Sample records for primary childrens hospital

  1. Primary care contact before and after emergency hospitalisation in children in English NHS hospitals: a linked administrative data study

    Directory of Open Access Journals (Sweden)

    Linda Wijlaars


    The majority of children consulted a GP both before and after an ACSC emergency admission. This suggest that the degree to which primary care can prevent ACSCs conditions in children might be less than previously thought. Further research is needed to determine which community or hospital based interventions, if any, can reduce ACSC emergency admissions.

  2. Allogeneic hematopoietic stem cell transplantation in children with primary immunodeficiencies: Hospital Israelita Albert Einstein experience. (United States)

    Fernandes, Juliana Folloni; Kerbauy, Fabio Rodrigues; Ribeiro, Andreza Alice Feitosa; Kutner, Jose Mauro; Camargo, Luis Fernando Aranha; Stape, Adalberto; Troster, Eduardo Juan; Zamperlini-Netto, Gabriele; Azambuja, Alessandra Milani Prandini de; Carvalho, Bruna; Dorna, Mayra de Barros; Vilela, Marluce Dos Santos; Jacob, Cristina Miuki Abe; Costa-Carvalho, Beatriz Tavares; Cunha, Jose Marcos; Carneiro-Sampaio, Magda Maria; Hamerschlak, Nelson


    To report the experience of a tertiary care hospital with allogeneic hematopoietic stem cell transplantation in children with primary immunodeficiencies. Seven pediatric patients with primary immunodeficiencies (severe combined immunodeficiency: n = 2; combined immunodeficiency: n = 1; chronic granulomatous disease: n = 1; hyper-IgM syndrome: n = 2; and IPEX syndrome: n = 1) who underwent eight hematopoietic stem cell transplants in a single center, from 2007 to 2010, were studied. Two patients received transplants from HLA-identical siblings; the other six transplants were done with unrelated donors (bone marrow: n = 1; cord blood: n = 5). All patients had pre-existing infections before hematopoietic stem cell transplants. One patient received only anti-thymocyte globulin prior to transplant, three transplants were done with reduced intensity conditioning regimens and four transplants were done after myeloablative therapy. Two patients were not evaluated for engraftment due to early death. Three patients engrafted, two had primary graft failure and one received a second transplant with posterior engraftment. Two patients died of regimen related toxicity (hepatic sinusoidal obstruction syndrome); one patient died of progressive respiratory failure due to Parainfluenza infection present prior to transplant. Four patients are alive and well from 60 days to 14 months after transplant. Patients' status prior to transplant is the most important risk factor on the outcome of hematopoietic stem cell transplants in the treatment of these diseases. Early diagnosis and the possibility of a faster referral of these patients for treatment in reference centers may substantially improve their survival and quality of life.

  3. Allogeneic hematopoietic stem cell transplantation in children with primary immunodeficiencies: Hospital Israelita Albert Einstein experience

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    Juliana Folloni Fernandes


    Full Text Available Objective: To report the experience of a tertiary care hospital withallogeneic hematopoietic stem cell transplantation in children withprimary immunodeficiencies. Methods: Seven patients with primaryimmunodeficiencies (severe combined immunodeficiency: n = 2;combined immunodeficiency: n = 1; chronic granulomatous disease:n = 1; hyper-IgM syndrome: n = 2; and IPEX syndrome: n = 1who underwent eight hematopoietic stem cell transplants (HSCTin a single center, from 2007 to 2010, were studied. Results: Twopatients received transplants from HLA-identical siblings; the othersix transplants were done with unrelated donors (bone marrow: n= 1; cord blood: n = 5. All patients had pre-existing infectionsbefore hematopoietic stem cell transplants. One patient receivedonly anti-thymocyte globulin prior to transplant, three transplantswere done with reduced intensity conditioning regimens and fourtransplants were done after myeloablative therapy. Two patientswere not evaluable for engraftment due to early death. Three patientsengrafted, two had primary graft failure and one received a secondtransplant with posterior engraftment. Two patients died of regimenrelated toxicity (hepatic sinusoidal obstruction syndrome; one patient died of progressive respiratory failure due to Parainfluenza infection diagnosed prior to transplant. Four patients are alive and well from 60 days to 14 months after transplant. Conclusion: Patients’ status prior to transplant is the most important risk factor on the outcome of hematopoietic stem cell transplants in the treatment of these diseases. Early diagnosis and the possibility of a faster referral of these patients for treatment in reference centers may substantially improve their survival and quality of life.

  4. The clinical pattern of primary hyperoxaluria in pediatric patient at Queen Rania Abdulla Children Hospital. (United States)

    Almardini, Reham I; Alfarah, Mahdi G; Salaita, Ghazi M


    Hyperoxaluria is a metabolic disorder that can lead to end stage renal disease (ESRD). It can be either inherited or acquired. Primary hyperoxaluria (PHO) is more common and characterized by an excessive production of oxalate leading to recurrent urolithiasis and progressive nephrocalcinosis. Due to the high rate of consanguineous marriage in Jordan this disease is commonly diagnosed in pediatric nephrology clinics. We aimed to demonstrate the clinical pattern and progression to ESRD in pediatric patients with hyperoxaluria at Queen Rania Abdulla Children Hospital. Medical records of all patients followed up in the pediatric nephrology clinic with the diagnosis of PHO during the period between September 2007 and March 2013 were reviewed. There were 70 patients with the diagnosis of PHO, 52.9% were males. The median age at presentation was 3 years ± 3 months with the youngest child being two months old. Diagnosis was made in the first year of life in 15.7% of patients. The most common presenting symptom was hematuria, while 14% of patients were asymptomatic and detected by family screening after the diagnosis of an index case. At the time of initial presentation, 15.7% of patients had ESRD and 25% had impaired renal function. Kidney stones were found in 57% of cases and nephrocalcinosis was found in 37%. High index of suspicion is needed to diagnose PHO in children presenting with kidney stone or unexplained hematuria. Twenty-four hour urine collection for oxalate are required to make the proper diagnosis. Family screening, when appropriate, is indicated for early detection of PHO.

  5. Primary antibody deficiencies at Queen Rania Children Hospital in Jordan: single center experience. (United States)

    Habahbeh, Zeyad M; Abu-Shukair, Mohammad E; Almutereen, Mohammad A; Alzyoud, Raed M; Wahadneh, Adel M


    Primary antibody deficiency, the most common primary immunodeficiency disorder, represents a heterogeneous spectrum of conditions caused by a defect in any critical stage of B cell development and is characterized by impaired production of normal amounts of antigen-specific antibodies. This retrospective study aimed at description and analysis of demographic, clinical, immunological features and complications of subjects diagnosed with primary antibody deficiency at a referral center in Jordan. The medical records of pediatric patients who were diagnosed as primary antibody deficiency (PAD) during the period from January 2006 to June 2013 were reviewed. Patients were diagnosed as PADs based on the Pan-American Group for Immunodeficiency (PAGID) and the European Society for Immunodeficiency (ESID) diagnostic criteria. A total number of 53 patients with PAD were identified; 37(70%) males and 16(30%) females, 16(30%) patients with congenital agammaglobulinemia, 16(30%) patients with common variable immunodeficiency, 4(7.5%) patients with IgG subclass deficiency, 10(19%) cases with transient hypogammaglobulinemia of infancy and 7(13.5%) patients as undefined PAD. The most common infection among patients was pneumonia (62%); followed by suppurative otitis media in 49% of patients. Cytopenia was the most noted autoimmune association and was found at prevalence of 22 %, other autoimmune associations (17%) including inflammatory arthritis, discoid lupus, inflammatory bowel disease, vasculitis and celiac disease. The prevalence of long-term complications was 58%, the most frequent ones were; stunted growth in 13%, bronchiectasis and lymphoproliferation in 11% for each. Our results indicated that congenital agammaglobulinemia and common variable immunodeficiency are the most frequent primary antibody deficiency in our patients. The awareness of families, general population as well as primary health physicians is crucial in the establishment of early diagnosis and prompt

  6. Clinical outcomes of primary palatoplasty in pre-school-aged cleft palate children in Srinagarind hospital: quality of life. (United States)

    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

  7. Primary headaches in children

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    Ajay Kumar Pan


    Full Text Available Headache is a widespread clinical problem; the prevalence is high in all age groups, from which children and teenagers are not spared. It has been reported that, as many as 75% of school-age children may experience headache infrequently, among them 10% have recurrent headaches. [1],[2] The vast majority of headaches are primary and classified as migraine, tension-type headache (TTH, cluster headache, and other trigeminal autonomic cephalgias. The type of primary headaches could usually be diagnosed by a thorough and careful history taking, and physical examination. Once the diagnosis of migraine is established and appropriate reassurance provided, a balanced and individually tailored treatment plan can be instituted. The goal of treatment includes abortive or acute pain treatment, preventive long-term treatment, and biobehavioral therapy. Knowledge of precise impact of primary headaches on child′s quality of life helps to design a proper comprehensive treatment plan.

  8. Children Hospitalized With Varicella in Denmark

    DEFF Research Database (Denmark)

    Glode Helmuth, Ida; Broccia, Marcella Ditte; Glenthøj, Jonathan Peter


    is not part of the national immunization program and there is no national surveillance of varicella. The primary aim of the study was to describe the epidemiology and clinical characteristics of children hospitalized with varicella in Denmark. The secondary aim was to validate the sensitivity and completeness...... of the Danish National Patient Register. METHODS: Active surveillance of children hospitalized with varicella was carried out at 4 pediatric departments. In the Danish National Patient Register, we identified all children discharged with an International Classification of Diseases, 10th revision code...... of varicella from the 4 departments. We used a capture-recapture analysis to estimate the "true" number of hospitalized children with varicella. RESULTS: By active surveillance, we identified 86 children eligible for clinical description. In 87% of cases, the children were 0-4 years of age. Complications were...

  9. Pain prevalence in hospitalized children

    DEFF Research Database (Denmark)

    Walther-Larsen, S; Pedersen, M T; Friis, S M


    admitted the same day. The single most common painful procedure named by the children was needle procedures, such as blood draw and intravenous cannulation. CONCLUSION: This study reveals high pain prevalence in children across all age groups admitted to four Danish university hospitals. The majority......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...... 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...

  10. Children's psychological responses to hospitalization. (United States)

    Vessey, Judith A


    The data-based literature addressing children's psychological responses to hospitalization was reviewed using methods outlined by Cooper (1989). Using a developmental science perspective, early research was reviewed and a model of variables that contribute to children's responses was constructed. This model consists of three major foci, including maturational and cognitive variables (developmental level, experience, coping style), ecological variables (family and hospital milieu), and biological variables (inborn factors and pathophysiology). Coping serves as the overarching framework for examining these variables and their contributions to children's responses to hospitalization. A variety of theoretical perspectives from the social sciences have been used, with psychoanalytic and stress and adaptation theories predominating. The majority of the research used simple case study, descriptive, or pre- and post-test designs. Methodologic issues were common. Little qualitative work has been done. Future research directions call for studies to adopt new theoretical and empirical models that are methodologically rigorous and clinically relevant and that embrace the precepts of developmental science.

  11. Rota virus Diarrhea in Hospitalized Children

    International Nuclear Information System (INIS)

    Habib, M. I.; Khan, K. M. A.; Zia, N.; Kazi, S. G.


    Objective: To determine the frequency and clinical features of Rota virus diarrhea in children presenting in a tertiary care hospital. Study Design: A cross-sectional, observational study. Place and Duration of Study: National Institute of Child Health, Karachi, from January to June 2007. Methodology: A total of three hundred children of either gender aged 1 month to 5 years, who presented with diarrhea of < 7 days as a primary illness were enrolled. Children with bloody diarrhea or nosocomial gastroenteritis acquired during hospitalization for other disease were not included. Detection of Rota virus in stool was done by enzyme linked immunoassay. Results: Out of 300 children, 188 (63%) tested positive and 112 (37%) tested negative for Rota virus. Positive Rota virus cases in 7 - 12 months of age was (n = 34, 18.08%). Overall, 151 (80.3%) children with Rota virus were less than 3 years old. 182 (60.7%) had fever, 118 (39.3%) had vomiting and 156 (82.9%) children had both fever and vomiting. Conclusion: This study shows that Rota virus is a common organism causing diarrhea in children less than 3 years of age. There is a need to incorporate Rota virus vaccine in the national EPI program to decrease the disease burden as highlighted in this study. (author)

  12. Primary vertebral tumours in children

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    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.

  13. Pattern of Primary Nocturnal Enuresis in Primary School Children ...

    African Journals Online (AJOL)

    Pattern of Primary Nocturnal Enuresis in Primary School Children (First Grade) in ... The control group consisting of 100 age-matched non-enuretic children ... was insignificantly associated with a positive family history, family size or birth rank.

  14. Toddler Developmental Delays After Extensive Hospitalization: Primary Care Practitioner Guidelines. (United States)

    Lehner, Dana C; Sadler, Lois S


    This review investigated developmental delays toddlers may encounter after a lengthy pediatric hospitalization (30 days or greater). Physical, motor, cognitive, and psychosocial development of children aged 1 to 3 years was reviewed to raise awareness of factors associated with developmental delay after extensive hospitalization. Findings from the literature suggest that neonatal and pediatric intensive care unit (NICU/PICU) graduates are most at risk for developmental delays, but even non-critical hospital stays interrupt development to some extent. Primary care practitioners (PCPs) may be able to minimize risk for delays through the use of formal developmental screening tests and parent report surveys. References and resources are described for developmental assessment to help clinicians recognize delays and to educate families about optimal toddler development interventions. Pediatric PCPs play a leading role in coordinating health and developmental services for the young child following an extensive hospital stay.

  15. Long-term follow-up of patients treated with primary radiotherapy for supradiaphragmatic Hodgkin's disease at St. Jude Children's Research Hospital

    International Nuclear Information System (INIS)

    Shah, Amit B.; Hudson, Melissa M.; Poquette, Catherine A.; Luo Xiaolong; Wilimas, Judith A.; Kun, Larry E.


    Objective: To assess disease control, patterns of relapse, factors predictive of relapse, and late effects of treatment, we reviewed all cases of supradiaphragmatic (SD) Hodgkin's disease (HD) treated with primary radiation therapy (RT) at our institution. Methods: We retrospectively reviewed the disease characteristics, treatment history, and long-term outcome of the 106 patients with Stage I and II supradiaphragmatic HD who received definitive irradiation at St. Jude Children's Research Hospital between 1970 and 1995. As of the date of analysis, 95 patients are alive, with a median follow-up of 13.3 years (range, 1.9-24.2 years). Results: The median age at diagnosis was 14.7 years (range, 3.7-22.7). Involved-field RT was given to 13 patients (12%), whereas 37 (35%) had mantle RT, 51 patients (48%) had subtotal nodal irradiation, and 5 (5%) had total nodal irradiation. Relapsed disease developed in 26 patients at a median of 1.8 years (range, 0.2-9.3 years). The 5- and 10-year estimated cumulative incidences of relapse were 20.9% ± 4.0% and 25.1% ± 4.3%, respectively. With a median dose of 36 Gy (range, 32-40), in-field failure rate was 6.2%, whereas subdiaphragmatic relapse in sites irradiated prophylactically was 1.5%. There was a trend toward an increased incidence of relapse with higher ESR (p 0.088) and greater number of sites of disease (p = 0.087). Age, stage, histology, nodal disease ≥6 cm, the presence of bulky mediastinal disease, and the method of staging did not affect the incidence of relapse. The pattern of failure could not be predicted based on the stage of disease, the extent of subdiaphragmatic staging, the extent of radiation therapy, or the sequence of RT fields - 'ping pong' vs. sequential. Subset analysis of Stage II patients revealed significantly more relapses in clinically staged patients. Excluding Stage IA patients with high cervical disease or peripheral nodal disease, nodal extension failures were more common for patients

  16. Digestive system complications among hospitalized children with ...

    African Journals Online (AJOL)


    least common complication, occurring in one (3.3%) of the cases studied. Conclusion: Acute ... Keywords: Acute abdominal crisis, children, haemoglobin, hospitalization, multi-systemic ... improvement of the management of such children.

  17. Spirometry use in children hospitalized with asthma. (United States)

    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

  18. Primary hyperparathyroidism: King Khalid University Hospital experience

    International Nuclear Information System (INIS)

    Fouda, Mona A.


    This study was conducted to examine the prevalence, mode of presentationand management of primary hyperparathyroidism in one of the major hospitalsin Saudi Arabia. This was a retrospective analysis of 24 cases of primaryhyperparathyroidism comprising of 21 females and three males, who were seenat King Khalid University Hospital over a period of 16 years from 1982 untilDecember 1997. The prevalence of disease was estimated to be estimated to be11.34 per 100,000 hospital population. The majority of patients presentedwith musculoskeletal complaints (62%-67%) and/or renal complications were(58%). Hyperclacemia was seen in 92% of the cases. Serum PTH was availablefor 21 patients and 20 had significantly elevated levels. Fifty percent ofthe patients had features of hyperparathyroid bone disease on plane x-ray,while 79% showed osteopenia of the femoral neck and dual x-rayabsorptiometry, and almost all the patients had lumbar osteopenia. Fiftypercent of the patients had features of metabolic bone disease on bone scan.Thallium -technetium subtraction studies proved to be the most reliable tool,with 83% sensitivity of 55%. CT scan of the neck was attempted in only inseven patients (29%), with a sensitivity of 86%. Twenty-one patients (87.5%)underwent surgical exploration and removal of the parathyroid adenoma. Singleparathyroid adenoma was identified in 85% of the cases, 5% had multipleadenomas and 5% had hyperplasia of the parathyroid gland. Our results showedthat primary hyperparathyroidism is not rare disease in Saudi Arabia. It hastendency for late presentation with complications. We believe that routinescreening for calcium, and early identification of such cases, are warrantedto reduce the morbidity of this easily treatable disorder. (author)

  19. Hospitalization of abused and neglected children. (United States)

    Marshall, W N


    To describe the use of inpatient hospitalization for abused and neglected children living in a metropolitan area. Retrospective record review of abused and neglected children admitted in 1992 and 1993 to hospitals with 87% of metropolitan area pediatric admissions; comparison of these data with population, crisis nursery, and child protective services data. Thirty-four abused and neglected children were admitted to hospital, representing 0.3% (34/11,066; 95% confidence interval, 0%-1.2%) of pediatric admissions and 0.2% (34/19,950; 95% confidence interval, 0%-0.6%) of child protective services reports. This represents a rate of hospitalization for child abuse of 10 children (95% confidence interval, 0-46) per 100,000 child population per year. Seven hundred fifteen children were admitted to the crisis nursery by child protective services. Of those admitted to the hospital, 12 needed intensive care, 5 of whom died. Only 3 of 34 hospital-admitted children had private health insurance; 19 of 34 were younger than 1 year. Inpatient hospitalization for abuse represented a small fraction of total pediatric admissions and of child protective services reports. Comprehensive medical care for most abused children and medical education about child abuse must occur in outpatient settings.

  20. Primary care referral management: a marketing strategy for hospitals. (United States)

    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.

  1. Heart rates in hospitalized children by age and body temperature. (United States)

    Daymont, Carrie; Bonafide, Christopher P; Brady, Patrick W


    Heart rate (HR) is frequently used by clinicians in the hospital to assess a patient's severity of illness and make treatment decisions. We sought to develop percentiles that characterize the relationship of expected HR by age and body temperature in hospitalized children and to compare these percentiles with published references in both primary care and emergency department (ED) settings. Vital sign data were extracted from electronic health records of inpatients temperature measurement pairs from each admission. Measurements from 60% of patients were used to derive the percentile curves, with the remainder used for validation. We compared our upper percentiles with published references in primary care and ED settings. We used 60,863 observations to derive the percentiles. Overall, an increase in body temperature of 1°C was associated with an increase of ∼ 10 beats per minute in HR, although there were variations across age and temperature ranges. For infants and young children, our upper percentiles were lower than in primary care and ED settings. For school-age children, our upper percentiles were higher. We characterized expected HR by age and body temperature in hospitalized children. These percentiles differed from references in primary care and ED settings. Additional research is needed to evaluate the performance of these percentiles for the identification of children who would benefit from further evaluation or intervention for tachycardia. Copyright © 2015 by the American Academy of Pediatrics.

  2. The Kusamala Program for primary caregivers of children 6-59 months of age hospitalized with severe acute malnutrition in Malawi: study protocol for a cluster-randomized controlled trial

    NARCIS (Netherlands)

    Daniel, Allison I.; van den Heuvel, Meta; Voskuijl, Wieger P.; Gladstone, Melissa; Bwanali, Mike; Potani, Isabel; Bourdon, Celine; Njirammadzi, Jenala; Bandsma, Robert H. J.


    Background: Severe acute malnutrition (SAM) is associated with high mortality rates and impairments in growth and development in children that do survive. There are complex nutritional, health, and behavioural risk factors involving severely malnourished children and their primary caregivers,

  3. [Nutritional status and risk in hospitalized children]. (United States)

    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.

  4. Primary vesicoureteral reflux in Sudanese children

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    El-Tigani M. A. Ali


    Full Text Available Vesicoureteral reflux (VUR is a common congenital renal tract anomaly in children. Reports from Sudan are scanty. We report the characteristics, presentation and outcome of primary VUR in a tertiary care hospital. The records of 30 patients (16 males; 53% followed-up between January 2004 and December 2010 were reviewed. The mean age at the time of diagnosis was 4 ± 3.9 years and 47% were <2 years of age. Renal ultrasound scan (USS failed to predict VUR in 17% of the patients. On voiding cysturethrogram (VCUG, VUR was bilateral in 57% and severe grade in 64%. Grades were not significantly associated with age, gender or site of VUR. Initial dimercaptosuccinic acid radionuclide scan showed renal damage in 61.5% of the patients. Renal damage was significantly associated with female gender and severe VUR, but not with age of onset or history of urinary tract infection (UTI. Thirteen patients (43.3% presented with acute UTI, eight (26.6% with non-specific urinary tract symptoms and nine (30% with persistently elevated serum creatinine. Urine cultures were positive in 73% of patients, and E. coli was the most common pathogen. Renal impairment at presentation was significantly associated with bilateral severe VUR and history of UTI but not age or gender. After a mean follow-up period of 1.78 years (6 months to 5 years, 70% of patients remained with normal renal function and 30% progressed to chronic kidney disease; two of them died. In conclusion, our data is different from many studies. Features of primary VUR in Sudanese children are late age of onset, equal gender affection and predominance of severe grade. Presentation is associated with a high rate of UTI, renal damage and advanced renal impairment. Measures to improve early detection and treatment of VUR may reduce the risk of kidney damage.

  5. Primary school children\\'s perspectives on common diseases and ...

    African Journals Online (AJOL)

    Background: Existing school health programmes in Uganda target children above five years for de-worming, oral hygiene and frequent vaccination of girls of reproductive age. Objective:To assess primary school children\\'s perspectives on common diseases they experience and medicines used in order to suggest reforms ...

  6. Hospital Management of Severe Hypertriglyceridemia in Children. (United States)

    Valaiyapathi, Badhma; Ashraf, Ambika P


    Severe Hypertriglyceridemia (HTG), i.e., plasma triglyceride levels exceeding 1000 mg/dL, is one of the established causes of acute pancreatitis and severe abdominal pain. There are no established pediatric guidelines regarding treatment of children and adolescents with severe HTG. To review the pathophysiology and etiology of severe HTG in the pediatric age group, and to discuss management options. Severe HTG is usually due to deficient or absent Lipoprotein Lipase (LPL) activity, which can be due to primary genetic etiology or secondary causes triggering HTG in those with underlying genetic susceptibility. Hospitalization is indicated for patients with severe HTG who are symptomatic with abdominal pain or pancreatitis, in those with uncontrolled diabetes requiring insulin, or, in those with substantial elevations of plasma TG. Fasting followed by fat free diet until plasma TG declines to severe pancreatitis, shock or multi-organ failure. Medications such as fibrates and omega-3 fatty acids are not effective if LPL activity is absent or when plasma TG is >1800 mg/dL. Medications only have an adjunct role in the management. Low fat diet, lifestyle changes, weight loss, control of secondary causes, and patient education form the mainstay of management once the patient is discharged. Copyright© Bentham Science Publishers; For any queries, please email at

  7. AKI in Children Hospitalized with Nephrotic Syndrome. (United States)

    Rheault, Michelle N; Zhang, Lei; Selewski, David T; Kallash, Mahmoud; Tran, Cheryl L; Seamon, Meredith; Katsoufis, Chryso; Ashoor, Isa; Hernandez, Joel; Supe-Markovina, Katarina; D'Alessandri-Silva, Cynthia; DeJesus-Gonzalez, Nilka; Vasylyeva, Tetyana L; Formeck, Cassandra; Woll, Christopher; Gbadegesin, Rasheed; Geier, Pavel; Devarajan, Prasad; Carpenter, Shannon L; Kerlin, Bryce A; Smoyer, William E


    Children with nephrotic syndrome can develop life-threatening complications, including infection and thrombosis. While AKI is associated with adverse outcomes in hospitalized children, little is known about the epidemiology of AKI in children with nephrotic syndrome. The main objectives of this study were to determine the incidence, epidemiology, and hospital outcomes associated with AKI in a modern cohort of children hospitalized with nephrotic syndrome. Records of children with nephrotic syndrome admitted to 17 pediatric nephrology centers across North America from 2010 to 2012 were reviewed. AKI was classified using the pediatric RIFLE definition. AKI occurred in 58.6% of 336 children and 50.9% of 615 hospitalizations (27.3% in stage R, 17.2% in stage I, and 6.3% in stage F). After adjustment for race, sex, age at admission, and clinical diagnosis, infection (odds ratio, 2.24; 95% confidence interval, 1.37 to 3.65; P=0.001), nephrotoxic medication exposure (odds ratio, 1.35; 95% confidence interval, 1.11 to 1.64; P=0.002), days of nephrotoxic medication exposure (odds ratio, 1.10; 95% confidence interval, 1.05 to 1.15; Pchildren with nephrotic syndrome. Nephrotoxic medication exposure was common in this population, and each additional nephrotoxic medication received during a hospitalization was associated with 38% higher risk of AKI. AKI was associated with longer hospital stay after adjustment for race, sex, age at admission, clinical diagnosis, and infection (difference, 0.45 [log]days; 95% confidence interval, 0.36 to 0.53 [log]days; Pchildren hospitalized with nephrotic syndrome and should be deemed the third major complication of nephrotic syndrome in children in addition to infection and venous thromboembolism. Risk factors for AKI include steroid-resistant nephrotic syndrome, infection, and nephrotoxic medication exposure. Children with AKI have longer hospital lengths of stay and increased need for intensive care unit admission. Copyright © 2015 by the

  8. Casemix reimbursement: a Singapore Children's Hospital perspective. (United States)

    Yoong, S L


    Casemix reimbursement was introduced to Singapore in October 1999 using the Australian National Diagnosis Related Groups Version 3.1 (AN-DRGs 3.1). The possible impact of this classification system on a Singapore Children's Hospital is discussed. Data on paediatric patients in KK Women's and Children's Hospital (KKH) were drawn from the inhouse Datamart warehouse system, and reviewed with regards to volume of patients, length of stay and charges. Several high cost categories were selected for a more in-depth review and discussed. The classification system and reimbursement method did not take into account the higher cost of treating children, thus penalising the Children's Hospital. The wide variety of cases treated also gave rise to difficulty in obtaining appropriate reimbursement. The lack of severity of illness measures was a drawback in the Diagnosis Related Group (DRG) for ventilated patients. The lack of outcome measures gave rise to potentially inequitable reimbursement in some high cost neonatal DRGs. While Casemix is an improvement over previous methods of providing Government funding in Singapore, particular aspects need to be reviewed, and reimbursement criteria refined to ensure equitable funding to Children's Hospital.

  9. Nature and pattern of primary teeth extractions in a tertiary care hospital setting in South India

    Directory of Open Access Journals (Sweden)

    Shini Susan Samuel


    Full Text Available Background: Many studies have been carried out on the prevalence of dental diseases in children although not much information is available regarding its outcome among Indian children. Aim: The aim of the present study was to analyze the type of primary tooth extracted and the reasons for the extraction among children attending a tertiary care hospital in the Southern part of India. Materials and Methods: The dental records of pediatric patients who had visited the dental clinic of a tertiary care hospital located in Tamil Nadu, South India from December 2013 to November 2016 were reviewed. Patients who underwent extraction of at least one primary tooth under local or general anesthesia were included in the study. Results: A total of 943 primary teeth were extracted from 447 patients over 3 years. The most commonly extracted tooth type was the first primary molar followed by the primary central incisor. Grouping by age, the most frequently extracted tooth type between 2 and 5 years was the primary central incisor, the first primary molar among the 6–9-year-old and the second primary molar among 10–15-year-old. The majority of primary teeth extractions were performed in the age group of 6–9 years. No significant gender differences were noted. The most common reason for extraction of primary teeth in children was dental caries. Conclusions: This study demonstrates a high prevalence of untimely primary teeth extractions in young children and dental caries continues to be the leading cause. It clearly reflects on the lack of infant oral health care, the inadequacy of awareness and underutilization of oral health services among children in India.

  10. Dietary Habits of Greek Primary School Children (United States)

    Piperakis, S. M.; Papadimitriou, V.; Zafiropoulou, M.; Piperakis, A. S.; Zisis, P.


    The purpose of this study was to assess Greek primary (1st to 6th grade) school children's dietary habits and the factors influencing them. Our results show that children know the value of different foods. The socio-economic status of father has no effect on the attitude of children towards choosing their diet, however, mothers' educational status appears to have an effect on their children's behaviour. Place of residence (urban or semi-rural areas) and gender does not influence their knowledge about different diets. It was, finally, shown that as children grow older they tend to eat less healthy foods.

  11. BCGitis and BCGosis in children with primary immunodeficiency - imaging characteristics

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    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.)

  12. Predicting hospitalization in children with acute asthma. (United States)

    Buyuktiryaki, A Betul; Civelek, Ersoy; Can, Demet; Orhan, Fazıl; Aydogan, Metin; Reisli, Ismail; Keskin, Ozlem; Akcay, Ahmet; Yazicioglu, Mehtap; Cokugras, Haluk; Yuksel, Hasan; Zeyrek, Dost; Kocak, A Kadir; Sekerel, Bulent E


    Acute asthma is one of the most common medical emergencies in children. Appropriate assessment/treatment and early identification of factors that predict hospitalization are critical for the effective utilization of emergency services. To identify risk factors that predict hospitalization and to compare the concordance of the Modified Pulmonary Index Score (MPIS) with the Global Initiative for Asthma (GINA) guideline criteria in terms of attack severity. The study population was composed of children aged 5-18 years who presented to the Emergency Departments (ED) of the tertiary reference centers of the country within a period of 3 months. Patients were evaluated at the initial presentation and the 1(st) and 4(th) hours. Of the 304 patients (median age: 8.0 years [interquartile range: 6.5-9.7]), 51.3% and 19.4% required oral corticosteroids (OCS) and hospitalization, respectively. Attack severity and MPIS were found as predicting factors for hospitalization, but none of the demographic characteristics collected predicted OCS use or hospitalization. Hospitalization status at the 1(st) hour with moderate/severe attack severity showed a sensitivity of 44.1%, specificity of 82.9%, positive predictive value of 38.2%, and negative predictive value of 86.0%; for MPIS ≥ 5, these values were 42.4%, 85.3%, 41.0%, and 86.0%, respectively. Concordance in prediction of hospitalization between the MPIS and the GINA guideline was found to be moderate at the 1(st) hour (κ = 0.577). Attack severity is a predictive factor for hospitalization in children with acute asthma. Determining attack severity with MPIS and a cut-off value ≥ 5 at the 1(st) hour may help physicians in EDs. Having fewer variables and the ability to calculate a numeric value with MPIS makes it an easy and useful tool in clinical practice. Copyright © 2013 Elsevier Inc. All rights reserved.

  13. Primary prevention in psychiatry in general hospitals in South Asia (United States)

    Sood, Mamta; Chadda, Rakesh Kumar; Kallivayalil, Roy Abraham


    The focus of primary prevention is on reducing the disease incidence. Primary prevention in mental health has been given minimal priority in low-resource settings with no significant investments. General hospitals are one of the main providers of mental health services in South Asia. This paper focuses on primary prevention activities, which can be undertaken in a general hospital in South Asia with abysmally low-mental health resources. For implementing primary prevention in psychiatry, a general hospital may be conceptualized as a population unit, located in a well-populated area with easy accessibility where different kinds of communities, for example, students and resident doctors, consultants, patients and their caregivers, and paramedical, nursing, administrative and other supportive staff, coexist and have varied functions. All the functional components of the general hospital psychiatric units (GHPUs) offer scope for introducing primary preventive psychiatry services. Psychiatrists in GHPUs can lead efforts for primary prevention in mental health in the hospital by employing strategies in the framework of universal, selective, and indicated prevention. The preventive strategies could be targeted at the patients visiting the hospital for various health services and their caregivers, employees, and the trainees. Similar principles can be employed in teaching and training. PMID:29497199

  14. [Communication between the primary care physician, hospital staff and the patient during hospitalization]. (United States)

    Menahem, Sasson; Roitgarz, Ina; Shvartzman, Pesach


    HospitaL admission is a crisis for the patient and his family and can interfere with the continuity of care. It may lead to mistakes due to communication problems between the primary care physician and the hospital medical staff. To explore the communication between the primary care physician, the hospital medical staff, the patient and his family during hospitalization. A total of 269 questionnaires were sent to all Clalit Health Services-South District, primary care physicians; 119 of these questionnaires (44.2%) were completed. Half of the primary care physicians thought that they should, always or almost always, have contact with the admitting ward in cases of internal medicine, oncology, surgery or pediatric admissions. However, the actual contact rate, according to their report, was only in a third of the cases. A telephone contact was more common than an actual visit of the patient in the ward. Computer communication between the hospital physicians and the primary care physicians is still insufficiently developed, although 96.6% of the primary care physicians check, with the aid of computer software, for information on their hospitalized patients. The main reasons to visit the hospitalized patient were severe medical conditions or uncertainty about the diagnosis; 79% of the physicians thought that visiting their patients strengthened the level of trust between them and their patients. There are sometimes communication difficulties and barriers between the primary care physicians and the ward's physicians due to partial information delivery and rejection from the hospital physicians. The main barriers for visiting admitted patients were workload and lack of pre-allocated time on the work schedule. No statistically significant differences were found between communication variables and primary care physician's personal and demographic characteristics. The communication between the primary care physician and the hospital physicians should be improved through

  15. Infection prevention and control practices in children's hospitals. (United States)

    Bender, Jeffrey M; Virgallito, Mary; Newland, Jason G; Sammons, Julia S; Thorell, Emily A; Coffin, Susan E; Pavia, Andrew T; Sandora, Thomas J; Hersh, Adam L


    We surveyed hospital epidemiologists at 28 Children's Hospital Association member hospitals regarding their infection prevention and control programs. We found substantial variability between children's hospitals in both the structure and the practice of these programs. Research and the development of evidence-based guidelines addressing infection prevention in pediatrics are needed.

  16. Incidence and Outcome of Acute Cardiorenal Syndrome in Hospitalized Children. (United States)

    Athwani, Vivek; Bhargava, Maneesha; Chanchlani, Rahul; Mehta, Amar Jeet


    To determine the incidence, etiology and outcome of Cardiorenal syndrome (CRS) in hospitalized children. A prospective cohort study was carried out in 242 children between 6 mo to 18 y of age hospitalized with primary cardiac, renal or any systemic disorder at a tertiary care center in India. The primary outcome was the development of CRS. Univariate and multivariate logistic regression analysis were performed to determine the risk of mortality secondary to CRS. Among 242 children, 67 (27.7%) children developed CRS and the rest 175 (72.3%) did not. Among those with CRS, 40.3%, 20.9%, and 38.8% had CRS-1, 3 and 5, respectively. Cardiac diseases leading to CRS were myocarditis (40.7%) followed by congenital heart disease (25.9%), rheumatic heart disease (18.5%), and dilated cardiomyopathy (7.4%); renal disease associated with CRS was acute glomerulonephritis (100%) and major systemic disorders leading to CRS were septicemia (53.8%), malaria (23.1%), scrub typhus (7.7%), and acute gastroenteritis (3.8%). The occurrence of CRS was associated with an increased risk of mortality (OR 6.3, 95% CI: 2.8, 14.1; p 0.000). A subgroup analysis revealed that children with CRS having acute kidney injury stage 2 and 3 also had a higher risk of mortality (p 0.001). The incidence of CRS is quite high in children with cardiac, renal or systemic diseases and is associated with a significant risk of mortality. Children presenting with these illnesses should be monitored for the occurrence of CRS so that early intervention may reduce mortality.

  17. Varicella-related Primary Health-care Visits, Hospitalizations and Mortality in Norway, 2008-2014. (United States)

    Mirinaviciute, Grazina; Kristensen, Erle; Nakstad, Britt; Flem, Elmira


    Norway does not currently implement universal varicella vaccination in childhood. We aimed to characterize health care burden of varicella in Norway in the prevaccine era. We linked individual patient data from different national registries to examine varicella vaccinations and varicella-coded primary care consultations, hospitalizations, outpatient hospital visits, deaths and viral infections of central nervous system in the whole population of Norway during 2008-2014. We estimated health care contact rates and described the epidemiology of medically attended varicella infection. Each year approximately 14,600 varicella-related contacts occurred within primary health care and hospital sector in Norway. The annual contact rate was 221 cases per 100,000 population in primary health care and 7.3 cases per 100,000 in hospital care. Both in primary and hospital care, the highest incidences were observed among children 1 year of age: 2,654 and 78.1 cases per 100,000, respectively. The annual varicella mortality was estimated at 0.06 deaths per 100,000 and in-hospital case-fatality rate at 0.3%. Very few (0.2-0.5%) patients were vaccinated against varicella. Among hospitalized varicella patients, 22% had predisposing conditions, 9% had severe-to-very severe comorbidities and 5.5% were immunocompromised. Varicella-related complications were reported in 29.3% of hospitalized patients. Varicella zoster virus was the third most frequent virus found among 16% of patients with confirmed viral infections of central nervous system. Varicella causes a considerable health care burden in Norway, especially among children. To inform the policy decision on the use of varicella vaccination, a health economic assessment of vaccination and mathematical modeling of vaccination impact are needed.

  18. Pediatric primary care providers' perspectives regarding hospital discharge communication: a mixed methods analysis. (United States)

    Leyenaar, JoAnna K; Bergert, Lora; Mallory, Leah A; Engel, Richard; Rassbach, Caroline; Shen, Mark; Woehrlen, Tess; Cooperberg, David; Coghlin, Daniel


    Effective communication between inpatient and outpatient providers may mitigate risks of adverse events associated with hospital discharge. However, there is an absence of pediatric literature defining effective discharge communication strategies at both freestanding children's hospitals and general hospitals. The objectives of this study were to assess associations between pediatric primary care providers' (PCPs) reported receipt of discharge communication and referral hospital type, and to describe PCPs' perspectives regarding effective discharge communication and areas for improvement. We administered a questionnaire to PCPs referring to 16 pediatric hospital medicine programs nationally. Multivariable models were developed to assess associations between referral hospital type and receipt and completeness of discharge communication. Open-ended questions asked respondents to describe effective strategies and areas requiring improvement regarding discharge communication. Conventional qualitative content analysis was performed to identify emergent themes. Responses were received from 201 PCPs, for a response rate of 63%. Although there were no differences between referral hospital type and PCP-reported receipt of discharge communication (relative risk 1.61, 95% confidence interval 0.97-2.67), PCPs referring to general hospitals more frequently reported completeness of discharge communication relative to those referring to freestanding children's hospitals (relative risk 1.78, 95% confidence interval 1.26-2.51). Analysis of free text responses yielded 4 major themes: 1) structured discharge communication, 2) direct personal communication, 3) reliability and timeliness of communication, and 4) communication for effective postdischarge care. This study highlights potential differences in the experiences of PCPs referring to general hospitals and freestanding children's hospitals, and presents valuable contextual data for future quality improvement initiatives

  19. Hospital burden of road traffic injury: major concern in primary and secondary level hospitals in Bangladesh. (United States)

    Mashreky, S R; Rahman, A; Khan, T F; Faruque, M; Svanström, L; Rahman, F


    To assess the burden of road traffic injury (RTI) in primary and secondary level hospitals in Bangladesh, and its economic impact on affected families. Cross-sectional study. The study was carried out in February and March 2001. To estimate the burden of RTI patients and the length of stay in hospital, the discharge records of primary and secondary level hospitals were used as data sources. Records from 16 district hospitals and 45 Upazila health complexes (subdistrict level hospitals), selected at random, were included in this study. A direct interview method was adopted to estimate the patient costs of RTI; this involved interviewing patients or their attendants. In this study, patient costs included money spent by the patient for medicine, transport, food and lodging (including attendants). Approximately 33% of the beds in primary and secondary level hospitals in Bangladesh were occupied by injury-related patients, and more than 19% of the injury patients had been injured in a road traffic accident. People aged 18-45 years were the major victims of RTI, and constituted 70% of the total RTI-related admissions in primary and secondary level hospitals. More than two-thirds of RTI patients were male. The average duration of hospital stay was 5.7 days, and the average patient cost for each RTI patient was US$86 (5834 BDT). RTI is a major cause of hospital admission in Bangladesh, and represents an economic and social burden for the family and the nation. A national strategy and road safety programme need to be developed to reduce the hospital burden and minimize the economic and social impact. 2010 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  20. Therapeutic Hypothermia after In-Hospital Cardiac Arrest in Children. (United States)

    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

  1. Primary total hip replacement versus hip resurfacing - hospital considerations. (United States)

    Ward, William G; Carter, Christina J; Barone, Marisa; Jinnah, Riyaz


    Multiple factors regarding surgical procedures and patient selection affect hospital staffing needs as well as hospital revenues. In order to better understand the potential impact on hospitals that hip arthroplasty device selection (standard total hip arthroplasty vs. resurfacing) creates, a review of all primary hip arthroplasties performed at one institution was designed to identify factors that impacted hospital staffing needs and revenue generation. All primary hip arthroplasties undertaken over three fiscal years (2008 to 2010) were reviewed, utilizing only hospital business office data and medical records data that had been previously extracted prior for billing purposes. Analysis confirmed differing demographics for two hip arthroplasty populations, with the resurfacing patients (compared to the conventional total hip arthroplasty population) consisting of younger patients (mean age, 50 vs. 61 years), who were more often male (75% vs. 45%), were more likely to have osteoarthritis as their primary diagnosis (83 vs. 67%) and were more often covered by managed care or commercial insurance (83 vs. 34%). They also had shorter hospital stays (mean length of stay, 2.3 vs. 4.1 days) and consequently provided a more favorable financial revenue stream to the hospital on a per patient basis. Several trends appeared during the study periods. There was a steady increase in all procedures in all groups except for the resurfacings, which decreased 26% in males and 53% in females between 2009 and 2010. Differences were observed in the demographics of patients presenting for resurfacing, compared to those presenting for conventional total hip arthroplasty. In addition to the revenue stream considerations, institutions undertaking a resurfacing program must commit the resources and planning in order to rehabilitate these patients more expeditiously than is usually required with conventional hip arthroplasty patients.

  2. Hospitalizations of Children with Autism Increased from 1999 to 2009 (United States)

    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…

  3. Bullying experience in primary school children


    Farah Aulia


    Bullying is still a significant problem today. Bullying occurs starting from the primary level up to college. The impact of the bullying on victims can be a lonely, difficult to adjust, insecurity, low self-esteem, depression and the worst is suicide. The earlier effort to detect bullying experienced by children will be able to prevent long-term effects caused. This study was conducted on 258 students of class 4-5 primary school in Yogyakarta. Data was collected through open-ended questionnai...

  4. Bullying experience in primary school children

    Directory of Open Access Journals (Sweden)

    Farah Aulia


    Full Text Available Bullying is still a significant problem today. Bullying occurs starting from the primary level up to college. The impact of the bullying on victims can be a lonely, difficult to adjust, insecurity, low self-esteem, depression and the worst is suicide. The earlier effort to detect bullying experienced by children will be able to prevent long-term effects caused. This study was conducted on 258 students of class 4-5 primary school in Yogyakarta. Data was collected through open-ended questionnaires associated with feelings and experiences of bullying in schools both as perpetrators and victims. The result showed that students feel negative emotions associated with bullying at school and most children experience bullying at school with a variety of forms, ranging from physical, verbal and relational from peers at school. These findings have implications related to the effort to do the school to help students cope with the impact of bullying experienced.

  5. Primary kidney disease and post-renal transplantation hospitalization costs. (United States)

    Ghoddousi, K; Ramezani, M K; Assari, S; Lankarani, M M; Amini, M; Khedmat, H; Hollisaaz, M T


    This study sought to assess posttransplantation hospitalizations costs in diabetic and nondiabetic subjects to see whether diabetes mellitus (DM) as a primary cause of end-stage renal disease (ESRD) increased posttransplantation hospitalization costs. From 2000 to 2005, the hospitalization costs of 387 consecutive rehospitalizations of kidney recipients were retrospectively compared for two groups: patients with ESRD due to DM (n=71) and those with ESRD of non-DM etiologies (n=316). The hospitalization costs included the costs of hotel, medications, surgical procedures, paraclinical tests, imaging tests, health personnel time, special services (ie, patient transportation by ambulance), and miscellaneous costs. Societal perspective was used with costs expressed in PPP$ purchase power parity dollars (PPP$) estimated to be equal to 272 Iranian rials. Compared with the non-DM group, DM patients experienced significantly higher median costs both in total (1262 vs 870 PPP$, P=.001) and in cost components related to hotel (384 vs 215 PPP$, P=.001), health personnel time (235 vs 115 PPP$, P<.001), paraclinical tests (177 vs 149 PPP$, P=.012), and special services (100 vs 74 PPP$, P=.041). The mean of age was higher (P<.001), and the transplantation hospitalization time interval was also shorter in the DM group (median: 2.7 vs 12, P=.025). Considering DM as a leading cause of ESRD and its increasing prevalence in some countries, the association between hospitalization costs of posttransplant patients and DM may be of great economic importance to many transplantation centers.

  6. Intussusception in children seen at Muhimbili National Hospital, Dar ...

    African Journals Online (AJOL)

    Intussusception in children seen at Muhimbili National Hospital, Dar es salaam. ... its magnitude of concern and any seasonal variation in our environment. ... majority of the children present late, >48 hours from the onset of symptoms and ...

  7. Nocturnal enuresis among primary school children

    Directory of Open Access Journals (Sweden)

    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.

  8. Sickle cell children traveling abroad: primary risk is infection. (United States)

    Runel-Belliard, Camille; Lesprit, Emmanuelle; Quinet, Béatrice; Grimprel, Emmanuel


    Pediatricians taking care of sickle cell children in France are concerned about giving travel advice. Very few articles are published and no study has been done about it. A lot of pediatricians are using their own experience to decide if sickle cell children can travel abroad. Studying the consequences of such travel for sickle cell children is important to discuss common recommendations. We conducted a prospective study from June 2006 to December 2007 on desires to travel expressed during our consultations with sickle cell children. We studied notable events that occurred during travel and at least 2 months after return. Of 52 desires to travel, 10 were cancelled. All of the 42 trips were to Africa. Median duration of travel was 1.29 months (0.5-3). Median age at travel was 7.6 years (0.2-17.7). Events during travel were two hospitalizations (4.8%), a transfusion (2.4%), and four paramedical or medical examinations (9.6%). After return, four events occurred: two SS children had Plasmodium falciparum malaria (4.8%) and two had digestive bacteremia (4.8%) in SC and Sbeta+ children. No event occurred during plane travel. None of our patients died. The primary risk for sickle cell children traveling to Africa is infection: malaria first and digestive septicemia second. These risks are increased by long travel and poor sanitary conditions. Each travel should be prepared a long time before departure, and each pediatrician should insist on malaria prophylaxis and sanitary conditions, especially for young children. Trips should be shorter than 1 month when possible. A longer prospective study will be done to confirm these results.

  9. Improving stethoscope disinfection at a children's hospital. (United States)

    Zaghi, Justin; Zhou, Jing; Graham, Dionne A; Potter-Bynoe, Gail; Sandora, Thomas J


    Stethoscopes are contaminated with pathogenic bacteria and pose a risk for transmission of infections, but few clinicians disinfect their stethoscope after every use. We sought to improve stethoscope disinfection rates among pediatric healthcare providers by providing access to disinfection materials and visual reminders to disinfect stethoscopes. Prospective intervention study. Inpatient units and emergency department of a major pediatric hospital. Physicians and nurses with high anticipated stethoscope use. Baskets filled with alcohol prep pads and a sticker reminding providers to regularly disinfect stethoscopes were installed outside of patient rooms. Healthcare providers' stethoscope disinfection behaviors were directly observed before and after the intervention. Multivariable logistic regression models were created to identify independent predictors of stethoscope disinfection. Two hundred twenty-six observations were made in the preintervention period and 261 in the postintervention period (83% were of physicians). Stethoscope disinfection compliance increased significantly from a baseline of 34% to 59% postintervention (P stethoscope disinfection supplies and visible reminders outside of patient rooms significantly increased stethoscope disinfection rates among physicians and nurses at a children's hospital. This simple intervention could be replicated at other healthcare facilities. Future research should assess the impact on patient infections.

