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Sample records for urban pediatric primary

  1. Use of an electronic medical record improves the quality of urban pediatric primary care.

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    Adams, William G; Mann, Adriana M; Bauchner, Howard

    2003-03-01

    To evaluate the quality of pediatric primary care, including preventive services, before and after the introduction of an electronic medical record (EMR) developed for use in an urban pediatric primary care center. A pre-postintervention analysis was used in the study. The intervention was a pediatric EMR. Routine health care maintenance visits for children eye-to-eye contact with patients was reduced, and 4 of 7 reported that use of the system increased the duration of visits (mean: 9.3 minutes longer). All users recommended continued use of the system. Use of the EMR in this study was associated with improved quality of care. This experience suggests that EMRs can be successfully used in busy urban pediatric primary care centers and, as recommended by the Institute of Medicine, must play a central role in the redesign of the US health care system.

  2. Pediatric caregiver attitudes toward email communication: survey in an urban primary care setting.

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    Dudas, Robert Arthur; Crocetti, Michael

    2013-10-23

    Overall usage of email communication between patients and physicians continues to increase, due in part to expanding the adoption of electronic health records and patient portals. Unequal access and acceptance of these technologies has the potential to exacerbate disparities in care. Little is known about the attitudes of pediatric caregivers with regard to their acceptance of email as a means to communicate with their health care providers. We conducted a survey to assess pediatric caregiver access to and attitudes toward the use of electronic communication modalities to communicate with health care providers in an urban pediatric primary care clinic. Participants were pediatric caregivers recruited from an urban pediatric primary care clinic in Baltimore, Maryland, who completed a 35-item questionnaire in this cross-sectional study. Of the 229 caregivers who completed the survey (91.2% response rate), 171 (74.6%) reported that they use email to communicate with others. Of the email users, 145 respondents (86.3%) stated that they would like to email doctors, although only 18 (10.7%) actually do so. Among email users, African-American caregivers were much less likely to support the expanded use of email communication with health care providers (adjusted OR 0.34, 95% CI 0.14-0.82) as were those with annual incomes less than US $30,000 (adjusted OR 0.26, 95% CI 0.09-0.74). Caregivers of children have access to email and many would be interested in communicating with health care providers. However, African-Americans and those in lower socioeconomic groups were much less likely to have positive attitudes toward email.

  3. Screening and Identification in Pediatric Primary Care

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    Simonian, Susan J.

    2006-01-01

    This article reviews issues related to behavioral screening in pediatric primary care settings. Structural-organizational issues affecting the use of pediatric primary care screening are discussed. This study also reviewed selected screening instruments that have utility for use in the primary care setting. Clinical and research issues related to…

  4. Imaging of primary pediatric lymphoma of bone

    International Nuclear Information System (INIS)

    Milks, Kathryn S.; McLean, Thomas W.; Anthony, Evelyn Y.

    2016-01-01

    Primary pediatric bone lymphoma is a rare form of non-Hodgkin lymphoma. Unlike nodal forms of lymphoma, imaging abnormalities in lymphoma of bone do not resolve rapidly in conjunction with treatment and radiologic findings can remain abnormal for years, making it difficult to evaluate treatment response. To evaluate the utility of imaging in assessment of patients with primary pediatric bone lymphoma. At our institution between 2004 and 2013, six cases of pathology-proven primary pediatric bone lymphoma were diagnosed. Retrospective chart review was performed to assess imaging utilization. Our data were qualitatively compared with existing literature to construct an algorithm for imaging patients with primary lymphoma of bone. Imaging evaluation of patients with primary pediatric bone lymphoma was highly variable at our institution. Conventional imaging was routinely used to evaluate response to treatment, despite lack of appreciable osseous change. Imaging in the absence of symptoms did not alter clinical management. Only positron emission tomography CT (PET/CT) proved capable of demonstrating imaging changes from the pretreatment to the post-treatment scans that were consistent with the clinical response to treatment. Surveillance imaging is likely unnecessary in patients with a known diagnosis of pediatric lymphoma of bone. Pretreatment and post-treatment PET/CT is likely sufficient to assess response. There is little data to support the use of interim and surveillance PET/CT. (orig.)

  5. Primary hepatic artery embolization in pediatric blunt hepatic trauma.

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    Ong, Caroline C P; Toh, Luke; Lo, Richard H G; Yap, Te-Lu; Narasimhan, Kannan

    2012-12-01

    Non-operative management of isolated blunt hepatic trauma is recommended except when hemodynamic instability requires immediate laparotomy. Hepatic artery angioembolization is increasingly used for hepatic injuries with ongoing bleeding as demonstrated by contrast extravasation on the CT scan. It is used primarily or after laparotomy to control ongoing hemorrhage. Hepatic angioembolization as part of multimodality management of hepatic trauma is reported mainly in adults, with few pediatric case reports. We describe our institution experience with primary pediatric hepatic angioembolization and review the literature with regard to indications and complications. Two cases (3 and 8 years old), with high-grade blunt hepatic injuries with contrast extravasation on the CT scan were successfully managed by emergency primary hepatic angioembolization with minimal morbidity and avoided laparotomy. To date, the only reports of pediatric hepatic angioembolization for trauma are 5 cases for acute bleeding and 15 delayed cases for pseudoaneurysm. The role of hepatic angioembolization in the presence of an arterial blush on CT in adults is accepted, but contested in a pediatric series, despite higher transfusion rate and mortality rate. We propose that hepatic angioembolization should be considered adjunct treatment, in lieu of, or in addition to emergency laparotomy for hemostasis in pediatric blunt hepatic injury. Copyright © 2012 Elsevier Inc. All rights reserved.

  6. Adequately Addressing Pediatric Obesity: Challenges Faced by Primary Care Providers.

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    Shreve, Marilou; Scott, Allison; Vowell Johnson, Kelly

    2017-07-01

    To assess the challenges primary care providers encounter when providing counseling for pediatric patients identified as obese. A survey assessed the current challenges and barriers to the screening and treatment of pediatric obesity for providers in northwest Arkansas who provide care to families. The survey consisted of 15 Likert scale questions and 4 open-ended questions. Time, resources, comfort, and cultural issues were reported by providers as the biggest barriers in screening and the treatment of pediatric obesity. All providers reported lack of time as a barrier to providing the care needed for obese children. Cultural barriers of both the provider and client were identified as factors, which negatively affect the care and treatment of obese children. Primary care providers continue to experience challenges when addressing pediatric obesity. In this study, a lack of adequate time to address obesity was identified as the most significant current barrier and may likely be tied to physician resources. Although reimbursement for obesity is increasing, the level of reimbursement does not support the time or the resources needed to treat patients. Many providers reported their patients' cultural view of obesity influenced how they counsel their patients. Increasing providers' knowledge concerning differences in how weight is viewed or valued may assist them in the assessment and care of obese pediatric patients. The challenges identified in previous research continue to limit providers when addressing obesity. Although progress has been made regarding knowledge of guidelines, continuing effort is needed to tackle the remaining challenges. This will allow for earlier identification and intervention, resulting in improved outcomes in pediatric obesity.

  7. Parental perspectives of screening for adverse childhood experiences in pediatric primary care.

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    Conn, Anne-Marie; Szilagyi, Moira A; Jee, Sandra H; Manly, Jody T; Briggs, Rahil; Szilagyi, Peter G

    2018-03-01

    Pediatricians recognize a need to mitigate the negative impact that adverse childhood experiences (ACEs) can have on health and development. However, ACEs screening and interventions in primary care pediatrics may be inhibited by concerns about parental perceptions. We assessed parent perspectives of screening for ACEs in the pediatric primary care setting, to understand their views on the potential impact of their ACEs on their parenting and to identify opportunities for pediatric anticipatory guidance. We used purposive sampling to recruit parents of children <6 years receiving care at an urban, pediatric clinic. Semistructured questions guided 1:1 interviews that were later coded by multiple researchers to verify reliability. A thematic framework approach guided analysis and identified main themes and subthemes. We reached thematic saturation after 15 parent interviews, which consistently revealed 3 interrelated themes. First, parents strongly supported ACEs screening as a bridge to needed services, and they recommended using a trauma-sensitive, person-centered approach in pediatric practices. Second, parents understood the intergenerational impact of ACEs and expressed a desire to break the cycle of adversity. Finally, parents saw their child's pediatrician as a potential change-agent who could provide support to meet their parenting goals. Parents want to discuss their ACEs and receive help and guidance from pediatricians. Furthermore, they perceive their child's pediatrician as having an important role to play in meeting their parenting goals. It is important to ensure that pediatricians have the training, skills and familiarity with available resources to meet parental expectations. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

  8. Primary repair for pediatric colonic injury: Are there differences among adult and pediatric trauma centers?

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    Khan, Muhammad; Jehan, Faisal; O'Keeffe, Terence; Pandit, Viraj; Kulvatunyou, Narong; Tang, Andrew; Gries, Lynn; Joseph, Bellal

    2017-12-01

    Management of colonic injuries (colostomy [CO] versus primary anastomosis [PA]) among pediatric patients remains controversial. The aim of this study was to assess outcomes in pediatric trauma patient with colonic injury undergoing operative intervention. The National Trauma Data Bank (2011-2012) was queried including patients with isolated colonic injury undergoing exploratory laparotomy with PA or CO with age ≤18 y. Missing value analysis was performed. Patients were stratified into two groups: PA and CO. Outcome measures were mortality, in-hospital complications, and hospital length of stay. Multivariate regression analysis was performed. A total of 1151 patients included. Mean ± standard deviation age was 11.61 ± 2.8 y, and median [IQR] Injury Severity Score was 12 [8-16]; 39% (n = 449) of the patients had CO, and 35.6% (n = 410) were managed in pediatric trauma centers (PC). Patients with CO had a higher Injury Severity Score (P trauma centers (AC). Moreover, there was no difference in mortality between the AC and the PC (P = 0.79). Our data demonstrate no difference in mortality in pediatric trauma patients with colonic injury who undergo primary repair or CO. However, adult trauma centers had lower rates of CO performed as compared to a similar cohort of patients managed in pediatric trauma centers. Further assessment of the reasons underlying such differences will help improve patient outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Nutrition: A Primary Therapy in Pediatric Acute Respiratory Distress Syndrome

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    Bryan Wilson

    2016-10-01

    Full Text Available Appropriate nutrition is an essential component of intensive care management of children with Acute Respiratory Distress Syndrome (ARDS and is linked to patient outcomes. One out of every two children in the PICU will develop malnutrition or have worsening of baseline malnutrition, and present with specific micronutrient deficiencies. Early and adequate enteral nutrition (EN is associated with improved 60-day survival after pediatric critical illness and yet, despite early EN guidelines, critically ill children receive on average only 55% of goal calories by PICU day 10. Inadequate delivery of EN is due to perceived feeding intolerance, reluctance to enterally feed children with hemodynamic instability, and fluid restriction. Underlying each of these factors is large practice variation between providers and across institutions for initiation, advancement and maintenance of EN. Strategies to improve early initiation, advancement, and to maintain delivery of EN are needed to improve morbidity and mortality from pediatric ARDS. Both over and underfeeding prolongs duration of mechanical ventilation in children and worsens other organ function such that precise calorie goals are needed. The gut is thought to act as a ‘motor’ of organ dysfunction and emerging data regarding the role of intestinal barrier functions and the intestinal microbiome on organ dysfunction and outcomes of critical illness present exciting opportunities to improve patient outcomes. Nutrition should be considered a primary rather than supportive therapy for pediatric ARDS. Precise nutritional therapies, which are titrated and targeted to preservation of intestinal barrier function, prevention of intestinal dysbiosis, preservation of lean body mass, and blunting of the systemic inflammatory response, offer great potential for improving outcomes of pediatric ARDS. In this review we examine the current evidence regarding dose, route, and timing of nutrition, current

  10. Automated conversation system before pediatric primary care visits: a randomized trial.

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    Adams, William G; Phillips, Barrett D; Bacic, Janine D; Walsh, Kathleen E; Shanahan, Christopher W; Paasche-Orlow, Michael K

    2014-09-01

    Interactive voice response systems integrated with electronic health records have the potential to improve primary care by engaging parents outside clinical settings via spoken language. The objective of this study was to determine whether use of an interactive voice response system, the Personal Health Partner (PHP), before routine health care maintenance visits could improve the quality of primary care visits and be well accepted by parents and clinicians. English-speaking parents of children aged 4 months to 11 years called PHP before routine visits and were randomly assigned to groups by the system at the time of the call. Parents' spoken responses were used to provide tailored counseling and support goal setting for the upcoming visit. Data were transferred to the electronic health records for review during visits. The study occurred in an urban hospital-based pediatric primary care center. Participants were called after the visit to assess (1) comprehensiveness of screening and counseling, (2) assessment of medications and their management, and (3) parent and clinician satisfaction. PHP was able to identify and counsel in multiple areas. A total of 9.7% of parents responded to the mailed invitation. Intervention parents were more likely to report discussing important issues such as depression (42.6% vs 25.4%; P PHP improved the quality of their care. Systems like PHP have the potential to improve clinical screening, counseling, and medication management. Copyright © 2014 by the American Academy of Pediatrics.

  11. Breastfeeding among Latino Families in an Urban Pediatric Office Setting

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    Elizabeth Sloand

    2016-01-01

    Full Text Available Objective. To determine the breastfeeding rate of Latino infants at an urban pediatric clinic in the first six months of life and to identify factors associated with breastfeeding. Methods. Investigators conducted a retrospective chart review of infants seen at the clinic in 2014 as part of a mixed methods study. Topics reviewed included demographics, infant health data, and feeding methods at 5 points in time. Bivariate correlations and cross-tabulations explored associations between variables. Results. Most of the mothers (75% fed their newborns with both breastfeeding and formula (las dos. At 6 months, a majority were formula-fed only (55.9%. Approximately 10% of mothers exclusively breastfed their newborns, and the trend of exclusive breastfeeding remained steady through the 6-month visit. Over time, the number of mothers who exclusively bottle-feed their infants steadily rises. There were no statistical differences among the feeding method groups with regard to birth order of child, number of adults or children in the household, vaccination rate, number of sick visits, or infants’ growth. Conclusions. More targeted attention to this population and other immigrant populations with culturally tailored interventions spanning the prenatal to early infancy periods could increase exclusive breastfeeding and ultimately improve child health.

  12. Pediatric Primary Care Providers' Relationships with Mental Health Care Providers: Survey Results

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    Pidano, Anne E.; Honigfeld, Lisa; Bar-Halpern, Miri; Vivian, James E.

    2014-01-01

    Background: As many as 20 % of children have diagnosable mental health conditions and nearly all of them receive pediatric primary health care. However, most children with serious mental health concerns do not receive mental health services. This study tested hypotheses that pediatric primary care providers (PPCPs) in relationships with mental…

  13. Developmental Surveillance and Screening Practices by Pediatric Primary Care Providers: Implications for Early Intervention Professionals

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    Porter, Sallie; Qureshi, Rubab; Caldwell, Barbara Ann; Echevarria, Mercedes; Dubbs, William B.; Sullivan, Margaret W.

    2016-01-01

    This study used a survey approach to investigate current developmental surveillance and developmental screening practices by pediatric primary care providers in a diverse New Jersey county. A total of 217 providers were contacted with a final sample size of 57 pediatric primary care respondents from 13 different municipalities. Most providers…

  14. Primary Pediatric Hypertension: Current Understanding and Emerging Concepts.

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    Tiu, Andrew C; Bishop, Michael D; Asico, Laureano D; Jose, Pedro A; Villar, Van Anthony M

    2017-09-01

    The rising prevalence of primary pediatric hypertension and its tracking into adult hypertension point to the importance of determining its pathogenesis to gain insights into its current and emerging management. Considering that the intricate control of BP is governed by a myriad of anatomical, molecular biological, biochemical, and physiological systems, multiple genes are likely to influence an individual's BP and susceptibility to develop hypertension. The long-term regulation of BP rests on renal and non-renal mechanisms. One renal mechanism relates to sodium transport. The impaired renal sodium handling in primary hypertension and salt sensitivity may be caused by aberrant counter-regulatory natriuretic and anti-natriuretic pathways. The sympathetic nervous and renin-angiotensin-aldosterone systems are examples of antinatriuretic pathways. An important counter-regulatory natriuretic pathway is afforded by the renal autocrine/paracrine dopamine system, aberrations of which are involved in the pathogenesis of hypertension, including that associated with obesity. We present updates on the complex interactions of these two systems with dietary salt intake in relation to obesity, insulin resistance, inflammation, and oxidative stress. We review how insults during pregnancy such as maternal and paternal malnutrition, glucocorticoid exposure, infection, placental insufficiency, and treatments during the neonatal period have long-lasting effects in the regulation of renal function and BP. Moreover, these effects have sex differences. There is a need for early diagnosis, frequent monitoring, and timely management due to increasing evidence of premature target organ damage. Large controlled studies are needed to evaluate the long-term consequences of the treatment of elevated BP during childhood, especially to establish the validity of the current definition and treatment of pediatric hypertension.

  15. [Physical therapy in pediatric primary care: a review of experiences].

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    de Sá, Miriam Ribeiro Calheiros; Thomazinho, Paula de Almeida; Santos, Fabiano Luiz; Cavalcanti, Nicolette Celani; Ribeiro, Carla Trevisan Martins; Negreiros, Maria Fernanda Vieira; Vinhaes, Marcia Regina

    2014-11-01

    To review pediatric physical therapy experiences described in the literature and to analyze the production of knowledge on physical therapy in the context of pediatric primary health care (PPHC). A systematic review was conducted according to the PRISMA criteria. The following databases were searched: MEDLINE, LILACS, SciELO, PubMed, Scopus and Cochrane; Brazilian Ministry of Health's CAPES doctoral dissertations database; and System for Information on Grey Literature in Europe (SIGLE). The following search terms were used: ["primary health care" and ("physical therapy" or "physiotherapy") and ("child" or "infant")] and equivalent terms in Portuguese and Spanish, with no restriction on publication year. Thirteen articles from six countries were analyzed and grouped into three main themes: professional dilemmas (three articles), specific competencies and skills required in a PPHC setting (seven articles), and practice reports (four articles). Professional dilemmas involved expanding the role of physical therapists to encompass community environments and sharing the decision-making process with the family, as well as collaborative work with other health services to identify the needs of children. The competencies and skills mentioned in the literature related to the identification of clinical and sociocultural symptoms that go beyond musculoskeletal conditions, the establishment of early physical therapy diagnoses, prevention of overmedication, and the ability to work as team players. Practice reports addressed stimulation in children with neurological diseases, respiratory treatment, and establishing groups with mothers of children with these conditions. The small number of studies identified in this review suggests that there is little knowledge regarding the roles of physical therapists in PPHC and possibly regarding the professional abilities required in this setting. Therefore, further studies are required to provide data on the field, along with a continuing

  16. An Innovative Model of Integrated Behavioral Health: School Psychologists in Pediatric Primary Care Settings

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    Adams, Carolyn D.; Hinojosa, Sara; Armstrong, Kathleen; Takagishi, Jennifer; Dabrow, Sharon

    2016-01-01

    This article discusses an innovative example of integrated care in which doctoral level school psychology interns and residents worked alongside pediatric residents and pediatricians in the primary care settings to jointly provide services to patients. School psychologists specializing in pediatric health are uniquely trained to recognize and…

  17. Nonspecific abdominal pain in pediatric primary care: evaluation and outcomes.

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    Wallis, Elizabeth M; Fiks, Alexander G

    2015-01-01

    To describe the characteristics of children with nonspecific abdominal pain (AP) in primary care, their evaluation, and their outcomes. Between 2007 and 2009, a retrospective cohort of children from 5 primary care practices was followed from an index visit with AP until a well-child visit 6 to 24 months later (outcome visit). Using International Classification of Disease, 9th Revision (ICD-9), codes and chart review, we identified afebrile children between 4 and 12 years old with AP. Use of diagnostic testing was assessed. Multivariable logistic regression was used to model the association of index visit clinical and demographic variables with persistent pain at the outcome visit, and receipt of a specific diagnosis. Three hundred seventy-five children presented with AP, representing 1% of the total population of 4- to 12-year-olds during the study period. Eighteen percent of children had persistent pain, and 70% of the study cohort never received a specific diagnosis for their pain. Seventeen percent and 14% of children had laboratory and radiology testing at the index visit, respectively. Only 3% of laboratory evaluations helped to yield a diagnosis. Among variables considered, only preceding pain of more than 7 days at the index visit was associated with persistent pain (odds ratio 2.15, 95% confidence interval 1.19-3.89). None of the variables considered was associated with receiving a specific diagnosis. Most children with AP do not receive a diagnosis, many have persistent pain, and very few receive a functional AP diagnosis. Results support limited use of diagnostic testing and conservative management consistent with national policy statements. Copyright © 2015 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  18. Pediatric Emergency Department and Primary Care Provider Attitudes on Assessing Childhood Adversity.

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    Schilling, Samantha; Murray, Ashlee; Mollen, Cynthia J; Wedin, Tara; Fein, Joel A; Scribano, Philip V

    2017-07-03

    The purpose of this study was to understand pediatric emergency department (ED) and primary care (PC) health care provider attitudes and beliefs regarding the intersection between childhood adversities and health care. We conducted in-depth, semistructured interviews in 2 settings (ED and PC) within an urban health care system. Purposive sampling was used to balance the sample among 3 health care provider roles. Interview questions were based on a modified health beliefs model exploring the "readiness to act" among providers. Interviews were recorded, transcribed, and coded. Interviews continued until theme saturation was reached. Saturation was achieved after 26 ED and 19 PC interviews. Emergency department/primary care providers were similar in their perception of patient susceptibility to childhood adversity. Childhood mental health problems were the most frequently referenced adverse outcome, followed by poor childhood physical health. Adult health outcomes because of childhood adversity were rarely mentioned. Many providers felt that knowing about childhood adversity in the medical setting was important because it relates to provision of tangible resources. There were mixed opinions about whether or not pediatric health care providers should be identifying childhood adversities at all. Although providers exhibited knowledge about childhood adversity, the perceived effect on health was only immediate and tangible. The effect of childhood adversity on lifelong health and the responsibility and potential accountability health systems have in addressing these important health determinants was not recognized by many respondents in our study. Addressing these provider perspectives will be a critical component of successful transformation toward more accountable health care delivery systems.

