidney transplants (6 of 15 [40%] positive, P children born after 1980. We conclude that SV40 causes natural infections in humans.
René-Pierre Buigues; Bernard Duval; Louis Rochette; Nicole Boulianne; Monique Douville-Fradet; Pierre Déry; Gaston De Serres
OBJECTIVE: To characterize the incidence and duration of hospitalization due to diarrhea and to assess the proportion of hospitalizations that are attributed to rotavirus-associated diarrhea.DESIGN: Retrospective study of hospitalization data.SETTING: Hospitals located in Quebec.POPULATION STUDIED: Children from one to 59 months of age who were discharged from hospital from April 1, 1985 to March 31, 1998.MAIN RESULTS: There were 63,827 hospitalizations for diarrhea over the study period, for...
Acar, Manolya; Sütçü, Murat; Aktürk, Hacer; Törün, Selda Hançerli; Uysalol, Metin; Meşe, Sevim; Salman, Nuran; Somer, Ayper
Clinical findings, mortality, and morbidity rates differ among influenza subspecies. Awareness of these differences will lead physicians to choose the proper diagnostic and therapeutic strategies and to foresee possible complications. The aim of this study was to evaluate the clinical differences of influenza subspecies among hospitalized children. Hospitalized children with proven influenza infection by polymerase chain reaction on nasopharyngeal swab specimens in our clinic, between December 2013 and March 2016, were enrolled. These children were divided into 3 groups as Influenza A/H1N1 (n=42), Influenza A/H3N2 (n=23), and Influenza B (n=35). The median age of the children was 51.5 months (range, 3-204 months). The most common presenting symptoms were fever (n=83), cough (n=58), and difficulty in breathing (n=25). The most common non-respiratory findings were lymphadenopathy (n=18) and gastrointestinal system involvement (n=17). Sixty-two percent of the patients (n=62) had chronic diseases. H1N1 and H3N2 were significantly more common among patients with chronic neurologic disorders and renal failure, respectively. Leukopenia (n=32) and thrombocytopenia (n=22) were the most common pathologic laboratory findings. Neutropenia, elevated CRP levels, and antibiotic use were significantly more common among patients with H1N1 infection. Seven patients were transferred to the intensive care unit with diagnoses of acute respiratory distress syndrome (n=4), encephalitis (n=2), and bronchiolitis (n=1). Two patients with chronic diseases and H1N1 infection died secondary to acute respiratory distress syndrome. Influenza A/H1N1 infection represented more severe clinical disease.
Bello, J; Núñez, F A; González, O M; Fernández, R; Almirall, P; Escobedo, A A
The risk factors associated with Giardia infection, in children hospitalized in Havana, Cuba, were recently explored. Children aged ≥5 years were more likely to be positive for Giardia infection than the younger children, with an odds ratio (OR) of 3·41 [95% confidence interval (CI) = 1·36-9·69]. The risk factors found to be associated with Giardia infection in univariate analyses were rural residence (OR = 3·01; CI = 1·23-7·35), belonging to a household that did not receive water from an aqueduct (OR = 3·27; CI = 1·21-8·91), drinking unboiled water (OR = 3·64; CI = 2·14-6·26), nail biting (OR = 3·47; CI = 1·97-6·08), eating unwashed vegetables raw (OR = 4·84; CI = 2·33-10·14), and a personal (OR = 3·23; CI = 1·58-6·59) or family history (OR = 3·96; CI = 1·53-10·47) of previous parasitic infection. In multivariate analyses, however, only two (modifiable) risk factors were found to be independently and significantly associated with Giardia infection: nail biting and eating unwashed vegetables raw. It therefore seems that, at least at the individual level, giardiasis-prevention activities in Havana should be focussed on health education to improve personal hygiene and food-related practices. If appropriately managed, the surveillance of drinking water and foodstuffs, for Giardia and other parasites, might also help to reduce the hospitalization of Cuban children.
Full Text Available Background Child abuse is a phenomenon that confronts the child, family, and society with irretrievable physical and mental injuries, and its negative effects continue until adulthood. Objectives The present study was conducted to identify and evaluate cases of abused children at a medical center. Patients and Methods This is a descriptive-analytic study. The subjects were all children and adolescents who were referred to Imam Hussein hospital within 6 months due to physical or psychiatric reasons and were diagnosed with child abuse and neglect by a child and adolescent psychiatrist. The number of these children was 73. Children and their parents were assessed by schedule for affective disorders and schizophrenia (SADS, Kiddie-SADS, and child abuse and demographic questionnaires. The statistical methods of mean and standard deviation were used to analyze the data. Results 56 cases (76% were physically abused, 53 cases (72.6% were emotionally abused, and 3 cases (12.3% were neglected. The most common psychiatric disorder in abused children was ADHD (65.8%. The next most common were oppositional defiant disorder, obsessive compulsive disorder, general anxiety disorder, and enuresis. About 80% of the abused children had at least one psychiatric disorder. The most common psychiatric disorders in mothers were general anxiety disorder (34.8% and depression (33.3%, and in fathers, it was substance abuse (19.7%. Conclusions Child abuse is a common phenomenon that relates to psychiatric disorders in the abused child or abuser parents. It seems that on-time identification and appropriate interventions can prevent further negative consequences for the child, family, and society.
Full Text Available The aim of the work is to develop an algorithm of differentiated therapy in children with PNE. 234 children aged 5-15 years were studied. Results of treatment of children with primary nocturnal enuresis using the traditional therapeutic scheme and the algorithm of differential therapy based on identification of individual pathology were analyzed. The best clinical effect (recovery— in 73,1%, improvement— in 19,4% of cases was obtained in children undergone the complex of recommended measures: psychological consultation, rational and family psychotherapy, medication correction, physical and physiotherapy, alarm-monitoring; the complex was used differentially, i.e. depending on the identified pathology. In conclusion the article stated that individual treatment program with the obligatory inclusion of alarm-control for child with PNE should be selected after performing the recommended set of diagnostic measures
Maria da Conceição Passeggi
Full Text Available This study deals with 4-10 year-old children stories and analyses how they portrait their experiences at school. It is the outcome of an inter-institutional research project performed at schools in Natal, São Paulo, Recife, Niterói and Boa Vista. To collect data, we opted for conversations of children in groups of five, who would share a conversation with a little alien whose planet lacked schools. The analyses revealed consensus and tensions between scholar cultu - re and childhood cultures, which affect the way children play and learn, make friends or not, remain children or not. When narrating, the child redefines his/her experience and contributes to seize the primary school as a place where he/she becomes (or not a citizen.
Ghritlaharey, Rajendra K; Budhwani, Keshav S; Shrivastava, Dhirendra K; Srivastava, Jyoti
The aim of this study was to review our experience with tube thoracostomy in the management of empyema thoracis in children. This retrospective study included 46 children (26 boys and 20 girls) who were admitted and managed for empyema thoracis, between January 1, 2010 and December 31, 2010 at the author's department of paediatric surgery. During the last 12 months, 46 children aged below 12 years were treated for empyema thoracis: Five (10.86%) were infants, 22 (47.82%) were 1 to 5 years and 19 (41.30%) were 6 to 12 years of age. All the patients presented with complaints of cough, fever and breathlessness of variable durations. Twenty three (50%) children had history of pneumonia and treatment prior to development of empyema. Thirty five (76.08%) children had right-sided and 11 (23.91%) had left-sided empyema. Thirty nine (84.78%) children were successfully treated with tube thoracostomy, systemic antibiotics and other supportive measures. Seven (15.21%) children failed to respond with above and needed decortications. Most commonly isolated bacteria were Pseudomonas (n = 12) and Staphylococcus aureus (n = 7). The average length of hospital stay in patients with tube thoracostomy was 15.35 days, and in patients who needed decortications was 16.28 days following thoracotomy. There was no mortality amongst above treated children. Majority of children with empyema thoracis are manageable with tube thoracostomy, antibiotics, physiotherapy and other supportive treatment. Few of them who fail to above measures need more aggressive management.
Rajendra K Ghritlaharey
Full Text Available Aim: The aim of this study was to review our experience with tube thoracostomy in the management of empyema thoracis in children. Patients and Methods: This retrospective study included 46 children (26 boys and 20 girls who were admitted and managed for empyema thoracis, between January 1, 2010 and December 31, 2010 at the author′s department of paediatric surgery. Results: During the last 12 months, 46 children aged below 12 years were treated for empyema thoracis: Five (10.86% were infants, 22 (47.82% were 1 to 5 years and 19 (41.30% were 6 to 12 years of age. All the patients presented with complaints of cough, fever and breathlessness of variable durations. Twenty three (50% children had history of pneumonia and treatment prior to development of empyema. Thirty five (76.08% children had right-sided and 11 (23.91% had left-sided empyema. Thirty nine (84.78% children were successfully treated with tube thoracostomy, systemic antibiotics and other supportive measures. Seven (15.21% children failed to respond with above and needed decortications. Most commonly isolated bacteria were Pseudomonas (n = 12 and Staphylococcus aureus (n = 7. The average length of hospital stay in patients with tube thoracostomy was 15.35 days, and in patients who needed decortications was 16.28 days following thoracotomy. There was no mortality amongst above treated children. Conclusions: Majority of children with empyema thoracis are manageable with tube thoracostomy, antibiotics, physiotherapy and other supportive treatment. Few of them who fail to above measures need more aggressive management.
Bailey Kerry A
Full Text Available Abstract Background Antiretroviral treatment services delivered in hospital settings in Africa increasingly lack capacity to meet demand and are difficult to access by patients. We evaluate the effectiveness of nurse led primary care based antiretroviral treatment by comparison with usual hospital care in a typical rural sub Saharan African setting. Methods We undertook a prospective, controlled evaluation of planned service change in Lubombo, Swaziland. Clinically stable adults with a CD4 count > 100 and on antiretroviral treatment for at least four weeks at the district hospital were assigned to either nurse led primary care based antiretroviral treatment care or usual hospital care. Assignment depended on the location of the nearest primary care clinic. The main outcome measures were clinic attendance and patient experience. Results Those receiving primary care based treatment were less likely to miss an appointment compared with those continuing to receive hospital care (RR 0·37, p p = 0·001. Those receiving primary care based, nurse led care were more likely to be satisfied in the ability of staff to manage their condition (RR 1·23, p = 0·003. There was no significant difference in loss to follow-up or other health related outcomes in modified intention to treat analysis. Multilevel, multivariable regression identified little inter-cluster variation. Conclusions Clinic attendance and patient experience are better with nurse led primary care based antiretroviral treatment care than with hospital care; health related outcomes appear equally good. This evidence supports efforts of the WHO to scale-up universal access to antiretroviral treatment in sub Saharan Africa.
Unni Alice Dahl
Full Text Available Introduction: Intermediate care is an organisational approach to improve the coordination of health care services between health care levels. In Central Norway an intermediate care hospital was established in a municipality to improve discharge from a general hospital to primary health care. The aim of this study was to investigate how health professionals experienced hospital discharge of elderly patients to primary health care with and without an intermediate care hospital. Methods: A qualitative study with data collected through semi-structured focus groups and individual interviews.Results: Discharge via the intermediate care hospital was contrasted favourably compared to discharge directly from hospital to primary health care. Although increased capacity to receive patients from hospital and prepare them for discharge to primary health care was viewed as a benefit, professionals still requested better communication with the preceding care level concerning further treatment and care for the elderly patients.Conclusions: The intermediate care hospital reduced the coordination challenges during discharge of elderly patients from hospital to primary health care. Nevertheless, the intermediate care was experienced more like an extension of hospital than an included part of primary health care and did not meet the need for communication across care levels.
Unni Alice Dahl
Full Text Available Introduction: Intermediate care is an organisational approach to improve the coordination of health care services between health care levels. In Central Norway an intermediate care hospital was established in a municipality to improve discharge from a general hospital to primary health care. The aim of this study was to investigate how health professionals experienced hospital discharge of elderly patients to primary health care with and without an intermediate care hospital. Methods: A qualitative study with data collected through semi-structured focus groups and individual interviews. Results: Discharge via the intermediate care hospital was contrasted favourably compared to discharge directly from hospital to primary health care. Although increased capacity to receive patients from hospital and prepare them for discharge to primary health care was viewed as a benefit, professionals still requested better communication with the preceding care level concerning further treatment and care for the elderly patients. Conclusions: The intermediate care hospital reduced the coordination challenges during discharge of elderly patients from hospital to primary health care. Nevertheless, the intermediate care was experienced more like an extension of hospital than an included part of primary health care and did not meet the need for communication across care levels.
An, Jeff; Keshavjee, Karim; Mirza, Kashif; Vassanji, Karim; Greiver, Michelle
Healthcare costs are driven by a surprisingly small number of patients. Predicting who is likely to require care in the near future could help reduce costs by pre-empting use of expensive health care resources such as emergency departments and hospitals. We describe the design of an architecture for a joint hospital-primary care data warehouse (JDW) that can monitor the effectiveness of in-hospital interventions in reducing readmissions and predict which patients are most likely to be admitted to hospital in the near future. The design identifies the key governance elements, the architectural principles, the business case, the privacy architecture, future work flows, the IT infrastructure, the data analytics and the high level implementation plan for realization of the JDW. This architecture fills a gap in bridging data from two separate hospital and primary care organizations, not a single managed care entity with multiple locations. The JDW architecture design was well received by the stakeholders engaged and by senior leadership at the hospital and the primary care organization. Future plans include creating a demonstration system and conducting a pilot study.
Øgard, Christina G; Engholm, Gerda; Almdal, Thomas P
The aim of the present study was to determine whether patients with the incident hospital diagnosis of primary hyperparathyroidism (PHPT) in Denmark during the period 1977-1993 had an increased mortality from cardiovascular disease and cancer compared to the rest of the Danish population. In a ra......The aim of the present study was to determine whether patients with the incident hospital diagnosis of primary hyperparathyroidism (PHPT) in Denmark during the period 1977-1993 had an increased mortality from cardiovascular disease and cancer compared to the rest of the Danish population...
Knierim, Kyle; Hall, Tristen; Fernald, Douglas; Staff, Thomas J; Buscaj, Emilie; Allen, Jessica Cornett; Onysko, Mary; Dickinson, W Perry
Most primary care residency training practices have close financial and administrative relationships with teaching hospitals and health systems. Many residency practices have begun integrating the core principles of the patient-centered medical home (PCMH) into clinical workflows and educational experiences. Little is known about how the relationships with hospitals and health systems affect these transformation efforts. Data from the Colorado Residency PCMH Project were analyzed. Results show that teaching hospitals and health systems have significant opportunities to influence residency practices' transformation, particularly in the areas of supporting team-based care, value-based payment reforms, and health information technology.
Mira, José Joaquín; Carrillo, Irene; Lorenzo, Susana; Ferrús, Lena; Silvestre, Carmen; Pérez-Pérez, Pastora; Olivera, Guadalupe; Iglesias, Fuencisla; Zavala, Elena; Maderuelo-Fernández, José Ángel; Vitaller, Julián; Nuño-Solinís, Roberto; Astier, Pilar; ,
Background Adverse events (AEs) cause harm in patients and disturbance for the professionals involved in the event (second victims). This study assessed the impact of AEs in primary care (PC) and hospitals in Spain on second victims. Methods A cross-sectional study was conducted. We carried out a survey based on a random sample of doctors and nurses from PC and hospital settings in Spain. A total of 1087 health professionals responded, 610 from PC and 477 from hospitals. Results A total of 43...
Noreña Peña,Ana Lucía; Cibanal Juan, Luis
The aim of this study is to describe the experience of children in their interactions with nursing professionals while in hospital. It is a qualitative study supported by the critical incident technique. Data was collected through participant observation and semi-structured interviews with thirty hospitalized children and teenagers between 8 and 14 years old. The results showed that children positively valued nursing care at the hospital and recognized that interactions with nursing staff inc...
Sekyia, Shigeru Ricardo; Luz, Talita Ribeiro da
Empirical evidences have pointed out the relevant role of breastfeeding to diminish infantile mortality. Children-friendly Hospitals (IHAC) is a worldwide action developed by the United Nations Children's Fund - UNICEF and by the World Health Organization, aiming to promote, protect and support breastfeeding and also prevent precocious weaning. The aim of the present study is to identify the main organizational changes which occurred in two hospitals, located in the State of Minas Gerais, Brazil that implemented IHAC. The organizational analysis carried out was based upon six perspectives, according to Motta's analytical chart that includes: strategic, structural, cultural, human, technological and political perspectives. A qualitative research was carried out, by using as a data gathering method the semi-structured interview, applied in all hierarchical levels. In order to interpret data, it was adopted the content analysis. In both cases, it could be concluded that the implementation of IHAC resulted in changes and improvement in the management of the organizations, due to the establishment of procedural patterns and staff training. It was verified that the cultural and technological changes occurred in a more intense manner and that the least perceived were the political and strategic changes.
Choo, K E; Razif, A; Ariffin, W A; Sepiah, M; Gururaj, A
A retrospective study of 137 patients with blood culture-positive typhoid fever admitted to the paediatric unit of the Hospital Universiti Sains Malaysia was carried out to study epidemiological, clinical, laboratory and treatment aspects of typhoid fever in Kelantanese children in hospital. The male:female ratio was 1:1.1. School-children were the most affected. Cases were seen throughout the year. The five most frequently presenting features were fever, hepatomegaly, diarrhoea, vomiting and cough. Rose spots were seen in only two patients. Complications included gastritis, bronchitis, ileus, psychosis, encephalopathy, gastro-intestinal bleeding and myocarditis. Relative bradycardia was not seen. Blood and stool cultures were positive in the 1st, 2nd and 3rd weeks of illness. There was no significant difference between percentages of elevated O and H titres, whether done during or after the 1st week of illness. A four-fold rise in (O) titres occurred in 50% of cases tested. We would miss 50% of typhoid fever cases if a titre (O) equal to more than 1/160 were relied upon for diagnosis. Altogether, 46% of patients had leucopenia. Chloramphenicol was the most commonly used antibiotic. There were two deaths.
Carmel, Amanda S; Steel, Peter; Tanouye, Robert; Novikov, Aleksey; Clark, Sunday; Sinha, Sanjai; Tung, Judy
Hospital admissions from the emergency department (ED) now account for approximately 50% of all admissions. Some patients admitted from the ED may not require inpatient care if outpatient care could be optimized. However, access to primary care especially immediately after ED discharge is challenging. Studies have not addressed the extent to which hospital admissions from the ED may be averted with access to rapid (next business day) primary care follow-up. We evaluated the impact of an ED-to-rapid-primary-care protocol on avoidance of hospitalizations in a large, urban medical center. We conducted a retrospective review of patients referred from the ED to primary care (Weill Cornell Internal Medicine Associates - WCIMA) through a rapid-access-to-primary-care program developed at New York-Presbyterian / Weill Cornell Medical Center. Referrals were classified as either an avoided admission or not, and classifications were performed by both emergency physician (EP) and internal medicine physician reviewers. We also collected outcome data on rapid visit completion, ED revisits, hospitalizations and primary care engagement. EPs classified 26 (16%) of referrals for rapid primary care follow-up as avoided admissions. Of the 162 patients referred for rapid follow-up, 118 (73%) arrived for their rapid appointment. There were no differences in rates of ED revisits or subsequent hospitalizations between those who attended the rapid follow-up and those who did not attend. Patients who attended the rapid appointment were significantly more likely to attend at least one subsequent appointment at WCIMA during the six months after the index ED visit [N=55 (47%) vs. N=8 (18%), P=0.001]. A rapid-ED-to-primary-care-access program may allow EPs to avoid admitting patients to the hospital without risking ED revisits or subsequent hospitalizations. This protocol has the potential to save costs over time. A program such as this can also provide a safe and reliable ED discharge option
Full Text Available Background Acute poisoning in children (APC is a preventable cause of pediatric emergency visits. Patterns of acute poisoning in children are different in various regions and times. Objectives The aim of this study was to assess the epidemiology of acute poisoning in children, who were referred to the emergency department of Qods teaching hospital in Qazvin, Iran. Methods In this descriptive, cross-sectional study, all children younger than 13 years old, admitted to the Qods teaching hospital in Qazvin (Iran, were assessed during September 2009 to September 2012. Demographic and clinical symptoms and signs of poisoned cases, poisonous agents and outcome of patients were studied. Results Four hundreds and thirty-four (2.59% of total hospital admission patients with APC were admitted to the emergency department during the study period; 63.36% were male. Overall, 345 (79.5% cases were under 6 years old. Drugs (265 cases were common agents for APC. The ingestion route was responsible in 391 of APC. Methadone, benzodiazepines and kerosene were the most frequent poisonous agents. Neurologic symptoms and signs (256 cases were the most common presentation of APC. Forty-five patients (10.36% were admitted to the PICU. Three deaths (%0.06 occurred with monoxide carbon and methadone poisoning. Monoxide carbon poisoning was the deadliest agent. Conclusions Acute poisoning in children is a serious preventable cause of hospital admissions. It is one of the differential diagnoses in patients with sudden onset of neurological, alimentary, respiratory symptoms and signs, who are visited at the emergency department. Parental awareness and education about keeping potential poisoning agents safely is essential to reduce APC in children.
Full Text Available BACKGROUND: This study was carried out on explanatory purposes to determine psychological compliance state of the children between age group 6-14, receiving education in a primary school province and how common some psychological infancy problems are. METHODS: The samples of the research consist of mothers and teachers of 255 children between age group 6-14, receiving education in a primary school in Sivas province. Personal Information Form and Psychological Compliance Measurement were used in the collection of data. RESULTS: According to the evaluation of teachers it was found out that while %27.5 of the children has psychological compliance problems. According to the evaluation of mothers, it was obtained that only 24.7% of the children has psychological compliance problems. The average compliance points were found higher in boys than girls, in younger age group than older age group, in group having physical disorders than not having any physical disorders. In the research a meaningful difference was not found when the average psychological compliance points and other variables were compared. When infancy psychological compliance problems evaluated, in 2.3% of the children stammer, in 3.1% habit-spasm disorder, in 7% finger sucking, in 1.9% encopresis, in 9% enuresis, and in 19.6 educational failures were determined. When the state of being problematical in behaviors and neurotic compared with the gender, it was traced that behavioral problems were higher in boys (59.5% than girls (40.5% and the neurotic problems were higher in girls (56. 3% than boys (56.3%. CONCLUSION: Consequently, it was recognized that improvement of the services for the psychological care of the children in the society and primary schools is crucially needed. [TAF Prev Med Bull 2008; 7(1.000: 47-52
Full Text Available To analyze the relationship between levels of air pollution and number of children hospitalizations because of respiratory tract infection in Shenmu County, the data regarding meteorological factors, environmental pollutants, that is SO2 and NO2, Particulate Matter 10 (PM10, and hospitalizations of children less than 16 years of age was collected during the time duration of November 2009 to October 2012. Using SAS 9.3, descriptive data analysis for meteorological and environmental factors and hospital admissions were performed along with main air pollutants determination. Using the statistical software R 3.0.1, a generalized additive Poisson regression model was established, the linear fitting models of the air pollutant concentrations and meteorological factors were introduced considering the lag effect, and the relative risk of the main atmospheric pollutants on children hospitalization was evaluated. The results showed that the primary air pollutant in Shenmu County is PM10 and its Pearson correlation coefficient with Air Pollution Index (API is 0.917. After control of long term climate trend, “week day effect,” meteorological factors, and impact of other contaminants, it was found that, on the same day and during the lag of 1 to 10 days, PM10 concentrations had no significant effect on children hospitalization rate.
Heber Silva-Díaz; Olinda Bustamante-Canelo; Franklin-Rómulo Aguilar-Gamboa; Katya Mera-Villasis; Jhonatan Ipanaque-Chozo; Eberth Seclen-Bernabe; Martha Vergara-Espinoza
Objective: To determine the type and frequency of predominant enteropathogens in acute diarrhea and their associated characteristics in children treated at Hospital Regional Lambayeque (HRL) - Peru...
Full Text Available The examination of primary school children to determine the ranking of significant factors that determine the structure of their functional state depending on the level of physical health. It is shown that the main factor in the structure of the functional state of younger schoolchildren in low-and lower-middle level of physical fitness is selected morpho-functional status, which characterizes the functions of the body at rest. For children with average or above average level of physical fitness is a leading factor in physical fitness of schoolchildren.
Yousef A Al-Turki
Conclusions: Complete (severe and partial erectile dysfunction was quite common among adult diabetic patients in a hospital-based primary care setting in Saudi Arabia. It is important for primary care physicians to diagnose erectile dysfunction in diabetic patients, and to counsel them early, as most patients are hesitant to discuss their concern during a consultation. Further studies are recommended to evaluate the effect of other risk factors on erectile dysfunction in diabetic patients.
José Manuel Ramos
Conclusions: Skin problems, mainly scabies, impetigo, and eczema were common in young children attended at a rural hospital in Southern Ethiopia. Children under 5 years should be examined thoroughly to rule out skin diseases, especially scabies.
... Primary Refractory/Recurrent Hodgkin Lymphoma in Children and Adolescents Primary refractory Hodgkin lymphoma is lymphoma that continues ... treated with an adult treatment regimen . Children and adolescents may have treatment-related side effects that appear ...
Iacovelli, Elisa; Tarantino, Samuela; De Ranieri, Cristiana; Vollono, Catello; Galli, Federica; De Luca, Massimiliano; Capuano, Alessandro; Porro, Arianna; Balestri, Martina; Guidetti, Vincenzo; Vigevano, Federico; Biondi, Gianni; Drewes, Asbjoern M; Valeriani, Massimiliano
Neurophysiological studies to evaluate spatial attention in children with primary headache are lacking. Tactile spatial attention modulates the N140 somatosensory evoked potential (SEP) amplitude. The aims of the study are: (1) to investigate the effect of spatial attention on the N140 amplitude in children with migraine and tension-type headache (TTH) and in healthy children, and (2) to correlate the neurophysiological results with a neuropsychological test for spatial attention. We studied 16 patients with migraine without aura (MoA), 12 TTH children and 10 healthy subjects. "Deux Barrage" test for spatial attention was administered. SEPs were recorded in a neutral condition (NC) and in a spatial attention condition (SAC). No significant differences in neuropsychological measures were found between MoA, TTH and healthy subjects. The N140 amplitude increase during SAC, as compared to NC, was significantly higher in patients than in healthy controls. Migraineurs showed a positive correlation between the N140 amplitude increase during SAC and their neuropsychological performance. Although spatial attention performances in children with headache are as good as in controls, the N140 amplitude increase during SAC in headache patients suggests that the psychophysiological mechanisms subtending spatial attention are different from those in healthy children. Copyright © 2011 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.
Adams, Annmarie; Theodore, David
This paper explores more than a century of changing ideas about the health of Canadian children through the architecture of pediatric hospitals in Montreal and Toronto. As a unique source in the history of medicine, hospital architecture reveals three distinct phases in the construction of children as patients. Early 20th-century children's hospitals remained bastions of older spatial attitudes towards health. The postwar hospital was self-consciously modern, with an arrangement more scientific and institutional than its predecessor. Through reference to other typologies, the postmodern hospital marks a curious return to the earlier attitude that children's health is a family affair. Is the hospital a home for children or an institution for science?
Tatiana Gandolfi de Oliveira; Juliana da Silva Bemfeito de Moraes; Flávia Thomé Moreira; Raquel Coris Arrelaro; Viviane Alves Ricardi; José Ricardo Dias Bertagnon; Yara Juliano
ABSTRACT Objective: To evaluate the admission of children aged 0 to 5 years due to respiratory infections at a major hospital in the Southern region of the city of São Paulo. Methods: A total of 4,240 clinical records of children hospitalized and diagnosed with pneumonia, bronchopneumonia, bronchiolitis and bronchitis were evaluated for the 2008-2009 period, based on age, gender and year season. Results: Out of this total of children aged 0 to 60-months, 139 (3.2%) presented with pneumonia...
Rosano, A.; Peschel, P.; Kugler, J.; Zee, J. van der; Ricciardi, W.; Guasticchi, G.
Background: Hospitalization may often be prevented by timely and effective outpatient care. For Italy we found that the type and density of primary-care facilities, among other factors, influence admission rates. However, results from Italy may not be valid for other types of health-care systems, e.
Lecoq, M; Drape, F
The study of 259 children in primary school revealed a prevalence of dysphonia of 10%, often undiagnosed, untreated or considered as benign. It would seem desirable to draw attention to this symptom, which may be an indication of organic pathology or of psychological problems, the early treatment of which may avoid later sequelae. It is sometimes necessary to allow a period for reflection in order to gain the cooperation of the child and his parents.
Full Text Available The authors systematically studied the introduction of animal-assisted activity into a children's hospital in Italy. This pilot study examined the reactions of children, their parents and the hospital staff and the hospital-wide infection rate before and after the introduction of animals. The SAM (self-assessment manikin, three behavioral scales, analysis of children's graphic productions, a parent questionnaire and a staff questionnaire were used to evaluate the effectiveness of the intervention. The children's participation was calculated. The analysis of the hospital infection rate was completed independently by the Hospital Infections Committee. The authors found that the presence of infections in the wards did not increase and the number of children at the meetings with pets in the wards was high (138 children. The study also found that the presence of animals produced some beneficial effects on children: a better perception of the environment and a good interaction with dogs. All parents were in favor of pets in the hospital, and 94% thought that this activity could benefit the child, as did the medical staff, although the staff needed more information about safety. The introduction of pets into the pediatric wards in an Italian children's hospital was a positive event because of the participation of hospitalized patients, the satisfaction expressed by both parents and medical staff, and the fact that the hospital infection rate did not change and no new infections developed after the introduction of dogs.
Moler, Frank W; Silverstein, Faye S; Holubkov, Richard; Slomine, Beth S; Christensen, James R; Nadkarni, Vinay M; Meert, Kathleen L; Clark, Amy E; Browning, Brittan; Pemberton, Victoria L; Page, Kent; Shankaran, Seetha; Hutchison, Jamie S; Newth, Christopher J L; Bennett, Kimberly S; Berger, John T; Topjian, Alexis; Pineda, Jose A; Koch, Joshua D; Schleien, Charles L; Dalton, Heidi J; Ofori-Amanfo, George; Goodman, Denise M; Fink, Ericka L; McQuillen, Patrick; Zimmerman, Jerry J; Thomas, Neal J; van der Jagt, Elise W; Porter, Melissa B; Meyer, Michael T; Harrison, Rick; Pham, Nga; Schwarz, Adam J; Nowak, Jeffrey E; Alten, Jeffrey; Wheeler, Derek S; Bhalala, Utpal S; Lidsky, Karen; Lloyd, Eric; Mathur, Mudit; Shah, Samir; Wu, Theodore; Theodorou, Andreas A; Sanders, Ronald C; Dean, J Michael
Therapeutic hypothermia is recommended for comatose adults after witnessed out-of-hospital cardiac arrest, but data about this intervention in children are limited. We conducted this trial of two targeted temperature interventions at 38 children's hospitals involving children who remained unconscious after out-of-hospital cardiac arrest. Within 6 hours after the return of circulation, comatose patients who were older than 2 days and younger than 18 years of age were randomly assigned to therapeutic hypothermia (target temperature, 33.0°C) or therapeutic normothermia (target temperature, 36.8°C). The primary efficacy outcome, survival at 12 months after cardiac arrest with a Vineland Adaptive Behavior Scales, second edition (VABS-II), score of 70 or higher (on a scale from 20 to 160, with higher scores indicating better function), was evaluated among patients with a VABS-II score of at least 70 before cardiac arrest. A total of 295 patients underwent randomization. Among the 260 patients with data that could be evaluated and who had a VABS-II score of at least 70 before cardiac arrest, there was no significant difference in the primary outcome between the hypothermia group and the normothermia group (20% vs. 12%; relative likelihood, 1.54; 95% confidence interval [CI], 0.86 to 2.76; P=0.14). Among all the patients with data that could be evaluated, the change in the VABS-II score from baseline to 12 months was not significantly different (P=0.13) and 1-year survival was similar (38% in the hypothermia group vs. 29% in the normothermia group; relative likelihood, 1.29; 95% CI, 0.93 to 1.79; P=0.13). The groups had similar incidences of infection and serious arrhythmias, as well as similar use of blood products and 28-day mortality. In comatose children who survived out-of-hospital cardiac arrest, therapeutic hypothermia, as compared with therapeutic normothermia, did not confer a significant benefit in survival with a good functional outcome at 1 year. (Funded by
Ensing, Hendrik T; Koster, Ellen S; Stuijt, Clementine C M; van Dooren, Ad A; Bouvy, Marcel L
Bridging the gap between hospital and primary care is important as transition from one healthcare setting to another increases the risk on drug-related problems and consequent readmissions. To reduce those risks, pharmacist interventions during and after hospitalization have been frequently studied, albeit with variable effects. Therefore, in this manuscript we propose a three phase approach to structurally address post-discharge drug-related problems. First, hospitals need to transfer up-todate medication information to community pharmacists. Second, the key phase of this approach consists of adequate follow-up at the patients' home. Pharmacists need to apply their clinical and communication skills to identify and analyze drug-related problems. Finally, to prevent and solve identified drug related problems a close collaboration within the primary care setting between pharmacists and general practitioners is of utmost importance. It is expected that such an approach results in improved quality of care and improved patient safety.
Tania Cristina Morais Santa Barbara Rehem
Full Text Available The aim of this study is to analyze and understand the reasons for the occurrence of sensitive hospitalizations in accordance with users. Qualitative study conducted with users who were admitted to Pedreira General Hospital, in São Paulo. The data was collected through semi structured interviews and thereafter, transcribed and processed in the electronic program Alceste. When analyzing the content, the access was seized fundamentally as an empirical category, bringing up problems that later deserved, from the Brazilian Ministry of Health, a specific Program to improve the quality and access to primary care. The hierarchical and pyramidal organization shape from the health system in the city of São Paulo can be one of the important aspects for the access matter and established as an important restricting factor in the primary care role in reducing or even preventing the occurrence of these hospitalizations.
Ebert, Kerry Danahy; Rentmeester-Disher, Jill; Kohnert, Kathryn
Substantial evidence points to the presence of subtle weaknesses in the nonlinguistic cognitive processing skills of children with primary (or specific) language impairment (PLI). It is possible that these weaknesses contribute to the language learning difficulties that characterize PLI, and that treating them can improve language skills. To test this premise, we treated two nonlinguistic cognitive processing skills, processing speed and sustained selective attention, in two Spanish-English bilingual children with PLI. The study followed a single-subject multiple baseline design, with both repeated measures and standardized pre- and post-testing as outcome measures. Results from the repeated measures tasks showed that both participants made gains in nonlinguistic cognitive processing skills as well as in Spanish and English. These results both replicate and extend prior work showing that nonlinguistic cognitive processing treatment can positively affect language skills in children with PLI.