  10. Diagnosing ADHD in Danish primary school children

    DEFF Research Database (Denmark)

    Tegtmejer, Thyge; Hjörne, Eva; Säljö, Roger


    This study of institutional categorization reports an investigation of the practices, procedures and assumptions of psychiatric staff members when diagnosing ADHD. The main data upon which the study is based consist of transcribed audio recordings of meetings in the psychiatric clinic. Here...... children referred from primary schools on the suspicion of ADHD are attended to. The tools and procedures for gathering information are shown to produce decontextualized and individualizing representations of children’s conduct. The evaluation against a number of norms is found to be central. Finally...

  11. [Associating children with contemporary visual arts in the hospital]. (United States)

    Dessuter, Brigitte


    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.

  12. Neurocognitive Function in Children with Primary Hypertension (United States)

    Lande, Marc B.; Batisky, Donald L.; Kupferman, Juan C.; Samuels, Joshua; Hooper, Stephen R.; Falkner, Bonita; Waldstein, Shari R.; Szilagyi, Peter G.; Wang, Hongyue; Staskiewicz, Jennifer; Adams, Heather R.


    Objective To compare neurocognitive test performance of children with primary hypertension to that of normotensive controls. Study design Seventy-five children (10-18 years of age) with newly diagnosed, untreated hypertension and 75 frequency matched normotensive controls had baseline neurocognitive testing as part of a prospective multicenter study of cognition in primary hypertension. Subjects completed tests of general intelligence, attention, memory, executive function, and processing speed. Parents completed rating scales of executive function and the Sleep-Related Breathing Disorder scale of the Pediatric Sleep Questionnaire (PSQ-SRBD). Results Hypertension and control groups did not differ significantly in age, sex, maternal education, income, race, ethnicity, obesity, anxiety, depression, cholesterol, glucose, insulin, and C-reactive protein. Subjects with hypertension had higher PSQ-SRBD scores (p = 0.04) and triglycerides (p = 0.037). Multivariate analyses showed that hypertension was independently associated with worse performance on the Rey Auditory Verbal Learning Test (List A Trial 1, p = 0.034; List A Total, p = 0.009; Short delay recall, p = 0.013), CogState Groton Maze Learning Test delayed recall (p = 0.002), Grooved Pegboard dominant hand (p = 0.045), and Wechsler Abbreviated Scales of Intelligence Vocabulary (p = 0.016). Results indicated a significant interaction between disordered sleep (PSQ-SRBD score) and hypertension on ratings of executive function (p = 0.04), such that hypertension heightened the association between increased disordered sleep and worse executive function. Conclusions Youth with primary hypertension demonstrated significantly lower performance on neurocognitive testing compared with normotensive controls, in particular, on measures of memory, attention, and executive functions. PMID:27692987


    Koukourikos, Konstantinos; Tzeha, Laila; Pantelidou, Parthenopi; Tsaloglidou, Areti


    Introduction: Play constitutes an essential parameter of the normal psychosomatic development of children, as well as their statutory right. It is also an important means of communication in childhood. Objective: To review, detect and highlight all data cited regarding the role of play during the hospitalization of children. Methodology: Literature review was achieved by searching the databases Scopus, PubMed, Cinhal in English, using the following key words: therapeutic play, play therapy, hospitalized child, therapist. Results: During hospitalization, play either in the form of therapeutic play, or as in the form of play therapy, is proven to be of high therapeutic value for ill children, thus contributing to both their physical and emotional well-being and to their recovery. It helps to investigate issues related to the child’s experiences in the hospital and reduce the intensity of negative feelings accompanying a child’s admission to hospital and hospitalization. Play is widely used in pre-operative preparation and invasive procedures, while its use among children hospitalized for cancer is beneficial. Conclusion: The use of play in hospital may become a tool in the hands of healthcare professionals, in order to provide substantial assistance to hospitalized children, as long as they have appropriate training, patience, and will to apply it during hospitalization. PMID:26889107

  14. Children as Researchers in Primary Schools: Choice, Voice and Participation (United States)

    Bucknall, Sue


    "Children as Researchers in Primary Schools" is an innovative and unique resource for practitioners supporting children to become "real world" researchers in the primary classroom. It will supply you with the skills and ideas you need to implement a "children as researchers" framework in your school that can be adapted for different ages and…

  15. Hospitalizations for critically ill children with traumatic brain injuries: a longitudinal analysis. (United States)

    Tilford, John M; Aitken, Mary E; Anand, K J S; Green, Jerril W; Goodman, Allen C; Parker, James G; Killingsworth, Jeffrey B; Fiser, Debra H; Adelson, P David


    This study examines the incidence, utilization of procedures, and outcomes for critically ill children hospitalized with traumatic brain injury over the period 1988-1999 to describe the benefits of improved treatment. Retrospective analysis of hospital discharges was conducted using data from the Health Care Cost and Utilization Project Nationwide Inpatient Sample that approximates a 20% sample of U.S. acute care hospitals. Hospital inpatient stays from all types of U.S. community hospitals. The study sample included all children aged 0-21 with a primary or secondary ICD-9-CM diagnosis code for traumatic brain injury and a procedure code for either endotracheal intubation or mechanical ventilation. None. Deaths occurring during hospitalization were used to calculate mortality rates. Use of intracranial pressure monitoring and surgical openings of the skull were investigated as markers for the aggressiveness of treatment. Patients were further classified by insurance status, household income, and hospital characteristics. Over the 12-yr study period, mortality rates decreased 8 percentage points whereas utilization of intracranial pressure monitoring increased by 11 percentage points. The trend toward more aggressive management of traumatic brain injury corresponded with improved hospital outcomes over time. Lack of insurance was associated with vastly worse outcomes. An estimated 6,437 children survived their traumatic brain injury hospitalization because of improved treatment, and 1,418 children died because of increased mortality risk associated with being uninsured. Improved treatment was valued at approximately dollar 17 billion, whereas acute care hospitalization costs increased by dollar 1.5 billion (in constant 2000 dollars). Increased mortality in uninsured children was associated with a dollar 3.76 billion loss in economic benefits. More aggressive management of pediatric traumatic brain injury appears to have contributed to reduced mortality rates over

  16. Recurrence of primary spontaneous pneumothorax in young adults and children. (United States)

    Noh, Dongsub; Lee, Sungsoo; Haam, Seok Jin; Paik, Hyo Chae; Lee, Doo Yun


    Although better nutritional support has improved the growth rates in children, the occurrence of primary spontaneous pneumothorax has also been increasing in children. The current study attempts to investigate the occurrence and recurrence of primary spontaneous pneumothorax and the efficacy of surgery for primary spontaneous pneumothorax in young adults and children. A total of 840 patients were treated for pneumothorax at our hospital from January 2006 to December 2010. Exclusion criteria for this study were age >25 or secondary, traumatic or iatrogenic pneumothorax, and a total of 517 patients were included. Patients were classified into three groups according to age at the first episode of primary spontaneous pneumothorax: Group A: ≤16 years; Group B: 17-18 years and Group C: ≥19 years. The study group was composed of 470 male and 47 female patients. There were 234 right-sided, 279 left-sided and 4 bilateral primary spontaneous pneumothoraces. Wedge resection by video-assisted thoracic surgery was performed in 285 patients, while 232 were managed by observation or closed thoracostomy. In the wedge resection group, 51 patients experienced recurrence. The recurrence rates after wedge resection were 27.9% in Group A, 16.5% in Group B and 13.2% in Group C (P = 0.038). The recurrence rates after observation or closed thoracostomy were 45.7% in Group A, 51.9% in Group B and 47.7% in Group C (P = 0.764). In the present study, postoperative recurrence rates were higher than those in the literature. Intense and long-term follow-up was probably one reason for the relatively high recurrence rate. The recurrence rate after wedge resection in patients aged ≤16 years was higher than that in older patients. There was no difference between the recurrence rates after observation or closed thoracostomy, regardless of age. These results suggest that wedge resection might be delayed in children. © The Author 2015. Published by Oxford University Press on behalf of the

  17. Primary hyperparathyroidism in children and adolescents (United States)

    Roizen, Jeffrey; Levine, Michael A.


    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. PMID:22989537

  18. Interventions for primary (intrinsic tracheomalacia in children

    Directory of Open Access Journals (Sweden)

    Vikas Goyal

    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

  19. Screening for nutritional risk in hospitalized children with liver disease. (United States)

    Song, Tiantian; Mu, Ying; Gong, Xue; Ma, Wenyan; Li, Li


    Malnutrition is a major contributor to morbidity and mortality from pediatric liver disease. We investigated the prevalence of both malnutrition and high nutritional risk in hospitalized children with liver disease as well as the rate of in-hospital nutritional support. A total of 2,874 hospitalized children and adolescents with liver disease aged 1 to 17 years (inclusive) were enrolled. Malnutrition was screened by anthropometric measures (height-for-age, weight-for-height, weight-for-age, and BMI- for-age z-scores). The Screening Tool for Risk on Nutritional Status and Growth (STRONGkids) was used to evaluate nutritional risk status. Nutrition markers in blood, rate of nutritional support, length of hospital stay, and hospital fees were compared among nutritional risk groups. The overall prevalence of malnutrition was 38.6%. About 20.0% of children had high nutritional risk, and prevalence of malnutrition was markedly greater in the high nutritional risk group compared with the moderate risk group (67.9% vs 31.3%). Serum albumin and prealbumin differed significantly between high and moderate risk groups (pnutritional risk and 3.5% with moderate nutritional risk received nutrition support during hospitalization. Children with high nutritional risk had longer hospital stays and greater hospital costs (pnutritional risk is also prevalent at admission. Albumin and prealbumin are sensitive markers for distinguishing nutritional risk groups. High nutritional risk prolongs length of stay and increases hospital costs. The nutritional support rate is still low and requires standardization.

  20. Children's Hospitals' Solutions for Patient Safety Collaborative Impact on Hospital-Acquired Harm. (United States)

    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 collaborative dedicated to implementing HAC-related best-practice prevention bundles and culture of safety interventions designed to increase the use of high-reliability organization practices resulted in significant HAC and SSE reductions. Structured collaboration and rapid sharing of evidence-based practices and tools are effective approaches to decreasing hospital-acquired harm. Copyright © 2017 by the American Academy of Pediatrics.

  1. Children in the hospital: elements of quality in drawings. (United States)

    Pelander, Tiina; Lehtonen, Kimmo; Leino-Kilpi, Helena


    Not much is known about how children perceive the quality of care that they receive in hospitals. This study set out to describe elements of quality in children's drawings of an ideal hospital. Thirty-five drawings were collected from children aged between 4 and 11 years during their stay in a university hospital in Finland. They were coded using the method of content analysis. The two main categories extracted from the analysis were the environment and the people of their ideal hospital. The emphasis was on the environment; patients, parents, and nurses appeared less frequently in the drawings. The findings showed that children are capable of offering valuable insights into the elements of quality through the medium of drawing.

  2. Patterns of referral to Red Cross War Memorial Children's Hospital ...

    African Journals Online (AJOL)

    Memorial Children's Hospital, K1ipfontein Road, Rondebosch, 7700 RSA,. Accepted 10 Apt 1990, ... of every patient referred in the study period, or recorded the folder number of ..... Council for providing a short-term grant; Mariah Jacobs of the.

  3. Hospital-based home care for children with cancer

    DEFF Research Database (Denmark)

    Hansson, Eva Helena; Kjaergaard, H; Schmiegelow, K


    , as it decreased the strain on the family and the ill child, maintained normality and an ordinary everyday life and fulfilled the need for safety and security. According to family members of children with cancer, hospital-based home care support enhanced their quality of life during the child's cancer trajectory......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...

  4. Changing patterns of psychiatric inpatient care for children and adolescents in general hospitals, 1988-1995. (United States)

    Pottick, K J; McAlpine, D D; Andelman, R B


    The authors examine patterns in utilization of psychiatric inpatient services by children and adolescents in general hospitals during 1988-1995. National Hospital Discharge Survey data were used to describe utilization patterns for children and adolescents with primary psychiatric diagnoses in general hospitals from 1988 to 1995. During the study period, there was a 36% increase in hospital discharges and a 44% decline in mean length of stay, resulting in a 23% decline in the number of bed-days, from more than 3 million to about 2.5 million. The number of nonpsychotic major depressive disorders increased significantly. Discharges from public hospitals have declined, and those from proprietary hospitals have risen. Concurrently, the role of private insurance declined and the role of Medicaid increased. During the period of study, the mean and median length of stay declined most for children and adolescents who were hospitalized in private facilities and those covered by private insurance. Across the United States, the mean length of stay declined significantly; this decline was almost 60% in the West. Discharges also declined in the West, in contrast to the Midwest and the South, where they significantly increased. Increased numbers of discharges and decreased length of stay may reflect evolving market forces and characteristics of hospitals. Further penetration by managed care into the public insurance system or modifications in existing Medicaid policy could have a profound impact on the availability of inpatient resources.

  5. The effect of educational interventions with siblings of hospitalized children. (United States)

    Gursky, Barbara


    Research has demonstrated that siblings of chronically ill children can experience significant emotional and behavior changes; however, few studies have looked at the specific impact of pediatric hospitalization on the nonhospitalized child. Studies also indicate that children who receive age-appropriate information are better equipped to handle the stress and anxiety often associated with hospitalization.This study explored whether siblings of hospitalized children who received educational interventions had lower anxiety levels compared to siblings who did not receive interventions. A pretest-posttest experimental design was used with 50 subjects, ages 6-17 years, recruited from a children's hospital within a university medical center. Subjects were matched according to age, sex, and race, with 25 siblings each in the experimental and control groups. Siblings assigned to the experimental group received interventions from a standardized educational intervention protocol developed by the researcher. Interventions focused on teaching the sibling about hospitalization, illness or injury, and treatment for the patient, based on cognitive stages of development. All interventions were conducted by child life specialists on staff at the hospital with extensive training and experience in preparation and procedural teaching. Results shows that siblings who received educational interventions had significantly lower anxiety levels after interventions, compared to siblings who did not receive interventions. These findings have significant impact on children's health care and supporting family needs when a child is hospitalized.

  6. Radiologic findings of primary pneumonia in children

    International Nuclear Information System (INIS)

    Song, Chi Sung; Kim, In One; Yeon, Kyung Mo


    It is not always easy to detect and interpret radiologic findings of pediatric pneumonia. Authors retrospectively analysed radiologic findings of 102 cases of pediatric primary pneumonia treated at Yeong-Deung-Po City Hospital between 1988 and 1990 to understand the past trend of radiologic pattern and to attain helpful information in diagnosing pediatric pneumonia hereafter. Results were as follows. Positive radiologic findings were noted in 85 cases (84%), but 17 cases (16%) showed indefinite lesion. The cases of infantile pneumonia (under 1 year of age) were 44. The most frequent finding was bilateral peribronchial infiltration with overearation (21 cases, 48%), followed by multiple patchy atelectasis associated with the findings of bilateral peribronchial infiltration and overaeration (nine cases, 23%), peribronchial infiltration without definite overaeration (six cases, 14%), alveolar consolidation superimposed on the peribronchial infiltration (three cases, 6%), alveolar consolidation (three cases, 6%) and bronchopneumonic pattern (two cases, 4%). The cases of pre-school age (1-5 years of age) were 34. Bilateral parahilar peribronchial infiltration was the most frequent finding (24 cases, 71%), followed by alveolar consolidation (six cases, 17%) and bronchopneumonic pattern (four cases, 12%). The cases of school age (over 6 years of age) were seven. Six cases (85%) showed alveolar consolidation and one case (15%) showed bronchopneumonic pattern. In short, the younger the patient was, the more frequently the interstitial infiltration occurred. Furthermore, overaeration and patchy atelectasis were unique findings of infantile pneumonia. After the school age, the pattern of pneumonia became similar to that of adults

  7. Cancer in Children at El Obeid Hospital, Western Sudan. | Doumi ...

    African Journals Online (AJOL)

    Conclusions: Cancers in children were seen at Western Sudan, and cases admitted to hospital only reflect the tip of the iceberg as many cases were directly referred to Oncology Hospitals. Establishment of a local radiation and isotopes centre is needed in this part of the country to provide oncology services and to integrate ...

  8. Research improves hospitals' approach to children's pain in Thailand

    International Development Research Centre (IDRC) Digital Library (Canada)

    Research that has enabled hospitals in Thailand to better treat children's pain ... requires nurses and doctors to have specialized training and more time to assess a ... having to stay longer in the hospital, or creating problems for their parents. ... pain numerically — on a scale of 1 to 10 — as is standard practice for adults.

  9. Refractive Errors in Primary School Children in Nigeria | Faderin ...

    African Journals Online (AJOL)

    The study was carried out to determine the prevalence of refractive errors in primary school children in the Nigerian Army children school. Bonny Camp, Lagos, Nigeria. A total of 919 pupils from two primary schools (one private school and one public school) were screened. The schools and classes were selected using ...

  10. Premature discharge of children from hospital admission at Ahmadu ...

    African Journals Online (AJOL)

    Introduction: Leaving hospital care prematurely could threaten the healthy survival of and expose children to a risk of harmful alternatives. It is also a concern and a challenge to healthcare providers and the health system. A better understanding of its characteristic could help mitigate the impact on children. Objective: To ...

  11. Hospitious Adoption: How Hospitality Empowers Children and Transforms Adoption (United States)

    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…

  12. Hospital-based home care for children with cancer

    DEFF Research Database (Denmark)

    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...

  13. Nutritional Contents of Lunch Packs of Primary School Children in ...

    African Journals Online (AJOL)

    Nutritional and health status have powerful influences on a child's ... well-being and cognitive development of school children. Students who ... Department of Pediatrics, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria. Abstract.

  14. Impact of Obesity on Clinical Outcomes in Urban Children Hospitalized for Status Asthmaticus. (United States)

    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.

  15. Day/Night Cycle: Mental Models of Primary School Children (United States)

    Chiras, Andreas


    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…

  16. Handgrip Strength and Malnutrition (Undernutrition) in Hospitalized Versus Nonhospitalized Children Aged 6-14 Years. (United States)

    Jensen, Kayla Camille; Bellini, Sarah Gunnell; Derrick, Jennifer Willahan; Fullmer, Susan; Eggett, Dennis


    Diagnosing undernutrition in hospitalized pediatric populations is crucial to provide timely nutrition interventions. Handgrip strength (HGS), a measurement of muscle function, is a reliable indicator of undernutrition. However, limited research exists on HGS in hospitalized pediatric patients. The primary aim of this study was to determine if HGS differed between hospitalized children within 48 hours of admission and nonhospitalized children. A secondary purpose was to describe the association of HGS with height, weight, body mass index (BMI), mid upper arm circumference (MUAC), activity level, disease severity, nutrition risk, and nutrition intervention. One hundred nine hospitalized and 110 nonhospitalized patients aged 6-14 years participated in this cross-sectional nonequivalent control group design study. Weight, height, MUAC, and HGS were measured within 48 hours of hospital admission for the hospitalized group or immediately following a well-child visit for the control group. Based on analysis of covariance, the HGS was estimated to be 12.4 ± 0.37 kgF (mean ± SE) for hospitalized subjects and 13.1 ± 0.37 for nonhospitalized subjects ( P = .2053). HGS was associated with age ( P < .0001), height ( P < .0001), dominant hand ( P < .0001), and MUAC z scores ( P = .0462). HGS was not significantly different between hospitalized and nonhospitalized participants, although anthropometric measurements were similar between groups. A strong relationship was demonstrated between HGS and BMI and MUAC z scores. Further research is needed that examines serial HGS measurements, feasibility in hospitalized patients, and the association of HGS measurements and nutrition risk.

  17. Psychiatric disorders in children attending a Nigerian primary care unit: functional impairment and risk factors

    Directory of Open Access Journals (Sweden)

    Tunde-Ayinmode Mosunmola


    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

  18. Outcomes for children hospitalized with abusive versus noninflicted abdominal trauma. (United States)

    Lane, Wendy Gwirtzman; Lotwin, Irwin; Dubowitz, Howard; Langenberg, Patricia; Dischinger, Patricia


    Abusive abdominal trauma (AAT) is the second leading cause of child abuse mortality. Previous outcome studies have been limited to data from trauma centers. The goals of this study were (1) to examine mortality, length of hospitalization, and hospital charges among a national sample of children hospitalized for AAT; and (2) to compare these outcomes with children with noninflicted abdominal trauma. Hospitalization data for children aged 0 to 9 years were obtained from the 2003 and 2006 Kids' Inpatient Database. Cases were identified using International Classification of Diseases, Ninth Revision, Clinical Modification and external cause of injury codes. Multivariable regression analyses were used to compare outcomes of children with AAT versus those with noninflicted injury. Children with AAT were younger, and more often insured by Medicaid. Among children surviving to discharge, those with AAT had longer hospitalizations (adjusted mean [95% confidence interval (CI)] length of stay: 7.9 (6.6-9.3) vs 6.4 (6.1-6.7) days, P assist families at risk should be supported.

  19. Food Allergy Concerns in Primary Classrooms: Keeping Children Safe (United States)

    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…

  20. How hospitalized children and parents perceive nurses and hospital amenities: A qualitative descriptive study in Poland. (United States)

    Marcinowicz, Ludmiła; Abramowicz, Paweł; Zarzycka, Danuta; Abramowicz, Magdalena; Konstantynowicz, Jerzy


    A qualitative descriptive design using an interview guide approach was adopted to investigate the patient-nurse relationship and paediatric ward amenities from the perspective of parents and hospitalised children in Poland. The study included 26 parents or caregivers of hospitalised children (between 13 months and 15 years old) and 22 children (from 10 to 16 years old). Qualitative content analysis was used to analyse the recorded verbal data. Data from patients' transcripts were coded and classified in terms of topics on the patient-nurse relationship and hospital care. We identified five main topics. 1. Nurse qualities; 2. Nurse verbal behaviour; 3. Nurse tone of voice and non-verbal behaviour; 4. Hospital amenities; 5. Parents' expectations towards nurses. Our study contributes to increased understanding of parents' and children's experiences of paediatric hospital care. © The Author(s) 2014.

  1. Hospital-based home care for children with cancer

    DEFF Research Database (Denmark)

    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...... children and 43 parents in the home care group, and 47 children and 66 parents receiving standard hospital care. RESULTS: All parents in the HBHC program were satisfied and preferred home care. There were no serious adverse events associated with HBHC, and costs did not increase. When adjusting for age......, gender, diagnosis and time since diagnosis, we found significant higher HRQOL scores in parent-reported physical health (P = 0.04; 95% confidence interval (CI): -0.2-19.5) and worry (P = 0.04; 95% CI: -0.4-20.6) in the home-care group indicating better physical health and less worry for children...

  2. The primary empty sella in children and its significance

    International Nuclear Information System (INIS)

    Tokiguchi, Susumu; Tsuchiya, Toshiaki; Ito, Jusuke


    The primary empty sella has been thought to be rare in children; only a few children have been described in the literature. The majority of such cases have been associated with congenital anomalies, optic atrophies, or cerebrospinal fluid rhinorrheas. We now report four cases of the primary empty sella in children. Two of the patients(Case 1 and Case 3) were prepubescent and had primary generalized epilepsy, while Case 2 and Case 4 complained of attacks of vascular headache and peri-orbital pain respectively. None of them showed any clinical evidence of endocrine disturbance. Ophthalmological examination revealed no abnormalities. The association of the primary empty sella with such disorders as primary epilepsy, attacks of vascular headache, and peri-orbital pain were thought to be almost certainly coincidental; the possibility was suggested that the empty sella might be present in children as an anatomical variant or as an acquired process in a certain percentage of them. (author)

  3. Parental leave: comparing children's hospitals with Fortune 500 companies. (United States)

    Weiss, A H; Gordon, E J; O'Connor, M E


    To identify parental leave policies and availability of support systems for new parents employed by children's hospitals and compare these benefits with those offered by Fortune 500 companies. Telephone or facsimile survey of all (n=118) children's hospitals and pediatric medical centers in the National Association of Children's Hospitals and Related Institutions 1995 Directory of Members, and 118 geographically matched Fortune 500 companies. Policies for maternity and paternity leave, adoption benefits, and support services for new parents were compared. Ninety-four children's hospitals (80%) and 82 Fortune 500 companies (69%) responded to the survey. No difference in duration of maternity (P>.30) or paternity (P=.12) leave was found. Sixty-two companies (77%) classified maternity leave as short-term disability while 47 hospitals (50%) classified it as sick time (Pleave as short-term disability generally gives better benefits to employees with short duration of service, whereas classifying maternity leave as sick time usually favors employees with longer employment. Companies provided more financial support for adoption expenses (Ppaid or unpaid leave for adoption (P=.14). Hospitals provided more on-site day care (69% vs 42%; Pparental leave benefits than Fortune 500 companies; however, they offer better support systems for parents returning to work after the birth of a child.

  4. Malnutrition in hospitalized children: prevalence, impact, and management. (United States)

    Groleau, Veronique; Thibault, Maxime; Doyon, Myriam; Brochu, Eve-Emmanuelle; Roy, Claude C; Babakissa, Corentin


    Malnutrition in hospitalized children has been reported since the late 1970s. The prevalence of acute and chronic malnutrition was examined in hospitalized patients in a general pediatric unit, and the impact and management of malnutrition were assessed. The nutritional risk score (NRS) and nutritional status (NS) (weight, height, body mass index, and skinfold thickness) of children aged zero to 18 years were assessed upon hospital admission. Growth and energy intake were monitored every three days until discharge. A total of 173 children (median age three years, 88 girls) participated; 79.8% had a moderate to severe NRS and 13.3% were acutely and/or chronically malnourished. A high NRS was associated with a longer hospital stay in children older than three years (Pchildren aged three years or younger (Pchildren with abnormal NS received 92.5% of recommended energy intake. This study suggests that all children admitted to hospital should have an evaluation of their NRS and NS, so that they can receive appropriate nutrition interventions provided by a multidisciplinary nutrition team.

  5. Air pollution and children's asthma-related emergency hospital visits in southeastern France. (United States)

    Mazenq, Julie; Dubus, Jean-Christophe; Gaudart, Jean; Charpin, Denis; Nougairede, Antoine; Viudes, Gilles; Noel, Guilhem


    Children's asthma is multifactorial. Environmental factors like air pollution exposure, meteorological conditions, allergens, and viral infections are strongly implicated. However, place of residence has rarely been investigated in connection with these factors. The primary aim of our study was to measure the impact of particulate matter (PM), assessed close to the children's homes, on asthma-related pediatric emergency hospital visits within the Bouches-du-Rhône area in 2013. In a nested case-control study on 3- to 18-year-old children, each control was randomly matched on the emergency room visit day, regardless of hospital. Each asthmatic child was compared to 15 controls. PM 10 and PM 2.5 , meteorological conditions, pollens, and viral data were linked to ZIP code and analyzed by purpose of emergency visit. A total of 68,897 visits were recorded in children, 1182 concerning asthma. Short-term exposure to PM 10 measured near children's homes was associated with excess risk of asthma emergency visits (adjusted odds ratio 1.02 (95% CI 1.01-1.04; p = 0.02)). Male gender, young age, and temperature were other risk factors. Conversely, wind speed was a protective factor. PM 10 and certain meteorological conditions near children's homes increased the risk of emergency asthma-related hospital visits in 3- to 18-year-old children in Bouches-du-Rhône. What is Known: • A relationship between short-term exposure to air pollution and increase in emergency room visits or hospital admissions as a result of increased pollution levels has already been demonstrated. What is New: • This study confirms these results but took into account confounding factors (viral data, pollens, and meteorological conditions) and is based on estimated pollution levels assessed close to the children's homes, rather than those recorded at the hospital. • The study area, the Mediterranean, is favorable to creation of secondary pollutants in these sunny and dry seasons.

  6. Prevalence of fall injuries and risk factors for fall among hospitalized children in a specialized childrens hospital in Saudi Arabia. (United States)

    AlSowailmi, Banan Abdullah; AlAkeely, Maha Heshaam; AlJutaily, Hayat Ibrahim; Alhasoon, Mohammad Abdulaziz; Omair, Amir; AlKhalaf, Hamad Abdullah


    Fall injuries among children during hospital stay is a major patient safety issue. Inpatient pediatric falls can lead to numerous negative consequences. In contrast to adults, there is a paucity of information on the prevalence and risk factors associated with children's falls during hospitalization. Identify the prevalence of fall injuries among hospital.ized children and describe the demographic and environmental factors that could predict a higher risk of severe outcomes of fall. Descriptive, cross-sectional prevalence study. Specialized children's hospital. Data was obtained through the electronic Safety Reporting System (SRS). All reported fall events during hospitalization in children less than or equal 14 years of age for the period from 1 April 2015 to 30 April 2016 were included. Fall events that occurred in the day care unit and the outpatient clinic were excluded. Prevalence and possible risk factors for fall events. 48. The prevalence of falls among the 4860 admitted children was 9.9 (95% CI=7.5, 13.1) per 1000 patients (48/4860). A majority of the falls were among boys (n=26, 54%), in the age group from 1-5 years old (n=22, 46%), in children at high risk of falling (n=35, 73%), with normal mobility status (n=21, 44%), and with no history of previ.ous falls (n=33, 69%). Severe injuries accounted for 25% of falls (n=12). However, falls among the moderate risk category (n=9, 69%) were more often severe than falls among the high risk category of children (n=12, 34%) (P=.03). Risk factor identification is required to prevent falls and their severe outcomes. Underreporting and single-centered study. None.

  7. Hospital admissions for dental treatment among children with cleft lip and/or palate born between 1997 and 2003: an analysis of Hospital Episode Statistics in England. (United States)

    Fitzsimons, Kate J; Copley, Lynn P; Smallridge, Jacqueline A; Clark, Victoria J; van der Meulen, Jan H; Deacon, Scott A


    Children with clefts have an increased tendency for dental anomalies and caries. To determine the pattern of hospital admissions for dental treatment during primary dentition among children with clefts. Cohort study based on Hospital Episode Statistics, an administrative database of all admissions to National Health Service hospitals in England. Patients born alive between 1997 and 2003 who had both a cleft diagnosis and cleft repair were included. The number of hospital admissions for surgical removal of teeth, simple extraction of teeth, and restoration of teeth before the age of seven was examined. Eight hundred and fifty-eight hospital admissions for dental treatment among 6551 children (dental treatment. The presence of additional anomalies, having a more severe cleft type, and living in relatively deprived areas increased the risk of hospital admission. Factors increasing the risk of hospital admission among cleft children should be taken into account when planning services. Efforts to reduce the number of hospital admissions should be focused on disease prevention, particularly among those most at risk of caries. © 2013 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  8. Failure to Thrive Hospitalizations and Risk Factors for Readmission to Children's Hospitals. (United States)

    Puls, Henry T; Hall, Matthew; Bettenhausen, Jessica; Johnson, Matthew B; Peacock, Christina; Raphael, Jean L; Newland, Jason G; Colvin, Jeffrey D


    Risk factors for failure to thrive (FTT) readmissions, including medical complexity, have not been described. We sought to characterize children hospitalized for FTT and identify risk factors associated with FTT-specific readmissions during the current era of increasing medical complexity among hospitalized children. This retrospective cohort study used the Pediatric Health Information System database of 43 freestanding children's hospitals across the United States. The cohort included children <2 years of age with index hospitalizations for FTT between 2006 and 2010. The main outcome was FTT-specific readmission within 3 years. Using Cox proportional hazards models, we assessed the association of demographic, clinical, diagnostic, and treatment characteristics with FTT-specific readmission. There were 10 499 FTT hospitalizations, with 14.1% being readmitted for FTT within 3 years and 4.8% within 30 days. Median time to readmission was 66 days (interquartile range, 19-194 days). Nearly one-half of children (40.8%) had at least 1 complex chronic condition (CCC), with 16.4% having ≥2 CCCs. After multivariable modeling, increasing age at admission, median household income in the lowest quartile (adjusted hazard ratio, 1.23 [95% confidence interval, 1.05-1.44]), and prematurity-related CCC (adjusted hazard ratio, 1.46 [95% confidence interval, 1.16-1.86]) remained significantly associated with readmission. Nearly one-half of children hospitalized for FTT had a CCC, and a majority of FTT-specific readmissions occurred after the traditional 30-day window. Children with prematurity-related conditions and low median household income represent unique populations at risk for FTT readmissions. Copyright © 2016 by the American Academy of Pediatrics.

  9. A single center 14 years study of infectious complications leading to hospitalization of patients with primary antibody deficiencies

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    Setareh Mamishi

    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.

  10. Factors associated with hospitalization of children with acute odontogenic infections

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    Klačar Jelena


    Full Text Available The aim of this study was to compare the sociodemographic and clinical features of odontogenic infections between hospitalized and nonhospitalized children and to show what were the risk factors in children that could predict the course of odontogenic infection and indicate the need for hospital treatment. The design of our study was of the case-control type. The two study groups consisted of 70 inpatients and 35 outpatients with odontogenic infections who were treated at Department of Pediatric Dentistry and Department of Maxillofacial Surgery at Clinical Center in Kragujevac, Serbia. Clinical and sociodemographic data were collected retrospectively from patients' hospital records. The following characteristics were significantly associated with hospital treatment of children with acute odontogenic infection: living in a village (OR =7.26,[1.43-36.96], multi-spatial infection (OR =0.04, [0.00-0.91], and affection of upper face (OR = 0.01, [0.00-0.86]. Tooth extraction was important intervention in the treatment regimen and reduced frequency of hospitalization (OR=0.07, [0.01-0.70]. The differences between hospitalized and non-hospitalized children were not significant in regard to: ethnicity, employment of parents, anatomical region of infection, side of the facial infection, source of infection (posterior or anterior deciduous or permanent teeth, and treatment (drainage and incision, oral or parenteral antibiotics. In children with acute odontogenic infection it is necessary to do tooth extraction in timely manner, especially if the source of infection is tooth from upper jaw and if it is multi-spatial infection.

  11. Constipation in children: avoiding hospital admissions by the use of a specialist community nurse. (United States)

    Bartle, David; Finlay, Fiona; Atherton, Fiona


    To review paediatric admissions with a primary diagnosis of constipation to see whether some could have been managed in the community instead. A review of the medical notes of all patients admitted with a primary diagnosis of constipation to the children's ward of a district general hospital over a 12-month period. Of 41 admissions (19 girls and 22 boys, age range 6 weeks to 12 years), the average length of stay was less than two nights. The short duration of hospital stay implies rapid improvement. It is likely that many of these children could have been managed in the community if suitable resources, such as a community nurse specialising in constipation, were available.

  12. A QI Initiative to Reduce Hospitalization for Children With Isolated Skull Fractures. (United States)

    Lyons, Todd W; Stack, Anne M; Monuteaux, Michael C; Parver, Stephanie L; Gordon, Catherine R; Gordon, Caroline D; Proctor, Mark R; Nigrovic, Lise E


    Although children with isolated skull fractures rarely require acute interventions, most are hospitalized. Our aim was to safely decrease the hospitalization rate for children with isolated skull fractures. We designed and executed this multifaceted quality improvement (QI) initiative between January 2008 and July 2015 to reduce hospitalization rates for children ≤21 years old with isolated skull fractures at a single tertiary care pediatric institution. We defined an isolated skull fracture as a skull fracture without intracranial injury. The QI intervention consisted of 2 steps: (1) development and implementation of an evidence-based guideline, and (2) dissemination of a provider survey designed to reinforce guideline awareness and adherence. Our primary outcome was hospitalization rate and our balancing measure was hospital readmission within 72 hours. We used standard statistical process control methodology to assess change over time. To assess for secular trends, we examined admission rates for children with an isolated skull fracture in the Pediatric Health Information System administrative database. We identified 321 children with an isolated skull fracture with a median age of 11 months (interquartile range 5-16 months). The baseline admission rate was 71% (179/249, 95% confidence interval, 66%-77%) and decreased to 46% (34/72, 95% confidence interval, 35%-60%) after implementation of our QI initiative. No child was readmitted after discharge. The admission rate in our secular trend control group remained unchanged at 78%. We safely reduced the hospitalization rate for children with isolated skull fractures without an increase in the readmissions. Copyright © 2016 by the American Academy of Pediatrics.

  13. Hospitality and the mental health of children and families. (United States)

    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.

  14. Mycoplasma Pneumoniae among Children Hospitalized with Community-acquired Pneumonia. (United States)

    Kutty, Preeta K; Jain, Seema; Taylor, Thomas H; Bramley, Anna M; Diaz, Maureen H; Ampofo, Krow; Arnold, Sandra R; Williams, Derek J; Edwards, Kathryn M; McCullers, Jonathan A; Pavia, Andrew T; Winchell, Jonas M; Schrag, Stephanie J; Hicks, Lauri A


    The burden and epidemiology of Mycoplasma pneumoniae (Mp) among U.S. children (<18 years) hospitalized with community-acquired pneumonia (CAP) are poorly understood. In the Etiology of Pneumonia in the Community (EPIC) study, we prospectively enrolled 2254 children hospitalized with radiographically-confirmed pneumonia from January 2010-June 2012 and tested nasopharyngeal/oropharyngeal swabs for Mp using real-time polymerase chain reaction (PCR). Clinical and epidemiological features of Mp-PCR-positive and -negative children were compared using logistic regression. Macrolide susceptibility was assessed by genotyping isolates. In the EPIC study, 182(8%) children were Mp-PCR-positive (median age: 7 years); 12% required intensive care and 26% had pleural effusion. No in-hospital deaths occurred. Macrolide resistance was found in 6/169(4%) isolates. Of 178(98%) Mp-PCR-positive children tested for co-pathogens, 50(28%) had ≥1 co-pathogen detected. Variables significantly associated with higher odds of Mp detection included age {10-17 years [adjusted odds ratio (aOR): 7.9 (95% confidence interval (CI): 4.5-13.6)] and 5-9 years [aOR: 4.8 (CI: 2.9-7.8)] vs. 2-4 years}, outpatient antibiotics ≤5 days pre-admission [aOR: 2.3 (CI: 1.5-3.4)], and co-pathogen detection [aOR: 2.1 (CI: 1.3-3.1)]. Clinical characteristics often seen included hilar lymphadenopathy, rales, headache, sore throat, and decreased breath sounds. Usually considered as a mild respiratory infection, M. pneumoniae was the most commonly detected bacteria among children ≥5 years hospitalized with CAP; one-quarter of whom had co-detections. Although associated with clinically non-specific symptoms, there was a need for intensive care support in some cases. M. pneumoniae should be included in the differential diagnosis for school-aged children hospitalized with CAP.

  15. Nutrition knowledge and nutritional status of primary school children ...

    African Journals Online (AJOL)


    Jan 4, 2010 ... b Research Fellow, CSL, Vaal University of Technology, South Africa ... Keywords: primary school children; nutrition knowledge; nutritional status. Nutrition ... research on basic nutrition education focusing on adolescents has.

  16. Nutritional status of children hospitalized for parapneumonic effusion.

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    Koen Huysentruyt

    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.

  17. Anemia among hospitalized children at a multispecialty hospital, Bangalore (Karnataka, India

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    Firdos Saba


    Full Text Available Background: Due to the limited availability of data related to anemia in hospitalized children, this research was conducted to study the occurrence, morphological patterns, distribution in different age groups, sex, and severity of anemia among children aged 6 months-12 years. Setting: Inpatients in department of pediatrics at a multispecialty hospital, Bangalore. Study Design: Descriptive cross sectional study from Oct, 2011 to Sep, 2012. Materials and Methods: Ethical clearance was obtained from the ethical committee of the hospital as per 1964 Declaration of Helsinki. Unrestricted random sampling method was used to select the study group consisting of 882 children between the age of 6 months and 12 years. After obtaining the consent, data were obtained and statistically analyzed using statistical tools like mean, median, standard deviation, and Chi-square test. Results: Out of 882 children selected, 642 (72.79% were anemic, out of which a majority of 629 (98% children suffered from nonhemoglobinopathies and a meagre 13 (2% suffered from hemoglobinopathies. Children in the age group of 6 months-1 year were most affected with nonhemoglobinopathies (33%. Moderate degree of anemia (hemoglobin = 7-9.9 g/dL was the commonest grade of anemia (80%, while microcytic hypochromic anemia was commonest morphological type of anemia (48%. Among hemoglobinopathies, thalassemia major was the most common (69%, that is 9 out of 13 patients. Conclusion: The occurrence of anemia among children aged between 6 months and 12 years is high and nonhemoglobinopathies predominate over the hemoglobinopathies.

  18. Why Are There So Few Ethics Consults in Children's Hospitals? (United States)

    Carter, Brian; Brockman, Manuel; Garrett, Jeremy; Knackstedt, Angie; Lantos, John


    In most children's hospitals, there are very few ethics consultations, even though there are many ethically complex cases. We hypothesize that the reason for this may be that hospitals develop different mechanisms to address ethical issues and that many of these mechanisms are closer in spirit to the goals of the pioneers of clinical ethics than is the mechanism of a formal ethics consultation. To show how this is true, we first review the history of collaboration between philosophers and physicians about clinical dilemmas. Then, as a case-study, we describe the different venues that have developed at one children's hospital to address ethical issues. At our hospital, there are nine different venues in which ethical issues are regularly and explicitly addressed. They are (1) ethics committee meetings, (2) Nursing Ethics Forum, (3) ethics Brown Bag workshops, (4) PICU ethics rounds, (5) Grand Rounds, (6) NICU Comprehensive Care Rounds, (7) Palliative Care Team (PaCT) case conferences, (8) multidisciplinary consults in Fetal Health Center, and (9) ethics consultations. In our hospital, ethics consults account for only a tiny percentage of ethics discussions. We suspect that most hospitals have multiple and varied venues for ethics discussions. We hope this case study will stimulate research in other hospitals analyzing the various ways in which ethicists and ethics committees can build an ethical environment in hospitals. Such research might suggest that ethicists need to develop a different set of "core competencies" than the ones that are needed to do ethics consultations. Instead, they should focus on their skills in creating multiple "moral spaces" in which regular and ongoing discussion of ethical issues would take place. A successful ethicist would empower everyone in the hospital to speak up about the values that they believe are central to respectful, collaborative practice and patient care. Such a role is closer to what the first hospital philosophers set

  19. Stereotyping and nurses' recommendations for treating pain in hospitalized children. (United States)

    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.

  20. Evaluation Of Methadone Poisoning in Hospitalized Children: A Short Review

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    Gholamali Maamouri


    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

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

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


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

  2. The importance of pets’ visit in recovery of hospitalized children

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    Andreia Maria Heins Vaccari


    Full Text Available Objective: To understand the experience of hospitalized childrenwhen visited by animals at hospital. Methods: Descriptive andexploratory research with qualitative approach in a private pediatrichospital in the city of São Paulo, Brazil. Thirteen children aged threeto six years were enrolled. Observation of the children before,during, and after the animal’s visit, interviews, and drawings weresome of the strategies used to collect data, which were submittedto the Bardin content analysis technique. Results: Three meaningcategories were identified and showed some of the benefits of thisexperience to children “pleasant contact with the animals”; “easierinteraction with staff and with other children”; “pain and discomfortrelief”. Conclusions: Animal visits make the environment morerelaxed, improve the interaction between the child, the staff andother children thus helping sick children to be more cooperativewith hospital procedures. This is an alternative strategy for pain anddiscomfort relief. It has also been observed that this activity benefitsnot only children but also adults who care them.

  3. Kinematic Measures of Imitation Fidelity in Primary School Children (United States)

    Williams, Justin H. G.; Casey, Jackie M.; Braadbaart, Lieke; Culmer, Peter R.; Mon-Williams, Mark


    We sought to develop a method for measuring imitation accuracy objectively in primary school children. Children imitated a model drawing shapes on the same computer-tablet interface they saw used in video clips, allowing kinematics of model and observers' actions to be directly compared. Imitation accuracy was reported as a correlation reflecting…

  4. Nutritional status of primary school children in Enugu, Nigeria using ...

    African Journals Online (AJOL)

    Malnutrition in children can co-exist as under- and over-nutrition in the same population with varying attendant medical risks. Objective: The aim of this study was to determine the nutritional status of primary school children in Enugu North LGA, using anthropometry. Methodology: This was a cross sectional descriptive study ...

  5. Exploratory Talk, Argumentation and Reasoning in Mexican Primary School Children (United States)

    Rojas-Drummond, Sylvia; Zapata, Margarita Peon


    The study analyses the effects of training primary school children in the use of a linguistic tool called "Exploratory Talk" (ET) on their capacity for argumentation. ET allows for reasoned confrontation and negotiation of points of view, making the reasoning visible in the talk. Eighty-eight Mexican children from the 5th and 6th grades…

  6. Health-related knowledge and behaviour of primary school children ...

    African Journals Online (AJOL)

    There is a serious need for children to be informed about the negative influence of unhealthy living which has become part and parcel of the post-industrial contemporary society. The aim of this study was to investigate the health-related knowledge and behaviour of senior primary school children in the Honeydew area, and ...

  7. Developing Children's Language Learner Strategies at Primary School (United States)

    Kirsch, Claudine


    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…

  8. The prevalence of undernutrition upon hospitalization in children in a developing country: A single hospital study from Malaysia

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    Way-Seah Lee


    Conclusion: The prevalence of undernutrition among children admitted to a tertiary hospital in Malaysia was 14%. Strategies for systematic screening and provision of nutritional support in children at risk of undernutrition as well as treatment of undernutrition in children requiring hospitalization are needed.

  9. Frequency of medical errors in hospitalized children in khorramabad Madani hospital during six months in 2008

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    azam Mohsenzadeh


    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.

  10. Fear of clowns in hospitalized children: prospective experience. (United States)

    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

  11. Preventing dehydration-related hospitalizations: a mixed-methods study of parents, inpatient attendings, and primary care physicians. (United States)

    Shanley, Leticia; Mittal, Vineeta; Flores, Glenn


    The goal of this study was to identify the proportion of dehydration-related ambulatory care-sensitive condition hospitalizations, the reasons why these hospitalizations were preventable, and factors associated with preventability. A cross-sectional survey of primary care providers (PCPs), inpatient attending physicians, and parents was conducted in a consecutive series of children with ambulatory care-sensitive conditions admitted to an urban hospital over 14 months. Eighty-five children were diagnosed with dehydration. Their mean age was 1.6 years; most had public (74%) or no (17%) insurance, and were nonwhite (91%). The proportion of hospitalizations assessed as preventable varied from 12% for agreement among all 3 sources to 45% for any source. Parents identified inadequate prevention (50%), poor self-education (34%), and poor quality of care (38%) as key factors. PCPs identified parents providing insufficient home rehydration (33%), not visiting the clinic (25%), and not calling earlier (16%) as reasons. Inpatient attending physicians cited home rehydration (40%), delays in seeking care (40%), and lacking a PCP (20%) as contributors. Physicians (PCPs and inpatient attending physicians) were more likely than parents to describe the admission as inappropriate (75% vs 67% vs 0%; P dehydration-related hospitalizations may be preventable. Inadequate parental education by physicians, insufficient home rehydration, deferring clinic visits, insurance and cost barriers, inappropriate admissions, poor quality of care, and parental dissatisfaction with PCPs are the reasons that these hospitalizations might have been prevented.

  12. Prevalence of geohelminth in soil and primary school children in ...

    African Journals Online (AJOL)

    A study of geohelminthes infections among primary school children aged 8 to 13 years was conducted in four selected primary schools in Panda Development Area, Karu LGA, Nasarawa State, Nigeria. Out of four hundred and eighty (480) soil samples collected from the four schools, 314 (82.63) were found to be positive ...

  13. Hospital care for mental health and substance abuse in children with epilepsy. (United States)

    Thibault, Dylan P; Mendizabal, Adys; Abend, Nicholas S; Davis, Kathryn A; Crispo, James; Willis, Allison W


    Reducing the burden of pediatric mental illness requires greater knowledge of mental health and substance abuse (MHSA) outcomes in children who are at an increased risk of primary psychiatric illness. National data on hospital care for psychiatric illness in children with epilepsy are limited. We used the Kids' Inpatient Database (KID), the Healthcare Cost and Utilization Project (HCUP), and the Agency for Healthcare Research and Quality from 2003 to 2009 to examine MHSA hospitalization patterns in children with comorbid epilepsy. Nonparametric and regression analyses determined the association of comorbid epilepsy with specific MHSA diagnoses and examined the impact of epilepsy on length of stay (LOS) for such MHSA diagnoses while controlling for demographic, payer, and hospital characteristics. We observed 353,319 weighted MHSA hospitalizations of children ages 6-20; 3280 of these involved a child with epilepsy. Depression was the most common MHSA diagnosis in the general population (39.5%) whereas bipolar disorder was the most common MHSA diagnosis among children with epilepsy (36.2%). Multivariate logistic regression models revealed that children with comorbid epilepsy had greater adjusted odds of bipolar disorder (AOR: 1.17, 1.04-1.30), psychosis (AOR: 1.78, 1.51-2.09), sleep disorder (AOR: 5.90, 1.90-18.34), and suicide attempt/ideation (AOR: 3.20, 1.46-6.99) compared to the general MHSA inpatient population. Epilepsy was associated with a greater LOS and a higher adjusted incidence rate ratio (IRR) for prolonged LOS (IRR: 1.12, 1.09-1.17), particularly for suicide attempt/ideation (IRR: 3.74, 1.68-8.34). Children with epilepsy have distinct patterns of hospital care for mental illness and substance abuse and experience prolonged hospitalization for MHSA conditions. Strategies to reduce psychiatric hospitalizations in this population may require disease-specific approaches and should measure disease-relevant outcomes. Hospitals caring for large numbers of

  14. Epidemiology Of Measles And Its Complications In Non- Hospitalized Children

    Directory of Open Access Journals (Sweden)

    Mangal N


    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.