  19. Primary headaches in pediatric patients with chronic rheumatic disease.

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    Uluduz, Derya; Tavsanli, Mustafa Emir; Uygunoğlu, Uğur; Saip, Sabahattin; Kasapcopur, Ozgur; Ozge, Aynur; Temel, Gulhan Orekici

    2014-11-01

    To assess the presence, prevalence and clinical characteristics of primary headaches in pediatric patients with chronic rheumatic diseases such as juvenile idiopathic arthritis (JIA) and familial Mediterranean fever (FMF), and to analyze the common pathophysiological mechanisms. In this noncontrolled, cross-sectional study, a semi-structured 53 item headache questionnaire was administered to subjects with FMF and JIA, and interviewed a total sample size of 601 patients younger than16years of age. The questionnaires were then analyzed according to the International Headache Society's diagnostic criteria. Children with FMF (n=378) and JIA (n=223) were studied. Each group was then divided into two subgroups according to whether the subjects reported headache or not. 29.5% of subjects with FMF reported having migraine, 37.6% probable migraine and 32.9% tension type headache (TTH). In JIA group 28.2% were diagnosed with migraine; 41.2% with probable migraine and 30.6% with TTH. No significant difference was found between all subjects with (n=258) and without (n=343) headache for variables such as living in a crowded family (p=0.95), being the first child in the family (p=0.63), academic achievement of the child (p=0.63), high education level (higher than high school) of the mother (p=0.52) and father (p=0.46). The presence of systemic disease was reported not to be effecting the daily life at the time of evaluation by 90.2% of the children with headache and 91.0% of the children without headache (p=0.94). 81.4% of the children reported their headaches were not aggravating with the exacerbation periods of their systemic disease. Family history of hypertension was reported higher by the subjects with headache (13.5% with headache and 4.0% without headache p=0.001). Diabetes mellitus was also reported higher (5.8% with headache; 0.5% without headache; p=0.006). Family history of headache was reported in 28.2% of the patients with headache whereas it was 17.4% of the

  20. Preliminary Validation of a Screening Tool for Adolescent Panic Disorder in Pediatric Primary Care Clinics

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    Queen, Alexander H.; Ehrenreich-May, Jill; Hershorin, Eugene R.

    2012-01-01

    This study examines the validity of a brief screening tool for adolescent panic disorder (PD) in a primary care setting. A total of 165 participants (ages 12-17 years) seen in two pediatric primary care clinics completed the Autonomic Nervous System Questionnaire (ANS; Stein et al. in Psychosomatic Med 61:359-364, 40). A subset of those screening…

  1. Urban-Rural Disparity in Geographical and Temporal Availability of Pediatric Clinics: A Nationwide Survey in Taiwan.

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    Leu, Hsin-I; Chang, Wei-Ting; Lin, Ming-Hwai; Chen, Tzeng-Ji; Hwang, Shinn-Jang; Chou, Li-Fang; Jeng, Mei-Jy

    2017-08-01

    The shortage and maldistribution of pediatricians affected after-hours pediatric services, especially in rural areas. Our study aimed to examine the urban-rural disparity in geographical and temporal availability of the pediatrician workforce in Taiwan by analyzing opening time schedules of all pediatric clinics throughout the country. The opening time schedules of nonhospital pediatric clinics were downloaded from the website of the National Health Insurance Administration in Taiwan for analysis. The geographical and temporal availability of pediatric clinics was calculated and stratified by urbanization level and opening time, which was divided into daytime and evening sessions over 1 week. Each of 368 towns in Taiwan was also regarded as a unit of measurement to estimate the local availability of at least one pediatric clinic open in after-hours sessions. Among 1483 nonhospital pediatric clinics in Taiwan, the overwhelming majority were situated in urban (65.8%) and suburban (30.6%) areas. On average, a pediatric clinic provided 16.3 (standard deviation=3.04) sessions of services per week. One-third (34.7%, n=50) of 144 suburban towns and over three-fourths (77.4%, n=120) of 155 rural towns had no pediatric clinic. Most pediatric clinics remained open on weekday evenings (91.1%) and during Saturday daytime (91.8%). The percentage of open clinics gradually decreased over the weekend: Saturday evening (58.1%), Sunday daytime (33.4%), and Sunday evening (19.4%). Rural pediatric clinics remained closed mostly on weekends. On Sunday evenings, pediatric clinics were open only in 5.2% of rural towns, with a decline of 77.1%, whereas they were open in 78.3% of urban towns, with a decline of 18.2%. Pediatric clinics in Taiwan were unevenly distributed between urban and rural areas. The disparity of pediatric services became more obvious at weekends. The consequences of undersupplied rural pediatric care deserve further investigation. Copyright © 2017. Published by

  2. Aspectos éticos en Pediatría, las inmunodeficiencias primarias Ethical aspects in Pediatrics, the primary immunodeficiencies

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    Martha Leonor Paradoa Pérez

    2012-12-01

    Full Text Available Las inmunodeficiencias primarias son enfermedades genéticas, caracterizadas por infecciones crónicas devastadoras que conllevan a la muerte, al desarrollo de tumores y a enfermedades autoinmunes, y la mayoría de estas enfermedades cursan en la edad pediátrica. Desde la última década del pasado siglo, el desarrollo de la tecnología, el surgimiento del Proyecto del Genoma Humano y la profundización en los aspectos bioéticos, han dado lugar a especificidades en la atención médica e investigativa del paciente pediátrico y del que desarrolla una enfermedad inmunológica. Este trabajo recoge los aspectos bioéticos más importantes y los dilemas éticos con los que se enfrenta el inmunólogo pediátrico en la atención al paciente con inmunodeficiencia primaria, el cual demanda la atención de, prácticamente, todas las especialidades pediátricas.Primary immunodeficiencies are genetic diseases characterized by devastating chronic infections leading to death, tumor development and autoimmune diseases, and most of diseases occur at pediatric ages. Since the last decade of the past century, the development of technology, the emergence of the Human Genome Project and the in-depth consideration of bioethical aspects have given rise to specificities in the medical and research care for the pediatric patients and for those suffering immunological diseases. This paper covered the most important bioethical aspects and the ethical dilemmas that the pediatric immunologist faces when taking care of a primary immunodeficiency patient, who practically requires the attention of all the pediatric specialties.

  3. Raising Awareness of Urban Environment Development in Primary Schools

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    Rosi Maja

    2016-12-01

    Full Text Available In the past few years, excessive efforts have been made to increase the city’s attractiveness and its international positioning. Also studies on the so-called city destination branding are on the rise. Theorists, as Ramirez (2001, Marzano and Scott (2009, among many others, are discussing different aspects of this complex process. Many approaches and strategies are dealing with the positioning of urban environments and city destinations, trying to provide at least some partial answers about achieving this objective. With proper marketing and branding, cities can do a lot to attract tourists and visitors. For successful city marketing and branding and for the successful long-term positioning of the destination in general, it is necessary to involve the key stakeholders and collaborate with as many as possible despite the fact that the branding of a city destination (or any destination for that matter is a complex process. It is significant that all the stakeholders, who are always carriers of different interests, are invited to collaborate in the planning of the tourism development and tourism development strategies, from the government, the private sector, schools etc. It is also important to involve the citizens, who can provide a valuable opinion about the environment they live in – what they like about their environment, what suggestion would they give to tourists about gastronomy, attractions, shops, events, etc. It is significant that citizens are proud of their urban environment, that they know their own environment, and that they have the motivation for the involvement in the process of improvement of their home environment (through projects, discussions, etc.. It is impossible to create attractive urban environments or cities if residents do not have a positive opinion about the place they live in. That is why it is essential for the education institutions at all levels, but especially for the institutions at the primary levels to

  4. Secular trends in pediatric antiretroviral treatment programs in rural and urban Zambia: a retrospective cohort study.

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    Sutcliffe, Catherine G; Bolton-Moore, Carolyn; van Dijk, Janneke H; Cotham, Matt; Tambatamba, Bushimbwa; Moss, William J

    2010-07-30

    Since 2003 pediatric antiretroviral treatment (ART) programs have scaled-up in sub-Saharan Africa and should be evaluated to assess progress and identify areas for improvement. We evaluated secular trends in the characteristics and treatment outcomes of children in three pediatric ART clinics in urban and rural areas in Zambia. Routinely collected data were analyzed from three ART programs in rural (Macha and Mukinge) and urban (Lusaka) Zambia between program implementation and July 2008. Data were obtained from electronic medical record systems and medical record abstraction, and were categorized by year of program implementation. Characteristics of all HIV-infected and exposed children enrolled in the programs and all children initiating treatment were compared by year of implementation. Age decreased and immunologic characteristics improved in all groups over time in both urban and rural clinics, with greater improvement observed in the rural clinics. Among children both eligible and ineligible for ART at clinic enrollment, the majority started treatment within a year. A high proportion of children, particularly those ineligible for ART at clinic enrollment, were lost to follow-up prior to initiating ART. Among children initiating ART, clinical and immunologic outcomes after six months of treatment improved in both urban and rural clinics. In the urban clinics, mortality after six months of treatment declined with program duration, and in the rural clinics, the proportion of children defaulting by six months increased with program duration. Treatment programs are showing signs of progress in the care of HIV-infected children, particularly in the rural clinics where scale-up increased rapidly over the first three years of program implementation. However, continued efforts to optimize care are needed as many children continue to enroll in ART programs at a late stage of disease and thus are not receiving the full benefits of treatment.

  5. Prevalence of primary glaucoma in an urban South Indian population

    Directory of Open Access Journals (Sweden)

    Jacob Aby

    1998-01-01

    Full Text Available Glaucoma is fast emerging as a major cause of blindness in India. In order to estimate the prevalence of primary open angle glaucoma (POAG and primary angle closure glaucoma (PACG in an urban South Indian population, we examined 972 individuals aged 30-60 years, chosen using a cluster sampling technique from 12 census blocks of Vellore town. They underwent a complete ocular examination, including applanation tonometry and gonioscopy, at the Medical College Hospital. Characteristic field defects on automated perimetry was a diagnostic requisite for POAG. Prevalence (95% CI of POAG, PACG, and ocular hypertension were 4.1 (0.08-8.1, 43.2 (30.14-56.3, and 30.8 (19.8-41.9 per 1,000, respectively. All the PACG cases detected were of the chronic type. Hitherto unavailable community-based information on primary glaucoma in our study population indicates that PACG is about five times as common as POAG.

  6. Pediatric symptom checklist ratings by mothers with a recent history of intimate partner violence: a primary care study.

    Science.gov (United States)

    Klassen, Brian J; Porcerelli, John H; Sklar, Elyse R; Markova, Tsveti

    2013-12-01

    Screening for psychosocial problems is an effective way to identify children who need further evaluation, and many brief, psychometrically strong measures exist for this purpose. More research is needed, however, about the performance of these measures in special populations who are familiar to primary care settings. The purpose of this study was to examine and compare maternal ratings on the Pediatric Symptom Checklist (PSC) between low-income, urban mothers who had suffered intimate partner violence (IPV) in the past year (n = 23) and a demographically-matched comparison group of mothers (n = 23). Victims of violence rated their children as having significantly more problems in a number of categories (Total PSC Score, Externalizing, and Internalizing) than did mothers in the comparison group. The PSC shows promise as an adequate screening tool for psychosocial problems in the children of women who have suffered IPV, but more research is needed.

  7. School Mental Health Professionals' Training, Comfort, and Attitudes toward Interprofessional Collaboration with Pediatric Primary Care Providers

    Science.gov (United States)

    Arora, Prerna G.; Connors, Elizabeth H.; Biscardi, Krystin A.; Hill, Allison M.

    2016-01-01

    Despite the well-documented need for interprofessional collaboration (IPC) between school mental health (SMH) professionals and pediatric primary care providers (PCPs), research on current collaborative practices of these professionals is limited. Accordingly, using survey methodology, this study investigated SMH professionals' previous training…

  8. Integrating Pregnancy Prevention Into an HIV Counseling and Testing Program in Pediatric Primary Care.

    Science.gov (United States)

    Wheeler, Noah J; Upadhya, Krishna K; Tawe, Marie-Sophie; Tomaszewski, Kathy; Arrington-Sanders, Renata; Marcell, Arik V

    2018-04-11

    Certified health educator (CHE)-based HIV counseling and testing typically focus on HIV and sexually transmitted infection (STI) prevention only. A quality improvement initiative examined integrating assessment of reproductive life plans, counseling about pregnancy prevention, and contraception referral into a CHE-based HIV testing program. Between February 2014 and January 2017, in one urban pediatric primary care clinic serving patients aged 0-25, CHEs assessed sexual history, HIV risk, short-term (i.e., the next 6-12 months) pregnancy desire, and current contraception method and satisfaction among patients aged 13-25 who had ever had vaginal sex, using a standardized questionnaire. Data were analyzed using a de-identified administrative dataset that also tracked referrals to initiate contraception and actual method initiation. Of 1,211 patients, most (96%) reported no short-term pregnancy or partner pregnancy desire. Use of less effective or no contraception, as well as method dissatisfaction, was common. A high proportion of female patients referred to new methods opted for more effective methods (62%) and initiated these methods (76%); a high proportion of male patients opted for receipt of condoms (67%). Patients reporting short-term pregnancy desire reported higher rates of previous pregnancy and STIs. Program findings highlight the potential benefit of integrating assessment for and counseling about pregnancy prevention in a CHE-based HIV testing program. This can more effectively address the needs of patients with concomitant risks of STI/HIV and unintended pregnancy, and link patients who do not desire pregnancy to more effective methods. Copyright © 2018 The Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  9. Relationships between pediatric asthma and socioeconomic/urban variables in Baltimore, Maryland

    Science.gov (United States)

    Kimes, Daniel; Ullah, Asad; Levine, Elissa; Nelson, Ross; Timmins, Sidey; Weiss, Sheila; Bollinger, Mary E.; Blaisdell, Carol

    2004-01-01

    Spatial relationships between clinical data for pediatric asthmatics (hospital and emergency department utilization rates), and socioeconomic and urban characteristics in Baltimore City were analyzed with the aim of identifying factors that contribute to increased asthma rates. Socioeconomic variables and urban characteristics derived from satellite data explained 95% of the spatial variation in hospital rates. The proportion of families headed by a single female was the most important variable accounting for 89% of the spatial variation. Evidence suggests that the high rates of hospital admissions and emergency department (ED) visits may partially be due to the difficulty of single parents with limited resources managing their child's asthma condition properly. This knowledge can be used for education towards mitigating ED and hospital events in Baltimore City.

  10. Identifying Areas of Primary Care Shortage in Urban Ohio

    Directory of Open Access Journals (Sweden)

    Hsin-Chung Liao

    Full Text Available ABSTRACT: This study considers both spatial and a-spatial variables in examining accessibility to primary healthcare in the three largest urban areas of Ohio (Cleveland, Columbus, and Cincinnati. Spatial access emphasizes the importance of geographic barriers between individuals and primary care physicians, while a-spatial variables include non-geographic barriers or facilitators such as age, sex, race, income, social class, education, living conditions and language skills. Population and socioeconomic data were obtained from the 2000 Census, and primary care physician data for 2008 was provided by the Ohio Medical Board. We first implemented a two-step method based on a floating catchment area using Geographic Information Systems to measure spatial accessibility in terms of 30-minute travel times. We then used principal component analysis to group various socio-demographic variables into three groups: (1 socioeconomic disadvantages, (2 living conditions, and (3 healthcare needs. Finally, spatial and a-spatial variables were integrated to identify areas with poor access to primary care in Cleveland, Columbus, and Cincinnati. KEYWORDS: Geographic information systems, healthcare access, spatial accessibility, primary care shortage areas

  11. Understanding and treatment of chronic abdominal pain in pediatric primary care.

    Science.gov (United States)

    Schurman, Jennifer Verrill; Kessler, Emily D; Friesen, Craig A

    2014-10-01

    This study examined the practices used by primary care pediatricians to assess and treat chronic abdominal pain (CAP), as an initial step in guiding clinical practice guideline (CPG) development. A survey was mailed to a random sample of office-based pediatrician members (primary care pediatricians [PCPs]) of the American Medical Association. PCPs (n = 470) provided information about the typical presentation of CAP, assessment/treatment approaches used in their own practice, their definition of a functional gastrointestinal disorder (FGID), and their familiarity with the Rome Criteria for diagnosing FGIDs. Substantial variability among PCPs was noted across all these areas. Results suggest that perceptions and practices of pediatric CAP vary widely among PCPs; no single standard of care emerged to guide development of a CPG for this population. Future research should evaluate the efficacy of specific strategies currently in use to identify potential opportunities for improving assessment and treatment of CAP in pediatric primary care. © The Author(s) 2014.

  12. Parental Reflective Functioning: An Approach to Enhancing Parent-Child Relationships in Pediatric Primary Care.

    Science.gov (United States)

    Ordway, Monica Roosa; Webb, Denise; Sadler, Lois S; Slade, Arietta

    2015-01-01

    The current state of science suggests that safe, responsive, and nurturing parent-child relationships early in children's lives promotes healthy brain and child development and protection against lifelong disease by reducing toxic stress and promoting foundational social-emotional health. Pediatric health care providers (HCPs) have a unique opportunity to foster these relationships. However, such a role requires a shift in pediatric health care from a focus only on children to one that includes families and communities, as well as the inclusion of children's social and emotional health with their physical health. To foster healthy parent-child relationships, HCPs must develop the expertise to integrate approaches that support the family's socioemotional health into pediatric primary care. This article suggests ways in which pediatric HCPs can integrate a focus on parental reflective functioning into their clinical work, helping parents to understand some of the thoughts and feelings that underlie their children's behavior. Copyright © 2015 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

  13. Training gaps for pediatric residents planning a career in primary care: a qualitative and quantitative study.

    Science.gov (United States)

    Rosenberg, Adam A; Kamin, Carol; Glicken, Anita Duhl; Jones, M Douglas

    2011-09-01

    Resident training in pediatrics currently entails similar training for all residents in a fragmented curriculum with relatively little attention to the career plans of individual residents. To explore strengths and gaps in training for residents planning a career in primary care pediatrics and to present strategies for addressing the gaps. Surveys were sent to all graduates of the University of Colorado Denver Pediatric Residency Program (2003-2006) 3 years after completion of training. Respondents were asked to evaluate aspects of their training, using a 5-point Likert scale and evaluating each item ranging from "not at all well prepared" to "extremely well prepared" for their future career. In addition, focus groups were conducted with practitioners in 8 pediatric practices in Colorado. Sessions were transcribed and hand coded by 2 independent coders. Survey data identified training in behavior and development (mean score, 3.72), quality improvement and patient safety strategies (mean, 3.57), and practice management (mean, 2.46) as the weakest aspects of training. Focus groups identified deficiencies in training in mental health, practice management, behavioral medicine, and orthopedics. Deficiencies noted in curriculum structure were lack of residents' long-term continuity of relationships with patients; the need for additional training in knowledge, skills, and attitudes needed for primary care (perhaps even a fourth year of training); and a training structure that facilitates greater resident autonomy to foster development of clinical capability and self-confidence. Important gaps were identified in the primary care training of pediatric residents. These data support the need to develop more career-focused training.

  14. [Echocardiography in diagnosis of primary cardiac tumors in pediatrics].

    Science.gov (United States)

    Erdmenger Orellana, Julio; Vázquez, Clara; Ortega Maldonado, Jesús

    2005-01-01

    We report the experience in the diagnosis of primary cardiac tumor during the period from 1999 to 2004, 8500 studies were revised echocardiographic carried out. We found 21 patients, 11 of female sex (55%). In 15/21 (71%), the age of presentation was less than 1 year. In 9/21 the tumor was multiple (42.8%), lodged in the ventricle right in 2/21 (9.5%), in the ventricle left 3 (14.2%), 8 in the septum interventricular (38%) and 4 compromised the auriculas. They were classified like rabdomiomas 14 (66%), 5 associates with sclerosis tuberosa, 4 mixomas (19%), 2 fibromas (9.5%) and 1 rabdomiosarcoma (4.7%). In five patients the diagnosis was prenatal. The global mortality went of 9.5%. The echocardiograpy is a good diagnosis method in our series the rabdomioma occupied the first place in frequency.

  15. Pediatrics

    Science.gov (United States)

    Spackman, T. J.

    1978-01-01

    The utilization of the Lixiscope in pediatrics was investigated. The types of images that can presently be obtained are discussed along with the problems encountered. Speculative applications for the Lixiscope are also presented.

  16. Pediatrics

    NARCIS (Netherlands)

    Rasheed, Shabana; Teo, Harvey James Eu Leong; Littooij, Annemieke Simone

    2015-01-01

    Imaging of pediatric patients involves many diverse modalities, including radiography, ultrasound imaging, computed tomography, magnetic resonance imaging, and scintigraphic and angiographic studies. It is therefore important to be aware of potential pitfalls that may be related to these modalities

  17. Pediatric Dentistry in Primary Healthcare: Creation, Development, and Evaluation of a Distance Education Course.

    Science.gov (United States)

    Bavaresco, Caren Serra; Bragança, Silvana Gonçalves; D'Avila, Otávio Pereira; Umpierre, Roberto; Harzheim, Erno; Rodrigues, Jonas Almeida

    2018-01-02

    Oral health in childhood is a major problem for global public health. In Brazil, the prevalence of childhood tooth decay varies from 12% to 46%. Dental care treatment in Brazil is almost the exclusive responsibility of primary healthcare (PHC). Therefore, it is essential these professionals are prepared to conduct restorative, endodontic, and exodontic treatments and preventive care in children. Children make up a large proportion of the population in territories requiring advanced dental care provided by PHC in Brazil. To care for these patients, it is necessary to have both manual dexterity and technical knowledge of pediatric dentistry. Accordingly, this study aimed to develop a distance course on pediatric dentistry. A pretest questionnaire consisting of 15 questions was used to assess initial dental knowledge of participants. After completion of a five-module course, participants retook the same initial dental knowledge questionnaire (post-test). Descriptive statistic and paired t test, one-way analysis of variance, and Pearson and Spearman correlation were used, and a significance level of 5% was set. The majority of participants completing the five-module course were women who earned specialty degrees beyond undergraduate studies and currently worked in PHC (>5 years). Participant performance on the dental knowledge questionnaire after completion of the five-module course improved pre- to post-test. These data suggest that completion of a distance course on pediatric dentistry can be an effective tool for improving knowledge of pediatric dentistry in PHC professionals.