Xu Yufeng; Wang Jichen [Department of Radiology, Peking University First Hospital, No. 8, Xishike Street, Xicheng District, Beijing 100034 (China); Peng Yun [Imaging Center, Beijing Children' s Hospital Affiliated to Capital Medical University, 56, Nanlishi Road, Xicheng District, Beijing 100045 (China); Zeng Jinjin, E-mail: firstname.lastname@example.org [Imaging Center, Beijing Children' s Hospital Affiliated to Capital Medical University, 56, Nanlishi Road, Xicheng District, Beijing 100045 (China)
Primary retroperitoneal neoplasms are uncommon in children. Retroperitoneal neoplasms are either mesodermal, neurogenic, germ cell ectodermal or lymphatic in origin. In general, primary retroperitoneal neoplasms in children have different spectrum and prevalence compared to those in adults. Neuroblastoma, rhabdomyosarcoma, benign teratoma and lymphoma are the common retroperitoneal neoplasms. In this review, the clinical and CT futures of common retroperitoneal neoplasms in children are described. Coarse, amorphous, and mottled calcification are very common in neuroblastoma. Paraganglioma tends to show marked and early enhancement and may present with clinical symptoms associated with the excess catecholamine. Sarcomas are often very large and have heterogeneous appearance. Imaging cannot be reliably used to identify the type of retroperitoneal sarcomas due to overlapped radiographic features. In children, lipoblastoma is the most common lipomatous tumor in the retroperitoneum. The percentage of visible fat in tumor varies depending on the cellular composition of the lesion. The CT characteristics of teratoma are quite variable, which may be cystic, solid, on a combination of both. Typically teratoma appears as a large complex mass containing fluid, fat, fat-fluid level, and calcifications. Lymphoma is often homogeneous on both enhanced and unenhanced CT scans. Necrosis and calcification are rare on CT. In conclusion, making a final histological diagnosis of retroperitoneal tumor base on CT features is not often possible; however, CT can help to develop a differential diagnosis and determine the size and extent of the retroperitoneal neoplasms.
Full Text Available Introduction: Enuresis is defined as the repeated voiding of urine into clothes or bed at least twice a week for at least 3 consecutive months in a child who is at least 5 years of age. The behavior is not due exclusively to the direct physiologic effect of a substance or a general medical condition. Diurnal enuresis defines wetting, whereas awake and nocturnal enuresis refers to voiding during sleep. Primary enuresis occurs in children who have never been consistently dry through the night, whereas secondary enuresis refers the resumption of wetting after at least 6 months of dryness. Monosymptomatic enuresis has no associated daytime symptoms, and nonmonosymptomatic enuresis, which is more common, often has at least one subtle daytime symptom. Monosymptomatic enuresis is rarely associated with significant organic underlying abnormalities. Obsessive–compulsive disorder (OCD is a chronic disabling illness characterized by repetitive, ritualistic behaviors over which the patients have little or no control. The purpose of this study was to investigate the relationship between OCD and nonmonosymptomatic nocturnal enuresis (NMNE. Materials and Methods: In this case–control study, we evaluated 186 children aged 6–17 years old who were visited in the pediatric clinics of Amir Kabir Hospital, Arak, Iran. The control group included 93 healthy children, and the case group included 93 age- and sex-matched children with stage 1–3 chronic kidney disease (CKD. Then, the children's behavioral status was evaluated using the Children's Yale-Brown Obsessive–Compulsive Scale. Results: The difference in compulsion was significant (P = 0.021, whereas the difference in obsession was significant between the two groups (P = 0.013. The most common symptom in CKD children with compulsion was silent repetition of words. Conclusion: Compulsive and obsessive are more common in NMNE versus healthy children. The observed correlation between compulsive-obsessive and
Background In 1998, a process of centralisation was initiated for services for children born with a cleft lip or palate in the UK. We studied the timing of this process in England according to its impact on the number of hospitals and surgeons involved in primary surgical repairs. Methods All live born patients with a cleft lip and/or palate born between April 1997 and December 2008 were identified in Hospital Episode Statistics, the database of admissions to English National Health Service hospitals. Children were included if they had diagnostic codes for a cleft as well as procedure codes for a primary surgical cleft repair. Children with codes indicating additional congenital anomalies or syndromes were excluded as their additional problems could have determined when and where they were treated. Results We identified 10,892 children with a cleft. 21.0% were excluded because of additional anomalies or syndromes. Of the remaining 8,606 patients, 30.4% had a surgical lip repair only, 41.7% a palate repair only, and 28.0% both a lip and palate repair. The number of hospitals that carried out these primary repairs reduced from 49 in 1997 to 13, with 11 of these performing repairs on at least 40 children born in 2008. The number of surgeons responsible for repairs reduced from 98 to 26, with 22 performing repairs on at least 20 children born in 2008. In the same period, average length of hospital stay reduced from 3.8 to 3.0 days for primary lip repairs, from 3.8 to 3.3 days for primary palate repairs, and from 4.6 to 2.6 days for combined repairs with no evidence for a change in emergency readmission rates. The speed of centralisation varied with the earliest of the nine regions completing it in 2001 and the last in 2007. Conclusions Between 1998 and 2007, cleft services in England were centralised. According to a survey among patients’ parents, the quality of cleft care improved in the same period. Surgical care became more consistent with current
Fitzsimons Kate J
Full Text Available Abstract Background In 1998, a process of centralisation was initiated for services for children born with a cleft lip or palate in the UK. We studied the timing of this process in England according to its impact on the number of hospitals and surgeons involved in primary surgical repairs. Methods All live born patients with a cleft lip and/or palate born between April 1997 and December 2008 were identified in Hospital Episode Statistics, the database of admissions to English National Health Service hospitals. Children were included if they had diagnostic codes for a cleft as well as procedure codes for a primary surgical cleft repair. Children with codes indicating additional congenital anomalies or syndromes were excluded as their additional problems could have determined when and where they were treated. Results We identified 10,892 children with a cleft. 21.0% were excluded because of additional anomalies or syndromes. Of the remaining 8,606 patients, 30.4% had a surgical lip repair only, 41.7% a palate repair only, and 28.0% both a lip and palate repair. The number of hospitals that carried out these primary repairs reduced from 49 in 1997 to 13, with 11 of these performing repairs on at least 40 children born in 2008. The number of surgeons responsible for repairs reduced from 98 to 26, with 22 performing repairs on at least 20 children born in 2008. In the same period, average length of hospital stay reduced from 3.8 to 3.0 days for primary lip repairs, from 3.8 to 3.3 days for primary palate repairs, and from 4.6 to 2.6 days for combined repairs with no evidence for a change in emergency readmission rates. The speed of centralisation varied with the earliest of the nine regions completing it in 2001 and the last in 2007. Conclusions Between 1998 and 2007, cleft services in England were centralised. According to a survey among patients’ parents, the quality of cleft care improved in the same period. Surgical care became more
Harambat, Jérôme; van Stralen, Karlijn J; Espinosa, Laura;
Primary hyperoxaluria (PH) as a cause of ESRD in children is believed to have poor outcomes. Data on management and outcomes of these children remain scarce.......Primary hyperoxaluria (PH) as a cause of ESRD in children is believed to have poor outcomes. Data on management and outcomes of these children remain scarce....
Full Text Available OBJECTIVE: Children with Down syndrome, the most common genetic cause of intellectual disability, are prone to multiple and varied health-related problems. This study describes patterns of hospitalisations for children and young people with Down syndrome in Western Australia. METHODS: Birth records were linked to the Western Australian population-based Intellectual Disability database to identify all children born with Down syndrome in Western Australia between 1 January, 1983 and 31 December, 1999. These records were linked to the Hospital Morbidity Data System to provide information on all hospitalisations up to 31 December, 2004. Hospitalisation data, coded using ICD-9CM or ICD-10 (v0.5 were grouped into clinically relevant categories using the primary diagnosis. Rates of hospital admission for all and specific diagnoses were expressed in 1000-person-years at-risk and median age at first admission and length of stay were calculated. RESULTS: Of the 405 children, 395 had one or more hospital admissions, totalling 3786 admissions for all children and an estimated 39.5 person-years in hospital. On average, children were admitted 9.7 times, with an estimated rate of 757.2 admissions per 1000pyr (95% CI: 680, 843. A quarter of all admissions occurred in the first year of life. The average hospital length of stay was 3.8 days (95% CI: 3.7, 4.1. Upper respiratory tract conditions affected the most children (58.5% and accounted for 12.1% of all admissions. Other disorders which affected a high percentage of children were ear/hearing conditions (50.6%, disorders of the oral cavity (38.0% and lower respiratory tract conditions (37.5%. Overall, children with Down syndrome were hospitalised at a rate five times (95% CI = 4.3-6.2 that of the general population. CONCLUSION: Children with Down syndrome are at increased risk of morbidity for varied causes underlining the importance of comprehensive and targeted primary care for this group.
Kamperis, Konstantinos; Hagstrøm, Søren; Rittig, Søren
PURPOSE: We investigated the role of urinary Ca excretion in monosymptomatic nocturnal enuresis, and defined normality and intra-individual variability in Ca excretion in healthy children. MATERIALS AND METHODS: We included 46 Danish children with desmopressin resistant nocturnal enuresis and 96...... healthy controls. We performed fractional urine collections at home during 2 days in controls or during hospitalization in children with enuresis. Urine volume, osmolality, and Ca and creatinine measurements were performed and Ca-to-creatinine ratios were calculated and compared between groups. Based...... on nocturnal urine output children with enuresis were characterized as having polyuria (nocturnal urine volume greater than 130% of expected bladder capacity) or not having polyuria. RESULTS: We did not find any differences in controls compared with children with enuresis who did not and did have nocturnal...
Angela Cristina Pontes
Full Text Available Objective: Epilepsy is the most frequent diagnosis in the ward;due to the high degree of complexity of its investigation andtreatment, the objective of this work was to proceed to an analysisof the interventions of the team with hospitalized epileptic childrenand their families. Methods: The data were obtained from theclinical handbooks and individual registers of the specialties.Results: There were 235 elective admissions, 88 regarding theEpilepsy. The services for specialties were distributed among those88 epileptic children: physiotherapy (34%, psychology (41% andoccupational therapy (88.6%. Conclusion: Given the severity ofthe social and biological sequelae associated with the diagnosisof epilepsy and the need for a family intervention, themultidisciplinary work focused on the child, in stimulationinterventions and promotion of his/her development, with a viewto minimize the sequelae; and providing the family with orientationand support, in order to give them more elaborate strategies forcoping with the disease and improve conditions for supplying postdischargeinfant treatment.
Else Mari Ruberg Ekra
Full Text Available The impact of a hospital environment on children has rarely been investigated. Recently, however, the perspective of hospitalized children has been taken into account. Being hospitalized and facing an illness represent a dramatic change in a child's daily life, and the quality of the environment may influence the child's experiences. The aim of this study was to investigate the experiences of children being hospitalized with newly diagnosed type 1 diabetes and to obtain an increased understanding of the environmental influences on the children's lifeworld. The study used a hermeneutic phenomenological approach. The design is a combination of observation of the participant, interviews, and photographs. Nine children, aged between 7 and 12 years, participated in the study. The data were collected between October 2008 and February 2010 and analysed in accordance with thematic analysis as described by van Manen. The children experienced change through recognition and adaptation. They perceived the environment as strange but still comfortable because of the “child-friendly” atmosphere, close contact with their relatives, and access to private space. The children were gradually able to adapt to their new life; they perceived their illness through bodily changes and developed practical skills and understanding. The findings underscored the necessity for an emphasis on the mutual relationship between the body and its environment. Bodily changes that occur during illness may lead to changes in one's perception of the environment. Children seem to be particularly affected when the body appears alien and the hospital environment is unfamiliar. A well-adapted environment, active involvement, and the incorporation of new habits are significant elements of gradually returning to a more familiar life. However, the child's new life requires alertness to the body's signals and acclimation to a demanding diabetes treatment regime. All these factors remind
The Morphology of the Primary Dental Arch of Chinese Children in Shijiazhuang-City Part-I: Research concerning the size of the primary tooth crown, primary dental arch and the condition of primary occlusion
岩崎, 浩; 林, 于昉; 宮沢, 裕夫; 宮崎, 顕道; 須澤, 弥生子; 張, 暁燕; 李, 憲起; 徐, 兵; 海, 懐麗; 張, 英懐; 廉, 雲敏; 牛, 夢勇; 王, 躍進; 蘇, 強; 小林, 茂夫
The purpose of this study was to investigate the size of the primary tooth crowns, primary dental arches, standard values and frequency distribution of primary occlusion in Chinese children. With the cooperation of a kindergarten in Shijiazhuang-city, China, the dental plasters from 55 children (36 boys and 19 girls, age range from 3-6 years old) with normal primary occlusion were collected. Because of different growth rates of the children, these children were divided into two groups, one co...
Chavhan, Govind B.; Babyn, Paul S.; Manson, David E. [The Hospital for Sick Children, Department of Diagnostic Imaging, Toronto (Canada); Roberts, Eve [The Hospital for Sick Children, Department of Gastroenterology, Toronto (Canada); Moineddin, Rahim [University of Toronto, Department of Family and Community Medicine, Toronto (Canada)
Even when histologic findings are highly suggestive of primary sclerosing cholangitis (PSC), cholangiographic correlation is required for the diagnosis. The present gold standard, endoscopic retrograde cholangiopancreatography (ERCP), is invasive and associated with complications. To evaluate the usefulness of magnetic resonance cholangiopancreatography (MRCP) in diagnosing PSC in children. MRCP studies were retrospectively reviewed in 20 children with clinical suspicion of PSC and who had undergone liver biopsy. MRCP studies were considered positive or negative for PSC depending on the presence or absence of dilatation, irregularity, multifocal strictures and beading of the bile ducts. Twenty children (14 boys, 6 girls) with an average age of 13 years qualified for the study. Of 19 diagnostic MRCP studies, 16 were called positive and 3 were called negative. An overall diagnosis of PSC-positive was assigned to all 19 patients based on clinical and laboratory findings, biopsy results and cholangiographic data. Based on this overall diagnosis, MRCP was 84% sensitive and accurate to diagnose PSC in children. MRCP can be a valuable tool in diagnosing pediatric PSC that can demonstrate major intra- and extrahepatic ducts in most cases. An unequivocally positive MRCP study should not be followed by ERCP for diagnosing PSC in children. (orig.)
Adamson, Adewole S; Suarez, Elizabeth A; Gorman, April R
Prescription underuse is associated with poorer clinical outcomes. A significant proportion of underuse is owing to primary nonadherence, defined as the rate at which patients fail to fill and pick up new prescriptions. Although electronic prescribing increases coordination of care and decreases errors, its effect on primary nonadherence is less certain. To analyze factors associated with primary nonadherence to dermatologic medications and study whether electronic prescribing affects rates of primary nonadherence. A retrospective review of medical records was conducted from January 1, 2011, to December 31, 2013, among a cohort of new patients prescribed dermatologic medications at a single, urban, safety-net hospital outpatient dermatology clinic. The primary outcome was the overall rate of primary nonadherence, defined as filling and picking up all prescribed medications within a 1-year period, and the difference in primary nonadherence between patients who received electronic prescriptions and those who received paper prescriptions. Secondary outcomes included the association of primary nonadherence with sex, age, relationship status, primary language, race/ethnicity, and number of prescriptions. A total of 4318 prescriptions were written for 2496 patients (mean [SD] age, 47.7 [13.2] years; 849 men and 1647 women). The overall rate of primary nonadherence was 31.6% (n = 788). Based on multivariable analysis, the risk of primary nonadherence was 16 percentage points lower among patients given an electronic prescription (15.2%) than patients given a paper prescription (31.5%). Primary nonadherence decreased with age (<30 y, 38.9%; 30-49 y, 35.3%; and 50-69 y, 26.3%), and then increased in elderly patients 70 years and older (31.9%). Of patients who were given 1, 2, 3, 4, or 5 prescriptions, rates of primary nonadherence were 33.1%, 28.8%, 26.4%, 39.8%, and 38.1%, respectively. Primary nonadherence decreased with age but then increased in elderly patients
Uchiyama, Takeshi; Yamashita, Yukari; Susami, Takafumi; Kochi, Shoko; Suzuki, Shigehiko; Takagi, Ritsuo; Tachimura, Takashi; Nakano, Yoko; Shibui, Takeo; Michi, Ken-ichi; Nishio, Juntaro; Hata, Yuiro
To investigate current trends in primary treatment for children with cleft lip and/or cleft palate in Japan. Nationwide, retrospective study under the direction of the Academic Survey Committee of the Japanese Cleft Palate Association based on analysis of data obtained via a booklet-style questionnaire completed by institutions providing primary treatment for cleft lip and/or palate patients. PARTICIPANTS, PATIENTS: Patients were 4349 children undergoing primary repair for cleft lip and/or palate at 107 participating institutions between 1996 and 2000. Cleft type, laterality; use of infant palatal plate; and timing and technique of primary repair for cleft lip and/or palate were evaluated by cleft surgeons at 107 participating institutions. Of a total of 2874 patients with cleft lip and palate or cleft palate only, infant palatal plates were used with 1087 (37.8%) and were not used with 1787 (62.2%). Primary unilateral lip repair was performed at the age of 2 to 6 months in more than 90% of patients. Bilateral cleft lip was treated by one-stage repair in 285 patients (44.5%) and by two-stage repair in 258 (40.2%). Primary one-stage palatal repair was performed in 2212 (76.9%) and two-stage palatal repair in 262 (9.1%) cleft palate patients. Information on treatment of the remaining 400 (14%) patients was unavailable. This investigation clarified current trends in primary treatment for cleft lip and/or palate in Japan. The results suggest the need for an increase in regional core hospitals and greater variation in treatment options.
Sodemann, Morten; Veirum, Jens Erik; Biai, S
During a recent armed conflict in Guinea-Bissau, we observed a marked decline in the case fatality among hospitalized children at the only paediatric department in the country.......During a recent armed conflict in Guinea-Bissau, we observed a marked decline in the case fatality among hospitalized children at the only paediatric department in the country....
Rager, Rhiannon Y.
Children with emotional and behavioral disorders often present with significant impairments in social, emotional, and academic functioning. For those with the most severe impairments, hospitalization is an essential intervention. Prior to releasing children from the hospital, a discharge plan is typically created in order to facilitate successful…
Rager, Rhiannon Y.
Children with emotional and behavioral disorders often present with significant impairments in social, emotional, and academic functioning. For those with the most severe impairments, hospitalization is an essential intervention. Prior to releasing children from the hospital, a discharge plan is typically created in order to facilitate successful…
Wynn, Barbara O.; Kawata, Jennifer
This study analyzed issues related to estimating indirect medical education costs specific to pediatric discharges. The Children's Hospital Graduate Medical Education (CHGNE) program was established to support graduate medical education in children's hospitals. This provision authorizes payments for both direct and indirect medical education…
Ichihara, Maria Yury T; Rodrigues, Laura C; Santos, Carlos A S T; Teixeira, Maria da Glória L C; Barreto, Mauricio L
Rotavirus has been the leading cause of severe cases of acute diarrhoea (AD) among children worldwide; however, in the same areas, a large reduction in AD related to rotavirus has been observed after the introduction of the rotavirus vaccine. In Brazil, where there is a high rotavirus vaccine coverage, AD caused by pathogens other than rotavirus is still a frequent cause of outpatient visits and hospitalisations among children under 5 years. A hospital-based case-control study enrolled children aged 4 to 24 months admitted to 10 hospitals from all five Brazilian Regions. Cases (n=1178) were children admitted with diarrhoea who tested negative for rotavirus in a stool sample. Controls (n=2515) were children admitted without diarrhoea, frequency matched to cases by sex and age group. We estimated odds ratios using logistic regression, in a hierarchical approach according to a previously defined conceptual framework. Population-attributable fractions (PAF) were estimated for each variable, each block and for all significant variables in the latter model adjusted. The factors studied accounted for 41% of the non-rotavirus AD hospital admissions and the main risk factors included lack of adequate excreta disposal (PAF=12%), untreated drinking water (PAF=11%) and a history of previous hospitalization due to AD (PAF=21%). Low socio-economic conditions, no public water supply, crowding and low weight-for-age made smaller contributions. These findings further our knowledge of risk factors associated with severe AD in the post-rotavirus vaccination era. We recommend further increase in coverage of basic sanitation, improvements in water quality and further expansion of primary healthcare coverage to reduce the occurrence of non-rotavirus severe diarrhoea and subsequent hospitalization of Brazilian children. © The Author 2015. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e
Legovic, M; Mady, L
This purpose of this research was to examine the stability of normal occlusion during the transition from primary to permanent dentition. The sample consisted of 128 children (83 boys and 45 girls) 4.5 to 5.5 years old with normal occlusion in the primary dentition. The subjects were reexamined at 12.5 to 13.5 years. None had received orthodontic treatment. Although all the subjects had normal occlusion in the primary dentition, 72.7% (73.5% boys and 71.1% girls) had developed anomalies following eruption of the permanent teeth. These anomalies included crowding, Class II Division 1 or Class II Division 2 malocclusion, mesial occlusion complex, lateral crossbite, anterior crossbite, premature tooth loss, openbite or other anomalies.
Ciofi Degli Atti, M L; Serino, L; Piga, S; Tozzi, A E; Raponi, M
Surgical Site Infections (SSIs) account for 16-34% of all health-care associated infections. This study aimed to assess the incidence rate of SSIs in children who underwent surgical procedures in an academic children's hospital in Italy. Prospective cohort study. We actively followed-up 0-17 year old children at 30 days of surgical procedures without implants conducted during one index week per quarter, from the second quarter of 2014, to the first quarter of 2016 (8 index weeks in total). Follow up data were collected by telephone interview, or derived by clinical records if patients were still hospitalized. SSIs were defined according to case definitions of Centers for Diseases Control, Atlanta, USA. We calculated cumulative incidence of SSIs per 100 surgical procedures, by patient characteristics, procedure characteristics, and quarter. To investigate variables associated with SSIs, we compared characteristics of procedures with SSIs with those of procedures without SSIs. Over the study period, SSI incidence was 1.0% (19 cases/1,830 surgical procedures). SSI incidence was significantly lower after ear, nose and throat procedures compared to all other procedures, and significantly decreased over time. Duration of surgery was a risk factor for SSIs; patients with SSIs had a significantly longer total length of stay (LOS), due to a prolonged post-operative LOS. As reported in adults, this study confirms that SSIs are associated with longer hospitalizations in children. Active surveillance of SSIs is an important component of the overall strategy to reduce the incidence of these infections in children.
Yoon, Jean; Rose, Danielle E; Canelo, Ismelda; Upadhyay, Anjali S; Schectman, Gordon; Stark, Richard; Rubenstein, Lisa V; Yano, Elizabeth M
As the Veterans Health Administration (VHA) reorganizes providers into the patient-centered medical home, questions remain whether this model of care can demonstrate improved patient outcomes and cost savings. We measured adoption of medical home features by VHA primary care clinics prior to widespread implementation of the patient-centered medical home and examined if they were associated with lower risk and costs of potentially avoidable hospitalizations. Secondary patient data was linked to clinic administrative and survey data. Patient and clinic factors in the baseline year (FY2009) were used to predict patient outcomes in the follow-up year. 2,853,030 patients from 814 VHA primary care clinics Patient outcomes were measured by hospitalizations for an ambulatory care sensitive condition (ACSC) and their costs and identified through diagnosis and procedure codes from inpatient records. Clinic adoption of medical home features was obtained from the American College of Physicians Medical Home Builder®. The overall mean home builder score in the study clinics was 88 (SD = 13) or 69%. In adjusted analyses an increase of 10 points in the medical home adoption score in a clinic decreased the odds of an ACSC hospitalization for patients by 3% (P = 0.032). By component, higher access and scheduling (P = 0.004) and care coordination and transitions (P = 0.020) component scores were related to lower risk of an ACSC hospitalization, and higher population management was related to higher risk (P = 0.023). Total medical home features was not related to ACSC hospitalization costs among patients with at least one (P = 0.074). Greater adoption of medical home features by VHA primary care clinics was found to be significantly associated with lower risk of avoidable hospitalizations with access and scheduling and care coordination/transitions in care as key factors.
Tener, Dafna; Ofir, Shoshi; Lev-Wiesel, Rachel; Franco, Nessia L; On, Avi
This qualitative study examined the subjective experience of children undergoing an invasive examination in the hospital when accompanied by a medical clown. In-depth semi-structured interviews were conducted with nine such children and nine of their accompanying parents. The children were patients in two outpatient departments (Pediatric Gastroenterology and a Center for the Sexually Abused) in a hospital in Israel. Interviews were coded thematically using an Atlas.ti software program. Analysis of the interviews indicated that the intervention of the clown positively changed the children's perceptions of the hospital, of experiencing the examination, and of their life narrative. Medical clowns thus appear to be a central, meaningful, and therapeutic source for children undergoing invasive examinations in hospital, as well as for their parents. Therefore, it may be advisable to incorporate medical clowns as an integral part of medical teams performing invasive procedures and to include the clowns in all stages of the hospital visit.
Norton, Julie; Raciti, Maria M
Issues addressed: This research explored primary caregivers' awareness of food neophobia and how food preferences develop in young children aged between 1 and 2.5 years. Methods: This qualitative study used case study methodology and comprised interviews with 24 primary caregivers of young children aged between 1 and 2.5 years. Results and conclusions: Primary caregivers of young children are unaware of food neophobia and food preference development in young children. So what? Raising primary caregivers' awareness of food neophobia and how food preferences develop in young children may encourage caregivers to decrease their children's exposure to non-core foods.
Full Text Available Consensus regarding management of pyogenic liver abscess (PLA among children is yet to emerge, and documentation on these subjects is scanty. Eighteen cases of PLA admitted at Children’s Medical Center in Tehran, Iran, over a 15 year period were analyzed to document the clinical profile and to evaluate the management of PLA among children. Records of all patients were reviewed for presenting signs and symptoms, any associated condition, investigative results, management, and follow–up findings. The overall rate of PLA was 48.9 per 100,000 pediatric admissions in our hospital. Moderate to severe malnutrition was present in five (27.8% and ascariasis in seven (38.9% children. Common presentations were fever (100%, abdominal pain (76.9%, and tender hepatomegaly (83.3%. Fourteen patients (77.8% had solitary liver abscess. Organism was isolated in 11 cases (63.3%, and staphylococcus aureus was the commonest isolate (66.7%.Twelve cases were managed conservatively with antibiotics alone, of these only two (16.7% required drainage later. Percutaneous aspiration was also undertaken in four additional (22.2% cases and open drainage in two (11.1%, at presentation. The overall mortality rate was 11.1%. Time taken for complete resolution ranged from 10 to 40 days. Altogether, we conclude that any child presenting with fever, abdominal pain, and tender hepatomegaly should be subjected to ultrasound scan for early detection of PLA. It seems that a combination of cloxacillin and gentamicin or a third generation cephalosporine and gentamicin, especially in infants, is a satistactory initial coverage. Therapeutic drainage is not an obligation in all cases of PLA. When required, percutaneous needle aspiration is safe and effective. Resolution and significant reduction in mortality has been made possible by early detection and appropriate antibiotic therapy.
Macedo, Isabela Fornerolli de; Souza, Tania Vignuda de; Oliveira, Isabel Cristina Dos Santos; Cibreiros, Sylvia Alves; Morais, Rita de Cássia Melão de; Vieira, Rosana Fidelis Coelho
to describe nursing team care and discuss the nursing team's conception of companion families of hospitalized children. The study was based on the theoretical framework of Collière's theory of nursing care identity. this was a qualitative study with 14 members of a nursing team, conducted through an unstructured group interview. Thematic data analysis was employed. habitual and repair care was delegated to families, regardless of the child's clinical condition. the team's official discourse about the families of hospitalized children, as recommended by the literature, refers to the family's alterity and participation in care provision, with sights on discharge and defending family participation as beneficial to children. In practice, however, the nursing staff makes concessions about the presence of chaperoning families and delegates care. descrever os cuidados da equipe de enfermagem e discutir as concepções da equipe de enfermagem frente à família acompanhante da criança hospitalizada. O referencial teórico está vinculado à identidade do cuidado de enfermagem de Collière. Estudo qualitativo com quatorze membros da equipe de enfermagem, utilizando a técnica de entrevista não diretiva em grupo. Foi realizada análise temática dos dados. os cuidados habituais e de reparação prestados à criança estão sendo delegados à família, independentemente da situação clínica da criança. o discurso oficial da equipe de enfermagem frente à família acompanhante da criança hospitalizada, preconizado pela literatura, refere-se à alteridade e à participação da família nos cuidados à criança, prevendo sua alta e justificando a participação como benéfica para a criança. Em contrapartida, na prática, a enfermagem faz concessões sobre a permanência da família e delega os cuidados.
Full Text Available Background. The treatment of acute coronary syndrome (ACS with ST-segment elevation with primary percutaneous transluminal coronary angioplasty (PTCA is the best way to treat these patients. Primary PTCA is also practicable with patients who are admitted into institution without catheter laboratory. The transport of patients into the tertiary institution is safe, but it is important to keep the time of ischemia as short as possible and to reach the time interval of door-balloon as recommended by the guidelines. The ACS patients with ST-segment elevation that were directed into General Hospital Novo mesto after examination at the internistic emergency department have been redirected to KC Ljubljana for realization of PTCA since October 2001.Methods. A prospective analysis of patients with ACS with STsegment elevation, who had been transferred from General Hospital Novo mesto to KC Ljubljana in the period from January 1, 2002 to December 31, 2002 to have a primary PTCA, was performed. The analysis comprised the following: the time interval of handling the patients at Internistic department of General Hospital Novo mesto, the time of transport of patients to Ljubljana and total time interval from the arrival of patients to General Hospital Novo mesto to the first inflation of balloon in Ljubljana. We monitored the complications that occurred during the treatment of the patients.Results. In the above mentioned period 29 patients (24 males and 5 females were transported from the General Hospital Novo mesto to the KC Ljubljana to have a primary PTCA performed. The total time interval measured between the patients’ arrival to General Hospital Novo mesto to the first inflation of balloon in Ljubljana in the year 2002 was 145 minutes, which is 17 minutes better than in the previous period. The time interval recommended by the guidelines was achieved with four patients.Conclusions. By recognizing the problems that had encountered with directing the
Valiani, Vincenzo; Gao, Shiyao; Chen, Zhiguo; Swami, Sunil; Harle, Christopher A.; Lipori, Gigi; Sourdet, Sandrine; Wu, Samuel; Nayfield, Susan G.; Sabbá, Carlo; Pahor, Marco; Manini, Todd M.
Objectives To examine the relationship between primary diagnoses and mobility impairment and recovery among hospitalized older adults. Design Prospective cohort study. Setting UF Health Shands Hospital, an 852-bed level I trauma center located in Gainesville, Florida. Participants 18,551 older adults (≥65 years) with 29,148 hospitalizations between 1/2009 and 4/2014. Measurements Incident and discharge mobility impairment and recovery were assessed using the Braden activity subscale score that was recorded by the nursing staff at every shift change–approximately three times per day. Primary diagnosis ICD-9 codes were used as predictors and re-categorized by using the Agency for Health Care Research and Quality Clinical Classification Software. Results Out of the 15,498 hospital records where the patient was initially observed to “walk frequently”, 3,186 (20.6%) developed incident mobility impairment (chair-fast or bedfast). Primary diagnoses with a surgical or invasive procedure were the most prevalent (77.2 %) among the hospital observations with incident mobility impairment; otherwise primary diagnoses without surgery were much more associated with discharge mobility impairment (59%). The highest incidence of mobility impairment occurred in patients with heart valve disorders and aortic and peripheral/visceral artery aneurysms (6.24 and 6.05 events per 30 person-days, respectively); septicemia showed the highest incidence rate for mobility limitation at discharge (0.94 events per 30 person-days). Mobility impairment was observed in 13,650 (46.8% of total) records at admission and 5,930 (43.44%) were observed to recover to a state of walking occasionally or frequently. Osteoarthritis and cancer of gastrointestinal organs/peritoneum had the highest incidence rate for mobility recovery (7.68 and 5.63 events per 30 person-days respectively). Conclusions Approximately 1 out of 5 patients who were mobile at admission became significantly impaired during
Mda, Siyazi; van Raaij, Joop M A; MacIntyre, Una E; de Villiers, François P R; Kok, Frans J
Human immunodeficiency virus (HIV)-infected children generally show poor growth. Episodes of diarrhoea and pneumonia in HIV-infected children are thought to be more severe than in HIV-uninfected children. The objective of this study was to compare duration of hospitalization, appetite and nutritional status of HIV-infected children with that of uninfected children. A cross-sectional study was performed on children (2-24 months) admitted with diarrhoea or pneumonia to the university hospital. Children were tested for HIV, and the duration of hospitalization was noted for 189 children. Follow-up for blood analysis (n=154) and appetite measurement (n=48) was performed 4-8 weeks after discharge. Appetite was measured as ad libitum intake of a commercial infant cereal using highly standardized procedures. Hospitalization (in days) was significantly longer in HIV-infected children; among children admitted with diarrhoea (5.9 ± 1.9 vs. 3.8 ± 1.5) (mean ± standard deviation) and with pneumonia (9.0 ± 2.5 vs. 5.9 ± 1.9). Serum zinc, iron and transferrin concentrations, and haemoglobin levels were significantly lower in HIV-infected children compared with uninfected children. Appetites [amounts eaten (g) per kg body weight] of HIV-infected children were significantly poorer than those of HIV-uninfected children (18.6 ± 5.8 vs. 25.2 ± 7.4). The eating rates (g min(-1) ) of HIV-infected children were also slower (17.6 ± 6.2 vs. 10.1 ± 3.7) Mean Z-scores for length-for-age were significantly lower among HIV-infected children compared with HIV-uninfected children. Weight-for-length Z-scores were not significantly different. In summary, HIV-infected children had a 55% longer duration of hospitalization and a 21% lower appetite.
Full Text Available Aim: In the present study, socio-demographic characteristics of routinely followed primary monosymptomatic enuretic cases and the success rate of simple behavioral therapy were evaluated. Methods: Questionnaires that inquire the characteristics of enuresis were conducted on the children and their families. The children were motivated and called for regular follow-ups. Treatment success was evaluated at the end of the first, the third and the sixth months and the first year. Patients were divided into two groups as successful or unsuccessful results of treatment. Features of unsuccessful group were evaluated. Results: The total success rate was 40% at the end of the first month, 38% at the end of the third month, 50% at the end of the sixth month and 54% at the end of the first year. Nightly fluid consumption and deep sleeping problems were significantly higher in the group with no treatment success. The number of introverted patients was higher in the unsuccessful group with respect to the other group. Conclusion: Motivation therapy can be offered as a first-step treatment for children with primary monosymptomatic nocturnal enuresis, who are within the age group between six and eight can be motivated for the treatment and do not have an intense amount of bed-wetting at night.