  15. The relationship between primary headache and constipation in children and adolescents


    Park, Mi-Na; Choi, Min-Gyu; You, Su Jeong


    Purpose Many patients presenting with headache also complain of constipation; the relationship between these two symptoms has not been explored in detail. The aim of this study was to investigate the association between primary headache and constipation. Methods This retrospective study included all children who attended the Inje University Sanggye Paik Hospital complaining of headache, and who had been followed up for at least 100 days. Patients were divided into 2 groups: group A, in whom t...

  16. The long term importance of English primary care groups for integration in primary health care and deinstitutionalisation of hospital care. (United States)

    Goodwin, N


    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. 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. 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. 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. 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.

  17. The long term importance of English primary care groups for integration in primary health care and deinstitutionalisation of hospital care

    Directory of Open Access Journals (Sweden)

    Nick Goodwin


    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.

  18. HIV Infection in hospitalized under-5 children with acute watery ...

    African Journals Online (AJOL)

    Prof Ezechukwu


    Dec 31, 2011 ... HIV with acute watery diarrhea as a clinical manifesta- tion.5,6,9,10 This study therefore attempts to find out the prevalence of HIV among children admitted into the. Diarrhoea Treatment and Training Unit of the University of Calabar Teaching Hospital, Calabar, Nigeria. This study will help in identifying ...

  19. Are We Meeting The Calorie Needs Of Hospitalized Children ...

    African Journals Online (AJOL)

    For the past four decades, nutrition has assumed its pride of place on the list of advances in surgery and general patient care. We prospectively reviewed the effect of hospitalisation on the nutritional status of 28 children admitted for various surgical and medical conditions at the Lagos University Teaching Hospital.

  20. [Overweight in primary school-age children. Prevalence and risk factors]. (United States)

    Funk, M B; Bausback-Schomakers, S; Hanschmann, K M; Gerhards, B; Kuhn, K; Krackhardt, B


    Various studies show that pre-school age is a sensitive period for the development of overweight and obesity. During a longitudinal study between 2010 and 2013, the municipal health authority (city of Frankfurt) in cooperation with the university children's hospital investigated the development of weight in children aged 5 to 8. The weight and height of a collective of 5720 children were measured (2010/11). In addition, nutritional and exercise habits, as well as media consumption was documented for 4758 children through a questionnaire during the school enrolment procedure. The weight and height of 3481 children were measured again in the second grade (2012/13). Over a period of 24 months, the percentage of overweight (not obese) children increased from 7.5 to 9.4 % and that of obese children from 4.5 to 5.0 %. 164 of 2818 children with a normal initial weight (5.8 %) changed to percentile class overweight or obese. 79 of 260 children who were initially overweight, not obese (30 %), changed to the group of normal weight, but only 4 out of 156 obese children (3 %). Increased TV consumption (> 1 h per day), availability of their own television, lack of physical activity, and consumption of high-calorie drinks were risk factors for the development of overweight during the primary school age. 72 % of parents of overweight children and 22 % of obese children falsely classified their children as normal weight. Targeted education about the risk of obesity in the primary school age and offers for early intervention should be established in the healthcare services concerned.

  1. Effectiveness of asthma education with and without a self-management plan in hospitalized children. (United States)

    Espinoza-Palma, Tatiana; Zamorano, Alejandra; Arancibia, Francisca; Bustos, María-Francisca; Silva, Maria José; Cardenas, Consuelo; De La Barra, Pedro; Puente, Victoria; Cerda, Jaime; Castro-Rodriguez, José A; Prado, Francisco


    Background. Formal education in primary care can reduce asthma exacerbations. However, there are few studies in hospitalized children, with none originating in Latin America. Methods. A prospective randomized study was designed to evaluate whether a full education with self-management plan (ESM) was more effective than an education without self-management plan (E) in reducing asthma hospitalization. Children (5 to 15 years of age) who were hospitalized for an asthma attack were divided in two groups. Children in the E group received general instructions based on a booklet. Those in the ESM group received the same booklet plus a self-management guide and a puzzle game that reinforces the lessons learned in the booklet. Patients were interviewed every 3 months, by telephone, for one year. Interviewers recording the number of hospitalizations, exacerbations, and emergency visits for asthma and oral steroid burst uses. Results. From 88 children who met the inclusion criteria, 77 (86%) completed one year of follow-up (41 from E and 36 from ESM group). Overall, after one year, the hospitalization decreased by 66% and the inhaled corticosteroids therapy increased from 36% to 79%. At the end of the study, there was no difference in exacerbations, emergency visits, oral steroid burst uses, or hospitalizations between the two groups. Conclusions. Asthma education with or without a self-management plan during asthma hospitalization were effective in reducing exacerbations, emergency visits, oral steroid burst uses, and future rehospitalizations. This evidence supports the importance of providing a complete asthma education plan in any patient who is admitted for asthma exacerbation.

  2. Social Networking Family of Caregivers during Hospitalization of Children. (United States)

    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

  3. Hospitality: transformative service to children, families, and communities. (United States)

    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. PsycINFO Database Record (c) 2014 APA, all rights reserved.

  4. Determinants of undernutrition among primary school children ...

    African Journals Online (AJOL)

    Materials and Methods: A cross-sectional descriptive study of 788 children aged 6-12 years selected by stratified, multistage ... Date of Acceptance: 03-Jul-2012 ..... 3 (0.8). 14 (3.6). Quintile class. Class 1(lowest). 109 (27.7). 45 (12.4). 69.69.

  5. Coping strategies used by hospitalized children with cancer undergoing chemotherapy. (United States)

    Sposito, Amanda Mota Pacciulio; Silva-Rodrigues, Fernanda Machado; Sparapani, Valéria de Cássia; Pfeifer, Luzia Iara; de Lima, Regina Aparecida Garcia; Nascimento, Lucila Castanheira


    To analyze coping strategies used by children with cancer undergoing chemotherapy during hospitalization. This was an exploratory study to analyze qualitative data using an inductive thematic analysis. Semistructured interviews using puppets were conducted with 10 children with cancer, between 7 and 12 years old, who were hospitalized and undergoing chemotherapy. The coping strategies to deal with chemotherapy were: understanding the need for chemotherapy; finding relief for the chemotherapy's side effects and pain; seeking pleasure in nourishment; engaging in entertaining activities and having fun; keeping the hope of cure alive; and finding support in religion. Children with cancer undergoing chemotherapy need to cope with hospitalizations, pain, medication side effects, idle time, and uncertainty regarding the success of treatment. These challenges motivated children to develop their own coping strategies, which were effective while undergoing chemotherapy. By gaining knowledge and further understanding about valid coping strategies during chemotherapy treatment, health professionals can mobilize personal and material resources from the children, health teams, and institutions aiming to potentiate the use of these strategies to make treatments the least traumatic. © 2015 Sigma Theta Tau International.

  6. Cellular telephone use among primary school children in Germany

    International Nuclear Information System (INIS)

    Boehler, Eva; Schuez, Joachim


    Background: There is some concern about potential health risks of cellular telephone use to children. We assessed data on how many children own a cellular telephone and on how often they use it in a population-based sample. Methods: We carried out a cross-sectional study among children in their fourth elementary school year, with a median-age of 10 years. The study was carried out in Mainz (Germany), a city with about 200,000 inhabitants. The study base comprised all 37 primary schools in Mainz and near surroundings. Altogether, 1933 children from 34 primary schools took part in the survey (participation rate of 87.8%). Results: Roughly a third of all children (n = 671, 34.7%) reported to own a cellular telephone. Overall, 119 (6.2%) children used a cellular telephone for making calls at least once a day, 123 (6.4%) used it several times a week and 876 (45.3%) children used it only once in a while. The remaining 805 (41.6%) children had never used a cellular telephone. The probability of owning a cellular telephone among children was associated with older age, being male, having no siblings, giving full particulars to height and weight, more time spent watching TV and playing computer games, being picked up by their parents from school by car (instead of walking or cycling) and going to bed late. The proportion of cellular telephone owners was somewhat higher in classes with more children from socially disadvantaged families. Conclusions: Our study shows that both ownership of a cellular telephone as well as the regular use of it are already quite frequent among children in the fourth grade of primary school. With regard to potential long-term effects, we recommend follow-up studies with children

  7. Risk-adjusted hospital outcomes for children's surgery. (United States)

    Saito, Jacqueline M; Chen, Li Ern; Hall, Bruce L; Kraemer, Kari; Barnhart, Douglas C; Byrd, Claudia; Cohen, Mark E; Fei, Chunyuan; Heiss, Kurt F; Huffman, Kristopher; Ko, Clifford Y; Latus, Melissa; Meara, John G; Oldham, Keith T; Raval, Mehul V; Richards, Karen E; Shah, Rahul K; Sutton, Laura C; Vinocur, Charles D; Moss, R Lawrence


    BACKGROUND The American College of Surgeons National Surgical Quality Improvement Program-Pediatric was initiated in 2008 to drive quality improvement in children's surgery. Low mortality and morbidity in previous analyses limited differentiation of hospital performance. Participating institutions included children's units within general hospitals and free-standing children's hospitals. Cases selected by Current Procedural Terminology codes encompassed procedures within pediatric general, otolaryngologic, orthopedic, urologic, plastic, neurologic, thoracic, and gynecologic surgery. Trained personnel abstracted demographic, surgical profile, preoperative, intraoperative, and postoperative variables. Incorporating procedure-specific risk, hierarchical models for 30-day mortality and morbidities were developed with significant predictors identified by stepwise logistic regression. Reliability was estimated to assess the balance of information versus error within models. In 2011, 46 281 patients from 43 hospitals were accrued; 1467 codes were aggregated into 226 groupings. Overall mortality was 0.3%, composite morbidity 5.8%, and surgical site infection (SSI) 1.8%. Hierarchical models revealed outlier hospitals with above or below expected performance for composite morbidity in the entire cohort, pediatric abdominal subgroup, and spine subgroup; SSI in the entire cohort and pediatric abdominal subgroup; and urinary tract infection in the entire cohort. Based on reliability estimates, mortality discriminates performance poorly due to very low event rate; however, reliable model construction for composite morbidity and SSI that differentiate institutions is feasible. The National Surgical Quality Improvement Program-Pediatric expansion has yielded risk-adjusted models to differentiate hospital performance in composite and specific morbidities. However, mortality has low utility as a children's surgery performance indicator. Programmatic improvements have resulted in

  8. Telemedicine for a Children's Field Hospital in Chechnya. (United States)

    Ehrlich, A I; Kobrinsky, B A; Petlakh, V I; Rozinov, V M; Shabanov, V E


    In 2001, the Children's Field Hospital in the Gudermes area of the Chechen Republic was connected to a telemedical centre at the Scientific Institute of Pediatrics and Children's Surgery in Moscow, via the Russian SCA HeliosNet satellite system. An asymmetric satellite link, in which there was a high-speed downlink from the satellite to Gudermes and a low-speed uplink from Gudermes to the satellite was used. In total, 179 teleconsultations were carried out from October 2001 until February 2002, when the field hospital was closed. Of the 179 teleconsultations, 26 were real-time, by videoconference and the rest were asynchronous, by email. Almost half of consultations were carried out for emergency or urgent reasons, thus demonstrating the value of providing access to the necessary experts. The use of satellite communication allowed telemedical support for medical decisions in a wide range of disease and trauma in children and teenage in a conflict situation.

  9. Attention deficit hyperactivity disorder in children with primary monosymptomatic nocturnal enuresis: A case-control study

    Directory of Open Access Journals (Sweden)

    Parsa Yousefichaijan


    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.

  10. Primary prophylaxis of venous thromboembolism in children. (United States)

    Cole, Catherine H


    Venous thromboembolism (VTE) is rare in children and young adolescents, and occurs predominantly in those with congenital heart disease in whom guidelines exist for VTE prophylaxis. For other paediatric patients, the rarity of the event makes writing an evidence-based clinical practice guideline difficult because each of the known risk factors contributes only a small increase in risk. Thrombophilia screening is controversial because few results assist with prediction of likely thrombosis and may not alter recommendations for prophylaxis. Recent publications highlight the importance of non-pharmacological prevention of VTE in children and adolescents undergoing surgery and the importance of liaison among surgeon, anaesthetist and haematologist. This annotation was written with the aim of collating current evidence for VTE prophylaxis and emphasising the need for further research in vulnerable subgroups.

  11. Clinical Profile and Electroencephalogram Findings in Children with Seizure Presenting to Dhulikhel Hospital. (United States)

    Poudyal, P; Shrestha, R Pb; Shrestha, P S; Dangol, S; Shrestha, N C; Joshi, A; Shrestha, A

    Background Seizure disorder is the most common childhood neurologic condition and a major public health concern. Identification of the underlying seizure etiology helps to identify appropriate treatment options and the prognosis for the child. Objective This study was conducted to investigate the clinical profile, causes and electroencephalogram findings in children with seizure presenting to a tertiary center in Kavre district. Method This was a hospital based prospective study carried out in the Department of Pediatrics, Dhulikhel Hospital, Kavre from 1st April 2015 to 31st March 2016. Variables collected were demographics, clinical presentations, laboratory tests, brain imaging studies, electroencephalography, diagnosis and outcome. Result Study included 120 (age 1 month to 16 years) children attending Dhulikhel Hospital. Majority of the patients were male (60.84%). Age at first seizure was less than 5 years in 75.83% of children. Seizure was generalized in 62.50%, focal in 31.67% and unclassified in 5.83%. Common causes of seizure were - Primary generalized epilepsy (26.66%), neurocysticercosis (10%) and hypoxic injury (6.6%) which was diagnosed in the perinatal period. Febrile seizure (26.66%) was the most common cause of seizure in children between 6 months to 5 years of age. Neurological examination, electroencephalography and Computed Tomography were abnormal in 71.66%, 68.92% and 58.14% cases respectively. Seizure was controlled by monotherapy in 69.16% cases and was resistant in 7.50% of the cases. Conclusion Primary generalized epilepsy and febrile seizure were the most common causes of seizures in children attending Dhulikhel Hospital. Electroencephalogram findings help to know the pattern of neuronal activity. Response to monotherapy was good and valproic acid was the most commonly used drug.

  12. Risk of malnutrition of hospitalized children in a university public hospital. (United States)

    Muñoz-Esparza, Nelly Carolina; Vásquez-Garibay, Edgar Manuel; Romero-Velarde, Enrique; Troyo-Sanromán, Rogelio


    The study aimed to demonstrate that the duration of hospitalization has a significant effect on the nutritional status of children treated in a university hospital. A longitudinal study was conducted during 2014, with a non-random sampling site concentration in children from birth to 19 years who were admitted to the hospital in the past 24 hours and who met the inclusion criteria and had signed informed consent. Upon entering, at 7 days, and at discharge, anthropometric indices, including weight/age, height/age, weight/height, BMI/age, head circumference/age, triceps and subscapular skin folds, and fat percentage, were obtained. Student's t-test, U Mann-Whitney, ANOVA, chi square, Wilcoxon, and odds ratios were used to analyze the data. In total, 206 patients were included: 40% infants, 25% preschoolers, 15% schoolchildren, and 20% teenagers. Infants had a significant improvement from admission to discharge in the indices weight/length (p = 0.042) and BMI (p = 0.002); adolescents showed decreased BMI from admission to discharge from the hospital (p = 0.05). Patients with longer hospitalization (more than 10 days) had an increased deficit in anthropometric indices at admission (p malnutrition and require greater monitoring of nutritional status during hospitalization.

  13. Shifting hospital care to primary care: An evaluation of cardiology care in a primary care setting in the Netherlands. (United States)

    Quanjel, Tessa C C; Struijs, Jeroen N; Spreeuwenberg, Marieke D; Baan, Caroline A; Ruwaard, Dirk


    In an attempt to deal with the pressures on the healthcare system and to guarantee sustainability, changes are needed. This study is focused on a cardiology Primary Care Plus intervention in which cardiologists provide consultations with patients in a primary care setting in order to prevent unnecessary referrals to the hospital. This study explores which patients with non-acute and low-complexity cardiology-related health complaints should be excluded from Primary Care Plus and referred directly to specialist care in the hospital. This is a retrospective observational study based on quantitative data. Data collected between January 1 and December 31, 2015 were extracted from the electronic medical record system. Logistic regression analyses were used to select patient groups that should be excluded from referral to Primary Care Plus. In total, 1525 patients were included in the analyses. Results showed that male patients, older patients, those with the referral indication 'Stable Angina Pectoris' or 'Dyspnoea' and patients whose reason for referral was 'To confirm disease' or 'Screening of unclear pathology' had a significantly higher probability of being referred to hospital care after Primary Care Plus. To achieve efficiency one should exclude patient groups with a significantly higher probability of being referred to hospital care after Primary Care Plus. NTR6629 (Data registered: 25-08-2017) (registered retrospectively).

  14. Causes of recurrent pneumonia in children in a general hospital. (United States)

    Hoving, M F Paulien; Brand, Paul L P


    Because the few previous studies on underlying causes of recurrent pneumonia in children have come from tertiary care referral centres where selection bias may be important, the aim of this study was to examine underlying causes of recurrent pneumonia in children in a general hospital. We performed a retrospective chart review in a general hospital of 62 children with recurrent pneumonia over a 7.5 years period. In 19 patients (30.6%), no cause was identified, commonly because favourable natural history obviated the need for a full and invasive diagnostic work-up. Other underlying causes included recurrent aspiration in 16 patients (25.7%), lung disease (airway stenosis, bronchiectasis, middle lobe syndrome or tracheooesophageal fistula) in 10 patients (16.1%) and immune deficiency in 10 patients (16.1%). In contrast to previous studies, asthma was never diagnosed as an underlying cause, but diagnostic confusion between asthma (or recurrent upper respiratory tract infections) and recurrent pneumonia was common. The cause of recurrent pneumonia in children remains elusive in almost a third of patients, partly because the favourable natural history consistent with immune system maturation eliminates the need for further diagnostic procedures. Asthma is more likely a differential diagnostic consideration than an underlying cause of recurrent pneumonia in children. A standardised diagnostic guideline is needed to improve knowledge on causes of recurrent pneumonia in children. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  15. The Phonemic Awareness Skills of Cochlear Implant Children and Children with Normal Hearing in Primary School

    Directory of Open Access Journals (Sweden)

    Aliakbar Dashtelei


    Full Text Available Objectives: Phonemic awareness skills have a significant impact on children speech and language. The purpose of this study was investigating the phonemic awareness skills of children with cochlear implant and normal hearing peers in primary school. Methods: phonemic awareness subscales of phonological awareness test were administered to 30 children with cochlear implantation at the first to sixth grades of primary school and 30 children with normal hearing who were matched in age with cochlear implant group. All of children were between 6 to 11 years old. Children with cochlear implant had at least 1 to 2 years of implant experience and they were over 5 years when they receive implantation. Children with cochlear implant were selected from Special education centers in Tehran and children with normal hearing were recruited from primary schools in Tehran. The phonemic awareness skills were assessed in both groups. Results: The results showed that the Mean scores of phonemic awareness skills in cochlear implant children were significantly lower than children with normal hearing (P<.0001. Discussion: children with cochlear implant, despite Cochlear implantation prosthesis, had lower performance in phonemic awareness when compared with normal hearing children. Therefore, due to importance of phonemic awareness skills in learning of literacy skills, and defects of these skills in children with cochlear implant, these skills should be assessed carefully in children with cochlear implant and rehabilitative interventions should be considered.


    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.

  17. [Analysis of individualized primary prophylactic treatment of 19 cases of children with severe hemophilia A]. (United States)

    Liu, G Q; Tang, L; Wu, X Y; Zhen, Y Z; Li, G; Chen, Z P; Wang, Y; Zhang, N N; Zhang, J S; Yu, G X; Wu, R H


    Objective: To study the current situation of primary prophylaxis in severe hemophilia A children and to explore rational regimen in order to provide evidence for the development of primary prophylaxis in China. Method: A retrospective clinical data collection and analysis was conducted for 19 severe hemophilia A children who received primary prophylaxis in Beijing Children's Hospital outpatient clinic between February 2011 and September 2015 and evaluated the regimen and efficacy. Result: (1) Primary prophylaxis regimen: the median beginning age 1.8 (range 0.5-2.9) years, the median FⅧ preparation using dosage 16.7 (8.0-23.5) U/(kg·time), the median using frequency was 1.0 (1.0-3.0) time/week. Eight cases among the patients received escalation of treatment intensity because of the poor bleeding control. (2) Efficacy: the median annual bleeding rate (ABR) was 1.9 (0-6.0) times/year, the median annual joint bleeding rate (AJBR) was 0 (0-3.3) times/year, without life threatening bleeding. All of them kept in 4th scale of Beijing Children Hospital daily activity level. The median annual factor consumption was 1 844 (840-5 040) U/kg. Conclusion: Low-dose primary prophylaxis regimen which were in low-dose /low frequencies and adjusted by bleeding frequency could decrease bleeding and joint bleeding frequency significantly, maintained the normal daily activity capacity and saved the factor consumption compared to standard regimen in severe hemophilia A children.

  18. Magical attachment: Children in magical relations with hospital clowns

    Directory of Open Access Journals (Sweden)

    Lotta Linge


    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.

  19. Primary immunodeficiency investigation in patients during and after hospitalization in a pediatric Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Erica Suavinho


    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.

  20. Use of drawings in children with pervasive developmental disorder during hospitalization: a developmental perspective. (United States)

    Stefanatou, Athena


    The level and nature of emotional upheaval and relationship to developmental stage was studied in children with pervasive developmental disorder (PDD) hospitalized for head injury. The sample consisted of 25 hospitalized children aged 5-12 years. Children were asked to make the drawing of a ;person in hospital'. The drawings were evaluated by Koppitz's emotional indicators. Punishment and persecution were the main cognitive constructs of children in order to explain hospitalization.

  1. Knowledge of the mothers of hospitalized children in a university hospital regarding diarrhea

    Directory of Open Access Journals (Sweden)

    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.

  2. Dental trauma that require fixation in a children's hospital. (United States)

    Bruns, Timothy; Perinpanayagam, Hiran


    Children and adolescents who suffer traumatic injuries often seek emergency treatment at a Children's Hospital. Complex injuries to permanent teeth and their periodontium require immediate repositioning and stabilization. Many of these emergencies are treated by pediatric dental residents at the Women and Children's Hospital of Buffalo, Buffalo, New York. The purpose of this study was to characterize these complex injuries of permanent teeth that require emergency treatment in a Children's Hospital. All of the cases of dental trauma which had involved permanent teeth and which had been treated with a splint in 2001 and 2002 were reviewed. There were 79 patients that were between 5 and 19 years of age with twice as many males (54) as females (25). The number of males increased from childhood (5-10 years) to early adolescence (11-15 years) and then decreased rapidly in late adolescence (16-19 years), whereas the number of females decreased steadily with age. Most of the incidents occurred during the summer months (72%), particularly in June and July (42%), and Fridays and Saturdays were the busiest days of the week. Most of the injuries were caused by organized and recreational sporting activities (39%) and accidental falls (33%), followed by interpersonal violence (15%) and a few motor vehicle accidents (7%). The 173 permanent tooth injuries were mostly luxations (62%) or avulsions (20%), with only a few fractures of the alveolar bone (5%) or tooth root (1%). Most of the displacements were lateral luxations (40%) or extrusions (18%) with only a few intrusions (3%). These injuries most commonly afflicted the maxillary central incisors (54%), followed by the maxillary laterals (18%) and mandibular centrals (17%). The emergency treatment that was provided at the Children's Hospital included replantation and repositioning, and the placement of a semi-rigid or flexible splint.

  3. The evaluation of primary care unit of Mahasarakham Hospital. (United States)

    Asavatanabodee, Paibool


    To evaluate the one-year performance outcome of Community Medical Care Unit (CMU) in Mahasarakham Hospital. This cross-sectional descriptive study used the CIPP model. The target population was divided into two groups. The first group consisted of the executive committee of Mahasarakham Hospital including one director, five Vice-directors, and 16 CMU paramedical personnel and public health administrators. The second group consisted of 281 randomized people in the service area of CMU, Mahasarakham Hospital. The overall outcome evaluation of both groups was high with mean of 3.53 and 3.86, respectively. The evaluation of context, input, and output was ranked high in both groups while the process ranking was moderate in the first group and high in the other group. The present study proposed that project guidelines be explicit policies, improvement in behavioral service, appropriate workload, adequate parking lot, and network sharing of hospital data bank. The quality and efficiency of CMU project are dependent upon explicit policy, well-planned structure of organization, efficient-informative systems, good development plan, and adequate manpower. The personnel should plan the project process and continuously improve the system. CMU project would be neither successful nor beneficial for the development ofpublic health care system if it lacked the participation of the people in the community and associated networks. The results of the present study might be the useful data for improving and developing the pattern of community healthcare service in urban area.

  4. Epilepsy in primary intracranial tumors in a neurosurgical hospital in ...

    African Journals Online (AJOL)

    Background: Seizures may be manifestation of intracranial tumor (IT) and demand thorough neurological evaluation. This paper examines epidemiology, lesion characteristics and outcome of seizures associated with primary IT. Methods: Retrospective analysis of medical records, computed tomography and magnetic ...

  5. Primary care for children with autism. (United States)

    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.

  6. [Acute care of critically ill children in general hospitals: organisation and training]. (United States)

    van Sambeeck, S J L; Janssen, E J M; Hundscheid, T; Martens, S J L; Vos, G D


    To gain insight into how the acute care of critically ill children at general hospitals is organised, whether staff is sufficiently trained and whether the necessary materials and medications are present. Questionnaire combined with a site visit. Questionnaires were sent to all primarily involved specialists (emergency room specialists and paediatricians), and to the auxiliary anaesthetists and intensivists involved, at the nine general hospitals in Southeast Netherlands. Two researchers performed standardised interviews with the lead paediatricians on site and checked for materials and medication present in the emergency and paediatric departments. Of the 195 questionnaires sent, 97 (49.7%) were deemed suitable for analysis. The response from the primary specialists involved (77.6%) was more than twice that of the auxiliary specialists (31.9%). At 7 hospitals, verbal agreements on the organisation of acute care were maintained, 1 hospital had a written protocol, and 2 hospitals had a task force addressing this topic. One out of 5 respondents was unaware of the verbal agreements and 1 out of 3 mistakenly assumed that a protocol existed. Two out of 3 primary specialists involved were certified for Advanced Paediatric Life Support (APLS); 1 out of 13 of the auxiliary specialists had such a certificate. Scenario training was being conducted at 8 hospitals. A paediatric resuscitation cart was available at both the emergency and paediatric departments of 8 hospitals, 3 of which were fully stocked at both departments. Laryngeal mask airways and PEEP-valves (Positive End Expiratory Pressure) were lacking at 6 of the 9 hospitals. The medication stock was complete at all the hospitals. The organisation of and training for the acute care of critically ill children and presence of materials - the aspects we investigated - need attention at all general hospitals evaluated. It appeared that many specialists are not APLS certified and written protocols concerning organisation

  7. Prevalence of rotavirus in children hospitalized with acute gastroenteritis in Imam Sajjad Hospital of Yasuj, 2011

    Directory of Open Access Journals (Sweden)

    P Khodadadi


    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

  8. Radiologic appearance of primary jaw lesions in children

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  9. Development of a hospital-based care coordination program for children with special health care needs. (United States)

    Petitgout, Janine M; Pelzer, Daniel E; McConkey, Stacy A; Hanrahan, Kirsten


    A hospital-based Continuity of Care program for children with special health care needs is described. A family-centered team approach provides care coordination and a medical home. The program has grown during the past 10 years to include inpatients and outpatients from multiple services and outreach clinics. Improved outcomes, including decreased length of stay, decreased cost, and high family satisfaction, are demonstrated by participants in the program. Pediatric nurse practitioners play an important role in the medical home, collaborating with primary care providers, hospital-based specialists, community services, and social workers to provide services to children with special health care needs. Copyright © 2013 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.

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

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


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

  11. Primary nocturnal enuresis in children. Background and treatment. (United States)

    Wille, S


    The aim of the present studies was to investigate background factors and treatment in children with monosymptomatic primary nocturnal enuresis. The study material comprised enuretics, former enuretics and controls from the municipal community of Falkenberg on the west coast of Sweden. Whenever possible all investigations were made with the children staying in their own home environment. Different background factors have been suspected as being causative: sleep disturbances, behavioural or psychological disturbances, small bladder capacity, increased night diuresis and an insufficient production of the antidiuretic hormone during sleep. These factors have been investigated in these studies. The treatment of enuresis has been dominated by the alarm and antidiuretic treatment with DDAVP. Primary nocturnal monosymptomatic enuresis is a common problem in childhood. In this study the prevalence among 392 seven year old children was 7.3%. A prior history of enuresis was found in 65% of families of the enuretics compared to 25% in controls. The enuretic children showed no statistically significant differences in behavioural or psychological problems compared to non-enuretic children. Enuretic children were described as heavy sleepers by their parents and a wake-up test performed at home showed that they were statistically significantly harder to arouse than the controls. Children with nocturnal enuresis, former enuretics and controls did not differ in social or behavioural traits in an interview study. No signs of symptom substitution was found when enuresis was resolved. Enuretic children had a normal bladder capacity and no statistically significant difference was found compared to controls and former enuretics. The enuretic children showed a normal calcium-creatinine quota in the urine. Former enuretic children showed a significantly enhanced calcium/creatinine quota compared to enuretics and controls. Enuretic children had a statistically significant lower morning

  12. MRI of primary meningeal tumours in children

    International Nuclear Information System (INIS)

    Yoon, H.K.; Na, D.G.; Byun, H.S.; Han, B.K.; Kim, S.S.; Kim, I.O.; Shin, H.J.


    Childhood meningeal tumours are uncommon and mostly meningiomas. We reviewed the histological and radiological findings in meningeal tumours in six children aged 12 years or less (four benign meningiomas, one malignant meningioma and one haemangiopericytoma). Compared to the adult counterpart, childhood meningiomas showed atypical features: cysts, haemorrhage, aggressiveness and unusual location. MRI features varied according to the site of the tumour, histology, haemorrhage, and presence of intra- or peritumoral cysts. Diagnosis of the extra-axial tumour was relatively easy in two patients with meningiomas, one malignant meningioma and one haemangiopericytoma. MRI findings strongly suggested an intra-axial tumour in two patients with benign meningiomas, because of severe adjacent edema. Awareness of the variable findings of childhood meningiomas and similar tumours may help in differentiation from brain tumours. (orig.)

  13. Factors associated with pneumonia in Yanomami children hospitalized for Ambulatory Care sensitive conditions in the north of Brazil. (United States)

    Caldart, Raquel Voges; Marrero, Lihsieh; Basta, Paulo Cesar; Orellana, Jesem Douglas Yamall


    In developing countries, pneumonia is the leading cause of sickness and mortality in childhood, especially among vulnerable groups. The scope of this study was to analyze the factors associated with pneumonia in Yanomami children hospitalized for Ambulatory Care Sensitive Conditions (ACSC). Hospital admissions were divided into two groups: i) pneumonia; and ii) other causes, according to the Brazilian ACSC list. Adjusted hospitalization rates were estimated and unconditional logistic regression was used to analyze factors associated with pneumonia. Over 90% of the registered cases were considered ACSC. The adjusted rate of ACSC was 18.6/1000. The odds ratio of hospitalization for pneumonia was 2.7 (CI: 1.3-5.4) times higher in children aged between 0.1 and 5.9 months; 1.9 (CI: 1.1-3.3) times higher in children who were hospitalized for 8-14 days; and three (CI: 1.2-7.5) times higher in children with a secondary diagnosis of malnutrition. The excess of avoidable hospitalizations is a clear indication of the low quality of care and limited accessibility to primary health care in indigenous territories, which is contrary to the assistance model proposed by the indigenous healthcare subsystem in Brazil, which should in theory focus on welfare technologies based on primary health care.

  14. Planning an outing from hospital for ventilator-dependent children. (United States)

    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.

  15. Primary bacterial peritonitis in otherwise healthy children: imaging findings

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  16. Neonatal hypoglycemia: prevalence and clinical manifestations in tehran children's hospital

    International Nuclear Information System (INIS)

    Dashti, N.; Einollahi, N.; Abbasi, S.


    To measure the prevalence of hypoglycemia among newborn infants in Children Hospital using a standard laboratory glucose method and to evaluate the evidence of clinical manifestations of hypoglycemia, designing appropriate strategies for prevention and treatment. The study population consisted of 673 neonates in Tehran Children's Hospital and was conducted between June 2004 and March 2005. The incidence of neonatal hypoglycemia in the present study group was 15.15% live births. The clinical features which remained significantly associated with the hypoglycemic neonates were refusal of feeding (45%), hyporeflexia (36.2%), irritability (30%), cyanosis (28.4%), tackypnea (24.5%), seizure (16.6%), weak cry (15.8%), apneic spels (9.8%), pallor (1.9%), cardiac arrest (9.1%) and sweating (1%). Hypoglycemia does occur frequently in newborn infants and requires careful monitoring and therapy of serum glucose. (author)

  17. Hospitalized children's representations of their relationship with nurses and doctors. (United States)

    Corsano, Paola; Majorano, Marinella; Vignola, Valentina; Cardinale, Elisa; Izzi, Giancarlo; Nuzzo, Maria Josè


    This article reports an explorative study which aims to investigate hospitalized children's views of their relationships with nurses and doctors. Twenty-seven school-aged children and adolescents from 6 to 15 years old in the paediatric haematology and oncology ward of an Italian hospital participated in the study. Each participant was asked to draw him or herself with a doctor or nurse from the ward while they were doing something. The drawings were analysed using Pictorial Assessment of Interpersonal Relationships (PAIR) and a qualitative analysis. The results showed that the participants viewed their relationships with health professionals positively, in particular with the nurses. This relationship was perceived as close, intimate, cohesive and without conflict. In some cases it became an emotional bond. Finally, this relationship helped the patients to cope with painful and uncomfortable medical procedures, which gradually became familiar and accepted. The clinical implications of this study are discussed.

  18. Patterns of malaria-related hospital admissions and mortality among Malawian children: an example of spatial modelling of hospital register data

    Directory of Open Access Journals (Sweden)

    Kleinschmidt Immo


    Full Text Available Abstract Background Malaria is a leading cause of hospitalization and in-hospital mortality among children in Africa, yet, few studies have described the spatial distribution of the two outcomes. Here spatial regression models were applied, aimed at quantifying spatial variation and risk factors associated with malaria hospitalization and in-hospital mortality. Methods Paediatric ward register data from Zomba district, Malawi, between 2002 and 2003 were used, as a case study. Two spatial models were developed. The first was a Poisson model applied to analyse hospitalization and minimum mortality rates, with age and sex as covariates. The second was a logistic model applied to individual level data to analyse case-fatality rate, adjusting for individual covariates. Results and conclusion Rates of malaria hospitalization and in-hospital mortality decreased with age. Case fatality rate was associated with distance, age, wet season and increased if the patient was referred to the hospital. Furthermore, death rate was high on first day, followed by relatively low rate as length of hospital stay increased. Both outcomes showed substantial spatial heterogeneity, which may be attributed to the varying determinants of malaria risk, health services availability and accessibility, and health seeking behaviour. The increased risk of mortality of children referred from primary health facilities may imply inadequate care being available at the referring facility, or the referring facility are referring the more severe cases which are expected to have a higher case fatality rate. Improved prognosis as the length of hospital stay increased suggest that appropriate care when available can save lives. Reducing malaria burden may require integrated strategies encompassing availability of adequate care at primary facilities, introducing home or community case management as well as encouraging early referral, and reinforcing interventions to interrupt malaria

  19. Characteristics of Hospitalized Children With a Diagnosis of Malnutrition: United States, 2010. (United States)

    Abdelhadi, Ruba A; Bouma, Sandra; Bairdain, Sigrid; Wolff, Jodi; Legro, Amanda; Plogsted, Steve; Guenter, Peggi; Resnick, Helaine; Slaughter-Acey, Jaime C; Corkins, Mark R


    Malnutrition is common in hospitalized patients in the United States. In 2010, 80,710 of 6,280,710 hospitalized children malnutrition (CDM). This report summarizes nationally representative, person-level characteristics of hospitalized children with a CDM. Data are from the 2010 Healthcare Cost and Utilization Project, which contains patient-level data on hospital inpatient stays. When weighted appropriately, estimates from the project represent all U.S. hospitalizations. The data set contains up to 25 ICD-9-CM diagnostic codes for each patient. Children with a CDM listed during hospitalization were identified. In 2010, 1.3% of hospitalized patients malnutrition's true prevalence may be underrepresented. Length of stay among children with a CDM was almost 2.5 times longer than those without a CDM. Hospital costs for children with a CDM were >3 times higher than those without a CDM. Hospitalized children with a CDM were less likely to have routine discharge and almost 3.5 times more likely to require postdischarge home care. Children with a CDM were more likely to have multiple comorbidities. Hospitalized children with a CDM are associated with more comorbidities, longer hospital stay, and higher healthcare costs than those without this diagnosis. These undernourished children may utilize more healthcare resources in the hospital and community. Clinicians and policymakers should factor this into healthcare resource utilization planning. Recognizing and accurately coding malnutrition in hospitalized children may reveal the true prevalence of malnutrition. © 2016 American Society for Parenteral and Enteral Nutrition.

  20. Inequalities in pediatric avoidable hospitalizations between Aboriginal and non-Aboriginal children in Australia: a population data linkage study. (United States)

    Falster, Kathleen; Banks, Emily; Lujic, Sanja; Falster, Michael; Lynch, John; Zwi, Karen; Eades, Sandra; Leyland, Alastair H; Jorm, Louisa


    Australian Aboriginal children experience a disproportionate burden of social and health disadvantage. Avoidable hospitalizations present a potentially modifiable health gap that can be targeted and monitored using population data. This study quantifies inequalities in pediatric avoidable hospitalizations between Australian Aboriginal and non-Aboriginal children. This statewide population-based cohort study included 1 121 440 children born in New South Wales, Australia, between 1 July 2000 and 31 December 2012, including 35 609 Aboriginal children. Using linked hospital data from 1 July 2000 to 31 December 2013, we identified pediatric avoidable, ambulatory care sensitive and non-avoidable hospitalization rates for Aboriginal and non-Aboriginal children. Absolute and relative inequalities between Aboriginal and non-Aboriginal children were measured as rate differences and rate ratios, respectively. Individual-level covariates included age, sex, low birth weight and/or prematurity, and private health insurance/patient status. Area-level covariates included remoteness of residence and area socioeconomic disadvantage. There were 365 386 potentially avoidable hospitalizations observed over the study period, most commonly for respiratory and infectious conditions; Aboriginal children were admitted more frequently for all conditions. Avoidable hospitalization rates were 90.1/1000 person-years (95 % CI, 88.9-91.4) in Aboriginal children and 44.9/1000 person-years (44.8-45.1) in non-Aboriginal children (age and sex adjusted rate ratio = 1.7 (1.7-1.7)). Rate differences and rate ratios declined with age from 94/1000 person-years and 1.9, respectively, for children aged primary care, have potential to narrow this gap.

  1. Job sharing at a children's hospital: evaluation by medical staff. (United States)

    Valentine, J P; Martin, C J


    To evaluate job sharing for registrars at Princess Margaret Hospital for Children, Perth, by seeking responses from members of the relevant medical teams. A questionnaire was sent to all 126 medical staff within the hospital (and three managers in medical administration) asking their views on job sharing for registrars. Whether job sharing should continue, who should do it, at what stage of training, and the effects on patient care. Among the 77 respondents (60%) there was broad support for the continuation of job sharing at the hospital: only 5 of 37 consultants and 2 of 19 non-job sharing registrars rejected the idea (with a further 4 consultants uncertain). 43% Of the consultants who had worked with job sharing registrars thought continuity of care was adversely affected. The committee for physician training of the Royal Australasian College of Physicians emphasises that advanced training should be flexible, with a wide range of opportunities for individuals to plan an appropriate training programme in line with their personal goals. This study has shown that job sharing for registrars at Princess Margaret Hospital for Children allows this choice. Action on concerns over any adverse effects on patient care should resolve any persisting disquiet.

  2. Use of children's artwork to evaluate the effectiveness of a hospital preparation program. (United States)

    Wilson, C J


    Approximately 1.5 million children are hospitalized on an emergency basis per year and are not able to be fully prepared for the event due to the emergency (Azarnoff & Woody, 1981). For this reason many pre-crisis hospital preparation programs are being instituted by hospitals and pediatric nurses. This pilot study investigated the use of children's artwork to evaluate the effectiveness of a hospital preparation program. The 6 to 10 year old children attending summer school at a day care center participated in a hospital preparation program. The purpose of the program was to decrease children's anxieties and fears in the event of an emergency hospitalization.

  3. Diet and lifesyle of a cohort of primary school children

    Directory of Open Access Journals (Sweden)

    E. Caputo


    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

  4. Assisted autogenic drainage in infants and young children hospitalized with uncomplicated pneumonia, a pilot study. (United States)

    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.

  5. Inter-hospital transport of critically ill children.

    LENUS (Irish Health Repository)

    Aherne, E


    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.

  6. Bilingual Children with Primary Language Impairment: 3 Months after Treatment (United States)

    Pham, Giang; Ebert, Kerry Danahy; Kohnert, Kathryn


    Background: Evidence on the treatment effectiveness for bilingual children with primary language impairment (PLI) is needed to advance both theory and clinical practice. Of key interest is whether treatment effects are maintained following the completion of short-term intense treatments. Aims: To investigate change in select language and cognitive…

  7. Long-term outcome of Tunisian children with primary ciliary ...

    African Journals Online (AJOL)

    Background: Primary ciliary dyskinesia (PCD) is rare. Its diagnosis requires experienced specialists and expensive infrastructure. Its prognosis is variable. Objective: To study the long-term outcome of PCD in Tunisian children with ciliary ultra-structure defects detected by electron microscope. Methods: Covering a period of ...

  8. Prediction of primary vs secondary hypertension in children. (United States)

    Baracco, Rossana; Kapur, Gaurav; Mattoo, Tej; Jain, Amrish; Valentini, Rudolph; Ahmed, Maheen; Thomas, Ronald


    Despite current guidelines, variability exists in the workup of hypertensive children due to physician preferences. The study evaluates primary vs secondary hypertension diagnosis from investigations routinely performed in hypertensive children. This retrospective study included children 5 to 19 years with primary and secondary hypertension. The proportions of abnormal laboratory and imaging tests were compared between primary and secondary hypertension groups. Risk factors for primary vs secondary hypertension were evaluated by logistic regression and likelihood function analysis. Patients with secondary hypertension were younger (5-12 years) and had a higher proportion of abnormal creatinine, renal ultrasound, and echocardiogram findings. There was no significant difference in abnormal results of thyroid function, urine catecholamines, plasma renin, and aldosterone. Abnormal renal ultrasound findings and age were predictors of secondary hypertension by regression and likelihood function analysis. Children aged 5 to 12 years with abnormal renal ultrasound findings and high diastolic blood pressures are at higher risk for secondary hypertension that requires detailed evaluation. © 2012 Wiley Periodicals, Inc.

  9. Intestinal Parasitic Infections in Primary School Children in Rural ...

    African Journals Online (AJOL)

    Background: Intestinal parasitic infections are a major public health problem in developing countries where majority of the affected persons are children. This study is aimed at determining the prevalence of intestinal parasitic infections and the effect of socio-demography in some rural primary schools in Ovia Northeast ...

  10. Attitudes to School Science Held by Primary Children in Pakistan (United States)

    Iqbal, Hafiz Muhammad; Nageen, Tabassum; Pell, Anthony William


    Attitudes to science scales developed earlier in England have been used in and around a Pakistan city with children in Primary/Elementary Grades 4-8. The limitations of a "transferred scale" in a culturally different context are apparent in a failure to reproduce the English factor patterns, but items are identified to serve as a base…

  11. Parental Involvement in Primary Children's Homework in Hong Kong (United States)

    Tam, Vicky C.; Chan, Raymond M.


    This study draws upon an ecological perspective to examine parental involvement in homework and its relationship with primary school children's educational outcomes within the Chinese sociocultural context of Hong Kong. Data were collected using homework diaries and questionnaires administered to 1,309 pairs of students and parents spanning all…

  12. Piagetian Cognitive Development and Primary Process Thinking in Children (United States)

    Wulach, James S.


    Thirty-seven middle-class white children, ages 5-8, were tested on eight Piagetian tasks and the Rorschach test, and divided into preoperational, transitional, and concrete operational groups. Measures of primary process vs. secondary process thinking were found to be related to the Piagetian stages of development. (GDC)

  13. Qualitative study of eating habits in Bruneian primary school children. (United States)

    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.

  14. Hospitalization Rate and Population-Based Incidence of Hospitalization for Community-Acquired Pneumonia Among Children in Suzhou, China. (United States)

    Shan, Wei; Shi, Ting; Zhang, Xiyan; Xue, Jian; Wang, Yin; Yu, Jia; Huang, Yukai; Lin, Sheng; Zhao, Genming; Tian, Jianmei; Zhang, Tao


    Data on hospitalization burden of CAP in children is very limited in China. This study aimed to estimate the hospitalization rate and population-based incidence of hospitalization of CAP for children <15 years of age in Suzhou, China. This was a retrospective study of children hospitalized in Soochow University Affiliated Children's Hospital (SCH) from January 2010 to December 2014. Children who were residents of downtown Suzhou, 29 days to <15 years of age, with discharge diagnosis codes (ICD-10) including J09 to J18 and J20 to J22 were included. All-cause clinical community-acquired pneumonia (CCAP) and radiographically confirmed pneumonia (RCAP) were identified based on individual medical chart review. The hospitalization rate (HR) and population-based cumulative incidence of hospitalization (HI) were calculated. Among 184,734 children <15 years old admitted to SCH during the study period, 31,302 children were identified as having CCAP, and 24,218 (77.4%) children confirmed as having RCAP. CCAP hospitalization occurred year round and peaked during winter and early spring. The overall HRs for CCAP and RCAP were 189.0 (95%CI, 187.1-190.9) and 146.2 (95%CI, 144-148) per 1,000 hospitalizations respectively, and the HIs per 100,000 children annually were CCAP, 3,235.8 (95%CI, 3207.3-3264.2) and RCAP, 2,503.5 (95%CI, 2,478.3-2,528.6). For children <5 years old, the HR for CCAP was 248.4 (95%CI, 245.9-250.9) and RCAP 194.0 (95%CI, 191.4-196.3) per 1,000 hospitalizations; the HI for CCAP was 6,956.2 (95%CI: 6,892.8-7,019.6) and 5,431.9 (95%CI: 5,375.4-5,488.4) per 100,000 children for RCAP. The highest HR and HI were observed in children 29 days to <6 months old: HR for CCAP was 407.4 (95%CI: 400.9-413.9) per 1,000 hospitalizations and HI for CCAP was 11,203.7 (95%CI: 11,026.8-11,380.6) per 100,000 children annually. There is a considerable burden of CAP among children <15 years of age in Suzhou, particularly among children 29 days to <6 months of age and during winter

  15. Evaluation of vitamin D levels in children with primary epistaxis. (United States)

    Almis, Habip; Bucak, Ibrahim Hakan; Caliskan, Muhammed Nebi; Turgut, Mehmet


    This study aimed to investigate whether there is a relationship between 25-hydroxy vitamin D [25(OH)D 3] values and incidences of primary epistaxis among children. A total of 42 cases and 55 matched controls were included in our study. The study group and control group were well matched for age and gender. Age, gender, activated partial thromboplastin time (APTT) with reference to the international normalized ratio (INR), prothrombin time (PT), and 25(OH)D 3, parathormone (PTH), alkaline phosphatase (ALP), calcium (Ca), magnesium (Mg), and phosphorus (P) values were recorded for each participant. Serum 25(OH) D values were found to be statistically significantly (P = 0.03) lower in children with primary epistaxis than in the healthy control group. Our study also revealed that 25(OH) D values were considerably (P epistaxis and upper respiratory tract infections (RTI) than in the group with primary epistaxis without upper RTI. Univariate logistic regression analyses demonstrated that 25(OH)D 3 epistaxis. Furthermore, multivariate logistic regression analyses revealed that 25(OH)D 3 epistaxis. Many studies have revealed that vitamin D is a preventive and therapeutic agent for inflammation and infection, thereby providing benefits for children with primary epistaxis. In line with this, our study suggested that a patient's vitamin D status could also be important for the prevention of childhood primary epistaxis, although further studies are required to validate our findings. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  16. Increasing Short-Stay Unplanned Hospital Admissions among Children in England; Time Trends Analysis ’97–‘06 (United States)

    Saxena, Sonia; Bottle, Alex; Gilbert, Ruth; Sharland, Mike


    Background Timely care by general practitioners in the community keeps children out of hospital and provides better continuity of care. Yet in the UK, access to primary care has diminished since 2004 when changes in general practitioners' contracts enabled them to ‘opt out’ of providing out-of-hours care and since then unplanned pediatric hospital admission rates have escalated, particularly through emergency departments. We hypothesised that any increase in isolated short stay admissions for childhood illness might reflect failure to manage these cases in the community over a 10 year period spanning these changes. Methods and Findings We conducted a population based time trends study of major causes of hospital admission in children 2 days. By 2006, 67.3% of all unplanned admissions were isolated short stays <2 days. The increases in admission rates were greater for common non-infectious than infectious causes of admissions. Conclusions Short stay unplanned hospital admission rates in young children in England have increased substantially in recent years and are not accounted for by reductions in length of in-hospital stay. The majority are isolated short stay admissions for minor illness episodes that could be better managed by primary care in the community and may be evidence of a failure of primary care services. PMID:19829695

  17. A clinicopathologic study of primary focal segmental glomerulosclerosis in children

    Directory of Open Access Journals (Sweden)

    Ali Lanewala


    Full Text Available There is very little information in the literature on the treatment and prognosis of primary focal segmental glomerulosclerosis (FSGS among children in Pakistan. This is a review of 94 children (≤16 years with a diagnosis of primary FSGS who presented to the Sindh Institute of Urology and Transplantation between 1995 and 2008. The clinical records and original renal biopsy reports were reviewed to determine demographic, clinical, laboratory and pathologic features. Renal biopsies were studied by light microscopy, immunofluoroscence and electron microscopy. Thera-peutic regimens and response to therapy were analyzed. Majority of the children (60, 63.8% had steroid-dependant nephrotic syndrome (SDNS and 33 (35% had steroid-resistant nephrotic syndrome (SRNS. Cyclosphosphamide was used in SDNS, and this produced complete remission (CR in 25/36 (69.4%, partial response (PR in 4/36 (11% and no response in 7/36 (19.4% cases. Cyclosporine was used in SRNS and some SDNS children, and showed a CR in 30 (52.6%, PR in 20 (35% and no response in seven (12.2% cases. Tacrolimus was used in seven (7.44% children. CR was obtained in two (28.5% and PR in five (71.4% cases. Renal insufficiency developed in 12 (12.7% children. Results from this study show that majority of the children with primary FSGS at our center could achieve high rates of sustained remission with second- and third-line immunosuppressive therapies with fairly good prognosis.