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

    Directory of Open Access Journals (Sweden)

    Erica Suavinho

    2014-03-01

    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.

  19. Pediatric Primary Care-Based Obesity Prevention for Parents of Preschool Children: A Pilot Study.

    Science.gov (United States)

    Sherwood, Nancy E; JaKa, Meghan M; Crain, A Lauren; Martinson, Brian C; Hayes, Marcia G; Anderson, Julie D

    2015-12-01

    The Healthy Homes/Healthy Kids Preschool (HHHK-Preschool) pilot program is an obesity prevention intervention integrating pediatric care provider counseling and a phone-based program to prevent unhealthy weight gain among 2- to 4-year-old children at risk for obesity (BMI percentile between the 50th and 85th percentile and at least one overweight parent) or currently overweight (85th percentile ≤ BMI pediatric primary care clinics were randomized to: (1) the Busy Bodies/Better Bites Obesity Prevention Arm or the (2) Healthy Tots/Safe Spots safety/injury prevention Contact Control Arm. Baseline and 6-month data were collected, including measured height and weight, accelerometry, previous day dietary recalls, and parent surveys. Intervention process data (e.g., call completion) were also collected. High intervention completion and satisfaction rates were observed. Although a statistically significant time by treatment interaction was not observed for BMI percentile or BMI z-score, post-hoc examination of baseline weight status as a moderator of treatment outcome showed that the Busy Bodies/Better Bites obesity prevention intervention appeared to be effective among children who were in the overweight category at baseline relative to those who were categorized as at risk for obesity (p = 0.04). HHHK-Preschool pilot study results support the feasibility, acceptability, and potential efficacy in already overweight children of a pediatric primary care-based obesity prevention intervention integrating brief provider counseling and parent-targeted phone coaching. What's New: Implementing pediatric primary care-based obesity interventions is challenging. Previous interventions have primarily involved in-person sessions, a barrier to sustained parent involvement. HHHK-preschool pilot study results suggest that integrating brief provider counseling and parent-targeted phone coaching is a promising approach.

  20. Do Pediatricians Ask About Adverse Childhood Experiences in Pediatric Primary Care?

    Science.gov (United States)

    Kerker, Bonnie D; Storfer-Isser, Amy; Szilagyi, Moira; Stein, Ruth E K; Garner, Andrew S; O'Connor, Karen G; Hoagwood, Kimberly E; Horwitz, Sarah M

    2016-03-01

    The stress associated with adverse childhood experiences (ACEs) has immediate and long-lasting effects. The objectives of this study were to examine 1) how often pediatricians ask patients' families about ACEs, 2) how familiar pediatricians are with the original ACE study, and 3) physician/practice characteristics, physicians' mental health training, and physicians' attitudes/beliefs that are associated with asking about ACEs. Data were collected from 302 nontrainee pediatricians exclusively practicing general pediatrics who completed the 2013 American Academy of Pediatrics Periodic Survey. Pediatricians indicated whether they usually, sometimes, or never inquired about or screened for 7 ACEs. Sample weights were used to reduce nonresponse bias. Weighted descriptive and logistic regression analyses were conducted. Only 4% of pediatricians usually asked about all 7 ACEs; 32% did not usually ask about any. Less than 11% of pediatricians reported being very or somewhat familiar with the ACE study. Pediatricians who screened/inquired about ACEs usually asked about maternal depression (46%) and parental separation/divorce (42%). Multivariable analyses showed that pediatricians had more than twice the odds of usually asking about ACEs if they disagreed that they have little effect on influencing positive parenting skills, disagreed that screening for social emotional risk factors within the family is beyond the scope of pediatricians, or were very interested in receiving further education on managing/treating mental health problems in children and adolescents. Few pediatricians ask about all ACEs. Pediatric training that emphasizes the importance of social/emotional risk factors may increase the identification of ACEs in pediatric primary care. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  1. Time dependence of risks and benefits in pediatric primary prevention implantable cardioverter-defibrillator therapy.

    Science.gov (United States)

    DeWitt, Elizabeth S; Triedman, John K; Cecchin, Frank; Mah, Doug Y; Abrams, Dominic J; Walsh, Edward P; Gauvreau, Kimberlee; Alexander, Mark E

    2014-12-01

    Implantable cardioverter defibrillators (ICDs) used to prevent sudden cardiac arrest in children not only provide appropriate therapy in 25% of patients but also result in a significant incidence of inappropriate shocks and other device complications. ICDs placed for secondary prevention have higher rates of appropriate therapy than those placed for primary prevention. Pediatric patients with primary prevention ICDs were studied to determine time-dependent incidence of appropriate use and adverse events. A total of 140 patients aged prevention were retrospectively identified. Demographics and times to first appropriate shock; adverse events (including inappropriate shock, lead failure, reintervention, and complication); generator replacement and follow-up were noted. During mean follow-up of 4 years, appropriate shock occurred in 19% patients and first adverse event (excluding death/transplant) occurred in 36%. Risk of death or transplant was ≈1% per year and was not related to receiving appropriate therapy. Conditional survival analysis showed rates of appropriate therapy and adverse events decrease soon after implantation, but adverse events are more frequent than appropriate therapy throughout follow-up. Primary prevention ICDs were associated with appropriate therapy in 19% and adverse event in 36% in this cohort. The incidence of both first appropriate therapy and device-related adverse events decreased during longer periods of follow-up after implantation. This suggests that indications for continued device therapy in pediatric primary prevention ICD patients might be reconsidered after a period of nonuse. © 2014 American Heart Association, Inc.

  2. Clinical, histopathologic, and genetic features of pediatric primary myelofibrosis--an entity different from adults.

    Science.gov (United States)

    DeLario, Melissa R; Sheehan, Andrea M; Ataya, Ramona; Bertuch, Alison A; Vega, Carlos; Webb, C Renee; Lopez-Terrada, Dolores; Venkateswaran, Lakshmi

    2012-05-01

    Primary myelofibrosis is a chronic myeloproliferative neoplasm characterized by cytopenias, leukoerythroblastosis, extramedullary hematopoiesis, hepatosplenomegaly and bone marrow fibrosis. Primary myelofibrosis is a rare disorder in adults; children are even less commonly affected by this entity, with the largest pediatric case series reporting on three patients. Most literature suggests spontaneous resolution of myelofibrosis without long term complications in the majority of affected children. We describe the clinical, pathologic, and molecular characteristics and outcomes of nineteen children with primary myelofibrosis treated in our center from 1984 to 2011. Most patients had cytopenia significant enough to require supportive therapy. No child developed malignant transformation and only five of the 19 children (26%) had spontaneous resolution of disease. Sequence analyses for JAK2V617F and MPLW515L mutations were performed on bone marrow samples from 17 and six patients, respectively, and the results were negative. In conclusion, analysis of this large series of pediatric patients with primary myelofibrosis demonstrates distinct clinical, hematologic, bone marrow, and molecular features from adult patients. Copyright © 2012 Wiley Periodicals, Inc.

  3. Surgical Intervention for Primary Spontaneous Pneumothorax in Pediatric Population: When and Why?

    Science.gov (United States)

    Yeung, Fanny; Chung, Patrick H Y; Hung, Esther L Y; Yuen, Chi Sum; Tam, Paul K H; Wong, Kenneth K Y

    2017-08-01

    Spontaneous pneumothorax in pediatric patients is relatively uncommon. The management strategy varies in different centers due to dearth of evidence-based pediatric guidelines. In this study, we reviewed our experience of thoracoscopic management of primary spontaneous pneumothorax (PSP) in children and identified risk factors associated with postoperative air leakage and recurrence. We performed a retrospective analysis of pediatric patients who had PSP and underwent surgical management in our institution between April 2008 and March 2015. Demographic data, radiological findings, interventions, and surgical outcomes were analyzed. A total of 92 patients with 110 thoracoscopic surgery for PSP were identified. The indications for surgery were failed nonoperative management with persistent air leakage in 32.7%, recurrent ipsilateral pneumothorax in 36.4%, first contralateral pneumothorax in 14.5%, bilateral pneumothorax in 10%, and significant hemopneumothorax in 5.5%. Bulla was identified in 101 thoracoscopy (91.8%) with stapled bullectomy performed. 14.5% patients had persistent postoperative air leakage and treated with reinsertion of thoracostomy tube and chemical pleurodesis. 17.3% patients had postoperative recurrence occurred at mean time of 11 months. Operation within 7 days of symptoms onset was associated with less postoperative air leakage (P = .04). Bilateral pneumothorax and those with abnormal radiographic features had significantly more postoperative air leakage (P = .002, P < .01 respectively) and recurrence (P < .01, P = .007). Early thoracoscopic mechanical pleurodesis and stapled bullectomy after thoracostomy tube insertion could be offered as a primary option for management of large PSP in pediatric population, since most of these patients had bulla identified as the culprit of the disease.

  4. Pediatric primary care to help prevent child maltreatment: the Safe Environment for Every Kid (SEEK) Model.

    Science.gov (United States)

    Dubowitz, Howard; Feigelman, Susan; Lane, Wendy; Kim, Jeongeun

    2009-03-01

    Effective strategies for preventing child maltreatment are needed. Few primary care-based programs have been developed, and most have not been well evaluated. Our goal was to evaluate the efficacy of the Safe Environment for Every Kid model of pediatric primary care in reducing the occurrence of child maltreatment. A randomized trial was conducted from June 2002 to November 2005 in a university-based resident continuity clinic in Baltimore, Maryland. The study population consisted of English-speaking parents of children (0-5 years) brought in for child health supervision. Of the 1118 participants approached, 729 agreed to participate, and 558 of them completed the study protocol. Resident continuity clinics were cluster randomized by day of the week to the model (intervention) or standard care (control) groups. Model care consisted of (1) residents who received special training, (2) the Parent Screening Questionnaire, and (3) a social worker. Risk factors for child maltreatment were identified and addressed by the resident physician and/or social worker. Standard care involved routine pediatric primary care. A subset of the clinic population was sampled for the evaluation. Child maltreatment was measured in 3 ways: (1) child protective services reports using state agency data; (2) medical chart documentation of possible abuse or neglect; and (3) parental report of harsh punishment via the Parent-Child Conflict Tactics scale. Model care resulted in significantly lower rates of child maltreatment in all the outcome measures: fewer child protective services reports, fewer instances of possible medical neglect documented as treatment nonadherence, fewer children with delayed immunizations, and less harsh punishment reported by parents. One-tailed testing was conducted in accordance with the study hypothesis. The Safe Environment for Every Kid (SEEK) model of pediatric primary care seems promising as a practical strategy for helping prevent child maltreatment

  5. Association of an Asthma Improvement Collaborative With Health Care Utilization in Medicaid-Insured Pediatric Patients in an Urban Community.

    Science.gov (United States)

    Kercsmar, Carolyn M; Beck, Andrew F; Sauers-Ford, Hadley; Simmons, Jeffrey; Wiener, Brandy; Crosby, Lisa; Wade-Murphy, Susan; Schoettker, Pamela J; Chundi, Pavan K; Samaan, Zeina; Mansour, Mona

    2017-11-01

    Asthma is the most common chronic condition of childhood. Hospitalizations and emergency department (ED) visits for asthma are more frequently experienced by minority children and adolescents and those with low socioeconomic status. To reduce asthma-related hospitalizations and ED visits for Medicaid-insured pediatric patients residing in Hamilton County, Ohio. From January 1, 2010, through December 31, 2015, a multidisciplinary team used quality-improvement methods and the chronic care model to conduct interventions in inpatient, outpatient, and community settings in a large, urban academic pediatric hospital in Hamilton County, Ohio. Children and adolescents aged 2 to 17 years who resided in Hamilton County, had a diagnosis of asthma, and were Medicaid insured were studied. Interventions were implemented in 3 phases: hospital-based inpatient care redesign, outpatient-based care enhancements, and community-based supports. Plan-do-study-act cycles allowed for small-scale implementation of change concepts and rapid evaluation of how such tests affected processes and outcomes of interest. The study measured asthma-related hospitalizations and ED visits per 10 000 Medicaid-insured pediatric patients. Data were measured monthly on a rolling 12-month mean basis. Data from multiple previous years were used to establish a baseline. Data were tracked with annotated control charts and with interrupted time-series analysis. Of the estimated 36 000 children and adolescents with asthma in Hamilton County (approximately 13 000 of whom are Medicaid insured and 6000 of whom are cared for in Cincinnati Children's Hospital primary care practices), asthma-related hospitalizations decreased from 8.1 (95% CI, 7.7-8.5) to 4.7 (95% CI, 4.3-5.1) per 10 000 Medicaid patients per month by June 30, 2014, a 41.8% (95% CI, 41.7%-42.0%) relative reduction. Emergency department visits decreased from 21.5 (95% CI, 20.6-22.3) to 12.4 (95% CI, 11.5-13.2) per 10 000 Medicaid patients per

  6. Integrating Behavioral Health into Pediatric Primary Care: Implications for Provider Time and Cost.

    Science.gov (United States)

    Gouge, Natasha; Polaha, Jodi; Rogers, Rachel; Harden, Amy

    2016-12-01

    Integrating a behavioral health consultant (BHC) into primary care is associated with improved patient outcomes, fewer medical visits, and increased provider satisfaction; however, few studies have evaluated the feasibility of this model from an operations perspective. Specifically, time and cost have been identified as barriers to implementation. Our study aimed to examine time spent, patient volume, and revenue generated during days when the on-site BHC was available compared with days when the consultant was not. Data were collected across a 10-day period when a BHC provided services and 10 days when she was not available. Data included time stamps of patient direct care; providers' direct reports of problems raised; and a review of medical and administrative records, including billing codes and reimbursement. This study took place in a rural, stand-alone private pediatric primary care practice. The participants were five pediatric primary care providers (PCPs; two doctors of medicine, 1 doctor of osteopathy, 2 nurse practitioners) and two supervised doctoral students in psychology (BHCs). Pediatric patients (N = 668) and their parents also participated. On days when a BHC was present, medical providers spent 2 fewer minutes on average for every patient seen, saw 42% more patients, and collected $1142 more revenue than on days when no consultant was present. The time savings demonstrated on days when the consultant was available point to the efficiency and potential financial viability of this model. These results have important implications for the feasibility of hiring behavioral health professionals in a fee-for-service system. They have equally useful implications for the utility of moving to a bundled system of care in which collaborative practice is valued.

  7. Cortisol/cortisone ratio and matrix metalloproteinase-9 activity are associated with pediatric primary hypertension.

    Science.gov (United States)

    Martinez-Aguayo, Alejandro; Campino, Carmen; Baudrand, Rene; Carvajal, Cristian A; García, Hernán; Aglony, Marlene; Bancalari, Rodrigo; García, Lorena; Loureiro, Carolina; Vecchiola, Andrea; Tapia-Castillo, Alejandra; Valdivia, Carolina; Sanhueza, Sebastian; Fuentes, Cristobal A; Lagos, Carlos F; Solari, Sandra; Allende, Fidel; Kalergis, Alexis M; Fardella, Carlos E

    2016-09-01

    To identify novel biomarkers associated with pediatric primary hypertension. We recruited 350 participants (4-16 years). Anthropometric parameters and aldosterone, plasma renin activity, cortisol, cortisone, Homeostasis Model Assessment Insulin Resistance (HOMA-IR), high-sensitivity C-reactive protein, adiponectin, IL-6, plasminogen activator inhibitor type 1 levels and matrix metalloproteinase-9 and matrix metalloproteinase-2 (MMP-9 and MMP-2) activities were measured. Genomic DNA was isolated. Patients with altered glucose metabolism, severe obesity [BMI-SD score (BMI-SDS) > 2.5], renovascular disease, primary aldosteronism and apparent mineralocorticoid excess syndrome were excluded. In selected participants (n = 320), SBP was positively correlated with BMI-SDS (r = 0.382, P cortisol/cortisone ratio (r = 0.231, P cortisol/cortisone ratio (P cortisol/cortisone ratio (OR = 3.92; 95% CI = 1.98-7.71) and increased MMP-9 activity (OR = 4.23; 95% CI = 2.15-8.32). We report that MMP-9 activity and the cortisol/cortisone ratio were higher in pediatric primary hypertensive patients, and these associations were independent of the effect of obesity. The potential role of these novel biomarkers in predicting hypertension risk and blood pressure regulation warrants further investigation.

  8. Primary treatment of pediatric plunging ranula with nonsurgical sclerotherapy using OK-432 (Picibanil).

    Science.gov (United States)

    Roh, Jong-Lyel; Kim, Hyo Sun

    2008-09-01

    Although surgery is the first choice of therapy for plunging ranula, it is associated with technical difficulties, morbidity and recurrence. Plunging ranula may be also primarily treated with nonsurgical sclerotherapy, but there is little experience in pediatric patients. We, therefore, assessed the efficacy of OK-432 sclerotherapy for pediatric plunging ranula. Nine children with plunging ranula were prospectively treated with intracystic injections of OK-432. At the outpatient clinic, the ranula was punctured in the neck and aspirated mucus was replaced with 0.1-0.2mg OK-432 solution. The size of the ranula was compared before and after sclerotherapy. Total or nearly total shrinkage was observed in 6 of 9 patients; marked reduction (>50% of original size) in 2; and partial reduction (<50% of original size) in 1. At a mean follow-up of 26 months after last sclerotherapy, recurrence was observed in only 1 patient; this patient showed complete response after reinjection of OK-432 solution. No significant complications were observed, with only fever and mild local pain observed in 4 patients for 2-4 days after treatment. OK-432 sclerotherapy is safe and effective in the treatment of pediatric plunging ranula. Sclerotherapy may become a primary treatment modality prior to surgery.

  9. Pediatric primary care providers' perspectives regarding hospital discharge communication: a mixed methods analysis.

    Science.gov (United States)

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

    2015-01-01

    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

  10. Exploring emotions and the shared decision-making process in pediatric primary care

    Directory of Open Access Journals (Sweden)

    Francesca Dicé

    2016-12-01

    Full Text Available This paper aims to identify conversational interaction patterns in pediatrics with a focus on the shared decision-making process and dialogue about emotions in doctor–patient relationships. We documented conversations in 163 visits by 168 children in pediatric primary care; we observed, audiorecordered, transcribed and analyzed them with specific instruments of analysis of doctor patient relationship. Our survey was conducted in four pediatric primary care practices and 15 health providers were involved. The data collection period lasted three months and was undertaken twice a week on days. We analyzed visits with Verona Coding Definitions of Emotional Sequences (VR-CoDES and Observing Patient Involvement in Shared Decision Making (OPTION instruments. Frequencies of emotions’ signals (cues/concerns obtained using VR-CoDES were analyzed and compared with the OPTION ratings. We documented 318 cues/concerns for parents and 167 for children. The relationship between cues/concerns and Healthcare Providers responses was strongest in dialogues between parents and pediatricians. The conversational patterns focused on the procedures of the care, with little opportunities of dialogue about emerging emotions. We also observed limited possibilities for participant involvement, especially by children, due to several difficulties integrating dialogue about emotions and concordance processes. The conversations seemed to be characterized by rarity of shared decision making or attention to the informational value of children’s emotions. It could be useful to implement psychological interventions to achieve an enrichment of the dialogue between participants, helping them to incorporate emotions into conversations and to recognize decisional competences, necessary to concordance processes.

  11. Developing a pediatric palliative care service in a large urban hospital: challenges, lessons, and successes.

    Science.gov (United States)

    Edlynn, Emily S; Derrington, Sabrina; Morgan, Helene; Murray, Jennifer; Ornelas, Beatriz; Cucchiaro, Giovanni

    2013-04-01

    We report the process of creating a new palliative care service at a large, urban children's hospital. Our aim was to provide a detailed guide to developing an inpatient consultation service, along with reporting on the challenges, lessons, and evaluation. We examined the hiring process of personnel and marketing strategies, a clinical database facilitated ongoing quality review and identified trends, and a survey project assessed provider satisfaction and how referring physicians used the palliative care service. The pilot phase of service delivery laid the groundwork for a more effective service by creating documentation templates and identifying relevant data to track growth and outcomes. It also allowed time to establish a clear delineation of team members and distinction of roles. The survey of referring physicians proved a useful evaluation starting point, but conclusions could not be generalized because of the low response rate. It may be necessary to reconsider the survey technique and to expand the sample to include patients and families. Future research is needed to measure the financial benefits of a well-staffed inpatient pediatric palliative care service.

  12. Ethiopia's urban primary health care reform: Practices, lessons, and ...

    African Journals Online (AJOL)

    Yayeh

    to assess the implementation of the pilot initiatives. ... Keywords:- Urban, health extension professionals, PHC, pilot. Background. The history of .... The FHT is divided into two sub-teams. .... helped in drawing attention to social sectors that were.

  13. Governance for Urban Health Equity: Mobilizing Demand for Primary ...

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

    Home · What we do ... New research will identify opportunities to improve health care for the urban poor and involve communities ... Addressing this governance crisis will be paramount to improving service delivery for slum residents and to ...