Uścinowicz, Mirosława; Kowalczuk-Krystoń, Monika; Bobrus-Chociej, Anna; Lebensztejn, Dariusz; Kaczmarski, Maciej
of this study was to assess the incidence and the cause of hospitalization of children with cholecystolithiasis. A retrospective analysis was carried out using medical data of children and adolescents treated in the Department of Pediatrics, Gastroenterology, and Pediatric Allergology of Bialystok Medical University. The analysis included causes of hospitalization, its course and accompanying illnesses. During the 4 years of analysis, 47 children (17 boys, 30 girls), aged from 7 months to 18 years, with the diagnosis of cholecystolithiasis were treated. The comprised 1.18% of children hospitalized with gastrointestinal disorders. Cholecystolithiasis without complications was diagnosed in 29 children (61.7%), with cholecystitis in 13 (27.7%), choledocholithiasis was diagnosed in 5 children (10.6%). In 11 children (23.4%) the complication presented in form of acute pancreatitis. In 23 children (48.9%) factors predisposing to chorocholelithiasis were identified. In 20, the following were considered to be a possible significant factor: in 7 children there was a positive family history (14.9%), in 6 children (12.8%) - it was obesity, in 3 children (6.4%) lipid metabolic errors: prematurity and parenteral feeding in 2 children (4.3%) and spherocytosis in 2 children (4.3%). Apart from the above, cholelithiasis was diagnosed in two children with hypothyreosis and in two with Down's Syndrome. In treatment of 20 children (42.6%) antibiotics were prescribed and in 4 children (8.5%) endoscopic sphincterotomy was performed. 25 children (53.2%) were referred for laparoscopic cholecystectomy. In 16 children (34.0%), treatment with ursodeoxycholic acid was recommended. Cholecystolithiasis is a rare cause of hospitalization in pediatric departments. However, it occurs in even the youngest children. It usually runs without complications, but there is a certain risk of serious complications. In the differential diagnosis of abdominal pain, cholelithiasis should be taken into account
Banasiak, Nancy Cantey
Spirometry is an essential part of diagnosing a child with asthma. The National Asthma Education and Prevention Program (NAEPP) and the Global Initiative for Asthma (GINA) expert panels recommend spirometry to be performed on children five years of age and older as an objective assessment of lung function, to diagnosis asthma, and for ongoing yearly management of asthma (GINA, 2012; NAEPP, 2007). According to the NAEPP expert panel, history and physical examination alone are not reliable to accurately diagnose asthma, exclude alternative diagnosis, or determine lung impairment (NAEPP, 2007 Dombkowski, Hassan, Wasilevich, and Clark (2010) found 52% of physicians who provide primary care to children used spirometry, but only 21% used spirometry according to the national guidelines, and only 35% of physicians surveyed were comfortable interpreting the test results. Zanconato, Meneghelli, Braga, Zacchello, and Baraldi (2005) found that 21% of spirometry readings were interpreted incorrectly, concluding that proper training and quality control were important to provide if spirometry in the primary care office setting is to be used. The purpose of this article is to review the appropriate use of spirometry in pediatric primary care.
McKay, Ailsa J; Newson, Roger B; Soljak, Michael; Riboli, Elio; Car, Josip; Majeed, Azeem
Identification of primary care factors associated with hospital admissions for adverse drug reactions (ADRs). Cross-sectional analysis of 2010-2012 data from all National Health Service hospitals and 7664 of 8358 general practices in England. We identified all hospital episodes with an International Classification of Diseases (ICD) 10 code indicative of an ADR, in the 2010-2012 English Hospital Episode Statistics (HES) admissions database. These episodes were linked to contemporary data describing the associated general practice, including general practitioner (GP) and patient demographics, an estimate of overall patient population morbidity, measures of primary care supply, and Quality and Outcomes Framework (QOF) quality scores. Poisson regression models were used to examine associations between primary care factors and ADR-related episode rates. 212,813 ADR-related HES episodes were identified. Rates of episodes were relatively high among the very young, older and female subgroups. In fully adjusted models, the following primary care factors were associated with increased likelihood of episode: higher deprivation scores (population attributable fraction (PAF)=0.084, 95% CI 0.067 to 0.100) and relatively poor glycated haemoglobin (HbA1c) control among patients with diabetes (PAF=0.372; 0.218 to 0.496). The following were associated with reduced episode likelihood: lower GP supply (PAF=-0.016; -0.026 to -0.005), a lower proportion of GPs with UK qualifications (PAF=-0.035; -0.058 to -0.012), lower total QOF achievement rates (PAF=-0.021; -0.042 to 0.000) and relatively poor blood pressure control among patients with diabetes (PAF=-0.144; -0.280 to -0.022). Various aspects of primary care are associated with ADR-related hospital episodes, including achievement of particular QOF indicators. Further investigation with individual level data would help develop understanding of the associations identified. Interventions in primary care could help reduce the ADR burden
The provision of primary health care to children and families is complex. The study outlined here explored outcomes from the provision of primary health care to children aged 5-13 years in a nurse-led clinic based in a primary school in Auckland, New Zealand. This multi-faceted study collected both qualitative and quantitative data, however it is the results of the quantitative arm of the study that are presented here. Data were collected from a variety of sources concerning conditions seen, age and ethnicity of users, types of services provided and impact on hospital usage. Findings demonstrate that the provision of comprehensive primary health care by the nurse at the clinic impacts positively on hospital visitation by children from the area where the clinic is located.
Haj-Hassan, Tanya Ali; Thompson, Matthew J; Mayon-White, Richard T; Ninis, Nelly; Harnden, Anthony; Smith, Lindsay FP; Perera, Rafael; Mant, David C
Background Symptoms are part of the initial evaluation of children with acute illness, and are often used to help identify those who may have serious infections. Meningococcal disease is a rapidly progressive infection that needs to be recognised early among children presenting to primary care. Aim To determine the diagnostic value of presenting symptoms in primary care for meningococcal disease. Design of study Data on a series of presenting symptoms were collected using a parental symptoms checklist at point of care for children presenting to a GP with acute infection. Symptom frequencies were compared with existing data on the pre-hospital features of 345 children with meningococcal disease. Setting UK primary care. Method The study recruited a total of 1212 children aged under 16 years presenting to their GP with an acute illness, of whom 924 had an acute self-limiting infection, including 407 who were reported by parents to be febrile. Symptom frequencies were compared with those reported by parents of 345 children with meningococcal disease. Main outcome measures were diagnostic characteristics of individual symptoms for meningococcal disease. Results Five symptoms have clinically useful positive likelihood ratios (LR+) for meningococcal disease: confusion (LR+ = 24.2, 95% confidence interval [CI] = 11.5 to 51.3), leg pain (LR+ = 7.6, 95% CI = 4.9 to 11.9), photophobia (LR+ = 6.5, 95% CI = 3.8 to 11.0), rash (LR+ = 5.5, 95% CI = 4.3 to 7.1), and neck pain/stiffness (LR+ = 5.3, 95% CI = 3.5 to 8.3). Cold hands and feet had limited diagnostic value (LR+ = 2.3, 95% CI = 1.9 to 3.0), while headache (LR+ = 1.0, 95% CI = 0.8 to 1.3), and pale colour (LR+ = 0.3, 95% CI = 0.2 to 0.5) did not discriminate meningococcal disease in children. Conclusion This study confirms the diagnostic value of classic ‘red flag’ symptoms of neck stiffness, rash, and photophobia, but also suggests that the presence of confusion or leg pain in a child with an unexplained acute
Dahan, Patricia; de Bessa, José; de Oliveira, Dayana Maria; Gomes, Camila Couto; Cardoso, Julio Cesar; Macedo, Isabela Teixeira; de Almeida Belo, Mariana; de Figueiredo, André Avarese; Netto, José Murillo B
Enuresis, sleep respiratory disorders and asthma compromise the quality of sleep in children and may occur in association with each other. An association between sleep respiratory disorders and enuresis has already been demonstrated. According to united airways disease abnormalities of the upper and lower airways may coexist. A child who wheezes has a greater chance of snoring and having obstructive sleep apnea. Since asthma and sleep respiratory disorders may be associated, and sleep respiratory disorders are associated with enuresis, we determined the possibility of an association between asthma and enuresis. Between August 20 and March 2015 parents/guardians of children 6 to 14 years old from 16 elementary schools in our area were randomly chosen for study. Children with nonmonosymptomatic enuresis and urological or neurological disease were excluded. The Tucson and ISAAC (International Study of Asthma and Allergies in Childhood) questionnaires were used to assess sleep respiratory disorders and asthma, respectively. A total of 523 children (283 males and 240 females) with a mean ± SD age of 9.42 ± 2.46 years were included in analysis. The overall prevalence of enuresis was 15.87% (95% CI 12.98-19.26). Asthmatic children with wheezing in the last 12 months were 2.33 times more likely to have had enuresis at some point in life (OR 2.33, 95% CI 1.37-3.95, p = 0.0017). If enuresis was present, the chance increased to 2.78 (95% CI 1.38-5.61, p = 0.0041). Enuretic children were 5.34 times more prone to have apnea reported by parents (95% CI 2.19-13.03, p = 0.0002). These findings demonstrate that asthma as well as sleep respiratory disorders is associated with primary nocturnal enuresis. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
Every Nathan R
Full Text Available Abstract Background Few studies report on the effect of organizational factors facilitating transfer between primary and tertiary care hospitals either within an integrated health care system or outside it. In this paper, we report on the relationship between degree of clinical integration of cardiology services and transfer rates of acute coronary syndrome (ACS patients from primary to tertiary hospitals within and outside the Veterans Health Administration (VHA system. Methods Prospective cohort study. Transfer rates were obtained for all patients with ACS diagnoses admitted to 12 primary VHA hospitals between 1998 and 1999. Binary variables measuring clinical integration were constructed for each primary VHA hospital reflecting: presence of on-site VHA cardiologist; referral coordinator at the associated tertiary VHA hospital; and/or referral coordinator at the primary VHA hospital. We assessed the association between the integration variables and overall transfer from primary to tertiary hospitals, using random effects logistic regression, controlling for clustering at two levels and adjusting for patient characteristics. Results Three of twelve hospitals had a VHA cardiologist on site, six had a referral coordinator at the tertiary VHA hospital, and four had a referral coordinator at the primary hospital. Presence of a VHA staff cardiologist on site and a referral coordinator at the tertiary VHA hospital decreased the likelihood of any transfer (OR 0.45, 95% CI 0.27–0.77, and 0.46, p = 0.002, CI 0.27–0.78. Conversely, having a referral coordinator at the primary VHA hospital increased the likelihood of transfer (OR 6.28, CI 2.92–13.48. Conclusions Elements of clinical integration are associated with transfer, an important process in the care of ACS patients. In promoting optimal patient care, clinical integration factors should be considered in addition to patient characteristics.
Sales, Anne E; Pineros, Sandra L; Magid, David J; Every, Nathan R; Sharp, Nancy D; Rumsfeld, John S
Background Few studies report on the effect of organizational factors facilitating transfer between primary and tertiary care hospitals either within an integrated health care system or outside it. In this paper, we report on the relationship between degree of clinical integration of cardiology services and transfer rates of acute coronary syndrome (ACS) patients from primary to tertiary hospitals within and outside the Veterans Health Administration (VHA) system. Methods Prospective cohort study. Transfer rates were obtained for all patients with ACS diagnoses admitted to 12 primary VHA hospitals between 1998 and 1999. Binary variables measuring clinical integration were constructed for each primary VHA hospital reflecting: presence of on-site VHA cardiologist; referral coordinator at the associated tertiary VHA hospital; and/or referral coordinator at the primary VHA hospital. We assessed the association between the integration variables and overall transfer from primary to tertiary hospitals, using random effects logistic regression, controlling for clustering at two levels and adjusting for patient characteristics. Results Three of twelve hospitals had a VHA cardiologist on site, six had a referral coordinator at the tertiary VHA hospital, and four had a referral coordinator at the primary hospital. Presence of a VHA staff cardiologist on site and a referral coordinator at the tertiary VHA hospital decreased the likelihood of any transfer (OR 0.45, 95% CI 0.27–0.77, and 0.46, p = 0.002, CI 0.27–0.78). Conversely, having a referral coordinator at the primary VHA hospital increased the likelihood of transfer (OR 6.28, CI 2.92–13.48). Conclusions Elements of clinical integration are associated with transfer, an important process in the care of ACS patients. In promoting optimal patient care, clinical integration factors should be considered in addition to patient characteristics. PMID:15649313
The article deals with the issues of organization of functioning of day-hospital for children in particular foreign countries. The hospitals and medical centers of USA and Canada exemplify the positive experience of curative, rehabilitative and psychological care to children in daytime. The demand for effective medical service of this type by children and their parents is noted. The possibility of using this experience in Russian health care is discussed.
Full Text Available Wilms′ tumor (WT is the most common abdominal tumor in children. Many pediatric renal tumors in the past were categorized as WT; however, in recent years, several specific renal tumors have been recognized as distinct pathological entities. The age and clinical presentation of the child and distinctive imaging features may help in reaching a specific diagnosis in most cases. This is important as it has implications on the pre-operative diagnostic work-up and prognosis of the child. However, it is often not possible to differentiate one from the other pediatric renal tumor on the basis of imaging alone, and the final diagnosis is often made at histological examination of the surgical specimen. This article reviews the imaging features of primary malignant renal neoplasms in children along with their clinical presentation and pathological features.
Full Text Available This study aims to identify children’s perceptions of the welfare of animals. The study sample consisted of 123 children aged 8 to 10, attending primary schools, who were interviewed. The questions were designed so as to generate both anthropocentric (centred on the interests of the human being and/or biocentric (centred on the interests of other beings arguments. Results showed a high incidence of biocentric arguments, associated with a contact with animals in places where nature is managed (zoos and other thematic places with animals, thus contradicting the idea that children have an exclusive utilitarian view of animals. Some of them even seem to understand the ecological role of animals, and produce reasons of an ecocentric character.
Ciofi Degli Atti, Marta; Filia, Antonietta; Bella, Antonino; Sisto, Annamaria; Barbieri, Maria Antonietta; Reale, Antonino; Raponi, Massimiliano
The Lazio region is one of the Italian regions where sustained measles transmission continues to occur. We investigated measles cases reported by the emergency department (ED) of the largest pediatric hospital in Italy, located in Lazio. We reviewed clinical records of all measles cases from 0 to 18 years of age evaluated in the ED in 2008-2013. We compared demographic and clinical characteristics of patients admitted to the inpatient setting with those of patients discharged home to assess possible determinants of hospital admission. Of 248 patients with measles evaluated in the ED, 113 (45.6%) were admitted as inpatients. The number of measles cases peaked in 2011 (N = 122; 49.2%), when epidemics were reported in Lazio. Median age was 2.7 years (range: 21 days to 17.9 years), and 31 patients (13%) had an underlying chronic illness. The strongest independent predictor of hospitalization was having an underlying chronic illness [adjusted odd ratio (OR): 9.87; 95% confidence interval: 3.13-31.13]. Other factors independently and significantly associated with higher risk of hospitalization were taking medications at the time of ED visit, being younger than 1 year of age and having altered liver enzyme values. Eighty-five percent of children >15 months of age who were hospitalized were not vaccinated. One hundred six hospitalized children (94%) had at least 1 measles complication; 1 child required intensive care for respiratory insufficiency. Hospitalizations of children with measles continue to occur in European areas where elimination has not been achieved. Children with chronic diseases represent a vulnerable population that is at higher risk of hospitalization.
Full Text Available Abstract Background: Appropriate management of care – for example, avoiding unnecessary attendances at, or admissions to, hospital emergency units when they could be handled in primary care – is an important part of health strategy. However, some variations in these outcomes could be due to genuine variations in health need. This paper proposes a new method of explaining variations in hospital utilisation across small areas and the general practices (GPs responsible for patient primary care. By controlling for the influence of true need on such variations, one may identify remaining sources of excess emergency attendances and admissions, both at area and practice level, that may be related to the quality, resourcing or organisation of care. The present paper accordingly develops a methodology that recognises the interplay between population mix factors (health need and primary care factors (e.g. referral thresholds, that allows for unobserved influences on hospitalisation usage, and that also reflects interdependence between hospital outcomes. A case study considers relativities in attendance and admission rates at a North London hospital involving 149 small areas and 53 GP practices. Results: A fixed effects model shows variations in attendances and admissions are significantly related (positively to area and practice need, and nursing home patients, and related (negatively to primary care access and distance of patient homes from the hospital. Modelling the impact of known factors alone is not sufficient to produce a satisfactory fit to the observations, and random effects at area and practice level are needed to improve fit and account for overdispersion. Conclusion: The case study finds variation in attendance and admission rates across areas and practices after controlling for need, and remaining differences between practices may be attributable to referral behaviour unrelated to need, or to staffing, resourcing, and access issues. In
Wong, Charlene A; Ostapovich, Gabrielle; Kramer-Golinkoff, Emily; Griffis, Heather; Asch, David A; Merchant, Raina M
Social media provide new channels for hospitals to engage with communities, a goal of increasing importance as non-profit hospitals face stricter definitions of community benefit under the Affordable Care Act. We describe the variability in social media presence among US children's hospitals and the distribution of their Facebook content curation. Social media data from freestanding children's hospitals were extracted from September-November 2013. Social media adoption was reviewed for each hospital-generated Facebook, Twitter, YouTube, Google+ and Pinterest platform. Facebook page (number of Likes) and Twitter account (number of followers) engagement were examined by hospital characteristics. Facebook posts from each hospital over a 6-week period were thematically characterized. We reviewed 5 social media platforms attributed to 45 children's hospitals and 2004 associated Facebook posts. All hospitals maintained Facebook and Twitter accounts and most used YouTube (82%), Google+ (53%) and Pinterest (69%). Larger hospitals were more often high performers for Facebook (67% versus 10%, pSocial media adoption by US children's hospitals was widespread. Beyond its traditional marketing role, social media can serve as a conduit for health education, engagement with communities, including community benefit. Copyright © 2015 Elsevier Inc. All rights reserved.
Full Text Available Abstract
Background: Hospitalization may often be prevented by timely and effective outpatient care either by preventing the onset of an illness, controlling an acute illness or managing a chronic disease with an appropriate follow-up. The objective of the study is to examine the variability of hospital admissions within Italian regions for Ambulatory Care Sensitive Conditions (ACSCs, and their relationship with primary care supply.
Methods: Hospital discharge data aggregated at a regional level collected in 2005 were analysed by type of ACS conditions. Main outcome measures were regional hospital admission rates for ACSCs. Negative binomial models were used to analyse the association with individual risk factors (age and gender and regional risk factors (propensity to hospitalisation and prevalence of specific conditions.
Non-parametric correlation indexes between standardised hospital admission rates and quantitative measures of primary care services were calculated.
Results: ACSC admissions accounted for 6.6% of total admissions, 35.7% were classified as acute conditions and 64.3% as chronic conditions. Admission rates for ACSCs varied widely across Italian regions with different patterns for chronic and acute conditions. Southern regions showed significantly higher rates for chronic conditions and North-eastern regions for acute conditions. We found a significant negative association between the provision of ambulatory specialist services and standardised hospitalization rates
(SHR for ACS chronic conditions (r=-0.50; p=0.02 and an inverse correlation among SHR for ACS acute conditions and the rate of GPs per 1,000 residents, although the latter was not statistically significant.
Conclusions: In Italy, about 480,000 inpatient hospital admissions in 2005 were attributable to ACSCs. Even
adjusting for potential confounders
Full Text Available ABSTRACT: BACKGROUND: Intestinal parasitic infections (IPIs are prevalent in developing countries like India and have been the important cau se of morbidity and mortality especially in children. OBJECTIVES: Estimate prevalence of various intestinal parasitic infections in hospital as well as in rural school children to obtain an ac curate understanding of the burden and cause of intestinal parasitic infections in Kancheepuram. MATERIALS AND METHODS: A total of 2654 stool samples were collected, processed, and mic roscopically examined for intestinal parasites. 2267 were adults and remaining 387 were c hildren. In addition, 314 rural school children were also included in the study. RESULTS: The overall prevalence of IPIs was estimated as 32.59% (739/2267 in hospital adults an d 55.50% (215/387 in hospital children and 56.68% (178/314 in rural school children; high prevalence rate was found among hospital children and in school children when compared to adu lts. Among the protozoans E. histolytica was the highest, followed by Giardia and among the helminths hookworm was highest followed by Ascaris lumbricoides, Enterobius vermicularis, H ymenolepis nana and Strongoloides larvae respectively. CONCLUSIONS: Intestinal parasitic infections spreads due to low s tandards of personal hygiene, poor sanitation, open air defecatio n and an illiterate population, thus suggesting need for regular surveys to minimize the IPIs rate in the community.
Full Text Available The nurses have come into contact with the patients very frequently in the primary hospital .It is the professional quality and excellent skill of communicating with patients that influenced first-hand result of nursing in a lot of cases. The nurses should aggrandize their professional quality and build up a new relationship between patients and nurses which corresponded with new epoch needs of optimizing effects.
Full Text Available Abstract Background Patients with type 1 diabetes are known to have a higher hospital admission rate than the underlying population and may also be admitted for procedures that would normally be carried out on a day surgery basis for non-diabetics. Emergency admission rates have sometimes been used as indicators of quality of diabetes care. In preparation for a study of hospital admissions, a systematic review was carried out on hospital admissions for children diagnosed with type 1 diabetes, whilst under the age of 15. The main thrust of this review was to ascertain where there were gaps in the literature for studies investigating post-diagnosis hospitalisations, rather than to try to draw conclusions from the disparate data sets. Methods A systematic search of the electronic databases PubMed, Cochrane LibrarMEDLINE and EMBASE was conducted for the period 1986 to 2006, to identify publications relating to hospital admissions subsequent to the diagnosis of type 1 diabetes under the age of 15. Results Thirty-two publications met all inclusion criteria, 16 in Northern America, 11 in Europe and 5 in Australasia. Most of the studies selected were focussed on diabetic ketoacidosis (DKA or diabetes-related hospital admissions and only four studies included data on all admissions. Admission rates with DKA as primary diagnosis varied widely between 0.01 to 0.18 per patient-year as did those for other diabetes-related co-morbidity ranging from 0.05 to 0.38 per patient year, making it difficult to interpret data from different study designs. However, people with Type 1 diabetes are three times more likely to be hospitalised than the non-diabetic populations and stay in hospital twice as long. Conclusion Few studies report on all admissions to hospital in patients diagnosed with type 1 diabetes whilst under the age of 15 years. Health care costs for type 1 patients are higher than those for the general population and information on associated patterns of
Mda, S.; Raaij, van J.M.A.; MacIntyre, U.E.; Villiers, de F.R.M.; Kok, F.J.
Human immunodeficiency virus (HIV)-infected children generally show poor growth. Episodes of diarrhoea and pneumonia in HIV-infected children are thought to be more severe than in HIV-uninfected children. The objective of this study was to compare duration of hospitalization, appetite and nutritiona
Mda, S.; Raaij, van J.M.A.; MacIntyre, U.E.; Villiers, de F.R.M.; Kok, F.J.
Human immunodeficiency virus (HIV)-infected children generally show poor growth. Episodes of diarrhoea and pneumonia in HIV-infected children are thought to be more severe than in HIV-uninfected children. The objective of this study was to compare duration of hospitalization, appetite and
Erva Monica Saputro
Full Text Available Background: Trabeculectomy is a surgical therapy for glaucoma to preserve visual function by lowering intraocular pressure (IOP. In some studies, the success of trabeculectomy in lowering IOP is greater than medication. Success is defined by IOP <21 mmHg, with or without glaucoma medication. Primary glaucoma based on the mechanism of aquous humor outflow is divided into primary open-angle glaucoma (POAG and primary angle-closure glaucoma (PACG. This study aimed to know the success rate of trabeculectomy in POAG and PACG. Methods: This study was a descriptive study conducted at Cicendo Eye Hospital using medical record of POAG and PACG patients who underwent trabeculectomy surgery on January–December 2013 with minimal one month follow-up. Data collection was conducted during September 2014. Data processed in this study were 100 eyes from 76 patients with diagnosis POAG and PACG. Results: The success rate for trabeculectomy in POAG was 79% and PACG was 86%, failure (IOP ≥ 21 mmHg 21% in POAG, and 14% in PACG for period 2013 at Cicendo Eye Hospital. Conclusions: The success rate of trabeculectomy at Cicendo Eye Hospital is good in one month, with or without glaucoma medication after surgery.
de Holanda, Eliane Rolim; Collet, Neusa
The objective of this qualitative study was to understand the perception that families of hospitalized children with chronic illness about their being away from the process of education. The empirical material was produced by means of interviews performed with families of hospitalized children with chronic illness. The data was analyzed based on the principles of thematic analysis. Among other aspects, the data showed the lack of systematized pedagogical actions in the studied hospital, in a way that the educational activities that were developed were seen as a moment of leisure. We understand that the hospital class is becoming an important health care technology for hospitalized children. Therefore, it requires support, especially from the Departments of Education, in terms of providing the necessary human resources, funding and materials. This is a pioneer study, capable of helping improve the quality of life of children with chronic illness.
LeBlanc John C
Full Text Available Abstract Background Bronchiolitis is the most common cause of lower respiratory tract illness in infancy, and hospital admission rates appear to be increasing in Canada and the United States. Inhaled beta agonists offer only modest short-term improvement. Trials of racemic epinephrine have shown conflicting results. We sought to determine if administration of racemic epinephrine during hospital stay for bronchiolitis improved respiratory distress, was safe, and shortened length of stay. Methods The study was a randomized, double-blind controlled trial of aerosolized racemic epinephrine compared to salbutamol every one to 4 hours in previously well children aged 6 weeks to ≤ 2 years of age hospitalized with bronchiolitis. The primary outcome was symptom improvement as measured by the Respiratory Distress Assessment Instrument (RDAI; secondary outcomes were length of stay in hospital, adverse events, and report of symptoms by structured parental telephone interview one week after discharge. Results 62 children with a mean age of 6.4 months were enrolled; 80% of children had Respiratory Syncytial Virus (RSV. Racemic epinephrine resulted in significant improvement in wheezing and the total RDAI score on day 2 and over the entire stay (p 0.05. Adverse events were not significantly different in the two arms. At one week post-discharge, over half of parents reported that their child still had a respiratory symptom and 40% had less than normal feeding. Conclusion Racemic epinephrine relieves respiratory distress in hospitalized infants with bronchiolitis and is safe but does not abbreviate hospital stay. Morbidity associated with bronchiolitis as identified by parents persists for at least one week after hospital discharge in most infants.
Jansen, Michele Ferraz; dos Santos, Rosane Maria; Favero, Luciane
It is a qualitative research study, descriptive-exploratory in nature, which aims to verify the benefits from the use of toys during nursing care to hospitalized children. Ten subjects participated in the study: three children and seven mothers of hospitalized children. Data were collected between May and July, 2008 by means of specific instruments for each age group and further organized in thematic categories: the use of toys to lessen hospitalization stress; toys facilitating understanding and acceptance of procedures; and the experience of using toys and hospitalization process. The results show that the use of toys is an excellent nursing resource to render care to admitted children. The features of the toys facilitated communication, participation, acceptance of procedure and child motivation, what enabled them to keep their individuality, lessen the stress and the possibility to implement children's and families' non-traumatic care.
This paper reports on a study of the prevalence and social correlates of dyssomnias, features associated with obstructive sleep apnoea, and parasomnias in primary school children aged 4-12. Head teachers of schools selected randomly from lists of local primary and special schools were contacted by telephone and asked to distribute a questionnaire package to the parents of all pupils aged 4-12 years. In all, 890 parents of children from mainstream schools and 300 from special schools were approached. The response rates were 64.7% and 60%, respectively. The results showed that significantly higher proportions of children in special schools than in mainstream schools presented four of the five dyssomnias investigated and all of the features associated with obstructive sleep apnoea. In contrast, only two of the seven parasomnias were presented by higher proportions of the children in special schools. Age and gender differences for the two groups of children are presented. Finally, multiple correlations were computed between a range of child, family, and environmental characteristics and the three problems most frequently reported: frequency of settling problems; sleeping in the parents' bed; and night waking. The findings are discussed with reference to other studies of children's sleep problems, and the implications for treatment are considered.
Mira, José Joaquín; Carrillo, Irene; Lorenzo, Susana
To explore what hospitals and primary care (PC) are doing to reduce the negative social impact of a serious adverse event (AE). We surveyed 195 hospital (n=113) and PC (n=82) managers from eight autonomous communities to explore the level of implementation of five interventions recommended after an AE to protect the reputation of healthcare institutions. Most institutions (70, 45.2% PC, and 85, 54.8% hospitals) did not have a crisis plan to protect their reputation after an AE. Internal (p=0.0001) and external (p=0.012) communications were addressed better in PC than in hospitals. Very few institutions had defined the managers' role in case of an AE (10.7% hospitals versus 6.25% PC). A majority of healthcare institutions have not planned crisis intervention after an AE with severe consequences nor have they defined plans to recover citizens' trust after an AE. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.
Quintard, Hervé; Severac, Mathilde; Martin, Claude; Ichai, Carole
The development of specialized units dedicated to life-threatening management has demonstrated to improve the prognosis of patients requiring such treatments. However, apart those focused on trauma and stroke, networks are still lacking in France. Despite, the implementation of standardisation of practices and guidelines, particularly in prehospital care, in-hospital clinical practices at admission remain heterogenous. This survey aimed to assess the structural and human organization of teaching hospitals in France concerning the primary in-hospital care for critically ill patients. A questionnaire of 45 items was sent by e-mail to 32 teaching hospitals between January and March 2013. It included information related to the description of the emergency department, of ICUs, and both structural and human organizations for primary in-hospital care of life-threatening patients. Seventy-five percent of teaching hospitals answered to the survey. Seven hundred to 1400 patients were admitted to emergency units per week and among them 10 to 20 were admitted for critically ill conditions. These latter were addressed in a specialized room of the emergency unit (Service d'admission des urgences vitales [SAUV]) in 40% of hospitals and in specialized room in ICU in 18% of cases. Intensivists were involved in 50% of hospitals, emergency physicians in 26% and it was mixed in 24% of hospitals. This survey is the first to assess the in-hospital organization of primary care for instable and life-threatening patients in France. Our results confirmed the extreme heterogeneity of structural and human organizations for primary in-hospital care of patients presenting at least one organ failure. Thus, a consensus is probably needed to homogenize and improve our practices. Copyright © 2015 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.
Kvigne, Valborg L; Leonardson, Gary R; Borzelleca, Joseph; Neff-Smith, Martha; Welty, Thomas K
The study describes the hospitalization rates and medical diagnoses of children with fetal alcohol syndrome (FAS) and incomplete FAS. Two retrospective case-control studies were conducted of Northern Plains American Indian children with FAS or incomplete FAS identified from 1981-93 by using the ICD-9-CM code 760.71. Children who had FAS or incomplete FAS were compared to each other and to children who did not have FAS. Compared to the controls, the 43 children with FAS (Study 1) and 35 children with incomplete FAS (Study 2) were hospitalized more often with otitis media (51.2 percent OR=4.32 and 31.4 percent OR=3.02 respectively), pneumonia (46.5 percent OR=4.21 and 34.3 percent OR=2.54), fetal alcohol syndrome (32.6 percent p=.001 and 14.3 percent p=.007), dehydration (23.3 percent OR=9.29 and 17.1 percent OR=4), and anemia (11.6 percent OR=10 and 17.1 percent p=.002) respectively. Children with FAS were hospitalized more often with failure to thrive (32.6 percent p=.001) and neglect (23.3 percent OR=10.0) than children with incomplete FAS and controls. Children with FAS were hospitalized with child sexual abuse (11.6 percent OR=10.0) and feeding problems (11.6 percent p=.007), and children with incomplete FAS were hospitalized with gastroenteritis (22.9 percent OR=14.55) and bronchitis (22.9 percent OR=3.0) more than control children. Children with FAS or incomplete FAS had more hospitalizations and longer average length of stays than control children.
Martínez, Isabel; López, Omar; Sotolongo, Franklin; Mirabal, Mayelin; Bencomo, Antonio
A cross-sectional and descriptive study was conducted among 318 children from the "Mártires del Corynthia" Primary School under the authorization of the Municipal Division of Education and the informed consent of their parents aimed at knowing the prevalence of meningoccoco carriers in school children, determining the epidemiological markers of the isolated strains and establishing the possible relation existing between the carrier and variables, such as age, sex, acute respiratory infection history, hacinamiento, amigdalectomy, inhibitory effect of of the accompanying flora and the secretory state of ABH antigens in saliva. All of them underwent nasopharyngeal exudate and a saliva sample was taken. In adition, the paents were surveyed about the risks factors to be investigated. 6.9 % of meningoccoco carriers were found and the NA:NT:P1:NST:L3,7,9 strains predominated. The risk factors with statistically significant results regarding the condition of carrier Neisseria meningitidis carrier were age, acute respiratory infection history, and the presence of Streptococcus pneumoniae and Neisseria lactamica of the accompanying bacterial flora in the nasopharynx of the children under study.
Ferrara, Calogero; Valeri, Gianluca; Salvolini, Luca [Department of Radiology, University of Ancona (Italy); Giovagnoni, Andrea [Department of Radiology, University of Modena (Italy)
Background: Primary sclerosing cholangitis (PSC) is a chronic cholestatic syndrome of unknown aetiology. Diagnosis is based on clinical and laboratory data in conjunction with imaging of the biliary tree using endoscopic retrograde cholangiopancreatography (ERCP). Objective: To evaluate the clinical usefulness of MR cholangiopancreatography (MRCP) in the diagnosis of PSC in children. Materials and methods: Twenty-one children with clinical and laboratory suspicion of PSC were enrolled. MRCP was performed using a superconductive system with a phased-array coil. Rapid acquisition with relaxation enhancement (RARE) T2-weighted and half-Fourier single-shot turbo-spin-echo (HASTE) sequences were used. The distribution and extent of biliary tree changes were evaluated and classified according to Majoie's classification. A comparison between MRCP and ERCP was performed blind in all cases to evaluate the usefulness of MRI. Results: In 13 cases (62%), MRCP showed abnormalities of the biliary tree which were considered positive for PSC, while in 8 cases there were no signs of PSC. Both MRCP and ERCP correctly identified changes in 13 cases and excluded abnormalities in 5. MRCP had a sensitivity of 81%, specificity of 100%, negative predictive value of 62%, positive predictive value of 100% and an accuracy of 85%. Conclusions: MRCP can be proposed as the preliminary non-invasive imaging modality for the diagnosis of PSC in children. (orig.)
Laulajainen-Hongisto, Anu; Saat, Riste; Lempinen, Laura; Aarnisalo, Antti A; Jero, Jussi
To evaluate the clinical picture and microbiological findings of children hospitalized due to acute otitis media and to analyze how it differs from acute mastoiditis. A retrospective review of the medical records of all children (0-16 years) hospitalized due to acute otitis media in the Department of Otorhinolaryngology at the Helsinki University Hospital, between 2003 and 2012. Comparison with previously published data of children with acute mastoiditis (n=56) from the same institute and period of time. The most common pathogens in the children hospitalized due to acute otitis media (n=44) were Streptococcus pneumoniae (18%), Pseudomonas aeruginosa (16%), Streptococcus pyogenes (14%), and Staphylococcus aureus (14%). One of the most common pathogens of out-patient acute otitis media, Haemophilus influenzae, was absent. Otorrhea was common in infections caused by S. pyogenes and otorrhea via tympanostomy tube in infections caused by P. aeruginosa. In children under 2 years-of-age, the most common pathogens were S. pneumoniae (43%), Moraxella catarrhalis (14%), and S. aureus (7%). S. pyogenes and P. aeruginosa were only found in children over 2 years-of-age. Previous health problems, bilateral infections, and facial nerve paresis were more common in children hospitalized due to acute otitis media, compared with acute mastoiditis, but they also demonstrated lower CRP values and shorter duration of hospital stay. The number of performed tympanostomies and mastoidectomies was also comparatively smaller in the children hospitalized due to acute otitis media. S. aureus was more common and S. pneumoniae, especially its resistant strains, was less common in the children hospitalized due to acute otitis media than acute mastoiditis. Acute otitis media requiring hospitalization and acute mastoiditis compose a continuum of complicated acute otitis media that differs from common out-patient acute otitis media. The bacteriology of children hospitalized due to acute otitis media
Mitchell Charles D
Full Text Available Abstract Background HHV-8 is closely related to Epstein-Barr virus (EBV, but the clinical presentations of these two infections in early childhood are not well understood. Also, it is not known whether infection by one virus correlates with another. Here, we compare the natural history of infection by these two viruses along with the clinical manifestations and risk factors that are associated with early childhood infection in Zambia, which is an endemic area for HHV-8. Methods This study was conducted in a cohort of 12 month old Zambian children (N = 677. Data on socio-economic status and a wide range of clinical manifestations were collected. Logistic regression was used to test for significant associations between the collected variables and HHV-8 or EBV serostatus at 12 months of age. Results We observed a significantly higher seroprevalence for EBV (58.9% as compared to HHV-8 (13.4%. HIV-1 infected children had at a significantly higher risk of being infected with HHV-8 (Odds ratio [OR] 3.69, 95% confidence interval [CI] 1.64 - 8.32. HIV-1 infection of the mothers was a significant risk factor for increased acquisition of EBV but not HHV-8 by children (OR 1.86, 05% CI 1.20 - 2.87. Self reported rash was marginally associated with primary infection for HHV-8 and EBV. Conclusions These results suggest that there is no correlation between EBV and HHV-8 infections. Infection by one does not increase the susceptibility for the second virus. Primary HHV-8 and EBV infection in early childhood may clinically present as rash but remains largely asymptomatic and may remain undetected in this population. HIV infection in the mother or child are important risk factors that contribute to EBV or HHV-8 infection.