  18. IVC filter placements in children: nationwide comparison of practice patterns at adult and children's hospitals using the Kids' Inpatient Database. (United States)

    Wadhwa, Vibhor; Trivedi, Premal S; Ali, Sumera; Ryu, Robert K; Pezeshkmehr, Amir


    Inferior vena cava (IVC) filter placement in children has been described in literature, but there is variability with regard to their indications. No nationally representative study has been done to compare practice patterns of filter placements at adult and children's hospitals. To perform a nationally representative comparison of IVC filter placement practices in children at adult and children's hospitals. The 2012 Kids' Inpatient Database was searched for IVC filter placements in children filter insertion (38.7), IVC filter placements were identified. A small number of children with congenital cardiovascular anomalies codes were excluded to improve specificity of the code used to identify filter placement. Filter placements were further classified by patient demographics, hospital type (children's and adult), United States geographic region, urban/rural location, and teaching status. Statistical significance of differences between children's or adult hospitals was determined using the Wilcoxon rank sum test. A total of 618 IVC filter placements were identified in children filters were placed in the setting of venous thromboembolism in children's hospitals (40/44, 90%) compared to adult hospitals (246/573, 43%) (Pfilters comprised 327/573 (57%) at adult hospitals, with trauma being the most common indication (301/327, 92%). The mean length of stay for patients receiving filters was 24.5 days in children's hospitals and 18.4 days in adult hospitals. The majority of IVC filters in children are placed in adult hospital settings. Children's hospitals are more likely to place therapeutic filters for venous thromboembolism, compared to adult hospitals where the prophylactic setting of trauma predominates.

  19. Children stories about primary schools: sceneries and (autobiographic research challenges

    Directory of Open Access Journals (Sweden)

    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.

  20. Differential approach to treatment of primary nocturnal enuresis in children

    Directory of Open Access Journals (Sweden)

    Nesterenko O.V.


    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

  1. Mnemonic abilities of primary school children with delayed mental development.

    Directory of Open Access Journals (Sweden)

    Murafa S.V.


    Full Text Available This paper presents the results of research regarding the mnemonic abilities of primary school children with developmental delays. Empirical studies of impaired mental development offer an opportunity to elucidate the psychological mechanisms underlying the process of normal development and enable us to consider at a micro level the formation of mental processes in ontogeny, which would, under normal conditions, be nondescript and not always amenable to psychological analysis. The research addresses an experimental investigation of productivity and qualitative characteristics of mnemonic abilities among primary school students with developmental delays. V.D. Shadrikov’s Theory of Abilities, developed in a systemic approach framework, is the theoretical basis of the research. The method of deploying a memorization activity, as elaborated by V.D. Shadrikov and L.V. Cheremoshkina, was the investigation tool used. The sample included students in grades 1 to 4 between ages 7 to 12 and included a total of 100 children (66 boys and 34 girls. The control group of primary school students with typical development included 105 children (50 boys and 55 girls. The research consisted of several stages: a pilot study, experimental research (the test task was to memorize card #1; the basic task was to memorize cards #2 and #3; to reproduce cards #2 and #3; and to poll the students, mathematical data processing, and a description of the levels of mnemonic ability development among primary students with developmental delays. The following procedures were employed during statistical analysis: Spearman r3, Mann-Whitney U-test, Jonckheere-Terpstra test, and Kruskal-Wallis test. The structure of mnemonic abilities in primary schoolchildren with developmental delays was determined to vary according to the underdevelopment of their operational mechanisms. For example, memory functions are based on the use of inborn mechanisms, and a portion of children differ in the

  2. Systematic literature review of hospital medication administration errors in children

    Directory of Open Access Journals (Sweden)

    Ameer A


    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

  3. Tube thoracostomy: Primary management option for empyema thoracis in children

    Directory of Open Access Journals (Sweden)

    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.

  4. [Ocular traumatism in children at Laquintinie Hospital, Douala (Cameroon)]. (United States)

    Bella-Hiag, A L; Mvogo, C E


    Pediatric ophthalmology is poorly developed in Cameroon. However, efforts are being made to collect data essential for the development of national strategies to combat blindness. We relate our experience, within this framework, at a large public hospital in Cameroon. We carried out a retrospective study covering the period from June 1993 to May 1998, studying the medical files of children under the age of 15 years with ocular traumatism. Data were collected from 144 files. The frequency of ocular/orbital injury was 7.8% and was the third most common condition, after ametropia and kerato-conjunctivitis, in this population. The mean age of the children was 7 years and 3 months and more boys (64%) than girls were affected. Ocular lesions were due to contusion in 83.3% of cases. The principal causes of the trauma were children's games (40.2%), and punishment by parents or teachers (23.7%). The ocular lesions were similar to those described in previous studies. Infection was rare, because the interval from trauma to consultation was very short. The functional prognosis was severe, with 24.3% of patients having final vision less than 1/10. We recommend that children should be informed about the dangers of violent games and that parents and teachers should be made aware of the dangers associated with brutality towards children. Finally, ophthalmologists should ensure that the injured eye is treated rapidly and carefully so as to minimize functional sequelae.


    Directory of Open Access Journals (Sweden)

    Kashmala khan


    Full Text Available Background: School going children is important part of our society. Their growth, development and body weight is of utmost significance and presents general health status of a community and nation as a whole. For the assessment of nutritional status WHO Asian cuts-off BMI for age recommended BMI less than 18.5 kg/m considered underweight, 18.5-24.9 normal weight, more than 25 overweight. The objective of this study is to access body mass status among primary school going children of Hyderabad. Methods: The study design was cross sectional study in which different school of Hyderabad were selected to collect data (semi government and private sector.This study has assessed the body mass index between 7-14 years old age group of both genders of primary school going children of Hyderabad. BMI has calculated with the help of weight and height of the body. Result: In this study out of 100 children 10%were 7-8 year old 20% were 9-10 year old, 20% were 11-12year old and 30% were 13-14 year old. The analysis shows 80% were underweight (below 18.5, 18% were normal weight (18.5-24.9 and only 2% overweight (above 25 according to the Asian cut-off value of BMI for Asian children. When it was analyzed by gender 62% of the boys and 18% of the girls were underweight, 6% of boys and 12% out of girls were normal weight, 2% of the boys were overweight no girl found overweight in the study. In the above study 80% found underweight, 18% normal weight, 2% overweight. Conclusion: Under nutrition among the school going children is currently a health problem faced by Hyderabad school going children. There is need to be taken address these problems in order to prevent nation from nutritional deficiency among school going children and buildup a strong and healthy nation in future.

  6. [Investigation on nutritional intakes for hospitalized children with blood disease]. (United States)

    Xu, Zi-Liang; Wu, Yun-Tang; Sun, Zhong; Zhu, Xiao-Fan; Li, Rui; Li, Hong-Qiang; Qi, Yu-Mei; Song, Ji-Chang; Han, Zhong-Chao


    To investigate the diet and nutritional status of hospitalized children with blood disease in order to provide nutritional guidelines. The patients' daily dietary intakes, including breakfast, lunch, dinner and additional meals, were recorded in detail for seven consecutive days. The intake amount of various nutrients was calculated using the dietary database. The majority of children with blood disease showed inadequate intakes of calories [mean 1825.81 kCal/d, 73.62% of the recommended intake (RNI)] and protein (mean 67.68 g/d, 81.34% of RNI). Intakes of vitamin E and riboflavin were adequate, but intakes of vitamin A, thiamine and vitamin C (66.67%, 77.78% and 69.89% of RNI, respectively) were inadequate. Iron and selenium intakes were adequate, but calcium and zinc intakes (41.11% and 56.21% of RNI, respectively) were grossly inadequate. Hospitalized children with blood disease had decreased dietary intakes of calories, protein, vitamin A, vitamin C, thiamin, calcium and zinc. The dietary pattern and nutritional intake need to be improved.

  7. Factors affecting subspecialty referrals by pediatric primary care providers for children with obesity-related comorbidities. (United States)

    Walsh, Carolyn O; Milliren, Carly E; Feldman, Henry A; Taveras, Elsie M


    To determine referral patterns from pediatric primary care to subspecialists for overweight/obesity and related comorbidities. We used the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey to identify overweight/obesity and 5 related comorbidities in primary care visits between 2005 and 2009 by children 6 to 18 years. The primary outcome was whether the visit ended in referral. We used multivariable analysis to examine factors associated with referral. We identified 34,225 database visits. A total of 17.1% were with overweight (body mass index=85th to 94th percentile) or obese (body mass index≥95th percentile) patients. A total of 7.1% of primary care visits with overweight/obese children ended in referral. Referral was more likely when obesity was the reason for visit (odds ratio=2.83; 95% confidence interval=1.61-4.97) but was not associated with presence of a comorbidity (odds ratio=1.35; 95% confidence interval=0.75-2.44). Most overweight or obese children are not referred, regardless of comorbidity status. One reason may be low levels of appropriate diagnosis.

  8. [Relationship between hyperuricemia and primary nephrotic syndrome in children]. (United States)

    Xiao, Huijie; Li, Qian; Wang, Fang; Yao, Yong; Zhong, Xuhui


    To analyze the relationship between hyperuricemia and primary nephrotic syndrome in childhood. A retrospective study was carried out in 107 children with primary nephrotic syndrome. The clinical data were analyzed with statistical methods to identify the related factors with hyperuricemia. The morbidity of hyperuricemia in children with primary nephrotic syndrome was 45% (48/107). Compared to those in normal serum uric acid group, the incidence of hypertension (33%, 16/48), serum triglyceride [2.59(1.62-3.87) mmol/L], creatinine [43.85(33.38-56.38)mmol/L], urea [6.11(3.77-8.40)mmol/L] and blood uric acid/creatinine ratio [9.30(7.03-12.72)] increased while creatinine clearance rate [141.74(103.57-160.97)ml/(min·1.73 (2))] decreased in hyperuricemia group. Hyperuricemia in children with primary nephrotic syndrome correlated with the increase of serum creatinine, urea and blood uric acid/creatinine ratio, the decrease of creatinine clearance rate and the occurance of hypertension.

  9. Primary pneumocystis infection in infants hospitalized with acute respiratory tract infection

    DEFF Research Database (Denmark)

    Larsen, Hans Henrik; von Linstow, Marie-Louise; Lundgren, Bettina


    with 431 episodes of acute respiratory tract infection (RTI) by using a real-time PCR assay. In 68 episodes in 67 infants, P. jirovecii was identified. The odds ratio (95% confidence interval) of a positive signal compared with the first quartile of age (7-49 days) was 47.4 (11.0-203), 8.7 (1......Acquisition of Pneumocystis jirovecii infection early in life has been confirmed by serologic studies. However, no evidence of clinical illness correlated with the primary infection has been found in immunocompetent children. We analyzed 458 nasopharyngeal aspirates from 422 patients hospitalized.......9-39.7), and 0.6 (0.1-6.7) for infants in the second (50-112 days), third (113-265 days), and fourth (268-4,430 days) age quartiles, respectively. Infants with an episode of upper RTI (URTI) were 2.0 (1.05-3.82) times more likely to harbor P. jirovecii than infants with a lower RTI. P. jirovecii may manifest...

  10. Mental Adaptation Problems of Children in a Primary School

    Directory of Open Access Journals (Sweden)

    Selma Dogan


    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: 47-52

  11. Mental Adaptation Problems of Children in a Primary School

    Directory of Open Access Journals (Sweden)

    Selma Dogan


    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

  12. Management of physical child abuse in South Africa: literature review and children's hospital data analysis. (United States)

    Janssen, T L; van Dijk, M; Al Malki, I; van As, A B


    The reason for this review is the lack of data on the management of physical abused children in Africa. The primary goal of the first part is to outline the management of physical child abuse in (South) Africa and provide suggestions for other governments in Africa on which to base their management of physical child abuse, at both governmental and hospital management level. The main aim of the second part is to outline the extent of the problem as seen at the Red Cross Memorial Children's Hospital (RCH) in Cape Town. The National Library of Medicine's PubMed database was searched for articles specifically about the management of physical child abuse. Hospital data were analysed in two phases: one addressed various types of assault in order to assess the number of patients admitted to the trauma unit of RCH between 1991 and 2009, and the other to identify all children with suspected non-accidental injury (NAI) presenting to the trauma unit at RCH from January 2008 until December 2010. Information on physical abuse of children in Africa in the English scientific literature remains disappointing with only two articles focusing on its management. RCH data for the period 1991-2009 recorded a total number of 6415 children hospitalised with injuries following assault, who accounted for 4.2% of all trauma admissions. Types of abuse included assault with a blunt or sharp instrument, rape/sexual assault and human bite wounds. Over the last 2 decades, there has been a minor decline in the number of cases of severe abuse requiring admission; admissions for other injuries have remained stable. More detailed analysis of hospital data for 2008-2010, found that boys were far more commonly assaulted than girls (70.5% vs 29.5%). Physical abuse appeared to be the most common cause of abuse; 89.9% of all boys and 60.5% of all girls presented after physical abuse. In order to eradicate child abuse, awareness of it as to be promoted in the community at large. Because the types of child

  13. Factor structure of functional state of primary school age children

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    Davidenko O.V.


    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.

  14. Urinary tract infection in Children Hospitalized at Constanta Clinical Infectious Diseases Hospital

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    Pînzaru Anca Daniela


    Full Text Available Introduction: In pediatrics, the urinary tract infection is one of the most frequent bacterial infection, representing an important health problem due to its high incidence, wide etiology, asymptomatic evolution, and multiple and sever complications, relapses and sequelae.” Material and Method: We evaluated 45 children, aged between 6 months and 16 years, diagnosed and treated for urinary tract infection at the Clinical Infectious Diseases Hospital, of Constanta County, in a period of 3 years and 6 months. Results: During studied period, between January 2014 and June 2017 from a total of 9343 patients admitted to the Constanta Clinical Infectious Diseases Hospital, we selected 45 children (4.81‰ diagnosed with urinary tract infection. The average age of children with urinary tract infections was 5 years and 5 months. The gender distribution revealed a 2:1 balance in girl’s favor. The most affected group of age was 1-3 years. Fever was the dominating symptom. Urine cultures were positive for 37 cases, meanwhile for eight cases had been negative. The predominant germs are E. coli for female and for male Proteus. We noticed that for E. coli the highest sensitivity is preserved to Ertapenem -15 cases, followed by Ceftriaxone and Ciprofloxacin -10 cases each, and Gentamycin -9 cases. Conclusions: Pediatric urinary tract infection should be considered in every patient under 3 years with unexplained fever.


    Directory of Open Access Journals (Sweden)

    Dwiyanti Puspitasari


    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.

  16. Hospitalized children drawing their pain: the contents and cognitive and emotional characteristics of pain drawings. (United States)

    Kortesluoma, Riitta-Liisa; Punamäki, Raija-Leena; Nikkonen, Merja


    Describing pain is difficult. Children like to draw, and through their drawing they reveal worrying issues. This study aimed to examine how hospitalized children express pain through drawings, and was carried out by examining children's thematic drawings of pain. A comparison was made between hospitalized children and healthy control groups with respect to the thematic contents and cognitive and emotional characteristics of pain drawings. The drawings were sorted in categories on the basis of content, and cognitive competence and emotional disturbances by the Draw-a-Person procedure. The hospitalized children showed a lower level of cognitive capacity than their healthy controls. The control group children revealed a higher level of emotional disturbance than the hospitalized children. The groups differed in the contents of their drawings. The drawings of the hospitalized children frequently depicted medical procedures, whereas the drawings of the healthy controls depicted more consoling human and family relations.

  17. Resource utilization for observation-status stays at children's hospitals. (United States)

    Fieldston, Evan S; Shah, Samir S; Hall, Matthew; Hain, Paul D; Alpern, Elizabeth R; Del Beccaro, Mark A; Harding, John; Macy, Michelle L


    Observation status, in contrast to inpatient status, is a billing designation for hospital payment. Observation-status stays are presumed to be shorter and less resource-intensive, but utilization for pediatric observation-status stays has not been studied. The goal of this study was to describe resource utilization characteristics for patients in observation and inpatient status in a national cohort of hospitalized children in the Pediatric Health Information System. This study was a retrospective cohort from 2010 of observation- and inpatient-status stays of ≤2 days; all children were admitted from the emergency department. Costs were analyzed and described. Comparison between costs adjusting for age, severity, and length of stay were conducted by using random-effect mixed models to account for clustering of patients within hospitals. Observation status was assigned to 67 230 (33.3%) discharges, but its use varied across hospitals (2%-45%). Observation-status stays had total median costs of $2559, including room costs and $678 excluding room costs. Twenty-five diagnoses accounted for 74% of stays in observation status, 4 of which were used for detailed analyses: asthma (n = 6352), viral gastroenteritis (n = 4043), bronchiolitis (n = 3537), and seizure (n = 3289). On average, after risk adjustment, observation-status stays cost $260 less than inpatient-status stays for these select 4 diagnoses. Large overlaps in costs were demonstrated for both types of stay. Variability in use of observation status with large overlap in costs and potential lower reimbursement compared with inpatient status calls into question the utility of segmenting patients according to billing status and highlights a financial risk for institutions with a high volume of pediatric patients in observation status.

  18. Hollow viscus injury in children: Starship Hospital experience

    Directory of Open Access Journals (Sweden)

    Upadhyay Vipul


    Full Text Available Abstract Starship Children's Hospital in Auckland, New Zealand, serves a population of 1.2 million people and is a tertiary institution for pediatric trauma. This study is designed to review all cases of abdominal injury (blunt and penetrating that resulted in injury of a hollow abdominal viscus including the stomach, duodenum, small intestine, large intestine and urinary bladder. The mechanism of injury; diagnosis and outcome were studied. This was done by retrospective chart review of patients admitted from January 1995 to December 2001. Thirty two injuries were found in 29 children. The age ranged from 7 months to 15 years with boys represented more commonly. Small bowel was the most frequently injured hollow viscus. Computerized Tomography (CT scan is an extremely useful tool for the diagnosis of HVI.

  19. Out-of-hospital cardiac arrests in children and adolescents

    DEFF Research Database (Denmark)

    Rajan, Shahzleen; Wissenberg, Mads; Folke, Fredrik


    BACKGROUND: There is insufficient knowledge of out-of-hospital cardiac arrest (OHCA) in the very young. OBJECTIVES: This nationwide study sought to examine age-stratified OHCA characteristics and the role of parental socioeconomic differences and its contribution to mortality in the young...... 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...

  20. Differentiating Acute Otitis Media and Acute Mastoiditis in Hospitalized Children. (United States)

    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.

  1. Intervention Programmes for Developing Positive Self-Concepts in Hospitalized Children. (United States)

    Lizasoain, Olga; Polaino, Aquilino


    Describes a program implemented in Navarra, Spain, to prepare children for hospitalization and to provide psychopedagogical follow-up to develop positive self-concepts. Describes the effects of the program on 40 hospitalized children between the ages of 8 and 12, reporting a more positive self-concept among the children who received the…

  2. Interventions to Improve Safe Sleep Among Hospitalized Infants at Eight Children's Hospitals. (United States)

    Kuhlmann, Stephanie; Ahlers-Schmidt, Carolyn R; Lukasiewicz, Gloria; Truong, Therese Macasiray


    Within hospital pediatric units, there is a lack of consistent application or modeling of the American Academy of Pediatrics recommendations for safe infant sleep. The purpose of this study was to improve safe sleep practices for infants in nonneonatal pediatric units with implementation of specific interventions. This multi-institutional study was conducted by using baseline observations collected for sleep location, position, and environment (collectively, "safe sleep") of infants admitted to pediatric units. Interventions consisted of: (1) staff education, including a commitment to promote safe sleep; (2) implementing site-generated safe sleep policies; (3) designating supply storage in patient rooms; and/or (4) caregiver education. Postintervention observations of safe sleep were collected. Eight hospitals participated from the Inpatient FOCUS Group of the Children's Hospital Association. Each site received institutional review board approval/exemption. Safe sleep was observed for 4.9% of 264 infants at baseline and 31.2% of 234 infants postintervention (Ppresent in 77% of cribs at baseline and 44% postintervention. However, the mean number of unsafe items observed in each sleeping environment was reduced by >50% (P=.001). Implementation of site-specific interventions seems to improve overall safe sleep in inpatient pediatric units, although continued improvement is needed. Specifically, extra items are persistently left in the sleeping environment. Moving forward, hospitals should evaluate their compliance with American Academy of Pediatrics recommendations and embrace initiatives to improve modeling of safe sleep. Copyright © 2016 by the American Academy of Pediatrics.

  3. Ciprofloxacin Use in Hospitalized Children: Approved or Off-label? (United States)

    Faghihi, Toktam; Tekmehdash, Leila Yavari; Radfar, Mania; Gholami, Kheirollah


    Fluoroquinolones are not routinely used as the first-line antimicrobial therapy in pediatrics. The American Academy of Pediatrics (AAP) and the United States Food and Drug Administration (FDA) approved fluoroquinolones on certain indications in children. The aim of this study was to evaluate to what extent and how ciprofloxacin is used on approved indication or as off-label. Besides, dose adequacy and treatment duration were assessed. In a 10-month observational study, all children receiving systemic ciprofloxacin were assessed. We classified ciprofloxacin prescription to an AAP/FDA or off-label indication. The off-label prescriptions were further categorized to justified and unjustified therapy subgroups. The AAP/FDA category and the justified subgroup constituted the appropriate prescriptions. During the study period, 32 patients were prescribed ciprofloxacin. In general, 37% (12) of prescriptions determined to be appropriate. Of the appropriate prescriptions, 7 were AAP/FDA-approved indications. Children with Crohn's disease with abdominal abscess and children with infectious bloody diarrhea constituted the off-label; justified therapy subgroup. Unjustified prescriptions mainly occurred in the presence of a suitable alternative antibiotic for ciprofloxacin. Mean ± SD of ciprofloxacin dose (mg/kg/day) and duration (days) were 21.25 ± 6.35 and 13.56 ± 8.48, respectively. Of the appropriate prescriptions, 41% were underdosed. Underdosing was more encountered in patients with cystic fibrosis. Duration of treatment of the appropriate prescriptions was determined to be appropriate. The majority of children were receiving ciprofloxacin off-label and in an inappropriate manner. This issue emphasizes that antimicrobial stewardship program on ciprofloxacin use in pediatric hospitals should be implemented. Further studies evaluating clinical and microbiological outcomes of these programs in children are needed.

  4. Identification and Evaluation of Abused Children at Imam Hossein Hospital. (United States)

    Arabghol, Fariba; Derakhshanpour, Firooze; Davari Ashtiyani, Rozita; Chimeh, Narges; Panaghi, Layli


    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. The present study was conducted to identify and evaluate cases of abused children at a medical center. 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. 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%). 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.

  5. Mercury Hair Concentration among Primary School Children in Malaysia

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    Nurul Izzah Abdul Samad


    Full Text Available The main concern regarding mercury exposure is the adverse health effect on the developing nervous system. The objective of this cross-sectional study was to determine hair mercury levels and their association with socio-demographic characteristics, complaints about mercury poisoning symptoms and the fish consumption pattern among children in Malaysia. A cross-sectional study was conducted among 215 school children aged 11 years old. Hair was collected from the children and the total mercury was analyzed using oxygen combustion–gold amalgamation atomic absorption spectrophotometry. Anthropometric data, a fish consumption questionnaire and mercury poisoning symptoms were collected during a personal interview. The mean hair mercury level among primary school children was 0.63 ± 0.59 µg/g with the geometric mean of 0.47 µg/g. A total of 14% of respondents had hair mercury levels above 1 µg/g. A multiple binary logistic regression analysis outlined that fish consumption of at least one meal per week increased the likelihood of having a high mercury level (odds ratio (OR 3.7, 95% confidence interval (CI 1.3–10.4. This study confirms the existence of a mercury burden among Malaysian children and the level is high compared to other regional studies. This study provides important baseline data regarding the mercury level among children in Malaysia.

  6. Morbidity and mortality pattern of hospitalized children with measles at mayo hospital, lahore (epidemic 2013)

    International Nuclear Information System (INIS)

    Javed, T.; Bibi, A.


    Major outbreak of measles took place in Punjab recently (2013), leading on to increase in hospitalized cases of measles in children wards, with unacceptably high morbidity and mortality. The aim of this study was to find out morbidity and mortality pattern of hospitalized cases of measles and associated factors. Design: Prospective case series conducted at Pediatric Department Mayo Hospital, Lahore for 7 months, i.e. from 1st Jan to 31st Jul 2013 Methods:A total of 628 cases of measles were admitted in the children ward, Unit II, Mayo Hospital, Lahore from Jan-Jul 2013. The diagnosis was assigned using WHO criteria. Cases were admitted through emergency on 24 hour basis and managed in HDU and Measles isolation section. Chest X-Ray and blood complete examination was done in all cases. Complications were noted and managed along with eye consultations where necessary. Data was recorded in a predesigned proforma and entered in computer. Results: 628 admitted cases were enrolled, with comparable sex distribution, having mean age 30.8+-26.25 months and mean weight 9.69+-4.14 Kg. Eighty three percent cases were below 6 years of age (33% <1 year), 71% cases were under weight and 68% were wasted (WHO classification). Sixty six percent cases had not received measles vaccination, 144 (23%) cases had received a single dose and 71 cases (12.2%) had received two doses before admission. Majority of cases belonged to Lahore city and its peri-urban areas (83%). Pneumonia (80%), diarrhea (37%), and encephalitis (7.7%) were common complications. Eye complications (corneal ulcers, keratitis, perforation and blindness) were seen in 7.3% cases. Being under weight, H/O improper measles immunization, presence of anemia, pneumonia and encephalitis were statistically significant risk factors for mortality. The case fatality rate was 8.76%. Conclusion:Recent Measles outbreak further highlights the importance of strengthening the need for routine and mass vaccination for all children. In a


    Directory of Open Access Journals (Sweden)

    Kashmala Khan


    Full Text Available Background: Children were major part of our society and their health issues were too much, so it’s necessary that child should b healthy so their health assessment is important worldwide the acceptable method for assessment of health status is anthropometry (weight & height. This study was done to assess the anthropometric measurement of primary school going children of Karachi, sindh Pakistan, and evaluate how much students were underweight. Methods: The study was done in different primary school of Karachi including private semiprivate and government. The study design was cross sectional study. The sample size of our study was 240, including both genders male& female with range between 7-12 years. Result: The result shows that 34.9% were underweight (below 5th percentile, 63.44% were normal weight (between 5-95th percentile and only0.8% overweight (above 95th percentile.The result showed male-female ratio was 51.5% boys and 48.5% were underweight. The prevalence of underweight in private sector was only 9.5% but in government it was 45.5%.The height of student also calculated and 26.3% children were below the 5th percentile of height for the age, 62.8% were between 5th to 95th percentile and 10.9% above 95thpercentile. Conclusion: The prevalence of underweight in primary school going children in Karachi shows the dietary requirements of children are not fulfilled properly and this may lead to many sever pathological conditions, so it is necessary to take positive steps regarding awareness of proper diet, hygiene and growth & development of child.

  8. [Antibiotic resistance analysis of Streptococcus pneumoniae isolates from the hospitalized children in Shanxi Children's Hospital from 2012 to 2014]. (United States)

    Ge, L L; Han, Z Y; Liu, A H; Zhu, L; Meng, J H


    Objective: To investigate the antibiotic resistance status of Streptococcus pneumoniae isolates from hospitalized children in Shanxi Children's Hospital. Method: E-test and Kirby-Bauer methods were applied to determine drug sensitivity of the isolates collected from the body fluid specimens of hospitalized children in Shanxi Children's Hospital from January 2012 to December 2014. The antimicrobial sensitivity and minimum inhibitory concentration (MIC) of Streptococcus pneumoniae to the conventional antibiotics were analyzed, in order to compare the annual trends of non-invasive isolates, while the differentiation of sensitivity from specimens. The comparison of rates was performed by Chi-squared test and Fisher's exact test. Result: A total of 671 isolates of streptococcus pneumoniae were obtained, which could be divided as non-invasive isolates(607), invasive isolates from non-cerebrospinal fluid(non-CSF)(40) and invasive isolates from cerebrospinal fluid(CSF)(24). The antimicrobial sensitivity(isolates(%)) of the 671 isolates were respectively vancomycin 671(100.0%), linezolid 671(100.0%), levofloxacin 665(99.1%), penicillin 595(88.7%), ceftriaxone 516(76.9%), cefotaxime 512(76.3%), sulfamethoxazole-trimethoprin(SMZ-TMP) 103(15.4%), clindamycin 28(4.2%), tetracycline 26(3.9%), erythromycin 12(1.8%). From 2012 to 2014, the susceptibility rates of non-invasive isolates to penicillin every year were 95.0%(96/101), 97.3%(110/113), 87.3%(343/393), respectively, and there was significant difference among the three years(χ(2)=13.266, P penicillin were 0.064, 2.000, 6.000 in 2012, which grew up to 1.000, 3.000, 16.000 in 2014. There was no significant difference in the susceptibility rate of non-invasive isolates to ceftriaxone and cefotaxime during these three years, (χ(2)=1.172, 1.198, both P >0.05). On the other hand, the values of MIC(50, )MIC(90) and the maximum value of MIC(mg/L) of ceftriaxone and cefotaxime both increased from 0.500, 2.000, 8.000 in 2012 to 0

  9. Nurse led, primary care based antiretroviral treatment versus hospital care: a controlled prospective study in Swaziland

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    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.


    Directory of Open Access Journals (Sweden)

    Agata Nowak


    Full Text Available Objective: An attempt to determine the level of knowledge of teachers in the symptoms, diagnosis and treatment of psychomotor disorders of schoolchildren. Materials and methods: 174 teachers of physical education and integrated education in primary schools were tested. The study used questionnaire technique. Results: As the most common disorders in the population of school-age children surveyed teachers list ADHD (30% and dyslexia (30%. Only 34% of respondents correctly determined epidemiology of psychomotor disorders and listed their symptoms. Over 80% of respondents claimed that they had never worked with children exhibiting psychomotor disorders. The majority of respondents (98% did not participate in training on working with children with developmental disabilities. Results: The state of knowledge of psychomotor disorders of the surveyed teachers is low. Teachers have difficulty not only in defining the epidemiology of various disorders but also in correct definition of symptoms full spectrum.

  11. Prevalence of Refractive errors in Primary school children in a rural ...

    African Journals Online (AJOL)

    Prevalence of Refractive errors in Primary school children in a rural community in Ebonyi state of Nigeria. ... PROMOTING ACCESS TO AFRICAN RESEARCH ... However, no previous vision screening study among primary schools children ...

  12. Peer Victimization and Academic Performance in Primary School Children. (United States)

    Mundy, Lisa K; Canterford, Louise; Kosola, Silja; Degenhardt, Louisa; Allen, Nicholas B; Patton, George C

    Peer victimization is a common antecedent of poor social and emotional adjustment. Its relationship with objectively measured academic performance is unclear. In this study we aimed to quantify the cross-sectional associations between peer victimization and academic performance in a large population sample of children. Eight- to 9-year-old children were recruited from a stratified random sample of primary schools in Australia. Academic performance was measured on a national achievement test (1 year of learning equals 40 points). Physical and verbal victimization were measured according to child self-report. Multilevel mixed-effects linear regression analyses were conducted. For female children, verbal victimization was associated with poorer academic performance on writing (β = 17.2; 95% confidence interval [CI], -28.2 to -6.2) and grammar/punctuation (β = -20.8; 95% CI, -40.1 to -1.6). Physical victimization was associated with poorer performance on numeracy (male children: β = -29.0; 95% CI, -53.8 to -4.1; female children: β = -30.1; 95% CI, -56.6 to -3.5), and writing (female children: β = -21.5; 95% CI, -40.4 to -2.7). Verbal and physical victimization were associated with poorer performance on reading (male children: β = -31.5; 95% CI, -59.9 to -3.1; female children: β = -30.2; 95% CI, -58.6 to -1.8), writing (female children: β = -25.5; 95% CI, -42.8 to -8.2), spelling (female children: β = -32.3; 95% CI, -59.6 to -4.9), and grammar/punctuation (female children: β = -32.2; 95% CI, -62.4 to -2.0). Children who were physically victimized were 6 to 9 months behind their non-victimized peers on measures of academic performance. There are growing reasons for education systems to invest in the prevention of bullying and promotion of positive peer relationships from the earliest years of school. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  13. Bridging a divide: architecture for a joint hospital-primary care data warehouse. (United States)

    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.

  14. Archetype and object: primary deintegration and primary love in analytical play therapy with young children. (United States)

    Peery, J Craig


    Jungian and post-Jungian theory of the development of the child's psyche is reviewed. A discrimination between primary and secondary deintegration is suggested. Post-Freudian theory regarding primary object relations is integrated with the Jungian model. The two approaches can contribute synergistically to inform and advance play therapy with young children. Patients from widely diverse cultural backgrounds use their relationship with the therapist as a helpful person (object), and engage in archetypal material from the collective unconscious, to help them work on and through their unresolved emotional issues.

  15. CT characteristics of primary retroperitoneal neoplasms in children

    International Nuclear Information System (INIS)

    Xu Yufeng; Wang Jichen; Peng Yun; Zeng Jinjin


    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.

  16. The relationship between mothers' coping patterns and children's anxiety about their hospitalization as reflected in drawings. (United States)

    Burns-Nader, Sherwood; Hernandez-Reif, Maria; Porter, Maggie


    This study explored the relationships between hospitalized children's anxiety level, mothers' use of coping strategies, and mothers' satisfaction with the hospital experience. Twenty-four hospitalized children and their mothers participated in this study. Children were asked to draw a person in the hospital, which was then coded as a projective measure of anxiety; mothers were asked to complete questionnaires on their coping behaviors and their satisfaction with their child's hospital experience. The use of more coping strategies by the mothers was related to less anxiety in the children. In addition, the more coping strategies the mothers used, the higher they reported their satisfaction. The findings suggest the importance of providing resources aimed at increasing maternal coping and satisfaction with the quality of care of a child's hospitalization in order to minimize the negative effects of the hospitalization on the children.

  17. Increased mortality in patients hospitalized with primary hyperparathyroidism during the period 1977-1993 in Denmark

    DEFF Research Database (Denmark)

    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...

  18. Rural district hospitals - essential cogs in the district health system - and primary healthcare re-engineering. (United States)

    le Roux, K W D P; Couper, I


    The re-engineering of primary healthcare (PHC) is regarded as an essential precursor to the implementation of National Health Insurance in South Africa, but improvements in the provision of PHC services have been patchy. The authors contend that the role of well- functioning rural district hospitals as a hub from which PHC services can be most efficiently managed has been underestimated, and that the management of district hospitals and PHC clinics need to be co-located at the level of the rural district hospital, to allow for proper integration of care and effective healthcare provision.

  19. Clinical and laboratory signs associated to serious dengue disease in hospitalized children

    Directory of Open Access Journals (Sweden)

    Sheila Moura Pone


    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.

  20. Incidence of obsessive–compulsive disorder in children with nonmonosymptomatic primary nocturnal enuresis (United States)

    Yousefichaijan, Parsa; Khosrobeigi, Ali; Salehi, Bahman; Taherahmadi, Hassan; Shariatmadari, Fakhreddin; Ghandi, Yazdan; Alinejad, Saeed; Farhadiruzbahani, Fateme


    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 NMNE makes

  1. Incidence of obsessive-compulsive disorder in children with nonmonosymptomatic primary nocturnal enuresis. (United States)

    Yousefichaijan, Parsa; Khosrobeigi, Ali; Salehi, Bahman; Taherahmadi, Hassan; Shariatmadari, Fakhreddin; Ghandi, Yazdan; Alinejad, Saeed; Farhadiruzbahani, Fateme


    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). 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. 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. Compulsive and obsessive are more common in NMNE versus healthy children. The observed correlation between compulsive-obsessive and NMNE makes psychological counseling mandatory in children with NMNE.

  2. Erectile dysfunction among diabetic patients in Saudi Arabia: A hospital-based primary care study

    Directory of Open Access Journals (Sweden)

    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.

  3. Access to primary care and the route of emergency admission to hospital: retrospective analysis of national hospital administrative data. (United States)

    Cowling, Thomas E; Harris, Matthew; Watt, Hilary; Soljak, Michael; Richards, Emma; Gunning, Elinor; Bottle, Alex; Macinko, James; Majeed, Azeem


    The UK government is pursuing policies to improve primary care access, as many patients visit accident and emergency (A and E) departments after being unable to get suitable general practice appointments. Direct admission to hospital via a general practitioner (GP) averts A and E use, and may reduce total hospital costs. It could also enhance the continuity of information between GPs and hospital doctors, possibly improving healthcare outcomes. To determine whether primary care access is associated with the route of emergency admission-via a GP versus via an A and E department. Retrospective analysis of national administrative data from English hospitals for 2011-2012. Adults admitted in an emergency (unscheduled) for ≥1 night via a GP or an A and E department formed the study population. The measure of primary care access-the percentage of patients able to get a general practice appointment on their last attempt-was derived from a large, nationally representative patient survey. Multilevel logistic regression was used to estimate associations, adjusting for patient and admission characteristics. The analysis included 2 322 112 emergency admissions (81.9% via an A and E department). With a 5 unit increase in the percentage of patients able to get a general practice appointment on their last attempt, the adjusted odds of GP admission (vs A and E admission) was estimated to increase by 15% (OR 1.15, 95% CI 1.12 to 1.17). The probability of GP admission if ≥95% of appointment attempts were successful in each general practice was estimated to be 19.6%. This probability reduced to 13.6% when <80% of appointment attempts were successful. This equates to 139 673 fewer GP admissions (456 232 vs 316 559) assuming no change in the total number of admissions. Associations were consistent in direction across geographical regions of England. Among hospital inpatients admitted as an emergency, patients registered to more accessible general practices were more

  4. Coal Mine Air Pollution and Number of Children Hospitalizations because of Respiratory Tract Infection: A Time Series Analysis

    Directory of Open Access Journals (Sweden)

    Yonglin Liu


    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.

  5. [Nutritional risk screening and its clinical significance in 706 children hospitalized in the surgical department]. (United States)

    Peng, Lu-Ting; Li, Rong; Zhao, Wei-Hua; Chen, Yin-Hua; Li, Xiao-Mei; Chen, Meng-Ying; Cao, Jia; Li, Xiao-Nan


    To investigate nutritional risk and its relationship with clinical outcome in children hospitalized in the surgical department, and to provide a scientific basis for clinical nutrition management. Nutritional risk screening was performed on 706 children hospitalized in the surgical department using the Screening Tool for Risk on Nutritional Status and Growth. The data on nutritional support during hospitalization, incidence of infectious complications, length of hospital stay, post operative length of hospital stay and total hospital expenses were recorded. Of the 706 cases, 11.5% had high nutritional risk, 46.0% had moderate nutritional risk, and 42.5% had low nutritional risk. Congenital hypertrophic pyloric stenosis, intestinal obstruction and congenital heart disease were the three most common types of high nutritional risk. The incidence of high nutritional risk was significantly higher in infants than in other age groups (Pnutritional risk received parenteral nutrition. Children with high nutritional risk were significantly more likely to have weight loss than children with low nutritional risk (Pnutritional risk had significantly increased incidence of infectious complications, length of hospital stay, post operative length of hospital stay and total hospital expenses compared with those with moderate or low nutritional risk (Pnutritional risk is seen in children hospitalized in the surgical department. Nutritional risk score is correlated with clinical outcome. Nutritional support for these children is not yet properly provided. Nutritional risk screening and standard nutritional support should be widely applied among hospitalized children.

  6. Hospitalizations and deaths due to pertussis in children from 1996 to 2013

    Directory of Open Access Journals (Sweden)

    Janayne F. Mançaneira


    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.

  7. Sleep architecture in school-aged children with primary snoring. (United States)

    Zhu, Yin; Au, Chun-Ting; Lam, Hugh S; Chan, Ching-Ching K; Ho, Crover; Wing, Yun-Kwok; Li, Albert M


    We aimed to examine if sleep architecture was altered in school-aged children with primary snoring (PS). Children ages 6 to 13 years from 13 primary schools were randomly recruited. A validated obstructive sleep apnea (OSA) screening questionnaire was completed by their parents. Children at high risk for OSA and a randomly chosen low-risk group were invited to undergo overnight polysomnography (PSG) and clinical examination. Participants were classified into healthy controls, PS, mild OSA, and moderate to severe OSA (MS OSA) groups for comparison. A total of 619 participants underwent PSG (mean age, 10.0 ± 1.8 years; 396 (64.0%) boys; 524 (84.7%) prepubertal). For the cohort as a whole, there were no significant differences in measures of sleep architecture between PS and nonsnoring healthy controls. In the multiple regression model, percentage of nonrapid eye movement (NREM) stage 1 (N1) sleep had a significantly positive association, whereas percentage of slow-wave sleep (SWS) had a significantly negative association with sleep-disordered breathing (SDB) severity after controlling for age, gender, body mass index (BMI) z score, and pubertal status. In prepubertal children with PS, no significant disruption of sleep architecture was found. However, pubertal adolescent PS participants had significantly higher adjusted percentage of N1 sleep and wake after sleep onset (WASO) compared to healthy controls. PS did not exert significant adverse influences on normal sleep architecture in prepubertal school-aged children. Nevertheless, pubertal adolescents with PS had increased N1 sleep and WASO. Copyright © 2013 Elsevier B.V. All rights reserved.

  8. Clinical characteristics of lung abscess in children: 15-year experience at two university hospitals. (United States)

    Choi, Mi Suk; Chun, Ji Hye; Lee, Kyung Suk; Rha, Yeong Ho; Choi, Sun Hee


    Information on the clinical features of lung abscess, which is uncommon in children, at hospitalizationis helpful to anticipate the disease course and management. There is no report concerning lung abscess in Korean children. We aimed to identify the clinical characteristics of pediatric lung abscess and compare the difference between primary and secondary abscess groups. The medical records of 11 lung abscess patients (7 males and 4 females) from March 1998 to August 2011 at two university hospitals were retrospectively reviewed. The clinical characteristics, symptoms, underlying disease, laboratory and radiologic findings, microbiological results, and treatments were examined. Six patients had underlying structural-related problems (e.g., skeletal anomalies). No immunologic or hematologic problem was recorded. The mean ages of the primary and secondary groups were 2.4 and 5.3 years, respectively, but the difference was not statistically significant. The mean length of hospital stay was similar in both groups (22.8 days vs. 21.4 days). Immunologic studies were performed in 3 patients; the results were within the normal range. Most patients had prominent leukocytosis. Seven and 4 patients had right and left lung abscess, respectively. Staphylococcus aureus, Streptococcus pneumoniae, and antimycoplasma antibodies were detected in both groups. Two patients with primary lung abscess were administered antibiotics in the absence of other procedures, while 8 underwent interventional procedures, including 5 with secondary abscess. The most common symptoms were fever and cough. All patients in the primary group were younger than 3 years. Structural problems were dominant. Most patients required interventional procedures and antibiotics.

  9. Preventable hospitalization and the role of primary care: a comparison between Italy and Germany.

    NARCIS (Netherlands)

    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,

  10. Spirometry in primary care for children with asthma. (United States)

    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.

  11. Therapeutic hypothermia after out-of-hospital cardiac arrest in children. (United States)

    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

  12. A Randomized Trial of Yoga for Children Hospitalized With Sickle Cell Vaso-Occlusive Crisis. (United States)

    Moody, Karen; Abrahams, Bess; Baker, Rebecca; Santizo, Ruth; Manwani, Deepa; Carullo, Veronica; Eugenio, Doris; Carroll, Aaron


    Sickle cell disease (SCD) vaso-occlusive crisis (VOC) remains an important cause of acute pain in pediatrics and the most common SCD complication. Pain management recommendations in SCD include nonpharmacological interventions. Yoga is one nonpharmacological intervention that has been shown to reduce pain in some populations; however, evidence is lacking in children with VOC. The primary objective of this study was to compare the effect of yoga vs. an attention control on pain in children with VOC. The secondary objectives were to compare the effect of yoga vs. an attention control on anxiety, lengths of stay, and opioid use in this population. Patients were eligible if they had a diagnosis of SCD, were 5-21 years old, were hospitalized for uncomplicated VOC, and had an admission pain score of ≥7. Subjects were stratified based on disease severity and randomized to the yoga or control group. Eighty-three percent of patients approached (N = 73) enrolled on study. There were no significant differences in baseline clinical or demographic factors between groups. Compared with the control group, children randomized to yoga had a significantly greater reduction in mean pain score after one yoga session (-0.6 ± 0.96 vs. 0.0 ± 1.37; P = 0.029). There were no significant differences in anxiety, lengths of stay, or opioid use between the two groups. This study provides evidence that yoga is an acceptable, feasible, and helpful intervention for hospitalized children with VOC. Future research should further examine yoga for children with SCD pain in the inpatient and outpatient settings. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  13. Positron Emission Tomography-Scanner at Children`s Hospital of Michigan at Detroit, Michigan

    Energy Technology Data Exchange (ETDEWEB)


    The Department of Energy has prepared an environmental assessment (EA), DOE/EA-0795, to support the DOE decision to provide a grant of $7,953,600 to be used in support of a proposed Positron Emission Tomography Scanner at Children`s Hospital of Michigan at Detroit, Michigan. Based upon the analysis in the EA, DOE has determined that the proposed action is not a major Federal action significantly affected the quality of the human environment within the meaning of the National Environmental Policy Act of 1969 (NEPA). Therefore, the preparation of an Environmental Impact Statement is not required and DOE is issuing this Finding of No Significant Impact (FONSI).