  14. Algorithm for Primary Full-thickness Skin Grafting in Pediatric Hand Burns

    Directory of Open Access Journals (Sweden)

    Yang Seo Park

    2012-09-01

    Full Text Available Background Pediatric hand burns are a difficult problem because they lead to serious handdeformities with functional impairment due to rapid growth during childhood. Therefore,adequate management is required beginning in the acute stage. Our study aims to establishsurgical guidelines for a primary full-thickness skin graft (FTSG in pediatric hand burns, basedon long-term observation periods and existing studies.Methods From January 2000 to May 2011, 210 patients underwent primary FTSG. Weretrospectively studied the clinical course and treatment outcomes based on the patients’medical records. The patients’ demographics, age, sex, injury site of the fingers, presence ofweb space involvement, the incidence of postoperative late deformities, and the duration ofrevision were critically analyzed.Results The mean age of the patients was 24.4 months (range, 8 to 94 months, consisting of141 males and 69 females. The overall observation period was 6.9 years (range, 1 to 11 yearson average. At the time of the burn, 56 cases were to a single finger, 73 to two fingers, 45 tothree fingers, and 22 to more than three. Among these cases, 70 were burns that included aweb space (33.3%. During the observation, 25 cases underwent corrective operations withan average period of 40.6 months.Conclusions In the volar area, primary full-thickness skin grafting can be a good indicationfor an isolated injured finger, excluding the web spaces, and injuries of less than three fingersincluding the web spaces. Also, in the dorsal area, full-thickness skin grafting can be a goodindication. However, if the donor site is insufficient and the wound is large, split-thicknessskin grafting can be considered.

  15. Algorithm for Primary Full-thickness Skin Grafting in Pediatric Hand Burns

    Directory of Open Access Journals (Sweden)

    Yang Seo Park

    2012-09-01

    Full Text Available BackgroundPediatric hand burns are a difficult problem because they lead to serious hand deformities with functional impairment due to rapid growth during childhood. Therefore, adequate management is required beginning in the acute stage. Our study aims to establish surgical guidelines for a primary full-thickness skin graft (FTSG in pediatric hand burns, based on long-term observation periods and existing studies.MethodsFrom January 2000 to May 2011, 210 patients underwent primary FTSG. We retrospectively studied the clinical course and treatment outcomes based on the patients' medical records. The patients' demographics, age, sex, injury site of the fingers, presence of web space involvement, the incidence of postoperative late deformities, and the duration of revision were critically analyzed.ResultsThe mean age of the patients was 24.4 months (range, 8 to 94 months, consisting of 141 males and 69 females. The overall observation period was 6.9 years (range, 1 to 11 years on average. At the time of the burn, 56 cases were to a single finger, 73 to two fingers, 45 to three fingers, and 22 to more than three. Among these cases, 70 were burns that included a web space (33.3%. During the observation, 25 cases underwent corrective operations with an average period of 40.6 months.ConclusionsIn the volar area, primary full-thickness skin grafting can be a good indication for an isolated injured finger, excluding the web spaces, and injuries of less than three fingers including the web spaces. Also, in the dorsal area, full-thickness skin grafting can be a good indication. However, if the donor site is insufficient and the wound is large, split-thickness skin grafting can be considered.

  16. Communication Challenges: A Qualitative Look at the Relationship Between Pediatric Hospitalists and Primary Care Providers.

    Science.gov (United States)

    Solan, Lauren G; Sherman, Susan N; DeBlasio, Dominick; Simmons, Jeffrey M

    2016-07-01

    Primary care providers (PCPs) and hospitalists endorse the importance of effective communication yet studies illustrate critical communication problems between these 2 provider types. Our objective was to develop deeper insight into the dimensions of and underlying reasons for communication issues and determine ways to improve communication and remove barriers by eliciting the perspectives of pediatric PCPs and hospitalists. Using qualitative methods, 2 sets of focus groups were held: 1) mix of local PCPs serving diverse populations, and 2) hospitalists from a free-standing, pediatric institution. The open-ended, semistructured question guides included questions about communication experiences, patient care responsibilities, and suggestions for improvement. Using inductive thematic analysis, investigators coded the transcripts, and resolved differences through consensus. Six PCP (n = 27) and 3 hospitalist (n = 15) focus groups were held. Fifty-six percent of PCPs and 14% of hospitalists had been practicing for >10 years. Five major themes were identified: problematic aspects of communication, perceptions of provider roles, push-pull, postdischarge responsibilities/care, and proposed solutions. Aspects of communication included specific problem areas with verbal and written communication. Perceptions of provider roles highlighted the issue of PCPs feeling devalued. Push-pull described conflicting expectations about a counterpart's role and responsibilities. Postdischarge responsibilities/care addressed unclear responsibilities related to patient follow-up. Proposed solutions were suggested for ways to improve communication. Deficiencies in communication hinder successful collaboration and can cause tension between providers in inpatient and outpatient settings. Understanding specific issues that contribute to poor communication like perceptions about provider roles is critical to improving relationships and facilitating combined efforts to improve patient care

  17. The clinical pattern of primary hyperoxaluria in pediatric patient at Queen Rania Abdulla Children Hospital.

    Science.gov (United States)

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

    2014-05-01

    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.

  18. Factors affecting subspecialty referrals by pediatric primary care providers for children with obesity-related comorbidities.

    Science.gov (United States)

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

    2013-08-01

    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.

  19. Who is a survivor? Perceptions from individuals who experienced pediatric cancer and their primary support persons.

    Science.gov (United States)

    Molinaro, Monica L; Fletcher, Paula C

    2018-04-01

    The purpose of this research was to examine the lived experiences of individuals who had cancer as children, as well as lived experiences of their current primary support persons. Based on van Manen's "new" interpretive phenomenology, interviews were conducted with ten pediatric cancer survivors and nine of their support persons to gain a more holistic understanding of the pediatric cancer experiences of children and their families. Four themes emerged from the data; however, only the topic of the use of the term "survivor" and identification with the term will be discussed. All participants in the study described their personal definition of the term survivor and what it meant to be a survivor. Additionally, all individuals in the study discussed the concept of being a survivor and if they would consider themselves, or their loved ones, to be "survivors." The results of this study provide health care professionals, family members, and individuals fundraising or advocating for cancer causes with insights on how the term survivor may be interpreted. This study may provide insight to individuals who had cancer as children, in showing that their personal perspective shapes their identity; although "survivor" is common cancer vernacular, individuals can choose not to identify with their illness experiences.

  20. Relationship between Teach-back and patient-centered communication in primary care pediatric encounters.

    Science.gov (United States)

    Badaczewski, Adam; Bauman, Laurie J; Blank, Arthur E; Dreyer, Benard; Abrams, Mary Ann; Stein, Ruth E K; Roter, Debra L; Hossain, Jobayer; Byck, Hal; Sharif, Iman

    2017-07-01

    We proposed and tested a theoretical framework for how use of Teach-back could influence communication during the pediatric clinical encounter. Audio-taped pediatric primary care encounters with 44 children with asthma were coded using the Roter Interaction Analysis System to measure patient-centered communication and affective engagement of the parent. A newly created Teach-back Loop Score measured the extent to which Teach-back occurred during the clinical encounter; parental health literacy was measured by Newest Vital Sign. Logistic regression was used to test the relationship between Teach-back and features of communication. Focus groups held separately with clinicians and parents elicited perceptions of Teach-back usefulness. Teach-back was used in 39% of encounters. Visits with Teach-back had more patient centered communication (p=0.01). Adjusting for parent health literacy, parent age, and child age, Teach-back increased the odds of both patient centered communication [proportional AOR (95% CI)=4.97 (4.47-5.53)]and negative affect [AOR (95% CI)=5.39 (1.68-17.31)]. Focus group themes common to clinicians and parents included: Teach-back is effective, could cause discomfort, should be used with children, and nurses should use it. Teach-back was associated with more patient-centered communication and increased affective engagement of parents. Standardizing Teach-back use may strengthen patient-centered communication. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. Brief Behavioral Therapy for Pediatric Anxiety and Depression in Primary Care: A Randomized Clinical Trial.

    Science.gov (United States)

    Weersing, V Robin; Brent, David A; Rozenman, Michelle S; Gonzalez, Araceli; Jeffreys, Megan; Dickerson, John F; Lynch, Frances L; Porta, Giovanna; Iyengar, Satish

    2017-06-01

    Anxiety and depression affect 30% of youth but are markedly undertreated compared with other mental disorders, especially in Hispanic populations. To examine whether a pediatrics-based behavioral intervention targeting anxiety and depression improves clinical outcome compared with referral to outpatient community mental health care. This 2-center randomized clinical trial with masked outcome assessment conducted between brief behavioral therapy (BBT) and assisted referral to care (ARC) studied 185 youths (aged 8.0-16.9 years) from 9 pediatric clinics in San Diego, California, and Pittsburgh, Pennsylvania, recruited from October 6, 2010, through December 5, 2014. Youths who met DSM-IV criteria for full or probable diagnoses of separation anxiety disorder, generalized anxiety disorder, social phobia, major depression, dysthymic disorder, and/or minor depression; lived with a consenting legal guardian for at least 6 months; and spoke English were included in the study. Exclusions included receipt of alternate treatment for anxiety or depression, presence of a suicidal plan, bipolar disorder, psychosis, posttraumatic stress disorder, substance dependence, current abuse, intellectual disability, or unstable serious physical illness. The BBT consisted of 8 to 12 weekly 45-minute sessions of behavioral therapy delivered in pediatric clinics by master's-level clinicians. The ARC families received personalized referrals to mental health care and check-in calls to support accessing care from master's-level coordinators. The primary outcome was clinically significant improvement on the Clinical Global Impression-Improvement scale (score ≤2). Secondary outcomes included the Pediatric Anxiety Rating Scale, Children's Depression Rating Scale-Revised, and functioning. A total of 185 patients were enrolled in the study (mean [SD] age, 11.3 [2.6] years; 107 [57.8%] female; 144 [77.8%] white; and 38 [20.7%] Hispanic). Youths in the BBT group (n = 95), compared with those in

  2. Principles of primary survey and resuscitation in cases of pediatric trauma.

    Directory of Open Access Journals (Sweden)

    Saba Jafarpour

    2015-04-01

    Full Text Available Trauma is a common cause of death and disability in children. Proper approach to pediatric trauma involves adherence to ABCDE sequence in the primary survey and resuscitation in order to promptly recognize and manage life-threatening conditions immediately. This readily reviewed sequence includes A: establishment and maintenance of a patent airway while maintaining cervical spine immobilization; B: evaluation of breathing, ventilation and oxygenation, immediate treatment of tension pneumothorax, open pneumothorax and massive hemothorax; C: evaluation and treatment of circulatory compromise and shock; D: Disability and Neurologic Status, assessment of signs of increased intracranial pressure and impending cerebral herniation; and E: Exposure while preventing hypothermia. Implementing these assessment and management priorities can result in more favorable outcomes.

  3. Principles of primary survey and resuscitation in cases of pediatric trauma.

    Directory of Open Access Journals (Sweden)

    Saba Jafarpour

    2014-12-01

    Full Text Available Trauma is a common cause of death and disability in children. Proper approach to pediatric trauma involves adherence to ABCDE sequence in the primary survey and resuscitation in order to promptly recognize and manage immediately life threatening conditions. This readily reviewed sequence includes A: establishment and maintenance of a patent airway while maintaining cervical spine immobilization; B: evaluation of breathing, ventilation and oxygenation, immediate treatment of tension pneumothorax, open pneumothorax and massive hemothorax; C: evaluation and treatment of circulatory compromise and shock; D: Disability and Neurologic Status, assessment of signs of increased intracranial pressure and impending cerebral herniation; and E: Exposure while preventing hypothermia. Implementing these assessment and management priorities can result in more favorable outcomes.

  4. Health promotion in pediatric primary care: importance of health literacy and communication practices.

    Science.gov (United States)

    Davis, Deborah Winders; Jones, V Faye; Logsdon, M Cynthia; Ryan, Lesa; Wilkerson-McMahon, Mandie

    2013-12-01

    Health literacy has been shown to predict health behaviors and outcomes above the effects of education or socioeconomic status. Much remains unknown about the health literacy of parents and the role it plays in children's health outcomes or in health disparities. The current study explored the health communication needs and health literacy indicators in a diverse sample of parents (n = 75) to identify potential areas for future interventions. The sample consisted of parents of children 18 to 36 months old who were visiting 3 different pediatric medical offices, 2 of which served low-income families and 1 located in an affluent suburb. When comparisons were made between 2 educational attainment groups, there were variations in indicators of health literacy and health communication needs. These data can be used to guide the development of interventions by primary care providers to improve parent education.

  5. Clinical study of anti-reflux surgery for pediatric patients with primary vesico-ureteral reflux

    International Nuclear Information System (INIS)

    Miyamae, Koichi; Kitani, Kosuke; Miyamoto, Kenji; Nakakuma, Kensuke; Hamada, Yasuyuki; Nagano, Koji; Kawano, Tomoyasu; Nakamura, Toshiro

    2012-01-01

    We reviewed the characteristics of 25 pediatric patients (41 ureters) with primary vesico-ureteral reflux (VUR) who underwent anti-reflux surgery. The patients comprised 14 males and 11 females. The median age at diagnosis and at operation was 5 years 3 months and 6 years 5 months, respectively. VUR grade comprised grade I, 4 cases, grade II, 3 cases, grade III, 11 cases, grade IV, 11 cases and grade V, 12 cases. We utilized the Cohen method as the anti-reflux surgery technique. VUR recurrence was detected in 1 case (2.9%) during follow-up. Moreover, there were no cases with progressive renal dysfunction or breakthrough infection. The rate of kidney with renal scar on scintigraphy before the operation was 48.9%, and the rate of kidney with renal dysfunction before the operation was 60.0%. As a result of Fisher's exact probability test, the risk factors of breakthrough infection (BTI) were high grade VUR and renal scar on scintigraphy. Based on our clinical results, our future strategy for the management of pediatric patients with primary VUR is proposed as follows. In all patients younger than 1 year old, antibacterial prophylaxis should be applied. For patients younger than 6 years old, the initial treatment should be antibacterial prophylaxis, but for patients with VUR of grade III or more, in cases of breakthrough infection or in cases with progressive renal dysfunction, surgical treatment should be considered. For patients older than 6 years with VUR of grade III or more, surgical treatment is strongly recommended. (author)

  6. [Prevalence of neurodevelopmental, behavioural and learning disorders in Pediatric Primary Care].

    Science.gov (United States)

    Carballal Mariño, Marta; Gago Ageitos, Ana; Ares Alvarez, Josefa; Del Rio Garma, Mercedes; García Cendón, Clara; Goicoechea Castaño, Ana; Pena Nieto, Josefina

    2017-11-20

    To determine the prevalence of psychiatric disorders in primary care pediatrics in Atlantic Galicia. An observational, descriptive, cross-sectional prevalence study was carried out in 9 outpatient clinics in A Coruña and Pontevedra with a population of 8293 children between September and November 2015. A total of 1286 randomly selected patients from 0 to 14 years of age were included. From the medical history was registered: age, sex, psychiatric diagnosis established by DSM-IV-TR criteria in its five axes, professionals who participated in the diagnosis and treatment of the process and what type of treatment was received. Authorization was obtained from the Research Ethics Committee of Galicia number 2015/427. 148 of 1286 patients presented psychiatric pathology (11,5% IC 95% 9.73-13,29), 68% male. Between 0 and 5years, the prevalence was 4.5%; between 6y and 10y, 18.5% and between 11y and 14y 22%. Symptoms lasted a median of 25 months. The most frequent pathologies in 1286 patients were ADHD (5.36%), language disorders (3.42%), learning disorders (3.26%), anxiety-depressive disorders (2.4%) and behavior disorders (1.87%). Of the 148 cases, 47% had comorbidity with another mental disorder. Most of them required attention by multiple social, health and educational professionals; 33% received psychopharmacological treatment. The prevalence of psychiatric disorders in pediatric primary care is frequent, chronic and complex, increases with age and requires many health, educational and social resources. Copyright © 2017. Publicado por Elsevier España, S.L.U.

  7. Comparative effectiveness of childhood obesity interventions in pediatric primary care: a cluster-randomized clinical trial.

    Science.gov (United States)

    Taveras, Elsie M; Marshall, Richard; Kleinman, Ken P; Gillman, Matthew W; Hacker, Karen; Horan, Christine M; Smith, Renata L; Price, Sarah; Sharifi, Mona; Rifas-Shiman, Sheryl L; Simon, Steven R

    2015-06-01

    Evidence of effective treatment of childhood obesity in primary care settings is limited. To examine the extent to which computerized clinical decision support (CDS) delivered to pediatric clinicians at the point of care of obese children, with or without individualized family coaching, improved body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) and quality of care. We conducted a cluster-randomized, 3-arm clinical trial. We enrolled 549 children aged 6 to 12 years with a BMI at the 95% percentile or higher from 14 primary care practices in Massachusetts from October 1, 2011, through June 30, 2012. Patients were followed up for 1 year (last follow-up, August 30, 2013). In intent-to-treat analyses, we used linear mixed-effects models to account for clustering by practice and within each person. In 5 practices randomized to CDS, pediatric clinicians received decision support on obesity management, and patients and their families received an intervention for self-guided behavior change. In 5 practices randomized to CDS + coaching, decision support was augmented by individualized family coaching. The remaining 4 practices were randomized to usual care. Smaller age-associated change in BMI and the Healthcare Effectiveness Data and Information Set (HEDIS) performance measures for obesity during the 1-year follow-up. At baseline, mean (SD) patient age and BMI were 9.8 (1.9) years and 25.8 (4.3), respectively. At 1 year, we obtained BMI from 518 children (94.4%) and HEDIS measures from 491 visits (89.4%). The 3 randomization arms had different effects on BMI over time (P = .04). Compared with the usual care arm, BMI increased less in children in the CDS arm during 1 year (-0.51 [95% CI, -0.91 to -0.11]). The CDS + coaching arm had a smaller magnitude of effect (-0.34 [95% CI, -0.75 to 0.07]). We found substantially greater achievement of childhood obesity HEDIS measures in the CDS arm (adjusted odds ratio, 2.28 [95% CI, 1

  8. How can primary care providers manage pediatric obesity in the real world?

    Science.gov (United States)

    Hopkins, Kristy F; Decristofaro, Claire; Elliott, Lydia

    2011-06-01

    To provide information regarding evidence-based interventions and clinical practice guidelines as a basis for a clinical toolkit utilizing a step management approach for the primary care provider in managing childhood obesity. Evidence-based literature including original clinical trials, literature reviews, and clinical practice guidelines. Interventions can be stratified based on initial screening of children and adolescents so that selection of treatment options is optimized. For all treatments, lifestyle modifications include attention to diet and activity level. Levels of initial success, as well as maintenance of target body mass index, may be related to the intensity and duration of interventions; involvement of family may increase success rates. For failed lifestyle interventions, or for patients with extreme obesity and/or certain comorbidities, pharmacologic or surgical options should be considered. Many intensive programs have shown success, but the resources required for these approaches may be unavailable to the typical community provider and family. However, using current guidelines, the primary care provider can initiate and manage ongoing interventions in pediatric obesity. A toolkit for primary care implementation and maintenance interventions is provided. ©2011 The Author(s) Journal compilation ©2011 American Academy of Nurse Practitioners.

  9. 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.

  10. Restricting youth suicide: behavioral health patients in an urban pediatric emergency department.

    Science.gov (United States)

    Rogers, Steven C; DiVietro, Susan; Borrup, Kevin; Brinkley, Ashika; Kaminer, Yifrah; Lapidus, Garry

    2014-09-01

    Suicide is the third leading cause of death among individuals age 10 years to 19 years in the United States. Adolescents with suicidal behaviors are often cared for in emergency departments (EDs)/trauma centers and are at an increased risk for subsequent suicide. Many institutions do not have standard procedures to prevent future self-harm. Lethal means restriction (LMR) counseling is an evidence-based suicide prevention strategy that informs families to restrict access to potentially fatal items and has demonstrated efficacy in preventing suicide. The objectives of this study were to examine suicidal behavior among behavioral health patients in a pediatric ED and to assess the use of LMR by hospital staff. A sample of 298 pediatric patients was randomly selected from the population of behavioral health patients treated at the ED from January 1 through December 31, 2012 (n = 2,294). Descriptive data include demographics (age, sex, race/ethnicity, etc,), chief complaint, current and past psychiatric history, primary diagnosis, disposition, alcohol/drug abuse, and documentation of any LMR counseling provided in the ED. Of the 298 patients, 52% were female, 47% were white, and 76% were in the custody of their parents. Behavior/out of control was the most common chief complaint (43%). The most common diagnoses were mood disorder (25%) and depression (20%). Thirty-four percent of the patients had suicidal ideation, 22% had a suicide plan, 32% had documented suicidal behavior, and 25% of the patients reported having access to lethal means. However, only 4% of the total patient population received any LMR counseling, and only 15% of those with access to lethal means had received LMR counseling. Providing a safe environment for adolescents at risk for suicidal behaviors should be a priority for all families/caretakers and should be encouraged by health care providers. The ED is a key point of entry into services for suicidal youth and presents an opportunity to implement

  11. Identification, Prevention, and Management of Childhood Overweight and Obesity in a Pediatric Primary Care Center.

    Science.gov (United States)

    Reed, Monique; Cygan, Heide; Lui, Karen; Mullen, Mary

    2016-08-01

    Background In the United States, overweight/obesity among youth has reached epidemic proportions. The purpose of this project was to (1) examine primary care provider adherence to American Academy of Pediatrics guidelines; (2) compare adherence based on patients' weight classification, age, race, and gender; and (3) identify areas for improvement in health care delivery. Methods A retrospective chart audit and feedback quality improvement project was conducted with a stratified random sample of 175 charts of 6- to 19-year-olds seen for well-child visits. Frequencies of provider adherence were reported. χ(2) Analyses of weight classification, age, race, or gender influence on adherence was calculated. Results After discussion with the primary care providers, 5 areas were identified as priorities for change (diagnosis based on BMI, parental history of obesity, sleep assessment, endocrine assessment, and attendance of patients at the follow-up visit). Conclusion Cost-efficient, feasible strategies to improve provider adherence to recommendations for identification, prevention and management of childhood overweight and obesity were identified. © The Author(s) 2015.