Zaini, M Z Anuar; Lim, C T; Low, W Y; Harun, F
This paper investigates the nutritional status of a randomly selected cohort of school children and the factors affecting it. This random survey was conducted in the state of Selangor, involving 1,405 primary students (aged 9-10 years from 54 national primary schools). Physical examination was carried out on all the students. Information on the students was also obtained from the parents. Blood samples were taken by using the finger pricking technique. Body mass index (BMI) was used as a measure of physical growth. The students were mainly from urban areas (82.9%). The mean age was 9.71 years and a higher proportion was females (51%). Malays constituted 83.6%, Indians 11.6% and Chinese 4.2% of the study population. The mean weight and height were 32.30 kg and 135.18 cm respectively. The mean BMI was 17.42 kg/m2, with 1.2% of the students underweight, 76.3% normal BMI, 16.3% overweight and 6.3% were obese. Nutritional status was significantly related to blood pressure, history of breast feeding, eating fast food, taking canned/bottled drinks, income and educational level of parents. Significant differences in nutritional status between sexes and locations (rural/urban) were also found. The prevalence of overweight and obese children was of concern. There is thus an urgent need for the School Health Program to periodically monitor the school children's eating habits and physical growth. Appropriate counselling on nutritional intake and physical activities should be given not only to schoolchildren but also to their teachers and parents or caregivers.
Mukattash, Tareq L; Nuseir, Khawla Q; Jarab, Anan S; Alzoubi, Karem H; Al-Azzam, Sayer I; Shara, Mohd
Due to the lack of properly tested medicines for children, there is little available information with regards to indications and dosing of medications in children. To collect data on sources where hospital based pediatricians obtain prescribing information when treating children and the extent of collaboration with the hospital pharmacist. Two hundred and fifty pediatricians in different hospitals within different cities in Jordan were asked to fill in a structured questionnaire regarding information sources used when prescribing for children. Questionnaires were collected from 162 (64.8%) hospital based pediatricians, who have completed the questionnaire by the designated date. Most (75.5%) reported that the Lexi Comp's Drug Information Handbook was the source that they most frequently used for drug information when prescribing for in children. The BNF and the BNFc (British National Formulary for children) were found to be the most sources that contain sufficient information that aids pediatricians when prescribing for children. A minority (22%) claimed to consult with the hospital pharmacist when they face difficulties when prescribing for children. Pediatricians rely on different information sources when they prescribe for children. Those sources vary in their reliability in aiding pediatrician when prescribing. Further work should be done in the provision of useful information on pediatric drug therapy to pediatricians. More steps should be taking place to activate collaboration and interaction between pediatricians and pharmacists as well.
Harn, S D; Dunning, D G
This study presents survey results regarding the utilization of a dental carnival as a primary educator of oral health in children. Three-hundred randomly selected parents/guardians (54.7 percent of the sample) returned useable surveys. Most carnival events/booths/characters received high ratings in both educational and entertainment value. The entertainment value of events/booths was enhanced by the level of physical activity involved. A significant reduction in the fear children have in going to the dentist was attributed by respondents to attending the carnival. Respondents indicated that the toothbrushing, flossing and nutrition habits of children were enhanced by the carnival experience. The dental carnival is also seen as being an integral member of the dental team, along with the family and dentist/hygienist, in educating children about dental health.
Full Text Available Aim: aim of the study was to evaluate the efficiency of two different surgical treatments of vesicoureteral reflux (VUR on succesfull rate and patient outcome. Methods: Retrospective study on children with primary VUR and their surgical treatment from 1999 to 2014 in the University Clinic for Pediatric Surgery in Skopje. A total of 76 children (114 ureters with VUR ranging from second to fifth grade were treated surgically, 44 patients (67 ureters with an open surgical technique and 32 patients (47 ureters with endoscopic treatment ”STING” procedure. The following parameters were analyzed: duration of the intervention, duration of the hospitalization, the need for antibiotics and analgesic therapy and the need for blood and blood derivatives transfusion. The result of the surgical treatment was also validated. A good result was considered when reduction of VUR by 2 degrees with the endoscopic method or by 3 degrees in the open surgical technique was noticed. Results: Using open surgical technique, patients were hospitalized for an average of 9 days (range from 5 to 13 days. All children received double antibiotic therapy. The need for analgesics lasted for 3 to 4 days. 90% of treated children needed blood and/or blood derivatives transfusion. Success rate with this method was 93.8%. Endoscopic procedure was performed as a one-day surgical procedure. The average duration was 15 minutes. Single, prophylactic dose of antibiotic was ordinated. There was no need for blood and/or blood derivatives transfusion. The overall success of the treatment was about 70%. Conclusion: Open surgical procedure is used for more complicated cases, VUR grade IV-V or by previously failed. Endoscopic, “STING” procedure was commonly used for patients with VUR grade greater than 2, after previously failed conservative treatment, febrile urinary infection despite antibiotic prophylaxis and/or emergence of new scarring in the renal parenchyma. Patient assessment and
Liu, Zifeng; Yu, Dongsheng; Zhou, Lijie; Yang, Jing; Lu, Jiaxuan; Lu, Hui; Zhao, Wei
The dental health of preschool children with congenital heart disease (CHD) is usually poor, which may contribute to the development of infective endocarditis (IE). Primary care physicians play an important role in providing access to preventive dental services, particularly for preschool children. The object of this study was to provide epidemiologic evidence for the impact of primary care physicians' (PCP's) counseling role on early childhood caries in children with CHD in Guangzhou, China, which might guide future caries prevention to decrease the risk of IE in children with CHD. A hospital-based, case-control study was performed, which contained 100 children with newly diagnosed early childhood caries and 100 matched (sex and age) children without dental caries. All of the subjects were diagnosed with CHD at birth and recruited from Guangdong Cardiovascular Institute from 2012 through 2013. A conditional multivariate logistic-regression model was used to assess the associations between PCPs' role and early childhood caries with a significance level of 5%. Our findings revealed that mother's education level (OR = 0.36, CL = 0.14-0.92) and knowledge, being educated on the relationship between CHD and infective endocarditis (OR = 0.48, CL = 0.25-0.94) and the impact of oral health on infective endocarditis (OR = 0.37, CL = 0.18-0.79) by the PCP were associated with early childhood caries. PCPs played an important role in preventing early childhood caries among preschool children with CHD in Guangzhou, China.
Kalifa A Bojang
Full Text Available BACKGROUND: In malaria endemic countries, children who have experienced an episode of severe anaemia are at increased risk of a recurrence of anaemia. There is a need to find ways of protecting these at risk children from malaria and chemoprevention offers a potential way of achieving this objective. METHODS: During the 2003 and 2004 malaria transmission seasons, 1200 Gambian children with moderate or severe anaemia (Hb concentration <7 g/dL were randomised to receive either monthly sulfadoxine-pyrimethamine (SP or placebo until the end of the malaria transmission season in which they were enrolled, in a double-blind trial. All study subjects were treated with oral iron for 28 days and morbidity was monitored through surveillance at health centres. The primary endpoint was the proportion of children with moderate or severe anaemia at the end of the transmission season. Secondary endpoints included the incidence of clinical episodes of malaria during the surveillance period, outpatient attendances, the prevalence of parasitaemia and splenomegaly, nutritional status at the end of the malaria transmission season and compliance with the treatment regimen. RESULTS: The proportions of children with a Hb concentration of <7 g/dL at the end of the malaria transmission season were similar in the two study groups, 14/464 (3.0% in children who received at least one dose of SP and 16/471 (3.4% in those who received placebo, prevalence ratio 0.89 (0.44,1.8 P = 0.742. The protective efficacy of SP against episodes of clinical malaria was 53% (95% CI 37%, 65%. Treatment with SP was safe and well tolerated; no serious adverse events related to SP administration were observed. Mortality following discharge from hospital was low among children who received SP or placebo (6 in the SP group and 9 in the placebo group respectively. CONCLUSIONS: Intermittent treatment with SP did not reduce the proportion of previously anaemic children with moderate or severe anaemia
Biai, Sidu; Rodrigues, Amabelia; Gomes, Melba
in the use of the standardised guidelines for the management of malaria, including strict follow-up procedures. Nurses and doctors were randomised to work on intervention or control wards. Personnel in the intervention ward received a small financial incentive ($50 (25 pounds sterling; 35 euros......OBJECTIVE: To test whether strict implementation of a standardised protocol for the management of malaria and provision of a financial incentive for health workers reduced mortality. DESIGN: Randomised controlled intervention trial. SETTING: Paediatric ward at the national hospital in Guinea......-Bissau. All children admitted to hospital with severe malaria received free drug kits. PARTICIPANTS: 951 children aged 3 months to 5 years admitted to hospital with a diagnosis of malaria randomised to normal or intervention wards. INTERVENTIONS: Before the start of the study, all personnel were trained...
Full Text Available Child and adolescent obesity currently affects at least 10-25�0of the paediatric population in most developed countries. The BMI value is one of the most appropriate method of defining obesity and has a strong association with body fatness and health risk. Two main environmental factors, nutrition and physical activity, could influence paediatric obesity development. This paper studies the relationship between sedentariness, snack and soft drink intake and overweight or obesity in children. 1194 primary school children (age 8-10 participated in the study. For all the subjects we measured the anthropometric data to calculate the BMI. The overweight and obesity prevalence was estimated using age-specific BMI cutoffs. A questionaire was also submitted to all the children by a single interviewer to obtain data about: a Weekly Physical Activity, b Weekly Sedentary Activity, c Alimentary Style. Spearman rank correlation and the Student’s t-test were used. The data demonstrated that 23.2�0of the children is overweight and the 4.8�0obese. BMI is inversely correlated to the physical activity, while there is positive correlation between BMI and number of double portions. Statistically significant positive correlation is present among eating snacks and hours of sedentariness, while there is a negative correlation between physical activity and TV hours. Physical activity in the childhood could be an important tool to prevent obesity development and adult-onset chronic diseases. It is important to encourage an active lifestyle in order to reduce sedentariness.
Mussman, Grant M; Vossmeyer, Michael T; Brady, Patrick W; Warrick, Denise M; Simmons, Jeffrey M; White, Christine M
Timely and reliable verbal communication between hospitalists and primary care physicians (PCPs) is critical for prevention of medical adverse events but difficult in practice. Our aim was to increase the proportion of completed verbal handoffs from on-call residents or attendings to PCPs within 24 hours of patient discharge from a hospital medicine service to ≥90% within 18 months. A multidisciplinary team collaborated to redesign the process by which PCPs were contacted following patient discharge. Interventions focused on the key drivers of obtaining stakeholder buy-in, standardization of the communication process, including assigning primary responsibility for discharge communication to a single resident on each team and batching calls during times of maximum resident availability, reliable automated process initiation through leveraging the electronic health record (EHR), and transparency of data. A run chart assessed the impact of interventions over time. The percentage of calls initiated within 24 hours of discharge improved from 52% to 97%, and the percentage of calls completed improved to 93%. Results were sustained for 18 months. Standardization of the communication process through hospital telephone operators, use of the discharge order to ensure initiation of discharge communication, and batching of phone calls were associated with improvements in our measures. Reliable verbal discharge communication can be achieved through the use of a standardized discharge communication process coupled with the EHR. © 2015 Society of Hospital Medicine.
Leininger, Michele; Stephenson, Laura A.
Length of stay in psychiatric inpatient units has received increasing attention with the external pressures for treatment cost-effectiveness and evidence that longer hospital stays do not appear to have significant advantages over shorter hospital stays. This study examined the relationship between length of psychiatric hospital stay and…
Rodrigues-Bastos, Rita Maria; Campos, Estela Márcia Saraiva; Ribeiro, Luiz Cláudio; Firmino, Róberti Uili Rodrigues; Bustamante-Teixeira, Maria Teresa
To study the most frequent causes of hospitalizations for primary care-sensitive conditions (HPCSC) in the city of Juiz de Fora, MG, Brazil, by age group and gender, over the periods of 2002 to 2005 and of 2006 to 2009. This was a descriptive study, with data collected from the Hospital Information System of the Unified Health System (Sistema de Informação Hospitalar do Sistema Único de Saúde - SIH-SUS) and from population projections by the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística - IBGE). HPCSC rates were calculated for 1,000 inhabitants, and the most frequent causes were studied by gender and age group, comparing both periods. HPCSP showed rates of 7.74/1,000 between 2002 and 2005 and 8.81/1,000 between 2006 and 2009. The main causes were heart failure, cerebrovascular diseases, angina pectoris, pulmonary diseases, and kidney and urinary tract infections, which together represented 4.9/1,000 in the first period and 5.6/1,000 in the second period. The evolution of the rates between both periods occurred differently by age group and gender. The study did not exhibit any remarkable differences in HPCSC rates between the periods. Regarding the most frequent causes, reduced hospitalization rates for gastroenteritis, asthma, high blood pressure, and cerebrovascular diseases were observed, as well as increased hospitalizations for heart failure, pulmonary diseases, epilepsies, and kidney and urinary tract infections; these hospitalizations occurred differently by gender and age group. The results showed that a deep reflection regarding the determinants of hospitalizations for avoidable causes is needed. Copyright © 2013 Elsevier Editora Ltda. All rights reserved.
García, Carla G.; Bhore, Rafia; Soriano-Fallas, Alejandra; Trost, Margaret; Chason, Rebecca; Ramilo, Octavio; Mejias, Asuncion
BACKGROUND The trends in hospitalization rates and risk factors for severe bronchiolitis have not been recently described, especially after the routine implementation of prophylaxis for respiratory syncytial virus (RSV) infections. OBJECTIVES To define the burden of hospitalizations related to RSV and non-RSV bronchiolitis in a tertiary-care children’s hospital from 2002 to 2007 and to identify the risk factors associated with severe disease. METHODS Medical records of patients hospitalized for bronchiolitis were reviewed for demographic, clinical, microbiologic, and radiologic characteristics as well as the presence of underlying medical conditions. Differences were evaluated between children with RSV and non-RSV bronchiolitis, and multivariable logistic regression analyses were performed to identify independent risk factors for severe disease. RESULTS Bronchiolitis hospitalizations in children younger than 2 years old (n =4800) significantly increased from 536 (3.3%) in 2002 to 1241 (5.5%) in 2007, mainly because of RSV infections. Patients with RSV bronchiolitis (n = 2840 [66%]) were younger at hospitalization and had a lower percentage of underlying medical conditions than children hospitalized with non-RSV bronchiolitis (27 vs 37.5%; P bronchiolitis. RSV infection and prematurity, regardless of the etiology, were identified as independent risk factors for severe bronchiolitis. CONCLUSIONS There was a significant increase in hospitalizations for RSV bronchiolitis from 2002 to 2007. A majority of the children with RSV bronchiolitis were previously healthy, but their disease severity was worse compared with those hospitalized with non-RSV bronchiolitis. PMID:21098154
Sahud, Hannah B; Binns, Helen J; Meadow, William L; Tanz, Robert R
The objectives of this study were (1) to determine fast food restaurant prevalence in hospitals with pediatric residencies and (2) to evaluate how hospital environment affects purchase and perception of fast food. We first surveyed pediatric residency programs regarding fast food restaurants in their hospitals to determine the prevalence of fast food restaurants in these hospitals. We then surveyed adults with children after pediatric outpatient visits at 3 hospitals: hospital M with an on-site McDonald's restaurant, hospital R without McDonald's on site but with McDonald's branding, and hospital X with neither on-site McDonald's nor branding. We sought to determine attitudes toward, consumption of, and influences on purchase of fast food and McDonald's food. Fifty-nine of 200 hospitals with pediatric residencies had fast food restaurants. A total of 386 outpatient surveys were analyzed. Fast food consumption on the survey day was most common among hospital M respondents (56%; hospital R: 29%; hospital X: 33%), as was the purchase of McDonald's food (hospital M: 53%; hospital R: 14%; hospital X: 22%). McDonald's accounted for 95% of fast food consumed by hospital M respondents, and 83% of them bought their food at the on-site McDonald's. Using logistic regression analysis, hospital M respondents were 4 times more likely than respondents at the other hospitals to have purchased McDonald's food on the survey day. Visitors to hospitals M and R were more likely than those at hospital X to believe that McDonald's supported the hospital financially. Respondents at hospital M rated McDonald's food healthier than did respondents at the other hospitals. Fast food restaurants are fairly common in hospitals that sponsor pediatric residency programs. A McDonald's restaurant in a children's hospital was associated with significantly increased purchase of McDonald's food by outpatients, belief that the McDonald's Corporation supported the hospital financially, and higher rating
Kitreerawutiwong, Nithra; Jordan, Sue; Hughes, David
Poor and middle-income Thai people rely heavily on primary care health services. These are staffed by a range of professionals. However, it is unknown whether the performance of primary care varies according to the staffing and organization of local service delivery units. Tambon (sub-district) health promotion hospitals (THPHs) were introduced in 2009 to upgrade the services offered by the previous health centres, but were faced with continuing shortages of doctors and nurses. The Ministry of Public Health (MoPH) designated three categories of THPH, defined according to whether they were regularly staffed by a medical practitioner, a qualified nurse or non-clinical public health officers. This study aimed to compare the performance of primary care offered by the three different types of primary care facilities in one public health region of Northern Thailand (Public Health Region 2). A cross-sectional survey was undertaken in 2013. Data were collected on accessibility, continuity, comprehensiveness, co-ordination and community orientation of care from 825 patients attending 23 primary care facilities. These were selected to include the three officially-designated types of Tambon (sub-district) health promotion hospitals (THPHs) led by medical, nursing or public health personnel. Survey scores were compared in unadjusted and adjusted analyses. THPHs staffed only by public health officers achieved the highest performance score (Mean = 85.14, SD. = 7.30), followed by THPHs staffed by qualified nurses (Mean = 82.86, SD. = 7.06). THPHs staffed by a doctor on rotation returned the lowest scores (Mean = 81.63, SD. = 7.22). Differences in overall scores resulted mainly from differences in reported accessibility, continuity, and comprehensiveness of care, rather than staff skill-mix per se. Policy on quality improvement should therefore focus on improving performance in these areas.
Kitreerawutiwong, Nithra; Jordan, Sue; Hughes, David
Background Poor and middle-income Thai people rely heavily on primary care health services. These are staffed by a range of professionals. However, it is unknown whether the performance of primary care varies according to the staffing and organization of local service delivery units. Tambon (sub-district) health promotion hospitals (THPHs) were introduced in 2009 to upgrade the services offered by the previous health centres, but were faced with continuing shortages of doctors and nurses. The Ministry of Public Health (MoPH) designated three categories of THPH, defined according to whether they were regularly staffed by a medical practitioner, a qualified nurse or non-clinical public health officers. This study aimed to compare the performance of primary care offered by the three different types of primary care facilities in one public health region of Northern Thailand (Public Health Region 2). Methods A cross-sectional survey was undertaken in 2013. Data were collected on accessibility, continuity, comprehensiveness, co-ordination and community orientation of care from 825 patients attending 23 primary care facilities. These were selected to include the three officially-designated types of Tambon (sub-district) health promotion hospitals (THPHs) led by medical, nursing or public health personnel. Survey scores were compared in unadjusted and adjusted analyses. Results THPHs staffed only by public health officers achieved the highest performance score (Mean = 85.14, SD. = 7.30), followed by THPHs staffed by qualified nurses (Mean = 82.86, SD. = 7.06). THPHs staffed by a doctor on rotation returned the lowest scores (Mean = 81.63, SD. = 7.22). Conclusions Differences in overall scores resulted mainly from differences in reported accessibility, continuity, and comprehensiveness of care, rather than staff skill-mix per se. Policy on quality improvement should therefore focus on improving performance in these areas. PMID:28339494
appropriate health education to reduce the morbidity and mortality associated with ... parents/caregivers of children with febrile seizures and the maternal .... consequences of harmful traditional pre-hospital treatment of .... The natural history of.
Schultz, F.W.; Geleijns, J.; Holscher, H.C.; Weststrate, J.; Zonderland, H.M.; Zoetelief, J.
Micturating cystourethrography (MCU) examinations of paediatric patients in a major Dutch children's hospital (JKZ) were evaluated to generate quantitative information on effective dose (E). A standard examination involves three radiographs plus fluoroscopy. Observed total dose-area product (DAP) fo
Folayan, M O; Arobieke, R I; Eziyi, E; Oyetola, E O; Elusiyan, J
The study describes the epidemiology, treatment, and treatment outcomes of the 10 cases of facial nerve palsy seen in children managed at the Obafemi Awolowo University Teaching Hospitals Complex, Ile...
Full Text Available The aim of this study was to determine the effects of training on anxiety in mothers of hospitalized children with urinary tract infection. The study was conducted in 40 mothers of hospitalized children in the Qazvin children hospital, during 2012-13. The subjects were selected by random sampling method and were divided into intervention and control groups. Data were collected through the Spielberger Anxiety Inventory on admission and two days before discharge. This questionnaire measures State anxiety and Trait anxiety subscales. Data were analyzed using paired T-test and independent sample T-test. Training had a significant effect on State anxiety in mothers of hospitalized children with urinary tract infection but did not affect Trait anxiety.
Bagay, Joann Marie
Challenges in professional nursing education today can be astonishing. Cognizant of the commitment to provide the most valuable learning experiences for our future nurses, academia and service organizations strive to meet this challenge. The escalation in nursing school enrollment, along with the increase in patient acuity and ongoing health care changes, requires hospitals and schools to continually review their practices to ensure positive outcomes. Providing pediatric nursing experiences to over 1,300 students annually, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center (UPMC) implemented a process to meet this need. A Faculty Advisory Council was established to provide a venue for representative nursing instructors to meet with the Nursing Education Department at the hospital. The commonality of focus by nursing faculty and Children's Hospital continues to strengthen both academia and service. This well-defined process supports positive pediatric experiences for nursing students at Children's Hospital of Pittsburgh of UPCM.
Zelli, P; Boussat, B; Wetzel, A; Ronin, C; Pons, J-C; Sergent, F
To characterize the indications of primary cesarean sections and discuss the various possibilities to reduce them. Retrospective study, carried out over a period of 1 year in a university hospital having a level 3 perinatal activity, including the 499 primary cesarean sections of 2013. Two groups were defined by parity: nulliparous patients (group 1) and multiparous patients who had never previously been delivered by cesarean section (group 2). We have assessed the indication of every primary cesarean section and health status of newborns in each group. Groups 1 and 2 respectively included 369 and 130 patients. The cesarean section rate in 2013 was 24.7% with a primary cesarean section rate of 17%. Seventy-four percent of the primary caesarean deliveries were performed on nulliparous women and 26% on multiparous (Pcesarean delivery were non-reassuring fetal heart rate tracing (47.1%), failure to progress (24.8%) for which nulliparous women were more involved (29% vs. 13%, Pcesarean section rate. Copyright © 2016. Published by Elsevier Masson SAS.
The purpose of this study is to explore primary school children's understandings about the shape of the Earth. The sample is consisted of 124 first-graders from five primary schools located in an urban city of Turkey. The data of the study were collected through children's drawings and semi-structured interviews. Results obtained from the drawings…
Full Text Available Introduction. Scoliosis, a lateral curvature of the spine, is the most frequent deformity of the spinal column. It is additionally aggravated by the inadequate environmental conditions in schools, such as unadjusted furniture, teaching aids and most of all, school bag and bad lighting. Material and methods. This investigation was carried out during the years 2005 and 2006 on the territory of the city of Kragujevac and included school children attending 22 primary and 8 secondary schools, whose medical records were obtained from school children health centres, the counseling centre for scoliosis at the Orthopedic Department of the Hospital in Kragujevac and the Institute of Public Health in Kragujevac. Results. The statistical analysis of these data showed that a significantly higher number of children with scoliosis was detected in 2005, being χ²=11.6, p<0.01 for primary schools. Scoliosis was more frequent in girls than in boys: in 2005 it was χ²=10.54, p<0.01 and in 2006 χ²=10.72, p<0.01 in primary schools, whereas no difference was found in secondary schools in 2005 -c2=4.14, p>0.05, but in 2006 scoliosis was more frequent in girls χ²=49.51, p<0.01. Conclusion. Scoliosis is extremely important in both primary and secondary schools and therefore, it is necessary to intensify preventive systematic examinations of school children.
Larsen, Michael Due; Schou, Mette; Kristiansen, Anja Sparre
AIM: This study had two aims: Firstly, to describe how prescriptions for proton pump inhibitor (PPI) in primary care were influenced by a change of the hospital drug policy, and secondly, to describe if a large discount on an expensive PPI (esomeprazole) to a hospital would influence prescribing...... policy on prescribings in primary care was measured by the likelihood of having a high-cost PPI prescribed before and after change of drug policy. RESULTS: In total, 9,341 hospital stays in 2009 and 2010 were included. The probability of a patient to be prescribed an expensive PPI after discharge...... for the recommended PPIs pantoprazole and lansoprazole to 14.6 and 26.1 %, respectively. The effect of a large discount on expensive PPI to hospital was 14.7 %, and this decreased to 2.6 % when coordinating drug policy in hospital and primary care. CONCLUSION: The likelihood of having an expensive PPI prescribed...
Slomine, Beth S; Silverstein, Faye S; Christensen, James R; Holubkov, Richard; Page, Kent; Dean, J Michael; Moler, Frank W
This study examined 12-month neurobehavioral outcomes in children who survived out-of-hospital cardiac arrest (OH-CA), were comatose after resuscitation, and were enrolled in a clinical trial to evaluate targeted temperature management to hypothermia (33.0°C) or normothermia (36.8°C) (Therapeutic Hypothermia after Pediatric Cardiac Arrest, Out-of-Hopsital [THAPCA-OH]; NCT00878644). Baseline functioning was assessed by caregiver responses on the Vineland Adaptive Behavior Scales-Second Edition (VABS-II) soon after OH-CA (based on functioning before OH-CA); children with broadly normal baseline functioning (VABS-II ≥70) were included in the THAPCA-OH primary outcome. VABS-II was completed again 12 months later. Then, face-to-face cognitive evaluations were completed. Analyses evaluated changes in VABS-II composite, domain, and subdomain scores and cognitive functioning at follow-up. Ninety-six of 295 enrolled children were alive at 12 months; 87 of 96 had broadly normal baseline functioning (VABS-II ≥70). Follow-up was obtained on 85/87. Forty-two of 85 had VABS-II ≥70 at 12 months. VABS-II composite, domain, and subdomain scores declined significantly between baseline and 12-month follow-up (P VABS-II scores were predictive of greater decline in neurobehavioral function. Treatment with hypothermia did not influence neurobehavioral outcomes. This is the largest study exploring long-term neurobehavioral outcomes in children surviving OH-CA who were comatose after resuscitation. Results revealed significant neurobehavioral morbidity across multiple functional domains, based both on caregiver reports and performance on objective cognitive measures, in survivors 1 year later. Copyright © 2016 by the American Academy of Pediatrics.
Pal, Rani; Edge, Julie
Poorly controlled diabetes adversely affects a child's education, with concentration difficulties, alterations in mood, behaviour and fatigue associated with high or low blood glucose levels. Between years 2004-6 we started all toddlers and children on intensive insulin regimens (multiple dose injection or pump) making it imperative that they received support during the school day. This required close monitoring of blood glucose levels and counting carbohydrate intake to adjust rapid-acting insulin dose or pump bolus at every meal. We report our experience of formulating a sustainable structure of support in primary schools based on trained volunteers who partake in the daily 'Individualised Care Plan (ICP)'. After overcoming multiple barriers, an acceptable system was negotiated with our Primary Care Trust (PCT) and Local Education Authority (LEA). In 2009, the PCT confirmed 3 years funding for a Paediatric Diabetes specialist nurse (PDSN) for schools. In 2010, the first full school year with agreed protocols was in place. By July 2012, our nurses had trained a total of 342 volunteers who provide care for 132 children. The Oxfordshire Schools Intervention Programme ensures that legal obligations are met. A risk assessment allows the LEA to provide indemnity to their school staff to give injections and do blood tests, after training and competency sign-off by a PDSN. Parents, volunteers and PDSN jointly agree a comprehensive 'ICP' and utilise a hand-held communication record book. Diabetes control improved (age 4-11 years cohort from 2004 onwards: Mean (SD) HbA1c in 2001-4 = 8.38 (1.09)%; in 2005-8 = 7.74 (0.81)%; in 2009-12 = 7.58 (0.69)%; ANOVA ptime to train/retrain/problem-solve annually (approximately 5-10days per month). The cost-benefits are discussed. We advocate that our programme supports each child's ICP, use of intensive insulin regimes in school-day and reassures parents that schools can deliver this safely.
Full Text Available Objective: The aim of this study was to evaluate the type, severity and progression of psychiatric pathologies in a sample of 372 outpatients (age range 18–65 years referred by their primary general practitioners (GPs to an Urgent Referral Team (URT based in a psychiatric hospital in Aberdeen, Scotland. This team offers immediate appointments (1- to 7-day delays for rapid assessments and early interventions to the outpatients referred by their primary family doctors.Method: One-sample t-test and z statistic were used for data analysis. From the total population, a convenience sample of 40 people was selected and assessed to evaluate whether follow-up appointments after the first visit could reduce the severity of suicidal ideation, depression and anxiety in the outpatients seen by the URT. A two-sample t-test and a Wilcoxon signed-rank test were used to assess the variations in the scores during the follow-up visits.Results: We found a statistically significant prevalence of depressive disorders, comorbid with anxiety at first presentation in people who were females, white, never married, living with a partner, not studying and not in paid employment. The common presentation of borderline personality disorder and dysthymia in this population underscores its vulnerability to major socioeconomic challenges.Conclusion: The data confirmed the impact that primary care cooperation with psychiatric hospitals can have on the psychiatric system, and as a reflection, on the population’s mental health and well-being. In fact, active cooperation and early diagnosis and intervention will help detect cases at risk in the general population and reduce admissions into hospitals.
Jansen, Angelique G S C; Sanders, Elisabeth A M; Schilder, Anne G M; Hoes, Arno W; de Jong, Vanya F G M; Hak, Eelko
OBJECTIVE: To determine age-specific antibiotic prescription and referral rates in preschool children diagnosed with acute respiratory tract infection (RTI) in primary care. DESIGN: Retrospective cohort study. SETTING: Research database of the Netherlands University Medical Center Utrecht Primary Ca
Vincent, Robert; Wegner, Inge; Vonck, Bernard M D; Bittermann, Arnold J; Kamalski, Digna M A; Grolman, Wilko
OBJECTIVES/HYPOTHESIS: To prospectively evaluate hearing outcomes in children with otosclerosis undergoing primary stapes surgery. STUDY DESIGN: A nonrandomized, nonblinded, prospective case series. METHODS: Thirty-four consecutive pediatric patients who underwent 41 primary stapedotomies for otoscl
Vincent, Robert; Wegner, Inge; Vonck, Bernard M D; Bittermann, Arnold J; Kamalski, Digna M A; Grolman, Wilko
OBJECTIVES/HYPOTHESIS: To prospectively evaluate hearing outcomes in children with otosclerosis undergoing primary stapes surgery. STUDY DESIGN: A nonrandomized, nonblinded, prospective case series. METHODS: Thirty-four consecutive pediatric patients who underwent 41 primary stapedotomies for
Jansen, Angelique G S C; Sanders, Elisabeth A M; Schilder, Anne G M; Hoes, Arno W; de Jong, Vanya F G M; Hak, Eelko
OBJECTIVE: To determine age-specific antibiotic prescription and referral rates in preschool children diagnosed with acute respiratory tract infection (RTI) in primary care. DESIGN: Retrospective cohort study. SETTING: Research database of the Netherlands University Medical Center Utrecht Primary Ca
Full Text Available The overuse of antibiotics in children is becoming a major public health problem. Although most of the common childhood infections such as diarrhea and upper respiratory tract infections are caused by viruses, large volumes of antibiotics are prescribed for these infections in children in the primary care settings. Excessive use of antibiotics is the fundamental risk factor for the development of antibiotic resistance. It is estimated that 90�0of upper respiratory tract infections are self limiting viral illnesses and even bacterial infections like acute otitis media often run a self limiting course. Clinical trials have shown that antibiotic use to treat common upper respiratory tract infections like sore throat, nasopharyngitis and otitis media has no or minimal benefit on the clinical outcome. This report discusses two strategies considered to reduce the use of antibiotic in these conditions: i No prescription, and ii Delayed prescription of antibiotics for common upper respiratory tract infections. Moreover, this report calls for a significant modification of the prescribing habits of physicians, and to also extend community awareness on the harms of the misuse and overuse of antibiotics. It is imperative to educate health workers as well as the Community in a coordinated and sustainable manner about the growing public health problem of antibiotic resistance.
WANG Ya-ping; LIU Ai-min; DAI Yu-wen; YANG Cheng; TANG Hong-feng
Objective: To explore better therapy and reduce the rate of re-relapse of primary nephritic syndrome in children who had been treated with corticosteroids but relapsed. Methods: Eighty relapsers were enrolled from Jan. 1994 to Apr. 2000, who were randomly divided into two groups. The treatment group (n=39) had been treated with tripterysium glucosides for three months,with the control group (n=41) members were treated with cyclophosphmide (CTX) by intermission intravenous pulse, with total dose of CTX not being more than 150 mg/kg. Prednisone, meanwhile, was given to both groups. The total treatment period of prednisone was prolonged by 12-18 months. Results: After following up for 3-7 years, the re-relapse rates of both groups were observed. The re-relapse rate of the treatment group was 28.2% to 29.3% in the CTX-controlled group. The re-relapse rates between two groups were almost similar, and with no observed significant difference (P>0.05). The side effect of tripterysium glucosides was less than that of CTX. Conclusion: For the treatment of relapsing nephritic syndrome in children, the combination of tripterysium glucosides and prolonged corticosteroid therapy is as effective as the regimen of CTX plus prolonged use of prednisone.