  14. The prevalence of undernutrition upon hospitalization in children in a developing country: A single hospital study from Malaysia. (United States)

    Lee, Way-Seah; Ahmad, Zulfadly


    Undernourished children who require hospital care have a longer duration of hospitalization and respond poorly to modern medical therapy. The objective of the present study was to ascertain the nutritional status of children admitted to a pediatric tertiary center in Malaysia and the risk factors leading to undernutrition upon admission. In this cross-sectional, hospital-based study, anthropometric measurements [weight, length/height, mid-upper arm circumference (MUAC), triceps skinfold thickness were performed in 285 children aged from 3 months to 15 years who were admitted to University Malaya Medical Centre, Kuala Lumpur in November 2013. Acute (wasting) and chronic (stunting) undernutrition were defined as weight-for-height (WFH) and height-for-age (HFA) standard deviation (S.D.), respectively. Underweight was defined as weight-for-age definition for acute undernutrition (HFA definition of acute undernutrition, an additional eight patients were noted to have acute undernutrition (n = 40, 14%). No significant risk factors associated with undernutrition were identified. The prevalence of undernutrition among children admitted to a tertiary hospital in Malaysia was 14%. Strategies for systematic screening and provision of nutritional support in children at risk of undernutrition as well as treatment of undernutrition in children requiring hospitalization are needed. Copyright © 2017. Published by Elsevier B.V.

  15. Costs, mortality likelihood and outcomes of hospitalized US children with traumatic brain injuries. (United States)

    Shi, Junxin; Xiang, Huiyun; Wheeler, Krista; Smith, Gary A; Stallones, Lorann; Groner, Jonathan; Wang, Zengzhen


    To examine the hospitalization costs and discharge outcomes of US children with TBI and to evaluate a severity measure, the predictive mortality likelihood level. Data from the 2006 Healthcare Cost and Utilization Project Kids' Inpatient Database (KID) were used to report the national estimates and characteristics of TBI-associated hospitalizations among US children percentage of children with TBI caused by motor vehicle crashes (MVC) and falls was calculated according to the predictive mortality likelihood levels (PMLL), death in hospital and discharge into long-term rehabilitation facilities. Associations with the PMLL, discharge outcomes and average hospital charges were examined. In 2006, there were an estimated 58 900 TBI-associated hospitalizations among US children, accounting for $2.56 billion in hospital charges. MVCs caused 38.9% and falls caused 21.2% of TBI hospitalizations. The PMLL was strongly associated with TBI type, length of hospital stay, hospital charges and discharge disposition. About 4% of children with fall or MVC related TBIs died in hospital and 9% were discharged into long-term facilities. The PMLL may provide a useful tool to assess characteristics and treatment outcomes of hospitalized TBI children, but more research is still needed.

  16. Hearing loss in children with primary ciliary dyskinesia. (United States)

    Kreicher, Kathryn L; Schopper, Heather K; Naik, Akash N; Hatch, Jonathan L; Meyer, Ted A


    To evaluate the type and severity of hearing impairment in pediatric patients with primary ciliary dyskinesia (PCD) and relate these measures to patient demographics, treatment options, and other otologic factors. A retrospective analysis of children with a diagnosis of PCD, Kartagener's syndrome, or situs inversus in the AudGen Database was conducted. Audiograms were analyzed for type of hearing loss (HL), severity, laterality, and progression. Medical charts were reviewed to identify factors that influence severity and progression of hearing loss. 56 patients met inclusion criteria and 42 patients had HL. 66.6% had bilateral and 33.3% had unilateral loss (70 total ears with HL). Conductive hearing loss (CHL) was the most common type of HL, though 30% of children had some sensorineural component to their hearing loss. 92.9% of children with HL received at least one diagnosis of otitis media, but HL did not improve in the majority (77.8%) of ears in our study regardless of ear tube placement. Slight to mild CHL and all types of otitis media are prevalent among patients with PCD, and some of these children have sensorineural hearing loss (SNHL). All patients diagnosed with situs inversus at birth should be evaluated by an otolaryngologist. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. Interventions for Primary School Children With Difficulties in Mathematics. (United States)

    Dowker, Ann


    Difficulty with arithmetic is a common problem for children and adults, though there has been some work on the topic for a surprisingly long time. This chapter will review some of the research that has been done over the years on interventions with primary school children. Interventions can be of various levels of intensiveness, ranging from whole-class approaches that take account of individual differences through small-group and limited-time individual interventions to extended-time individual interventions. Interventions discussed here include those involving peer tuition and group collaboration; those involving board and computer games; and those that involve assessing children's strengths and weaknesses in different components of mathematics; and targeting remedial activities to the assessed weaknesses. Most of the interventions discussed in this chapter specifically involve mathematics (usually mainly arithmetic), but there is also some discussion of attempts to improve mathematics by training children in domain-general skills, including Piagetian operations, metacognition, and executive functions. © 2017 Elsevier Inc. All rights reserved.

  18. Primary Nocturnal Enuresis among school children in Jordan

    International Nuclear Information System (INIS)

    Hazza, I.; Tarwneh, H.


    We attempted in this study, to estimate the prevalence of primarynocturnal enuresis (PNE) in children of Jordan and to examine factorsassociated with PNE. We sent questionnaires to 950 parents of children aged6-8 years, randomly selected from three primary schools in Jordan. Thequestionnaire was designed to evaluate the prevalence and factors associatedwith PNE. The response rate was 71.6%. The overall prevalence of PNE was23.8%. This prevalence declined with age from 48.9% at 7 years and 8.4% at 8years. Our findings indicate that the prevalence of PNE in Jordan is higherthan the reported from other Asian or European countries, while theassociated factors are similar. (author)

  19. Multidisciplinary approach to hospitalized epileptic children and their families

    Directory of Open Access Journals (Sweden)

    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.

  20. [Justification of off-label antibiotics uses in hospitalized children]. (United States)

    Berthod, Christelle; Kassaï, Behrouz; Boussageon, Remy; Adelaide, Léopold; Jacquet-Lagrèze, Matthias; Lajoinie, Audrey


    Unlicensed and off-label (UL/OL) drugs are commonly used in pediatrics wards, especially the antibiotics. It remains unclear if this strategy is justified by randomized controlled trials of good quality? The aim of this study was to compare the level of evidence of UL/OL antibiotics prescription in hospitalized children. The initial hypothesis was that the UL/OL antibiotics prescriptions had a lower level of evidence than licensed antibiotics. This observational study assessed the antibiotics prescription in the children mother and women hospital of Lyon. Each antibiotic medicine courses was classified depending on: (i) they were licensed, UL or OL, (ii) their level of evidence for efficiency (sufficient evidence, insufficient evidence, no evidence) and (iii) the existence or not of randomized controlled trials (RCT) or not. The antibiotics medicine courses in atypical cases were excluded (rare disease, lack of diagnosis, comorbidities modifying antibiotic use). Data were collected with computerized patient file data. The data were compared using Fisher exact test and χ 2 . One hundred and eight medicine courses were identified, corresponding to 72 mono, bi or tri-antibiotic therapies administered to 62 patients; 34% were OL and 66% were licensed. No prescriptions were UL. Thirty-two prescriptions were excluded from the evidence assessment. No proof of efficiency was found for any of the 76 analyzed medicine courses. RCTs were found for 36 of the analyzed medicine courses (47%); licensed medicine courses were significantly more justified by RCTs than UL/OL medicine courses (63% vs. 16%, Pantibiotics in pediatrics, regardless their license status. Nevertheless, the licensed prescriptions have shown more data of efficiency than OL prescriptions. Still, even when data were found, no antibiotics prescriptions reach the threshold of good quality studies. New clinical trials should respond to the patient needs. Copyright © 2017 Société française de pharmacologie et

  1. Endoscopic placement of double-J ureteric stents in children as a treatment for primary hydronephrosis. (United States)

    Pogorelić, Zenon; Brković, Tomislava; Budimir, Dražen; Todorić, Jakov; Košuljandić, Đurđica; Jerončić, Ana; Biočić, Mihovil; Saraga, Marijan


    The aim of this study was to determine the efficacy and potential complications of double-J ureteric stents in the treatment of primary hydronephrosis in pediatric patients. A retrospective case-records review of 133 patients (45 girls and 88 boys) treated because of primary hydronephrosis with double-J ureteric stents, in Department of Pediatric Surgery, Split University Hospital, between December 1997 and December 2014, was performed. Success of treatment, results of follow up investigations and complications were recorded. Patients were followed up clinically and radiologically for a minimum of 2 years following stent insertion. In all, 133 endoscopic double-J ureteric stents insertions were performed. Of the total number of patients, left-sided hydronephrosis was found in 82 patients, right-sided in 38, and bilateral in 13 patients. The median age of children was 2 years (range 0-17 years). Mean hospital stay was 2 days (range 1-10 days). In primary hydronephrosis, double-J ureteric stenting alone was effective with resolution of hydronephrosis in 73% of cases (97/133 insertions). Regarding the age of the patients the highest success of 83.5% was achieved in age group 0-4 years. Success in groups 5-9 years; 10-14 years and 15-17 years were 47%; 33.5% and 0%, respectively. Several complications have been recorded: symptomatic infections, migration in the renal pelvis and bladder, progression of hydronephrosis, spontaneously prolapse of prosthesis, bleeding and perforation of the renal pelvis. A significant, decreasing trend in success rates by age of participants was observed (p hydronephrosis. Endoscopic placement of ureteric double-J stents should be considered as a first-line treatment in the management of primary hydronephrosis especially in children till 4 years of age, with success rate of 83.5% and without the need for conventional surgery. In a case of failure we are time-consuming to definitive surgery.

  2. Centralisation of services for children with cleft lip or palate in England: a study of hospital episode statistics (United States)


    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

  3. Ventilation inhomogeneity in children with primary ciliary dyskinesia

    DEFF Research Database (Denmark)

    Green, Kent; Buchvald, Frederik F; Marthin, June Kehlet


    The lung clearance index (LCI) derived from the multiple breath inert gas washout (MBW) test reflects global ventilation distribution inhomogeneity. It is more sensitive than forced expiratory volume in 1 s (FEV(1)) for detecting abnormal airway function and correlates closely with structural lung...... damage in children with cystic fibrosis, which shares features with primary ciliary dyskinesia (PCD). Normalised phase III slope indices S(cond) and S(acin) reflect function of the small conducting and acinar airways, respectively. The involvement of the peripheral airways assessed by MBW tests has...

  4. Clinical care of children with primary ciliary dyskinesia

    DEFF Research Database (Denmark)

    Lucas, Jane S; Alanin, Mikkel Christian; Collins, Samuel


    INTRODUCTION: Primary ciliary dyskinesia (PCD) is a rare heterogeneous disorder, usually inherited as an autosomal recessive condition but X-linked inheritance is also described. Abnormal ciliary function in childhood leads to neonatal respiratory distress in term infants, persistent wet cough...... is inappropriate since differences in pathophysiology, morbidity and prognosis risk treatment failure and lack of adherence. Areas covered: Review authors searched PubMed and Cochrane databases for publications relating to management of children with PCD. Because of the paucity of data, we emphasise the need...

  5. Hospital admissions in children with down syndrome: experience of a population-based cohort followed from birth.

    Directory of Open Access Journals (Sweden)

    Patrick Fitzgerald

    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.

  6. Being hospitalized with a newly diagnosed chronic illness--a phenomenological study of children's lifeworld in the hospital. (United States)

    Ekra, Else Mari Ruberg; Gjengedal, Eva


    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 children of their body

  7. Being hospitalized with a newly diagnosed chronic illness—A phenomenological study of children's lifeworld in the hospital

    Directory of Open Access Journals (Sweden)

    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

  8. Being hospitalized with a newly diagnosed chronic illness—A phenomenological study of children's lifeworld in the hospital (United States)

    Gjengedal, Eva


    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 children of their body

  9. Bilingual children with primary language impairment: 3 months after treatment. (United States)

    Pham, Giang; Ebert, Kerry Danahy; Kohnert, Kathryn


    Evidence on the treatment effectiveness for bilingual children with primary language impairment (PLI) is needed to advance both theory and clinical practice. Of key interest is whether treatment effects are maintained following the completion of short-term intense treatments. To investigate change in select language and cognitive skills in Spanish-English bilingual children with PLI 3 months after children have completed one of three experimental treatment conditions. There are two main study aims. First, to determine if skills in Spanish, English and cognitive processing decline, improve or are maintained after treatment has been completed. Second, to determine if differential rates of change are a function of the type of treatment children received. Participants were 48 children, aged 5:6-11:3, who spoke Spanish and English and were diagnosed with moderate to severe PLI. Participants received 6 weeks of treatment focused on English only (EO), bilingual skills in Spanish and English (BI) or nonlinguistic cognitive processing (NCP). Treatment effects reported in a previous study were determined by comparing pre- and post-treatment performance on a variety of language and cognitive measures. Here we re-administered each measure 3 months after completion of the experimental treatments. Hierarchical linear models were calculated for each measure using pre-, post- and follow-up testing scores to estimate change trajectories and compare outcomes between treatment conditions. Participants in all three treatment conditions either maintained skills or showed improvement even after treatment was discontinued for 3 months. Main findings included (1) comparable, positive rates of change on all English language outcomes for EO and BI conditions; (2) maintenance of Spanish language skills, and (3) modest improvements in NCP following the discontinuation of treatment. This study is the first to examine longer-term treatment effects for bilingual school-age children with PLI

  10. The epidemiology of burns in young children from Mexico treated at a U.S. hospital. (United States)

    Patel, Dipen D; Rosenberg, Laura; Rosenberg, Marta; Leal, Jesus; Andersen, Clark R; Foncerrada, Guillermo; Lee, Jong O; Jimenez, Carlos J; Branski, Ludwik; Meyer, Walter J; Herndon, David N


    Young children are the most vulnerable for sustaining burns. At this pediatric burn hospital we have provided medical care to young children with severe burns from Mexico for many years. This study identified modifiable risk factors that could be used to assist in prevention of burns in this age group. A retrospective chart review was performed with children Mexico who were injured from 2000 to 2013. The medical records of 447 acute patients were reviewed. There were 187 females and 260 males with large burns >20% total body surface area (TBSA) burned. Primary causes of burns were flame and scalds. Children with flame injuries were older (3.0±1.5 years of age) than those with scalds (2.6±1.2 years of age). Admissions attributed to flame burns were largely from explosions by propane tanks, gas line leaks, and house fires. Most admissions for scalds were predominantly from falling in large containers of hot water, food, or grease; and fewer were attributed to spills from hot liquids. Most cases reported to a social service agency were to find resources for families. Mortality rate for flame and scald burns was low. It is important take into account demographic, cultural, and socioeconomic variables when developing and implementing prevention programs. Burn prevention instruction for parents is crucial. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  11. Blood pressure variability in children with primary vs secondary hypertension. (United States)

    Leisman, Daniel; Meyers, Melissa; Schnall, Jeremy; Chorny, Nataliya; Frank, Rachel; Infante, Lulette; Sethna, Christine B


    Increased blood pressure variability (BPV) is correlated with adverse cardiovascular (CV) events in adults. However, there has been limited research on its effect in the pediatric population. Additionally, BPV differences between primary and secondary hypertension (HTN) are not known. Children with primary and secondary HTN underwent 24-hour ambulatory blood pressure monitoring and echocardiography studies. BPV measures of standard deviation (SD), average real variability (ARV), and range were calculated for the 24-hour, daytime, and nighttime periods. Seventy-four patients (median age, 13.5 years; 74% boys) were examined, 40 of whom had primary HTN. Body mass index z score and age were independent predictors of systolic ARV (R(2) =0.14) and SD (R(2) =0.39). There were no statistically significant differences in overall or wake period BPV measures between secondary or primary HTN groups, but sleep period diastolic SD was significantly greater in the secondary HTN group (9.26±3.8 vs 7.1±2.8, P=.039). On multiple regression analysis, secondary HTN was associated with increased sleep period diastolic SD (P=.025). No metrics of BPV in the overall, wake, and sleep periods were found to be significantly associated with left ventricular hypertrophy (LVH). The results of this study do not show a strong relationship between overall or wake BPV with primary vs secondary HTN, but the association of secondary HTN with sleep period diastolic BPV deserves further exploration. Contrary to expectation, the findings of this study failed to indicate a relationship between BPV and LVH for all patients as well for primary hypertensive and secondary hypertensive patients. ©2014 Wiley Periodicals, Inc.

  12. Children's Exposure to Radon in Nursery and Primary Schools. (United States)

    Branco, Pedro T B S; Nunes, Rafael A O; Alvim-Ferraz, Maria C M; Martins, Fernando G; Sousa, Sofia I V


    The literature proves an evident association between indoor radon exposure and lung cancer, even at low doses. This study brings a new approach to the study of children's exposure to radon by aiming to evaluate exposure to indoor radon concentrations in nursery and primary schools from two districts in Portugal (Porto and Bragança), considering different influencing factors (occupation patterns, classroom floor level, year of the buildings' construction and soil composition of the building site), as well as the comparison with IAQ standard values for health protection. Fifteen nursery and primary schools in the Porto and Bragança districts were considered: five nursery schools for infants and twelve for pre-schoolers (seven different buildings), as well as eight primary schools. Radon measurements were performed continuously. The measured concentrations depended on the building occupation, classroom floor level and year of the buildings' construction. Although they were in general within the Portuguese legislation for IAQ, exceedances to international standards were found. These results point out the need of assessing indoor radon concentrations not only in primary schools, but also in nursery schools, never performed in Portugal before this study. It is important to extend the study to other microenvironments like homes, and in time to estimate the annual effective dose and to assess lifetime health risks.

  13. Trauma-informed care for children in the ambulance : international survey among pre-hospital providers

    NARCIS (Netherlands)

    Alisic, Eva; Tyler, Mark P; Giummarra, Melita J; Kassam-Adams, Rahim; Gouweloos, Juul; Landolt, Markus A; Kassam-Adams, Nancy


    Background: Pre-hospital providers, such as paramedics and emergency medical technicians, are in a position to provide key emotional support to injured children and their families. Objective: Our goal was to examine (a) pre-hospital providers' knowledge of traumatic stress in children, attitudes

  14. The Efficacy of Hospitalization of Nonorganic Failure-to-Thrive Children: A Meta-Analysis. (United States)

    Fryer, George E., Jr.


    A meta-analysis of eight studies, involving 192 subjects, was performed to ascertain the efficacy of hospitalization of children with nonorganic failure to thrive. Hospitalization was found to approximately double the probability of catch-up physical growth for the children, but psychosocial development was only modestly hastened by…

  15. Health care burden of Clostridium difficile infection in hospitalized children with inflammatory bowel disease. (United States)

    Pant, Chaitanya; Anderson, Michael P; Deshpande, Abhishek; Altaf, Muhammad A; Grunow, John E; Atreja, Ashish; Sferra, Thomas J


    Children with inflammatory bowel disease (IBD), similar to adults, are at increased risk of acquiring a Clostridium difficile infection (CDI). Our objective was to characterize the health care burden associated with CDI in hospitalized pediatric patients with IBD. We extracted and analyzed cases with a discharge diagnosis of IBD or CDI from the U.S. Healthcare Cost and Utilization Project Kids' Inpatient Database. In our primary analysis, we evaluated pediatric cases with a principal diagnosis of IBD or CDI. For the year 2009, we identified 12,610 weighted cases with IBD of which 3.5% had CDI. In children with IBD, CDI was independently associated with lengthier hospital stays (8.0 versus 6.0 days; adjusted regression coefficient, 2.1 days; 95% confidence interval [CI], 1.4-2.8), higher charges ($45,126 versus $34,703; adjusted regression coefficient, $11,506; 95% CI, 6192-16,820), and greater need for parenteral nutrition (15.9% versus 12.1%; adjusted odds ratio, 1.5; 95% CI, 1.1-2.0) and blood transfusion (17.7% versus 9.8%; adjusted odds ratio, 1.8; 95% CI, 1.4-2.4). There were no deaths. We made similar observations in a subanalysis of cases with principal or secondary diagnoses of IBD or CDI. The incidence of CDI in patients with IBD increased between 2000 and 2009 from 21.7 to 28.0 cases per 1000 IBD cases per year (P CDI complicating ulcerative colitis (28.1 versus 42.2, P CDI represents a significant health care burden in hospitalized children with IBD.


    Directory of Open Access Journals (Sweden)

    G. Khotaii


    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.

  17. Nursing team's conceptions about the families of hospitalized children. (United States)

    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.


    Directory of Open Access Journals (Sweden)

    Renata Okrajšek


    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

  19. Preventing Hospitalization with Veterans Affairs Home-Based Primary Care: Which Individuals Benefit Most? (United States)

    Edwards, Samuel T; Saha, Somnath; Prentice, Julia C; Pizer, Steven D


    To examine how medical complexity modifies the relationship between enrollment in Department of Veterans Affairs (VA) home-based primary care (HBPC) and hospitalization for ambulatory care-sensitive conditions (ACSC) for veterans with diabetes mellitus and whether the effect of HBPC on hospitalizations varies according to clinical condition. Retrospective cohort study. VA and non-VA hospitals. VA beneficiaries aged 67 and older with diabetes mellitus and enrolled in Medicare (N = 364,972). Instrumental variables regression models were used to estimate the effect of HBPC enrollment on hospitalization for ACSCs (defined according to the Agency for Healthcare Research and Quality Prevention Quality Indicators) overall and in subgroups stratified according to medical complexity. Models were also estimated for each ACSC to determine which conditions were most sensitive to HBPC. Distance from the veteran's residence to the nearest HBPC site was used as the instrumental variable. HBPC was associated with fewer ACSC hospitalizations (odds ratio (OR) = 0.35 per person-month, 95% confidence interval (CI) = 0.30-0.42). For veterans in the highest quartile of medical complexity, HBPC enrollment was associated with fewer ACSC hospitalizations (OR = 0.43, 95% CI = 0.19-0.93), whereas for those in the lowest quartile, HBPC was associated with more ACSC hospitalizations (OR = 33.2, 95% CI = 4.6-240.1). HBPC enrollment was associated with fewer hospitalizations for a range of ACSCs. HBPC enrollment was associated with fewer hospitalizations for a range of ACSCs in veterans with diabetes mellitus but only in the most medically complex individuals. This demonstrates the importance of appropriate targeting and suggests that the effect of HBPC is attributable to its comprehensive approach rather than condition-specific interventions. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

  20. In-hospital Mobility Variations across Primary Diagnoses among Older Adults (United States)

    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

  1. Clinical features of patients with subarachnoid hemorrhage arriving through a referral from a local primary hospital

    International Nuclear Information System (INIS)

    Yamazaki, Takaaki; Kubota, Tsukasa; Shimazaki, Mitsunori


    We investigated the current state of and problems in patients with subarachnoid hemorrhage initially diagnosed and treated by general physicians at a local referring hospital and subsequently transferred to our hospital for neurosurgical treatment. We studied 37 consecutive patients with subarachnoid hemorrhage over a 7-year period from April 2001 to March 2008. A total of 7 men and 30 women aged 50 to 89 years (average: 71.2±9.5 years) were included in this study. Thirteen patients (35.1%) were referred to our hospital with diagnoses other than subarachnoid hemorrhage. Twenty-three of 27 patients who had CT scans were diagnosed correctly in the referring hospital, while only 1 of 10 patients was correctly diagnosed without CT. Time from the onset to admission to our hospital ranged from 85 minutes to 144 hours (average: 15.3±29 hours). The reasons of delay in patients who took more than 12 hours to reach us were patients' delay in visiting the referring hospital in 3 cases and uncertain initial diagnosis in 6. All 6 cases complained of sudden headache, but did not undergo CT. All patients were transferred by an ambulance car, and the duration of transfer ranged from 60 to 120 minutes (average: 85.4±15.7 minutes). None of the patients experienced rebleeding during transfer. Subarachnoid hemorrhage can be diagnosed correctly at the local primary hospital with CT, allowing appropriate primary treatments. Initial misdiagnosis is the major cause of delay in transferring patients to neurosurgical facilities. (author)

  2. Poliovirus Excretion in Children with Primary Immunodeficiency Disorders, India. (United States)

    Mohanty, Madhu Chhanda; Madkaikar, Manisha Rajan; Desai, Mukesh; Taur, Prasad; Nalavade, Uma Prajwal; Sharma, Deepa Kailash; Gupta, Maya; Dalvi, Aparna; Shabrish, Snehal; Kulkarni, Manasi; Aluri, Jahnavi; Deshpande, Jagadish Mohanrao


    Prolonged excretion of poliovirus can occur in immunodeficient patients who receive oral polio vaccine, which may lead to propagation of highly divergent vaccine-derived polioviruses (VDPVs), posing a concern for global polio eradication. This study aimed to estimate the proportion of primary immunodeficient children with enterovirus infection and to identify the long-term polio/nonpolio enterovirus excreters in a tertiary care unit in Mumbai, India. During September 2014-April 2017, 151 patients received diagnoses of primary immunodeficiency (PID). We isolated 8 enteroviruses (3 polioviruses and 5 nonpolio enteroviruses) in cell culture of 105 fecal samples collected from 42 patients. Only 1 patient with severe combined immunodeficiency was identified as a long-term VDPV3 excreter (for 2 years after identification of infection). Our results show that the risk of enterovirus excretion among children in India with PID is low; however, systematic screening is necessary to identify long-term poliovirus excreters until the use of oral polio vaccine is stopped.

  3. Transitioning Children from Psychiatric Hospitals to Schools: The Role of the Special Educator (United States)

    Simon, Joan B.; Savina, Elena A.


    Over a quarter of a million U.S. students each year reside for a period of time in a psychiatric inpatient hospital setting to receive mental health treatment. Following inpatient treatment, most children are transitioned from the hospital into a regular school setting. Little is known about how these transitions are managed by hospital or school…

  4. The new Nelson Mandela Children's Hospital – a white elephant or ...

    African Journals Online (AJOL)

    A children's hospital is not a novel venture for Johannesburg. Those white paediatricians who trained in Johannesburg before the opening of the new Johannesburg Academic Hospital (now the. Charlotte Maxeke Johannesburg Academic Hospital) in 1978 will probably remember with considerable fondness and nostalgia ...

  5. A Qualitative Study Investigating Gender Differences in Primary Work Stressors and Levels of Job Satisfaction in Greek Junior Hospital Doctors (United States)

    Antoniou, Alexander-Stamatios; Cooper, Cary L.; Davidson, Marilyn J.


    Primary work stressors and job satisfaction/dissatisfaction in Greek Junior Hospital Doctors (JHDs) are investigated to identify similarities and differences in the reports obtained from male and female hospital doctors. Participants in the study included 32 male and 28 female Greek hospital doctors who provided information through…

  6. Primary gamma-herpesviral infection in Zambian children

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    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.

  7. Factors affecting nutritional status of Malaysian primary school children. (United States)

    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.

  8. Predictors of Hospitalization among Children on ART in Ethiopia: a Cohort study. (United States)

    Haileamlak, Abraham; Hagos, Tesfalem; Abebe, Workeabeba; Abraham, Loko; Asefa, Henok; Teklu, Alula M


    Substantial progress has been made in the management of pediatric HIV infection in Ethiopia with the implementation of mother-to-child-prevention programs. Since the introduction of HAART in 2005, mortality among HIV-infected children has reduced while the rate of hospitalization was expected to rise. The purpose of this study, therefore, was to assess predictors of hospitalization in children on ART in seven university referral hospitals in Ethiopia. A prospective cohort study design was employed on children age 0-18 years as part of a multisite observational study. ART-experienced eligible and ART-naïve children with HIV/AIDS were enrolled into the Advanced Clinical Monitoring (ACM) till December 31, 2012 were included. From the database, information on hospitalization and other independent variables were extracted. Analysis was done using both SPSS for Windows version 16.0 and STATA. Descriptive analyses and modeling was done using logistic regression. Of the 405 children on ART (174 experienced, 231 naive), 86 (20.7%) were hospitalized for various reasons; two children were excluded since they were hospitalized for unrelated conditions (appendicitis and burn). Fifty one (60.7%) of the eighty four admitted children were hospitalized in the first six months of ART initiation. Of the independent variables, only the presence of opportunistic infections and duration on ART were significantly associated with hospitalization both on bi-variable and multivariable analyses (P-value ART increased by one month, the risk of hospitalization decreased by 5.4%, which is statistically significant (P hospitalized increased by 35.2% (P = 0.002). Of the individual opportunistic infections, pneumonia was found to be the only predictor of hospitalization (P-value = 0.002). This study showed that nearly two-third of the hospitalization was within 6 months of initiation of ART; and presence of OI and duration on ART were the only predictors of hospitalization.

  9. A missed primary care appointment correlates with a subsequent emergency department visit among children with asthma. (United States)

    McGovern, Colleen Marie; Redmond, Margaret; Arcoleo, Kimberly; Stukus, David R


    Since the Affordable Care Act's implementation, emergency department (ED) visits have increased. Poor asthma control increases the risk of acute exacerbations and preventable ED visits. The Centers for Medicare and Medicaid Services support the reduction of preventable ED visits to reduce healthcare spending. Implementation of interventions to avoid preventable ED visits has become a priority for many healthcare systems yet little data exist examining children's missed asthma management primary care (PC) appointments and subsequent ED visits. Longitudinal, retrospective review at a children's hospital was conducted for children with diagnosed asthma (ICD-9 493.xx), ages 2-18 years, scheduled for a PC visit between January 1, 2010, and June 30, 2012 (N = 3895). Records were cross-referenced with all asthma-related ED visits from January 1, 2010 to December 31, 2012. Logistic regression with maximum likelihood estimation was conducted. None of the children who completed a PC appointment experienced an ED visit in the subsequent 6 months whereas 2.7% of those with missed PC appointments had an ED visit (χ 2 = 64.28, p asthma as one mechanism for preventing ED visits was demonstrated. Interventions targeting missed visits could decrease asthma-related morbidity, preventable ED visits, and healthcare costs.

  10. Children's Behavioral Adjustment in Pre-Primary Schools in Tanzania : A Multilevel Approach

    NARCIS (Netherlands)

    Shavega, Theresia J.; Brugman, Daniel; van Tuijl, Cathy


    Research Findings: The present study concerns children's behavioral adjustment in the context of pre-primary schools in Tanzania. Twenty teachers and 320 children from 20 pre-primary schools participated in the study. Teacher-child relationships, children's behavioral adjustment, and teachers'

  11. Hospital readmissions of patients with heart failure: the impact of hospital and primary care organizational factors in Northern Italy.

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    Vera Maria Avaldi

    Full Text Available Primary health care is essential for an appropriate management of heart failure (HF, a disease which is a major clinical and public health issue and a leading cause of hospitalization. The aim of this study was to evaluate the impact of different organizational factors on readmissions of patients with HF.The study population included elderly resident in the Local Health Authority of Bologna (Northern Italy and discharged with a diagnosis of HF from January to December 2010. Unplanned hospital readmissions were measured in four timeframes: 30 (short-term, 90 (medium-term, 180 (mid-long-term, and 365 days (long-term. Using multivariable multilevel Poisson regression analyses, we investigated the association between readmissions and organizational factors (discharge from a cardiology department, general practitioners' monodisciplinary organizational arrangement, and implementation of a specific HF care pathway.The 1873 study patients had a median age of 83 years (interquartile range 77-87 and 55.5% were females; 52.0% were readmitted to the hospital for any reason after a year, while 20.1% were readmitted for HF. The presence of a HF care pathway was the only factor significantly associated with a lower risk of readmission for HF in the short-, medium-, mid-long- and long-term period (short-term: IRR [incidence rate ratio]=0.57, 95%CI [confidence interval]=0.35-0.92; medium-term: IRR=0.70, 95%CI=0.51-0.96; mid-long-term: IRR=0.79, 95%CI=0.64-0.98; long-term: IRR=0.82, 95%CI=0.67-0.99, and with a lower risk of all-cause readmission in the short-term period (IRR=0.73, 95%CI=0.57-0.94.Our study shows that the HF care specific pathway implemented at the primary care level was associated with lower readmission rate for HF in each timeframe, and also with lower readmission rate for all causes in the short-term period. Our results suggest that the engagement of primary care professionals starting from the early post-discharge period may be relevant in the

  12. Modelling multiple hospital outcomes: the impact of small area and primary care practice variation

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    Congdon Peter


    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

  13. Bilingual children with primary language impairment: 3 months after treatment (United States)

    Pham, Giang; Ebert, Kerry Danahy; Kohnert, Kathryn


    Background Evidence on the treatment effectiveness for bilingual children with primary language impairment (PLI) is needed to advance both theory and clinical practice. Of key interest is whether treatment effects are maintained following the completion of short-term intense treatments. Aims To investigate change in select language and cognitive skills in Spanish–English bilingual children with PLI 3 months after children have completed one of three experimental treatment conditions. There are two main study aims. First, to determine if skills in Spanish, English and cognitive processing decline, improve or are maintained after treatment has been completed. Second, to determine if differential rates of change are a function of the type of treatment children received. Methods & Procedures Participants were 48 children, aged 5:6–11:3, who spoke Spanish and English and were diagnosed with moderate to severe PLI. Participants received 6 weeks of treatment focused on English only (EO), bilingual skills in Spanish and English (BI) or nonlinguistic cognitive processing (NCP). Treatment effects reported in a previous study were determined by comparing pre- and post-treatment performance on a variety of language and cognitive measures. Here we re-administered each measure 3 months after completion of the experimental treatments. Hierarchical linear models were calculated for each measure using pre-, post- and follow-up testing scores to estimate change trajectories and compare outcomes between treatment conditions. Outcomes & Results Participants in all three treatment conditions either maintained skills or showed improvement even after treatment was discontinued for 3 months. Main findings included (1) comparable, positive rates of change on all English language outcomes for EO and BI conditions; (2) maintenance of Spanish language skills, and (3) modest improvements in NCP following the discontinuation of treatment. Conclusions & Implications This study is the first

  14. How U.S. children's hospitals use social media: A mixed methods study. (United States)

    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.

  15. Children and adolescents ostomized in a reference hospital. Epidemiological profile

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    Orlando José dos Santos


    Full Text Available Objectives: To assess the epidemiological profile of children and adolescents with intestinal stoma, assisted at the Presidente Dutra University Hospital (HUPD, São Luís (MA. Methods: Observational, descriptive, retrospective, and individuated study. Data were collected from 110 children and adolescents with elimination intestinal stoma, from January 2006 to February 2013. The following variables were analyzed: age, gender, patient origin, and stomata indication, type, and temporal character. After data collection, descriptive analysis was made by Bioestat 5.0 program. Results: Of 110 patients, 78.2% were male and 21.8% female. The average age was 9.4 years old. 55.5% came from the Maranhão state countryside, and 44.5% from the capital, São Luís. Regarding stoma type, colostomies made up 88.2%, and were 11.8% ileostomies, all temporary stoma. The main cause was trauma (42.7%, with firearm abdominal puncture being the most frequent cause (71.5% of the category; followed by congenital anomalies (38.2%, and obstructive (5.4% and inflammatory (4.5% causes. Conclusion: Studied children and adolescents were mostly male, from Maranhão state countryside. The main cause was trauma, and colostomy was the most common stoma type. Resumo: Objetivos: Avaliar o perfil epidemiológico de crianças e adolescentes portadores de estomas intestinais atendidos no Hospital Universitário Presidente Dutra (HUPD em São Luís (MA. Métodos: Estudo observacional, descritivo, retrospectivo e individuado em que foram coletados dados de 110 crianças e adolescentes com estomas intestinais de eliminação de janeiro de 2006 a fevereiro de 2013. Analisaram-se as variáveis: idade, sexo, procedência dos pacientes, indicação, tipo e caráter temporal dos estomas. Após coleta dos dados, foi feita análise descritiva pelo programa Bioestat 5.0. Resultados: Dos 110 pacientes, 78,2% eram do sexo masculino e 21,8% do sexo feminino. A idade média foi de 9,4 anos. 55

  16. Success Rate of Trabeculectomy in Primary Glaucoma at Cicendo Eye Hospital on January–December 2013

    Directory of Open Access Journals (Sweden)

    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.

  17. Electronic discharge summary and prescription: improving communication between hospital and primary care. (United States)

    Murphy, S F; Lenihan, L; Orefuwa, F; Colohan, G; Hynes, I; Collins, C G


    The discharge letter is a key component of the communication pathway between the hospital and primary care. Accuracy and timeliness of delivery are crucial to ensure continuity of patient care. Electronic discharge summaries (EDS) and prescriptions have been shown to improve quality of discharge information for general practitioners (GPs). The aim of this study was to evaluate the effect of a new EDS on GP satisfaction levels and accuracy of discharge diagnosis. A GP survey was carried out whereby semi-structured interviews were conducted with 13 GPs from three primary care centres who receive a high volume of discharge letters from the hospital. A chart review was carried out on 90 charts to compare accuracy of ICD-10 coding of Non-Consultant Hospital Doctors (NCHDs) with that of trained Hopital In-Patient Enquiry (HIPE) coders. GP satisfaction levels were over 90 % with most aspects of the EDS, including amount of information (97 %), accuracy (95 %), GP information and follow-up (97 %) and medications (91 %). 70 % of GPs received the EDS within 2 weeks. ICD-10 coding of discharge diagnosis by NCHDs had an accuracy of 33 %, compared with 95.6 % when done by trained coders (p communication with primary care. It has led to a very high satisfaction rating with GPs. ICD-10 coding was found to be grossly inaccurate when carried out by NCHDs and it is more appropriate for this task to be carried out by trained coders.


    Directory of Open Access Journals (Sweden)

    Memeti Shaban


    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

  19. Hospital admission patterns subsequent to diagnosis of type 1 diabetes in children : a systematic review

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    Waugh Norman


    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

  20. [What are hospitals and primary care doing to mitigate the social impact of serious adverse events]. (United States)

    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.

  1. Nutritional screening for improving professional practice for patient outcomes in hospital and primary care settings. (United States)

    Omidvari, Amir-Houshang; Vali, Yasaman; Murray, Susan M; Wonderling, David; Rashidian, Arash


    Given the prevalence of under-nutrition and reports of inadequate nutritional management of patients in hospitals and the community, nutritional screening may play a role in reducing the risks of malnutrition. Screening programmes can invoke costs to health systems and patients. It is therefore important to assess the effectiveness of nutritional screening programmes. To examine the effectiveness of nutritional screening in improving quality of care (professional practice) and patient outcomes compared with usual care. We searched the following databases: CENTRAL (The Cochrane Library), MEDLINE, EMBASE and CINAHL up to June 2012 to find relevant studies. Randomised controlled studies, controlled clinical trials, controlled before-after studies and interrupted time series studies assessing the effectiveness of nutritional screening were eligible for inclusion in the review. We considered process outcomes (for example patient identification, referral to dietitian) and patient outcomes (for example mortality, change in body mass index (BMI)). Participants were adult patients aged 16 years or over. We included studies conducted in different settings, including hospitals, out-patient clinics, primary care or long term care settings. We independently assessed the risk of bias and extracted data from the included studies. Meta-analysis was considered but was not conducted due to the discrepancies between the studies. The studies were heterogeneous in their design, setting, intervention and outcomes. We analysed the data using a narrative synthesis approach. After conducting initial searches and screening the titles and abstracts of the identified literature, 77 full text papers were retrieved and read. Ultimately three studies were included. Two controlled before-after studies were conducted in hospital settings (one in the UK and one in the Netherlands) and one cluster randomised controlled trial was conducted in a primary care setting (in the USA).The study conducted in

  2. [Benefits from the use of toys during nursing care delivered to hospitalized children]. (United States)

    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.

  3. Racemic epinephrine compared to salbutamol in hospitalized young children with bronchiolitis; a randomized controlled clinical trial [ISRCTN46561076

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    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.

  4. Prevalence of hearing loss among primary school children in Mbarara, Uganda. (United States)

    Basañez, Irving; Nakku, Doreen; Stangl, Susan; Wanna, George B


    Hearing loss in children is a common entity worldwide. We examined the prevalence and etiology of hearing loss among primary school children in Mbarara, Uganda. Cross-sectional study in primary school children aged 5-14 was performed to determine the prevalence of hearing loss. Ugandan primary school children were screened for disabling hearing loss (threshold >30dB) and confirmatory audiometry was performed on those who failed the screening. There were 639 children screened. Thirty-five (5.5%) of children screened failed and were referred for further testing. Two children were lost to follow-up. The percentage of children with true hearing loss was 3.1%. The incidence of failed hearing screening and hearing loss in Mbarara, Uganda is similar to other populations. Hearing loss is a significant problem in Uganda and efforts should be made for primary, secondary, and tertiary prevention of hearing loss. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  5. Dientamoeba fragilis colonization is not associated with gastrointestinal symptoms in children at primary care level

    NARCIS (Netherlands)

    Holtman, Gea A.; Kranenberg, Justin J.; Blanker, Marco H.; Ott, Alewijn; Lisman-van Leeuwen, Yvonne; Berger, Marjolein Y.


    Background. Dientamoeba fragilis is commonly identified in children in primary care and is suspected to cause gastrointestinal disease. Objective. To determine the association between D. fragilis colonization and gastrointestinal symptoms in children. Methods. We performed a cross-sectional study

  6. Technical nursing students interacting with family members of hospitalized children

    Directory of Open Access Journals (Sweden)

    Juliana Yukari Takahashi Onishi

    Full Text Available ABSTRACT Objective: To understand technical nursing students' meaning of interacting with family members of hospitalized children. Method: Symbolic Interactionism was used as the theoretical framework and Qualitative Content Analysis was the methodological procedure. A total of eight graduates from an institution situated in the city of Osasco, Sao Paulo state, participated in this study. Data were collected through semi-structured interviews. Results: A total of five representative themes were revealed: Dealing with difficult situations with family members; Perceiving oneself to be unprepared to interact with family members; Family members being a helpful tool; Developing strategies to obtain a good interaction with family members; and Teachers being facilitators of the interaction with family members. Final considerations: To be acquainted with this experience has led to the understanding of the need to include the theme of family care in the curriculum of the Technical Nursing Course. Additionally, the present study contributed to reflections on the importance of such knowledge for this population and to the development of future studies, as this theme has been scarcely explored in the literature.

  7. Technical nursing students interacting with family members of hospitalized children. (United States)

    Onishi, Juliana Yukari Takahashi; Ribeiro, Circéa Amália; Silva, Maria Cristina Ferreira Carlos Rodrigues da; Borba, Regina Issuzu Hirooka de


    To understand technical nursing students' meaning of interacting with family members of hospitalized children. Symbolic Interactionism was used as the theoretical framework and Qualitative Content Analysis was the methodological procedure. A total of eight graduates from an institution situated in the city of Osasco, Sao Paulo state, participated in this study. Data were collected through semi-structured interviews. A total of five representative themes were revealed: Dealing with difficult situations with family members; Perceiving oneself to be unprepared to interact with family members; Family members being a helpful tool; Developing strategies to obtain a good interaction with family members; and Teachers being facilitators of the interaction with family members. To be acquainted with this experience has led to the understanding of the need to include the theme of family care in the curriculum of the Technical Nursing Course. Additionally, the present study contributed to reflections on the importance of such knowledge for this population and to the development of future studies, as this theme has been scarcely explored in the literature.

  8. Home Health Nursing Care and Hospital Use for Medically Complex Children. (United States)

    Gay, James C; Thurm, Cary W; Hall, Matthew; Fassino, Michael J; Fowler, Lisa; Palusci, John V; Berry, Jay G


    Home health nursing care (HH) may be a valuable approach to long-term optimization of health for children, particularly those with medical complexity who are prone to frequent and lengthy hospitalizations. We sought to assess the relationship between HH services and hospital use in children. Retrospective, matched cohort study of 2783 hospitalized children receiving postdischarge HH services by BAYADA Home Health Care across 19 states and 7361 matched controls not discharged to HH services from the Children's Hospital Association Case Mix database between January 2004 and September 2012. Subsequent hospitalizations, hospital days, readmissions, and costs of hospital care were assessed over the 12-month period after the initial hospitalization. Nonparametric Wilcoxon signed rank tests were used for comparisons between HH and non-HH users. Although HH cases had a higher percentage of complex chronic conditions (68.5% vs 65.4%), technology assistance (40.5% vs 35.7%), and neurologic impairment (40.7% vs 37.3%) than matched controls (P ≤ .003 for all), 30-day readmission rates were lower in HH patients (18.3% vs 21.5%, P = .001). At 12 months after the index admission, HH patients averaged fewer admissions (0.8 vs 1.0, P < .001), fewer days in the hospital (6.4 vs 6.6, P < .001), and lower hospital costs ($22 511 vs $24 194, P < .001) compared with matched controls. Children discharged to HH care experienced less hospital use than children with similar characteristics who did not use HH care. Further investigation is needed to understand how HH care affects the health and health services of children. Copyright © 2016 by the American Academy of Pediatrics.

  9. Comorbidities treated in primary care in children with chronic fatigue syndrome / myalgic encephalomyelitis: A nationwide registry linkage study from Norway. (United States)

    Bakken, Inger J; Tveito, Kari; Aaberg, Kari M; Ghaderi, Sara; Gunnes, Nina; Trogstad, Lill; Magnus, Per; Stoltenberg, Camilla; Håberg, Siri E


    Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a complex condition. Causal factors are not established, although underlying psychological or immunological susceptibility has been proposed. We studied primary care diagnoses for children with CFS/ME, with children with another hospital diagnosis (type 1 diabetes mellitus [T1DM]) and the general child population as comparison groups. All Norwegian children born 1992-2012 constituted the study sample. Children with CFS/ME (n = 1670) or T1DM (n = 4937) were identified in the Norwegian Patient Register (NPR) (2008-2014). Children without either diagnosis constituted the general child population comparison group (n = 1337508). We obtained information on primary care diagnoses from the Norwegian Directorate of Health. For each primary care diagnosis, the proportion and 99 % confidence interval (CI) within the three groups was calculated, adjusted for sex and age by direct standardization. Children with CFS/ME were more often registered with a primary care diagnosis of weakness/general tiredness (89.9 % [99 % CI 88.0 to 91.8 %]) than children in either comparison group (T1DM: 14.5 % [99 % CI: 13.1 to 16.0 %], general child population: 11.1 % [99 % CI: 11.0 to 11.2 %]). Also, depressive disorder and anxiety disorder were more common in the CFS/ME group, as were migraine, muscle pain, and infections. In the 2 year period prior to the diagnoses, infectious mononucleosis was registered for 11.1 % (99 % CI 9.1 to 13.1 %) of children with CFS/ME and for 0.5 % (99 % CI (0.2 to 0.8 %) of children with T1DM. Of children with CFS/ME, 74.6 % (1292/1670) were registered with a prior primary care diagnosis of weakness / general tiredness. The time span from the first primary care diagnosis of weakness / general tiredness to the specialist health care diagnosis of CFS/ME was 1 year or longer for 47.8 %. This large nationwide registry linkage study confirms that the clinical picture in CFS

  10.  Treating Children Without Antibiotics in Primary Healthcare

    Directory of Open Access Journals (Sweden)

    Narayanan Kutty


    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.

  11. Is the Earth Flat or Round? Primary School Children's Understandings of the Planet Earth: The Case of Turkish Children (United States)

    Özsoy, Sibel


    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…

  12. Tuberculosis caseload in children with severe acute malnutrition related with high hospital based mortality in Lusaka, Zambia. (United States)

    Munthali, Tendai; Chabala, Chishala; Chama, Elson; Mugode, Raider; Kapata, Nathan; Musonda, Patrick; Michelo, Charles


    Tuberculosis and severe acute malnutrition (SAM) in children pose a major treatment and care challenge in high HIV burden countries in Africa. We investigated the prevalence of Tuberculosis notifications among hospitalised under-five children with severe acute malnutrition. A retrospective review of medical records for all children aged 0-59 months admitted to the University Teaching Hospital from 2009 to 2013 was performed. Descriptive statistics were employed to estimate TB caseload. Logistic regression was used to identify predictors of the TB caseload. A total of (n = 9540) under-five children with SAM were admitted over the period reviewed. The median age was 16 months (IQR 11-24) and the proportion diagnosed with TB was 1.58% (95% CI 1.3, 1.8) representing 151 cases. Of these, only 37 (25%) were bacteriologically confirmed cases. The HIV seroprevalence of children with SAM and TB was 46.5%. Children with SAM and TB were 40% more likely to die than children with SAM and without TB. Tuberculosis contributes to mortality among children with SAM in high TB and HIV prevalence settings. The under detection of cases and association of TB with HIV infection in malnutrition opens up opportunities to innovate integrative case finding approaches beyond just HIV counselling and testing within existing mother and child health service areas to include TB screening and prevention interventions, as these are critical primary care elements.