  12. Forging a pediatric primary care-community partnership to support food-insecure families.

    Science.gov (United States)

    Beck, Andrew F; Henize, Adrienne W; Kahn, Robert S; Reiber, Kurt L; Young, John J; Klein, Melissa D

    2014-08-01

    Academic primary care clinics often care for children from underserved populations affected by food insecurity. Clinical-community collaborations could help mitigate such risk. We sought to design, implement, refine, and evaluate Keeping Infants Nourished and Developing (KIND), a collaborative intervention focused on food-insecure families with infants. Pediatricians and community collaborators codeveloped processes to link food-insecure families with infants to supplementary infant formula, educational materials, and clinic and community resources. Intervention evaluation was done prospectively by using time-series analysis and descriptive statistics to characterize and enumerate those served by KIND during its first 2 years. Analyses assessed demographic, clinical, and social risk outcomes, including completion of preventive services and referral to social work or our medical-legal partnership. Comparisons were made between those receiving and not receiving KIND by using χ2 statistics. During the 2-year study period, 1042 families with infants received KIND. Recipients were more likely than nonrecipients to have completed a lead test and developmental screen (both P < .001), and they were more likely to have received a full set of well-infant visits by 14 months (42.0% vs. 28.7%; P < .0001). Those receiving KIND also were significantly more likely to have been referred to social work (29.2% vs. 17.6%; P < .0001) or the medical-legal partnership (14.8% vs. 5.7%; P < .0001). Weight-for-length at 9 months did not statistically differ between groups. A clinical-community collaborative enabled pediatric providers to address influential social determinants of health. This food insecurity-focused intervention was associated with improved preventive care outcomes for the infants served. Copyright © 2014 by the American Academy of Pediatrics.

  13. Primary pulmonary tuberculosis in infancy: A resurgent disease in the urban United States

    International Nuclear Information System (INIS)

    Amodio, J.; Abramson, S.; Berdon, W.

    1986-01-01

    Primary pulmonary tuberculosis in infancy still exists in the urban United States, reflecting new immigrations from less developed areas. The clinical diagnosis may be difficult and routine chest radiographs may be confusing. We found magnification high KV filtered radiography to be very useful in delineating the primary complex and its effect on the tracheobronchial tree. Twelve infants and small children with primary pulmonary tuberculosis were seen in the years 1978-1984. (orig.)

  14. Impact of audit and feedback and pay-for-performance interventions on pediatric hospitalist discharge communication with primary care providers.

    Science.gov (United States)

    Tejedor-Sojo, Javier; Creek, Tracy; Leong, Traci

    2015-01-01

    The study team sought to improve hospitalist communication with primary care providers (PCPs) at discharge through interventions consisting of (a) audit and feedback and (b) inclusion of a discharge communication measure in the incentive compensation for pediatric hospitalists. The setting was a 16-physician pediatric hospitalist group within a tertiary pediatric hospital. Discharge summaries were selected randomly for documentation of communication with PCPs. At baseline, 57% of charts had documented communication with PCPs, increasing to 84% during the audit and feedback period. Following the addition of a financial incentive, documentation of communication with PCPs increased to 93% and was sustained during the combined intervention period. The number of physicians meeting the study's performance goal increased from 1 to 14 by the end of the study period. A financial incentive coupled with an audit and feedback tool was effective at modifying physician behavior, achieving focused, measurable quality improvement gains. © 2014 by the American College of Medical Quality.

  15. Assessing the impact of urbanization on regional net primary productivity in Jiangyin County, China.

    Science.gov (United States)

    Xu, C; Liu, M; An, S; Chen, J M; Yan, P

    2007-11-01

    Urbanization is one of the most important aspects of global change. The process of urbanization has a significant impact on the terrestrial ecosystem carbon cycle. The Yangtze Delta region has one of the highest rates of urbanization in China. In this study, carried out in Jiangyin County as a representative region within the Yangtze Delta, land use and land cover changes were estimated using Landsat TM and ETM+ imagery. With these satellite data and the BEPS process model (Boreal Ecosystem Productivity Simulator), the impacts of urbanization on regional net primary productivity (NPP) and annual net primary production were assessed for 1991 and 2002. Landsat-based land cover maps in 1991 and 2002 showed that urban development encroached large areas of cropland and forest. Expansion of residential areas and reduction of vegetated areas were the major forms of land transformation in Jiangyin County during this period. Mean NPP of the total area decreased from 818 to 699 gCm(-2)yr(-1) during the period of 1991 to 2002. NPP of cropland was only reduced by 2.7% while forest NPP was reduced by 9.3%. Regional annual primary production decreased from 808 GgC in 1991 to 691 GgC in 2002, a reduction of 14.5%. Land cover changes reduced regional NPP directly, and the increasing intensity and frequency of human-induced disturbance in the urbanized areas could be the main reason for the decrease in forest NPP.

  16. Differences between rural and urban primary care units in Turkey: Implications on residents′ training

    Directory of Open Access Journals (Sweden)

    Hulya Yikilkan

    2013-01-01

    Full Text Available Context: Family practice training takes place at primary care based training centers linked to Education and Research State Hospitals in Turkey. There is a discussion if these units are adequate to train primary care staff and if the patients of these units reflect the applicants of primary care. Aims: The aim of our study is to investigate the demographic characteristics, the effect of distance on primary care utilization, and most common diagnosis of the patients who applied to two different outpatient clinics: One urban and one rural. Settings and Design: Study was conducted from the electronic health records of the patients applied to outpatient clinics of Ankara Diskapi Yildirim Beyazit Training and Research Hospital Department of Family Medicine between 1 January and 31 December 2009. Results: Total number of patients applied to both of the outpatient clinics was 34,632 [urban clinic: 16.506 (47.7%, rural clinic: 18.126 (52.3%]. Leading three diagnoses were upper respiratory tract infection (URTI, general medical examination (GME, and hypertension (HT in the most common 10 diagnosis. Conclusion: In our study, the rural outpatient clinic is regarded as a primary care unit in the neighborhood of living area and the urban clinic as close to working environment. We found statistically meaningful differences in most common diagnosis, gender, age, and consultation time between the rural and urban clinics. According to our results, family practitioners′ field training should take place at different primary care units according to sociodemographic characteristics of each country.

  17. HPV vaccine decision making in pediatric primary care: a semi-structured interview study

    Directory of Open Access Journals (Sweden)

    Feemster Kristen A

    2011-08-01

    Full Text Available Abstract Background Despite national recommendations, as of 2009 human papillomavirus (HPV vaccination rates were low with Methods Between March and June, 2010, we conducted qualitative interviews with 20 adolescent-mother-clinician triads (60 individual interviews directly after a preventive visit with the initial HPV vaccine due. Interviews followed a guide based on published HPV literature, involved 9 practices, and continued until saturation of the primary themes was achieved. Purposive sampling balanced adolescent ages and practice type (urban resident teaching versus non-teaching. Using a modified grounded theory approach, we analyzed data with NVivo8 software both within and across triads to generate primary themes. Results The study population was comprised of 20 mothers (12 Black, 9 Conclusions Programs to improve HPV vaccine delivery in primary care should focus on promoting effective parent-clinician communication. Research is needed to evaluate strategies to help clinicians engage reluctant parents and passive teens in discussion and measure the impact of distinct clinician decision making approaches on HPV vaccine delivery.

  18. Role of the pediatric nurse practitioner in promoting breastfeeding for late preterm infants in primary care settings.

    Science.gov (United States)

    Ahmed, Azza H

    2010-01-01

    The preterm birth rate has been increasing steadily during the past two decades. Up to two thirds of this increase has been attributed to the increasing rate of late preterm births (34 to stamina; difficulty with latch, suck, and swallow; temperature instability; increased vulnerability to infection; hyperbilirubinemia, and more respiratory problems than the full-term infant. Late preterm infants usually are treated as full term and discharged within 48 hours of birth, so pediatric nurse practitioners in primary care settings play a critical role in promoting breastfeeding through early assessment and detection of breastfeeding difficulties and by providing anticipatory guidance related to breastfeeding and follow-up. The purpose of this article is to describe the developmental and physiologic immaturity of late preterm infants and to highlight the role of pediatric nurse practitioners in primary care settings in supporting and promoting breastfeeding for late preterm infants.

  19. "What about FH of my child?" parents' opinion on family history collection in preventive primary pediatric care.

    Science.gov (United States)

    Syurina, Elena V; Gerritsen, Anne-Marie Jm; Hens, Kristien; Feron, Frans Jm

    2015-08-01

    Family history (FH) in Preventive Primary Pediatric Care is to identify children at risk for complex diseases and provide personal preventive strategies. This study was to assess parents' opinion on FH collection. Semi-structured interviews were conducted. Among issues addressed were: former experiences with FH, knowledge about FH, family definition and sharing information about FH. The importance of FH for participants depended on their knowledge, perceived family health status and former experiences. After insight into FH, parents shift to believing it to be important, but certain barriers exist in reporting FH. Parents suggest that the importance of FH should be more emphasized and more trusting relationship with Preventive Primary Pediatric Care should be invested in.

  20. Job satisfaction: rural versus urban primary health care workers' perception in Ogun State of Nigeria.

    Science.gov (United States)

    Campbell, P C; Ebuehi, O M

    2011-01-01

    Job satisfaction implies doing a job one enjoys, doing it well, and being suitably rewarded for one' efforts. Several factors affect job satisfaction. To compare factors influencing job satisfaction amongst rural and urban primary health care workers in southwestern Nigeria. A cross sectional comparative study recruited qualified health workers selected by multi stage sampling technique from rural and urban health facilities in four local government areas (LGAs) of Ogun State in Southwestern Nigeria. Data were collected and analysed using Epi info V 3.5.1 RESULTS: The response rates were 88(88%) and 91(91%) respectively in the rural and urban areas. While urban workers derived satisfaction from availability of career development opportunities, materials and equipment, in their current job, rural workers derived satisfaction from community recognition of their work and improved staff relationship. Major de-motivating factors common to both groups were lack of supportive supervision, client-provider relationship and lack of in-service training. However more rural 74(84.1%) than urban 62(68.1%) health workers would prefer to continue working in their present health facilities (p=0.04). There was a statistically significant difference between the two groups in job satisfaction with respect to tools availability and career development opportunities (pfactors influencing job satisfaction between rural and urban healthcare workers. There is need for human resource policy to be responsive to the diverse needs of health workers particularly at the primary level.

  1. Decreasing Net Primary Productivity in Response to Urbanization in Liaoning Province, China

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    Tan Chen

    2017-01-01

    Full Text Available Regional ecosystems have been greatly affected by the rapid expansion of urban areas. In order to explore the impact of land use change on net primary productivity (NPP in rapidly developing cities during the current urbanization process, we quantified land use change in Liaoning province between 2000 and 2010 using net primary productivity as an indicator of ecosystem productivity and health. The Carnegie–Ames–Stanford Approach model was used to estimate NPP by region and land use. We used a unit circle-based evaluation model to quantify local urbanization effects on NPP around eight representative cities. The dominant land use types were farmland, woodland and urban, with urban rapidly replacing farmland. Mean annual NPP and total NPP decreased faster from 2005 to 2010 than from 2000 to 2005, reflecting increasing urbanization rates. The eastern, primarily woodland part of Liaoning province had the greatest reduction in NPP, while the western part, which was primarily farmland and grassland, had the lowest reduction.

  2. Linking primary production, climate and land use along an urban-wildland transect: a satellite view

    International Nuclear Information System (INIS)

    Hu Yonghong; Jia Gensuo; Guo Huadong

    2009-01-01

    Variation of green vegetation cover influences local climate dynamics, exchange of water-heat between land and atmosphere, and hydrological processes. However, the mechanism of interaction between vegetation and local climate change in subtropical areas under climate warming and anthropogenic disturbances is poorly understood. We analyzed spatial-temporal trends of vegetation with moderate-resolution imaging spectroradiometer (MODIS) vegetation index datasets over three sections, namely urban, urban-rural fringe and wildland along an urban-wildland transect in a southern mega-city area in China from 2000-2008. The results show increased photosynthetic activity occurred in the wildland and the stable urban landscape in correspondence to the rising temperature, and a considerable decrease of vegetation activity in the urban-rural fringe area, apparently due to urban expansion. On analyzing the controlling factors of climate change and human drivers of vegetation cover change, we found that temperature contributed to vegetation growth more than precipitation and that rising temperature accelerated plant physiological activity. Meanwhile, human-induced dramatic modification of land cover, e.g. conversion of natural forest and cropland to built-up areas in the urban-rural fringe, has caused significant changes of green vegetation fraction and overall primary production, which may further influence local climate.

  3. Greek Primary School Children's Representations of the Urban Environment as Seen through Their Drawings

    Science.gov (United States)

    Stokas, Dimitrios; Strezou, Elena; Malandrakis, George; Papadopoulou, Penelope

    2017-01-01

    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…

  4. Culturally Relevant Literature: What Matters Most to Primary-Age Urban Learners

    Science.gov (United States)

    Cartledge, Gwendolyn; Keesey, Susan; Bennett, Jessica G.; Ramnath, Rajiv; Council, Morris R., III.

    2016-01-01

    The ratings and rationales primary-age urban learners gave culturally relevant reading passages was the focus of this descriptive study. First- and second-grade students each read 30 researcher-developed passages reflecting the students' immediate and historical backgrounds. The students rated the passages and gave a reason for their ratings. A…

  5. Identification of the sources of primary organic aerosols at urban schools: A molecular marker approach

    International Nuclear Information System (INIS)

    Crilley, Leigh R.; Qadir, Raeed M.; Ayoko, Godwin A.; Schnelle-Kreis, Jürgen; Abbaszade, Gülcin; Orasche, Jürgen; Zimmermann, Ralf; Morawska, Lidia

    2014-01-01

    Children are particularly susceptible to air pollution and schools are examples of urban microenvironments that can account for a large portion of children's exposure to airborne particles. Thus this paper aimed to determine the sources of primary airborne particles that children are exposed to at school by analyzing selected organic molecular markers at 11 urban schools in Brisbane, Australia. Positive matrix factorization analysis identified four sources at the schools: vehicle emissions, biomass burning, meat cooking and plant wax emissions accounting for 45%, 29%, 16% and 7%, of the organic carbon respectively. Biomass burning peaked in winter due to prescribed burning of bushland around Brisbane. Overall, the results indicated that both local (traffic) and regional (biomass burning) sources of primary organic aerosols influence the levels of ambient particles that children are exposed at the schools. These results have implications for potential control strategies for mitigating exposure at schools. - Highlights: • Selected organic molecular markers at 11 urban schools were analyzed. • Four sources of primary organic aerosols were identified by PMF at the schools. • Both local and regional sources were found to influence exposure at the schools. • The results have implications for mitigation of children's exposure at schools. - The identification of the most important sources of primary organic aerosols at urban schools has implications for control strategies for mitigating children's exposure at schools

  6. Transformation of a Pediatric Primary Care Waiting Room: Creating a Bridge to Community Resources.

    Science.gov (United States)

    Henize, Adrienne W; Beck, Andrew F; Klein, Melissa D; Morehous, John; Kahn, Robert S

    2018-06-01

    Introduction Children and families living in poverty frequently encounter social risks that significantly affect their health and well-being. Physicians' near universal access to at-risk children and their parents presents opportunities to address social risks, but time constraints frequently interfere. We sought to redesign our waiting room to create a clinic-to-community bridge and evaluate the impact of that redesign on family-centered outcomes. Methods We conducted a pre-post study of a waiting room redesign at a large, academic pediatric primary care center. Design experts sought input about an optimal waiting room from families, community partners and medical providers. Family caregivers were surveyed before and after redesign regarding perceived availability of help with social needs and access to community resources, and hospitality and feelings of stress. Pre-post differences were assessed using the Chi square or Wilcoxon rank sum test. Results The key redesign concepts that emerged included linkages to community organizations, a welcoming environment, and positive distractions for children. A total of 313 caregiver surveys were completed (pre-160; post-153). Compared to pre-redesign, caregivers surveyed post-redesign were significantly more likely to perceive the waiting room as a place to obtain help connecting to community resources and find information about clinical and educational resources (both p < 0.05). Families were also significantly more likely to report the waiting room as more welcoming and relaxing, with sufficient privacy and space (all p < 0.05). Discussion Waiting rooms, typically a place of wasted time and space, can be redesigned to enhance families' engagement and connection to community resources.

  7. Differential effectiveness of depression disease management for rural and urban primary care patients.

    Science.gov (United States)

    Adams, Scott J; Xu, Stanley; Dong, Fran; Fortney, John; Rost, Kathryn

    2006-01-01

    Federally qualified health centers across the country are adopting depression disease management programs following federally mandated training; however, little is known about the relative effectiveness of depression disease management in rural versus urban patient populations. To explore whether a depression disease management program has a comparable impact on clinical outcomes over 2 years in patients treated in rural and urban primary care practices and whether the impact is mediated by receiving evidence-based care (antidepressant medication and specialty care counseling). A preplanned secondary analysis was conducted in a consecutively sampled cohort of 479 depressed primary care patients recruited from 12 practices in 10 states across the country participating in the Quality Enhancement for Strategic Teaming study. Depression disease management improved the mental health status of urban patients over 18 months but not rural patients. Effects were not mediated by antidepressant medication or specialty care counseling in urban or rural patients. Depression disease management appears to improve clinical outcomes in urban but not rural patients. Because these programs compete for scarce resources, health care organizations interested in delivering depression disease management to rural populations need to advocate for programs whose clinical effectiveness has been demonstrated for rural residents.

  8. Epidemiology of Hymenolepis nana infections in primary school children in urban and rural communities in Zimbabwe.

    Science.gov (United States)

    Mason, P R; Patterson, B A

    1994-04-01

    Fecal specimens were obtained on 3 occasions at 10-12 wk intervals from 315 children in 3 rural villages in Zimbabwe and from 351 children in the high-density suburbs of an adjacent small town. Specimens were examined qualitatively and quantitatively for eggs of Hymenolepis nana, and these were found in 142 (21%) children. Infections occurred more frequently in younger children in the urban area but in older children in rural areas. The prevalence in urban areas (24%) was higher than in rural areas (18%), and in urban areas infection correlated with low "hygiene scores" (determined by observation) and with the presence in the household of an infected sibling. The prevalence of infection in the 3 rural communities did not correlate with availability of water, number of households per toilet, with low "hygiene scores," or with the presence of an infected sibling. Treatment with a single oral dose of 15 mg/kg praziquantel cured 84% of the infected children. New or reinfections occurred more frequently in households that had an infected sibling in an urban but not rural setting. The study demonstrates distinct differences in the transmission of H. nana infection in rural and urban communities. The data suggest intrafamily transmission in urban areas, particularly in households with poor hygiene behavior, leading to primary infection early in life. In rural areas, the prevalence of infection and the incidence of reinfection were highest in children of school age, and there was little evidence for intrafamily transmission of the parasite.

  9. Changing pattern and outcome of pediatric chest injuries in urban Syria.

    Science.gov (United States)

    Darwish, Bassam; Mahfouz, Mohammad Z; Al-Nosairat, Saeed; Izzat, Mohammad Bashar

    2018-01-01

    Background Pediatric chest injuries were infrequent in our practice, but the outbreak of the Syrian crisis resulted in an increase in number and a change in the pattern of thoracic trauma incidents. We compared our experience of pediatric chest injuries before and during the crisis. Methods We reviewed the records of 256 children aged 12.8 ± 5 years who were admitted to our hospital with the diagnosis of chest trauma over a 12-year period. Collected data included mechanism of injury, associated injuries, method of management, length of hospital stay, complications, and mortality. Results The incidence of pediatric chest injuries increased significantly following the outbreak of the crisis, and penetrating injuries prevailed, mainly due to shrapnel, bullets, and stab wounds. Forty percent of patients with blunt injuries and 20% of those with penetrating injuries were managed conservatively, whereas urgent thoracotomies were indicated in 10%, mostly in patients with penetrating injuries. Associated injuries were more frequent in patients with blunt injuries and resulted in a longer hospital stay and an increased mortality rate. The overall mortality rate was 7.8% and it was higher in children younger than 7 years of age and in patients who had been subjected to blunt injuries. Conclusions There has been a recent substantial upsurge in the incidence of pediatric thoracic trauma, with a predominance of penetrating injuries. Most patients could be managed nonoperatively, but a small subset required an open thoracotomy. The presence of associated injuries constitutes the main determinant of prognosis in this group of patients.

  10. Using mHealth technologies to improve the identification of behavioral health problems in urban primary care settings

    OpenAIRE

    Staeheli, Martha; Aseltine, Robert H; Schilling, Elizabeth; Anderson, Daren; Gould, Bruce

    2017-01-01

    Introduction: Behavioral health disorders remain under recognized and under diagnosed among urban primary care patients. Screening patients for such problems is widely recommended, yet is challenging to do in a brief primary care encounter, particularly for this socially and medically complex patient population. Methods: In 2013, intervention patients at an urban Connecticut primary clinic were screened for post-traumatic stress disorder, depression, and risky drinking (n?=?146) using an elec...