Macy, Michelle L; Hall, Matthew; Alpern, Elizabeth R; Fieldston, Evan S; Shanley, Leticia A; Hronek, Carla; Hain, Paul D; Shah, Samir S
Pediatric observation units (OUs) have demonstrated reductions in lengths of stay (LOS) and costs of care. Hospital-level outcomes across all observation-status stays have not been evaluated in relation to the presence of a dedicated OU in the hospital. To compare observation-status stay outcomes in hospitals with and without a dedicated OU. Cross-sectional analysis of hospital administrative data. Observation-status stay outcomes were compared in hospitals with and without a dedicated OU across 4 categories: (1) LOS, (2) standardized costs, (3) conversion to inpatient status, and (4) return care. Observation-status stays in 31 free-standing children's hospitals contributing observation patient data to the Pediatric Health Information System database, 2011. Fifty-one percent of the 136,239 observation-status stays in 2011 occurred in 14 hospitals with a dedicated OU; the remainder were in 17 hospitals without. The percentage of observation-status same-day discharges was higher in hospitals with a dedicated OU compared with hospitals without (23.8 vs 22.1, P observation-status stays without impacting other hospital-level outcomes. Inclusion of location of care (eg, dedicated OU, inpatient unit, emergency department) in hospital administrative datasets would allow for more meaningful comparisons of models of hospital care. © 2015 Society of Hospital Medicine.
Full Text Available Hospitalization is a condition of a person because of illness and hospital admission. Research objectives determine the influence of audio recorded guided imagery method to stress of hospitalization in school-age children in hospital in Palu. Quasi-experimental research design with pre and post test design with control group. The sample of children aged 7-12 years were 26 respondents intervention group and 26 control group respondents. Intervention is the method of audio recorded guided imagery, three times a day for two days (one session equal to15 minutes. The results showed the significant difference mean stress score of hospitalization after the intervention (Pv = 0.004. No contribution of confounding variables. Based on these results, audio recorded guided imagery intervention can be applied to care the sick pediatric in hospital.
Hospital personnel have been shown to report child maltreatment to social services less frequently than other professionals. This quantitative study shows that one-half of the respondents within the four largest Swedish children's hospitals had never made a report. However, nurses' and nurse assistants' odds of being low reporters were…
Hynd, George W.; And Others
Investigated concurrent validity of the McCarthy Scales of Children's Abilities (MSCA) with Native American primary-grade children. Significantly low General Cognitive Index indicates that the MSCA with Native American children is not recommended for psychodiagnostic purposes. However, perceptual-performance and motor scales may provide useful…
Kassem, Diana Faour; Hoffmann, Yoav; Shahar, Naama; Ocampo, Smadar; Salomon, Liora; Zonis, Zeev
Since 2013, wounded and ill children from Syria have received treatment in Israel. Screening cultures indicated that multidrug-resistant (MDR) pathogens colonized 89 (83%) of 107 children. For 58% of MDR infections, the pathogen was similar to that identified during screening. MDR screening of these children is valuable for purposes of isolation and treatment. PMID:27618479
Mpimbaza, Arthur; Miles, Melody; Sserwanga, Asadu; Kigozi, Ruth; Wanzira, Humphrey; Rubahika, Denis; Nasr, Sussann; Kapella, Bryan K.; Yoon, Steven S.; Chang, Michelle; Yeka, Adoke; Staedke, Sarah G.; Kamya, Moses R.; Dorsey, Grant
The primary source of malaria surveillance data in Uganda is the Health Management Information System (HMIS), which does not require laboratory confirmation of reported malaria cases. To improve data quality, an enhanced inpatient malaria surveillance system (EIMSS) was implemented with emphasis on malaria testing of all children admitted in select hospitals. Data were compared between the HMIS and the EIMSS at four hospitals over a period of 12 months. After the implementation of the EIMSS, over 96% of admitted children under 5 years of age underwent laboratory testing for malaria. The HMIS significantly overreported the proportion of children under 5 years of age admitted with malaria (average absolute difference = 19%, range = 8–27% across the four hospitals) compared with the EIMSS. To improve the quality of the HMIS data for malaria surveillance, the National Malaria Control Program should, in addition to increasing malaria testing rates, focus on linking laboratory test results to reported malaria cases. PMID:25422396
Abstract Background Characterization of severe malaria cases on arrival to hospital may lead to early recognition and improved management. Minimum community based-incidence rates (MCBIRs) complement hospital data, describing the malaria burden in the community. Methods A retrospective analysis of all admitted malaria cases to a Mozambican rural hospital between June 2003 and May 2005 was conducted. Prevalence and case fatality rates (CFR) for each sign and symptom were calculated. Logistic re...
Yaw Boateng Mensah
Full Text Available Background: Intussusception is a common abdominal emergency in children which necessitates prompt diagnosis and management. Nonsurgical methods of managing this condition are rapidly gaining popularity with fluoroscopic-guided pneumatic reduction being one of such methods that has been used with great success in many countries. We present our initial experience with fluoroscopic-guided pneumatic reduction of intussusception at Korle Bu Teaching Hospital which is also the first time the technique has been used in Ghana. Materials and Methods: A total of 18 children were enrolled in the study between August 2007 and February 2008 at Korle Bu Teaching Hospital, Accra, Ghana. Patients were given air enema under fluoroscopic-guidance using locally assembled equipment. The intraluminal pressure was monitored with a pressure gauge and was not permitted to go above 120 mmHg. A total of three attempts of 3 min each were allowed. Results: There were 12 males and 6 females. The average age of the patients was 8.3 months (SD= 3 months. Twelve (67% of the cases were reduced successfully while 6 (33% failed to reduce. A majority of those that did not reduced had symptoms for at least 2 days. Bowel perforation occurred in three (16.7% cases. Conclusion: Pneumatic reduction of intussusception is a cost-effective and rapid method of management of intussusception. It however has limitations like high reported rate of bowel perforation and limited ability to identify lead points. The benefits however seem to outweigh these challenges, such as fluoroscopic-guided pneumatic reduction has a very high success rate. Fluoroscopic guided pneumatic reduction should be considered as one of the primary modes of reduction in Ghana and other neighbouring countries that are yet to practice it.
Full Text Available Introduction: Current knowledge on morbidity and mortality in HIV-infected children comes from data collected in specific research programmes, which may offer a different standard of care compared to routine care. We described hospitalization data within a large observational cohort of HIV-infected children in West Africa (IeDEA West Africa collaboration. Methods: We performed a six-month prospective multicentre survey from April to October 2010 in five HIV-specialized paediatric hospital wards in Ouagadougou, Accra, Cotonou, Dakar and Bamako. Baseline and follow-up data during hospitalization were recorded using a standardized clinical form, and extracted from hospitalization files and local databases. Event validation committees reviewed diagnoses within each centre. HIV-related events were defined according to the WHO definitions. Results: From April to October 2010, 155 HIV-infected children were hospitalized; median age was 3 years [1–8]. Among them, 90 (58% were confirmed for HIV infection during their stay; 138 (89% were already receiving cotrimoxazole prophylaxis and 64 children (40% had initiated antiretroviral therapy (ART. The median length of stay was 13 days (IQR: 7–23; 25 children (16% died during hospitalization and four (3% were transferred out. The leading causes of hospitalization were WHO stage 3 opportunistic infections (37%, non-AIDS-defining events (28%, cachexia and other WHO stage 4 events (25%. Conclusions: Overall, most causes of hospitalizations were HIV related but one hospitalization in three was caused by a non-AIDS-defining event, mostly in children on ART. HIV-related fatality is also high despite the scaling-up of access to ART in resource-limited settings.
Kartaloglu, Zafer; Bozkanat, Erkan; Ozturkeri, Hakan; Okutan, Oguzhan; Ilvan, Ahmet
The aim of this study was to investigate the prevalence of primary drug resistance to tuberculosis. We evaluated the clinical data, radiological features and sputum samples from 365 newly diagnosed patients with a positive culture of pulmonary tuberculosis at the Turkish Military Chest Diseases Hospital, Istanbul, Turkey. No patients had taken antituberculosis drugs previously. The Bactec method was used to perform drug susceptibility testing for isoniazid, rifampicin, ethambutol, and streptomycin. Primary resistance to one or more drugs was detected in 87 (23.8%) patients; resistance to isoniazid was most common (54 patients) followed by resistance to ethambutol (n = 39), rifampicin (n = 11), and streptomycin (n = 9). One-drug resistance was detected in 69 patients; two-drug resistance in 11, three-drug resistance in 6, and four-drug resistance in 1. Multidrug resistance (resistance to at least isoniazid and rifampicin) was detected in 10 patients. In logistic-regression analysis, primary drug resistance was associated with radiological advanced tuberculosis (p < 0.001). Primary resistance to one or more drugs used in treating tuberculosis is relatively high. It is necessary to regularly screen for and treat drug resistance among those who live in close quarters, such as army barracks, school dormitories and prisons. Regular surveillance of drug sensitivity patterns should be maintained to determine appropriate alternate drug regimens and detect the spread of resistant stains in the population. Copyright 2002 S. Karger AG, Basel
Full Text Available Abstract Background Correct upright posture is considered to be a measure of good musculoskeletal health. Little is known about the usual variability of children's upright standing posture. The aim of this study was to assess differences between repeated measures of upright posture in a group of primary school children. Methods Sagittal plane photographs of usual, relaxed upright standing posture of 38 boys and girls aged 5–12 years were taken twice within an hour. Reflective markers were placed over the canthus, tragus, C7 spinous process, greater trochanter and lateral malleolus. Digitising software was used to calculate the x,y plane coordinates, from which five postural angles were calculated (trunk, neck, gaze, head on neck, lower limb. Height, weight, motor control estimates (as measured by the Brace Tests and presence of recent pain were recorded for each child, and the association between the first test measure of posture angles and these factors was assessed using linear regression and ANOVA models. Multiple ANOVA models were applied to analyse the effect of repeated testing, and significant predictors on the angles. Results Four of the five postural angles (trunk, neck, head on neck, lower limb were significantly influenced by age. As age was strongly associated with height (r2 = 0.84 and moderately associated with weight and motor control (r2 = 0.67, 0.56 respectively, these developmental parameters may well explain the age effect on angles. There was no relationship between age and pain reported on either the testing day, or recently, and there was no gender influence on any angle. There was no significant effect of repeated testing on any angle (ICC>0.93. None of the hypothesized predictors were associated with differences in angles from repeated testing. Conclusion This study outlined the variability of relaxed upright standing posture of children aged 5–12 years, when measured twice in an hour. Age influenced the size of the
Chin, Jui-Chih; Tsuei, Mengping
The aim of this study was to explore the digital game-based learning for children with chronic illnesses in the hospital settings. The design-based research and qualitative methods were applied. Three eight-year-old children with leukemia participated in this study. In the first phase, the multi-user game-based learning system was developed and…
Chin, Jui-Chih; Tsuei, Mengping
The aim of this study was to explore the digital game-based learning for children with chronic illnesses in the hospital settings. The design-based research and qualitative methods were applied. Three eight-year-old children with leukemia participated in this study. In the first phase, the multi-user game-based learning system was developed and…
Farrell, Joan; Cope, Scott Brooks; Cooper, James H; Mathias, Leigh
An experimental two-group comparison pilot study of forty chronically ill hospitalized children was carried out at Wolfson Children's Hospital in Jacksonville, Florida. Three Godly Play interventions were given to participants in the experimental group. Children in the control group did not participate but received a fairy tale book as a control. The sample was evenly distributed with twenty (20) males and twenty (20) females. Ages ranged from six (6) to fifteen (15) years and all participants were chronically ill. Five (5) variables were studied. Of the five (5), three (3) showed significant differences before and after Godly Play: the Staic-Trait Anxiety Scale (p = .049), the Children's Depression Inventory (p = .011), and the McBride Spirituality Assessment (p = .033). A marginal difference in parent satisfaction with hospital care of children in the experimental and control groups was also determined (p = .058). Findings suggest that Godly Play had a significant effect on anxiety, depression, and spirituality of children and support the idea that the parents of children who participated in Godly Play were more satisfied with hospital care than those parents whose children did not engage in Godly Play.
Piedra, Pedro A.; Mansbach, Jonathan M.; Jewell, Alan M.; Thakar, Sneha D.; Grant, Cameron C.; Sullivan, Ashley F.; Espinola, Janice A.; Camargo, Carlos A.
Background In the United States (U.S.), Bordetella pertussis incidence has increased. Cough and apnea are common findings in pertussis and also in bronchiolitis, the most common cause of hospitalization in U.S. infants. The objective was to determine the prevalence of B. pertussis infection in children hospitalized with bronchiolitis and to describe its clinical course. Methods Children hospitalized with bronchiolitis and age bronchiolitis in the winter. Making a diagnosis of pertussis can be challenging because the disease can be atypical, and may not meet the CDC definition of probable infection. PMID:25970109
Almström, Markus; Svensson, Jan F; Patkova, Barbora; Svenningsson, Anna; Wester, Tomas
To investigate the correlation between in-hospital surgical delay before appendectomy for suspected appendicitis and the finding of perforated appendicitis in children. All children undergoing acute appendectomy for suspected acute appendicitis at Karolinska University Hospital, Stockholm, Sweden from 2006 to 2013 were reviewed for the exposure of surgical delay. Primary endpoint was the histopathologic finding of perforated appendicitis. The main explanatory variable was in-hospital surgical delay, using surgery within 12 hours as reference. Secondary endpoints were postoperative wound infection, intra-abdominal abscess, reoperation, length of hospital stay, and readmission. To adjust for selection bias, a logistic regression model was created to estimate odds ratios for the main outcome measures. Missing data were replaced using multiple imputation. The study comprised 2756 children operated for acute appendicitis. Six hundred sixty-one (24.0%) had a histopathologic diagnosis of perforated appendicitis. In the multivariate logistic regression analysis, increased time to surgery was not associated with increased risk of histopathologic perforation. There was no association between the timing of surgery and postoperative wound infection, intra-abdominal abscess, reoperation, or readmission. In-hospital delay of acute appendectomy in children was not associated with an increased rate of histopathologic perforation. Timing of surgery was not an independent risk factor for postoperative complications. The results were not dependent on the magnitude of the surgical delay. The findings are analogous with previous findings in adults and may aid the utilization of available hospital- and operative resources.
García-Rodríguez, Antonio; Gutiérrez-Bedmar, Mario; Bellón-Saameño, Juan Ángel; Muñoz-Bravo, Carlos; Fernández-Crehuet Navajas, Joaquín
To describe the psychosocial environment of health professionals in public health in primary and hospital care, and compare it with that of the general Spanish working population, as well as to evaluate the effect of psychosocial risk factors on symptoms related to perceived stress. Cross-sectional study with stratified random sampling. Health care workers in the province of Granada, distributed in 5 hospitals and 4 health districts. A total of 738 employees (medical and nursing staff) of the Andalusian Health Service (SAS) were invited to take part. CopSoQ/Istas21 questionnaire developed for the multidimensional analysis of the psychosocial work environment. Stress symptoms were measured with the Stress Profile questionnaire. The response rate was 67.5%. Compared with the Spanish workforce, our sample showed high cognitive, emotional, and sensory psychological demands, possibilities for development and sense of direction in their work. Primary care physicians were the group with a worse psychosocial work environment. All the groups studied showed high levels of stress symptoms. Multivariate analysis showed that variables associated with high levels of stress symptom were younger and with possibilities for social relations, role conflict, and higher emotional demands, and insecurity at work. Our findings support that the psychosocial work environment of health workers differs from that of the Spanish working population, being more unfavorable in general practitioners. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.
Faraoni, David; DiNardo, James A; Goobie, Susan M
The relationship between preoperative anemia and in-hospital mortality has not been investigated in the pediatric surgical population. We hypothesized that children with preoperative anemia undergoing noncardiac surgery may have an increased risk of in-hospital mortality. We identified all children between 1 and 18 years of age with a recorded preoperative hematocrit (HCT) in the 2012, 2013, and 2014 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) pediatric databases. The endpoint was defined as the incidence of in-hospital mortality. Children with preoperative anemia were identified based on their preoperative HCT. Demographic and surgical characteristics, as well as comorbidities, were considered potential confounding variables in a multivariable logistic regression analysis. A sensitivity analysis was performed using propensity-matched analysis. Among the 183,833 children included in the 2012, 2013, and 2014 ACS NSQIP database, 74,508 had a preoperative HCT recorded (41%). After exclusion of all children children were anemic, and 39,071 (76%) were nonanemic. The median preoperative HCT was 33% (interquartile range, 31-35) in anemic children, and 39% (interquartile range, 37-42) in nonanemic children (P anemia was associated with higher odds for in-hospital mortality (OR, 2.17; 95% CI, 1.48-3.19; P anemia was also associated with higher odds of in-hospital mortality (OR, 1.75; 95% CI, 1.15-2.65; P = .004). Our study demonstrates that children with preoperative anemia are at increased risk for in-hospital mortality. Further studies are needed to assess whether the correction of preoperative HCT, through the development of a patient blood management program, improves patient outcomes or simply reduces the need for transfusions.
Full Text Available Objectives: To determine the effectiveness of nutritional screening programmes in improving quality of care and patient outcomes compared with usual care. Methods: Searches were performed on MEDLINE, EMBASE, CINHAL, the Cochrane database, and Current Controlled Trials. Due to the assumed scarcity of high quality evidence, interventional studies in hospital or primary care settings with adequate reporting and comparisons were considered as eligible. Team members met after reviewing the papers. Decisions on inclusion or exclusion of papers were made when all agreed. Two reviewers independently extracted data from included studies. Results: 705 abstracts were considered and thirty full-text papers were ordered and reviewed. Following further review of the extracted data two papers met the inclusion criteria. One was a clustered randomized study of 26 general practices to evaluate the effectiveness of screening for elderly ailments including malnutrition. It concluded nutritional screening did not improve referral to dieticians, detection of nutritional problems, or patients’ quality of life. This study was underpowered for evaluating the effectiveness of nutritional screening. A non-randomized controlled before-after study of four hospital wards concluded that intervention improved weight recording, but not referral to dieticians or care at the mealtime of at risk patients. Discussion: Very few studies assess the effectiveness of nutritional screening with relevant outcomes and acceptable quality. The available evidence does not support systematic application of screening tools to hospital, or general practice patients. Given the current level of interest and political support for nutritional screening, further studies are urgently required.
A significant number of neonates are admitted to tertiary paediatric units for prolonged stays annually, despite limited availability of neonatal beds. As the three Dublin paediatric hospitals merge, this pressure will be transferred to our new National Children’s Hospital.\\r\
Akakpo, Patrick Kafui; Derkyi-Kwarteng, Leonard; Gyasi, Richard Kwasi; Quayson, Solomom Edward; Naporo, Simon; Anim, Jehoram Tei
Ovarian tumours are a leading cause of death in Ghana. Even though geographical and racial differences exist in the frequency, types and age distribution of primary ovarian tumours, information about the clinical and pathological characteristics of ovarian tumours in Ghana and its neighboring countries is scanty. We determined the frequency, age distribution, histopathological types and clinical features of primary ovarian tumours diagnosed at the Korle-Bu Teaching Hospital in Ghana to aid in the management of patients. All pathology records of ovarian tumours diagnosed from January 2001 to December 2010 were reviewed. Histopathologically, tumours were classified according to the then World Health Organization 1999 classification. Biographical and clinical data of patients were also collected and entered into Epi-info to determine the frequency, age distribution and other clinical features of the types of ovarian tumour. Seven hundred and six ovarian tumours were studied. Germ cell tumours were the most common (41.9%), with mean age of occurrence being 30.7 years (SD 12.7), they were dominated by mature teratomas (39.2%). Surface epithelial tumours were second, and commonly occurred in women aged 35-44years, 77 (26.8%). Sex cord stromal tumours followed with mean age of occurrence of 40.2 years (SD 17.9). The most common malignant tumours were surface epithelial (52.1%) dominated by serous carcinomas with mean age 50.1 years. Most patients (47.7%) presented within 1 month of onset of symptoms, feeling a lower abdominal mass (38.5%). The most common primary ovarian tumours in this study are Germ cell tumours, dominated by mature teratomas. Adenocarcinomas are mostly serous and occur in younger women compared to findings of other Western studies. The single most common malignant ovarian tumour in children and adolescents is Burkitt lymphoma. Patients who develop ovarian tumours have no specific symptoms or signs at presentation, to aid early diagnosis.
Wood, Nicholas J
Specialist immunisation clinics review and manage children who have experienced an adverse event following immunisation and provide advice to parents and health care providers regarding the revaccination of these children. Information collected by these clinics supplement passive surveillance data and allow the investigation of suspected safety signals associated with the delivery of immunisation programs. This paper reviews the role and experience of the Immunisation Adverse Events Clinic at The Children's Hospital at Westmead and identifies areas for development.
Laham, Federico R; Mansbach, Jonathan M; Piedra, Pedro A; Hasegawa, Kohei; Sullivan, Ashley F; Espinola, Janice A; Camargo, Carlos A
In this analysis of a prospective, multicenter study of children hospitalized with bronchiolitis, 925 had respiratory syncytial virus (RSV)-A and 649 had RSV-B. Overall, bronchiolitis severity did not differ by RSV subtype. However, among children with RSV-only bronchiolitis, those children with RSV-A had higher risk of intensive care treatment (odds ratio, 1.31; 95% confidence interval, 1.00-1.71; P = 0.048) when compared with those having RSV-B.
Thunberg, Gunilla; Buchholz, Margret; Nilsson, Stefan
There is a lack of research on the use of augmentative and alternative communication (AAC) in paediatric care, despite the fact that most children in need of AAC frequently need to visit hospitals and sometimes have to stay for long periods. The aim of this study was to investigate parents' experiences of the hospital visits with their children with communicative disabilities and to collect their ideas about how to optimize communication in this situation. Ten parents who had children with communicative disability took part in three focus group interviews. The analysis had a retrospective qualitative content theory. In the qualitative content analysis of the focus group interviews, 4 categories and 17 subcategories were identified. Overall, the results highlighted the importance of enabling direct communication between the child and the staff during the hospital stay. Parents of children with communication difficulties highlighted the importance of listening to their children and understanding their needs during hospital care and that hospital staff are in need of more knowledge in communicative disability and AAC to accomplish this. Training programmes for health-care professionals should be established to facilitate these requirements and connect to the United Nations conventions. Hospitals should provide and use AAC/communicative support.
Rømsing, Janne; Larsen, Camilla; Friis, Susanne Molin
BACKGROUND: Children being cared for in hospital often undergo multiple diagnostic and therapeutic procedures. Procedure-related pain, anxiety, and distress may consequently place a significant burden on the children. Although standards for pain management exist, procedure-related pain remains...... inadequately treated. OBJECTIVE: To determine the frequency and pain intensity of procedures in children, as well as the associated pharmacologic interventions to manage the pain in a Danish University Hospital. METHODS: During a 3-month period in 2013, a structured questionnaire was used to prospectively...
Hawkes, C P
Egg allergy is incorrectly considered to constitute a contraindication to MMR in the community, despite a long history of its safe administration to egg allergic children. The product insert perpetuates this misinformation but the Irish guidelines from the RCPI are unequivocal. We reviewed all paediatric cases vaccinated in our hospital in 2007-2008. Forty seven of 91 children receiving vaccinations in hospital, had been referred for MMR due to concerns regarding egg allergy. In 32% (n=15), GP referral for vaccination was made despite correspondence from the clinic advising routine vaccination in the community. Nineteen were second MMR immunisations, which should all have occurred in the community. Unnecessary hospital referral for MMR vaccination is an extra burden on hospital resources, and causes unwarranted anxiety amongst parents of children with egg allergy. A change in practice seems difficult to achieve, as many referrals happen despite individualised correspondence to GPs and other referring clinicians outlining the current guidelines.
Cantó, M A Gutiérrez; Quiles, J M Ortigosa; Vallejo, O Girón; Pruneda, R Ruiz; Morote, J Sánchez; Piñera, M J Guirao; Carmona, G Zambudio; Fuentes, M J Astillero; Collado, I Castaño; Barón, Cárceles
To be hospitalized is a highly distressing event for children. At present, a resort used in Spain and other countries to reduce children's anxiety in the health context are hospital's clown. We studied the effect of the hospital's clowns about the anxiety in children that going to be operated. We recruited 60 children aged 6 to 10 years scheduled to undergo elective surgery. 30 children would have clowns before the surgery (case group) and 30 would not have them (control group). In the case group, two clowns performed for children. We measured the anxiety with several scales (STAIC, CCPH, faces scale), after the performance and until 7 days after the surgery. The outcomes show both groups a tendency to increase anxiety but the children of the case group showed less increase at the anxiety's score. In the control group is showed that the children are more alterated at seven days from the discharge. Children that receive the clown's care, have tendency to be less distressing and with less fear that another ones, measurement by STAIC and faces scale, and these results are maintained seven days after the discharge.
Dicko, Fatoumata; Desmonde, Sophie; Koumakpai, Sikiratou
hospitalized; median age was 3 years [1-8]. Among them, 90 (58%) were confirmed for HIV infection during their stay; 138 (89%) were already receiving cotrimoxazole prophylaxis and 64 children (40%) had initiated antiretroviral therapy (ART). The median length of stay was 13 days (IQR: 7-23); 25 children (16...... but one hospitalization in three was caused by a non-AIDS-defining event, mostly in children on ART. HIV-related fatality is also high despite the scaling-up of access to ART in resource-limited settings.......INTRODUCTION: Current knowledge on morbidity and mortality in HIV-infected children comes from data collected in specific research programmes, which may offer a different standard of care compared to routine care. We described hospitalization data within a large observational cohort of HIV...
Samra, José A; Hagood, Nancy L; Summer, Andrea; Medina, Marco T; Holden, Kenton R
The first case of Chikungunya virus in Honduras was identified in 2014. The virus has spread widely across Honduras via the Aedes aegypti mosquito, leading to an outbreak of Chikungunya virus (CHIKV) in 2015 that significantly impacted children. A retrospective chart review of 235 children diagnosed with CHIKV and admitted to the National Autonomous University of Honduras Hospital Escuela (Hospital Escuela) in Tegucigalpa, Honduras, was accomplished with patients who were assessed for clinical features and neurologic complications. Of 235 children admitted to Hospital Escuela with CHIKV, the majority had symptoms of fever, generalized erythematous rash, and irritability. Fourteen percent had clinical arthritis. Ten percent of patients had seizures. Six percent had meningoencephalitis. There were 2 childhood deaths during the course of this study, one from meningoencephalitis and another from myocarditis. Chikungunya virus can cause severe complications in children, the majority of which impact the central nervous system.
Dusi, Paola; Steinbach, Marilyn
This study involves 35 research participants: 20 immigrant parents (primarily mothers from South America, North Africa, Eastern Europe and the Middle East) and 15 primary school children, aged 10-11. These children were born outside Italy and primary school was their first encounter with the Italian educational system. We observed their processes…
Meda, L.; Sookrajh, R.; Maharaj, B.
This paper questions whether the second Millennium Development Goal of achieving universal primary education targets by 2015 for all children to complete a full course of primary schooling, can be realised. A key contention of this paper is that this forecast is far-fetched when we take into cognizance refugee children's accessibility to…
In taking its theoretical impetus from hermeneutic phenomenology, the qualitative research reported in this paper aimed to identify characteristics of children's spirituality in Australian Catholic primary schools. The videotaped life expressions of two groups of six children in each of three Australian Catholic primary schools formed the texts of…
Ojugo, Augustine I.
The purpose of this study was to determine the status of the health appraisal services provided for primary school children in Edo State, Nigeria. Using the cross-sectional survey design a total of 1506 primary school children were selected from across the state as the study participants. The analysis of data collected through a 14-item…
Kuldas, Seffetullah; Sinnakaudan, Santi; Hashim, Shahabuddin; Ghazali, Munirah
Although the early development of children's number sense is a strong predictor of their later mathematics achievements, it has been overlooked in primary schools in Malaysia. Mainly attributable to underdeveloped number sense of Malaysian primary and secondary school children, their inability to handle simple mathematics tasks, which require the…
Bhat, Y J; Hassan, I; Bashir, S; Farhana, A; Maroof, P
Pyodermas are a common group of infectious dermatological conditions on which few studies have been conducted. This study aimed to characterise the clinical and bacteriological profile of pyodermas, and to determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) infection in primary pyodermas in a dermatology outpatient department in Kashmir. Methods We conducted a hospital based cross-sectional study in the outpatient Department of Dermatology, Sexually Transmitted Diseases and Leprosy of Shri Maharaja Hari Singh Hospital, Srinagar, Jammu and Kashmir, India. Patients presenting with primary pyodermas were included in the study. A detailed history and complete physical and cutaneous examination was carried out along with microbiological testing to find aetiological microorganisms and their respectiveantimicrobial susceptibility patterns. Antimicrobial susceptibility testing, including that for methicillin resistance, was carried out by standard methods as outlined in the current Clinical and Laboratory Standards Institute guidelines. Results In total, 110 patients were included; the age of the study population ranged from 3 to 65 years (mean age 28 years); 62% were male. Poor personal hygiene was noted in 76 (69%). Furunculosis (56; 51%) was the most common clinical presentation. Staphylococcus aureus was isolated in 89 (81%) of cases, and MRSA formed 54/89 (61%) of Staphylococcus aureus isolates. All MRSA strains were sensitive to vancomycin. Conclusion The prevalence of MRSA was high in this sample of communityacquired primary pyodermas. It is therefore important to monitor the changing trends in bacterial infection and their antimicrobial susceptibility patterns and to formulate a definite antibiotic policy which may be helpful in decreasing the incidence of MRSA infection.
Nelson, Katherine E; Hexem, Kari R; Feudtner, Chris
Trisomy 13 and trisomy 18 are generally considered fatal anomalies, with a majority of infants dying in the first year after birth. The inpatient hospital care that these patients receive has not been adequately described. This study characterized inpatient hospitalizations of children with trisomy 13 and trisomy 18 in the United States, including number and types of procedures performed. Retrospective repeated cross-sectional assessment of hospitalization data from the nationally representative US Kids' Inpatient Database, for the years 1997, 2000, 2003, 2006, and 2009. Included hospitalizations were of patients aged 0 to 20 years with a diagnosis of trisomy 13 or trisomy 18. The number of hospitalizations for each trisomy type ranged from 846 to 907 per year for trisomy 13 (P = .77 for temporal trend) and 1036 to 1616 per year for trisomy 18 (P < .001 for temporal trend). Over one-third (36%) of the hospitalizations were of patients older than 1 year of age. Patients underwent a total of 2765 major therapeutic procedures, including creation of esophageal sphincter (6% of hospitalizations; mean age 23 months), repair of atrial and ventricular septal defects (4%; mean age 9 months), and procedures on tendons (4%; mean age 8 years). Children with trisomy 13 and trisomy 18 receive significant inpatient hospital care. Despite the conventional understanding of these syndromes as lethal, a substantial number of children are living longer than 1 year and undergoing medical and surgical procedures as part of their treatment.
Nancy L. Weaver
Full Text Available Objective: Not-for-profit hospitals are required to meet federal reporting requirements detailing their community benefit activities, which support their tax-exempt status. Children's hospitals have long provided community injury prevention (IP programming and thus can inform public health outreach work in other areas. This work describes IP programming as a community service offered by children's hospitals in the U.S. Methods: The IP specialist at 232 US-based member institutions of the Children's Hospital Association were invited to complete an assessment of their hospital's IP outreach programming. Results: 47.7 percent of hospitals request financial data from IP programming for tax reporting purposes. Almost all offer injury prevention (IP services; the majority are in the community (60.3% and 34.5% are hospital-based. Most IP units are independent (60.3% and 71.8% are responsible for their own budgets. Conclusions: By integrating dissemination and implementation sciences and community health needs assessments, these findings can help advance community services provided by hospitals to impact public health.
Hwang, Eun Ha; Park, Jae Hong; Chun, Peter
Purpose Undernutrition during hospitalization increases the risk of nosocomial infection and lengthens the disease courses. The aim of this study was to evaluate the risk factors of weight loss during hospitalization in children. Methods All the patients who were admitted in general wards between April and May 2014 were enrolled. Patients aged >18 years and discharged within 2 days were excluded. Weight loss during hospitalization was defined as a decrease in body weight of >2% in 8 hospital days or on the day of discharge. Patients who lost body weight during hospitalization were compared with patients who maintained their body weights. Significant parameters were evaluated by using the multivariate logistic regression analysis. Results We enrolled 602 patients, of whom 149 (24.8%) lost >2% of their body weight. Complaint of pain (p=0.004), admission to the surgical department (p=0.001), undergoing surgery (p=0.044), undergoing abdominal surgery (p=0.034), and nil per os (NPO) durations (p=0.003) were related to weight loss during hospitalization. The patients who had high weight-for-age tended to lose more body weight (p=0.001). Admission to the surgical department (odds ratio [OR], 1.668; 95% confidence interval [CI], 1.054-2.637; p=0.029) and long NPO durations (OR, 1.496; 95% CI, 1.102-2.031; p=0.010) were independent risk factors of weight loss during hospitalization. The patients with high weight-for-age tended to lose more weight during hospitalization (OR, 1.188; 95% CI, 1.029-1.371; p=0.019). Conclusion Greater care in terms of nutrition should be taken for patients who are admitted in the surgical department and have prolonged duration of nothing by mouth. PMID:28090472
Hsu, Eric Y; Schwend, Richard M; Julia, Leamon
Many primary care physicians believe that there are too few pediatric orthopaedic specialists available to meet their patients' needs. However, a recent survey by the Practice Management Committee of the Pediatric Orthopaedic Society of North America found that new referrals were often for cases that could have been managed by primary care practitioners. We wished to determine how many new referral cases seen by pediatric orthopaedic surgeons are in fact conditions that can be readily managed by a primary care physician should he/she chose to do so. We prospectively studied all new referrals to our hospital-based orthopaedic clinic during August 2010. Each new referral was evaluated for whether it met the American Board of Pediatrics criteria for being a condition that could be managed by a primary care pediatrician. Each referral was also evaluated for whether it met the American Academy of Pediatrics Surgery Advisory Panel guidelines recommending referral to an orthopaedic specialist, regardless of whether it is for general orthopaedics or pediatric orthopaedics. On the basis of these criteria, we classified conditions as either a condition manageable by primary care physicians or a condition that should be referred to an orthopaedic surgeon or a pediatric orthopaedic surgeon. We used these guidelines not to identify diagnosis that primary care physicians should treat but, rather, to compare the guideline-delineated referrals with the actual referrals our specialty pediatric orthopaedic clinic received over a period of 1 month. A total of 529 new patient referrals were seen during August 2010. A total of 246 (47%) were considered primary care conditions and 283 (53%) orthopaedic specialty conditions. The most common primary care condition was a nondisplaced phalanx fracture (25/246, 10.1%) and the most common specialty condition was a displaced single-bone upper extremity fracture needing reduction (36/283, 13%). Only 77 (14.6%) of the total cases met the strict
Dotan, Gad; Stolovitch, Chaim; Moisseiev, Elad; Cohen, Shlomi; Kesler, Anat
Headache is a common complaint in children occasionally requiring hospital admission. The purposes of the present study were to analyze the prevalence of uncorrected ametropia in children with headache admitted to the hospital, and evaluate the importance of refraction assessment as part of their evaluation. A retrospective review of children admitted to the Tel Aviv Medical Center for headache evaluation from December 2008 to March 2013, in whom the only abnormality found was an uncorrected refractive error. During the study period 917 children with headache were hospitalized for evaluation and 16 (1.7%) of them (9 boys, mean age 12 years, range 8-18 years) were found to have an uncorrected ametropia. Average headache duration was 4 months (range, 1 week to 1 year) and mean follow-up was 15 months (range, 1 month to 3 years). Twelve (75%) children had brain imaging and 4 children (25%) had a lumbar puncture before their refractive abnormality was identified. Anisometropia and myopia were the most common refractive errors encountered (n = 10 each), followed by hyperopia (n = 6) and astigmatism (n = 3). Despite having uncorrected refractive errors most children (n = 10) did not complain of any visual difficulty. All children were given proper refractive correction and 14 of them reported complete headache resolution on re-examination one month later. Uncorrected ametropia is a possible cause of headache among hospitalized children. Therefore, complete ophthalmic evaluation, which includes proper refraction assessment, is important as it can identify a treatable headache etiology. Children without visual difficulty should be equally evaluated, as many children with headache and uncorrected amteropia do not have vision complaints.