  13. Children hospitalized due to acute otitis media: how does this condition differ from acute mastoiditis? (United States)

    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

  14. A retrospective evaluation of traumatic dental injury in children who applied to the dental hospital, Turkey. (United States)

    Sari, M E; Ozmen, B; Koyuturk, A E; Tokay, U; Kasap, P; Guler, D


    The purpose of this study was to analyze traumatic dental injuries in children visiting the dental hospital emergency department in Samsun of Turkey, in the period from 2007 to 2011. Data of age, gender, causes of dental trauma, injured teeth, type of dental injuries, the application period, the dental treatments, and traumatic dental injuries according to the seasons were obtained from the records at dental hospital. Of all 320 patients with traumatic dental injury, 205 were boys and 115 were girls with a boys/girls ratio 1.78:1. Traumatic dental injury was observed more frequently in the 7-12 age groups: 52.5% in girls and 67.8% in boys. Falls are the major cause of traumatic dental injury in the age group 6-12 (51.4%). Sport activities are a common cause of traumatic dental injury in the 7-12 age group (34.2%). Patients visited a dentist within approximately 2 h (57.1%). The upper anterior teeth were subjected to trauma more frequently than the lower anterior teeth. The maxillary central incisors were the most commonly affected teeth, and the mandibular canins were the least affected teeth. In primary teeth, avulsion was the most common type of dental injury (23%); on the other hand, enamel fractures were the most common type of dental injury (30.6%) observed in permanent teeth. In the primary dentition, the most commonly performed treatments were dental examination and prescribing (70%). The most common treatment choices in permanent teeth were restoration and dental examination (49.7 and 15.8%, respectively). The results of the study show that the emergency intervention to traumatized teeth is important for good prognosis of teeth and oral tissues. Therefore, the parents should be informed about dental trauma in schools, and dental hospital physicians should be subjected to postgraduate training.

  15. Ophthalmic infections in children presenting to Angkor Hospital for Children, Siem Reap, Cambodia. (United States)

    Khauv, Phara; Turner, Paul; Soeng, Channy; Soeng, Sona; Moore, Catrin E; Bousfield, Rachel; Stoesser, Nicole; Emary, Kate; Thanh, Duy Pham; Baker, Stephen; Hang, Vu Thi Ty; van Doorn, H Rogier; Day, Nicholas P J; Parry, Christopher M


    Ophthalmic infections cause significant morbidity in Cambodian children but aetiologic data are scarce. We investigated the causes of acute eye infections in 54 children presenting to the ophthalmology clinic at Angkor Hospital for Children, Siem Reap between March and October 2012. The median age at presentation was 3.6 years (range 6 days - 16.0 years). Forty two patients (77.8%) were classified as having an external eye infection, ten (18.5%) as ophthalmia neonatorum, and two (3.7%) as intra-ocular infection. Organisms were identified in all ophthalmia neonatorum patients and 85.7% of patients with an external eye infection. Pathogens were not detected in either of the intra-ocular infection patients. Most commonly isolated bacteria were Staphylococcus aureus (23 isolates), coagulase-negative staphylococci (13), coliforms (7), Haemophilus influenzae/parainfluenzae (6), Streptococcus pneumoniae (4), and Neisseria gonorrhoeae (2). Chlamydia trachomatis DNA was detected in 60% of swabs taken from ophthalmia neonatorum cases. This small study demonstrates the wide range of pathogens associated with common eye infections in Cambodian children. The inclusion of molecular assays improved the spectrum of detectable pathogens, most notably in neonates.

  16. Reducing hospital admissions of healthy children with functional constipation: a quality initiative. (United States)

    Deneau, Mark; Mutyala, Ramakrishna; Sandweiss, David; Harnsberger, Janet; Varier, Raghu; Pohl, John F; Allen, Lauren; Thackeray, Callie; Zobell, Sarah; Maloney, Christopher


    Functional constipation (FC) is a common medical problem in children, with minimal risk of long-term complications. We determined that a large number of children were being admitted to our children's hospital for FC in which there was no neurological or anatomical cause. Our hospital experienced a patient complication in which a patient died after inpatient treatment of FC. Subsequently, we developed a standardised approach to determine when paediatric patients needed hospitalisation for FC, as well as to develop a regimented outpatient therapeutic approach for such children to prevent hospitalisation. Our quality improvement initiative resulted in a large decrease in the number of children with FC admitted into the hospital as well as a decrease in the number of children needing faecal disimpaction in the operating room. Our quality improvement process can be used to decrease hospitalisations, decrease healthcare costs and improve patient care for paediatric FC.

  17. Chinese Handwriting Performance of Primary School Children with Dyslexia (United States)

    Lam, Sutie S. T.; Au, Ricky K. C.; Leung, Howard W. H.; Li-Tsang, Cecilia W. P.


    The aim of this study was to investigate the Chinese handwriting performance of typical children and children with dyslexia, and to examine whether speed and accuracy of handwriting could reliably discriminate these two groups of children. One hundred and thirty-seven children with dyslexia and 756 typical children were recruited from main stream…

  18. Primary care management of respiratory tract infections in Dutch preschool children

    NARCIS (Netherlands)

    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

  19. Observation-status patients in children's hospitals with and without dedicated observation units in 2011. (United States)

    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 hospitals with a dedicated OU (11.06%) compared with hospitals without (9.63%, P 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.

  20. Reduced in-hospital mortality after improved management of children under 5 years admitted to hospital with malaria

    DEFF Research Database (Denmark)

    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...

  1. Mutual Expectations of Mothers of Hospitalized Children and Pediatric Nurses Who Provided Care: Qualitative Study. (United States)

    Konuk Şener, Dilek; Karaca, Aysel

    This study attempted to identify the mutual expectations of mothers whose children were hospitalized in the pediatric department of a university hospital and nurses who provided care. A descriptive phenomenological design has been used in this study. Data were obtained through tape-recorded semi-structured interviews. This study was conducted at a pediatric clinic, at a university hospital in a small city in Turkey. Participants comprised five nurses working in the children's clinic and 24 mothers who accompanied their children to the hospital. The six major themes that emerged were mothers' feelings and thoughts about the hospital experience, mothers' expectations for attention and support during hospitalization, mothers' expectations for invasive procedures, issues regarding physical comfort and hospital infrastructure, nurses' feelings and thoughts about working in the pediatric clinic, and nurses' expectations of the mothers. Mothers expected nurses to provide physical support including medication administration, and installing/applying IV and nebulizer treatments; and emotional support in terms of having a friendly, rather than critical attitude, and being approachable and receptive of mothers' questions and anxieties. Nurses stated that they were aware of these expectations but needed mothers to be understanding and tolerant, considering their difficult working conditions. Children's hospitalization is a stressful experience for parents. Open and therapeutic communication and relationships between parents and nurses contribute to improving the quality of care provided to children and their families. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Comparing performance of 30-day readmission risk classifiers among hospitalized primary care patients. (United States)

    Garrison, Gregory M; Robelia, Paul M; Pecina, Jennifer L; Dawson, Nancy L


    Hospital readmission within 30 days of discharge occurs in almost 20% of US Medicare patients and may be a marker of poor quality inpatient care, ineffective hospital to home transitions, or disease severity. Within a patient centered medical home, care transition interventions may only be practical from cost and staffing perspectives if targeted at patients with the greatest risk of readmission. Various scoring algorithms attempt to predict patients at risk for 30-day readmission, but head-to-head comparison of performance is lacking. Compare published scoring algorithms which use generally available electronic medical record data on the same set of hospitalized primary care patients. The LACE index, the LACE+ index, the HOSPITAL score, and the readmission risk score were computed on a consecutive cohort of 26,278 hospital admissions. Classifier performance was assessed by plotting receiver operating characteristic curves comparing the computed score with the actual outcome of death or readmission within 30 days. Statistical significance of differences in performance was assessed using bootstrapping techniques. Correct readmission classification on this cohort was moderate with the following c-statistics: Readmission risk score 0.666; LACE 0.680; LACE+ 0.662; and HOSPITAL 0.675. There was no statistically significant difference in performance between classifiers. Logistic regression based classifiers yield only moderate performance when utilized to predict 30-day readmissions. The task is difficult due to the variety of underlying causes for readmission, nonlinearity, and the arbitrary time period of concern. More sophisticated classification techniques may be necessary to increase performance and allow patient centered medical homes to effectively focus efforts to reduce readmissions. © 2016 John Wiley & Sons, Ltd.

  3. Fifty Years of Burn Care at Shriners Hospitals for Children, Galveston. (United States)

    Čapek, Karel D; Culnan, Derek M; Desai, Manubhai H; Herndon, David N


    More than 50 years ago, Shriners Hospitals for Children expanded their philanthropy to include care for burned children. In so doing, the effects of their work weightily expanded from rehabilitation and quality of life outcomes to include survival proper. As the first facility dedicated to the care of burned children, originally designated the Shriners Burn Institute, the Galveston hospital remains the cornerstone of this endeavor. Shriners maintains charitable pediatric hospitals, provide care irrespective of the patient's or the family's ability to pay, and promote research. The sole criterion for admission at Shriners Hospitals for Children is the determination by a surgeon at a Shriners hospital that "the child's trouble may be corrected or improved." This philanthropic effort to provide medical care for children is one expression of the human commonality recognized by Shriners. In this article, we provide some background information on how this hospital came into existence as well as a global summary of its interventions toward greater survival and more complete rehabilitation of burned children. Based on the findings presented herein, we assert that there is less suffering and less loss of life due to childhood burns today than in previous years. We attribute much of this improvement to the simple voluntary collective decision by Shriners to provide alms for burned children.

  4. Pilonidal sinus disease surgery in children: the first study to compare crystallized phenol application to primary excision and closure. (United States)

    Ates, Ufuk; Ergun, Ergun; Gollu, Gulnur; Sozduyar, Sumeyye; Kologlu, Meltem; Cakmak, Murat; Dindar, Huseyin; Yagmurlu, Aydin


    Pilonidal sinus (PS) is an infectious and inflammatory disease of sacrococcygeal region. Current methods include; surgical excision with/without suturing the defect, rhomboid excision and flap and chemical substance application. In this study, crystallized phenol application was compared to excision and primary closure. This retrospective study included pediatric patients with PS who were treated with excision and primer closure technique and phenol application. The patients' medical data were analyzed retrospectively. This study included 117 patients with PS. There were 52 girls (44%) and 65 boys (56%). Mean age of children was 15.6 (12-20) years. Excision and primary closure were applied to 77 patients (66%) and phenol was applied to 40 patients (34%). The children in phenol group were discharged on the operation day; mean hospitalization time in the excision and primary closure group was 2.7 (1-14) days. Mean follow up was 44.6 (8-82) months for primary excision and closure group and 8.1 (1-19) months for phenol group. Although many surgical and non-surgical treatment modalities have been described for PS, the optimal one remains unknown. Limited with the retrospective nature of the data, crystallized phenol application seems a feasible minimal invasive alternative to primary closure of PS with lower recurrence and complication rates in children. Level III. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. A comparison of the 'cost per child treated' at a primary care-based sedation referral service, compared to a general anaesthetic in hospital. (United States)

    Jameson, K; Averley, P A; Shackley, P; Steele, J


    To compare the cost-effectiveness of dental sedation techniques used in the treatment of children, focusing on hospital-based dental general anaesthetic (DGA) and advanced conscious sedation in a controlled primary care environment. Data on fees, costs and treatment pathways were obtained from a primary care clinic specialising in advanced sedation techniques. For the hospital-based DGA cohort, data were gathered from hospital trusts in the same area. Comparison was via an average cost per child treated and subsequent sensitivity analysis. Analysing records spanning one year, the average cost per child treated via advanced conscious sedation was pound245.47. As some treatments fail (3.5% of cases attempted), and the technique is not deemed suitable for all patients (4-5%), DGA is still required and has been factored into this cost. DGA has an average cost per case treated of pound359.91, 46.6% more expensive than advanced conscious sedation. These cost savings were robust to plausible variation in all parameters. The costs of advanced conscious sedation techniques, applied in a controlled primary care environment, are substantially lower than the equivalent costs of hospital-based DGA, informing the debate about the optimum way of managing this patient group.

  6. The proposed Nelson Mandela Children's Hospital, Johannesburg: providing the best care for children in the developing world. (United States)

    Bolton, Keith


    Construction will soon commence on the Nelson Mandela Children's Hospital (NMCH) in Johannesburg, South Africa. The Hospital will have 250-300 beds and will provide tertiary and quaternary care to children in specific Centers of Excellence. Admission to this referral facility will be based entirely on medical needs. The disciplines that are catered for include Paediatric surgery, oncology, nephrology, cardiology, intensive care and imaging. The NMCH will be South Africa's first "Private Hospital - Not for Gain". Funding for capital expenditure is currently being raised by the Trust. Operational expenditure will come from the Department of Health, private insurers and neighbouring governments.

  7. Hospital-based school for children with chronic illness in Taiwan. (United States)

    Chen, Der-Fang; Tsai, Tsuen-Chiuan; Su, Yu-Tsun; Lin, Chi-Wei


    To provide educational support and avoid unwanted damage that may impede learning for children with chronic illness, the learning environment should be friendly and safe. There is a need to establish schools inside hospitals, however, which may be neglected in a highly efficient health care system. A study was conducted to identify hospital-based schools for sick children in Taiwan, and to explore the barriers for implementation. The data were collected by structured telephone interview and retrieval of hospital web information. The study targeted social workers and nurses in the pediatric wards of 29 hospitals, plus officials from the Education Bureau in Taiwan. The interviewers inquired about the availability of a formal educational program inside hospitals and the barriers (if any) in providing educational supports. Taiwan has only one hospital-based informal school and eight hospitals with rotating bedside teachers. Education inside hospitals occurs mostly through voluntary teaching in informal education models. Information about special educational resources has not been widely distributed to patients and health care providers. Professional personnel in Taiwan are not well aware of the needs to establish a hospital-based school. The educational needs of children with chronic illness can be easily neglected even in an industrialized country. The establishment of policy and the enrichment of professional education on advocacy are necessary to eliminate educational inequities and benefit sick children. Copyright © 2014. Published by Elsevier B.V.

  8. Eye Injuries Among Primary School Children in Enugu, Nigeria: Rural vs Urban. (United States)

    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 children children had evidence of injury to the eye or its adnexa. Eyelid scar was the commonest (5.34%) followed by eyebrow scar (2.10%). Canthal scar was the next (0.32%). Two girls had monocular blindness from eye trauma (0.16%). One had leucoma, while the other had a dislocated lens. All the monocular blind children of this study were from the urban area. The home was the commonest environment for an eye injury (69.39%) followed by the 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 of

  9. Facility type and primary care performance in sub-district health promotion hospitals in Northern Thailand.

    Directory of Open Access Journals (Sweden)

    Nithra Kitreerawutiwong

    Full Text Available 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.

  10. Marketing fast food: impact of fast food restaurants in children's hospitals. (United States)

    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

  11. Application of smart phone and supporting set for fundus imaging in primary hospital of rural area

    Directory of Open Access Journals (Sweden)

    Yong-Feng Jing


    Full Text Available AIM: To describe the application of smart phone and supporting set for acquiring fundus images with slitlamp examination and non-contact lens in primary hospital of the rural area. METHODS: The supporting set for smart phone was purchased from taobao and securely connected to the ocular lens of slitlamp microscopy. The fundus photos were imaged with assistance of non-contact slitlamp lens from Volk. RESULTS: High quality images of various retinal diseases could be successfully taken with smart phone and supporting set by slitlamp examination. The fundus images were send to patients with Wechat as medical records or used for telconsultant. CONCLUSION: High resolution smart phones are wildly used nowadays and supporting sets are very accessible; thus high quality of images could be obtained with minimal cost in rural hospitals. The digital fundus images will be beneficial for medical record and rapid diagnosis with telconsultant.

  12. The Effect of Adjuvant Zinc Therapy on Recovery from Pneumonia in Hospitalized Children: A Double-Blind Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Mohammad Javad Qasemzadeh


    Full Text Available Objectives. Pneumonia is one of the common mortality causes in young children. Some studies have shown beneficial effect of zinc supplements on treatment of pneumonia. The present study aimed to investigate the effects of short courses of zinc administration on recovery from this disease in hospitalized children. Methods. In a parallel Double-Blind Randomized Controlled Trial at Ayatollah Golpaygani Hospital in Qom, 120 children aged 3–60 months with pneumonia were randomly assigned 1 : 1 to receive zinc or placebo (5 mL every 12 hours along with the common antibiotic treatments until discharge. Primary outcome was recovery from pneumonia which included the incidence and resolving clinical symptoms and duration of hospitalization. Results. The difference between two groups in all clinical symptoms at admittance and the variables affecting the disease such as age and sex were not statistically significant (P<0.05 at baseline. Compared to the placebo group, the treatment group showed a statistically significant decrease in duration of clinical symptoms (P=0.044 and hospitalization (P=0.004. Conclusions. Supplemental administration of zinc can expedite the healing process and results in faster resolution of clinical symptoms in children with pneumonia. In general, zinc administration, along with common antibiotic treatments, is recommended in this group of children. It can also reduce the drug resistance caused by multiple antibiotic therapies. This trial is approved by Medical Ethic Committee of Islamic Azad University in Iran (ID Number: 8579622-Q. This study is also registered in AEARCTR (The American Economic Association's Registry for Randomized Controlled Trials. This trial is registered with RCT ID: AEARCTR-0000187.

  13. [Primary intestinal lymphangiectasia: twenty years of experience at a Mexican tertiary care hospital]. (United States)

    Valdovinos-Oregón, D; Ramírez-Mayans, J; Cervantes-Bustamante, R; Toro-Monjaraz, E; Cázares-Méndez, M; Cadena-León, J; Zárate-Mondragón, F; Montijo-Barrios, E


    Primary intestinal lymphangiectasia is a rare congenital disease described by Waldmann in 1961 that is a consequence of obstruction of the lymphatic drainage of the small bowel with secondary lymph vessel dilation. This distorts the architecture of the villi and causes a leakage of lymph into the intestinal lumen, resulting in protein-losing enteropathy and malabsorption. To describe the clinical, biochemical, radiologic, endoscopic, and histologic characteristics in children with primary intestinal lymphangiectasia. A retrospective observational, descriptive, cross-sectional study was conducted that reviewed the case records of children diagnosed with primary intestinal lymphangiectasia that were seen at the Department of Gastroenterology and Nutrition of the Instituto Nacional de Pediatría within the time frame of January 1, 1992 to September 30, 2012. Four patients were found that presented with primary intestinal lymphangiectasia. Three of them had been diagnosed before 3 years of age. All the patients presented with chronic diarrhea, edema, lymphopenia, hypocalcemia, and hypogammaglobulinemia, and 3 patients presented with hypocholesterolemia. Bowel transit time, endoscopy, and intestinal biopsies were characteristic of this pathology. Intestinal lymphangiectasia should be suspected when there is a clinical picture of chronic diarrhea and protein-losing enteropathy accompanied with edema at any level, as well as hypoalbuminemia, hypocalcemia, lymphopenia, hypogammaglobulinemia, and hypocholesterolemia, which are the main biochemical findings of this pathology. All children presenting with intestinal lymphangiectasia should undergo an upper gastrointestinal series with bowel transit time and endoscopy with biopsies taken at the level of the duodenum. Treatment includes diet and the periodic administration of albumin and gamma globulin. Copyright © 2013 Asociación Mexicana de Gastroenterología. Published by Masson Doyma México S.A. All rights reserved.

  14. A clinical tool for evaluating emotional well-being: self-drawings of hospitalized children. (United States)

    Dolidze, Khatuna; Smith, Emma L; Tchanturia, Kate


    This study investigated how the emotional wellbeing of children with congenital heart defect (CHD) hospitalized for heart surgery was expressed in self-drawings before and after their surgical treatment. A sample of 293 children produced self-drawings (hospitalized n=168, non-hospitalized n=125). The results indicate significant differences between drawings by hospitalized compared to non-hospitalized children, including size, color and omission of body parts. These differences were interpreted in line with previous analyses of projective drawing. We conclude that self-drawing evaluation is a useful tool to reveal insights into emotional wellbeing, promoting safe and easy communication. Crown Copyright © 2013. Published by Elsevier Inc. All rights reserved.

  15. Psychopathology of the General Population Referred by Primary Care Physicians for Urgent Assessment in Psychiatric Hospitals

    Directory of Open Access Journals (Sweden)

    Judith McLenan


    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.

  16. The influence of hospital drug formulary policies on the prescribing patterns of proton pump inhibitors in primary care

    DEFF Research Database (Denmark)

    Larsen, Michael Due; Schou, Mette; Kristiansen, Anja Sparre


    decreased from 33.5 to 9.4 %, corresponding to a risk ratio of 0.28. In primary care after discharge, 13.4 % of esomeprazole use was initiated in the hospital, and this was 8.4 % for PPIs in general. After the change of hospital drug policy, this decreased to 6.5 % for esomeprazole and increased......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...

  17. Improving nutritional status of children with cystic fibrosis at Red Cross War Memorial Children's Hospital. (United States)

    van der Spuy, Dorothy A; Cader, Shihaam; van der Spuy, Gian D; Westwood, Anthony T


    To determine the nutritional status of children attending a cystic fibrosis clinic in a tertiary hospital in South Africa and compare it to previously reported 10-year rates. Weights and heights were measured of 69 (37 male and 32 female) children aged between 1 year and 18 years. Expected weight-for-age, expected height-for-age, expected weight-for-height and body mass index (BMI) were compared with international standards for underweight, stunting, wasting and BMI goal. The nutritional status of the patients has improved over the last 10 years, most significantly for wasting, which decreased from 58.3% in 1996 to 15.9% in 2006 (95% confidence interval (CI), 1.315-14.09, P nutritional status, although deficits remain. The normalisation of mean weight-for-age and weight-for-height with far fewer wasted patients is encouraging. Interventions are needed in some areas to ensure that all children show progress. © 2011 The Authors. Journal of Paediatrics and Child Health © 2011 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  18. [Humanization through the art of environment of children's emergency in a hospital]. (United States)

    Ullán, Ana M; Fernández, Esperanza; Belver, Manuel H


    This article aims to present and discuss a case-study of human betterment through the arts applied to a children's hospital. The experience related to the betterment of these environments took place in the Children's Emergency Service of the University Hospital in Salamanca. After describing the context of the case-study some attention will be devoted to the phases of the process, emphasizing those aspects linked to children's care culture and their families as well as the symbolic dimension of the space and the participation of different professionals in the experience. The case-study is assessed from different standpoints but special importance is given to parents' opinions. 51 parents of children in the emergency unit were interweaved during a month. Parents valued positively the service and stated that artists' intervention had been beneficial for the children's emotional state. The article concludes with a debate about the meaning of the hospital environment and the quality associated with its physical premises.

  19. Serum Thyroid-Stimulating Hormone Levels and Body Mass Index Percentiles in Children with Primary Hypothyroidism on Levothyroxine Replacement. (United States)

    Shaoba, Asma; Basu, Sanjib; Mantis, Stelios; Minutti, Carla


    To determine the association, if any, between thyroid-stimulating hormone (TSH) levels and body mass index (BMI) percentiles in children with primary hypothyroidism who are chemically euthyroid and on treatment with levothyroxine. This retrospective cross-sectional study consisted of a review of medical records from RUSH Medical Center and Stroger Hospital, Chicago, USA of children with primary hypothyroidism who were seen in the clinic from 2008 to 2014 and who were chemically euthyroid and on treatment with levothyroxine for at least 6 months. The patients were divided into two groups based on their TSH levels (0.34-hypothyroidism who are chemically euthyroid on treatment with levothyroxine, there is a positive association between higher TSH levels and higher BMI percentiles. However, it is difficult to establish if the higher TSH levels are a direct cause or a consequence of the obesity. Further studies are needed to establish causation beyond significant association.

  20. A Comparison of Ambulatory Care Sensitive Hospitalizations Among Children With and Without Autism Spectrum Disorder. (United States)

    Carbone, Paul S; Young, Paul C; Stoddard, Gregory J; Wilkes, Jacob; Trasande, Leonardo


    To compare the prevalence of hospitalizations for ambulatory care sensitive conditions (ACSC) in children with and without autism spectrum disorder (ASD) and to compare inpatient health care utilization (total charges and length of stay) for the same conditions in children with and without ASD. The 2009 Kids' Inpatient Database was used to examine hospitalizations for ACSC in children within 3 cohorts: those with ASD, those with chronic conditions (CC) without ASD, and those with no CC. The proportion of hospitalizations for ACSC in the ASD cohort was 55.9%, compared with 28.2% in the CC cohort and 22.9% in the no-CC cohort (P Hospitalized children with ASD were more likely to be admitted for a mental health condition, epilepsy, constipation, pneumonia, dehydration, vaccine-preventable diseases, underweight, and nutritional deficiencies compared with the no-CC cohort. Compared with the CC cohort, the ASD cohort was more likely to be admitted for mental health conditions, epilepsy, constipation, dehydration, and underweight. Hospitalized children with ASD admitted for mental health conditions had significantly higher total charges and longer LOS compared with the other 2 cohorts. The proportion of potentially preventable hospitalizations is higher in hospitalized children with ASD compared with children without ASD. These data underscore the need to improve outpatient care of children with ASD, especially in the areas of mental health care and seizure management. Future research should focus on understanding the reasons for increased inpatient health care utilization in children with ASD admitted for mental health conditions. Copyright © 2015 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  1. Feelings of women accompanying children hospitalized in a Paediatric Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Cassiana Mendes Bertoncello Fontes


    Full Text Available Objective: Analise feelings of women accompanying children in a paediatric intensive care unit Materials and Methods: Data were collected from August to October 2015 by the authors from individual interviews recorded with 15 women. The instrument was structured with the identification of qualitative variables, described in absolute and relative frequencies, and a guiding question. The "corpus" of each interview was electronically transcribed, floating readings were held and statements were categorized and analysed according Analise Content.  Results: 14 (93% are biological mothers; average age 30 years; 11 (73% have completed primary education; six (46% have an occupation or a profession. The four themes were inferred: ambivalence of feelings and coping were related to how individuals express and deal with the hospitalized patient’s situation; empathy with the health team and the structural condition of the critical environment can also generate feelings. Nursing diagnoses were formulated from the reported feelings. Conclusion: It was observed that the feelings identified could be originated by the health-illness hospitalization process as well as the structural components of the critical environment. Keywords: Paediatric Intensive Care Units; Women; Feelings.

  2. [Primary lymphoma of the central nervous system: 20 years' experience in a referral hospital]. (United States)

    Calderón-Garcidueñas, A L; Pacheco-Calleros, J; Castelán-Maldonado, E; Nocedal-Rustrián, F C

    Primary central nervous system lymphomas (PCNSL) are rare neoplasms. AIM. To study the clinical aspects and the immuno-phenotype of all cases of PCNSL in a 20 years lapse in a referral hospital in Northeastern Mexico. From January 1986 to December 2005 all PCNSL histologically confirmed were studied. The primary lymphomas were 1% of malignant central nervous system neoplasms. 21 cases were studied (ages from 9-70 years) with male predominance (2:1). 24% patients had immuno-suppression. The more frequent clinical data were: papilledema (71%), headache (62%), paresis (48%) and seizures (33%). 33% of patients died during the first six months after diagnosis. The T lymphomas were 19% of cases and corresponded to small cell type. PCNSL are still a diagnostic challenge. Multicenter studies are required in order to determine the best treatment protocol.

  3. Calling for the Development of Children's Number Sense in Primary Schools in Malaysia (United States)

    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…

  4. Refugee Children in South Africa: Access and Challenges to Achieving Universal Primary Education (United States)

    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…

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

    NARCIS (Netherlands)

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

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

  6. "Why Don't They Report?" Hospital Personnel Working with Children at Risk (United States)

    Svärd, Veronica


    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…

  7. Placebo controlled trial of zinc supplementation on duration of hospital stay in children with pneumonia

    International Nuclear Information System (INIS)

    Singh, A.K.; Iqbal, M.J.; Akhtar, R.; Afzal, M.F.


    Background: Pneumonia is one of the leading causes of morbidity and mortality in children younger than 5 years of age. Zinc may have an important protective role in cases of childhood pneumonia. Objectives: To study the effect of zinc supplementation on duration of hospital stay in children (6 months to 5 years) with pneumonia. Methodology: This Randomized control trial was conducted in the Department of Paediatrics Unit - I, King Edward Medical University / Mayo Hospital, Lahore from January to December 2011. After consent, 150 children from 6 months to 5 years of age with pneumonia consistent with WHO ARI definition along with crepitations on auscultation were registered by non-probability purposive sampling and were randomized into treatment group (Group A) and placebo group (Group B). Seventy five children supplemented with zinc for 14 days while 75 children were supplemented with placebo. Outcome measure was duration of hospital stay. T-test was used to compare the groups. Results: Out of total study population of 150, majority (35%) of children were below 2 years. There was male predominance (64%). Mean duration of hospital stay was significantly reduced in treatment group (p value < 0.05). Conclusion: Zinc supplementation results in statistically significant reduction in the duration of hospital stay in children (6 months to 5 years) with pneumonia. (author)

  8. The effectiveness of development programming strength in primary school children

    Directory of Open Access Journals (Sweden)

    O.M. Khudolii


    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.

  9. The effectiveness of development programming strength in primary school children

    Directory of Open Access Journals (Sweden)

    Khudolii O.M.


    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.

  10. A Critical Analysis on Primary Schools Preparedness for the Transition of Autistic Children in Kenya (United States)

    Otina, Salmon O.; Thinguri, Ruth W.


    Autistic children, characterized by impaired social interactions, impaired communication, repetitive and stereotyped patterns of behaviors, are also entitled to education just like the other children in the society. It is therefore important that primary schools in Kenya get prepared so that the children are able to transit to schools from their…

  11. A Multi-Modal Digital Game-Based Learning Environment for Hospitalized Children with Chronic Illnesses. (United States)

    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…

  12. [Factors associated with involuntary hospital admissions in technology-dependent children]. (United States)

    Okido, Aline Cristiane Cavicchioli; Pina, Juliana Coelho; Lima, Regina Aparecida Garcia


    To identify the factors associated with involuntary hospital admissions of technology-dependent children, in the municipality of Ribeirão Preto, São Paulo State, Brazil. A cross-sectional study, with a quantitative approach. After an active search, 124 children who qualified under the inclusion criteria, that is to say, children from birth to age 12, were identified. Data was collected in home visits to mothers or the people responsible for the children, through the application of a questionnaire. Analysis of the data followed the assumptions of the Generalized Linear Models technique. 102 technology-dependent children aged between 6 months and 12 years participated in the study, of whom 57% were male. The average number of involuntary hospital admissions in the previous year among the children studied was 0.71 (±1.29). In the final model the following variables were significantly associated with the outcome: age (OR=0.991; CI95%=0.985-0.997), and the number of devices (OR=0.387; CI95%=0.219-0.684), which were characterized as factors of protection and quantity of medications (OR=1.532; CI95%=1.297-1.810), representing a risk factor for involuntary hospital admissions in technology-dependent children. The results constitute input data for consideration of the process of care for technology-dependent children by supplying an explanatory model for involuntary hospital admissions for this client group.

  13. Frequency of nocturnal symptoms in asthmatic children attending a hospital out-patient clinic

    NARCIS (Netherlands)

    Meijer, G. G.; Postma, D. S.; Wempe, J. B.; Gerritsen, J.; Knol, K.; van Aalderen, W. M.


    Since nocturnal symptoms indicate more severe asthma, we investigated their frequency in a hospital-based population of asthmatic children. Recognition of these symptoms offers the possibility to introduce appropriate treatment. We studied 796 consecutive children with asthma (mean (SD) age 9 (4)

  14. [Psychosocial stress environment and health workers in public health: Differences between primary and hospital care]. (United States)

    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.

  15. Transforming the Primary Care Training Clinic: New York State's Hospital Medical Home Demonstration Pilot. (United States)

    Angelotti, Marietta; Bliss, Kathryn; Schiffman, Dana; Weaver, Erin; Graham, Laura; Lemme, Thomas; Pryor, Veronica; Gesten, Foster C


    Training in patient-centered medical home (PCMH) settings may prepare new physicians to measure quality of care, manage the health of populations, work in teams, and include cost information in decision making. Transforming resident clinics to PCMHs requires funding for additional staff, electronic health records, training, and other resources not typically available to residency programs. Describe how a 1115 Medicaid waiver was used to transform the majority of primary care training sites in New York State to the PCMH model and improve the quality of care provided. The 2013-2014 Hospital Medical Home Program provided awards to 60 hospitals and 118 affiliated residency programs (training more than 5000 residents) to transform outpatient sites into PCMHs and provide high-quality, coordinated care. Site visits, coaching calls, resident surveys, data reporting, and feedback were used to promote and monitor change in resident continuity and quality of care. Descriptive analyses measured improvements in these areas. A total of 156 participating outpatient sites (100%) received PCMH recognition. All sites enhanced resident education using PCMH principles through patient empanelment, development of quality dashboards, and transforming resident scheduling and training. Clinical quality outcomes showed improvement across the demonstration, including better performance on colorectal and breast cancer screening rates (rate increases of 13%, P≤.001, and 11%, P=.011, respectively). A 1115 Medicaid waiver is a viable mechanism for states to transform residency clinics to reflect new primary care models. The PCMH transformation of 156 sites led to improvements in resident continuity and clinical outcomes.

  16. Specific work with manifestations ADHD by the children at the primary school


    MUSILOVÁ, Veronika


    This thesis focuses on specific work of primary school teachers that is related to children with the symptoms of ADHD. The theoretical part describes primary school system, young school age children from the perspective of development psychology, further it deals with ADHD in terms of terminology, occurrence, origins of this disorder and description of symptoms ADHD. The practical part of this thesis contains interviews with teachers which encountered children with ADHD during their working e...

  17. [Evaluation of primary health care activities at the Albert Schweitzer hospital in Lambarene, Gabon]. (United States)

    Diallo, M; Ninteretse, B


    In 1999 the Albert Schweitzer Hospital in Lambrene, Gabon set up a community health care service that provides immunization campaigns and mother/child health care and manages 9 village health care centers in a district with a population of approximately 64000 inhabitants. An evaluation conducted in April 2006 showed that collection of a consultation charge (15 euros) could cover the basic costs of operating these centers and purchasing necessary medicines. Three of the four centers evaluated demonstrated good quality indicators including properly kept records, posting of information bulletins for patients, appropriate referrals, and good relations with village authorities. At the center that performed poorly, the nurse apparently received no pay or lodging. Analysis of data about pediatric activity showed that diagnosis of diarrhea, malnutrition and anemia has fallen while hospitalization for tuberculosis and urinary schistomiasis is now being recorded. At the same time, village health centers are increasingly concerned with problems related to management and prevention of AIDS, malaria and urinary schistomiasis. This service shows that with good supervision it is possible to improve the quality of primary health care with partial but adequate recovery of costs and that basic health care workers are able to provide overall management for complicated patients, facilitate the work of reference hospital, and report new health problems.

  18. The Prolonged Neonatal Admission: Implications for our National Children's Hospital

    LENUS (Irish Health Repository)

    McGlacken-Byrne, SM


    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\

  19. Hospital malnutrition in children: what are the challenges?

    African Journals Online (AJOL)


    Oct 20, 2016 ... Hospital malnutrition can be regarded as a universal problem. It is highly prevalent in the young,1 in acute2 and chronic1 disease conditions and in developed1 as well as developing2 countries. It is associated with many adverse outcomes, including prolonged ICU1 and hospital length of stay,1,3,4,5 ...

  20. Effect of probiotic Lactobacillus strains in young children hospitalized with acute diarrhea

    DEFF Research Database (Denmark)

    Rosenfeldt, Vibeke; Michaelsen, Kim Fleischer; Jakobsen, Mogens


    intervention, the length of hospitalization was reduced by 48% (3.5 vs. 1.7 days, P = 0.03). At the end of the intervention, rotavirus antigen was found in 12% of patients from the treatment group vs. 46% from the control group (P = 0.02). CONCLUSIONS: The two probiotics, L. rhamnosus 19070-2 and L. reuteri...... DSM 12246, ameliorated acute diarrhea in hospitalized children and reduced the period of rotavirus excretion. Oral bacteriotherapy was associated with a reduced length of hospital stay. The beneficial effects were most prominent in children treated early in the diarrheal phase....

  1. A systematic procedure for identifying and classifying children with dyscalculia among primary school children in India. (United States)

    Ramaa, S; Gowramma, I P


    This paper describes the procedures adopted by two independent studies in India for identifying and classifying children with dyscalculia in primary schools. For determining the presence of dyscalculia both inclusionary and exclusionary criteria were used. When other possible causes of arithmetic failure had been excluded, figures for dyscalculia came out as 5.98% (15 cases out of 251) in one study and 5.54% (78 out of 1408) in the second. It was found in the latter study that 40 out of the 78 (51.27%) also had reading and writing problems. The findings are discussed in the light of previous studies.

  2. Children staying in hospital: a research on psychological stress of caregivers

    Directory of Open Access Journals (Sweden)

    Commodari Elena


    Full Text Available Abstract Background Having a child hospitalized is a stressful event for parents. Previous studies have found increased stress in families with children affected by different kinds of pathologies, and analyzed disease related objective variables producing stress. However, most of these studies recruited caregivers of children with chronic or serious illnesses, and focused on evaluation of objective environmental stressors and did not consider subjective "perception" of stress. The aim of this study was to investigate perception of acute stress in caregivers taking care of children without serious physical damage that were hospitalized for short periods. Moreover, some variables, such as recreational and school services offered to children, influencing perception of cognitive, physiological and behavioral state relating to the sensation of "being stressed" were analyzed. Methods This study was realized with a sample of caregivers of children hospitalized for mild acute diseases. Research was conducted using two standardized tests, PSM (Psychological Stress Measure and STAI (State Trait Anxiety Inventory, whose characteristics of reliability and validity had been successfully established. Results Present data showed that caregivers of hospitalized children perceived high levels of stress and anxiety. Perception of stress was influenced by the degree of kindred with patients, length of hospitalization, and, notably, participation in some of the activities offered to children, mainly school services. Discussion Findings showed that child hospitalization is a stressful event for caregivers, even if hospitalization is for middle and transient pathologies. Perception of stress was influenced by length of hospitalization, and by degree of kindred. Findings even suggest that some services offered to children can modulate caregivers' perception of stress and impact of hospitalization. Caregivers whose children used school services describe themselves as

  3. Relationship Between Preoperative Anemia and In-Hospital Mortality in Children Undergoing Noncardiac Surgery. (United States)

    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.

  4. Interface management of pharmacotherapy. Joint hospital and primary care drug recommendations. (United States)

    Björkhem-Bergman, Linda; Andersén-Karlsson, Eva; Laing, Richard; Diogene, Eduardo; Melien, Oyvind; Jirlow, Malena; Malmström, Rickard E; Vogler, Sabine; Godman, Brian; Gustafsson, Lars L


    In September 2012 an interactive course on the "Interface Management of Pharmacotherapy" was organized by the Stockholm Drug and Therapeutics Committee in cooperation with Department of Clinical Pharmacology at Karolinska Institutet and at Karolinska University Hospital in Stockholm, Sweden, in collaboration with the WHO. The basis for the course was the "Stockholm model" for the rational use of medicines but also contained presentations about successful models in interface management of pharmacotherapy in other European countries. The "Stockholm model" consists of 8 components: 1) Independent Drug and Therapeutics Committee with key role for respected drug experts with policy for "interest of conflicts", 2) The "Wise List", recommendations of medicines jointly for primary and hospital care, 3) Communication strategy with continuous medical education, 4) Systematic introduction of new expensive medicines, 5) E-pharmacological support at "point of care", 6) Methods and tools for follow-up of medicines use, 7) Medicines policy strategy and 8) Operative resources. The course highlighted the importance of efficient and targeted communication of drug recommendations building on trust among prescribers and patients for the guidelines to achieve high adherence. Trust is achieved by independent Drug and Therapeutics Committees with a key role for respected experts and a strict policy for "conflicts of interest". Representations of GPs are also crucial for successful implementation, being the link between evidence based medicine and practice. The successful models in Scotland and in Stockholm as well as the ongoing work in Catalonia were considered as examples of multifaceted approaches to improve the quality of medicine use across primary and hospital care.

  5. Implementing a pediatric obesity care guideline in a freestanding children's hospital to improve child safety and hospital preparedness. (United States)

    Porter, Renee M; Thrasher, Jodi; Krebs, Nancy F


    Medical and surgical care of children with severe obesity is complicated and requires recognition of the problem, appropriate equipment, and safe management. There is little literature describing patient, provider, and institutional needs for the severely obese pediatric patient. Nonetheless, the limited data suggest 3 broad categories of needs unique to this population: (a) airway management, (b) drug dosing and pharmacology, and (c) equipment and infrastructure. We describe an opportunity at the Children's Hospital Colorado to better prepare and optimize care for this patient population by creation of a Pediatric Obesity Care Guideline that focused on key areas of quality and safety. Copyright © 2012 Elsevier Inc. All rights reserved.

  6. Maternal morbidity and mortality due to primary PPH-experience at ayub teaching hospital abbottabad

    International Nuclear Information System (INIS)

    Naz, H.; Sarwar, I.; Nisa, A.U.


    Postpartum Haemorrhage (PPH) remains a significant cause of maternal mortality and morbidity like hypovolemic shock, anaemia, multi organ failure, consumptive coagulopathy, disseminated intra vascular coagulation (DIC), blood transfusion related complications and hysterectomy leading to loss of childbearing potential. The present study was conducted to determine the frequency of PPH and the associated maternal morbidity at the Department of Gynaecology Unit B, Ayub Teaching Hospital Abbottabad. The study was carried out in the Department of Obstetrics and Gynaecology Unit B of the Ayub teaching Hospital Abbottabad from 18th April 2006 to 17 July 2006. The study population included all cases admitted with primary PPH during the study period. For calculation of frequencies, the total number of deliveries in the setting during the study period was used. All subjects underwent a complete obstetrical clinical workup comprising of history, general physical examination, abdominal and pelvic examination, relevant laboratory investigations. The maternal condition was assessed and managed according to established hospital protocols which included both pharmacological and surgical intervention. All maternal complications were noted and recorded on pre-designed proformas. Data was entered and analyzed by computer. A total of 50 cases of primary PPH were recorded during the study period. The frequency of PPH was calculated as 7.1%. The major cause of PPH was uterine atony found in 29 (58%) cases, followed by cervical, vaginal and perineal tears in 12 (24%) cases. Initially all patients were managed pharmacologically followed by surgical intervention. Subtotal (haemostatic) hysterectomy was performed in 10 (20%) cases. Maternal morbidity was detected in 31 (62%) of cases; the major morbidities were DIC in 3 (6%) cases. Acute renal failure in 3 (6%) patients and shock in 2 (9.9%) cases and anaemia in 20 (90.1%) cases. The study concludes that the frequency of primary PPH in this

  7. [Prevalence of respiratory syncytial virus infection in hospitalized children at a children's hospital and effects of climate change on the prevalence in Suzhou, China]. (United States)

    Geng, Jia; Guo, Wan-Liang; Zhang, Xue-Lan


    To investigate the prevalence of respiratory syncytial virus (RSV) infection in hospitalized children and the relationship between the prevalence and the climate change in Suzhou, China. A total of 42 664 nasopharyngeal secretions from hospitalized children with acute respiratory infection at the Suzhou Children's Hospital were screened for RSV antigens using direct immunofluorescence. Monthly meteorological data (mean monthly air temperature, monthly relative humidity, monthly rainfall, total monthly sunshine duration, and mean monthly wind velocity) in Suzhou between 2001 and 2011 were collected. The correlations between RSV detection rate and climatic factors were evaluated using correlation and stepwise regression analysis. The annual RSV infection rate in hospitalized children with respiratory infection in the Suzhou Children's Hospital varied between 11.85% and 27.30% from 2001 to 2011. In the 9 epidemic seasons, each spanning from November to April of the next year, from 2001 to 2010, the RSV detection rates were 40.75%, 22.72%, 39.93%, 27.37%, 42.71%, 21.28%, 38.57%, 19.86%, and 29.73%, respectively; there were significant differences in the detection rate between the epidemic seasons. The monthly RSV detection rate was negatively correlated with mean monthly air temperature, total monthly sunshine duration, monthly rainfall, monthly relative humidity, and mean monthly wind velocity (P<0.05). Stepwise regression analysis showed that mean monthly air temperature fitted into a linear model (R(2)=0.64, P<0.01). From 2001 to 2011, RSV infection in Suzhou was predominantly prevalent between November and April of the next year. As a whole, the infection rate of RSV reached a peak every other year. Air temperature played an important role in the epidemics of RSV infection in Suzhou.

  8. Estimating the unit costs of public hospitals and primary healthcare centers. (United States)

    Younis, Mustafa Z; Jaber, Samer; Mawson, Anthony R; Hartmann, Michael


    Many factors have affected the rise of health expenditures, such as high-cost medical technologies, changes in disease patterns and increasing demand for health services. All countries allocate a significant portion of resources to the health sector. In 2008, the gross domestic product of Palestine was estimated to be at $6.108bn (current price) or about $1697 per capita. Health expenditures are estimated at 15.6% of the gross domestic product, almost as much as those of Germany, Japan and other developed countries. The numbers of hospitals, hospital beds and primary healthcare centers in the country have all increased. The Ministry of Health (MOH) currently operates 27 of 76 hospitals, with a total of 3074 beds, which represent 61% of total beds of all hospitals in the Palestinian Authorities area. Also, the MOH is operating 453 of 706 Primary Health Care facilities. By 2007, about 40 000 people were employed in different sectors of the health system, with 33% employed by the MOH. This purpose of this study was to develop a financing strategy to help cover some or all of the costs involved in operating such institutions and to estimate the unit cost of primary and secondary programs and departments. A retrospective study was carried out on data from government hospitals and primary healthcare centers to identify and analyze the costs and output (patient-related services) and to estimate the unit cost of health services provided by hospitals and PHCs during the year 2008. All operating costs are assigned and allocated to the departments at MOH hospitals and primary health care centers (PPHCs) and are identified as overhead departments, intermediate-service and final-service departments. Intermediate-service departments provide procedures and services to patients in the final-service departments. The costs of the overhead departments are distributed to the intermediate-service and final-service departments through a step-down method, according to allocation

  9. An Evaluation and Ranking of Children's Hospital Websites in the United States. (United States)

    Huerta, Timothy R; Walker, Daniel M; Ford, Eric W


    Children's hospitals are faced with the rising need for technological innovation. Their prospective health care consumers, who increasingly depend on the Web and social media for communication and consumer engagement, drive this need. As patients and family members navigate the Web presence of hospitals, it is important for these specialized organizations to present themselves and their services efficiently. The purpose of this study was to evaluate the website content of children's hospitals in order to identify opportunities to improve website design and create benchmarks to judge improvement. All websites associated with a children's hospital were identified using a census list of all children's hospitals in the United States. In March of 2014, each website and its social media were evaluated using a Web crawler that provided a 5-dimensional assessment that included website accessibility, marketing, content, technology, and usability. The 5-dimensional assessment was scored on a scale ranging from 0 to 10 with positive findings rated higher on the scale. Websites were ranked by individual dimensions as well as according to their average ranking across all dimensions. Mean scores of 153 websites ranged from 5.05 to 8.23 across all 5 dimensions. Results revealed that no website scored a perfect 10 on any dimension and that room exists for meaningful improvement. Study findings allow for the establishment of baseline benchmarks for tracking future website and social media improvements and display the need for enhanced Web-based consumer engagement for children's hospitals.

  10. The role of transthoracic ultrasonography in predicting the outcome of community-acquired pneumonia in hospitalized children.

    Directory of Open Access Journals (Sweden)

    I-Chen Chen

    Full Text Available TUS findings of fluid bronchogram, multifocal involvement, and pleural effusion were associated with adverse outcomes, including longer hospital stay, ICU admission, and tube thoracotomy in hospitalized CAP children. Therefore, TUS is a novel tool for prognostic stratifications of CAP in hospitalized children.

  11. Factors associated with enuresis among primary school children in ...

    African Journals Online (AJOL)

    of treatment in 89(41.6%), 42 (19.6%) and 6 (2.8%) children respectively. Conclusion: Arousal difficulty, positive family history of enuresis and family stress were common risk factors for enuresis. Also, enuretic children had higher rates of poor school performance compared with non-enuretic children. The inappropriate ...