  11. Why Wait? Early Determinants of School Dropout in Preventive Pediatric Primary Care.

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    Marie-José Theunissen

    Full Text Available To answer the question of what bio-psychosocial determinants in infancy, early and middle childhood, and adolescence predict school drop-out in young adulthood, we approached the complex process towards school dropout as a multidimensional, life-course phenomenon. The aim is to find signs of heightened risks of school dropout as early as possible which will eventually help public health workers in reducing these risks.In a case-control design, we used data from both the Preventive Pediatric Primary Care (PPPC files (that contain information from birth onwards and additional questionnaires filled out by 529 youngsters, aged 18-23 years, and living in the South-east of the Netherlands. We first conducted univariate logistic regression analyses with school-dropout as the dependent variable. Backward and forward stepwise analyses with the significant variables were done with variables pertaining to the 0 to 4 year period. Remaining significant variables were forced into the next model and subsequently variables pertaining to respectively the 4 to 8, 8 to 12 and 12 to 16 year period were introduced in a stepwise analysis. All analyses were cross-validated in an exploratory and confirmatory random half of the sample.One parent families and families with a non-Western background less often attended the health examinations of the PPPC and such less attendance was related to school dropout. The birth of a sibling (OR 0.63, 95% CI 0.43-0.93 in infancy and self-efficacy (OR 0.53, 95% CI 0.38-0.74 in adolescence decreased the odds of school dropout; externalizing behavior (OR 2.81, 95% CI 1.53-5.14 in middle childhood and (sickness absence (OR 5.62, 95% CI 2.18-14.52 in adolescence increased the risks.To prevent school dropout, PPPC professionals should not wait until imminent dropout, but should identify and tackle risk factors as early as possible and actively approach youngsters who withdraw from public health care.

  12. Why Wait? Early Determinants of School Dropout in Preventive Pediatric Primary Care

    Science.gov (United States)

    Theunissen, Marie-José; Bosma, Hans; Verdonk, Petra; Feron, Frans

    2015-01-01

    Background To answer the question of what bio-psychosocial determinants in infancy, early and middle childhood, and adolescence predict school drop-out in young adulthood, we approached the complex process towards school dropout as a multidimensional, life-course phenomenon. The aim is to find signs of heightened risks of school dropout as early as possible which will eventually help public health workers in reducing these risks. Methods In a case-control design, we used data from both the Preventive Pediatric Primary Care (PPPC) files (that contain information from birth onwards) and additional questionnaires filled out by 529 youngsters, aged 18–23 years, and living in the South-east of the Netherlands. We first conducted univariate logistic regression analyses with school-dropout as the dependent variable. Backward and forward stepwise analyses with the significant variables were done with variables pertaining to the 0 to 4 year period. Remaining significant variables were forced into the next model and subsequently variables pertaining to respectively the 4 to 8, 8 to 12 and 12 to 16 year period were introduced in a stepwise analysis. All analyses were cross-validated in an exploratory and confirmatory random half of the sample. Results One parent families and families with a non-Western background less often attended the health examinations of the PPPC and such less attendance was related to school dropout. The birth of a sibling (OR 0.63, 95% CI 0.43–0.93) in infancy and self-efficacy (OR 0.53, 95% CI 0.38–0.74) in adolescence decreased the odds of school dropout; externalizing behavior (OR 2.81, 95% CI 1.53–5.14) in middle childhood and (sickness) absence (OR 5.62, 95% CI 2.18–14.52) in adolescence increased the risks. Conclusion To prevent school dropout, PPPC professionals should not wait until imminent dropout, but should identify and tackle risk factors as early as possible and actively approach youngsters who withdraw from public health care

  13. Why Wait? Early Determinants of School Dropout in Preventive Pediatric Primary Care.

    Science.gov (United States)

    Theunissen, Marie-José; Bosma, Hans; Verdonk, Petra; Feron, Frans

    2015-01-01

    To answer the question of what bio-psychosocial determinants in infancy, early and middle childhood, and adolescence predict school drop-out in young adulthood, we approached the complex process towards school dropout as a multidimensional, life-course phenomenon. The aim is to find signs of heightened risks of school dropout as early as possible which will eventually help public health workers in reducing these risks. In a case-control design, we used data from both the Preventive Pediatric Primary Care (PPPC) files (that contain information from birth onwards) and additional questionnaires filled out by 529 youngsters, aged 18-23 years, and living in the South-east of the Netherlands. We first conducted univariate logistic regression analyses with school-dropout as the dependent variable. Backward and forward stepwise analyses with the significant variables were done with variables pertaining to the 0 to 4 year period. Remaining significant variables were forced into the next model and subsequently variables pertaining to respectively the 4 to 8, 8 to 12 and 12 to 16 year period were introduced in a stepwise analysis. All analyses were cross-validated in an exploratory and confirmatory random half of the sample. One parent families and families with a non-Western background less often attended the health examinations of the PPPC and such less attendance was related to school dropout. The birth of a sibling (OR 0.63, 95% CI 0.43-0.93) in infancy and self-efficacy (OR 0.53, 95% CI 0.38-0.74) in adolescence decreased the odds of school dropout; externalizing behavior (OR 2.81, 95% CI 1.53-5.14) in middle childhood and (sickness) absence (OR 5.62, 95% CI 2.18-14.52) in adolescence increased the risks. To prevent school dropout, PPPC professionals should not wait until imminent dropout, but should identify and tackle risk factors as early as possible and actively approach youngsters who withdraw from public health care.

  14. Correlates of late-life major depression: a comparison of urban and rural primary care patients.

    Science.gov (United States)

    Friedman, Bruce; Conwell, Yeates; Delavan, Rachel L

    2007-01-01

    The objective of this study was to determine whether factors associated with depression differ between elderly residents of rural and urban areas. The research design was cross-sectional and observational. The study subjects consisted of 926 Medicare primary care patients (650 urban and 276 rural) who were age 65+ and cognitively intact and had enrolled in a randomized, controlled Medicare demonstration. Major depression was identified by the Mini International Neuropsychiatric Interview. A logistic regression model was estimated that included a rural-urban indicator variable, additional independent variables, and interaction terms between the rural-urban indicator and independent variables that were significant at p Reporting 0-1 close friends (odds ratio [OR]: 6.86; 95% confidence interval [CI]: 2.18-21.58), 2+ emergency room visits during the past 6 months (OR: 4.00; 95% CI: 1.19-13.43), and more financial strain (OR: 1.50; 95% CI: 1.01-2.23) were associated with significantly higher likelihood of major depression among rural as compared with urban patients. The SF-36 Physical Component Summary score had a curvilinear relationship with major depression and was higher for urban patients. The predicted probability for major depression is lower for the rural patients when financial strain is low, about the same for rural and urban patients when strain is intermediate, and higher for rural patients when strain is high. Clinicians in rural areas should be vigilant for major depression among patients with very few close friends, several recent emergency department visits, and financial strain.

  15. Social work in a pediatric primary health care team in a group practice program.

    Science.gov (United States)

    Coleman, J V; Lebowitz, M L; Anderson, F P

    1976-01-01

    The inclusion of a psychiatric social worker as a member of a pediatric team in a prepaid group practice extends the range of pediatric mental health services to children. This paper discusses the collaboration of the social worker with the pediatricians and allied health personnel on the team in dealing with the emotional problems of referred children and their parents. Case examples are included. All cases seen by the social worker during a 6-month period are reviewed. With available psychiatric backup a wide range of emotional problems are identified, and effective mental health care is provided.

  16. Understanding the acceptability of a computer decision support system in pediatric primary care.

    Science.gov (United States)

    Bauer, Nerissa S; Carroll, Aaron E; Downs, Stephen M

    2014-01-01

    Individual users' attitudes and opinions help predict successful adoption of health information technology (HIT) into practice; however, little is known about pediatric users' acceptance of HIT for medical decision-making at the point of care. We wished to examine the attitudes and opinions of pediatric users' toward the Child Health Improvement through Computer Automation (CHICA) system, a computer decision support system linked to an electronic health record in four community pediatric clinics. Surveys were administered in 2011 and 2012 to all users to measure CHICA's acceptability and users' satisfaction with it. Free text comments were analyzed for themes to understand areas of potential technical refinement. 70 participants completed the survey in 2011 (100% response rate) and 64 of 66 (97% response rate) in 2012. Initially, satisfaction with CHICA was mixed. In general, users felt the system held promise; however various critiques reflected difficulties understanding integrated technical aspects of how CHICA worked, as well as concern with the format and wording on generated forms for families and users. In the subsequent year, users' ratings reflected improved satisfaction and acceptance. Comments also reflected a deeper understanding of the system's logic, often accompanied by suggestions on potential refinements to make CHICA more useful at the point of care. Pediatric users appreciate the system's automation and enhancements that allow relevant and meaningful clinical data to be accessible at point of care. Understanding users' acceptability and satisfaction is critical for ongoing refinement of HIT to ensure successful adoption into practice.

  17. Effect of conventional and sugar free pediatric syrup formulations on primary tooth enamel hardness: An in vitro study

    Directory of Open Access Journals (Sweden)

    Gaurao Vasant Mali

    2015-01-01

    Full Text Available Objectives: To assess and compare the effect of conventional and sugar free pediatric syrup formulations on primary tooth enamel hardness over a period of 14 days. Materials and Methods: An in vitro study was done on 40 noncarious deciduous teeth. 10 teeth in each group were dipped in 4 pediatric medicinal syrups (1 sugarfree and 3 conventional for 1 min thrice daily for 14 days and the enamel surface micro hardness was checked at baseline, 7 th day and 14 th day by Vickers hardness testing machine. The pH, titratable acidity and buffering capacity of the syrups were assessed. Results: The pH of syrups were above critical pH for demineralization of the tooth but tiratable acidity and buffering capacity differed. ANOVA test indicated that the reduction in mean micro hardness was maximum in Group D (Conventional Analgesic syrup and least in Group A (Sugarfree cough syrup on 7 th and 14 th day. On intergroup comparison there was no difference (P > 0.05 in micro hardness between Group B (Conventional Cough syrup and Group C (Conventional Antibiotic. However, highly significant (P < 0.01 difference between the either pair of Group B with Group D, and Group C with Group D on 14 th day. The percentage reduction in micro hardness on 14 th day was maximum for Group D (24.4 ± 2.2 and minimum for Group A (14.0 ± 1.3 which was statistically significant (P < 0.01. Conclusion: Sugar free pediatric medicines can be effective in reducing dental erosion and efforts should be made to incorporate sugar substitutes in formulation of pediatric medicines.

  18. Pediatric echocardiograms performed at primary centers: Diagnostic errors and missing links!

    International Nuclear Information System (INIS)

    Saraf, Rahul P; Suresh, PV; Maheshwari, Sunita; Shah, Sejal S

    2015-01-01

    The present study was undertaken to assess the accuracy of pediatric echocardiograms done at non-tertiary centers and to evaluate the relationship of inaccurate interpretations with age, echocardiogram performer and complexity of congenital heart disease (CHD). The echocardiogram reports of 182 consecutive children with CHD (5 days-16 years) who were evaluated at a non-tertiary center and subsequently referred to our center were reviewed. Age of the child at echocardiogram, echocardiogram performer and complexity of CHD were noted. These reports were compared with echocardiogram done at our center. Discrepancies were noted and categorized. To assess our own error rate, we compared our echocardiogram reports with the findings obtained during surgery (n = 172), CT scan (n = 9) or cardiac catheterization reports (n = 1). Most of the children at the non-tertiary center (92%) underwent echocardiogram by personnel other than a pediatric cardiologist. Overall, diagnostic errors were found in 69/182 (38%) children. Moderate and major discrepancies affecting the final management were found in 42/182 (23%) children. Discrepancies were higher when the echocardiogram was done by personnel other than pediatric cardiologist (P < 0.01) and with moderate and high complexity lesions (P = 0.0001). There was no significant difference in proportion of these discrepancies in children ≤ 1 year vs. >1 year of age. A significant number of pediatric echocardiograms done at non-tertiary centers had discrepancies that affected the management of these children. More discrepancies were seen when the echocardiogram performer was not a pediatric cardiologist and with complex CHD

  19. Differences in the use of spirometry between rural and urban primary care centers in Spain.

    Science.gov (United States)

    Márquez-Martín, Eduardo; Soriano, Joan B; Rubio, Myriam Calle; Lopez-Campos, Jose Luis

    2015-01-01

    The aim of this study is to evaluate the ability and practice of spirometry, training of technicians, and spirometry features in primary care centers in Spain, evaluating those located in a rural environment against those in urban areas. An observational cross-sectional study was conducted in 2012 by a telephone survey in 970 primary health care centers in Spain. The centers were divided into rural or urban depending on the catchment population. The survey contacted technicians in charge of spirometry and consisted of 36 questions related to the test that included the following topics: center resources, training doctors and technicians, using the spirometer, bronchodilator test, and the availability of spirometry and maintenance. Although the sample size was achieved in both settings, rural centers (RCs) gave a lower response rate than urban centers (UCs). The number of centers without spirometry in rural areas doubled those in the urban areas. Most centers had between one and two spirometers. However, the number of spirometry tests per week was significantly lower in RCs than in UCs (4 [4.1%] vs 6.9 [5.7%], Pspirometries was higher in RCs than in UCs (209 [73.0%] vs 207 [64.2%], P=0.003). RCs were more satisfied with the spirometries (7.8 vs 7.6, P=0.019) and received more training course for interpreting spirometry (41.0% vs 33.2%, P=0.004). The performance of the bronchodilator test showed a homogeneous measure in different ways. The spirometer type and the reference values were unknown to the majority of respondents. This study shows the differences between primary care RCs and UCs in Spain in terms of performing spirometry. The findings in the present study can be used to improve the performance of spirometry in these areas.

  20. [Relevant factors of early puberty timing in urban primary schools in Chongqing].

    Science.gov (United States)

    Luo, Yan; Liu, Qin; Wen, Yi; Liu, Shudan; Lei, Xun; Wang, Hong

    2016-05-01

    To investigate the status of puberty timing and relevant factors of early puberty timing in children from grade one to four in urban primary schools of Chongqing. According to the purposive sample method, four urban primary schools in Chongqing were selected and of which 1471 children from grade one to four who have obtained informed consent were recruited. Questionnaire survey on social-demographic characteristics and family environment (e.g., age, parents' relationship, diet and lifestyle, etc), and Pubertal Development Scale (PDS) survey and physical examination (measurements of height, weight, pubertal development status, etc) were conducted. P25, P50, P75 ages of each important pubertal event were calculated by probit regression. Univariate and multivariate analysis were used to analyze relevant factors. The detection rate of early puberty timing was 17.7%, and the median ages of the onset of breast and testicular development were 10.77 and 11.48 years old, respectively. Multivariate logistic regression showed that early puberty timing occurred more likely in girls than in boys (OR = 0.561, 95% CI 0.406-0.774), and bad relationship between parents (OR = 1.320, 95% CI 1.007-1.729) and hair-products-use (OR = 1.685, 95%, CI 1.028-2.762) were risk factors of early puberty timing. Early onset of puberty in urban Chongqing is still exist. Gender, parents' relationship, and hair-products-use have an essential impact on early puberty timing.

  1. Primary care pediatrics and public health: meeting the needs of today's children.

    Science.gov (United States)

    Kuo, Alice A; Etzel, Ruth A; Chilton, Lance A; Watson, Camille; Gorski, Peter A

    2012-12-01

    The proportion of children suffering from chronic illnesses--such as asthma and obesity, which have significant environmental components--is increasing. Chronic disease states previously seen only in adulthood are emerging during childhood, and health inequalities by social class are increasing. Advocacy to ensure environmental health and to protect from the biological embedding of toxic stress has become a fundamental part of pediatrics. We have presented the rationale for addressing environmental and social determinants of children's health, the epidemiology of issues facing children's health, recent innovations in pediatric medical education that have incorporated public health principles, and policy opportunities that have arisen with the passage of the 2010 Patient Protection and Affordable Care Act.

  2. Maternal posttraumatic stress disorder and depression in pediatric primary care: association with child maltreatment and frequency of child exposure to traumatic events.

    Science.gov (United States)

    Chemtob, Claude M; Gudiño, Omar G; Laraque, Danielle

    2013-11-01

    Maternal posttraumatic stress disorder (PTSD) may be associated with increased risk for child maltreatment and child exposure to traumatic events. Exposure to multiple traumatic events is associated with a wide range of adverse health and social outcomes in children. To examine the association of probable maternal depression, PTSD, and comorbid PTSD and depression with the risk for child maltreatment and parenting stress and with the number of traumatic events to which preschool children are exposed. Cross-sectional observational design. We used analysis of variance to determine whether probable maternal psychopathology groups differed on child maltreatment, parenting stress, and children's exposure to traumatic events. Hierarchical regression analyses were used to examine the unique and interactive effects of depression and PTSD severity scores on these outcomes. Urban pediatric primary care outpatient clinic. Ninety-seven mothers of children aged 3 to 5 years. Pediatric primary care visit. Probable maternal depression and/or PTSD, parenting stress, child exposure to traumatic events, and child maltreatment. Mothers with probable comorbid PTSD and depression reported greater child-directed psychological aggression and physical assault and greater parenting stress. The children of mothers with PTSD (mean number of events the child was exposed to, 5.0) or with comorbid PTSD and depression (3.5 events) experienced more traumatic events than those of mothers with depression (1.2 events) or neither disorder (1.4 events). Severity of depressive symptoms uniquely predicted physical assault and neglect. Symptom scores for PTSD and depression interacted to predict psychological aggression and child exposure to traumatic events. When PTSD symptom severity scores were high, psychological aggression and the number of traumatic events children experienced rose. Depressive symptom severity scores predicted the risk for psychological aggression and exposure to traumatic events

  3. Psychiatric morbidity among adult patients in a semi-urban primary care setting in Malaysia

    Directory of Open Access Journals (Sweden)

    Omar Khairani

    2009-06-01

    Full Text Available Abstract Background Screening for psychiatric disorders in primary care can improve the detection rate and helps in preventing grave consequences of unrecognised and untreated psychiatric morbidity. This is relevant to the Malaysian setting where mental health care is now also being provided at primary care level. The aim of this paper is to report the prevalence of psychiatric illness in a semi-urban primary care setting in Malaysia using the screening tool Patient Health Questionnaire (PHQ. Methods This is a cross-sectional study carried out in a semi-urban primary healthcare centre located south of Kuala Lumpur. Systematic random sampling was carried out and a total of 267 subjects completed the PHQ during the study period. Results The proportion of respondents who had at least one PHQ positive diagnosis was 24.7% and some respondents had more than one diagnosis. Diagnoses included depressive illness (n = 38, 14.4%, somatoform disorder (n = 32, 12.2%, panic and anxiety disorders (n = 17, 6.5%, binge eating disorder (n = 9, 3.4% and alcohol abuse (n = 6, 2.3%. Younger age (18 to 29 years and having a history of stressors in the previous four weeks were found to be significantly associated (p = 0.036 and p = 0.044 respectively with PHQ positive scores. Conclusion These findings are broadly similar to the findings of studies done in other countries and are a useful guide to the probable prevalence of psychiatric morbidity in primary care in other similar settings in Malaysia.

  4. Young children with functional abdominal pain (FAP) and irritable bowel syndrome (IBS) followed in pediatric gastroenterology (PED-GI) vs primary pediatric care (PED): Differences in outcomes

    Science.gov (United States)

    The American Academy of Pediatrics suggests that children with recurrent abdominal pain without alarm signs be managed in pediatric rather than specialty care. However, many of these children are seen in tertiary care. In a longitudinal examination of physical and psychological symptoms, we hypothes...

  5. Urban air pollution and respiratory emergency visits at pediatric unit, Reggio Emilia, Italy.

    Science.gov (United States)

    Bedeschi, Emanuela; Campari, Cinzia; Candela, Silvia; Collini, Giorgia; Caranci, Nicola; Frasca, Gabriella; Galassi, Claudia; Francesca, Gabriella; Vigotti, Maria Angela

    2007-02-01

    Short-term effects of air pollution on daily mortality and hospital admissions for respiratory causes are well documented. Few studies, however, explore the association between exposure to air pollution and daily emergency room visits for respiratory disorders, particularly in Italy and particularly among children as a susceptible population. A time-series analysis was conducted to explore the short-term association between air pollutants (PM10, total suspended particulates [TSP], NO2, SO2, CO, O3) and pediatric emergency room (ER) visits in a small city of northern Italy, Reggio Emilia, during the period 03/01/2001-03/31/2002. There were 1051 ER visits included in the study. Data were analyzed using generalized additive models (GAM), adjusting for various confounding variables, including temperature, humidity, and pollens (Graminaceae). The analyses were also stratified according to the nationality of children (Italians and foreigners). In single-pollutant models, the strongest associations were observed at lag 3 for a 10-microg/m3 increase of TSP (2.7% increase in ER, 95% CI 0.7-4.6) and PM10 (3.0% increase, 95% CI 0.4-5.7), and at lag 4 for a 10-microg/m3 increase of NO2 (11.0% increase in ER, 95% CI 3.6-18.8). At lag 3, the percentage increase in ER visits is similar for the 2 groups of children (Italians and foreigners) for TSP and PM10. The results of the study support the findings that air pollution is a relevant determinant of deterioration of respiratory health among children.

  6. The Breathmobile Program: structure, implementation, and evolution of a large-scale, urban, pediatric asthma disease management program.