Full Text Available Germ cell tumors occur mostly in the gonad. Extragonadal germ cell tumors are rare, and most occur in the retroperitoneum and mediastinum. Primary mediastinal germ cell tumors are often found in the anterior portion of the mediastinum and include teratomas and non-teratomatous tumors. Non-teratomatous tumors include seminomas and malignant non-seminomatous germ cell tumors (MNSGCTs. MNSGCTs include yolk sac tumors, choriocarcinomas, embryonal carcinomas, and mixed type germ cell tumors. Teratomas are the most common germ cell tumors of the mediastinum, and seminomas are the most common non-teratomatous germ cell tumors of the mediastinum. Cases of primary mediastinal MNSGCT reported in the literature are rare. In this report, we review all primary mediastinal germ cell tumors from a 10-year period at the Chung-Ho Memorial Hospital of Kaohsiung Medical University. A total of 14 cases were reviewed, including 11 patients with mature teratomas, two with yolk sac tumors, and one with seminoma. We discuss the differences in clinical presentation, histopathologic characteristics, treatment, and prognosis.
hospital, the report recommended that '... all levels of the health system ..... needs of the new population of Cape Town, the RCCH will have to bear much of the ... The balance between these factors will vary in ... Annual Report, 1986. Cape.
entry mode as the only independent predictor for prolonged D2B time. Conclusion: Baseline differences exist between walk-in and EMS-transported STEMI patients undergoing primary PCI. Hospital entry mode was the most important predictor for prolonged treatment times for primary PCI, independent of age, Latino ethnicity, heart rate, systolic blood pressure and initial troponin value. Prolonged door to ECG and ECG to CL activation times are modifiable factors associated with prolonged treatment times in walk-in STEMI patients. In addition to promoting the use of EMS transport, efforts are needed to rapidly identify and expedite the triage of walk-in STEMI patients. [West J Emerg Med. 2014;15(1:81–87.
Full Text Available The problems of optimizing development strength in primary school children. The purpose of the program is to validate the technology development strength abilities in the classroom physical education at school. A program of strength training by taking into account the effects of power loads. Found that the use of the combined method (option I makes it possible to obtain positive results in force readiness school classes 2-4 through 3-9 sessions. The combined method (option II significantly affects the dynamics of the forces of the local group of muscles. The use of mobile gaming allows for a higher level of emotional strength to develop the ability of students. The dynamics of power indices (option II significantly affects operation: dynamic method - 25-45 reps (rest interval between sets 30-60 seconds, the method of maximum effort - 18-30 reps (rest interval between sets 30-60 seconds method of isometric effort - 15-25 reps (rest interval between sets 30-60 seconds, the method of repeated efforts - 36-60 reps (rest interval between sets 30-60 seconds.
Okpala, Nonso Ejikeme; Umeh, Rich Enujioke; Onwasigwe, Ernest Nnemeka
A cross-sectional survey of the prevalence of eye injuries among primary school children in two noncontiguous local government areas of Enugu State of Nigeria was undertaken. One of the local government areas was urban, while the other one was rural. Children who were schools in the urban area and three randomly selected schools in the rural area were interviewed and examined with Snellen chart, pen torch, head loupe, and direct ophthalmoscope. The findings were recorded using a semi-structured questionnaire and the World Health Organization Programme for Prevention of Blindness (WHO/PBL) eye examination form. Training on visual acuity measurement was done for each of the class teachers. A total of 1,236 children school (20.41%). The farm was next in frequency (7.14%), especially among boys in the rural area. The church and the road/street constituted the remainder. Regarding persons causing the injury, the child's playmate was the commonest (55.10%) followed by self (27.55%). Parents and guardians were the next (9.18%). These were injuries associated with corporal punishment. Corporal punishment-related eye injury, according to this study, appears to be common in the rural area and affects boys predominantly. Other human intermediary agents that cause an eye injury include passersby (2.04%), RTA (2.04%), siblings (2.04%), and others (1.02%). The primary agents that caused an eye injury were sticks/wood, 29 (29.60%); stone, 21 (21.43%); pieces of metal, 19 (19.39%); fall, 10 (10.20%); fight/fist blow, 9 (9.918%); plastic, 2 (2.04%); fingernails, 2 (2.04%); farm tools/fruits, 2 (2.04%); and RTA, glass, and headbutt, each 1.02%. Farm implements/fruits as well as fingernails appear to be fairly common primary agents that cause an eye injury in the rural Enugu, Nigeria. In terms of prevalence, there was no significant difference between the urban and rural areas. The findings from this study showed a high prevalence of eye injury among primary school children. In terms
Sarkar, Rajiv; Tate, Jacqueline E; Ajjampur, Sitara S R; Kattula, Deepthi; John, Jacob; Ward, Honorine D; Kang, Gagandeep
Cryptosporidium spp. is a common, but under-reported cause of childhood diarrhea throughout the world, especially in developing countries. A comprehensive estimate of the burden of cryptosporidiosis in resource-poor settings is not available. We used published and unpublished studies to estimate the burden of diarrhea, hospitalization and mortality due to cryptosporidial infections in Indian children. Our estimates suggest that annually, one in every 6-11 children diarrhea, 1 in every 169-633 children will be hospitalized and 1 in every 2890-7247 children will die due to cryptosporidiosis. Since there are approximately 42 million children transmission and prevention modalities of Cryptosporidium spp. in India and other developing countries.
Gomes, Ilvana Lima Verde; Caetano, Rosângela; Jorge, Maria Salete Bessa
Along the years, the rights of children and adolescents including those related to hospital context have been proclaimed in Brazil. The low level of knowledge by health professionals about the rights can be a factor that contributes to that non observance. In this paper, we tried to understand how health professionals who deal with inpatient children on a daily basis perceive children's and their families' rights. It was a research of descriptive aspect with qualitative analysis using semi-structured interviews. Eleven interviews have been carried out with health professionals of a pediatrics hospital in the city of Fortaleza, capital of the state of Ceará, during 2006. The analysis of the data happened after a process of multiple readings and these were interpreted with the reference regarding the elaborated topics. The analysis resulted in two themes: Knowledge of children's rights by the multi-professional team and Guarantee of children's rights. We can conclude that health professionals know children's rights partially, especially those rights contained in the ECA (Children and Adolescent's Statute), with a tendency to see mainly those rights which were limited to their professional category: the guarantee of children's rights is one of the objectives of the hospital and a desire of almost all professionals.
Henschke, Nicholas; Harrison, Christopher; McKay, Damien; Broderick, Carolyn; Latimer, Jane; Britt, Helena; Maher, Christopher G
Background Primary care settings play a vital role in the early detection and appropriate management of musculoskeletal conditions in paediatric populations. However, little data exist regarding these conditions in a primary care context or on the presentation of specific musculoskeletal disorders in children. The aim of this study was to estimate the caseload and describe typical management of musculoskeletal conditions in children and adolescents presenting to primary care in Australia. Met...
Bines, Julie E; Jamieson, Peter
Hospitals are complex places that provide a rich learning environment for students, staff, patients and their families, professional groups and the community. The "new" Royal Children's Hospital opened in late 2011. Its mission is focused on improving health and well-being of children and adolescents through leadership in healthcare, research and education. Addressing the need to create "responsive learning environments" aligned with the shift to student-centred pedagogy, two distinct learning environments were developed within the new Royal Children's Hospital; (i) a dedicated education precinct providing a suite of physical environments to promote a more active, collaborative and social learning experience for education and training programs conducted on the Royal Children's Hospital campus and (ii) a suite of learning spaces embedded within clinical areas so that learning becomes an integral part of the daily activities of this busy Hospital environment. The aim of this article is to present the overarching educational principles that lead the design of these learning spaces and describe the opportunities and obstacles encountered in the development of collaborative learning spaces within a large hospital development.
Maria Teresa Bechere Fernandes
Full Text Available OBJECTIVES: To investigate the prevalence of excess body weight in the pediatric ward of University Hospital and to test both the association between initial nutritional diagnosis and the length of stay and the in-hospital variation in nutritional status. METHODS: Retrospective cohort study based on information entered in clinical records from University Hospital. The data were collected from a convenience sample of 91 cases among children aged one to 10 years admitted to the hospital in 2009. The data that characterize the sample are presented in a descriptive manner. Additionally, we performed a multivariate linear regression analysis adjusted for age and gender. RESULTS: Nutritional classification at baseline showed that 87.8% of the children had a normal weight and that 8.9% had excess weight. The linear regression models showed that the average weight loss z-score of the children with excess weight compared with the group with normal weight was −0.48 (p = 0.018 and that their length of stay was 2.37 days longer on average compared with that of the normal-weight group (p = 0.047. CONCLUSIONS: The length of stay and loss of weight at the hospital may be greater among children with excess weight than among children with normal weight.
The study was undertaken at a play therapy unit in a Swedish hospital. The purpose was directed toward investigating what takes place during play therapy when children were given the opportunity to use expressive arts such as clay, paint, and/or textile, and the meaning children input into their art objects. The study describes an approach to working with hospitalized children when they visited the play therapy unit. During a three-year period, hospitalized children (n=22) participated in the study. The assumption was that given the opportunity to express themselves freely by using a variety of expressive arts, children will tell what they express in their art works. It might mirror their thoughts and feelings of being hospitalized. The result of the qualitative analyzes generated the themes fear, longing, and powerlessness. The results also showed that expressive arts were a medium for communication. Expressive arts should be used as a tool to help the child express her/himself when being hospitalized.
Das, Rina; Sarker, Anupam; Saha, Haimanti; Bin Shahid, Abu Sadat Mohammad Sayeem; Shahunja, K M; Chisti, Mohammod Jobayer
There is lack of information in the medical literature on clinically diagnosed Down syndrome children presenting with diarrhea. Our aim was to describe our experience with Down syndrome patients admitted with diarrhea by evaluating the factors associated with Down syndrome presenting with diarrheal illness. In this retrospective chart analysis, we enrolled all the diarrheal children aged 0-59 months admitted to the Dhaka Hospital of the International Centre for Diarrheal Disease Research, Bangladesh (icddr, b), from March 2011 to February 2013. Down syndrome children with diarrhea constituted cases and randomly selected threefold diarrheal children without Down syndrome constituted controls. Among 8422 enrolled children 32 and 96 were the cases and the controls, respectively. Median age (months) of the cases and the controls was comparable (7.6 (4.0, 15.0) versus 9.0 (5.0, 16.8); p = 0.496). The cases more often presented with severe acute malnutrition, developmental delay, congenital heart disease, hypothyroidism, sepsis, hypocalcemia, developed hospital acquired infection (HAI) during hospitalization, and required prolonged stay at hospital compared to the controls (for all p syndrome should be investigated for these simple clinical parameters for their prompt management that may prevent HAI and prolonged hospital stay.
Ansari, Sh.; Shirzadi, E; Elahi, M
Background A fungal infection represents a growing problem in children with hematologic malignancies, during chemotherapy induced neutropenia. Fungal colonization is considered a major risk factor for subsequent fungal infections. The aim of this retrospective study was to evaluate prevalence of fungal infection among children admitted to hospital between 2005 and 2010 in Tehran, Iran. Materials and Methods 617 hematological patients in the age range of neoteric to 19 years old were enrolled ...
The public relations staff believed the birth of healthy septuplets would become a human interest story for local media. But the staff was stunned at the outpouring of international and national media knocking at their front doors. The staff of both Iowa Methodist Medical Center and Blank Children's Hospital in Des Moines, Iowa, organized a communications plan for 14 official press conferences, constant updates to the media and a website to handle ongoing inquiries from the public. As a result, the story of the McCaughey septuplets was shown in more than 10,000 television stories around the world. The hospitals received more than 36,000 magazine and newspaper articles. The public relations staff not only fielded more than 2,000 phone calls in the days following the Nov. 19 birth, but more than 15 major networks parked their vehicles and satellite dishes in front of the hospital.
Mohamed H Bakri
Full Text Available Background: Sickle cell disease (SCD in children with a history of repeated hospitalization is distressing for children as well as their parents leading to anxiety and has negative effects on the psychological state of children and their families. Objective: The aim of the study was to determine the overall effect of SCD on the behavior of young children age 1½ to 5 years old who had repeated history of hospitalization, compared to a control group of healthy children attended a vaccination clinic. Patients and Methods: Thirty-five children of age 1½ to 5 years who have SCD and repeated history of hospitalization were recruited from pediatric clinic as the study group and matched with same number of healthy children who attended vaccination clinic, as a control group. Both groups were administered the child behavior checklist (CBCL 1½ to 5 years and diagnostic and statistical (DSM-oriented scale. Behavior data were collected through a semi-structured questionnaire. Results: Children who have SCD had statistically significant behavioral changes on CBCL compared to the control group: Anxiety/depression (65.2 vs. 55.1; P < 0.001, somatic complaint (66.7 vs. 54.4; P < 0.001 withdrawn (63.4 vs. 53.2; P < 0.001, aggressive behavior (60.4 vs. 56; P=0.04, and internalizing symptoms (64.7 vs. 51.5; P < 0.001, respectively. The DSM scale showed that children with SCD scored significantly higher in pervasive developmental disorder compared to the control group (60.9 vs. 53.9; P < 0.001 respectively. Conclusion: Children with SCD who had history of repeated hospitalization are at an increased risk of developing behavioral problems. Psychological counseling, social support, and proper pain management could minimize these behavioral consequences.
Full Text Available To determine the incidence of renal scarring among patients with primary vesicoureteral reflux (VUR and the possible risk factor(s, we studied 90 children (60 girls and 30 boys with VUR followed in the Pediatric Nephrology Unit at the Ege University Hospital from 1998 to 2003. All the patients were assessed for VUR grade by voiding cystoureterography and for presence of renal scarring by (99 m technetium dimercapto-succinic acid scintigraphy. All infants with VUR were given low-dose prophylactic antibiotics and followed-up until resolution of the reflux. Grade of reflux and number of urinary tract infection (UTI episodes (≥3 were found to be statistically significant risk factors for renal scarring (P 0.05. Similarly, there was no statistically significant difference of frequency of renal scarring among the different age groups (P >0.05. We conclude that recurrences of UTI and VUR severity are significant risk factors for renal scarring in children with VUR. Therefore, identification of VUR at an early age may offer the opportunity to prevent episodes of UTI and possible formation of renal scars that may result in end-stage renal failure.
Full Text Available Demetrius Ellis, Yosuke MiyashitaChildren’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, PA, USAAbstract: The prevalence of hypertension has increased at an accelerated rate in older children and adolescents. This has raised great concern about premature development of cardiovascular disease, which has major long-term health and financial implications. While obesity and sedentary habits largely explain this phenomenon, there are other social and cultural influences that may unmask genetic susceptibility to hypertension in the pediatric population. While it is essential to exclude numerous causes of secondary hypertension in every child, these disorders are not discussed in this review. Rather, the aim of this review is to familiarize pediatricians with casual and ambulatory blood pressure measurement, epidemiology, pathophysiology, and management of several common conditions that play a role in the development of hypertension in children and adolescents. Besides primary hypertension and obesity-related hypertension, emphasis is given to epidemiology, measurement of blood pressure, including ambulatory blood pressure monitoring, hypertension associated with drug use, teenage pregnancy, and video and computer games. Lastly, because pediatricians are increasingly confronted with special issues concerning the management of the hypertensive athlete, this topic is also addressed.Keywords: hypertension, adolescents, obesity, drugs, pregnancy, athletes
Janayne F. Mançaneira
Full Text Available ABSTRACT OBJECTIVES: To assess temporal trends of hospitalizations and deaths from pertussis in Brazilian children in the period of 1996-2013. METHODS: This was a descriptive ecological study of temporal trends, based on the DATASUS database. The number of hospitalizations and deaths from pertussis in children up to 19 years of age from January 1996 to December 2013 was obtained. Descriptive statistics were applied for data analysis. RESULTS: During the study period, a total of 19,047 hospital admissions from pertussis were recorded, of which 88.2% occurred in infants younger than 1 year. In the period 1996-2010, the mean annual number of admissions was 755, ranging from a maximum of 1179 in 2004 to a minimum of 400 in 2010. There was an increase of admissions in the last three consecutive years (2011, 2012, and 2013 with 1177, 2954 and 3589 hospitalizations, respectively. There were 498 deaths from pertussis throughout the study period, of which 96.8% occurred in children younger than one year. There was an increase in the number of deaths from pertussis in children in the years 2011, 2012, and 2013, with 40, 93, and 87 recorded deaths, respectively. The increase in hospitalizations and deaths from pertussis in children occurred in all regions of the country, with the highest increase observed in the Southeast, North and Northeast regions. CONCLUSIONS: There was a substantial increase in hospitalizations and deaths from pertussis in children for three consecutive years (2011, 2012, and 2013 in all Brazilian regions. The most affected age group was that of children younger than one year.
Full Text Available Objectives: To characterise the prescription of non-formulary drugs to children and neonates at a Brazilian teaching hospital and identify adverse drug reactions (ADRs, drug interactions, and prescription of potentially hazardous medicines.Methods: A prospective exploratory study was carried out between January and May 2011 at the general paediatric wards and paediatric oncology, paediatric intensive care, and neonatal care units of the study hospital. Non-formulary drugs were categorised as approved, off-label, or not approved for use in children according to Brazilian compendia. Electronic health records were actively searched for ADRs and the possibility of moderate to severe interactions between non-formulary drugs and other medicines was determined with the Micromedex® database.Results: Overall, 109 children or neonates received non-formulary drugs. Of these drugs, 54% were approved for use in children, 12.2% were used off-label, and 33.8% were not approved for use in children. Non-formulary drugs accounted for 13.4% of total prescriptions; 5.3% of drugs had a potential for interactions and five were possibly associated with ADRs.Conclusion: Prescription of non-formulary drugs not approved for use in children was common at the study hospital. Studies such as this provide information on the use of medicines for special indications and permit assessment of the relevance of hospital formularies for the paediatric population.
Hemminki, Kari; Sundquist, Kristina; Sundquist, Jan; Ji, Jianguang
Cancer of unknown primary (CUP) is a heterogeneous syndrome diagnosed at metastatic sites. The etiology is unknown but immune dysfunction may be a contributing factor. Patients with autoimmune diseases were identified from the Swedish Hospital Discharge Register and linked to the Swedish Cancer Registry. Standardized incidence ratios (SIRs) were calculated for subsequent CUP and compared with subjects without autoimmune diseases. A total of 789,681 patients were hospitalized for any of 32 autoimmune diseases during years 1964-2012; 2,658 developed subsequent CUP, giving an overall SIR of 1.27. A total of 16 autoimmune diseases were associated with an increased risk for CUP; polymyositis/dermatomyositis showed the highest SIR of 3.51, followed by primary biliary cirrhosis (1.81) and Addison's disease (1.77). CUP risk is known to be reduced in long-time users of pain-relieving nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin. For patients with ankylosing spondylitis and with some other autoimmune diseases, with assumed chronic medication by NSAIDSs, CUP risks decreased in long-term follow-up. The overall risk of CUP was increased among patients diagnosed with autoimmune diseases, which call for clinical attention and suggest a possible role of immune dysfunction in CUP. The associations with many autoimmune diseases were weak which may imply that autoimmunity may not synergize with CUP-related immune dysfunction. However, long-term NSAID medication probably helped to curtail risks in some autoimmune diseases and CUP risks were generally higher in autoimmune diseases for which NSAIDs are not used and for these CUP appears to be a serious side effect.
Hospitals, Hospital locations within Sedgwick County. This layer is maintained interactively by GIS staff. Primary attributes include hospital name, address, number of beds, and trauma capabilities. Published to schosp_a.shp., Published in 2008, 1:1200 (1in=100ft) scale, Sedgwick County Government.
NSGIC Local Govt | GIS Inventory — Hospitals dataset current as of 2008. Hospital locations within Sedgwick County. This layer is maintained interactively by GIS staff. Primary attributes include...
de Menezes, Fernanda Souza; Leite, Heitor Pons; Fernandez, Juliana; Benzecry, Silvana Gomes; de Carvalho, Werther Brunow
The aims of this study were to estimate the occurrence of hypophosphatemia and to identify potential risk factors and outcome measures associated with this disturbance in children admitted to a pediatric intensive care unit. Data concerning 42 children admitted consecutively to 1 pediatric intensive care unit over a 1-year period were examined. Serum phosphorus levels were measured on the third day of admission, where levels below 3.8 mg/dL were considered indicative of hypophosphatemia. Hypophosphatemia was found in 32 children (76%), and there was a significant association between this disturbance and malnutrition (P = .04). Of the potential risk factors such as sepsis, diuretic/steroid therapy, starvation (over 3 days), and Pediatric Index of Mortality, none discriminated for hypophosphatemia. There were no associations between hypophosphatemia and mortality, length of stay in the pediatric intensive care unit, or time on mechanical lung ventilation. Hypophosphatemia was a common finding in critically ill children and was associated with malnutrition.
Apr 21, 2006 ... of overweight and obese children in South Africa, this prevalence has ... basic anthropometry and physical development of children in South Africa. ..... physical activity level differences, or a combination is unknown. Another ...
Full Text Available Background. In general, primary immunodeficiency diseases (PIDs are underdiagnosed in most countries. The objective of this study was to describe the frequency and clinical spectrum of PID in the most important tertiary hospitals in our region. Methods. An observational, cross-sectional, with retrospective chart, review study was conducted. A total of 26 patients were included and grouped according to the updated classification of PIDs. Results. PIDs spectra were as follows: predominantly antibody deficiency diseases were the most common category (65.38%, followed by other well-defined immunodeficiency syndromes (11.55%, congenital defects of phagocyte number and/or function (7.69%, complement deficiencies (3.85%, combined T- and B-cell immunodeficiencies (3.85%, and defects in innate immunity (3.85%. The mean time elapsed from the onset of symptoms to the reference and diagnosis by a tertiary hospital was of 4.65 ± 6.95 years. Conclusions. Predominant antibody deficiency disease was the most common group of PIDs, agreeing with international reports. Awareness of underdiagnosis by physicians is crucial for a prompt diagnosis and treatment, which in turn should improve the quality of life among patients with PIDs.
Kim, Yun K; Nyambat, Batmunkh; Hong, Young S; Lee, Chang G; Lee, Joo W; Kilgore, Paul E
Our objective was to describe respiratory disease hospitalizations among children in a community of Seoul, Republic of Korea. Discharge data (January 1995-December 2005) from Guro Hospital (Seoul, Republic of Korea) were collected from the hospital medical records office. Respiratory virus test results (March 2004-December 2005) and hospitalization charges to the National Health Insurance Corporation (January 2002-December 2005) were provided by hospital laboratory and administrative departments. Variations in hospitalizations, test results and total hospitalization-associated medical charges were described by age, clinical complaint, discharge month and length of stay. Over the 11-y period, 4247 paediatric hospitalizations for lower respiratory disease occurred. Semi-annual epidemics were identified in October-December and April-May. Among a subset (n=400) of patients, 48% had respiratory syncytial virus, 16% parainfluenza virus, 19% influenza viruses and 17% adenovirus infection. On admission, children had respiratory problems (53%), fever (39%), or other systemic problems (8%). The median charge of a lower respiratory disease hospitalization was highest in January ($1334) and lowest in October ($1076). Median hospitalization charges were highest among children 8-15 years of age compared with younger children =2 years and those 3-7 years of age. Respiratory disease hospitalizations among children demonstrated annual variations reflecting patterns of children with laboratory-confirmed respiratory viral infections. In the Republic of Korea, prospective studies that use standardized laboratory testing for respiratory pathogens in children will help to estimate the total burden of viral lower respiratory tract disease.
Wanderci Marys Oliveira Abrão
Full Text Available INTRODUCTION: In 2010, to reduce the occurrence of serious pneumococcal disease, the Ministry of Health in Brazil incorporated the 10-valent pneumococcal vaccine in the immunization schedule of children younger than two years of age. The objective of this study was to evaluate the impact of vaccination on the incidence of infectious respiratory diseases in infants before and after the introduction of the 10-valent pneumococcal vaccine. METHODS: This cross-sectional study involved primary care and hospital networks from a city in Minas Gerais State, Brazil, between 2009 and 2012. RESULTS: A 40% reduction in the prevalence of community-acquired pneumonia (CAP was observed after introducing the pneumococcal conjugate vaccine. Male children were 28% more likely to develop the disease. The prevalence ratio ([PR] = 1.96, 95% CI: 1.52 to 2.53, p < 0.05 suggested that not being vaccinated was associated with the occurrence of pneumonia. The prevalence of CAP was 70% lower (PR 0.30, 95% CI: 0.24 to 0.37, p<0.05 in children vaccinated as recommended compared to children with delayed vaccination, suggesting that the updated vaccine schedule improves protection. CONCLUSIONS: Immunization with the 10-valent pneumococcal vaccine appeared to reduce the number of pneumonia cases in children during the study period. Prospective studies are needed to confirm the efficacy of the vaccine against the occurrence of pneumococcal pneumonia.
Clayton, Heather B; Sappenfield, William M; Gulitz, Elizabeth; Mahan, Charles S; Petersen, Donna J; Stanley, Kara M; Salihu, Hamisu M
(1) Assess the accuracy of public health data sources used to investigate primary late preterm cesarean delivery (PLPCD) and (2) compare differences in data accuracy by hospital PLPCD rate classification. This analysis uses data from the Florida Investigation of Late Preterm and Cesarean Delivery (FILPCD), an investigation of singleton, PLPCD's that occurred from 2006 to 2007 in hospitals classified with either a low or high PLPCD rate (high rate 39.4-58.3 %, low rate 11.9-25.1 %). Three data sources were validated with maternal medical records: birth certificates, hospital discharge data, and combined birth certificate and hospital discharge data. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and kappa values were calculated. A summary measure of kappa values was compared by hospital PLPCD rate classification using the paired sample Wilcoxon signed rank test. Large variations in accuracy of data elements were found by hospital PLPCD rate classification, with low PLPCD rate hospitals demonstrating higher overall data accuracy. The summary measure of agreement was significantly higher for low PLPCD rate hospitals compared to high PLPCD rate hospitals (0.60 vs. 0.50, p late preterm birth are vital for public health practitioners and policy makers who seek to address the growing concern over recent increases in CD and late preterm birth. Understanding the potential for systematic differences in reporting accuracy by hospital PLPCD rate is important to data quality improvement efforts.
Full Text Available Abstract Background The elderly population consumes a large share of medical resources in the western world. A significant portion of the expense is related to hospitalizations. Objectives To evaluate an intervention program designed to reduce the number of hospitalization of elderly patients by a more optimal allocation of resources in primary care. Methods A multidimensional intervention program was conducted that included the re-engineering of existing work processes with a focus on the management of patient problems, improving communication with outside agencies, and the establishment of a system to monitor quality of healthcare parameters. Data on the number of hospitalizations and their cost were compared before and after implementation of the intervention program. Results As a result of the intervention the mean expenditure per elderly patient was reduced by 22.5%. The adjusted number of hospitalizations/1,000 declined from 15.1 to 10.7 (29.3%. The number of adjusted hospitalization days dropped from 132 to 82 (37.9% and the mean hospitalization stay declined from 8.2 to 6.7 days (17.9%. The adjusted hospitalization cost ($/1,000 patients dropped from $32,574 to $18,624 (42.8%. The overall clinic expense, for all age groups, dropped by 9.9%. Conclusion Implementation of the intervention program in a single primary care clinic led to a reduction in hospitalizations for the elderly patient population and to a more optimal allocation of healthcare resources.
Smith, Anne B.
Children's perceptions of the roles of mother, father, and teacher were examined in a sample of 98 children of 7 to 9 years. Children of working mothers numbered 54. Interview data were coded into five main role categories: Domestic, Child Care, Paid Work, Biological, and Personal. Results showed no effect of age or maternal work status on…
sasan Saket; seyed nasrolah Hosseini; gholamreza Goudarzi; azam Mohsenzadeh; khatereh anbari; neda Beyranvand
Background : Helicobacter pylori is a microorganism which results in gastritis, peptic ulcer and is associated with GI malignancies. This bacteria has an important role in GI disease .There is not enough data about prevalence of H.P infection among children (1-14 years old) in Lorestan province, so this study performed to determine the sero-prevalence of H.P among children referred to Shahid Madani children's hospital of Khorramabad and risk factors related to it were studied too. Materi...
Maria Fernanda Acosta Romo
Full Text Available Objective: To understand the meaning of the experiences felt by parents of premature children who are hospitalized in the Neonatal Intensive Care Unit of a hospital in the city of Pasto, Nariño, taking into account the phenomenological theory of Edmund Husserl. Materials and methods: In order to understand these experiences, a qualitative phenomenological study was carried out with eight parents in a range of age between 17 and 35. Results: The investigative process identified five categories, which emerged from the process of codification or nomothetic analysis of the speeches convergences. Two of these categories were considered for this article: Feelings and affective bond as an expression of parental love and process of interaction with the health staff. Conclusion: The parents of children in hospital were not prepared for the birth of a premature baby, so they experienced feelings of sadness, anxiety, self-criticism and fear, altering the affective bond between parents and children.
Background The burden of out of pocket spending for the Mexican population is high compared to other countries. Even patients insured by social security institutions have to face the cost of health goods, services or nonmedical expenses related to their illness. Primary caregivers, in addition, experience losses in productivity by taking up responsibilities in care giving activities. This situation represents a mayor economic burden in an acute care setting for elderly population. There is evidence that specialized geriatric services could represent lower overall costs in these circumstances and could help reduce these burdens. The aim of this study was to investigate economic burden differences in caregivers of elderly patients comparing two acute care services (Geriatric and Internal Medicine). Specifically, economic costs associated with hospitalization of older adults in these two settings by evaluating health care related out of pocket expenditures (OOPE), non-medical OOPE and indirect costs. Methods A comparative analysis of direct and indirect costs in hospitalised elderly patients (60-year or older) and their primary informal caregivers in two health care settings, using a prospective cohort was performed. Economic burden was measured by out of pocket expenses and indirect costs (productivity lost) due to care giving activities. The analysis included a two-part model, the first one allowing the estimation of the probability of observing any health care related and non-medical OOPE; and the second one, the positive observations or expenditures. Results A total of 210 subjects were followed during their hospital stay. Of the total number of subjects 95% reported at least one non-medical OOPE, being daily transportation the most common expense. Regarding medical OOPE, medicines were the most common expense, and the mean numbers of days without income were 4.12 days. Both OOPE and indirect costs were significantly different between type of services, with less
López-Ortega, Mariana; García-Peña, Carmen; Granados-García, Víctor; García-González, José Juan; Pérez-Zepeda, Mario Ulises
The burden of out of pocket spending for the Mexican population is high compared to other countries. Even patients insured by social security institutions have to face the cost of health goods, services or nonmedical expenses related to their illness. Primary caregivers, in addition, experience losses in productivity by taking up responsibilities in care giving activities. This situation represents a mayor economic burden in an acute care setting for elderly population. There is evidence that specialized geriatric services could represent lower overall costs in these circumstances and could help reduce these burdens.The aim of this study was to investigate economic burden differences in caregivers of elderly patients comparing two acute care services (Geriatric and Internal Medicine). Specifically, economic costs associated with hospitalization of older adults in these two settings by evaluating health care related out of pocket expenditures (OOPE), non-medical OOPE and indirect costs. A comparative analysis of direct and indirect costs in hospitalised elderly patients (60-year or older) and their primary informal caregivers in two health care settings, using a prospective cohort was performed. Economic burden was measured by out of pocket expenses and indirect costs (productivity lost) due to care giving activities. The analysis included a two-part model, the first one allowing the estimation of the probability of observing any health care related and non-medical OOPE; and the second one, the positive observations or expenditures. A total of 210 subjects were followed during their hospital stay. Of the total number of subjects 95% reported at least one non-medical OOPE, being daily transportation the most common expense. Regarding medical OOPE, medicines were the most common expense, and the mean numbers of days without income were 4.12 days. Both OOPE and indirect costs were significantly different between type of services, with less overall economic burden to
Department of Homeland Security — This database contains locations of Hospitals for 50 states and Washington D.C. , Puerto Rico and US territories. The dataset only includes hospital facilities and...
Sills, Marion R; Hall, Matthew; Fieldston, Evan S; Hain, Paul D; Simon, Harold K; Brogan, Thomas V; Fagbuyi, Daniel B; Mundorff, Michael B; Shah, Samir S
Quantifying how close hospitals came to exhausting capacity during the outbreak of pandemic influenza A (H1N1) 2009 can help the health care system plan for more virulent pandemics. This ecologic analysis used emergency department (ED) and inpatient data from 34 US children's hospitals. For the 11-week pandemic (H1N1) 2009 period during fall 2009, inpatient occupancy reached 95%, which was lower than the 101% occupancy during the 2008-09 seasonal influenza period. Fewer than 1 additional admission per 10 inpatient beds would have caused hospitals to reach 100% occupancy. Using parameters based on historical precedent, we built 5 models projecting inpatient occupancy, varying the ED visit numbers and admission rate for influenza-related ED visits. The 5 scenarios projected median occupancy as high as 132% of capacity. The pandemic did not exhaust inpatient bed capacity, but a more virulent pandemic has the potential to push children's hospitals past their maximum inpatient capacity.
For children, maintenance of personal hygiene helps to improve the quality of life and longevity. This is of particular importance in a slum community with compromised living situation. This study was undertaken to find out the knowledge and practice of personal hygiene among the primary school children living in a slum area, to identify any misconception among them regarding the maintenance of personal hygiene, to find out their morbidity pattern, and also to elicit the relationship between practice of personal hygiene among the children and the literacy status of their mother. A cross-sectional observational study was conducted among 104 primary school children of a primary school situated in the slum area of Chetla, Kolkata, India with the help of a predesigned, pre-tested and structured questionnaire. Data were analyzed statistically by simple proportions and tests of significance. It was found that the female students were more knowledgeable than the male students regarding the maintenance of personal hygiene. There was a wide gap between practice and knowledge of personal hygiene among the primary school children living in the slum area. Even, misconceptions do exist on certain indicators of personal hygiene among the students. Statistically significant association was observed between practices of personal hygiene among the primary school children and the literacy status of their mother. Future of a society depends considerably on the health of its children. The parents and the school teachers, as constructive shapers of children's health behaviors, should play a responsible role in early education of children on personal hygiene.