  12. A comparative study of propranolol versus silver nitrate cautery in the treatment of recurrent primary epistaxis in children (United States)

    Ahmed, Ahmed E; Abo El-Magd, Essam A; Hasan, Gamal M; El-Asheer, Osama M


    Background Epistaxis is a common medical problem in pediatric population. Although in most cases it is mild and self-limiting, a proportion of childhood epistaxis is massive, recurrent, or resistant to conventional management. Objective To compare effectiveness of propranolol as a treatment option for childhood epistaxis versus conventional silver nitrate cautery. Study design and methodology This is a prospective interventional comparative study that was carried out during a period of 1 year (January 1, 2013 to December 31, 2013) at Qena University Hospital and Assiut University Children’s Hospital. One hundred children aged 6–12 years who presented with epistaxis to Qena University Hospital and Assiut University Children’s Hospital during the study period and fulfilling the inclusion criteria were included in the study. They were randomly assigned into one of two interventional groups, where 50 children were treated with oral propranolol (propranolol treatment group) and another 50 children were treated with conventional silver nitrate cautery (cauterization treatment group) for their epistaxis. Propranolol was given at a dose of 1.5–2 mg/kg/day (divided into three doses). Patients were followed for 6 months after their discharge for recurrence of epistaxis. Results Both groups of patients showed minimal recurrent epistaxis with rates of 14% for propranolol treated group and 12% for cauterization group, with no statistically significant difference between both groups. Local pain was found to be more in patients treated with silver nitrate cauterization. Conclusion Treatment of primary epistaxis with propranolol or silver nitrate cautery showed equal rates of recurrence, and local nasal pain was slightly more among silver nitrate cauterization treated group. Propranolol could be a favorable treatment option for patients with primary epistaxis. Further studies that include multiple centers and larger number of patients are recommended for more clarification

  13. Animal livestock and the risk of hospitalized diarrhoea in children under 5 years in Vietnam. (United States)

    Thiem, Vu Dinh; Schmidt, Wolf-Peter; Suzuki, Motoi; Tho, Le Huu; Yanai, Hideki; Ariyoshi, Koya; Anh, Dang Duc; Yoshida, Lay-Myint


    To investigate the association between environmental exposure to livestock and incidence of diarrhoea among Vietnamese children. A population-based cohort of 353,525 individuals, living in 75,828 households in Khanh Hoa Province, Vietnam, with baseline data covering geo-referenced information on demography, socio-economic status and household animals was investigated. Geographic information system was applied to calculate the density of livestock. The data were linked to hospitalized diarrhoea cases of children under 5 years recorded at two hospitals treating patients from the area as inpatients in the study area. Overall, 3116 children with diarrhoea were hospitalized during the study period. The incidence of diarrhoea hospitalization was 60.8/1000 child-years. Male gender, age Vietnam. Public health interventions to reduce childhood diarrhoea burden should focus on well-recognized causes such as sanitation, personal hygiene, access to adequate clean water supply and vaccination. © 2012 Blackwell Publishing Ltd.

  14. Is hospital based MMR vaccination for children with egg allergy here to stay?

    LENUS (Irish Health Repository)

    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.

  15. Frequency of causes of primary postpartum haemorrhage in a tertiary care hospital

    International Nuclear Information System (INIS)

    Munir, S.I.


    Objective: To study the frequency of causes of primary postpartum hemorrhage (PPH) in women managed in a tertiary care Hospital. material and Methods: The study was conducted in the department of Obstetrics and Gynecology, Unit - 1, Lady Willingdon Hospital King Edward Medical University, Lahore from July 2013 to December 2013. All the women having postpartum haemorrhage after vaginal delivery in the labour room or referred with primary postpartum haemorrhage were included in the study and were evaluated to see the frequency of postpartum haemorrhage as well as the causes of PPH in women being treated in a tertiary care unit. Results: During the study period 1344 women delivered in unit I and 250 patients developed postpartum haemorrhage giving frequency of primary postpartum haemorrhage 18.60%. Majority of the women 29.6% (n = 74) were between 26 - 30 years of age, mean and SD was 28.43 ± 4.76 years. The gestation of 55.2% (n = 138) patients was between 37 - 40 weeks. The frequency of postpartum haemorrhage in booked women during antenatal period was recorded as 25.2% (n = 63) while 74.8% (n = 187) were not booked in any health facility. Among patients who developed PPH, uterine atony was the most common cause 57.6% (n = 144), followed by genital tract teats which was 29.2% (n = 73). The rest of the causes of PPH were retained placenta in 10% (n = 25), uterine rupture in 3.6% (n = 9) and uterine inversion in 1.6% (n = 4). Conclusions: Postpartum haemorrhage is still a leading but preventable cause of maternal morbidity and mortality in our country due to under utilization of health facilities, the major cause is uterine atony followed by perineal tears. (author)

  16. Risk factors for renal scarring in children with primary vesicoureteral reflux disease

    Directory of Open Access Journals (Sweden)

    Sevgi Mir


    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.

  17. Primary hypertension and special aspects of hypertension in older children and adolescents

    Directory of Open Access Journals (Sweden)

    Ellis D


    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

  18. Hospital-acquired malnutrition in children at a tertiary care hospital

    African Journals Online (AJOL)

    Del-Rossi Sean Quadros

    As such, there is a need for hospitals to monitor its occurrence using cost- effective but accurate tools. Table 1: General .... Malades Hospital, France.2. Our study ... daily weight loss, which is the critical threshold for an adverse clinical outcome ...

  19. Investigation and analysis of interventional procedures being carried out in the primary hospital in Yunnan province of China

    International Nuclear Information System (INIS)

    Ding Rong; Huang Ming; Zhou Jinmei; Yang Yinshan; Zhao Ling; Wu Hao; Wu Qijie


    Objective: To investigate and analyze the interventional techniques being employed or being anticipated to be adopted in the primary hospitals in Yunnan province of China in order to further promote the interventional procedures in clinical practice. Methods: A total of 52 Yunnan provincial state hospitals and county hospitals were enrolled in this investigation. During the period from Sep. 2009 to Dec. 2012, questionnaires were used to find out the interventional techniques being employed or being anticipated to be adopted in these 52 hospitals, and the results were analyzed. The common clinical issues were discussed and the improvement measures were suggested. Results: The number of effective questionnaire was 38 (38/52). Four county hospitals did not have basic condition to carry out the interventional technique, 41.70-/o of hospitals expected that they would be able to develop the technique of inferior vena cava filter, 35.3% of hospitals anticipated to employ 125 I seed implantation with stenting for liver cancer, and 32.3% of hospitals wanted to use digestive tract stent implantation. The difficulties to hinder the development of interventional techniques included the shortage of necessary interventional equipment and the irrational orderly system of professional succession. Conclusion: The interventional procedures being carried out nowadays in the primary hospitals in Yunnan province of China are quite few. The difference in the interventional techniques being anticipated to be carried out between the municipal hospitals and county hospitals is not significant. With the increasing demand of interventional treatment, the primary hospitals will have broad prospects in developing interventional treatment. (authors)

  20. [Evaluation of the effect of hospital clown's performance about anxiety in children subjected to surgical intervention]. (United States)

    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.

  1. [Trends in hospitalization for primary care-sensitive conditions and associated factors in Porto Alegre, Rio Grande do Sul, Brazil]. (United States)

    da Costa, Juvenal Soares Dias; Pattussi, Marcos Pascoal; Morimoto, Tissiani; de Arruda, Jocinei Santos; Bratkowski, Gabriela Rodrigues; Sopelsa, Mariani; Fritzen, Janaina Soder; do Canto, Vaneza de Andrade da Fontoura; Marques, Maximiliano Chagas


    An ecological study was conducted to analyze trends in hospitalization for primary care-sensitive conditions linking the results to the investments in health and coverage of the Family Health Strategy in Porto Alegre, between 1998 and 2012. The causes of hospitalization for primary care-sensitive conditions were based on the national list provided by the Ministry of Health. The data were obtained from the Hospital Information System of the Unified Health System (SUS). Standardized rates were created and investments increased by 27%, though investments in primary care increased by 83%. The expansion of coverage by the Family Health Strategy was almost fourfold, though it remained below the recommended values. There was no change in the trend of hospitalization for primary care-sensitive conditions. The analysis did not make it possible to establish if patients who were hospitalized for primary care-sensitive conditions had access to the Family Health Strategy or not, suggesting the need to incorporate data of place of origin in the information system. Studies using the Hospital Information System contribute to its enhancement, fomenting the assessment, management and design of health policies.

  2. Increasing Prevalence of Hepatitis C among Hospitalized Children Is Associated with an Increase in Substance Abuse. (United States)

    Barritt, A Sidney; Lee, Brian; Runge, Thomas; Schmidt, Monica; Jhaveri, Ravi


    To evaluate the impact of substance abuse on pediatric hepatitis C virus (HCV) prevalence, we examined geographic and demographic data on inpatient hospitalizations in children with HCV. We examined hospitalizations in children using the Kids' Inpatient Database, a part of the Healthcare Cost and Utilization Project. We identified cases using the International Classification of Diseases, 9th edition, codes for HCV infection during 2006, 2009, and 2012. Nonparametric tests for trend were used to calculate trend statistics. From 2006 to 2012 nationally, the number of hospitalizations of children with HCV increased 37% (2.69 to 3.69 per 10 000 admissions; P substance use among children with HCV increased from 25% in 2006 to 41% in 2012 (P teenagers, highly associated with substance abuse, and concentrated in Northeast and Southern states. These results strongly suggest that public health efforts to prevent and treat HCV will also need to include adolescents. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Clinical Features and Neurologic Complications of Children Hospitalized With Chikungunya Virus in Honduras. (United States)

    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.

  4. A survey on evaluation function for contaminations and doses in the primary and the secondary radiation emergency hospitals

    International Nuclear Information System (INIS)

    Yamada, Yuji; Akashi, Makoto; Shiraishi, Kunio; Suzuki, Toshikazu; Ishigure, Nobuhito; Endo, Akira; Sanada, Tetsuya; Nakayama, Kazushige; Shizuma, Kiyoshi; Takada, Chie; Momose, Takumaro; Hoshi, Masaharu; Yamaguchi, Takenori


    The questionnaire on evaluation function for contaminations and doses was sent to the primary and the secondary radiation emergency hospitals in Japan by the network council for physical dosimetry in National Institute of Radiological Sciences (NIRS) designated as the tertiary hospital. The recovery percentage from the 88 hospitals was 70%. It turned out that six primary hospitals in 37 hospitals did not have even the basic instruments on radiation measurement such as GM counter and personal dosimeter. 64% of the secondary hospitals have the whole body counter, but its operation frequency including exercise was considerably low. It is thought that the main cause originates in a chronic manpower shortage and the budget shortfall seen by all the primary and the secondary hospitals. And also peculiar difficulty of correspondence to the radiation emergency medical treatment and the few experience might promote the problem. Thus the anxiety of the site staff had been appeared to the result of the questionnaire survey in shape like the opinion and the demand, etc. It will be necessary to advance the enhancement of training and to make the manual for the contaminations and the doses evaluation in the hospitals. (author)

  5. Screening for nutritional risk in hospitalized children: comparison of two instruments

    Directory of Open Access Journals (Sweden)

    Dwi Novianti


    Full Text Available Background Malnutrition in hospitalized children has negative impact on morbidity, mortality, length of stay, and health-care cost. A simple screening tool is needed to detect hospital malnutrition risk in children. Objective To compare the level of agreement of the Screening Tool for Malnutrition in Pediatrics (STAMP and Pediatric Nutritional Risk Score (PNRS with anthropometric measurements, as screening tools for hospital malnutrition in children. Methods A cross-sectional study was conducted from February to July 2014 in the Pediatric and Surgery Wards at H. Adam Malik Hospital, Medan, North Sumatera. Inclusion criteria were children aged 2 to 18 years who were hospitalized for more than 72 hours. Subjects were screened using STAMP and PNRS, and underwent anthropometric measurement on admission. The weight measurements were repeated on the 3rd and 7th days, and just before discharge. The STAMP and PNRS results were compared in terms of level of agreement with anthropometric measurements. Data were analyzed by Kappa value and Spearman’s correlation test. Results A total of 127 children were screened with both instruments. The PNRS had slight agreement with hospital malnutrition prevalence (κ=0.175; P=0.028, while STAMP had not  (κ=0.080; P=0.193. Both screening tools had weak positive correlations with length of stay, but the correlation was stronger for PNRS than for STAMP (r=0.218; P=0.014 vs. r=0.188; P=0.034, respectively. The prevalence of hospital malnutrition was 40.9%.  Conclusions The PNRS screening tool has slight agreement with anthropometric measurement for identifying hospital malnutrition risk in children.

  6. Prevalence of Persistent Primary Reflexes and Motor Problems in Children with Reading Difficulties (United States)

    McPhillips, M.; Sheehy, N.


    It has been shown that some children with reading difficulties have underlying developmental delay and that this may be related to the persistence of primary reflexes. This study investigated the prevalence of persistent primary reflexes in the ordinary primary school population and how this related to other cognitive and social factors. Three…

  7. A Survey on 100 Children with Acute Ataxia in Mofid Children Hospital Tehran, Iran

    Directory of Open Access Journals (Sweden)

    Parvaneh Karim-Zadeh


    Full Text Available Objective: The term “Ataxia” is used to denote disturbances of the body posture and its movement that are normally controlled by the cerebellum. frontal lobes and the posterior columns of the spinal cord. The initial symptom and the most prominent feature of ataxia is abnormal gait which is characterized by lurching and wide base walking. Knowing that, the acute ataxia is among those problems that brings very soon the child to pediatrics neurology department and in view of lack of any survey in this neid in our country, we decided to investigate the etiology of acute ataxia in Islamic Republic of Iran. Materials & Methods: Our patients were recruited from 100 children who were brought to neurology service of Mofid children hospital with the chief complaint of acute ataxia over 2 years period. (sep 2001 to sep 2003. All of those 100 patients were admitted and required investigations were performed. Results: Results of our workup revealed that the most common cause of acute ataxia is acute cerebellar one, which all of them preceded by viral febrile illness. The second frequent cause of acute. Ataxia is due to drug intoxication, which commonly was observed between 2 – 4 years period. Conclusion: The remaining etiologies in descending frequency were as follow, Infectious polyneuropathy, Migraine, Opsoclonus – Myoclonus, Brain tumor, ADEM,MS and Epilepsy.

  8. Accidental falls in hospitalized children: an analysis of the vulnerabilities linked to the presence of caregivers. (United States)

    Bagnasco, A; Sobrero, M; Sperlinga, L; Tibaldi, L; Sasso, L


    This study stemmed from the data gathered by a research conducted by the coordinator of the Department of Healthcare Services and a group of nurses involved in a research on accidental falls in hospitalized children at the "G. Gaslini" Children's Hospital and Scientific Research Institute in Genoa, Italy. The first retrospective study evaluated the accidental falls in hospitalized children referred to the three-year period 2003-2006, while the second perspective study, referred to the trimester March-May 2007, found that the main cause of falls in children was parent's distraction. The method adopted in the first phase of our study was a proactive risk analysis (The Basics of Healthcare Failure Mode and Effect Analysis), identified in the first place by the VA National Centre for Patient Safety and applied to the "Child and parent hospital admission process". This proactive risk analysis has proven to be very effective in preventing the risk of accidental falls in hospitalized children through effective communication and educational interventions. The second phase of our study consisted of two Focus Groups for accidental traumatic events. The analysis of the results of the study showed how effective communication is instrumental, not only to have a better awareness of the children and their parents during their stay in hospital, but also to implement educational sessions on prevention to reduce the risk of accidental traumatic events. The present study contributes to improve safety and the quality of care by motivating nurses to keep their attention high on falls in hospitalized children, by monitoring and the development of new risk assessment tools.

  9. Using of WHO guidelines for the management of severe malnutrition to cases of marasmus and kwashiorkor in a Colombia children's hospital. (United States)

    Ramírez Prada, D; Delgado, G; Hidalgo Patiño, C A; Pérez-Navero, J; Gil Campos, M


    In 2007, the Hospital Infantil Los Ángeles (HILA) in Colombia implemented a slightly-modified version of the WHO guidelines for the diagnosis and management of malnutrition during childhood. To evaluate the efficacy of the WHO-HILA protocol in children hospitalized with severe, chronic marasmus and kwashiorkor malnutrition (MS-KWK) in 2007 and 2008. In this descriptive retrospective study the records of 100 children hospitalized with MSKWK were initially evaluated. Of these, 30 fulfilled the inclusion criteria: children of both sexes with a primary diagnosis of MS-KWK. Patients with any chronic disease liable to cause malnutrition were excluded. Anthropometric parameters, clinical signs and biochemical indicators of malnutrition were assessed upon admission and again at discharge following application of the WHO guidelines. Univariate analysis was performed for each study variable; serum hemoglobin and albumin levels on admission and at discharge were compared, and data were subjected to bivariate analysis. Marasmus was diagnosed in 23.3% of children, kwashiorkor in 73.3% and marasmic kwashiorkor in 3.3%. The major clinical findings were: edema (70%), emaciation (40%), "flag sign" hair (42.86%), low serum albumin (93%) and anemia (80%). Thirteen children following the WHO-HILA protocol showed a significant nutritional status improvement (pmalnutrition. Implementation of this protocol should therefore be considered in all children´s hospitals in countries where this disease is prevalent.

  10. Pesticide-Related Hospitalizations Among Children and Teenagers in Texas, 2004-2013. (United States)

    Trueblood, Amber B; Shipp, Eva; Han, Daikwon; Ross, Jennifer; Cizmas, Leslie H


    Acute exposure to pesticides is associated with nausea, headaches, rashes, eye irritation, seizures, and, in severe cases, death. We characterized pesticide-related hospitalizations in Texas among children and teenagers for 2004-2013 to characterize exposures in this population, which is less well understood than pesticide exposure among adults. We abstracted information on pesticide-related hospitalizations from hospitalization data using pesticide-related International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes and E-codes. We calculated the prevalence of pesticide-related hospitalizations among children and teenagers aged #19 years for all hospitalizations, unintentional exposures, intentional exposures, pesticide classifications, and illness severity. We also calculated age- and sex-specific prevalence of pesticide-related hospitalizations among children. The prevalence of pesticide-related hospitalizations among children and teenagers was 2.1 per 100,000 population. The prevalence of pesticide-related hospitalizations per 100,000 population was 2.7 for boys and 1.5 for girls. The age-specific prevalence per 100,000 population was 5.3 for children aged 0-4 years, 0.3 for children and teenagers aged 5-14 years, and 2.3 for teenagers aged 15-19 years. Children aged 0-4 years had the highest prevalence of unintentional exposures, whereas teenagers aged 15-19 years had the highest prevalence of intentional exposures. Commonly reported pesticide categories were organophosphates/carbamates, disinfectants, rodenticides, and other pesticides (e.g., pyrethrins, pyrethroids). Of the 158 pesticide-related hospitalizations, most were coded as having minor (n=86) or moderate (n=40) illness severity. Characterizing the prevalence of pesticide-related hospitalizations among children and teenagers leads to a better understanding of the burden of pesticide exposures, including the type of pesticides used and the severity of potential

  11. Patterns of Contact with Hospital for Children with an Autism Spectrum Disorder: A Danish Register-Based Study (United States)

    Atladottir, Hjordis Osk; Schendel, Diana E.; Lauritsen, Marlene B.; Henriksen, Tine Brink; Parner, Erik T.


    The aim of this study was to study patterns of contact with hospital for children with autism spectrum disorder (ASD) using Danish population based register data. We included all children born in Denmark from 1994 through 2002. We found that children diagnosed with ASD had an increased rate of contact with hospital, almost regardless of the cause…

  12. Pleurectomy versus pleural abrasion for primary spontaneous pneumothorax in children. (United States)

    Joharifard, Shahrzad; Coakley, Brian A; Butterworth, Sonia A


    Primary spontaneous pneumothorax (PSP) represents a common indication for urgent surgical intervention in children. First episodes are often managed with thoracostomy tube, whereas recurrent episodes typically prompt surgery involving apical bleb resection and pleurodesis, either via pleurectomy or pleural abrasion. The purpose of this study was to assess whether pleurectomy or pleural abrasion was associated with lower postoperative recurrence. The records of patients undergoing surgery for PSP between February 2005 and December 2015 were retrospectively reviewed. Recurrence was defined as an ipsilateral pneumothorax requiring surgical intervention. Bivariate logistic regressions were used to identify factors associated with recurrence. Fifty-two patients underwent 64 index operations for PSP (12 patients had surgery for contralateral pneumothorax, and each instance was analyzed separately). The mean age was 15.7±1.2years, and 79.7% (n=51) of patients were male. In addition to apical wedge resection, 53.1% (n=34) of patients underwent pleurectomy, 39.1% (n=25) underwent pleural abrasion, and 7.8% (n=5) had no pleural treatment. The overall recurrence rate was 23.4% (n=15). Recurrence was significantly lower in patients who underwent pleurectomy rather than pleural abrasion (8.8% vs. 40%, p<0.01). In patients who underwent pleural abrasion without pleurectomy, the relative risk of recurrence was 2.36 [1.41-3.92, p<0.01]. Recurrence of PSP is significantly reduced in patients undergoing pleurectomy compared to pleural abrasion. Level III, retrospective comparative therapeutic study. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Investigating shadows: a pedagogical intervention project with primary school children (United States)

    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.

  14. Clinical Predictors of Hospital Admission in Children Aged 0-24 Months with Acute Bronchiolitis

    Directory of Open Access Journals (Sweden)

    Nucksheeba Aziz


    Full Text Available BACKGROUND Bronchiolitis is a significant cause of acute morbidity in children less than 2 years old and some children with bronchiolitis are admitted to the hospital. AIMS AND OBJECTIVES To identify clinical predictors of hospital admission in children aged 0-24 months with acute bronchiolitis.   METHODS: All children in the age group of 0-24 months presenting with acute bronchiolitis to a dedicated pediatric emergency department of GB pant cantonment children hospital, Govt Medical College Srinagar,   from April 2012-March 2013 were included in the study, provided they met the inclusion criteria. Non-parametric numerical variables were analyzed using Mann Whitney u test. Chi square was used to analyzecategorical variables, p value < 0.05 was considered significant. RESULTS: 763(552(72.3% male, mean age 8.52+/- 3.59 months children (0-24months presented with acute bronchiolitis during the study period. 435(313 (72% male, mean age 6.69+/-3.8 monthspatients were admitted to the hospital. The eight best predictors of admission (age, respiratory rate, heart rate, oxygen saturation, fever, grunt, dehydration and duration of symptoms were determined. CONCLUSION:This study has identified clinical predictors of admission in children aged 0-24 months with acute bronchiolitis. This information can be used as a guide in deciding whether to admit a child with bronchiolitis.

  15. The casemix system of hospital funding can further disadvantage Aboriginal children. (United States)

    Ruben, A R; Fisher, D A


    The Northern Territory Health Service implemented a casemix system of hospital funding in 1996 using national averages and national cost weights as benchmarks for length of stay and funding. Clinicians and health administrators were concerned about the potential of this model to impair health service delivery, especially to children of Aboriginal or Torres Strait Islander (ATSI) descent, whose current poor health has been well described. Data were collected on children aged under 10 years who were discharged from the Royal Darwin Hospital between 1 July 1991 and 30 June 1996 and assigned one of four DRGs (simple pneumonia, bronchitis and asthma, gastroenteritis, nutritional and metabolic disorders). Data collected included age, sex, ethnicity, duration of hospital stay, location of residence and presence of comorbidities. There were significant differences in the proportion of children with multiple comorbidities between ATSI and non-ATSI children, as well as between rural- and urban-dwelling ATSI children. A higher proportion of ATSI compared with non-ATSI children had prolonged hospital stays (22.6% v. 1.5%), with the variables influencing length of stay in ATSI children including "age casemix classification system for a "typical" Australian population on a region with a high proportion of people of ATSI descent.

  16. Primary Germ Cell Tumors of the Mediastinum: 10 Years of Experience in a Tertiary Teaching Hospital

    Directory of Open Access Journals (Sweden)

    Chih-Jen Yang


    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.

  17. Carnivalesque Enactment at the Children's Medical Centre of Rabin Hospital. (United States)

    Lev-Aladgem, Shulamith


    Describes the basic characteristics of the "carnivalesque enactment" and its therapeutic potential. Explains a case study of the drama project at the Rabin Children's Medical Centre, how the carnivalesque enactment was developed step by step, and the kind of effect it stimulated among the children. Suggests new theatrical experiments with…

  18. An overview of hepatitis A at Tyger- berg Children's Hospital

    African Journals Online (AJOL)


    May 14, 2008 ... In a minority of cases, fulminant hepatitis can occur.1 The bulk of hepatitis A infection occurs in young children, in whom jaundice is often so subtle that it can ... This study confirms that hepatitis A is a serious risk to young children in the Western Cape, with significant .... Acute liver failure in the United States.

  19. Efficient neutralization of primary isolates by the plasma from HIV-1 infected Indian children. (United States)

    Prakash, S S; Chaudhary, Alok Kumar; Lodha, Rakesh; Kabra, S K; Vajpayee, Madhu; Hazarika, Anjali; Bagga, Barun; Luthra, Kalpana


    We tested the plasma of 51 HIV-1-infected children (23 naïve and 28 ART treated) for neutralization against five primary isolates (PIs) generated from adult Indian HIV-1-infected patients. The plasma exhibited neutralization potential with significantly higher neutralizing antibody titers in ART-treated children than naïve children against three out of five PIs (pIndian children.

  20. Pattern of malignant tumors in children: a hospital based study

    International Nuclear Information System (INIS)

    Khan, S.M.; Nasreen, S.; Zai, S.


    From 1990 to 1999 data from 32743 cancer patients (males 18502, females 14241) were analyzed to know the frequency of the most common cancers in local and well as well as afghan refugees. There were 3760 children with biopsy proven cancers 2910 belonged to the north-west frontier province (NWFP), while the remaining 850 were Afghan refugees. Among children of NWFP male were 1945 (67%) and 965(33%) females. In Afghan children, males were 570(67%) and females were 280(33%). The most common tumors in children of NWFP were lymphoid leukemia, lymphoma, tumors of the central nervous system (CNS), myeloid leukemia, soft tissue sarcoma wilms, tumours, retinoblastoma, bone tumor neuroblastoma, and ovarian tumors. Whereas Afghan children had Lymphoid leukemia, lymphoma, myeloid leukemia, wilms, tumor, retinoblastoma, tumors of soft tissue bones CNS, neuroblastoma and ovarian tumors. (author)

  1. Community-Acquired Pneumonia Hospitalization among Children with Neurologic Disorders. (United States)

    Millman, Alexander J; Finelli, Lyn; Bramley, Anna M; Peacock, Georgina; Williams, Derek J; Arnold, Sandra R; Grijalva, Carlos G; Anderson, Evan J; McCullers, Jonathan A; Ampofo, Krow; Pavia, Andrew T; Edwards, Kathryn M; Jain, Seema


    To describe and compare the clinical characteristics, outcomes, and etiology of pneumonia among children hospitalized with community-acquired pneumonia (CAP) with neurologic disorders, non-neurologic underlying conditions, and no underlying conditions. Children children's hospitals. Neurologic disorders included cerebral palsy, developmental delay, Down syndrome, epilepsy, non-Down syndrome chromosomal abnormalities, and spinal cord abnormalities. We compared the epidemiology, etiology, and clinical outcomes of CAP in children with neurologic disorders with those with non-neurologic underlying conditions, and those with no underlying conditions using bivariate, age-stratified, and multivariate logistic regression analyses. From January 2010-June 2012, 2358 children with radiographically confirmed CAP were enrolled; 280 (11.9%) had a neurologic disorder (52.1% of these individuals also had non-neurologic underlying conditions), 934 (39.6%) had non-neurologic underlying conditions only, and 1144 (48.5%) had no underlying conditions. Children with neurologic disorders were older and more likely to require intensive care unit (ICU) admission than children with non-neurologic underlying conditions and children with no underlying conditions; similar proportions were mechanically ventilated. In age-stratified analysis, children with neurologic disorders were less likely to have a pathogen detected than children with non-neurologic underlying conditions. In multivariate analysis, having a neurologic disorder was associated with ICU admission for children ≥2 years of age. Children with neurologic disorders hospitalized with CAP were less likely to have a pathogen detected and more likely to be admitted to the ICU than children without neurologic disorders. Published by Elsevier Inc.

  2. Economic burden to primary informal caregivers of hospitalized older adults in Mexico: a cohort study. (United States)

    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

  3. Personal hygiene among primary school children living in a slum of Kolkata, India. (United States)

    Sarkar, M


    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.

  4. Frequency of Cardiorenal Syndrome Type-I in Hospitalized Children with Acute Heart Failure in a Tertiary-Care Hospital

    International Nuclear Information System (INIS)

    Zaidi, M.; Rahman, A. J.; Haque, A.; Sadqani, S.; Maheshwari, P. K.


    Objective: To determine the frequency of cardiorenal syndrome in hospitalized children with acute heart failure. Study Design: Descriptive study. Place and Duration of Study: Paediatric Intensive Care Unit, The Aga Khan University Hospital, Karachi, from December 2010 to December 2011. Methodology: Sixty eight (68) children with acute heart failure fulfilling the selection criteria were evaluated for worsening of renal function (WRF). Serum creatinine was done at baseline and repeated at 72 hours to see the worsening of renal function. Estimated serum creatinine clearance was calculated by Schwartz formula. Results: Mean age of patients was 43.6 +- 55.2 months. There were 43 (63%) males, 70% were under 57 months of age. Mean weight on admission was 14.7 +- 19.13 kg and mean height was 83 cm (+- 31.08 SD). Mean serum creatinine on admission was 0.77 mg/dl (+- 1.18 SD). Worsening renal function was noted in 55 (81%) of children, out of those, majority 36 (70.5%) were under 5 years of age. Conclusion: Worsening renal function was found in 81% of children admitted with the diagnosis of acute heart failure. Majority (70.5%) were under 5 years of age indicating a closer observation of renal status in younger age group to reduce, morbidity and mortality. (author)

  5. The Effect of Children's Rights Training on Primary School Students' Utilisation and Knowledge Level about Children's Rights (United States)

    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…

  6. Acute Pesticide Poisoning in Children: Hospital Review in Selected Hospitals of Tanzania

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    Elikana Lekei


    Full Text Available Background. Acute pesticide poisoning (APP is a serious problem worldwide. Because the burden of childhood APP is unknown in Tanzania, this study describes the distribution, circumstances, and patterns of APP involving children under 18 years in Tanzania. Methodology. A 12-month prospective study was conducted in 10 Tanzanian healthcare facilities in 2006 using a data collection tool for surveillance. Results. Of 53 childhood poisoning cases identified, 56.6% were female. The most common poisoning circumstances were accidents (49.1% and suicide (30.2%. The most vulnerable children were 16-17 years old (30.2%. Suicide was significantly more common in females (PRR females/males = 1.66; 95% CI = 1.03–2.68 and accidental cases were more common in children aged 10 years or younger. Suicide was concentrated in children over 10 years, comprising 53% of cases in this age group. Organophosphates (OPs, zinc phosphide, and endosulfan were common amongst reported poisoning agents. The annual APP incidence rate was 1.61/100,000. Conclusion. APP is common among children in this region of Tanzania. Prevention of suicide in older children should address mental health issues and control access to toxic pesticides. Prevention of accidents in younger children requires safer storage and hygiene measures. Diverse interventions are needed to reduce pesticide poisoning among children in Tanzania.

  7. The Role of Rotavirus Infection Requiring Treatment in a Hospital in Children with Diarrheal Syndrome

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    Yu.Yu. Stepanova


    Full Text Available The aim of this research was to investigate the prognostic and diagnostic value of some clinical and biological factors in the development of acute intestinal rotavirus infection in children. We observed 161 children aged 1 month to 6 years. 81 children were diagnosed with rotavirus infection, and 80 — with secretory diarrhea of unknown origin. Treatment of children was carried out in a hospital. Analysis of clinical and anamnestic data enabled to choose the most prognostically and diagnostically important predictors out of 117 studied risk factors. The authors investigated the association of clinical and biological factors with the severity of rotavirus infection, which would highlight the groups of children with high risk of rotavirus infection, which requires treatment in a hospital. The practical application of the results of this work should be the optimization of early diagnostics of rotavirus infections and timeliness of preventive measures.

  8. [Knowledge of health professionals about the rights of hospitalized children: an exploratory study]. (United States)

    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.

  9. Gastroenteritis attributable to rotavirus in hospitalized Saudi Arabian children in the period 2007–2008 (United States)

    Khalil, Mohamed; Azhar, Esam; Kao, Moujahed; Al-Kaiedi, Noura; Alhani, Hatim; Al Olayan, Ibrahim; Pawinski, Robert; Gopala, Kusuma; Kandeil, Walid; Anis, Sameh; Van Doorn, Leen Jan; DeAntonio, Rodrigo


    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. The proportion of RVGE among GE hospitalizations was 40.7% (95% confidence interval: 37.6–43.9). The highest percentage of RVGE hospitalizations (83.1%) was seen in children younger than 2 years of age. The highest proportion of RV among GE hospitalizations was in June 2007 with 57.1%. The most common RV types detected were G1P[8] (49.3%), G1G9P[8] (13.2%), and G9P[8] (9.6%). Before hospitalization, severe GE episodes occurred in 88.1% RV-positive and 79.6% RV-negative children. Overall, 94% children had recovered by the time they were discharged. Two children (one RV positive and one RV negative) died due to GE complications. Conclusion RVGE is responsible for a high proportion of hospitalizations in Saudi children younger than 5 years of age. Routine RV vaccination has therefore been introduced into the national immunization program and may help reduce the morbidity, mortality, and disease burden

  10. Designing new collaborative learning spaces in clinical environments: experiences from a children's hospital in Australia. (United States)

    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.

  11. Excess body weight in children may increase the length of hospital stay

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    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.

  12. Smoking status in parents of children hospitalized with a diagnosis of respiratory system disorders

    Directory of Open Access Journals (Sweden)

    Nursan Cinar


    Full Text Available The purpose of this study was to investigate the relationship between the statuses of hospitalized children with diagnosis of respiratory tract disease with cigarette use in the parents. This descriptive study was conducted in a Gowerment Hospital in the Sakarya city center in Turkey between June 2007 and June 2008. The inclusion criterion was willingness of families with children hospitalized due to diagnosis of respiratory disease to particípate in the study. Data were collected from 345 parents using the questionnaire prepared by researchers. In our study parental smoking was observed in 42.3% of fathers, 7.8% mothers and for 20.9% both parents were smoking. It was found that the hospitalization rates were more than two times higher in children diagnosed with pneumonia and bronchitis and three times higher in children hospitalized for asthma whose parents smoke at home compared to those whose parents are non-smokers. Health care professionals who take care of children need to discuss the harmful effects of smoking and the importance of reducing childhood exposure to secondhand smoke; parents should be educated and encouraged not to smoke.

  13. The impact of single and shared rooms on family-centred care in children's hospitals. (United States)

    Curtis, Penny; Northcott, Andy


    To explore whether and how spatial aspects of children's hospital wards (single and shared rooms) impact upon family-centred care. Family-centred care has been widely adopted in paediatric hospitals internationally. Recent hospital building programmes in many countries have prioritised the provision of single rooms over shared rooms. Limited attention has, however, been paid to the potential impact of spatial aspects of paediatric wards on family-centred care. Qualitative, ethnographic. Phase 1; observation within four wards of a specialist children's hospital. Phase 2; interviews with 17 children aged 5-16 years and 60 parents/carers. Sixty nursing and support staff also took part in interviews and focus group discussions. All data were subjected to thematic analysis. Two themes emerged from the data analysis: 'role expectations' and 'family-nurse interactions'. The latter theme comprised three subthemes: 'family support needs', 'monitoring children's well-being' and 'survey-assess-interact within spatial contexts'. Spatial configurations within hospital wards significantly impacted upon the relationships and interactions between children, parents and nurses, which played out differently in single and shared rooms. Increasing the provision of single rooms within wards is therefore likely to directly affect how family-centred care manifests in practice. Nurses need to be sensitive to the impact of spatial characteristics, and particularly of single and shared rooms, on families' experiences of children's hospital wards. Nurses' contribution to and experience of family-centred care can be expected to change significantly when spatial characteristics of wards change and, as is currently the vogue, hospitals maximise the provision of single rather than shared rooms. © 2016 John Wiley & Sons Ltd.

  14. Clinical Presentation and Outcomes among Children with Sepsis Presenting to a Public Tertiary Hospital in Tanzania

    Directory of Open Access Journals (Sweden)

    Teresa Bleakly Kortz


    Full Text Available BackgroundPediatric sepsis causes significant global morbidity and mortality and low- and middle-income countries (LMICs bear the bulk of the burden. International sepsis guidelines may not be relevant in LMICs, especially in sub-Saharan Africa (SSA, due to resource constraints and population differences. There is a critical lack of pediatric sepsis data from SSA, without which accurate risk stratification tools and context-appropriate, evidence-based protocols cannot be developed. The study’s objectives were to characterize pediatric sepsis presentations, interventions, and outcomes in a public Emergency Medicine Department (EMD in Tanzania.MethodsProspective descriptive study of children (28 days to 14 years with sepsis [suspected infection with ≥2 clinical systemic inflammatory response syndrome (SIRS criteria] presenting to a tertiary EMD in Dar es Salaam, Tanzania (July 1 to September 30, 2016. Outcomes included: in-hospital mortality (primary, EMD mortality, and hospital length of stay. We report descriptive statistics using means and SDs, medians and interquartile ranges, and counts and percentages as appropriate. Predictive abilities of SIRS criteria, the Alert-Verbal-Painful-Unresponsive (AVPU score and the Lambaréné Organ Dysfunction Score (LODS for in-hospital, early and late mortality were tested.ResultsOf the 2,232 children screened, 433 (19.4% met inclusion criteria, and 405 were enrolled. There were 247 (61% subjects referred from an outside facility. Approximately half (54.1% received antibiotics in the EMD, and some form of microbiologic culture was collected in 35.8% (n = 145 of subjects. In-hospital and EMD mortality were 14.2 and 1.5%, respectively, median time to death was 3 days (IQR 1–6, and median length of stay was 6 days (IQR 1–12. SIRS criteria, the AVPU score, and the LODS had low positive (17–27.1, 33.3–43.9, 18.3–55.6%, respectively and high negative predictive values (88.6–89.8, 86.5

  15. Liver transplantation at Red Cross War Memorial Children's Hospital ...

    African Journals Online (AJOL)

    The liver transplant programme for infants and children at Red Cross War Memorial ... Four combined liver/kidney transplants have been performed. ... was complicated by chronic rejection (1) and TB-drug-induced subfulminant liver failure (1).

  16. Kids in the atrium: comparing architectural intentions and children's experiences in a pediatric hospital lobby. (United States)

    Adams, Annmarie; Theodore, David; Goldenberg, Ellie; McLaren, Coralee; McKeever, Patricia


    The study reported here adopts an interdisciplinary focus to elicit children's views about hospital environments. Based at the Hospital for Sick Children (SickKids), Toronto, the research explores the ways in which designers and patients understand and use the eight-storey lobby, The Atrium, a monumental addition constructed in 1993. It is a public place that never closes; hundreds of children pass through the namesake atrium every day. Combining methodological approaches from architectural history and health sociology, the intentions and uses of central features of the hospital atrium are examined. Data were collected from observations, focused interviews, and textual and visual documents. We locate the contemporary atrium in a historical context of building typologies rarely connected to hospital design, such as shopping malls, hotels and airports. We link the design of these multi-storey, glass-roofed spaces to other urban experiences especially consumption as normalizing forces in the everyday lives of Canadian children. Seeking to uncover children's self-identified, self-articulated place within contemporary pediatric hospitals, we assess how the atrium--by providing important, but difficult-to-measure functions such as comfort, socialization, interface, wayfinding, contact with nature and diurnal rhythms, and respite from adjacent medicalized spaces--contributes to the well-being of young patients. We used theoretical underpinnings from architecture and humanistic geography, and participatory methods advocated by child researchers and theorists. Our findings begin to address the significant gap in understanding about the relationship between the perceptions of children and the settings where their healthcare occurs. The study also underlines children's potential to serve as agents of architectural knowledge, reporting on and recording their observations of hospital architecture with remarkable sophistication. 2009 Elsevier Ltd. All rights reserved.

  17. Respiratory care practitioners as primary providers of neonatal intubation in a community hospital: an analysis. (United States)

    Noblett, K E; Meibalane, R


    Respiratory care practitioners (RCPs) serve as the primary providers of neonatal endotracheal intubation (ETI) in our institution. ETIs are performed by registered respiratory therapists who have completed Pediatric Advanced Life Support and Neonatal Advanced Life Support training and have successfully completed 3 intubations under the direct supervision of a senior therapist. The purpose of this study was to (1) ascertain whether RCPs can successfully provide this type of service with acceptable complications rates and (2) survey the economic impact of this practice on patient charges in our hospital. An analysis of each intubation event in which an RCP participated was collected and compiled over a 5-month period (9-94 to 2-95). Calculations were made of the success rate and complications. A total of 38 ETIs were performed by the RCPs. Of these, 37 (97.4%) were performed with neonatal ETI at a Level-II nursery in a community hospital, and this practice may result in a cost reduction.

  18. Peculiarities of mathematics instruction for beginners for children with disabilities in regular primary schools

    Directory of Open Access Journals (Sweden)

    Jablan Branka


    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.

  19. Happy crisis tests hospitals' PR plan. Septuplets' arrival swamps Iowa hospitals with national, international media. Blank Children's Hospital, Iowa Methodist Medical Center, Des Moines. (United States)


    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.

  20. Frequency of bedwetting among primary school children in Benha ...

    African Journals Online (AJOL)

    Objectives: The overall objective was health promotion of school children, and the specific objectives were: to determine the frequency and risk factors of nocturnal enuresis (NE) among school children in Qaluobia governorate Egypt, and to examine its associations with behavioral and emotional problems. Subjects and ...

  1. Impact of the antipneumococcal conjugate vaccine on the occurrence of infectious respiratory diseases and hospitalization rates in children

    Directory of Open Access Journals (Sweden)

    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.

  2. Feelings experienced by parents when their premature children are hospitalized. A contribution to the humanized care

    Directory of Open Access Journals (Sweden)

    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.

  3. Diarrhoea in slum children: observation from a large diarrhoeal disease hospital in Dhaka, Bangladesh. (United States)

    Ferdous, Farzana; Das, Sumon Kumar; Ahmed, Shahnawaz; Farzana, Fahmida Dil; Malek, Mohammad Abdul; Das, Jui; Latham, Jonathan Ross; Faruque, Abu Syed Golam; Chisti, Mohammod Jobayer


    To determine and compare socio-demographic, nutritional and clinical characteristics of children under five with diarrhoea living in slums with those of children who do not live in slums of Dhaka, Bangladesh. From 1993 to 2012, a total of 28 948 under fives children with diarrhoea attended the Dhaka Hospital of icddr,b. Data were extracted from the hospital-based Diarrhoea Disease Surveillance System, which comprised 17 548 under fives children from slum and non-slum areas of the city. Maternal illiteracy [aOR = 1.57; 95% confidence interval (1.36, 1.81), P-value slum-dwelling children after controlling for co-variates. Measles immunisation [0.52 (0.47, 0.59) P slum dwellers than other children in univarate analysis only. Slum-dwelling children are more malnourished, have lower immunisation rates (measles vaccination and vitamin A supplementation) and higher rates of measles, are more susceptible to diarrhoeal illness due to V. cholerae and suffer from severe dehydration more often than children from non-slum areas. Improved health and nutrition strategies should give priority to children living in urban slums. © 2014 John Wiley & Sons Ltd.

  4. Characteristics of Rotavirus Diarrhea in Hospitalized Children in Kosovo (United States)

    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

  5. Risk Factors of Pneumonia Among Children Under 5 Years at a Pediatric Hospital in Sudan

    Directory of Open Access Journals (Sweden)

    Siham M.O. Gritly


    Full Text Available Introduction: Pneumonia is major cause of mortality among acute respiratory infections, killing up to 5 million of children below the age of 5 years annually in developing countries. Total 50% out-patients cases in Sudan are children while 30% of children admissions are due to pneumonia. Every year, the number of deaths in infant and children below the age of 5 years is reported to be 12 million. Objectives: The aim of this study is to find out the pneumonia risks in Sudan among children <5 years and to establish a baseline data and statistical information about pneumonia in the age group for future use. Study design and Setting: A hospital based descriptive study was conducted among children <5 years at Mohamed Al-Amin Hamid Pediatric Hospital in February 2017. Methods: Parents of 40 children <5 years admitted to the hospital during the study period completed the constructed questionnaire after obtaining informed consents from each of them. Data was then analyzed. Results: Children in this study consisted of 27 (57.50% males and 13 (42.5% females. Factors found to have association with pneumonia include low socio-economic status and low educational level of mothers. Conclusion and Recommendations: The study concluded that the pneumonia is more prevalent in children less than one year. Factors found to have association with pneumonia include low socioeconomic status and low educational level of mothers admitted to Mohamed Al-Amin pediatric hospital in Omdurman locality. It was recommended to have an early diagnosis and treatment of pneumonia. Community health education and completion of the immunization program are recommended to decrease the infection.

  6. Prevalence of malnutrition in hospital children in federal teaching ...

    African Journals Online (AJOL)

    Background: Malnutrition is a state of excess or deficiency in energy, protein and or other nutrients which causes measurable adverse effects on body forms and function. A holistic approach is required in the management of hospitalized pediatric patients and includes the assessment and management of nutritional ...

  7. Research improves hospitals' approach to children's pain in Thailand

    International Development Research Centre (IDRC) Digital Library (Canada)


    Mar 4, 2013 ... Research that has enabled hospitals in Thailand to better treat ... a night shift, it's pretty hard for them to spend a significant amount of time with one ... great suffering for family members and debilitating stress for nursing staff.

  8. Double Bind: Primary Caregivers of Children with Special Health Care Needs and Their Access to Leave Benefits (United States)

    Chung, Paul J.; Garfield, Craig F.; Elliott, Marc N.; Vestal, Katherine D.; Klein, David J.; Schuster, Mark A.


    Objective Family leave benefits are a critical tool allowing parents to miss work to care for their ill children. We examined whether access to benefits varies by level of childcare responsibilities among employed parents of children with special health care needs (CSHCN). Methods We conducted telephone interviews with three successive cohorts of employed parents of CSHCN, randomly sampled from a California children’s hospital. At Wave 1 (November 2003 to January 2004) we conducted 372 parent interviews. At Wave 2 (November 2005 to January 2006) we conducted 396 parent interviews. At Wave 3 (November 2007 to December 2008) we conducted 393 parent interviews. We pooled these samples for bivariate and multivariate regression analyses, using wave indicators and sample weights. Results Parents with more childcare responsibilities (primary caregivers) reported less access to sick leave/vacation (65% vs. 82%, Ppaid leave outside of sick leave/vacation (41% vs. 51%, Pleave benefits. Even in the context of part-time employment, however, primary caregivers were just as likely as secondary caregivers both to miss work due to their child’s illness and to report being unable to miss work when they needed to. Conclusions Due in part to employment and gender differences, leave benefits among parents of CSHCN are skewed away from primary caregivers and toward secondary caregivers. Thus, primary caregivers may face particularly difficult choices between employment and childcare responsibilities. Reducing this disparity in access to benefits may improve health for CSHCN and their families. PMID:23477748

  9. Inpatient capacity at children's hospitals during pandemic (H1N1) 2009 outbreak, United States. (United States)

    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.

  10. Improving outcomes from out-of-hospital cardiac arrest in young children and adolescents. (United States)

    Atkins, Dianne L; Berger, Stuart


    Out-of-hospital cardiac arrest (OHCA) is an unusual but devastating occurrence in a young person. Years of life-lost are substantial and long-term health care costs of survivors can be high. However, there have been noteworthy improvements in cardiopulmonary resuscitation (CPR) standards, out-of hospital care, and postcardiac arrest therapies that have resulted in a several-fold improvement in resuscitation outcomes. Recent interest and research in resuscitation of children has the promise of generating improvements in the outcomes of these patients. Integrated and coordinated care in the out-of-hospital and hospital settings are required. This article will review the epidemiology of OHCA, the 2010 CPR guidelines, and developments in public access defibrillation for children.

  11. Sun Protection Among New Zealand Primary School Children. (United States)

    Gage, Ryan; Leung, William; Stanley, James; Reeder, Anthony; Mackay, Christina; Smith, Moira; Barr, Michelle; Chambers, Tim; Signal, Louise


    Schools are an important setting for raising skin cancer prevention awareness and encouraging sun protection. We assessed the clothes worn and shade used by 1,278 children in eight schools in the Wellington region of New Zealand. These children were photographed for the Kids'Cam project between September 2014 and March 2015 during school lunch breaks. Children's mean clothing coverage (expressed as a percentage of body area covered) was calculated. Data on school sun-safety policies were obtained via telephone. Mean total body clothing coverage was 70.3% (95% confidence interval = 66.3%, 73.8%). Body regions with the lowest mean coverage were the head (15.4% coverage), neck (36.1% coverage), lower arms (46.1% coverage), hands (5.3% coverage), and calves (30.1% coverage). Children from schools with hats as part of the school uniform were significantly more likely to wear a hat (52.2%) than children from schools without a school hat (2.7%). Most children (78.4%) were not under the cover of shade. Our findings suggest that New Zealand children are not sufficiently protected from the sun at school. Schools should consider comprehensive approaches to improve sun protection, such as the provision of school hats, sun-protective uniforms, and the construction of effective shade.