    Science.gov (United States)

    Jones, Craig A; Clement, Loran T; Hanley-Lopez, Jean; Morphew, Tricia; Kwong, Kenny Yat Choi; Lifson, Francene; Opas, Lawrence; Guterman, Jeffrey J

    2005-08-01

    Despite more than a decade of education and research-oriented intervention programs, inner city children with asthma continue to engage in episodic "rescue" patterns of healthcare and experience a disproportionate level of morbidity. The aim of this study was to establish and evaluate a sustainable community-wide pediatric asthma disease management program designed to shift inner city children in Los Angeles from acute episodic care to regular preventive care in accordance with national standards. In 1995 the Southern California Chapter of the Asthma and Allergy Foundation of America (AAFA), the Los Angeles County Department of Health Services (LAC DHS), and the Los Angeles Unified School District (LAUSD) established an agreement to initiate and sustain the Breathmobile Program. This program includes automated case identification, mobile school-based clinics, and highly structured clinical encounters supported by an advanced information technology solution. Interdisciplinary teams of asthma care specialists provide regular and ongoing care to children at school and county clinic sites over a wide geographic area of urban Los Angeles. Each team operates in a specially equipped mobile clinic (Breathmobile), efficiently moving a structured healthcare process to school and county clinic sites with large numbers of children. Demographic, clinical, and participation data is tracked carefully in an electronic medical record system. Program operations, clinical oversight, and patient tracking are centralized at a care coordination center. Clinical operations and methods have been replicated in fixed specialty clinic sites at the Los Angeles County + University of Southern California Medical Center. Clinical and process measures are regularly evaluated to assure quality, plan iterative improvement, and support evidence-based care. Four Breathmobiles deliver ongoing care at more than 90 school sites. The program has engaged over five thousand patients and their families in a

  7. Effect of a text messaging intervention on influenza vaccination in an urban, low-income pediatric and adolescent population: a randomized controlled trial.

    Science.gov (United States)

    Stockwell, Melissa S; Kharbanda, Elyse Olshen; Martinez, Raquel Andres; Vargas, Celibell Y; Vawdrey, David K; Camargo, Stewin

    2012-04-25

    Influenza infection results in substantial costs, morbidity, and mortality. Vaccination against influenza is particularly important in children and adolescents who are a significant source of transmission to other high-risk populations, yet pediatric and adolescent vaccine coverage remains low. Traditional vaccine reminders have had a limited effect on low-income populations; however, text messaging is a novel, scalable approach to promote influenza vaccination. To evaluate targeted text message reminders for low-income, urban parents to promote receipt of influenza vaccination among children and adolescents. Randomized controlled trial of 9213 children and adolescents aged 6 months to 18 years receiving care at 4 community-based clinics in the United States during the 2010-2011 influenza season. Of the 9213 children and adolescents, 7574 had not received influenza vaccine prior to the intervention start date and were included in the primary analysis. Parents of children assigned to the intervention received up to 5 weekly immunization registry-linked text messages providing educational information and instructions regarding Saturday clinics. Both the intervention and usual care groups received the usual care, an automated telephone reminder, and access to informational flyers posted at the study sites. Receipt of an influenza vaccine dose recorded in the immunization registry via an electronic health record by March 31, 2011. Receipt was secondarily assessed at an earlier fall review date prior to typical widespread influenza activity. Study children and adolescents were primarily minority, 88% were publicly insured, and 58% were from Spanish-speaking families. As of March 31, 2011, a higher proportion of children and adolescents in the intervention group (43.6%; n = 1653) compared with the usual care group (39.9%; n = 1509) had received influenza vaccine (difference, 3.7% [95% CI, 1.5%-5.9%]; relative rate ratio [RRR], 1.09 [95% CI, 1.04-1.15]; P = .001). At the

  8. Pediatric MS

    Science.gov (United States)

    ... Pediatric MS Share this page Facebook Twitter Email Pediatric MS Pediatric MS Pediatric MS Support Pediatric Providers ... system through the Pediatric MS Support Group . Treating pediatric MS In 2018 the U.S. Food and Drug ...

  9. Pediatric portal hypertension

    Science.gov (United States)

    Vogel, Clarissa Barbon

    2017-01-01

    Abstract: Pediatric portal hypertension management is a team approach between the patient, the patient's family, the primary caregiver, and specialty providers. Evidence-based practice guidelines have not been established in pediatrics. This article serves as a review for the primary care NP in the management of pediatric portal hypertension, discussing the etiology, pathophysiology, and clinical presentation of pediatric portal hypertension, diagnostic tests, and treatment and management options. PMID:28406835

  10. Implementation and Evaluation of Two Educational Strategies to Improve Screening for Eating Disorders in Pediatric Primary Care.

    Science.gov (United States)

    Gooding, Holly C; Cheever, Elizabeth; Forman, Sara F; Hatoun, Jonathan; Jooma, Farah; Touloumtzis, Currie; Vernacchio, Louis

    2017-05-01

    Routine screening for disordered eating or body image concerns is recommended by the American Academy of Pediatrics. We evaluated the ability of two educational interventions to increase screening for eating disorders in pediatric primary care practice, predicting that the "active-learning" group would have an increase in documented screening after intervention. We studied 303 practitioners in a large independent practice association located in the northeastern United States. We used a quasi-experimental design to test the effect of printed educational materials ("print-learning" group, n = 280 participants) compared with in-person shared learning followed by on-line spaced education ("active-learning" group, n = 23 participants) on documented screening of adolescents for eating disorder symptoms during preventive care visits. A subset of 88 participants completed additional surveys regarding knowledge of eating disorders, comfort screening for, diagnosing, and treating eating disorders, and satisfaction with their training regarding eating disorders. During the preintervention period, 4.5% of patients seen by practitioners in both the print-learning and active-learning groups had chart documentation of screening for eating disorder symptoms or body image concerns. This increased to 22% in the active-learning group and 5.7% in the print-learning group in the postintervention period, a statistically significant result. Compared with print-learning participants, active-learning group participants had greater eating disorder knowledge scores, increases in comfort diagnosing eating disorders, and satisfaction with their training in this area. In-person shared learning followed by on-line spaced education is more effective than print educational materials for increasing provider documentation of screening for eating disorders in primary care. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  11. Air Pollutants, Climate, and the Prevalence of Pediatric Asthma in Urban Areas of China

    Directory of Open Access Journals (Sweden)

    Juanjuan Zhang

    2016-01-01

    Full Text Available Background. Prevalence of childhood asthma varies significantly among regions, while its reasons are not clear yet with only a few studies reporting relevant causes for this variation. Objective. To investigate the potential role of city-average levels of air pollutants and climatic factors in order to distinguish differences in asthma prevalence in China and explain their reasons. Methods. Data pertaining to 10,777 asthmatic patients were obtained from the third nationwide survey of childhood asthma in China’s urban areas. Annual mean concentrations of air pollutants and other climatic factors were obtained for the same period from several government departments. Data analysis was implemented with descriptive statistics, Pearson correlation coefficient, and multiple regression analysis. Results. Pearson correlation analysis showed that the situation of childhood asthma was strongly linked with SO2, relative humidity, and hours of sunshine (p<0.05. Multiple regression analysis indicated that, among the predictor variables in the final step, SO2 was found to be the most powerful predictor variable amongst all (β=-19.572, p < 0.05. Furthermore, results had shown that hours of sunshine (β = -0.014, p < 0.05 was a significant component summary predictor variable. Conclusion. The findings of this study do not suggest that air pollutants or climate, at least in terms of children, plays a major role in explaining regional differences in asthma prevalence in China.

  12. Primary cervical leiomyoma: A rare cause of a posterior neck mass in a pediatric patient.

    Science.gov (United States)

    Oliver, Jeremie D; Anzalone, C Lane; Balakrishnan, Karthik

    2018-01-01

    A 13-year-old male presents for evaluation of a right-sided posterolateral neck mass, first noted four years prior to presentation; incisional biopsy two years ago suggested a benign lymph node. Recent growth and increased pain prompted referral to our tertiary care center. MR imaging revealed a densely calcified mass in the right posterior paraspinous muscles with intense enhancement with gadolinium contrast, approximately 5 cm × 2.8 cm x 4.6 cm. Incisional biopsy showed leiomyoma with extensive dystrophic calcifications. This case describes a rare finding of extraesophageal leiomyoma of the neck; this is only the second such case reported in a pediatric patient. Copyright © 2017 Elsevier B.V. All rights reserved.

  13. Child Passenger Safety Technician Consultation in the Pediatric Primary Care Setting.

    Science.gov (United States)

    Burstein, Dina; Zonfrillo, Mark R; Baird, Janette; Mello, Michael J

    2017-09-01

    Correct use of a child safety seat (CSS) can reduce the risk of fatal motor vehicle crash-related injury by up to 71%; however, misuse rates for CSS are as high as 70%. We recruited 189 caregivers at 2 large suburban pediatric office practices; 94 in the intervention group and 95 in the control group. All participants completed a baseline survey and received a CSS safety brochure. Intervention participants had their CSS installation checked at enrollment by a certified child passenger safety (CPS) technician. Follow-up was conducted 4 months post enrollment. Intervention group participants had a 21.3% reduction in critical misuse at follow-up, whereas control participants critical misuse rate at follow-up was identical to the intervention group at baseline. A consult with a certified CPS technician, at the time of a routine visit to the pediatrician, resulted in a reduction in CSS misuse rates.

  14. New visions for basic research and primary prevention of pediatric allergy

    DEFF Research Database (Denmark)

    Hamelman, E.; Herz, U.; Holt, P.

    2008-01-01

    , resources need to be focused on better understanding of the early allergic events and on interventional studies to investigate new strategies of primary and secondary prevention. Accordingly, this review summarizes the state-of-the-art of genetic, immunological and clinical aspects of primary prevention...

  15. {sup 18}F-FDG PET/CT compared to conventional imaging modalities in pediatric primary bone tumors

    Energy Technology Data Exchange (ETDEWEB)

    London, Kevin [The Children' s Hospital at Westmead, Department of Nuclear Medicine, Sydney, NSW (Australia); University of Sydney, Discipline of Paediatrics and Child Health, Sydney Medical School, Sydney, NSW (Australia); Stege, Claudia; Kaspers, Gertjan [VU Medical Centre, Divisions of Paediatric Oncology/Haematology, Amsterdam (Netherlands); Cross, Siobhan; Dalla-Pozza, Luciano [The Children' s Hospital at Westmead, Department of Oncology, Sydney (Australia); Onikul, Ella [The Children' s Hospital at Westmead, Department of Medical Imaging, Sydney (Australia); Graf, Nicole [The Children' s Hospital at Westmead, Department of Pathology, Sydney (Australia); Howman-Giles, Robert [The Children' s Hospital at Westmead, Department of Nuclear Medicine, Sydney, NSW (Australia); University of Sydney, Discipline of Imaging, Sydney Medical School, Sydney, NSW (Australia)

    2012-04-15

    F-Fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET) is useful in adults with primary bone tumors. Limited published data exist in children. To compare hybrid FDG positron emission tomography/computed tomography (PET/CT) with conventional imaging (CI) modalities in detecting malignant lesions, predicting response to chemotherapy and diagnosing physeal involvement in pediatric primary bone tumors. Retrospective analysis of PET/CT and CI reports with histopathology or follow-up > 6 months as reference standard. Response parameters and physeal involvement at diagnosis were compared to histopathology. A total of 314 lesions were detected in 86 scans. Excluding lung lesions, PET/CT had higher sensitivity and specificity than CI (83%, 98% and 78%, 97%, respectively). In lung lesions, PET/CT had higher specificity than CI (96% compared to 87%) but lower sensitivity (80% compared to 93%). Higher initial SUV{sub max} and greater SUV{sub max} reduction on PET/CT after chemotherapy predicted a good response. Change in tumor size on MRI did not predict response. Both PET/CT and MRI were very sensitive but of low specificity in predicting physeal tumor involvement. PET/CT appears more accurate than CI in detecting malignant lesions in childhood primary bone tumors, excluding lung lesions. It seems better than MRI at predicting tumor response to chemotherapy. (orig.)

  16. 18F-FDG PET/CT compared to conventional imaging modalities in pediatric primary bone tumors

    International Nuclear Information System (INIS)

    London, Kevin; Stege, Claudia; Kaspers, Gertjan; Cross, Siobhan; Dalla-Pozza, Luciano; Onikul, Ella; Graf, Nicole; Howman-Giles, Robert

    2012-01-01

    F-Fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET) is useful in adults with primary bone tumors. Limited published data exist in children. To compare hybrid FDG positron emission tomography/computed tomography (PET/CT) with conventional imaging (CI) modalities in detecting malignant lesions, predicting response to chemotherapy and diagnosing physeal involvement in pediatric primary bone tumors. Retrospective analysis of PET/CT and CI reports with histopathology or follow-up > 6 months as reference standard. Response parameters and physeal involvement at diagnosis were compared to histopathology. A total of 314 lesions were detected in 86 scans. Excluding lung lesions, PET/CT had higher sensitivity and specificity than CI (83%, 98% and 78%, 97%, respectively). In lung lesions, PET/CT had higher specificity than CI (96% compared to 87%) but lower sensitivity (80% compared to 93%). Higher initial SUV max and greater SUV max reduction on PET/CT after chemotherapy predicted a good response. Change in tumor size on MRI did not predict response. Both PET/CT and MRI were very sensitive but of low specificity in predicting physeal tumor involvement. PET/CT appears more accurate than CI in detecting malignant lesions in childhood primary bone tumors, excluding lung lesions. It seems better than MRI at predicting tumor response to chemotherapy. (orig.)

  17. Urban-rural difference in satisfaction with primary healthcare services in Ghana

    Directory of Open Access Journals (Sweden)

    Sanni Yaya

    2017-11-01

    Full Text Available Abstract Background Understanding regional variation in patient satisfaction about healthcare systems (PHCs on the quality of services provided is instrumental to improving quality and developing a patient-centered healthcare system by making it more responsive especially to the cultural aspects of health demands of a population. Reaching to the innovative National Health Insurance Scheme (NHIS in Ghana, surpassing several reforms in healthcare financing has been a milestone. However, the focus of NHIS is on the demand side of healthcare delivery. Studies focusing on the supply side of healthcare delivery, particularly the quality of service as perceived by the consumers are required. A growing number of studies have focused on regional differences of patient satisfaction in developed countries, however little research has been conducted concerning patient satisfaction in resource-poor settings like in Ghana. This study was therefore dedicated to examining the variation in satisfaction across rural and urban women in Ghana. Methods Data for the present study were obtained from the latest demographic and health survey in Ghana (GDHS 2014. Participants were 3576 women aged between 15 and 49 years living in non-institutional settings in Ghana. Summary statistics in percentages was used to present respondents’ demographic, socioeconomic characteristics. Chi-square test was used to find association between urban-rural differentials with socio-economic variables. Multiple logistic regression was performed to measure the association of being satisfied with primary healthcare services with study variables. Model fitness was tested by pseudo R 2. Statistical significance was set at p < 0.05. Results The findings in this study revealed that about 57.1% were satisfied with primary health care services. The urban and rural areas reported 57.6 and 56.6% respectively which showed no statistically significant difference (z = 0.64; p = 0.523; 95

  18. Usability testing of a computerized communication tool in a diverse urban pediatric population.

    Science.gov (United States)

    Tsimicalis, Argerie; Stone, Patricia W; Bakken, Suzanne; Yoon, Sunmoo; Sands, Stephen; Porter, Rechelle; Ruland, Cornelia

    2014-01-01

    Developed in Norway, Sisom is an interactive, rigorously tested, computerized, communication tool designed to help children with cancer express their perceived symptoms/problems. Children travel virtually from island to island rating their symptoms/problems. While Sisom has been found to significantly improve communication in patient consultations in Norway, usability testing is warranted with US children prior to further use in research studies. The objective of this study was to determine the usability of Sisom in a sample of English- and Spanish-speaking children in an urban US community. A mixed-methods usability study was conducted with a purposive sample of healthy children and children with cancer. Semistructured interviews were used to assess healthy children's symptom recognition. Children with cancer completed 8 usability tasks captured with Morae 3.3 software. Data were downloaded, transcribed, and analyzed descriptively. Four healthy children and 8 children with cancer participated. Of the 44 symptoms assessed, healthy children recognized 15 (34%) pictorial symptoms immediately or indicated 13 (30%) pictures were good representations of the symptom. Six children with cancer completed all tasks. All children navigated successfully from one island to the next, ranking their symptom/problem severity, clicking the magnifying glass for help, or asking the researcher for assistance. All children were satisfied with the aesthetics and expressed an interest in using Sisom to communicate their symptoms/problems. A few minor suggestions for improvement and adjustment may optimize the use of Sisom for US children. Sisom may help clinicians overcome challenges assessing children's complex symptoms/problems in a child-friendly manner.

  19. Job satisfaction of primary health-care providers (public sector in urban setting

    Directory of Open Access Journals (Sweden)

    Pawan Kumar

    2013-01-01

    Full Text Available Introduction: Job satisfaction is determined by a discrepancy between what one wants in a job and what one has in a job. The core components of information necessary for what satisfies and motivates the health work force in our country are missing at policy level. Therefore present study will help us to know the factors for job satisfaction among primary health care providers in public sector. Materials and Methods: Present study is descriptive in nature conducted in public sector dispensaries/primary urban health centers in Delhi among health care providers. Pretested structured questionnaire was administered to 227 health care providers. Data was analyzed using SPSS and relevant statistical test were applied. Results: Analysis of study reveals that ANMs are more satisfied than MOs, Pharmacist and Lab assistants/Lab technicians; and the difference is significant (P < 0.01. Age and education level of health care providers don′t show any significant difference in job satisfaction. All the health care providers are dissatisfied from the training policies and practices, salaries and opportunities for career growth in the organization. Majority of variables studied for job satisfaction have low scores. Five factor were identified concerned with job satisfaction in factor analysis. Conclusion: Job satisfaction is poor for all the four groups of health care providers in dispensaries/primary urban health centers and it is not possible to assign a single factor as a sole determinant of dissatisfaction in the job. Therefore it is recommended that appropriate changes are required at the policy as well as at the dispensary/PUHC level to keep the health work force motivated under public sector in Delhi.

  20. Assessing the impact of the urbanization process on net primary productivity in China in 1989–2000

    International Nuclear Information System (INIS)

    Tian, Guangjin; Qiao, Zhi

    2014-01-01

    Urban development affects the material circulation and energy flow of ecosystems, thereby affecting the Net Primary Productivity (NPP). The loss of NPP due to urban expansion was calculated integrating GLO-PEM with remote sensing and GIS techniques in China during the period of 1989–2000. Using urban expansion and the mean NPP for the different land use types in the fourteen regions, the total loss of NPP was calculated as 0.95 Tg C, which accounted for 0.03% of the national NPP of 1989. The total loss of NPP due to the transformation from cropland to urban land accounted for 91.93%, followed by forest (7.17%) and grassland (0.69%). However, the conversion from unused land, industrial and construction land, and water bodies to urban land resulted in an increase in the NPP. The regions locating in eastern China and middle China had large reductions in the total NPP due to urban expansion. -- Highlights: • This paper assesses the impact of urbanization process on net primary productivity in China. • TM images were interpreted to obtain the extent and spatial distribution of urban development. • Using mean NPP for different land uses, we calculated total loss of NPP was 0.949447 Tg C in China. • The total loss of NPP owing to the transformation from cropland to urban land accounted for 91.93%. -- The loss of NPP due to urban expansion was calculated as 0.95 Tg C in China in 1989–2000, which accounted for 0.03% of the national NPP of 1989

  1. Rural and urban Ugandan primary school children's alternative ideas about animals

    Science.gov (United States)

    Otaala, Justine

    This study examined rural and urban Ugandan primary children's alternative ideas about animals through the use of qualitative research methods. Thirty-six children were selected from lower, middle, and upper primary grades in two primary schools (rural and urban). Data were collected using interview-about-instance technique. Children were shown 18 color photographs of instances and non-instances of familiar animals and asked to say if the photographed objects were animals or not. They were then asked to give reasons to justify their answers. The interviews were audiotaped and transcribed. The results indicate that children tended to apply the label "animal" to large mammals, usually found at home, on the farm, in the zoo, and in the wild. Humans were not categorized as animals, particularly by children in the lower grades. Although the children in upper grades correctly identified humans as animals, they used reasons that were irrelevant to animal attributes and improperly derived from the biological concept of evolution. Many attributes children used to categorize instances of animals were scientifically unacceptable and included superficial features, such as body outline, anatomical features (body parts), external features (visual cues), presence or absence and number of appendages. Movement and eating (nutrition) were the most popular attributes children used to identify instances of animals. The main differences in children's ideas emanated from the reasons used to identify animals. Older rural children drew upon their cultural and traditional practices more often than urban children. Anthropomorphic thinking was predominant among younger children in both settings, but diminished with progression in children's grade levels. Some of the implications of this study are: (1) teachers, teacher educators and curriculum developers should consider learners' ideas in planning and developing teaching materials and interventions. (2) Teachers should relate humans to other

  2. Contracting with private providers for primary care services: evidence from urban China.

    Science.gov (United States)

    Wang, Yan; Eggleston, Karen; Yu, Zhenjie; Zhang, Qiong

    2013-01-17

    Controversy surrounds the role of the private sector in health service delivery, including primary care and population health services. China's recent health reforms call for non-discrimination against private providers and emphasize strengthening primary care, but formal contracting-out initiatives remain few, and the associated empirical evidence is very limited. This paper presents a case study of contracting with private providers for urban primary and preventive health services in Shandong Province, China. The case study draws on three primary sources of data: administrative records; a household survey of over 1600 community residents in Weifang and City Y; and a provider survey of over 1000 staff at community health stations (CHS) in both Weifang and City Y. We supplement the quantitative data with one-on-one, in-depth interviews with key informants, including local officials in charge of public health and government finance.We find significant differences in patient mix: Residents in the communities served by private community health stations are of lower socioeconomic status (more likely to be uninsured and to report poor health), compared to residents in communities served by a government-owned CHS. Analysis of a household survey of 1013 residents shows that they are more willing to do a routine health exam at their neighborhood CHS if they are of low socioeconomic status (as measured either by education or income). Government and private community health stations in Weifang did not statistically differ in their performance on contracted dimensions, after controlling for size and other CHS characteristics. In contrast, the comparison City Y had lower performance and a large gap between public and private providers. We discuss why these patterns arose and what policymakers and residents considered to be the main issues and concerns regarding primary care services.