Smits, A; Mansfield, S; Singh, S
To complement the role of primary care teams working with patients with HIV disease and AIDS within greater London and to ease the load on the special hospital units a home support team was developed. It comprises six specialist nurses, a general practitioner trained medical officer, and a receptionist and is funded from regional and district sources and charities. A nurse is available for out of hours and emergency weekend calls, with support from the patient's general practitioner or the attached medical officer. During the first 18 months 249 patients were seen; the mean duration of care was five months. Nearly a third (18/50, 30%) of patients who were terminally ill died at home. The team's activities included practical nursing care, emotional support for carers and patients, and advice and guidance to primary care teams. Problems in providing care in patients' homes included issues relating to confidentiality and 24 hour cover. With the increasing incidence of HIV infection the home support team may be a useful model for care of large numbers of patients with symptomatic HIV disease, especially in large urban areas. PMID:2106936
Noversa, Silvana; Abreu, Cátia; Varela, Paulo; Costa, Manuel F. M.
This communication results from a pedagogical intervention project, carried out at a primary school in the district of Braga - Portugal. The intervention took place in a class of the 3rd year, composed of 16 students, and it incorporated the practice of inquiry-based science teaching addressing the theme "Light Experiments", which is part of the "Environmental Studies" curricular area. Various class activities were planned and implemented concerning some of the factors that influence the shadow of an object, in order to find answers to the following three questions: a) will 3rd year students, aged 7/8 years, be able to construct and execute an investigation strategy that involves manipulating and controlling variables? b) what are the main difficulties experienced by students in the designing and execution of such a strategy? c) how will students, in interaction with the teacher and with their peers, gradually design and execute their investigation strategy in order to respond to the problem formulated? The project adopted an action research methodology. A careful record was kept of the events most relevant to the questions under study in each class. This data was used to prepare the class diaries - descriptive and reflective narratives prepared based on recorded audio and field notes made during participant observation in the context of the classroom. A content analysis of the diaries has identified a few elements that provide answers to the research questions raised. In order to plan and implement a research project with children in the 7/8 years old range require a high level of scaffolding to allow students to gradually build a coherent strategy to tackle the research problem. Teacher's role is crucial. The teacher, by questioning and inducing reasoning and discussion, promotes encourages and regulates the cognitive activity of students. Some level of autonomy should be given to the students in large group collaborative work.
Full Text Available "nBackground: Anthropometric data can be used to identify the physical dimensions of equipment, furniture, etc. The use of furniture that fails to fulfill the anthropometric data of its users has a negative impact on human health. Specific anthropometric dimensions are necessary to design school furniture. Anthropometric data have been measured in many communities especially among schoolchildren. There are different ethnic groups with probably different anthropometric data in Iran, and anthropometric data can change by time, so gathering data about anthropometric dimensions is important. This study was designed to obtain anthropometric dimensions of Iranian children (Fars ethnicity aged 7-11 years. "nMethods: In a cross-sectional study in Yazd, Iran, descriptive statistics as well as key percentiles for 17 static anthropometric data of primary school students (1015 males and 1015 females, were measured and compared between boys and girls. "nResults: The age of the students was between 6 and 11 years. Mean weight was between 21.56±5.33 kg and 36.63±9.45 kg in boys and between 20.79±3.48 kg and 35.88±9.40 kg in girls. Mean height was between 1187/02±53.98 mm and 1420.83± 69.39 mm in boys and between 1173.90±51.01mm and 1421.27±70.82 mm in girls. There was also some difference in other anthropometric data between two genders. "nConclusion: Results of this study showed some differences in anthropometric data with other studies. We also observed significant gender differences in some dimensions as well.
Silva, Pâmela R S; Rosa, Antonia M; Hacon, Sandra S; Ignotti, Eliane
To analyze the distribution of hospitalizations of children for asthma in the states comprising the Brazilian Amazon, as well as the variations of hospitalization according to climatic seasonality. A descriptive study of the distribution of hospitalizations for asthma of individuals aged 0 to 14 years living in the Brazilian Amazon, according to trend, spatial distribution, and climatic seasonality over the period from 2001 to 2007. We used the database of authorizations for hospitalizations (AIH) of the Hospital Information System (SIH/SUS) of the Brazilian Ministry of Health. The spatial distribution of hospitalizations for asthma resembles the configuration of the "arc of deforestation," mainly in the states of Rondônia and Maranhão. The distribution of annual hospitalizations for asthma decreased from 8.1 to 2.6 hospitalizations/1,000 inhabitants during the period. There was a peak of hospitalizations in March and May in all states. The seasonal differences were on average 10%, with the highest rates during the rainy season. We concluded that hospitalizations for asthma are more frequent in the months of more intense rainfall, with greater magnitude in the states comprising the "arc of deforestation" in the Brazilian Amazon, especially Rondônia and Maranhão.
King, Marta A; Nkoy, Flory L; Maloney, Christopher G; Mihalopoulos, Nicole L
To determine how frequently physicians identify and address overweight/obesity in hospitalized children and to compare physician documentation across training level (medical student, intern, resident, attending). We conducted a retrospective chart review. Using an administrative database, Centers for Disease Control and Prevention body mass index calculator, and random sampling technique, we identified a study population of 300 children aged 2-18 years with overweight/obesity hospitalized on the general medical service of a tertiary care pediatric hospital. We reviewed admission, progress, and discharge notes to determine how frequently physicians and physician trainees identified (documented in history, physical exam, or assessment) and addressed (documented in hospital or discharge plan) overweight/obesity. Physicians and physician trainees identified overweight/obesity in 8.3% (n = 25) and addressed it in 4% (n = 12) of 300 hospitalized children with overweight/obesity. Interns were most likely to document overweight/obesity in history (8.3% of the 266 patients they followed). Attendings were most likely to document overweight/obesity in physical examination (8.3%), assessment (4%), and plan (4%) of the 300 patients they followed. Medical students were least likely to document overweight/obesity including it in the assessment (0.4%) and plan (0.4%) of the 244 hospitalized children with overweight/obesity they followed. Physicians and physician trainees rarely identify or address overweight/obesity in hospitalized children. This represents a missed opportunity for both patient care and physician trainee education. Copyright © 2015 Elsevier Inc. All rights reserved.
Fetal Medicine Unit, Groote Schuur Hospital and University of Cape Town. L S Matthews, MB ChB .... echocardiography, ultrasonography, computed tomography. (CT) and magnetic ... anomalous pulmonary veins, atrioventricular septal defects,. September 2006 .... maturity, because of the high rate of stillbirths and dystocia.
Ozmen, Suna Kaymak; Ocal, Tugba; Ozmen, Ahmet
Recently, children's rights issue has taken attention. In this study, main purpose was to investigate the utilisation and knowledge level of 4th and 5th grade primary school students after children's rights training. The participants of this survey study were selected randomly from 10 schools. Results indicated that students had the chance to…
Ismaili-Jaha, Vlora; Shala, Muje; Azemi, Mehmedali; Hoxha-Kamberi, Teuta; Avdiu, Muharrem; Spahiu, Shqipe; Jaha, Luan
Background: Diarrhea is a leading cause of child mortality worldwide. Rotavirus is one of the most common causes of severe diarrhea and dehydration in children. Authors reviewed epidemiological and clinical data of the rotavirus diarrhea in Kosovo. Methods: This is a prospective study carried between January 1st and December 31st 2011. All data, comprising demographics, nutrition, clinical presentation, laboratory findings, management and outcome of the rotavirus diarrhea are collected on the specially designed form. Results: 116 children with rotavirus diarrhea are included in the study. The majority boys (74.4%) and children aged 0 – 12 months (82.75%). Mean age of children in the study was 16.38 months. Almost every third child in the study was hypotrophic (29.2%). More than half of the infants (55.2%) were on mixed food, somewhat more than every third was breast feeding (36.45%), and every twelfth (8.33%) was on artificial milk (animal or formula). Apart from diarrhea, present in all patients, vomiting (97.41%) and fever (43.96%) were characteristics of the clinical presentation of the diarrhea. Two thirds of the children had mild grade dehydration (70.7%). All patients recovered with no sequels. Conclusion: Rotavirus continues to be responsible for a significant portion of acute diarrhea in Kosovo. Clinical features, epidemiological data and the agglutination test are safe enough to establish the diagnosis. Treated correctly rotavirus diarrhea has a favorable outcome. PMID:25568634
Feinstein, James; Dai, Dingwei; Zhong, Wenjun; Freedman, Jason; Feudtner, Chris
Hospitalized infants, children, and adolescents are typically exposed to numerous distinct medications during inpatient admissions, increasing their risk of potential drug-drug interactions (PDDIs). We assessed the prevalence and characteristics of PDDI exposure of pediatric patients treated in children's hospitals. This retrospective cohort study included patients hospitalized in children's hospitals throughout the United States. PDDIs were identified by using the MicroMedex DRUG-REAX system. We calculated the patients exposed to PDDIs, stratified according to the seriousness of the interaction; daily and cumulative counts of PDDI exposures; and characterization of the cited potential adverse effects. Of 498 956 hospitalizations in 2011, 49% were associated with ≥1 PDDI, with a "contraindicated" PDDI occurring in 5% of all hospitalizations, a "major" PDDI present in 41%, a "moderate" PDDI in 28%, and a "minor" PDDI in 11%. Opioids were involved in 25% of all PDDIs, followed by antiinfective agents (17%), neurologic agents (15%), gastrointestinal agents (13%), and cardiovascular agents (13%). One-half of all PDDI exposures were due to specific drug pairs occurring in ≤3% of patients per hospital day. The most common potential adverse drug events included additive respiratory depression (in 21% of PDDIs), bleeding risk (5%), QT interval prolongation (4%), reduced iron absorption/availability (4%), central nervous system depression (4%), hyperkalemia (3%), and altered diuretic effectiveness (3%). Exposure to PDDIs is common among hospitalized children. Empirical data are needed to determine the probability and magnitude of the actual harm for each specific PDDI, particularly for less common drug pairs. Copyright © 2015 by the American Academy of Pediatrics.
Phillips, M.; Kumate-Rodríguez, J.; Mota-Hernández, F.
The treatment received by children aged under 5 years with diarrhoea was studied in the Hospital Infantil de México (Federico Goméz), Mexico City. The costs of treatment were calculated and estimates were made of how these had changed since the establishment of an oral rehydration unit in the hospital in 1985. The results indicate that drug treatment of outpatients was generally appropriate and inexpensive. In contrast, the cost of drugs for inpatients was considerably higher. The seriousness...
Miranda-Choque, Edwin; Servicio de Infectología, Instituto Nacional de Salud del Niño. Lima, Perú. Médico Infectólogo.; Ramírez, Carlos; Servicio de Infectología, Instituto Nacional de Salud del Niño. Lima, Perú. Médico Infectólogo.; Candela-Herrera, Jorge; Servicio de Infectología, Instituto Nacional de Salud del Niño. Lima, Perú. Médico Pediatra.; Díaz, Javier; Servicio de Infectología, Instituto Nacional de Salud del Niño. Lima, Perú. Médico Pediatra.; Fernández, Ana; Servicio de Infectología, Instituto Nacional de Salud del Niño. Lima, Perú. Médico Pediatra.; Kolevic, Lenka; Servicio de Infectología, Instituto Nacional de Salud del Niño. Lima, Perú. Médico Pediatra.; Segura, Eddy R.; Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia. Lima, Perú. Escuela de Medicina, Univesidad Peruana de Ciencias Aplicadas. Lima, Perú. Médico Epidemiólogo Clínico.; Farfán-Ramos, Sonia; Hospital de Emergencias Pediátricas. Lima, Perú. Enfermera, especialista en Enfermería Pediátrica, Magister en Salud Pública y Comunitaria, Magister en Administración de Salud.
ObjectiveTo determine the clinical and demographic characteristics of pneumonia with influenza virus AH1N1/2009 pandemic at the National Institute of Child. Methods. Retrospective case series in children hospitalized for influenza pneumonia pandemic AH1N1/2009 in a pediatric hospital. Reviewed the medical records between the months of June to September 2009. All cases had virological confirmation, we describe the clinical characteristics and conditions of severity. Results. A total of 74 ...
Phillips, M.; Kumate-Rodríguez, J.; Mota-Hernández, F.
The treatment received by children aged under 5 years with diarrhoea was studied in the Hospital Infantil de México (Federico Goméz), Mexico City. The costs of treatment were calculated and estimates were made of how these had changed since the establishment of an oral rehydration unit in the hospital in 1985. The results indicate that drug treatment of outpatients was generally appropriate and inexpensive. In contrast, the cost of drugs for inpatients was considerably higher. The seriousness...
Van Ginderdeuren, F; Vandenplas, Y; Deneyer, M; Vanlaethem, S; Buyl, R; Kerckhofs, E
To evaluate the effectiveness of two airway clearance techniques (ACT's) in children autogenic drainage (AAD), intrapulmonary percussive ventilation (IPV), or bouncing (B) (control group), ninety-three finished the study. Mean time to recovery in days was our primary outcome measure. The impact of the treatment and the daily improvement was also assessed by a validated clinical and respiratory severity score (WANG score), heart rate (HR), and oxygen saturation (SaO2 ). Mean time to recovery was 4.5 ± 1.9 days for the control group, 3.6 ± 1.4 days, P < 0.05 for the AAD group and 3.5 ± 1.3 days, P = 0.03 for the IPV group. Wang scores improved significantly for both physiotherapy techniques compared to the control group. Both ACT's reduced significantly the length of hospital stay compared to no physiotherapy. Pediatr Pulmonol. 2017;52:225-231. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.
Liu, Zifeng; Yu, Dongsheng; Zhou, Lijie; Yang, Jing; Lu, Jiaxuan; Lu, Hui; Zhao, Wei
The dental health of preschool children with congenital heart disease (CHD) is usually poor, which may contribute to the development of infective endocarditis (IE).Primary care physicians play an important role in providing access to preventive dental services, particularly for preschool children. The object of this study was to provide epidemiologic evidence for the impact of primary care physicians’ (PCP’s) counseling role on early childhood caries in children with CHD in Guangzhou, China, which might guide future caries prevention to decrease the risk of IE in children with CHD. A hospital-based,case-control study was performed, which contained 100 children with newly diagnosed early childhood caries and 100 matched (sex and age) children without dental caries. All of the subjects were diagnosed with CHD at birth and recruited from Guangdong Cardiovascular Institute from 2012 through 2013. A conditional multivariate logistic-regression model was used to assess the associations between PCPs’ role and early childhood caries with a significance level of 5%. Our findings revealed that mother's education level (OR = 0.36,CL = 0.14–0.92) and knowledge, being educated on the relationship between CHD and infective endocarditis (OR = 0.48, CL = 0.25–0.94) and the impact of oral health on infective endocarditis (OR = 0.37, CL = 0.18–0.79) by the PCP were associated with early childhood caries. PCPs played an important role in preventing early childhood caries among preschool children with CHD in Guangzhou, China.
Full Text Available The dental health of preschool children with congenital heart disease (CHD is usually poor, which may contribute to the development of infective endocarditis (IE. Primary care physicians play an important role in providing access to preventive dental services, particularly for preschool children. The object of this study was to provide epidemiologic evidence for the impact of primary care physicians’ (PCP’s counseling role on early childhood caries in children with CHD in Guangzhou, China, which might guide future caries prevention to decrease the risk of IE in children with CHD. A hospital-based, case-control study was performed, which contained 100 children with newly diagnosed early childhood caries and 100 matched (sex and age children without dental caries. All of the subjects were diagnosed with CHD at birth and recruited from Guangdong Cardiovascular Institute from 2012 through 2013. A conditional multivariate logistic-regression model was used to assess the associations between PCPs’ role and early childhood caries with a significance level of 5%. Our findings revealed that mother’s education level (OR = 0.36, CL = 0.14–0.92 and knowledge, being educated on the relationship between CHD and infective endocarditis (OR = 0.48, CL = 0.25–0.94 and the impact of oral health on infective endocarditis (OR = 0.37, CL = 0.18–0.79 by the PCP were associated with early childhood caries. PCPs played an important role in preventing early childhood caries among preschool children with CHD in Guangzhou, China.
Villarini, Milena; Dominici, Luca; Piccinini, Renza; Fatigoni, Cristina; Ambrogi, Maura; Curti, Gianluca; Morucci, Piero; Muzi, Giacomo; Monarca, Silvano; Moretti, Massimo
The International Agency for Research on Cancer has classified several antineoplastic drugs in Group 1 (human carcinogens), among which chlorambucil, cyclophosphamide (CP) and tamoxifen, Group 2A (probable human carcinogens), among which cisplatin, etoposide, N-ethyl- and N-methyl-N-nitrosourea, and Group 2B (possible human carcinogens), among which bleomycins, merphalan and mitomycin C. The widespread use of these mutagenic/carcinogenic drugs in the treatment of cancer has led to anxiety about possible genotoxic hazards to medical personnel handling these drugs. The aim of the present study was to evaluate work environment contamination by antineoplastic drugs in a hospital in Central Italy and to assess the genotoxic risks associated with antineoplastic drug handling. The study group comprised 52 exposed subjects and 52 controls. Environmental contamination was assessed by taking wipe samples from different surfaces in preparation and administration rooms and nonwoven swabs were used as pads for the surrogate evaluation of dermal exposure, 5-fluorouracil and cytarabine were chosen as markers of exposure to antineoplastic drugs in the working environment. The actual exposure to antineoplastic drugs was evaluated by determining the urinary excretion of CP. The extent of primary, oxidative and excision repaired DNA damage was measured in peripheral blood leukocytes with the alkaline comet assay. To evaluate the role, if any, of genetic variants in the extent of genotoxic effects related to antineoplastic drug occupational exposure, the study subjects were genotyped for GSTM1, GSTT1, GSTP1 and TP53 polymorphisms. Primary DNA damage significantly increased in leukocytes of exposed nurses compared to controls. The use of personal protective equipment (i.e. gloves and/mask) was associated with a decrease in the extent of primary DNA damage.
Dubé, Eve; Gagnon, Dominique; Huot, Caroline; Paré, Renée; Jacques, Solange; Kossowski, Alexandra; Quach, Caroline; Landry, Monique
Despite a publicly funded immunization program and continuous promotional efforts, vaccine uptake for seasonal influenza in Quebec (Canada) remains under its goal of 80%. Missed opportunities can explain the low influenza vaccine rates among chronically ill children. To address that, demonstration projects using the live attenuated influenza vaccine (LAIV) were implemented in 3 pediatric tertiary care hospitals to evaluate the feasibility and acceptability of implementing influenza immunization of chronically ill children in hospitals' outpatient clinics. A diary was used to document barriers and enabling factors regarding the implementation, and a questionnaire was distributed to healthcare professionals involved in the project in each hospital. Parent's knowledge, attitudes and behaviors (KAB) about influenza immunization and acceptability of immunization in outpatient clinics were also measured with a questionnaire. As part of the project, 2,478 children were immunized. Enabling factors included the financial support received from Quebec ministry of Health, the nasal mode of administration of the LAIV and the presence of a leader specifically dedicated to influenza immunization. Barriers to influenza immunization in outpatient clinics included difficulties of hiring extra staff to work in immunization clinics and additional tasks added to regular activities of the clinics. Results from both questionnaires illustrated a high level of acceptability of seasonal influenza immunization in hospitals' outpatient clinics by parents and healthcare professionals. Influenza immunization in pediatric tertiary care hospital is an effective way to reach chronically ill children and does not involve major feasibility or acceptability issues.
Full Text Available An increased incidence of Streptococci pyogenes (group A streptococcus [GAS] infections and rheumatic fever has been reported over the past decade. The present study was conducted to determine whether a similar increase in such infections was observed after varicella, an infection previously shown to be associated with a high incidence of streptococcal infections. The charts of all children admitted with chickenpox to the Hospital for Sick Children in Toronto, Ontario from January 1, 1980 to December 31, 1989 were reviewed. Immunocompromised children and those hospitalized for another reason who had an incidental diagnosis of chickenpox were excluded. Twenty-five cases with bacterial infection complicating chickenpox were compared with 103 patients without secondary infection. No statistically significant differences were observed for age, gender, duration of illness prior to hospitalization or duration of hospitalization in the two groups. GAS was the most frequent isolate in the cases, followed by Staphylococcus aureus, Escherichia coli and Haemophilus influenzae. The types of infection were significantly different for GAS compared with other organisms, with a predominance of skin infections in the former group (χ2 analysis, P<0.05. No increase in the incidence of GAS infections was observed over time. This study confirms the importance of GAS infections in patients with varicella, but no increase was observed in hospitalized children during the 10-year study period.
Sajjan, Sushma; Jain, Puneet; Sharma, Suvasini; Seth, Anju; Aneja, Satinder
To study the magnitude and pattern of injuries in children with epilepsy. This prospective cohort study enrolled children with epilepsy (CWE) aged 2-16 years on treatment with anti-epileptics for a minimum duration of one-month and compared them with their own siblings (controls). A semi-structured questionnaire was used to enquire about epilepsy and type and frequency of injuries sustained at monthly follow-up visits. Participants were followed up for 12-months for occurrence of injuries. 208 cases and 212 controls were analyzed. 21 cases (10.1%) and 10 controls (4.7%) had sustained injuries (P=0.03) (RR 2.1; 95% CI, 1.0 - 4.4). Seizure-related injuries were present in 4.3% of cases. Children with epilepsy are at an increased risk of injuries and hence need supervision.
Ferreira, Caroline Cristina Moreira; Remedi, Patrícia Pereira; de Lima, Regina Aparecida Garcia
This bibliographic study involved the Medline and LILACS databases as well as non-systematized searches and covered the period from 1994 to 2004. We aimed to analyze the bibliographic production on pediatric nursing and music, in order to identify current knowledge in this area. Our analysis revealed 3 units of meaning: the setting, interventions and repercussions. The results disclose the benefits music can offer to hospitalized children, their family members and health teams. We observed that music can be used in hospitals as a low-cost, nonpharmacological and noninvasive intervention, promoting development processes with a view to the health of children, families and workers.
Mikkelsen, Gitte; Frederiksen, Kirsten
mikkelsen g. & frederiksen k. (2011) Family-centred care of children in hospital - a concept analysis. Journal of Advanced Nursing67(5), 1152-1162. ABSTRACT: Aim. This paper reports a concept analysis of family-centred nursing care of hospitalized children. Background. Family-centred care...... and scientific maturity of the concept. Findings. There is good agreement on the defining attributes of the concept, but they are described by sub concepts in need of clarification. The relationship between family and professionals is characterized by a mutual dependency and shared responsibility for the child...... include the perspective of the sick child....
Paccione-Dyszlewski, Margaret R; Conelea, Christine A; Heisler, Walter C; Vilardi, Jodie C; Sachs, Henry T
Behavioral crisis management, including the use of seclusion and restraint, is the most high risk process in the psychiatric care of children and adolescents. The authors describe hospital-wide programmatic changes implemented at a children's psychiatric hospital that aimed to improve the quality of crisis management services. Pre/post quantitative and qualitative data suggest reduced restraint and seclusion use, reduced patient and staff injury related to crisis management, and increased patient satisfaction during the post-program period. Factors deemed beneficial in program implementation are discussed.
Craver, Randall; Sandquist, Dane; Nadell, Joseph; Velez, Maria
Our 25 year experience with 35 medulloblastomas included classic (NOS) 22 (63%), anaplastic (ANA) 5(14%), desmoplastic (DES) 4(11%), excessive nodularity (EN) 3(9%), and large cell (LC) 1(3%). Overall 5, 10, and 15 year survivals were .6631, .5851, and .5051. Those under 3 years at diagnosis had an overall 2 year survival of .4379. Two survived 17(NOS) and 19 (EN) years. In the 26 children 3 years or older, late deaths occurred at 8, 8, and 14 years (5, 10, 15 year survivals .7375, .6392, .5114). Because late deaths occur; continued follow-up of these children is required.
Lee, Diana S; Gross, Elissa; Rinke, Michael L
Nearly one-third of the children in the United States are obese or overweight and face associated physical and mental health issues.(1,2) Parents often misperceive and underreport their child's weight status.(3-5) This misperception is a major barrier to increasing healthy lifestyle choices, such as limiting screen time, increasing physical activity, improving diet, and participating in prevention programs.(6-8) Increasing parental awareness of children's weight status is an important initial step in addressing the obesity epidemic.
Rajan, Shahzleen; Wissenberg, Mads; Folke, Fredrik
population. METHODS: All OHCA patients in Denmark, ≤21 years of age, were identified from 2001 to 2010. The population was divided into infants (adolescents/young adults (16-21 years). Multivariate logistic regression......-school children, school children and high school adolescents were 11.5, 3.5, 1.3 and 5.3 per 100,000 inhabitants. Overall bystander CPR rate was 48.8%, and for age groups: 55.4%, 41.2%, 44.9% and 63.0%, respectively. Overall 30-day survival rate was 8.1%, and for age groups: 1.4%, 4.5%, 16.1% and 9...
Pinto, Jamie M; Petrova, Anna
Despite unproven effectiveness, Lactobacillus acidophilus is a widely used probiotic in the treatment of pediatric diarrhea. In this report, we evaluated the association between length of stay (LOS) for 290 young children hospitalized with acute diarrhea and adjuvant therapy with a probiotic mixture containing 80% L acidophilus that was included in treatment for 22.4% of them. Overall, no association between LOS and use of L acidophilus was recorded after controlling for age, length of diarrhea symptoms, duration of intravenous fluids, and prior exposure to antibiotic. However, LOS was directly associated with use of L acidophilus in children with negative stool studies, and no such association was recorded in children with positive stool for rotavirus or other infections. We concluded that adjuvant therapy with L acidophilus mixture is not beneficial for young children hospitalized with acute diarrhea.
Sheila Moura Pone
Full Text Available Abstract Objective: To evaluate the validity of clinical and laboratory signs to serious dengue disease in hospitalized children. Methods: Retrospective cohort of children (19 and negative likelihood ratio <0.6. Pleural effusion and abdominal distension had higher sensitivity (82.6%. History of bleeding (epistaxis, gingival or gastrointestinal bleeding and severe hemorrhage (pulmonary or gastrointestinal bleeding in physical examination were more frequent in serious dengue disease (p < 0.01, but with poor accuracy (positive likelihood ratio = 1.89 and 3.89; negative likelihood ratio = 0.53 and 0.60, respectively. Serum albumin was lower in serious dengue forms (p < 0.01. Despite statistical significance (p < 0.05, both groups presented thrombocytopenia. Platelets count, hematocrit, and hemoglobin parameters had area under the curve <0.5. Conclusions: Lethargy, abdominal distension, pleural effusion, and hypoalbuminemia were the best clinical and laboratorial markers of serious dengue disease in hospitalized children, while bleeding, severe hemorrhage, hemoconcentration and thrombocytopenia did not reach adequate diagnostic accuracy. In pediatric referral hospitals, the absence of hemoconcentration does not imply absence of plasma leakage, particularly in children with previous fluid replacement. These findings may contribute to the clinical management of dengue in children at referral hospitals.
Brady, Patrick W; Varadarajan, Kartik; Peterson, Laura E; Lannon, Carole; Gross, Thomas
Our objective was to describe the prevalence and nature of adverse medical device events (AMDEs) in tertiary care children's hospitals. In our retrospective cohort study of patients at 44 children's hospitals in the Pediatric Health Information System (PHIS), we included all inpatient stays with an AMDE-related diagnosis from January 1, 2004 to December 31, 2011. We identified AMDEs by diagnoses that specified a device in their definition. We included events present on admission as well as those complicating hospital stays. We described the characteristics of these admissions and patients, and stratified analysis by device category and presence of a complex chronic condition. Of 4,115,755 admissions in the PHIS database during the study period, 136,465 (3.3%) had at least 1 AMDE. Vascular access and nervous system devices together represented 44.4% of pediatric AMDE admissions. The majority (75.5%) of AMDE admissions were of children with complex chronic conditions. The most common age group was patients aged 2 years or less at the time of their first AMDE-related admission. AMDEs occur commonly in a population cared for in tertiary children's hospitals. Research to more specifically delineate AMDEs and their predictors are next steps to understand and improve device safety in children.
Gastanaduy, Paul A.; Islam, Khaleda; Rahman, Mahmudur; Rahman, Mustafizur; Luby, Stephen P.; Heffelfinger, James D.; Parashar, Umesh D.; Gurley, Emily S.
Background: In anticipation of introduction of a rotavirus vaccine into the national immunization program of Bangladesh, active hospital-based surveillance was initiated to provide prevaccine baseline data on rotavirus disease. Methods: Children 5 years of age and younger admitted with acute gastroenteritis (AGE) (≥3 watery or looser-than-normal stools or ≥1 episode of forceful vomiting) at 7 hospitals throughout Bangladesh were identified. Clinical information and stool specimens were collected from every 4th patient. Specimens were tested for rotavirus antigen by enzyme immunoassays; 25% of detected rotaviruses were genotyped. Results: From July 2012 to June 2015, rotavirus was detected in 2432 (64%) of 3783 children hospitalized for AGE. Eight enrolled children died, including 4 (50%) who were rotavirus positive. Rotavirus was detected year-round in Bangladesh with peak detection rates of >80% during November–February. Most (86%) rotavirus AGE cases were 6–23 months of age. Sixty-nine percent of children with rotavirus had severe disease (Vesikari score, ≥11). Among 543 strains genotyped, G1P (31%) and G12P (29%) were the most common. Conclusions: Rotavirus is a major cause of morbidity in Bangladeshi children, accounting for nearly two-thirds of AGE hospitalizations. These data highlight the potential value of rotavirus vaccination in Bangladesh, and will be the key for future measurement of vaccine impact. PMID:27798545
Full Text Available Aim: The objective of this study was to determine the first aid practices performed and, effecting factors in burn injuries in before hospital admission. Material and Method: The study was conducted in burn centers of two hospitals in the Erzurum, between December 2013 and August 2014. The population was consisted of inpatient children aged 0-12 years who were treated in burn centers of related hospitals and their mothers at the date of the study. The study was carried out with a total of 121 children and their mothers who met the research inclusion criteria. Questionnaire data was used to collect data. In data analysis, percentage distributions, means and chi-square test were used. Results: It was found that, children%u2019 mothers applicate the cold water first when the burns ocur (57.9%, secondly only applying cold water (27.3%, then the mothers took off their children to hospital not to any application (75.2%, burn wound on the olive oil riding (10.7%, burn wound yogurt riding (8.3%. Discussion: As a result, it was determined that children%u2019 mothers don%u2019t have an adequate level of first-aid knowledge, and younger mothers with low levels of education living in rural areas perform incorrect first aid practices.
Enshaei, A; Masoudi, N
Burning is the second most common cause of home injuries in Iran that is often the cause of conflicts between children and young adults. Burning can lead to early and late complications that scar and contracture are the most common. Burn waste treatment is done by two methods: excision and then skin graft after the formation of granulation tissue; and excision and graft simultaneously that in this study, these two methods are compared. This was performed as a quasi-experimental analysis and retrospective study on all patients who were hospitalized for burn scar. All patients who have associated with weak eningimmune diseases such as diabetes, acquired immunodeficiency or congenital, taking steroids and patients undergoing chemotherapy etc. are excluded. The method of grafting in patients is primary graft procedure that was compared with patients who are treated using secondary graft. Data collected through review of patients' hospital and clinic chart. The mean burn percentage in the primary repair group was 14.4% and in the delayed repair group was 16.6%, respectively. The incidence of hematoma in both groups was zero. Skin necrosis and graft rejection and infection in the primary repair group was in 3.7% of patients and in the delayed repair group was in 1.2% of cases (P=0.5) CONCLUSION: Based on the findings of this study, no difference was observed between the two methods of excision and primary graft with delayed graft in the incidence of graft rejection. Due to the shorter treatment of primary graft and patient satisfaction and also according to the findings of this study excision and primary graft method seems appropriate method for treating old waste burning.
José Manuel Ramos; Paula Molés-Poveda; Dalu Tessema; Mubarack Kedir; Gamadi Safayo; Abraham Tesfasmariam; Francisco Reyes; Isabel Belinchón
Objective: To examine the prevalence of cutaneous disorders in children under 5 years old who attended a rural hospital in Southern Ethiopia.Methods: A prospective cross-sectional study was conducted from January 26 to February 20, 2015 in children under 5 years old who attended Gambo Rural Hospital in West Arsi of the Oromia Region, Ethiopia.Results: A total of 324 children were included(59.6% male) whose median age was 16.4months. In total, 147 children [45.4%; 95% confidence interval(CI): 40.0%–50.8%]under 5 years had a skin problem, of which 101(68.7%) consulted for that reason. The other 46(31.3%) consulted for a general health problem and the dermatological condition was a secondary finding during the physical exploration. In 93 children(28.7%; 95% CI:20%–33.8%), it was the main disease, and in 54 children(16.5%; 95% CI: 13.0%–21.1%)it was concomitant with other diseases. The most common dermatological disease was scabies(n = 44, 13.6%; 95% CI: 10.3%–17.7%). Impetigo was diagnosed in 32 children(9.9%; 95% CI: 7.1%–13.3%), of which 23(71.9%) had complicated impetigo. Nineteen children(5.9%; 95% CI: 3.8%–9.0%) had eczema, 10(3.1%) had eczema associated to other conditions. The following most frequent skin problems were tinea(n = 9; 2.8%),infected wound and ulcer(n = 7; 2.2%), and burns(n = 6; 1.9%).Conclusions: Skin problems, mainly scabies, impetigo, and eczema were common in young children attended at a rural hospital in Southern Ethiopia. Children under 5 years should be examined thoroughly to rule out skin diseases, especially scabies.
Jose Manuel Ramos; Paula Moles-Poveda; Dalu Tessema; Mubarack Kedir; Gamadi Safayo; Abraham Tesfasmariam; Francisco Reyes; Isabel Belinch on
Objective: To examine the prevalence of cutaneous disorders in children under 5 years old who attended a rural hospital in Southern Ethiopia. Methods: A prospective cross-sectional study was conducted from January 26 to February 20, 2015 in children under 5 years old who attended Gambo Rural Hospital in West Arsi of the Oromia Region, Ethiopia. Results: A total of 324 children were included (59.6%male) whose median age was 16.4 months. In total, 147 children [45.4%; 95% confidence interval (CI): 40.0%–50.8%] under 5 years had a skin problem, of which 101 (68.7%) consulted for that reason. The other 46 (31.3%) consulted for a general health problem and the dermatological condition was a secondary finding during the physical exploration. In 93 children (28.7%;95%CI:20%–33.8%), it was the main disease, and in 54 children (16.5%;95%CI:13.0%–21.1%) it was concomitant with other diseases. The most common dermatological disease was scabies (n=44, 13.6%;95%CI:10.3%–17.7%). Impetigo was diagnosed in 32 children (9.9%;95%CI:7.1%–13.3%), of which 23 (71.9%) had complicated impetigo. Nineteen children (5.9%;95%CI:3.8%–9.0%) had eczema, 10 (3.1%) had eczema associated to other conditions. The following most frequent skin problems were tinea (n = 9; 2.8%), infected wound and ulcer (n=7;2.2%), and burns (n=6;1.9%). Conclusions: Skin problems, mainly scabies, impetigo, and eczema were common in young children attended at a rural hospital in Southern Ethiopia. Children under 5 years should be examined thoroughly to rule out skin diseases, especially scabies.
Full Text Available AIM: Aim of the study is to study the spectrum of AGN in children and to assess the age, sex and seasonal incidence and prognostic factors. Acute glomerulonephritis is one of the most common condition seen in children. The study group included 50 children. In most of the children presenting complaints s of are puffiness of face, haematuria and oliguria. METHODS AND MATERIALS: Fifty children who were admitted in the government hospital during the period of September 2013 to January 2015 were included in the stud y. RESULTS: The maximum admissions were seen from the months of September to December. Common age group was between 3 and 8 years. Rare age group was below 2 years. Hypertension was noticed in 32 out of 50 children. Albuminuria and hematuria were commonest urinary abnormalities. CONCLUSION: acute glomerulonephritis is less common below 2 years. Hypertension was of varying degree. Cardiomegaly by x - ray was an added feature.