  12. Racial/ethnic differences in hospital use and cost among a statewide population of children with Down syndrome. (United States)

    Derrington, Taletha Mae; Kotelchuck, Milton; Plummer, Katrina; Cabral, Howard; Lin, Angela E; Belanoff, Candice; Shin, Mikyong; Correa, Adolfo; Grosse, Scott D


    Children with Down syndrome (DS) use hospital services more often than children without DS, but data on racial/ethnic variations are limited. This study generated population-based estimates of hospital use and cost to 3 years of age by race/ethnicity among children with DS in Massachusetts using birth certificates linked to birth defects registry and hospital discharge data from 1999 to 2004. Hospital use (≥ 1 post-birth hospitalization and median days hospitalized birth and post-birth) and reasons for hospitalization were compared across maternal race/ethnicity using relative risk (RR) and Wilcoxon rank sums tests, as appropriate. Costs were calculated in 2011 United States dollars. Greater hospital use was observed among children with DS with Hispanic vs. Non-Hispanic White (NHW) mothers (post-birth hospitalization: RR 1.4; median days hospitalized: 20.0 vs. 11.0, respectively). Children with DS and congenital heart defects of Non-Hispanic Black (NHB) mothers had significantly greater median days hospitalized than their NHW counterparts (24.0 vs. 16.0, respectively). Respiratory diagnoses were listed more often among children with Hispanic vs. NHW mothers (50.0% vs. 29.1%, respectively), and NHBs had more cardiac diagnoses (34.1% vs. 21.5%, respectively). The mean total hospital cost was nine times higher among children with DS ($40,075) than among children without DS ($4053), and total costs attributable to DS were almost $18 million. Median costs were $22,781 for Hispanics, $18,495 for NHBs, and $13,947 for NHWs. Public health interventions should address the higher rates of hospital use and hospitalizations for respiratory and cardiac diseases among racial/ethnic minority children with DS in Massachusetts. Copyright © 2013 Elsevier Ltd. All rights reserved.

  13. Traumatic dental injuries and their association with malocclusion in the primary dentition of Irish children.

    LENUS (Irish Health Repository)

    Norton, Eimear


    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.

  14. Methylphenidate use and school performance among primary school children : a descriptive study

    NARCIS (Netherlands)

    van der Schans, Jurjen; Cicek, Rukiye; Vardar, Sefike; Bos, Jens H. J.; de Vries, Tjalling W.; Hoekstra, Pieter J.; Hak, Eelko


    Background: There is no conclusive evidence that stimulants have beneficial effects on major associated outcome parameters, particularly school performance. We assessed the differences in school performance among children using methylphenidate at the end of primary school in relation to various

  15. Diagnostic strategies in children with chronic gastrointestinal symptoms in primary care

    NARCIS (Netherlands)

    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

  16. Physicians and Physician Trainees Rarely Identify or Address Overweight/Obesity in Hospitalized Children. (United States)

    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.

  17. Comparison of dementia recorded in routinely collected hospital admission data in England with dementia recorded in primary care. (United States)

    Brown, Anna; Kirichek, Oksana; Balkwill, Angela; Reeves, Gillian; Beral, Valerie; Sudlow, Cathie; Gallacher, John; Green, Jane


    Electronic linkage of UK cohorts to routinely collected National Health Service (NHS) records provides virtually complete follow-up for cause-specific hospital admissions and deaths. The reliability of dementia diagnoses recorded in NHS hospital data is not well documented. For a sample of Million Women Study participants in England we compared dementia recorded in routinely collected NHS hospital data (Hospital Episode Statistics: HES) with dementia recorded in two separate sources of primary care information: a primary care database [Clinical Practice Research Datalink (CPRD), n = 340] and a survey of study participants' General Practitioners (GPs, n = 244). Dementia recorded in HES fully agreed both with CPRD and with GP survey data for 85% of women; it did not agree for 1 and 4%, respectively. Agreement was uncertain for the remaining 14 and 11%, respectively; and among those classified as having uncertain agreement in CPRD, non-specific terms compatible with dementia, such as 'memory loss', were recorded in the CPRD database for 79% of the women. Agreement was significantly better (p primary care (CPRD) than in hospital (HES) data. Age-specific rates for dementia based on the hospital admission data were lower than the rates based on the primary care data, but were similar if the delay in recording in HES was taken into account. Dementia recorded in routinely collected NHS hospital admission data for women in England agrees well with primary care records of dementia assessed separately from two different sources, and is sufficiently reliable for epidemiological research.

  18. Quality of life in primary school children: The Health Oriented Pedagogical Project (HOPP). (United States)

    Ringdal, Kristen; Ringdal, Gerd Inger; Olsen, Helene Kristin; Mamen, Asgeir; Fredriksen, Per Morten


    The primary aim of the present study was to evaluate the association between parents' level of education, measurements of physical attributes, and quality of life in a general sample of primary school children. The children's and the parents' versions of the Inventory of Life Quality in Children and Adolescents (ILC) were used to measure health-related quality of life (QOL) in 2140 school children (response rate 93%) and 1639 parents (response rate 71%) recruited from nine primary schools in Norway. A set of physical characteristics were also measured in the children: body mass index (BMI), waist circumference, average daily minutes of physical activity, aerobic fitness, and handgrip strength. The regression analysis showed stronger relationships between the covariates and QOL for the parents' assessments than for the children's. Parents' level of education was significantly related to children's QOL, with the strongest association for parental QOL assessment. Among the physical variables, aerobic fitness ( B = 0.01, p > .001 in both samples), and handgrip strength in the parents' sample ( B = 0.21, p < .05) were significantly related to the children's QOL. The present study replicated the well-known finding that parents' sociodemographic status is important for children's QOL. Our new contribution is to show that the physiological variables aerobic fitness and muscular strength also contributed significantly to explain variance in QOL. This opens up interesting perspectives on how to improve QOL among children through more emphasis on physical activity and physical fitness in schools.

  19. Hospitalized children as social actors in the assessment and management of their pain


    Kortesluoma, R.-L. (Riitta-Liisa)


    Abstract By acknowledging pain as subjective and only fully perceived by the person in pain, the main aim of this study was to report on the use of qualitative child interviewing and drawings as a research method to elicit hospitalized children’s perceptions and descriptions of their pain experience. Further, the second aim was to contribute to the improvement of pain assessment and management in hospitalized children by approaching the question from the children’s point of view through th...

  20. Hospital-Diagnosed Pertussis Infection in Children and Long-term Risk of Epilepsy

    DEFF Research Database (Denmark)

    Olsen, Morten; Thygesen, Sandra K; Østergaard, John R


    , maternal history of epilepsy, presence of congenital malformations, and gestational age. Unique personal identifiers permitted unambiguous data linkage and complete follow-up for death, emigration, and hospital contacts. RESULTS: We identified 4700 patients with pertussis (48% male), of whom 90 developed......: In Denmark, risk of epilepsy was increased in children with hospital-diagnosed pertussis infections compared with the general population; however, the absolute risk was low....

  1. Economic burden of primary compared with recurrent Clostridium difficile infection in hospitalized patients: a prospective cohort study. (United States)

    Shah, D N; Aitken, S L; Barragan, L F; Bozorgui, S; Goddu, S; Navarro, M E; Xie, Y; DuPont, H L; Garey, K W


    Few studies have investigated the additional healthcare costs of recurrent C. difficile infection (CDI). To quantify inpatient treatment costs for CDI and length of stay among hospitalized patients with primary CDI only, compared with CDI patients who experienced recurrent CDI. This was a prospective, observational cohort study of hospitalized adult patients with primary CDI followed for three months to assess for recurrent CDI episodes. Total and CDI-attributable hospital length of stay (LOS) and hospitalization costs were compared among patients who did or did not experience at least one recurrent CDI episode. In all, 540 hospitalized patients aged 62±17 years (42% males) with primary CDI were enrolled, of whom 95 patients (18%) experienced 101 recurrent CDI episodes. CDI-attributable median (interquartile range) LOS and costs (in US$) increased from 7 (4-13) days and $13,168 (7,525-24,456) for patients with primary CDI only versus 15 (8-25) days and $28,218 (15,050-47,030) for patients with recurrent CDI (Pcosts increased from 11 (6-22) days and $20,693 (11,287-41,386) for patients with primary CDI only versus 24 (11-48) days and $45,148 (20,693-82,772) for patients with recurrent CDI (Pcost of pharmacological treatment while hospitalized was $60 (23-200) for patients with primary CDI only (N=445) and $140 (30-260) for patients with recurrent CDI (P=0.0013). This study demonstrated that patients with CDI experience a significant healthcare economic burden attributed to CDI. Economic costs and healthcare burden increased significantly for patients with recurrent CDI. Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  2. Changes in pediatric tracheostomy 1982-2011: a Canadian tertiary children's hospital review. (United States)

    Ogilvie, Lauren N; Kozak, Jessica K; Chiu, Simon; Adderley, Robert J; Kozak, Frederick K


    Pediatric tracheostomy has undergone notable changes in frequency and indication over the past 30 years. This study investigates pediatric tracheostomy at British Columbia Children's Hospital (BCCH) over a 30-year period. A retrospective chart review of tracheostomy cases at BCCH from 1982 to 2011 was conducted. Charts were reviewed for demographics, date of tracheostomy, indication, complications, mortality and date of decannulation. Data from three 10-year time periods were compared using Fisher's Exact test to examine changes over time. 251 procedures (154 males) performed on 231 patients were reviewed. Mean age at tracheostomy was 3.74 years with 48% of procedures undertaken before the age of one year. Frequency of procedure by year has generally declined into the early 2000's. Upper airway obstruction was the most common indication accounting for 33% of procedures. The rate of complication across the entire cohort was 22% with 63% of patients being decannulated. Tracheostomy related mortality occurred in 2.0% of cases reviewed. Changes occurred in primary indications with infections indicating less procedures and neurological impairments indicating more procedures over time. Complications increased and the decannulation rate decreased over this 30-year review. Pediatric tracheostomy is considered a safe and effective procedure at BCCH. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Management for the children with otitis media with effusion in the tertiary hospital. (United States)

    Choung, Yun-Hoon; Shin, You Ree; Choi, Seong Jun; Park, Keehyun; Park, Hun Yi; Lee, Jong Bin; Han, Dong Hee; Kahng, Hison


    Recently, new evidence-based recommendations have been introduced for diagnosing and managing otitis media with effusion (OME) in children. However, there are some difficulties to follow the general guidelines in the tertiary hospitals. The purpose is to evaluate the efficiency of antibiotics or antihistamines for treatment of children with OME in the tertiary hospital with a randomized prospective clinical study. Eighty-four children with OME who had been diagnosed in the tertiary hospital were randomized to receive 5 different medications for 2 weeks. We prescribed antibiotics (amoxicillin-clavulanate syrup) in Group I (n=16), antibiotics/steroids (prednisolone) in Group II (n=18), antibiotics/antihistamines (ebastine) in Group III (n=15), antibiotics/steroids/antihistamines in Group IV (n=17), and mucolytics (ivy leaf extract) in Group V (n=17) for control. We followed-up children every 2 weeks and evaluated the state of OME at 3 months. Thirty six (42.9%) of 84 children were resolved within average 6.9 weeks after the treatments. Thirty-six (42.9%) were treated with ventilation tube insertion and 12 patients (14.3%) were observed. There was no difference in the resolution rates of OME among the five different protocols (P>0.05). There was no difference in the resolution rates among groups who used steroids, antihistamines, steroids and antihistamines, or other medications to manage 42 children with allergies (P>0.05). In the tertiary hospital, the cure rate of children with OME was not as high as well-known, and antibiotics or anti-allergic medications were not more effective than control. We may, therefore, need any other guidelines which are different from the previous evidence-based recommendations, including early operation in the tertiary hospitals.

  4. Survival outcome of intermediate risk neuroblastoma at Children Cancer Hospital Egypt. (United States)

    Elzomor, Hossam; Ahmed, Gehad; Elmenawi, Salma; Elkinaai, Naglaa; Refaat, Amal; Soliman, Sonya; Abdelwahab, Mai Amr; Zaghloul, Mohamed Saad; Fawzy, Mohamed


    The study aims to evaluate survival outcome in newly diagnosed pediatric intermediate risk neuroblastoma patients treated at the Children Cancer Hospital - Egypt and their relation to various clinical and pathological factors. The study included stage 3 patients INSS) stage 4 disease, stage 4 children 1-1.5 years with favorable biology, and infants stage 4 s (with unfavorable biologic features). Patients received systemic chemotherapy, in the form of etoposide and carboplatin alternating with cyclophosphamide, doxorubicin and vincristine, administered at 3-week intervals, with a total of 6 or 8 cycles guided by reaching objective overall response (complete/very good partial/partial response). The study included 136 patients, 67 males and 69 females. 101 patients had abdominal primary tumors, 28 had mediastinal masss and 7 with masses in the neck; 68% were stage 3 and the remaining (n = 44) had metastatic disease. The three-year overall survival (OS) and event-free survival (EFS) estimates were 94% ± 2% and 90.9% ± 2.5%, respectively. OS and EFS by gender, age, pathology and INPC were all statistically not significantly different. Moreover, OS for patients having surgery versus no surgery (inoperable residual only) was statistically significant (98.4% ± 1.6% & 88.7% ± 5.3%, respectively, p = .034). A very high rate of survival is currently achievable in patients with intermediate risk neuroblastoma by chemotherapy or chemotherapy and surgery. In addition to response, our plan is to adopt biologically-based treatment to reduce treatment-induced complications among survivors. Copyright © 2018 National Cancer Institute, Cairo University. Production and hosting by Elsevier B.V. All rights reserved.

  5. A crisis management quality improvement initiative in a children's psychiatric hospital: design, implementation, and outcome. (United States)

    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.

  6. The presence of a primary male caregiver affects children's ...

    African Journals Online (AJOL)

    caregiver has an influence, direct or indirect, on children's language skills. Keywords: ... the presence/absence of a father figure on language development were mainly conducted in ... centres via the classroom teachers or day mothers.

  7. Frequency of bedwetting among primary school children in Benha ...

    African Journals Online (AJOL)

    Ashraf H. Mohammed


    Feb 24, 2014 ... Objectives: The overall objective was health promotion of school children, and the specific .... A Chinese study reported that the prevalence .... The attitudes of ... Pelvic floor exercises should be done and the child had to be.

  8. Determination of the Pre-Hospital Practices Performed for Children with Burn Injuries

    Directory of Open Access Journals (Sweden)

    Mehtap Kavurmaci


    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.

  9. Experience of family members as a result of children's hospitalization at the Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Maria Virginia Martins Faria Faddul Alves


    Full Text Available Objective. To describe the experience of family members as a result of children's hospitalization at the Intensive Care Unit (ICU. Methodology. Descriptive and cross-sectional study. A structured interview was held with 20 relatives of patients hospitalized at two clinics of the Botucatu Medical School at Universidade Estadual Paulista 'Júlio de Mesquita Filho'. Information was collected between July and September 2010. Results. The main characteristics of the participating relatives were: 80% mothers of the children; 70% low education level and 70% married. Sixty percent of the children were hospitalized at the ICU for the first time. Eighty percent of the interviewees believe that the children's behavior changes inside the unit and 85% consider that visiting hours are sufficient. The predominant negative feelings are fear (50% and insecurity (20%, while the predominant positive feelings are hope (50% and the expectation of discharge (25%. The professional who most supported the relatives was the nurse (35%. Conclusion. The family members' experience as a result of the children's hospitalization at the ICU involves positive and negative aspects, which also affect the child's behavior at the unit.

  10. Clinical and laboratory signs associated to serious dengue disease in hospitalized children

    Directory of Open Access Journals (Sweden)

    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.

  11. Outcome of short-term hospitalization for children with severe asthma. (United States)

    Weinstein, A G; Faust, D S; McKee, L; Padman, R


    This study presents results of a family-centered, short-term residential program in which medical, behavioral, and treatment assessments were provided to the child with severe asthma and the family. After a median stay of 15 days, forty-four consecutively admitted children with severe asthma achieved a 93% reduction in hospital days (median, 7 hospital days for the year before treatment versus median 0 hospital days per patient per year at 20 1/2-month follow-up; p less than 0.001) and an 81% reduction in emergency care (median, 4 visits for the year previously versus median, 0.4 visits per patient per year at follow-up; p less than 0.01). There was also a significant reduction in corticosteroid bursts and improvement in FEV1. Unique to this program was mandatory family participation focusing on the child's and family's adaptation to severe asthma and development of family-specific interventions to promote compliance with the treatment regimen. Child and family functioning was assessed at admission and follow-up. Hospital use at follow-up was greater for children from dysfunctional families. Families demonstrating difficulties in disciplining the child with asthma required more hospital days both before admission and at follow-up. Short-term hospitalization for children with severe asthma is associated with significant improvement in pulmonary morbidity when the family of the child is included in assessment and treatment.

  12. In-hospital mortality pattern of severely injured children

    DEFF Research Database (Denmark)

    Do, Hien Quoc; Steinmetz, Jacob; Rasmussen, Lars S


    the mortality pattern of severely injured children admitted to a Danish level I trauma centre. METHODS: We included trauma patients aged 15 years or less, who subsequent a trauma team activation were admitted during the 9-year period 1999-2007. Data were collected prospectively for subjects who had a length...

  13. Four decades of conjoined twins at Red Cross Children's Hospital ...

    African Journals Online (AJOL)

    anatomy and discordant anomalies, especially in the right- ... and functional description of normal and fused anatomy. ... Over a period of 42 years (1964- 2006), Red Cross Children's .... transfused ranged from 10% to 450% of the estimated blood ... Owing to cross-circulation, pharmacokinetics ... size of the right ventricle.

  14. Cerebral Palsy in Pakistani Children: A Hospital Based Survey

    Directory of Open Access Journals (Sweden)

    Atif Ahmed Khan


    Conclusion:Spastic quadriplegia or spastic diplegia are the commonest presentations in Pakistani children diagnosed with CP. The frequent etiological factors in CP development are birth asphyxia, prematurity, meningoencephalitis and kernicterus. [Cukurova Med J 2014; 39(4.000: 705-711

  15. [Hyperthyroidism in children at the University Hospital in Dakar (Senegal)]. (United States)

    Boiro, Djibril; Diédhiou, Demba; Niang, Babacar; Sow, Djiby; Mbodj, Mandiaye; Sarr, Anna; Ndongo, Aliou Abdoulaye; Thiongane, Aliou; Guèye, Modou; Thiam, Lamine; Seck, Ndiogou; Dieng, Yaay Joor; Ba, Abou; Ba, Idrissa Demba; Diallo, Ibrahima Mané; Ndiaye, Ousmane; Diop, Said Nourou


    Hyperthyroidism in children is rare and constitutes a problem because of its psychosomatic impact. This study aimed to present an overview of the state of knowledge on these aspects in children from Dakar. We conducted a multicenter, descriptive study over a period of 15 years. We evaluated the epidemiological, clinical and etiologic aspects of hyperthyroidism in children. 239 patients were included in the study with a prevalence of 2.4%, a sex ratio (M/F) of 0.36 and an average age of 10.8 years. The inclusion criteria were being the eldest son in a family(26.3%), being advanced (36.9%) or delayed (12.5%) in maturation, having short stature (40.1%). It was caused by Graves' disease in 90.3% of cases with psychoaffective factor in 22.1%. On a clinical point of view tachycardia (92.4%), goiter (91.1%), exophthalmia (81.8%), weight loss (69.8%) prevailed but with bed-wetting (30.2%) and psychic manifestations (3.1%). Cardiovascular and cutaneous manifestations were positively associated with age (p Hyperthyroidism in children differs from that in adults because of induction factors, growth disturbances and enuresis. Age and sex seem to favor the clinical picture of thyrotoxicosis and its associated signs.

  16. Interventions for reducing medication errors in children in hospital

    NARCIS (Netherlands)

    Maaskant, Jolanda M; Vermeulen, Hester; Apampa, Bugewa; Fernando, Bernard; Ghaleb, Maisoon A; Neubert, Antje; Thayyil, Sudhin; Soe, Aung


    BACKGROUND: 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

  17. Interventions for reducing medication errors in children in hospital

    NARCIS (Netherlands)

    Maaskant, Jolanda M.; Vermeulen, Hester; Apampa, Bugewa; Fernando, Bernard; Ghaleb, Maisoon A.; Neubert, Antje; Thayyil, Sudhin; Soe, Aung


    Background 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

  18. Tuberculosis in children at Mbarara University Teaching Hospital ...

    African Journals Online (AJOL)

    Conclusion: HIV positive children with suspected TB frequently have signs that suggest the presence of other diseases such as Lymphocystic Interstitial Pneumonitis (LIP) and chronic bronchiectasis; and are less likely to have a diagnosis of “probable or confirmed TB” after investigations. Patients with an uncertain diagnosis ...

  19. Practical use and implementation of PET in children in a hospital PET centre

    DEFF Research Database (Denmark)

    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....

  20. Practical use and implementation of PET in children in a hospital PET centre

    International Nuclear Information System (INIS)

    Borgwardt, Lise; Larsen, Helle Jung; Pedersen, Kate; Hoejgaard, Liselotte


    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.)

  1. Practical use and implementation of PET in children in a hospital PET centre

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  2. Children Treated at an Expeditionary Military Hospital in Iraq (United States)


    cryptorchidism [752.89]) 3 Hernia (inguinal [550.9], ventral [553.2]) 3 Vascular (228.01)/lymphatic (457.9) malformation 3 Craniofacial malformation...girl who underwent resection of a cervical cystic hy- groma at our hospital and later received radiofrequency ablation treatment of her enlarged tongue...head and neck mass 2 Orthopedic fixation 2 Hernia repair 2 Computed tomography while under general anesthesia 2 Orchidopexy 1 Repair of rectal

  3. Cognitive Abilities of Pre- and Primary School Children with Spina Bifida in Uganda (United States)

    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…

  4. Greek Primary School Children's Representations of the Urban Environment as Seen through Their Drawings (United States)

    Stokas, Dimitrios; Strezou, Elena; Malandrakis, George; Papadopoulou, Penelope


    In the present study, we explore aspects of Greek primary school children's representations about the urban environment through the use of drawings and their relation to sustainability. For that purpose, 104 children, aged 9-12 (4th and 6th grades), were asked to make two drawings of their town: one as it is now and another as they would like it…

  5. Continuity in Primary School Children's Eating Problems and the Influence of Parental Feeding Strategies (United States)

    Matton, Annelies; Goossens, Lien; Braet, Caroline; Van Durme, Kim


    Eating problems are highly prevalent and seem to show continuity in children. Nevertheless, the effect of different maternal and paternal feeding practices on changes in these problems is not fully understood yet. This study examines short-term continuity in primary school children's overeating, loss of control (over eating), restraint and…

  6. Children's Friendships in Diverse Primary Schools: Teachers and the Processes of Policy Enactment (United States)

    Vincent, Carol; Neal, Sarah; Iqbal, Humera


    Drawing on data from a project exploring children's and adults' friendships across social class and ethnic difference, this paper focuses on the enactment of national and institutional policy around children's friendships as realized in three primary schools in diverse urban areas in London. Through a focus on the way in which social and emotional…

  7. Children's Understanding of Experimental Contrast and Experimental Control: An Inventory for Primary School (United States)

    Osterhaus, Christopher; Koerber, Susanne; Sodian, Beate


    Experimentation skills are a central component of scientific thinking, and many studies have investigated whether and when primary-school children develop adequate experimentation strategies. However, the answers to these questions vary substantially depending on the type of task that is used: while discovery tasks, which require children to…

  8. Modeling the Factors Associated with Children's Mental Health Difficulties in Primary School: A Multilevel Study (United States)

    Humphrey, Neil; Wigelsworth, Michael


    The current study explores some of the factors associated with children's mental health difficulties in primary school. Multilevel modeling with data from 628 children from 36 schools was used to determine how much variation in mental health difficulties exists between and within schools, and to identify characteristics at the school and…

  9. Inclusion of children with autism and ADHD in physical education (PE) at primary school in Denmark

    DEFF Research Database (Denmark)

    Bentholm, Anette Lisbeth

    Inclusion of children with autism and ADHD in physical education (PE) at primary school in DenmarkMore children diagnosed with autism and ADHD have been included in primary school by law in Denmark over the last years (L379, 2012). In a new School reform (L406, 2014) the children have to particip......Inclusion of children with autism and ADHD in physical education (PE) at primary school in DenmarkMore children diagnosed with autism and ADHD have been included in primary school by law in Denmark over the last years (L379, 2012). In a new School reform (L406, 2014) the children have...... to participate in physical activities at least 45 minutes each school day. Autism and ADHD are disabling conditions that affects social communication and interaction, and often also their motor skills and cognition (Harvey & Reid, 2003; Verret, 2010). Therefore these children can be challenge to participate...... a process-oriented methodology (Baur & Ernst, 2011).The methods of the research are primarily based on qualitative methods: Analysis of the curriculum for PE from the Danish ministry of Education and political strategies of inclusion, field observations primarily in PE, interviews with the 11 children...

  10. Reading Performance Profile of Children with Dyslexia in Primary and Secondary School Students (United States)

    Balci, Emine; Çayir, Aybala


    The purpose of the present research was to provide information to the community about the reading subskill profiles of children with dyslexia in primary and secondary school students. 175 children (aged 7-15 yrs) were examined on a varied set of phonological coding, spelling and fluent reading tasks. For this purpose, students' fluent reading were…

  11. Diagnostic test strategies in children at increased risk of inflammatory bowel disease in primary care

    NARCIS (Netherlands)

    Holtman, Gea A.; Lisman-van Leeuwen, Yvonne; Kollen, Boudewijn J.; Norbruis, Obbe F.; Escher, Johanna C.; Walhout, Laurence C.; Kindermann, Angelika; de Rijke, Yolanda B.; van Rheenen, Patrick F.; Berger, Marjolein Y.


    In children with symptoms suggestive of inflammatory bowel disease (IBD) who present in primary care, the optimal test strategy for identifying those who require specialist care is unclear. We evaluated the following three test strategies to determine which was optimal for referring children with

  12. Handwriting in 2015: A Main Occupation for Primary School-Aged Children in the Classroom? (United States)

    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…

  13. Parents, Mental Illness, and the Primary Health Care of Infants and Young Children. (United States)

    Fenichel, Emily, Ed.


    This bulletin issue contains five papers on the theme of adults with mental illness who are parents of very young children. "Parents, Mental Illness, and the Primary Health Care of Infants and Young Children" (John N. Constantino) offers the experience of a trainee in a combined residency in pediatrics and psychiatry, focusing on…

  14. Apprehensive parents: a qualitative study on parents seeking immediate primary care for their children

    NARCIS (Netherlands)

    Hugenholtz, M.; Bröer, C.; van Daalen, R.


    Background: Children are more frequent users of out-of-hours primary care than other age groups, although their medical problems are less urgent. Aim: To gain insight into the health-seeking behaviour of parents who ask for immediate medical attention for their children. Design of study: Qualitative

  15. Relation of Home Chaos to Cognitive Performance and Behavioral Adjustment of Pakistani Primary School Children (United States)

    Shamama-tus-Sabah, Syeda; Gilani, Nighat; Wachs, Theodore D.


    Recent findings from Western developed countries have linked home chaos to children's cognitive performance and behavioral problems. In the present paper we test whether the same pattern of associations can be replicated in a non-Western developing country. Our sample was 203 Pakistani primary school children. To assess home chaos the Confusion,…

  16. CCTV Surveillance in Primary Schools: Normalisation, Resistance, and Children's Privacy Consciousness (United States)

    Birnhack, Michael; Perry-Hazan, Lotem; German Ben-Hayun, Shiran


    This study explored how primary school children perceive school surveillance by Closed Circuit TV systems (CCTVs) and how their perceptions relate to their privacy consciousness. It drew on interviews with 57 children, aged 9-12, who were enrolled in three Israeli public schools that had installed CCTVs, and on information gathered from members of…

  17. Is Privacy at Risk when Commercial Websites Target Primary School Children? A Case Study in Korea (United States)

    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…

  18. The effects of interactive music therapy on hospitalized children with cancer: a pilot study. (United States)

    Barrera, Maru E; Rykov, Mary H; Doyle, Sandra L


    The use of music therapy with children in health settings has been documented, but its effectiveness has not yet been well established. This pilot study is a preliminary exploration of the effectiveness of interactive music therapy in reducing anxiety and increasing the comfort of hospitalized children with cancer. Pre- and post-music therapy measures were obtained from children (N = 65) and parents. The measures consisted of children's ratings of mood using schematic faces, parental ratings of the child's play performance, and satisfaction questionnaires completed by parents, children and staff. There was a significant improvement in children's ratings of their feelings from pre- to post-music therapy. Parents perceived an improved play performance after music therapy in pre-schoolers and adolescents but not in school-aged children. Qualitative analyses of children's and parents' comments suggested a positive impact of music therapy on the child's well-being. These preliminary findings are encouraging and suggest beneficial effects of interactive music therapy with hospitalized pediatric hematology/oncology patients. In future studies replicating these findings should be conducted in a randomized control trial. Copyright 2002 John Wiley & Sons, Ltd.

  19. Worry and problem-solving skills and beliefs in primary school children


    Parkinson, Monika; Creswell, Catharine


    Objective. To examine the association between worry and problem-solving skills and beliefs (confidence and perceived control) in primary school children.\\ud Method. Children (8–11 years) were screened using the Penn State Worry Questionnaire for Children. High (N ¼ 27) and low (N ¼ 30) scorers completed measures of anxiety, problem-solving skills (generating alternative solutions to\\ud problems, planfulness, and effectiveness of solutions) and problem-solving beliefs(confidence and perceived ...

  20. Psychotropic drug effects contributing to psychiatric hospitalization of children: a preliminary study. (United States)

    Fialkov, M J; Hasley, S


    Over an 11-month period on a Children's Psychiatric Unit 5% of 60 first admissions for hospitalization were apparently associated with adverse effects of psychotropic medication. Forty (66%) of the first admissions had used, prior to hospitalization, a wide variety of drugs including stimulants, major and minor tranquilizers, anticonvulsants, antidepressants and over-the-counter drugs containing antihistamines and analgesics. It is suggested that inappropriate and injudicious use of psychotropic medications may be associated with unanticipated adverse behavioral effects, which can result in deterioration of a child's functioning to the point of necessitating psychiatric hospitalization. Early identification of these unwanted psychotropic effects has diagnostic, prognostic, economic, and legal implications.

  1. Eye Injuries among Primary School Children in Enugu, Nigeria: Rural vs Urban

    Directory of Open Access Journals (Sweden)

    Nonso Ejikeme Okpala


    (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 of treatment, 58.16% of the children with an eye injury had no form of treatment for it. The children from this study with monocular blindness did not receive adequate medical treatment. Treatment of an eye injury, according to this study, was sought from chemists (19.39%, at hospital/health centers (16.33%, at home (3.06%, and from traditional healers (3.06%. The persons who treated an eye injury, as observed from this study, were doctors (14.29%, nurses (4.08%, chemists (17.35%, and traditional healers and fathers (3.06% each. The frequency of noninjury-related diagnosis made in this study was refractive error, 4.85%; allergic conjunctivitis, 1.94%; oculocutaneous albinism, 0.24%; prepapillary vascular loops, 0.40%; and then ptosis, exotropia, stye, corneal opacity, and retinitis pigmentosa, 0.08% each. The annual incidence of an eye injury according to this study was 3.48%. The majority of the causes of an eye injury, as per this study, were preventable. Appropriate promotion of preventive eye care among children may go a long way in reducing the burden of blindness from eye injuries.

  2. Burden of diarrhea, hospitalization and mortality due to cryptosporidial infections in Indian children.

    Directory of Open Access Journals (Sweden)

    Rajiv Sarkar


    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.

  3. Incidence of nutritional anaemia among the under five children attending Ahmed Gasim hospital

    International Nuclear Information System (INIS)

    Mohamed, Hager Elrasheed Ali


    A survey was carried out in Khartoum North Ahmed Gasim specialist Hospital for children to identify aetiological factors that lead to incidence of nutritional anaemia among children under under five years of age. The sample consists of 192 patients taken from the hospital wards (experimental group), and 60 healthy children taken from out patient vaccination department of same hospital. A questionnaire was used as a tool for collection data regarding children and their families with emphasis to general information, socio-economic information, dietary information, anthropometric information, medical history and laboratory investigations including haemoglobin, hematocrit (PCV)%, peripheral blood picture, serum ferritin, serum folate and serum B 12 . Results show no correlation between anaemia and age R(0.1048) p 1 2 deficiency. Some children affected had mixed deficiency anaemia (3.182). Iron deficiency without anaemia was common among healthy children (control) 22.8%. Some recommendations were set for the improvement of the existing situation e.g. health education, nutrition education with emphasis on intake of supplements and weaning diets rich in iron and folate. Follow up and surveillance program to compact nutritional anaemia should be adopted.(Author)

  4. Hospitals (United States)

    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...

  5. Factors Influencing Helmet Use, Head Injury, and Hospitalization Among Children Involved in Skateboarding and Snowboarding Accidents. (United States)

    Sadeghian, Homa; Nguyen, Brian; Huynh, Nhan; Rouch, Joshua; Lee, Steven L; Bazargan-Hejazi, Shahrzad


    Up to 75% of skateboarders and snowboarders admitted to the hospital sustain head injuries. It is unclear why not all children and teenagers wear helmets while snowboarding and skateboarding given the protection they afford. To report on the prevalence of, and factors associated with, skateboarding and snowboarding in injured children and to explore factors that influence helmet use, head injury, and hospitalization in this sample. A cross-sectional study of skateboard- and snowboard-associated injuries from 2003 to 2012 among individuals younger than age 18 years using National Electronic Injury Surveillance System (NEISS) data from approximately 100 hospitals. Helmet use, head injury, and hospitalization. Of 1742 patients in the study, 852 (48.9%) and 890 (51.1%) were skateboarders and snowboarders, respectively. Overall, 907 (52.1%) did not use helmets, and 704 (40.4%) sustained head injuries. Multiple logistic regression analysis showed that age, race/ethnicity, location of boarding, and engaging in skateboarding influenced helmet use. Sex, race/ethnicity, helmet use, and skateboarding predicted head injury. Age, sex, skateboarding, and head injury predicted hospital admission. Statistically significant differences exist in helmet use, head injury, and hospitalization rates between skateboarders and snowboarders. Our findings suggest that injury prevention and outreach programs are needed to increase helmet use and reduce the risk of head injury and hospitalization in skateboarders and other at-risk groups. Further studies are needed to clarify the association between race/ethnicity and helmet use among skateboarders and snowboarders.

  6. Delirium in Hospitalized Children with Cancer: Incidence and Associated Risk Factors. (United States)

    Traube, Chani; Ariagno, Sydney; Thau, Francesca; Rosenberg, Lynne; Mauer, Elizabeth A; Gerber, Linda M; Pritchard, David; Kearney, Julia; Greenwald, Bruce M; Silver, Gabrielle


    To assess the incidence of delirium and its risk factors in hospitalized children with cancer. In this cohort study, all consecutive admissions to a pediatric cancer service over a 3-month period were prospectively screened for delirium twice daily throughout their hospitalization. Demographic and treatment-related data were collected from the medical record after discharge. A total of 319 consecutive admissions, including 186 patients and 2731 hospital days, were included. Delirium was diagnosed in 35 patients, for an incidence of 18.8%. Risk factors independently associated with the development of delirium included age Delirium was associated with increased hospital length of stay, with median length of stay for delirious patients of 10 days compared with 5 days for patients who were not delirious during their hospitalization (P delirium was a frequent complication during admissions for childhood cancer, and was associated with increased hospital length of stay. Multi-institutional prospective studies are warranted to further characterize delirium in this high-risk population and identify modifiable risk factors to improve the care provided to hospitalized children with cancer. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Workplace violence against medical staff of Chinese children's hospitals: A cross-sectional study. (United States)

    Li, Zhe; Yan, Chun-Mei; Shi, Lei; Mu, Hui-Tong; Li, Xin; Li, An-Qi; Zhao, Cheng-Song; Sun, Tao; Gao, Lei; Fan, Li-Hua; Mu, Yi


    In China, medical staff of children's hospitals are commonly exposed to violence. However, few studies on medical violence are conducted in the settings of children's hospitals. The aim of this study is to assess the incidence, magnitude, consequences, and potential risk factors of workplace violence (WPV) against medical staff of children's hospitals. A retrospective cross-sectional design was used. A self-administered questionnaire was utilized to collect data on 12 children's hospitals. The questionnaires were distributed to a stratified proportional random sample of 2,400 medical staff; 1,932 valid questionnaires were collected. A chi-square test and multiple logistic regression analysis were conducted. A total of 68.6% of respondents had experienced at least one WPV incident involving non-physical and/or physical violence in the past year. The perpetrators were mainly family members of patients (94.9%). Most of the WPV occurred during the day shift (70.7%) and in wards (41.8%). Males were 1.979 times (95% CI, 1.378 to 2.841) more likely than females to experience physical violence. Emergency departments were more exposed to physical violence than other departments. Oncology was 2.733 times (95% CI, 1.126 to 6.633) more exposed to non-physical violence than the emergency department. As a result of WPV, victims felt aggrieved and angry, work enthusiasm declined, and work efficiency was reduced. However, only 5.6% of the victims received psychological counseling. Medical staff are at high risk of violence in China's children's hospitals. Hospital administrators and related departments should pay attention to the consequences of these incidents. There is a need for preventive measures to protect medical staff and provide a safer workplace environment. Our results can provide reference information for intervention strategies and safety measures.

  8. Assessment of Gross Malnutrition among Primary School Children ...

    African Journals Online (AJOL)


    Jun 28, 2017 ... with overweight and obesity belonged to upper social class, whereas more underweight ... Department of Paediatrics, Federal Teaching Hospital, .... physical activities as well as quality health education ..... States, Brazil, China and Russia. ... The Nigerian poverty profile 2010

  9. Nutrition knowledge and nutritional status of primary school children ...

    African Journals Online (AJOL)


    Jan 4, 2010 ... are a decreased fibre intake and increased intakes of total protein and animal protein ... has implemented various national nutrition and primary health- .... fish, chicken, dried beans, legumes, peas and soy, 4) the dairy group,.

  10. Characteristics of Rotavirus Diarrhea in Hospitalized Children in Kosovo


    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...

  11. The Pattern of Electronic Game Use and Related Bodily Discomfort in Hong Kong Primary School Children (United States)

    Lui, Donald P. Y.; Szeto, Grace P. Y.; Jones, Alice Y. M.


    The present study examined the usage pattern of electronic game devices among primary school children in Hong Kong. Commonly used types of games devices were grouped into three main categories: large-screen/TV-based games, small handheld game devices and active game devices. A survey was conducted among 476 students in a local primary school, with…

  12. Developing and Implementing a Mobile Conservation Education Unit for Rural Primary School Children in Lao PDR (United States)

    Hansel, Troy; Phimmavong, Somvang; Phengsopha, Kaisone; Phompila, Chitana; Homduangpachan, Khiaosaphan


    In this article, the authors examine the implementation and success of a mobile conservation education unit targeting primary schools in central Lao PDR (People's Democratic Republic). The mobile unit conducted 3-hour interactive programs for school children focused on the importance of wildlife and biodiversity around the primary schools in rural…

  13. Children Literature Based Program for Developing EFL Primary Pupils' Life Skills and Language Learning Strategies (United States)

    Abdelhalim, Safaa M.


    This study examines the effectiveness of a proposed English language program based on integrating two forms of children literature, mainly short stories and songs, in developing the needed life skills and language learning strategies of primary school students. Besides, it emphasized the importance of providing EFL fifth year primary students with…

  14. Language Practices and Attitudes of Australian Children of Indian Descent in a Primary Education Setting (United States)

    Bissoonauth, Anu


    This paper investigated linguistic practices and choices of Australian children of Indian descent, an under-researched group, who are studying Hindi in primary education. Data was collected using a questionnaire and semi-structured interviews with sixty participants across 3 primary schools in the Sydney area. The findings revealed, as expected,…

  15. Effects of a Theory-Based Education Program to Prevent Overweightness in Primary School Children

    NARCIS (Netherlands)

    Kocken, P.L.; Scholten, A.M.; Westhoff,E.; Kok, B.P.H.; Taal, E.M.; Goldbohm, R.A.


    The effectiveness of the “Extra Fit!” (EF!) education program in promoting healthy diet and physical activity to prevent and reduce overweightness among primary school children aged 9 to 11 was evaluated. A randomized controlled design was carried out in 45 primary schools (n = 1112) in the

  16. Teachers' Recognition and Referral of Anxiety Disorders in Primary School Children (United States)

    Headley, Clea J.; Campbell, Marilyn A.


    This study investigated the ability of primary school teachers to recognise and refer children with anxiety symptoms. Two hundred and ninety-nine primary school teachers completed a questionnaire exploring their recognition and referral responses to five hypothetical vignettes that described boys and girls with varying severity of anxiety…

  17. Obesity in 7 - 10-year-old children in urban primary schools in Port ...

    African Journals Online (AJOL)

    Objective. The primary aim of this study was to quantify the prevalence of overweight and obesity among urban 7 - 10-year-old children in affluent (quintile 5) English-medium primary schools in Port Elizabeth. Method. A quantitative, descriptive one-way cross-sectional research design utilising random sampling was used.

  18. Brief Report: Healing Touch Consults at a Tertiary Care Children's Hospital. (United States)

    Schlefman, Amanda; Rappaport, David I; Adams-Gerdts, Walle; Stubblefield, Samuel C


    Components of complementary and alternative medicine are increasingly being implemented at academic medical centers. These approaches include therapeutic touch or healing touch (HT), an energy-based therapy using light touch on or near the body. Limited data exist regarding complementary and alternative medicine use at children's hospitals. The aim of this study was to evaluate patterns and clinical characteristics of HT consultations among children hospitalized at Nemours/A.I. duPont Hospital for Children. We conducted a retrospective chart review of all patients hospitalized from January 2012 through December 2013, comparing patients who received HT consultations with those who did not. There were 25,396 admissions during the study period; 882 (4%) of these, representing 593 individual patients, received an HT consultation. As compared with those without an HT consultation, patients receiving HT were older (median 12 years vs 5 years, P<.001), female (58% vs 46%, P<.001), and more likely to be admitted to the hematology/oncology or blood/bone marrow transplant units (P<.001). Patients with HT consultations had longer hospitalizations (median 121 hours vs 38 hours, P<.001) and more medical problems (median 12 vs 4, P<.001). Six attending physicians were responsible for placing the majority of HT consultations. Of the 593 patients receiving an HT consultation, 21% received ≥2 consultations during the study period. Certain patients, such as those with longer hospitalizations and more medical problems, were more likely to receive HT consultations. Many patients received multiple consultations, suggesting that HT may be an important aspect of ongoing care for hospitalized children.

  19. An integrative review of communication between parents and nurses of hospitalized technology-dependent children. (United States)

    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

  20. Immune response and anamnestic immune response in children after a 3-dose primary hepatitis b vaccination

    International Nuclear Information System (INIS)

    Afzal, M.F.; Sultan, M.A.; Saleemi, A.I.


    Diseases caused by Hepatitis B virus (HBV) have a worldwide distribution. Pakistan adopted the recommendations of World Health Organization (WHO) for routine universal infant vaccination against hepatitis B in 2002, currently being administered at 6, 10, and 14 weeks of age in a combination vaccine. This study was conducted to determine the immune response and anamnestic immune response in children, 9 months-10 years of age, after a 3-dose primary Hepatitis B vaccination. Methods: This cross sectional study was conducted in the Department of Paediatrics, King Edward Medical University/Mayo Hospital, Lahore, Pakistan, from January to June, 2014. A total of 200 children of either sex between the ages of 9 months to 10 years, docu mented to have received 3 doses of hepatitis B vaccines according to Expanded Program of Immunization (6,10,14 weeks) schedule in infancy, were recruited by consecutive sampling. The level of serum anti-HBsAb by ELIZA was measured. Children with anti-HBs titers =10 mIU/mL were considered to be immune. Those with anti-HBsAb levels <10 mIU/mL were offered a booster dose of infant recombinant hepatitis B vaccine. The second serum sample was obtained 21-28 days following the administration of the booster dose and the anamnestic immune response was measured. Data was analysed using SPSS 17 to determine the relation between time interval since last vaccination and antibody titer. Chi square test was applied. Results: Of the 200 children, protective antibody response was found in 58 percent. Median serological response was 18.60 (range 2.82-65.15). Antibody levels were found to have a statistically significant (p-value 0.019) negative correlation with the time since last administration of vaccine. A booster dose of Hepatitis B vaccine was administered to all non-responders, with each registering a statistically significant (p-value 0.00) anamnestic response. Conclusion: The vaccination schedule with short dosage interval was unable to provide

  1. Care of children with disabilities in Primary Health Care

    Directory of Open Access Journals (Sweden)

    Thaís Giudice Schultz


    Full Text Available Objective: This article describes an experience report that aimed to present perceptions on the care of children with disabilities in the Family Health Strategy (FHS, showing its limits and potentials based on the experience of participation in the program ‘PET-Saúde’. Method: Data were collected from field notes which recorded the monitoring of the care process offered to children with disabilities by the FHS teams. The study was conducted in a health facility in the city of Rio de Janeiro for one year. Results: Content analysis results listed the two main themes that composed the issues of concern for child care in this experience: the coordination of health care and the family and community orientation as the core for child care in the FHS. Conclusion: Despite the weakness in compliance with these categories, which are principles and fundamentals of the FHS, this is a privileged space with regard to care practices for children with disabilities.

  2. Features of Graphomotor Skills Development in Primary School Children

    Directory of Open Access Journals (Sweden)

    Kuzeva O.V.


    Full Text Available The results of the study of serial graphic skills and writing formation in elementary school children are represented in the article. Special characteristics of the development of these skills in 7 and 9 years old children in norm and with learning disabilities (LD were found using computerized experimental methods and general neuropsychological diagnostics. Third-formers in norm achieve significant results in the development of graphomotor skills and writing while children with LD have difficulties in its automating. 1st grade students with LD show complex cognitive difficulties that influence the formation of graphomotor skills and handwriting, in the 3d grade tempo characteristics and quality of writing primarily suffer. The main reason of such dysfunction is the decrease of serial organization of movements, planning and control functions, as well as the deficit of neurodynamic components of activity.

  3. The therapeutic efficacy of propranolol in children with recurrent primary epistaxis (United States)

    Bjelakovic, Bojko; Bojanovic, Mila; Lukic, Stevo; Saranac, Ljiljana; Vukomanovic, Vladislav; Prijic, Sergej; Zivkovic, Nikola; Randjelovic, Dusica


    We hypothesized that some characteristics of beta-blockers, including negative inotropic, peripheral vasoconstrictor, and antiangiogenic effects, might be potentially useful in treating children with epistaxis. From June 2010 to March 2012, a total of seven children with recurrent primary epistaxis resistant to conventional management were observed at our institution. An overall effectiveness of propranolol was noted in all seven children when given a dose of 1.5–2 mg/kg/day (divided into three doses) as a second line therapy for terminating epistaxis. Based on our first experience, we believe that propranolol could be a favorable treatment option for patients with primary epistaxis. PMID:23467483

  4. Primary health care quality and hospitalizations for ambulatory care sensitive conditions in the public health system in Porto Alegre, Brazil. (United States)

    Gonçalves, Marcelo Rodrigues; Hauser, Lisiane; Prestes, Isaías Valente; Schmidt, Maria Inês; Duncan, Bruce Bartholow; Harzheim, Erno


    To investigate the relation of hospitalization for ambulatory care sensitive conditions (ACSC) with the quality of public primary care health services in Porto Alegre, Brazil. Cohort study constructed by probabilistic record linkage performed from August 2006 to December 2011 in a population ≥18 years of age that attended public primary care health services. The Primary Care Assessment Tool (PCATool-Brazil) was used for evaluation of primary care services. Of 1200 subjects followed, 84 were hospitalized for primary care sensitive conditions. The main causes of ACSC hospital admissions were cardiovascular (40.5%) and respiratory (16.2%) diseases. The PCATool average score was 5.3, a level considerably below that considered to represent quality care. After adjustment through Cox proportional hazard modelling for covariates, >60 years of age [hazard ratio (HR): 1.13; P = 0.001), lesser education (HR: 0.66; P = 0.02), ethnicity other than white (HR: 1.77; P = 0.01) and physical inactivity (HR: 1.65; P = 0.04) predicted hospitalization, but higher quality of primary health care did not. Better quality of health care services, in a setting of overwhelmingly low quality services not adapted to the care of chronic conditions, did not influence the rate of avoidable hospitalizations, while social and demographic characteristics, especially non-white ethnicity and lesser schooling, indicate that social inequities play a predominant role in health outcomes. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail:

  5. Evaluation of generalized pruritus in patients without primary skin lesions in Razi Hospital

    Directory of Open Access Journals (Sweden)

    Jomhori P


    Full Text Available Pruritus is an unpleasant sensation that provokes the desire to scratch. It has long been recognized as a presenting or concomitant symptom of many systemic diseases. Indeed, generalized pruritus is reported to be associated with underlying diseases in 10-50 percent of cases. This study was conducted to investigate the underlying diseases in pruritic patients without primary skin lesion. Seventy-five patients with at least one-month history of pruritus with no primary skin lesions, presenting to dermatological clinics of Razi Hospital, from April 97 until December 99 were evaluated. The work up procedure consisted of medical history, physical examination, laboratory findings (CBC, ESR, blood chemistry, thyroid function tests, urinalysis, stool exam, chest X-ray and in selected cases, additional specific tests. Fifty-four patients were female, and 21 male the mean age was 45.7y±16.41, and the mean duration of pruritus, 21.8m±21. I