Borgwardt, Lise; Larsen, Helle Jung; Pedersen, Kate; Hoejgaard, Liselotte [Department of Clinical Physiology, Nuclear Medicine and PET, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen (Denmark)
Children are not just small adults - they differ in their psychology, normal physiology and pathophysiology, and various aspects should be considered when planning a positron emission tomography (PET) scan in a child. PET in children is a growing area, and this article describes the practical use and implementation of PET in children in a hospital PET centre. It is intended to be of use to nuclear medicine departments implementing or starting to implement PET scans in children. Topics covered are: dealing with children, dosimetry, organisation within the department and relations with other departments, preparation of the child (provision of information to the child and parents and the fasting procedure), the imaging procedure (resting, tracer injection, positioning, sedation and bladder emptying) and pitfalls in the interpretation of PET scans in children, including experiences with telemedicine. (orig.)
Borgwardt, Lise; Larsen, Helle Jung; Pedersen, Kate
Children are not just small adults-they differ in their psychology, normal physiology and pathophysiology, and various aspects should be considered when planning a positron emission tomography (PET) scan in a child. PET in children is a growing area, and this article describes the practical use...... and implementation of PET in children in a hospital PET centre. It is intended to be of use to nuclear medicine departments implementing or starting to implement PET scans in children. Topics covered are: dealing with children, dosimetry, organisation within the department and relations with other departments......, preparation of the child (provision of information to the child and parents and the fasting procedure), the imaging procedure (resting, tracer injection, positioning, sedation and bladder emptying) and pitfalls in the interpretation of PET scans in children, including experiences with telemedicine....
Full Text Available The paper studies the issue of education of visually impaired children, hearing impaired children and children with intellectual disabilities in regular primary schools in the context of mathematics instruction for beginners. The authors state the basic characteristics of mathematics instruction for beginners with respect to the contents studied in the first four grades of primary school, as well as the key problems and educational needs of visually impaired children, hearing impaired children and children with intellectual disabilities. The basic characteristics of inclusive education and the key role of teacher in this process are pointed out. Starting from the developmental peculiarities of children with disabilities, the authors emphasize the importance of applying an individualized approach in teaching mathematics. Possible didactic and methodical solutions are discussed, as well as different approaches in teaching this subject that can facilitate learning of mathematical contents to visually impaired children, hearing impaired children and children with intellectual disabilities. Bearing in mind the peculiarities of inclusive education, i.e. the need for the children with disabilities to participate in common activities with the other children in the class, the authors emphasize the importance of encouraging interaction and communication among children in the process of learning mathematical contents.
Dimitrova, Dimana; Ross, Lawrence
The incidence of coccidioidomycosis is increasing, and published pediatric experience is limited. This study further characterizes pediatric coccidioidomycosis by describing experience with 64 patients cared for at Children's Hospital of Los Angeles over 20 years, with focus on sites of involvement and severity, as well as serologic profiles of affected children. © The Author 2014. Published by Oxford University Press on behalf of the Pediatric Infectious Diseases Society. All rights reserved. For Permissions, please e-mail: email@example.com.
Hosseinian, Masoumeh; Mirbagher Ajorpaz, Neda; Esalat Manesh, Soophia
Background: Despite the paramount importance of the patient’s satisfaction, there are limited data on mothers’ satisfaction with the nursing care provided to their children in Iranian clinical settings. Objectives: This study aimed to evaluate mothers’ satisfaction with two systems of providing care to their hospitalized children. Patients and Methods: This research was a two-group quasi-experimental study. Primarily, the basics of the case method and the functional care delivery systems were...
In my master's thesis, I dealt with the issue of transition of special needs children from kindergarten to school. First, I provided a general description of the term transition, and then I focused more on the period when children first enter school. I described two dominant approaches to transition of children when starting school – school readiness and transition in accordance with the ecological model. I showed why this transition to school may represent an obstacle, what may hinder the pr...
Full Text Available The aim of this study was to investigate the characteristics of our hospitalized patients with the diagnosis of iron deficiency anemia (IDA and effects of the IDA prevention project of the Turkish Ministry of Health which was started in 2004. The recommended dose of prophylactic iron supplementation was 1-2 mg/kg/day. The files of 1519 patients who were hospitalized to Konya Education and Research Hospital Pediatrics Clinic were reviewed. A total of 50 patients consisting of 35 boys and 15 girls with the mean age of 16,59 ± 1,68 months were included into the study. The prevalence of IDA was 3.29% (boys: 4.23%, girls: 2.1%. Hgb and Hct of the patients >24 months were significantly higher than those of the patients with the age of 6–12 months. Iron supplementation receiving rates were very low. Of the 28 patients older than 12 months, only 44% of them had received a full course of iron supplementation for 8 months. In conclusion, although prophylactic iron supplementation lowered the prevalences of IDA, receiving rates of iron supplementation were not adequate. While IDA is still a public health problem, prophylactic approaches should be carried out more effectively.
Gunuc, Selim; Misirli, Ozge; Odabasi, H Ferhan
This case study examines the utilization of Twitter as a communication channel among primary school children. This study tries to answer the following questions: "What are the cases for primary school children's use of Twitter for communication?" and "What are primary school children's experiences of utilizing Twitter for communication?" Participants were 7th grade students (17 female, 34 male; age 13 years) studying in a private primary school in Turkey within the 2011-12 academic year. A questionnaire, semi-structured interview, document analysis, and open ended questions were used as data collection tools. The children were invited and encouraged to use Twitter for communication. Whilst participants had some minor difficulties getting accustomed to Twitter, they managed to use Twitter for communication, a conclusion drawn from the children's responses and tweets within the study. However, the majority of children did not consider Twitter as a communication tool, and were observed to quit using Twitter once the study had ended. They found Twitter unproductive and restrictive for communication. Furthermore, Twitter's low popularity among adolescents was also a problem. This study suggests that social networking tools favored by children should be integrated into educational settings in order to maximize instructional benefits for primary school children and adolescents.
Full Text Available Cryptosporidium spp. is a common, but under-reported cause of childhood diarrhea throughout the world, especially in developing countries. A comprehensive estimate of the burden of cryptosporidiosis in resource-poor settings is not available.We used published and unpublished studies to estimate the burden of diarrhea, hospitalization and mortality due to cryptosporidial infections in Indian children. Our estimates suggest that annually, one in every 6-11 children <2 years of age will have an episode of cryptosporidial diarrhea, 1 in every 169-633 children will be hospitalized and 1 in every 2890-7247 children will die due to cryptosporidiosis. Since there are approximately 42 million children <2 years of age in India, it is estimated that Cryptosporidium results in 3.9-7.1 million diarrheal episodes, 66.4-249.0 thousand hospitalizations, and 5.8-14.6 thousand deaths each year.The findings of this study suggest a high burden of cryptosporidiosis among children <2 years of age in India and makes a compelling case for further research on transmission and prevention modalities of Cryptosporidium spp. in India and other developing countries.
Coller, Ryan J; Nelson, Bergen B; Klitzner, Thomas S; Saenz, Adrianna A; Shekelle, Paul G; Lerner, Carlos F; Chung, Paul J
Interventions to reduce disproportionate hospital use among children with medical complexity (CMC) are needed. We conducted a rigorous, structured process to develop intervention strategies aiming to reduce hospitalizations within a complex care program population. A complex care medical home program used 1) semistructured interviews of caregivers of CMC experiencing acute, unscheduled hospitalizations and 2) literature review on preventing hospitalizations among CMC to develop key drivers for lowering hospital utilization and link them with intervention strategies. Using an adapted version of the RAND/UCLA Appropriateness Method, an expert panel rated each model for effectiveness at impacting each key driver and ultimately reducing hospitalizations. The complex care program applied these findings to select a final set of feasible intervention strategies for implementation. Intervention strategies focused on expanding access to familiar providers, enhancing general or technical caregiver knowledge and skill, creating specific and proactive crisis or contingency plans, and improving transitions between hospital and home. Activities aimed to facilitate family-centered, flexible implementation and consideration of all of the child's environments, including school and while traveling. Tailored activities and special attention to the highest utilizing subset of CMC were also critical for these interventions. A set of intervention strategies to reduce hospitalizations among CMC, informed by key drivers, can be created through a structured, reproducible process. Both this process and the results may be relevant to clinical programs and researchers aiming to reduce hospital utilization through the medical home for CMC. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
de Oliveira, Kézia; Veronez, Marly; Marques, Camilla Delavalentina Cavalini; Higarashi, Ieda Harumi; Marcon, Sonia Silva
Exploratory and descriptive study, of qualitative nature, developed with the purpose of knowing the route of the child's family admitted to the hospital. The data were collected at the pediatric unit of the Regional University Hospital of Maringá (HUM), through semi-structured interviews with the accompanying family members. After analysis of content, two categories emerged: the role of the family in the identification of deviations in the child's health, and the (un)readiness of the health services: impacts on the child health attendance. The study evidenced an expectation of the family in face of the child's illness, searching for alternative strategies and late seeking for health services. These, in turn, show gaps along the attendance process, from diagnosis to treatment, thus raising familiar stress and increasing the possibilities of aggravation of the clinical condition of the child.
Giambra, Barbara K; Stiffler, Deborah; Broome, Marion E
With advances in health care, the population of children who are technology-dependent is increasing and, therefore, the need for nurses to understand how best to engage in communication with the parents of these children is critical. Shared communication between the parents of hospitalized technology-dependent children and their nurses is essential to provide optimal care for the child. The components and behaviors of the parent-nurse communication process that improve mutual understanding of optimal care for the child had not previously been examined. Among parents of hospitalized technology-dependent children and their nurses, what communication behaviors, components, concepts, or processes improve mutual understanding of optimal care for the child? An integrative review of both qualitative and quantitative studies was conducted. Key words including communication, hospitalized, nurse, parent, pediatric, and technology-dependent were used to search databases such as Cumulative Index to Nursing and Allied Health and Medline for years 2000-2014. The data regarding the process of parent-nurse communication were extracted as they related to the mutual understanding of optimal care for the child. The data were grouped into themes and compared across studies, designs, populations, and settings. Six articles were identified that provided information regarding the processes of shared communication among the parents of hospitalized technology-dependent children and their nurses. Providing clear information, involving parents in care decisions, trust and respect for each other's expertise, caring attitudes, advocacy, and role negotiation were all found to be important factors in shared parent-nurse communication. The results of this integrative review inform our understanding of the parent-nurse communication process. The findings provide nurses with an understanding of strategies to better engage in respectful, engaging, and intentional communication with parents of
Kruger, Colin; Summers, Mike
Studies 34 elementary school children's understanding of five aspects of energy waste and the ways in which these conceptions develop following teaching. Concludes that the children had good prior awareness of some behaviors that save energy, but their reasons for thinking this were based largely on everyday intuitive ideas that involved…
de Greeff, Johannes Wilhelmus
There is increasing evidence that physical activity can improve cognitive functions of primary school children, especially the executive functions (functions that are important for goal directed cognition and behavior). Physically active academic lessons, however, do not improve executive functions
This study sought to establish the prevalence of traumatic dental injuries in the primary dentition of Irish children and to investigate the relationship between dental trauma and non-nutritive sucking habits.
Holtman, Geeske Atje
Chronic or recurrent gastrointestinal symptoms are common presentations among children in primary care. Because symptoms of functional gastrointestinal disorders may be indistinguishable from inflammatory bowel disease (IBD), it is a diagnostic challenge for clinicians to differentiate between them
Zeinab M. Monir
CONCLUSION: Comorbid academic and psychosocial dysfunction in primary school children were observed in South Sinai. A national strategy to minimise the educational gap between Bedouin and urban areas should be implemented.
Falkard, Brie; Uddin, Taher; Rahman, M Arifur; Franke, Molly F; Aktar, Amena; Uddin, Muhammad Ikhtear; Bhuiyan, Taufiqur Rahman; Leung, Daniel T; Charles, Richelle C; Larocque, Regina C; Harris, Jason B; Calderwood, Stephen B; Qadri, Firdausi; Ryan, Edward T
Vibrio cholerae, the cause of cholera, induces both innate and adaptive immune responses in infected humans. Leptin is a hormone that plays a role in both metabolism and mediating immune responses. We characterized leptin levels in 11 children with cholera in Bangladesh, assessing leptin levels on days 2, 7, 30, and 180 following cholera. We found that patients at the acute stage of cholera had significantly lower plasma leptin levels than matched controls, and compared with levels in late convalescence. We then assessed immune responses to V. cholerae antigens in 74 children with cholera, correlating these responses to plasma leptin levels on day 2 of illness. In multivariate analysis, we found an association between day 2 leptin levels and development of later anti-cholera toxin B subunit (CtxB) responses. This finding appeared to be limited to children with better nutritional status. Interestingly, we found no association between leptin levels and antibody responses to V. cholerae lipopolysaccharide, a T cell-independent antigen. Our results suggest that leptin levels may be associated with cholera, including the development of immune responses to T cell-dependent antigens. © The American Society of Tropical Medicine and Hygiene.
Papaevangelou, V; Quinlivan, M; Lockwood, J; Papaloukas, O; Sideri, G; Critselis, E; Papassotiriou, I; Papadatos, J; Breuer, J
A prospective observational study was conducted to examine whether asymptomatic VZV reactivation occurs in immunocompetent children hospitalized in an ICU and its impact on clinical outcome. A secondary aim was to test the hypothesis that vaccinated children have a lower risk of reactivation than naturally infected children. Forty immunocompetent paediatric ICU patients and healthy controls were enrolled. Patients were prospectively followed for 28 days. Clinical data were collected and varicella exposure was recorded. Admission serum levels of TNF-a, cortisol and VZV-IgG were measured. Blood and saliva samples were collected for VZV-DNA detection via real-time PCR. As a comparison, the detection of HSV-DNA was also examined. Healthy children matched for age and varicella exposure type (infection or vaccination) were also included. VZV reactivation was observed in 17% (7/39) of children. Children with VZV reactivation had extended duration of fever (OR = 1.17; 95% CI, 1.02-1.34). None of the varicella-vaccinated children or healthy controls had detectable VZV-DNA in any blood or saliva samples examined. HSV-DNA was detected in saliva from 33% of ICU children and 2.6% of healthy controls. Among children with viral reactivation, typing revealed wild-type VZV and HSV-1. In conclusion, VZV reactivation occurs in immunocompetent children under severe stress and is associated with prolonged duration of fever.
Pavare, Jana; Grope, Ilze; Gardovska, Dace
In accordance with the 1st International pediatric sepsis consensus conference, where sepsis was defined as SIRS associated with suspected or proven infection, we have identified the need to assess the prevalence of SIRS and sepsis in children with abnormal temperatures hospitalized in The Children's Clinical University Hospital in Latvia. A descriptive prospective point prevalence study (using two time periods, each 24 h, randomly chosen) was conducted on all children (n = 943) treated in the hospital. All children with abnormal temperatures - fever or hypothermia (n = 92) - were included in the study. Questionnaires evaluating age-specific SIRS criteria were completed. The prevalence of SIRS was detected with 95% CI. Out of a total of 943 patients treated in the hospital, 10% (n = 92) had abnormal temperatures. In all these cases the abnormal temperature was a fever; hypothermia was not established in any patient. Of the children with fever, 72% (n = 66) had SIRS. Of the SIRS patients, 8% (n = 5) developed sepsis, 5% (n = 3) severe sepsis and 2% (n = 1) septic shock. Seventy-six percent (n = 50) of the SIRS patients had fever in combination with respiratory rate >2 SD above normal for age; 50% (n = 33) had fever with abnormal leukocyte count; 15% (n = 10) had fever with tachycardia >2 SD above normal for age. Most of the SIRS patients (39%, n = 25) were aged 2-5 years. Twenty-one percent (n = 14) of the children with SIRS and 50% (n = 2) of those with severe sepsis and septic shock had an underlying disease. In no case was SIRS and sepsis recognized by doctors and the diagnoses were not recorded on the patients' cards. Our results would indicate a high risk for sepsis development in children with SIRS. Early SIRS diagnosis and awareness of risk of developing sepsis could change the medical approach to the patient in everyday clinical practice, eventually leading to early, goal-directed therapy for sepsis.
case driven EMRs for use in clinical quality assurance and passive decision support. Stud...2 grams) Vancomycin 15 mg/kg IV (max: 1 gram) Sepsis in Oncology/Bone Marrow Transplant Meropenem 40...Children’s Hospital Oakland before and after the implementation of an Electronic Health Record with Clinical
安云凤; 柳菲菲; 丁美娟
Objective: To find the problems in the hospital medical record management, and take positive and effective measures to provide a basis to improve the quality of management of primary hospital medical record. Methods: use the follow-up way to make a survey, examine the medical record room at random. Results: The medical records room is lack of management talents. Business knowledge is poor. Infrastructure is well equipped. The system is not perfect. Conclusion: Case management of the primary hospital need hospital's attention, and should take effective measures to promote the development of primary hospital medical record management.%目的:查找医院病案管理中存在的问题,采取积极有效的措施,为提高基层医院病案管理质量提供依据.方法:对二级以上医院利用随访方式调查,随机到实地病案室查看.结果:病案室缺少管理人员,业务知识差,基础设施不齐,制度不健全等.结论:基层医院病案管理急需医院重视,应主动采取有效措施,促进基层医院病案管理事业的发展.
Chatterjee, Archana; Heybrock, Brenda; Plummer, Sharon; Eischen, Kay
Adherence to written infection control policies and procedures was studied and on-site education was provided for 1 year at a children's hospital. There was significant improvement in sharp objects disposal, hazardous waste handling, availability of personal protective equipment, isolation precautions, and staff knowledge regarding location of the exposure control plan.
Johannesen, J; Svensson, J; Mortensen, H B;
This article looks at a diabetes clinic for children and young people at the Copenhagen University Hospital in Herlev, Denmark and how things have changed at the clinic over the past 10 years as it has doubled its number of patients and switched insulin treatment regimens. The authors document...
Kruisinga, F.H.; Heinen, R.C.; Heymans, H.S.A.
The information centre of the Emma Children's Hospital AMC (EKZ AMC) is a specialised information centre where paediatric patients and persons involved with the patient can ask questions about all aspects of disease and its social implications. The aim of the study was to evaluate the question-answe
Background Seizure is one of the common causes of childhood hospitalization with significant mortality and morbidity. There is limited data regarding acute seizures episodes form the developing countries. Current study aims to find the common etiology of seizure and classify seizure types in various age groups presenting to tertiary center in Western Nepal. Methods This was a hospital based retrospective study carried out in the data retrieved from the records maintained in the Department of Pediatrics, Manipal Teaching Hospital, Pokhara from 1st July 2007 to 31st July 2011.Variables collected were demographics, clinical presentations, laboratory tests, brain imaging studies, electroencephalography, diagnosis and hospital course. Results A total of 551 patients were admitted for seizures with 338 (61.3%) males and 213 (38.7%) females. Among these patients, 295 (53.5%) presented with fever and 317 (57.5%) of children were less than 5 years of age. Generalized tonic-clonic seizures were the most common seizure type (69.9%). Seizure disorder (33.4%), febrile seizures (30.7%), CNS infections and neurocysticercosis were common etiologies. Abnormal brain images were noted in 111 (45.9%) of 242 patients and most common abnormality was neurocysticercosis 66 (59.5%). Conclusion CNS infections and febrile convulsions were common causes of seizures in febrile children. Neuroimaging should be advised in all afebrile children for the diagnosis of neurocysticercosis. Children diagnosed as seizure disorder require long term follow up studies including neurophysiologic studies. PMID:23536998
Argent, Andrew C.; And Others
All child abuse-related patients (n=503) seen at 1 Cape Town (South Africa) hospital over a 1-year period were reviewed. Abuse was confirmed in 389 cases (160 physical abuse and 229 sexual abuse). Most (81 percent) of the young children were seen by residents with minimal pediatric training. Lack of staff speaking Xhosa (spoken by 134 of the…
Tagge, Edward P; Thirumoorthi, Arul S; Lenart, John; Garberoglio, Carlos; Mitchell, Kenneth W
Lean Six Sigma (LSS) is a process improvement methodology that utilizes a collaborative team effort to improve performance by systematically identifying root causes of problems. Our objective was to determine whether application of LSS could improve efficiency when applied simultaneously to all services of an academic children's hospital. In our tertiary academic medical center, a multidisciplinary committee was formed, and the entire perioperative process was mapped, using fishbone diagrams, Pareto analysis, and other process improvement tools. Results for Children's Hospital scheduled main operating room (OR) cases were analyzed, where the surgical attending followed themselves. Six hundred twelve cases were included in the seven Children's Hospital operating rooms (OR) over a 6-month period. Turnover Time (interval between patient OR departure and arrival of the subsequent patient) decreased from a median 41min in the baseline period to 32min in the intervention period (p<0.0001). Turnaround Time (interval between surgical dressing application and subsequent surgical incision) decreased from a median 81.5min in the baseline period to 71min in the intervention period (p<0.0001). These results demonstrate that a coordinated multidisciplinary process improvement redesign can significantly improve efficiency in an academic Children's Hospital without preselecting specific services, removing surgical residents, or incorporating new personnel or technology. Prospective comparative study, Level II. Copyright © 2017 Elsevier Inc. All rights reserved.
Langham, Max R; Walter, Arianne; Boswell, Timothy C; Beck, Robert; Jones, Tamekia L
Informed consent for operative procedures performed on children relies on the ability of the surgeon to estimate and describe accurately the risks and benefits of the planned operation to the parents. Understanding patient-specific risks is also an important prerequisite for surgeons and hospital administrators who wish to change hospital processes and improve patient safety. This study tests the feasibility of estimating the risk of death within 30 days of surgery using National Surgical Quality Improvement Program (NSQIP)-Pediatric data from a single children's hospital. Patient data submitted to NSQIP-Pediatric from our hospital were analyzed to identify variables predictive of death within 30 days of operation. A multiple logistic regression model was constructed using 3 years of data and validated using data submitted the following year. The model was then tested using the participant use file provided by NSQIP-Pediatric for 2012. The model identified 7 variables predictive of death: neonatal status, respiratory support, inotropic support, having a blood disorder, cerebrovascular injury, previous cardiac intervention, and the work relative value unit for the procedure. The resulting final model had a c statistic = 0.97. It is possible for a participating children's hospital to use NSQIP-Pediatric data to develop risk models for patient mortality occurring within 30 days of operation at their institution. The model presented may be generalizable to other institutions, but needs further testing and refining. Copyright © 2015 Elsevier Inc. All rights reserved.
Faustino, E. Vincent S.; Raffini, Leslie J.
Venous thromboembolism, which includes deep venous thrombosis and pulmonary embolism, is a potentially preventable condition in children. In adults, pharmacologic prophylaxis has been shown to significantly reduce the incidence of venous thromboembolism in distinct patient cohorts. However, pediatric randomized controlled trials have failed to demonstrate the efficacy of pharmacologic prophylaxis against thrombosis associated with central venous catheters, the most important risk factor for venous thromboembolism in children. Despite the lack of supporting evidence, hospital-based initiatives are being undertaken to try to prevent venous thromboembolism in children. In this study, we sought to review the published guidelines on the prevention of venous thromboembolism in hospitalized children. We identified five guidelines, all of which were mainly targeted at adolescents and used various risk-stratification approaches. In low-risk children, ambulation was the recommended prevention strategy, while mechanical prophylaxis was recommended for children at moderate risk and pharmacologic and mechanical prophylaxis were recommended for the high-risk group. The effectiveness of these strategies has not been proven. In order to determine whether venous thromboembolism can be prevented in children, innovative clinical trial designs are needed. In the absence of these trials, guidelines can be a source of valuable information to inform our practice. PMID:28184368
Batra, Shweta; Ng, Elaine Yu Ching; Foo, Feng; Noori, Omar; McCaskill, Mary; Steinbeck, Katharine
To describe the characteristics, diagnoses and outcomes of older adolescents, aged 16-19 years, presenting to a paediatric ED. A retrospective review of total ED presentations by older adolescents to a tertiary paediatric hospital between 2010 and 2012, inclusive, was undertaken to determine if behavioural or mental health problems were common. A total of 1184 ED presentations by 730 older adolescents were identified. Injury and abdominal pain were the most common complaints for presentations by older adolescents to the ED. The median length of stay in ED was 241 (range: 0-3873) min. More than 60% of the older adolescent ED presentations were triaged urgent or semi-urgent, and 39% of all these presentations resulted in hospital admission. Two-thirds of these older adolescents had a chronic illness, which accounted for 77% of all ED presentations by older adolescents. The history of chronic illness was considered related or relevant in the evaluation and management of over 80% of older adolescents. Of all the ED presentations by older adolescents with chronic illness, only one quarter had transition planning documentation. A high prevalence of chronic illness was found in older adolescents attending the paediatric ED. There was no evidence that behavioural and mental health issues dominated. These findings reflect admission policy. © 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.
Mikhael, Michel; Cleary, John P; Dhar, Vijay; Chen, Yanjun; Nguyen, Danh V; Chang, Anthony C
Objective The aim of this article is to examine characteristics of birth tourism (BT) neonates admitted to a neonatal intensive care unit (NICU). Methods This was a retrospective review over 3 years; BT cases were identified, and relevant perinatal, medical, social, and financial data were collected and compared with 100 randomly selected non-birth tourism neonates. Results A total of 46 BT neonates were identified. They were more likely to be born to older women (34 vs. 29 years; p < 0.001), via cesarean delivery (72 vs. 48%; p = 0.007), and at a referral facility (80 vs. 32%; p < 0.001). BT group had longer hospital stay (15 vs. 7 days; p = 0.02), more surgical intervention (50 vs. 21%; p < 0.001), and higher hospital charges (median $287,501 vs. $103,105; p = 0.003). One-third of BT neonates were enrolled in public health insurance program and four BT neonates (10%) were placed for adoption. Conclusion Families of BT neonates admitted to the NICU face significant challenges. Larger studies are needed to better define impacts on families, health care system, and society.
Bentholm, Anette Lisbeth
A case study: Inclusion for children with psychiatric diagnosis in physical education (PE) at primary school.Research bagground and aim:A large majority in the Danish parliament decided in 2012 that more children with special needs for example children with psychiatric diagnosis as autism spectrum...... disorder, ASD and attention deficit hyperactivity disorder, ADHD, are going to be included in primary school instead of going to special schools before the end of 2015 (LOV nr. 379, 2012). In August 2014 started a new Schoolreform in Denmark where the children fx are going to participate in physical......; Verret, 2010). Therefore these children are challenged to participate in physical activity and team-based interventions at school compared to children who does not have these difficulties. In the literature there is only little attention about this problem from a qualitative and sociological perspective...
Sazonov Kocevar, V; Thomas, J; Jonsson, L
of concomitant allergic rhinitis on asthma-related hospital resource utilization among children below 15 years of age with asthma in Norway. METHODS: A population-based retrospective cohort study of children (aged 0-14 years) with asthma was conducted using data from a patient-specific public national database......BACKGROUND: Preliminary evidence suggests that inadequately controlled allergic rhinitis in asthmatic patients can contribute towards increased asthma exacerbations and poorer symptom control, which may increase medical resource use. The objective of this study was therefore to assess the effect...... of hospital admissions during a 2-year period, 1998-1999. Multivariate linear regression, adjusting for risk factors including age, gender, year of admission, urban/rural residence and severity of asthma episode, estimated the association between allergic rhinitis and total hospital days. A multivariate Cox...
Full Text Available In this study we try to clear the prevalance of age and sex and clinical and radiographic"nmanifestations of primary hyperparathyroidism. In this duration 47 patients with primary"nhyperparathyroidism that bed in two important hospitals in Tehran were studied."nThe ratio between women to men was 7 to 1 and most prevalance of disease were in fouyth decade. The pain boon was the cheif complain of patients and osteopenia was the most radiographic findings."nIn addition a case of primary hyperparathyroidism with mandibular and other bone involvement was reported.
Harlan, Gregory A; Nkoy, Flory L; Srivastava, Rajendu; Lattin, Gena; Wolfe, Doug; Mundorff, Michael B; Colling, Dayvalena; Valdez, Angelika; Lange, Shay; Atkinson, Sterling D; Cook, Lawrence J; Maloney, Christopher G
Delays, omissions, and inaccuracy of discharge information are common at hospital discharge and put patients at risk for adverse outcomes. We assembled an interdisciplinary team of stakeholders to evaluate our current discharge process between hospitalists and primary care providers (PCPs). We used a fishbone diagram to identify potential causes of suboptimal discharge communication to PCPs. Opportunities for improvement (leverage points) to achieve optimal transfer of discharge information were identified using tally sheets and Pareto charts. Quality improvement strategies consisted of training and implementation of a new discharge process including: (1) enhanced PCP identification at discharge, (2) use of an electronic discharge order and instruction system, and (3) autofaxing discharge information to PCPs. The new discharge process's impact was evaluated on 2,530 hospitalist patient discharges over a 34-week period by measuring: (1) successful transfer of discharge information (proportion of discharge information sheets successfully faxed to PCPs), (2) timeliness (proportion of sheets faxed within 2 days of discharge), and (3) content (presence of key clinical elements in discharge sheets). Postintervention, success, and timeliness of discharge information transfer between pediatric hospitalists and PCPs significantly improved while content remained high.
Carrillo, I; Ferrús, L; Silvestre, C; Pérez-Pérez, P; Torijano, M L; Iglesias-Alonso, F; Astier, P; Olivera, G; Maderuelo-Fernández, J A
To identify the Spanish studies conducted since 2014 on second victims. Its main objective was to identify a global response to the second victim problem, assessing the impact of adverse events (AE) on caregivers and developing of a set of tools to reduce their impact. Descriptive studies in which a sample of managers and safety coordinators from Hospitals and Primary Care were surveyed to determine the activities being carried out as regards second victims, as well as a sample of health professionals to describe their experience as a second victims. Qualitative studies are included to design a guide of recommended actions following an AE, an online awareness program on this phenomenon, an application (app) with activities on safety that are the responsibility of the managers, and a web tool for the analysis of AEs. A total of 1,493 professionals (managers, safety coordinators and caregivers) from eight Spanish regions participated. The guide of recommendations, the online program, and the developed applications are accessible on the website: www.segundasvictimas.es, which has received more than 2,500 visits in one year. Study results represent a starting point in the study of the second victim phenomenon in Spain. The tools developed raise the awareness of the medical healthcare community about this problem, and provide professionals with basic skills to manage the impact of AEs. Copyright © 2016 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.
Full Text Available Mohamed Khalil,1 Esam Azhar,2,3 Moujahed Kao,3 Noura Al-Kaiedi,3 Hatim Alhani,4 Ibrahim Al Olayan,5 Robert Pawinski,6,7 Kusuma Gopala,8 Walid Kandeil,7 Sameh Anis,7,9 Leen Jan Van Doorn,10 Rodrigo DeAntonio7 1Public Health and Research Development, Ministry of Health, Riyadh, Saudi Arabia; 2Medical Laboratory Technology Department, Faculty of Applied Medical Sciences, 3Special Infectious Agents Unit, Bio-Safety Level 3, King Fahad Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia; 4Maternity and Children’s Hospital, Dammam, Saudi Arabia; 5Maternity and Children’s Hospital, Qassim, Saudi Arabia; 6Reckitt Benckiser Pharmaceuticals, Slough, UK; 7GlaxoSmithKline Vaccines, Wavre, Belgium; 8GlaxoSmithKline Pharmaceuticals Ltd, Bangalore, Karnataka, India; 9AbbVie Biopharmaceuticals GmbH, Dubai, United Arab Emirates; 10DDL Diagnostic Laboratory, Rijswijk, the Netherlands Purpose: Rotavirus (RV is a leading cause of severe gastroenteritis (GE in children across the world. As there is a lack of epidemiological data for RV gastroenteritis (RVGE in Saudi Arabia, this hospital-based study was designed to estimate the disease burden of RVGE and assess the prevalent RV types in Saudi children younger than 5 years of age.Patients and methods: Children hospitalized for acute GE were enrolled at four pediatric referral hospitals in Saudi Arabia. The study was conducted from February 2007 to March 2008 and used the World Health Organization's generic protocol for RVGE surveillance. The Vesikari severity scale was used to assess the severity of RVGE. Stool samples were tested for RV using an enzyme-linked immunosorbent assay. Samples were further typed by reverse transcriptase–polymerase chain reaction and hybridization assay for determining the G and P types.Results: A total of 1,007 children were enrolled; the final analysis included 970 children, of whom 395 were RV positive, 568 were RV negative, and seven had unknown RV status
Kim, Sora; Yi, Soon-Hyung
This study discusses privacy risk factors when commercial web sites target primary school children in Korea. Specifically, the authors examined types of personal information required for membership subscriptions and whether privacy policies at commercial sites for children abide by privacy guidelines. A total of 159 commercial sites targeting…
Harambat, J.; Stralen, K.J. van; Espinosa, L.; Groothoff, J.W.; Hulton, S.A.; Cerkauskiene, R.; Schaefer, F.; Verrina, E.; Jager, K.J.; Cochat, P.; Hoitsma, A.J.; Hemke, A.C.
BACKGROUND AND OBJECTIVES: Primary hyperoxaluria (PH) as a cause of ESRD in children is believed to have poor outcomes. Data on management and outcomes of these children remain scarce. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This study included patients aged <19 years who started renal rep
What can listening to children's ideas about poetry teach us? This article considers ways in which exploring primary-aged students' perceptions of poetry can inform teachers' work with children. Using strategies from earlier studies in secondary schools, a small-scale project with Year 6 students revealed their complex and sometimes contradictory…
Bannink, Femke; Fontaine, Johnny R. J.; Idro, Richard; van Hove, Geert
This study investigates cognitive abilities of pre/primary school children without and with spina bifida in Uganda. Qualitative semi structured interviews and quantitative functioning scales measurements were combined and conducted with 133 parents, 133 children with spina bifida, and 35 siblings. ANCOVA was used to test for differences in…
Scheuer, Nora; de la Cruz, Montserrat; Pozo, Juan Ignacio; Echenique, Monica; Marquez, Maria Silvina
This paper studies the process of learning to write from an insider perspective, by adopting the framework of implicit theories of learning. We interviewed 160 children attending kindergarten or primary education in public schools in Argentina (20 children from each of the eight grades from kindergarten to seventh grade). Main questions explored…
Schokker, Siebrig; Groenhof, Feikje; van der Veen, Willem Jan; van der Molen, Thys
Objective: To evaluate prescriptions of asthma medication for children in primary care. Methods: Data on prescriptions of asthma medication for children aged 0-9 years were collected from a general practice-based network in the north eastern part of the Netherlands. Prevalence, incidence,
McMaster, Emily; Roberts, Tara
Historically, handwriting is a skill acquired by children in the classroom. The relevance of this skill today is currently debated due to advances in technology. A nonexperimental time-series design investigated how much time Australian primary school children spend on handwriting in the classroom. A second aim investigated how much time was spent…
Children with mild developmental disorders sometimes show giftedness. In this study, an original checklist was developed to identify gifted characteristics specific to science learning among twice-exceptional primary school children in Japan. The checklist consisted of 60 items on Attitudes, Thinking, Skills, and Knowledge/Understanding. A total…