  3. Contracting with private providers for primary care services: evidence from urban China

    Science.gov (United States)

    2013-01-01

    Controversy surrounds the role of the private sector in health service delivery, including primary care and population health services. China’s recent health reforms call for non-discrimination against private providers and emphasize strengthening primary care, but formal contracting-out initiatives remain few, and the associated empirical evidence is very limited. This paper presents a case study of contracting with private providers for urban primary and preventive health services in Shandong Province, China. The case study draws on three primary sources of data: administrative records; a household survey of over 1600 community residents in Weifang and City Y; and a provider survey of over 1000 staff at community health stations (CHS) in both Weifang and City Y. We supplement the quantitative data with one-on-one, in-depth interviews with key informants, including local officials in charge of public health and government finance. We find significant differences in patient mix: Residents in the communities served by private community health stations are of lower socioeconomic status (more likely to be uninsured and to report poor health), compared to residents in communities served by a government-owned CHS. Analysis of a household survey of 1013 residents shows that they are more willing to do a routine health exam at their neighborhood CHS if they are of low socioeconomic status (as measured either by education or income). Government and private community health stations in Weifang did not statistically differ in their performance on contracted dimensions, after controlling for size and other CHS characteristics. In contrast, the comparison City Y had lower performance and a large gap between public and private providers. We discuss why these patterns arose and what policymakers and residents considered to be the main issues and concerns regarding primary care services. PMID:23327666

  4. Experiences of violence and deficits in academic achievement among urban primary school children in Jamaica.

    Science.gov (United States)

    Baker-Henningham, Helen; Meeks-Gardner, Julie; Chang, Susan; Walker, Susan

    2009-05-01

    The aim of this study was to examine the relationship between children's experiences of three different types of violence and academic achievement among primary school children in Kingston, Jamaica. A cross-sectional study of 1300 children in grade 5 [mean (S.D.) age: 11 (0.5) years] from 29 government primary schools in urban areas of Kingston and St. Andrew, Jamaica, was conducted. Academic achievement (mathematics, reading, and spelling) was assessed using the Wide Range Achievement Test. Children's experiences of three types of violence - exposure to aggression among peers at school, physical punishment at school, and exposure to community violence - were assessed by self-report using an interviewer administered questionnaire. Fifty-eight percent of the children experienced moderate or high levels of all three types of violence. Boys had poorer academic achievement and experienced higher levels of aggression among peers and physical punishment at school than girls. Children's experiences of the three types of violence were independently associated with all three indices of academic achievement. There was a dose-response relationship between children's experiences of violence and academic achievement with children experiencing higher levels of violence having the poorest academic achievement and children experiencing moderate levels having poorer achievement than those experiencing little or none. Exposure to three different types of violence was independently associated with poor school achievement among children attending government, urban schools in Jamaica. Programs are needed in schools to reduce the levels of aggression among students and the use of physical punishment by teachers and to provide support for children exposed to community violence. Children in Jamaica and the wider Caribbean experience significant amounts of violence in their homes, communities, and schools. In this study, we demonstrate a dose-response relationship between primary school

  5. Reported characteristics of children referred from primary care to pediatric allergy specialist care

    NARCIS (Netherlands)

    Brakel, T.M.; Flokstra-De Blok, B.M.J.; Oude Elberink, J.N.G.; Schuttelaar, M.L.A.; Christoffers, W.A.; Roerdink, E.M.; Molen, van der Thys; Dubois, A.E.J.

    2013-01-01

    Background: For the majority of patients suspected of allergy, management is mostly the responsibility of general practitioners (GPs), but may include specialist referral in selected cases. The purpose of this study is to obtain insight in characteristics of children that are referred from primary

  6. Food Insecurity Screening in Pediatric Primary Care: Can Offering Referrals Help Identify Families in Need?

    Science.gov (United States)

    Bottino, Clement J; Rhodes, Erinn T; Kreatsoulas, Catherine; Cox, Joanne E; Fleegler, Eric W

    2017-07-01

    To describe a clinical approach for food insecurity screening incorporating a menu offering food-assistance referrals, and to examine relationships between food insecurity and referral selection. Caregivers of 3- to 10-year-old children presenting for well-child care completed a self-administered questionnaire on a laptop computer. Items included the US Household Food Security Survey Module: 6-Item Short Form (food insecurity screen) and a referral menu offering assistance with: 1) finding a food pantry, 2) getting hot meals, 3) applying for Supplemental Nutrition Assistance Program (SNAP), and 4) applying for Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Referrals were offered independent of food insecurity status or eligibility. We examined associations between food insecurity and referral selection using multiple logistic regression while adjusting for covariates. A total of 340 caregivers participated; 106 (31.2%) reported food insecurity, and 107 (31.5%) selected one or more referrals. Forty-nine caregivers (14.4%) reported food insecurity but selected no referrals; 50 caregivers (14.7%) selected one or more referrals but did not report food insecurity; and 57 caregivers (16.8%) both reported food insecurity and selected one or more referrals. After adjustment, caregivers who selected one or more referrals had greater odds of food insecurity compared to caregivers who selected no referrals (adjusted odds ratio 4.0; 95% confidence interval 2.4-7.0). In this sample, there was incomplete overlap between food insecurity and referral selection. Offering referrals may be a helpful adjunct to standard screening for eliciting family preferences and identifying unmet social needs. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  7. Differences in the use of spirometry between rural and urban primary care centers in Spain

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    Márquez-Martín E

    2015-08-01

    Full Text Available Eduardo Márquez-Martín,1 Joan B Soriano,2 Myriam Calle Rubio,3 Jose Luis Lopez-Campos1,4 On behalf of the 3E project 1Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, 2Instituto de Investigación Hospital Universitario de la Princesa (IISP, Universidad Autónoma de Madrid, Cátedra UAM-Linde, 3Servicio de Neumología, Hospital Universitario Clínico San Carlos, 4Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES, Instituto de Salud Carlos III, Madrid, Spain Objectives: The aim of this study is to evaluate the ability and practice of spirometry, training of technicians, and spirometry features in primary care centers in Spain, evaluating those located in a rural environment against those in urban areas.Methods: An observational cross-sectional study was conducted in 2012 by a telephone survey in 970 primary health care centers in Spain. The centers were divided into rural or urban depending on the catchment population. The survey contacted technicians in charge of spirometry and consisted of 36 questions related to the test that included the following topics: center resources, training doctors and technicians, using the spirometer, bronchodilator test, and the availability of spirometry and maintenance.Results: Although the sample size was achieved in both settings, rural centers (RCs gave a lower response rate than urban centers (UCs. The number of centers without spirometry in rural areas doubled those in the urban areas. Most centers had between one and two spirometers. However, the number of spirometry tests per week was significantly lower in RCs than in UCs (4 [4.1%] vs 6.9 [5.7%], P<0.01. The availability of a specific schedule for conducting spirometries was higher in RCs than in UCs (209 [73.0%] vs 207 [64.2%], P=0.003. RCs were more satisfied with the spirometries (7.8 vs 7.6, P

  8. PREVALENCE AND RISK FACTORS OF OBESITY IN PRIMARY SCHOOL IN URBAN AND RURAL AREAS

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    Made Ratna Dewi

    2013-10-01

    Full Text Available Normal 0 false false false IN X-NONE X-NONE Obesity has become a continous increasing global health problem. Obesity can happen in adult population and also on children as well as teenagers. There are several factors that influence the occurrence of obesity. The aim of this study is to determine the prevalence and risk factors for obesity in primary school children in urban and rural areas. A cross sectional study was conducted with a total sample of 241 pupils in several elementary schools. Anthropometric status determine using body mass index for age and obesity stated if measurement exceed ?95th percentile based on CDC 2000. Analysis data perform with the Pearson Chi-square, Fisher's Exact Test, and logistic regression. A P value of <0.05 was considered significant. This study showed the prevalence of obesity was 15%. The prevalence of obesity in urban areas was 21% and rural areas was 5%. The result showed risk of obesity multiplied by 3.8 times in urban children as they had a habit of "snacking" had risk of suffering obesity by 3.4 times (95% CI 1.2 to 9.0. Children who had habit of having fast food more than 2 times per week had the more risk of obesity by 5 times (95% CI 1.9 to 13.5. Mothers education in urban areas as a protective factor. Conclusion of this study show that the prevalence of obesity in urban areas is 21% and 5% in rural areas. “Snacking” habit and eating fast food more than 2 times per week increase the risk of obesity in urban areas, while in rural areas no risk factors consider significant for obesity. /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0cm; line-height:115%; mso

  9. Tertiary center experience with primary endoscopic laryngoplasty in pediatric acquired subglottic stenosis and literature review

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    Jaber Alshammari

    2017-03-01

    Conclusion: Our study showed that primary endoscopic management was successful in 82.3% of cases of acquired subglottic stenosis including those with high grade stenosis and long segment of more than 12 mm in terms of the craniocaudal length. CO2 laser was an important tool to convert mature hard stenotic segment into a soft one. The latter yielded to the lateral pressure created by balloon dilatation better.

  10. The Brief Early Childhood Screening Assessment: Preliminary Validity in Pediatric Primary Care.

    Science.gov (United States)

    Fallucco, Elise M; Wysocki, Tim; James, Lauren; Kozikowski, Chelsea; Williams, Andre; Gleason, Mary M

    Brief, well-validated instruments are needed to facilitate screening for early childhood behavioral and emotional problems (BEPs). The objectives of this study were to empirically reduce the length of the Early Childhood Screening Assessment (ECSA) and to assess the validity and reliability of this shorter tool. Using caregiver ECSA responses for 2467 children aged 36 to 60 months seen in primary care, individual ECSA items were ranked on a scale ranging from "absolutely retain" to "absolutely delete." Items were deleted sequentially beginning with "absolutely delete" and going up the item prioritization list, resulting in 35 shorter versions of the ECSA. A separate primary care sample (n = 69) of mothers of children aged 18 to 60 months was used to determine the sensitivity and specificity of each shorter ECSA version using psychiatric diagnosis on the Diagnostic Infant and Preschool Assessment as the gold standard. The version with the optimal balance of sensitivity, specificity, and length was selected as the Brief ECSA. Associations between Brief ECSA scores and other pertinent measures were evaluated to estimate reliability and validity. A 22-item measure reflected the best combination of brevity, sensitivity and specificity. A cutoff score of 9 or higher on the 22-item Brief ECSA demonstrated acceptable sensitivity (89%) and specificity (85%) for predicting a psychiatric diagnosis. Brief ECSA scores correlated significantly and in expected directions with scores on pertinent measures and with demographic variables. The results indicate that the Brief ECSA has sound psychometric properties for identifying young children with BEPs in primary care.

  11. Eye Injuries Among Primary School Children in Enugu, Nigeria: Rural vs Urban.

    Science.gov (United States)

    Okpala, Nonso Ejikeme; Umeh, Rich Enujioke; Onwasigwe, Ernest Nnemeka

    2015-01-01

    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

  12. A clinico-epidemiological study of pediatric leprosy in the urban leprosy center of a tertiary care institute

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    Sukumaran Pradeep Nair

    2017-01-01

    Conclusions: This study showed a prevalence of 6.65% of pediatric leprosy cases. BT was the most common type of leprosy, and the prevalence of lepromatous leprosy, lepra reactions, and deformity was low.

  13. Entrustable professional activities in post-licensure training in primary care pediatrics: Necessity, development and implementation of a competency-based post-graduate curriculum

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    Fehr, Folkert

    2017-11-01

    Full Text Available There is an absence of broad-based and binding curricular requirements for structured competency-based post-graduate medical training in Germany, and thus no basis for comparing the competencies of physicians undergoing training in a medical specialty (. In response, the German Society of Primary Care Pediatrics’ working group on post-graduate education (DGAAP has identified realistic entrustable professional activities (EPAs in primary care, defined their number, scope and content, selected competency domains, specified required knowledge and skills, and described appropriate assessment methods. These guidelines are referred to as and can be accessed electronically by educators in pediatric medicine; the use and effectiveness of these guidelines are monitored by the German Association for Medical Education’s committee on post-graduate education (GMA. Teaching and training in pediatric medicine should take EPAs into consideration. To accomplish this, phases dedicated to primary care should be integrated into formal medical specialty training. Primary care pediatrics must enhance the sites where such training takes place into learning environments that prepare physicians trainees and turn the practicing specialists into mentoring educators.

  14. Competencies and Training Guidelines for Behavioral Health Providers in Pediatric Primary Care.

    Science.gov (United States)

    Njoroge, Wanjiku F M; Williamson, Ariel A; Mautone, Jennifer A; Robins, Paul M; Benton, Tami D

    2017-10-01

    This article focuses on the cross-discipline training competencies needed for preparing behavioral health providers to implement integrated primary care services. After a review of current competencies in the disciplines of child and adolescent psychiatry, psychology, and social work, cross-cutting competencies for integrated training purposes are identified. These competencies are comprehensive and broad and can be modified for use in varied settings and training programs. An existing and successful integrated care training model, currently implemented at Children's Hospital of Philadelphia, is described. This model and the training competencies are discussed in the context of recommendations for future work and training. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Social workers in pediatric primary care: communication, gender, and scope of practice.

    Science.gov (United States)

    Lynch, Sean

    2014-01-01

    While many child mental health issues manifest themselves in primary care, few pediatricians have received mental health training, and their communication with social workers may be limited due to unfamiliarity with mental health professions. The purpose of this study was to use ethnographic interviews to investigate factors affecting communication satisfaction between social workers and pediatricians. The study found that scope of practice issues were a communication barrier. This barrier is significant because health reform may lead social workers and pediatricians to collaborate more frequently in the future.

  16. Moroccan Mothers' Involvement in Dialogic Literary Gatherings in a Catalan Urban Primary School: Increasing Educative Interactions and Improving Learning

    Science.gov (United States)

    de Botton, Lena; Girbés, Sandra; Ruiz, Laura; Tellado, Itxaso

    2014-01-01

    This article analyses a case study on Moroccan mothers' involvement in the Dialogic Literary Gathering (DLG) in an urban primary school in Catalonia (Spain). DLG is a dialogic learning environment that improves reading skills and communicative abilities and promotes school-community links. This activity has been identified in previous European…

  17. Dengue seroprevalence and force of primary infection in a representative population of urban dwelling Indonesian children

    Science.gov (United States)

    Nealon, Joshua; Satari, Hindra Irawan; Karyanti, Mulya Rahma; Sekartini, Rini; Soedjatmiko, Soedjatmiko; Gunardi, Hartono; Medise, Bernie Endyarni; Sasmono, R. Tedjo; Simmerman, James Mark; Bouckenooghe, Alain; Hadinegoro, Sri Rezeki

    2017-01-01

    Background Indonesia reports the second highest dengue disease burden in the world; these data are from passive surveillance reports and are likely to be significant underestimates. Age-stratified seroprevalence data are relatively unbiased indicators of past exposure and allow understanding of transmission dynamics. Methodology/Principal Findings To better understand dengue infection history and associated risk factors in Indonesia, a representative population-based cross-sectional dengue seroprevalence study was conducted in 1–18-year-old urban children. From October to November 2014, 3,210 children were enrolled from 30 geographically dispersed clusters. Serum samples were tested for anti-dengue IgG antibodies by indirect ELISA. A questionnaire investigated associations between dengue serologic status and household socio-demographic and behavioural factors. Overall, 3,194 samples were tested, giving an adjusted national seroprevalence in this urban population of 69.4% [95% CI: 64.4–74.3] (33.8% [95% CI: 26.4–41.2] in the 1–4-year-olds, 65.4% [95% CI: 69.1–71.7] in the 5–9-year-olds, 83.1% [95% CI: 77.1–89.0] in the 10–14-year-olds, and 89.0% [95% CI: 83.9–94.1] in the 15–18-year–olds). The median age of seroconversion estimated through a linear model was 4.8 years. Using a catalytic model and considering a constant force of infection we estimated 13.1% of children experience a primary infection per year. Through a hierarchical logistic multivariate model, the subject’s age group (1–4 vs 5–9 OR = 4.25; 1–4 vs. 10–14 OR = 12.60; and 1–4 vs 15–18 OR = 21.87; p<0.0001) and the number of cases diagnosed in the household since the subject was born (p = 0.0004) remained associated with dengue serological status. Conclusions/Significance This is the first dengue seroprevalence study in Indonesia that is targeting a representative sample of the urban paediatric population. This study revealed that more than 80% of children aged 10

  18. Effect of routine mental health screening in a low-resource pediatric primary care population.

    Science.gov (United States)

    Berger-Jenkins, Evelyn; McCord, Mary; Gallagher, Trish; Olfson, Mark

    2012-04-01

    Despite evidence for its feasibility, the usage of mental health screening in primary care practices with overburdened providers and few referral options remains unclear. This study explores the effects of routine screening on mental health problem identification and management in a low-resource setting. Medical records of 5 to 12 year-old children presenting for well visits before and after screening was implemented were reviewed. Multivariate logistic regression was used to explore associations between study period and identification/management practices. Changes in the number of visits and wait times for a co-located referral service were assessed post hoc. Parents disclosed more mental health problems, and providers initiated more workups but referred fewer patients after screening was implemented. The proportion of new visits and wait times for the referral service did not change. Even in low-resource settings, screening may facilitate parental disclosure and increase clinical attention to mental health problems without overburdening referral services.

  19. Experience in Training of Primary Health Care Specialists in the Context of the Integrated Management of Childhood Illness in the Teaching of Pediatrics to Junior Students

    Directory of Open Access Journals (Sweden)

    O.D. Fofanov

    2013-09-01

    Full Text Available The article describes an overview of the basic principles of the integrated management of childhood illness (IMCI strategy, which is designed to improve the quality of care for children up to 5 years at the level of primary health care. The first experience of the implementation of this strategy in the educational process while studying of pediatrics at the junior courses within the curriculum is described. A considerable attention is paid to the method of mastering communication skills by the junior students’ and applying them in the collection of medical history, communicating with parents and relatives of children. According to IMCI recommendations all health care professionals, who work in primary health care, must master the methodology of counseling family about care for healthy and sick children, feeding, providing optimal conditions for the physical and neuropsychological development. Our first experience demonstrates the feasibility of implementing IMCI individual issues in the educational process while studying pediatrics for the junior classes.

  20. Eye Injuries among Primary School Children in Enugu, Nigeria: Rural vs Urban

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    Nonso Ejikeme Okpala

    2015-01-01

    Full Text Available 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 <15 years in two randomly selected primary schools in the urban area and three randomly selected schools in the rural area were interviewed and examined with Snellen chart, pen torch, head loupe, and direct ophthalmoscope. The findings were recorded using a semi-structured questionnaire and the World Health Organization Programme for Prevention of Blindness (WHO/PBL eye examination form. Training on visual acuity measurement was done for each of the class teachers. A total of 1,236 children <15 years of age were studied and analyzed. Slightly more females, 652 (52.8%, than males, 584 (47.2%, constituted the sample population giving a female/male ratio of 1.1:1. A total of 98 (7.93% 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

  1. Rural-to-Urban Migrants' Experiences with Primary Care under Different Types of Medical Institutions in Guangzhou, China.

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    Jiazhi Zeng

    Full Text Available China is facing the unprecedented challenge of rapidly increasing rural-to-urban migration. Migrants are in a vulnerable state when they attempt to access to primary care services. This study was designed to explore rural-to-urban migrants' experiences in primary care, comparing their quality of primary care experiences under different types of medical institutions in Guangzhou, China.The study employed a cross-sectional survey of 736 rural-to-urban migrants in Guangzhou, China in 2014. A validated Chinese version of Primary Care Assessment Tool--Adult Short Version (PCAT-AS, representing 10 primary care domains was used to collect information on migrants' quality of primary care experiences. These domains include first contact (utilization, first contact (accessibility, ongoing care, coordination (referrals, coordination (information systems, comprehensiveness (services available, comprehensiveness (services provided, family-centeredness, community orientation and culturally competent. These measures were used to assess the quality of primary care performance as reported from patients' perspective. Analysis of covariance was conducted for comparison on PCAT scores among migrants accessing primary care in tertiary hospitals, municipal hospitals, community health centers/community health stations, and township health centers/rural health stations. Multiple linear regression models were used to explore factors associated with PCAT total scores.After adjustments were made, migrants accessing primary care in tertiary hospitals (25.49 reported the highest PCAT total scores, followed by municipal hospitals (25.02, community health centers/community health stations (24.24, and township health centers/rural health stations (24.18. Tertiary hospital users reported significantly better performance in first contact (utilization, first contact (accessibility, coordination (information system, comprehensiveness (service available, and cultural competence

  2. Bullying, Depression, and Suicide Risk in a Pediatric Primary Care Sample.

    Science.gov (United States)

    Kodish, Tamar; Herres, Joanna; Shearer, Annie; Atte, Tita; Fein, Joel; Diamond, Guy

    2016-05-01

    Suicide is a serious public health concern for US youth. Research has established an association between bullying and suicide risk. However, several questions remain regarding this relationship. The present study examined (a) whether experiences of verbal, physical, and cyber bullying were uniquely associated with general suicide risk; (b) whether each specific form of bullying was related to suicide attempt; and (c) whether depression moderated the relationship between each type of bullying and suicide risk. The sample included medical records of 5,429 youth screened in primary care when providers had mental health concerns. Patients were screened using the Behavioral Health Screen (BHS), which assessed a range of mental health problems and behaviors, including bullying, depression, and suicide. All types of bullying were associated with suicide risk, but verbal bullying was uniquely associated with suicide attempt. Depression significantly moderated the relationship between each type of bullying and suicide risk. The study's limitations include the use of cross-sectional and self-data reports. When medical providers evaluate suicide risk, bullying should be considered as a possible precipitant, especially if the patient is depressed. Verbal bullying may be particularly important in understanding severity of suicide risk.

  3. Assessing the impact of the urbanization process on net primary productivity in China in 1989-2000.

    Science.gov (United States)

    Tian, Guangjin; Qiao, Zhi

    2014-01-01

    Urban development affects the material circulation and energy flow of ecosystems, thereby affecting the Net Primary Productivity (NPP). The loss of NPP due to urban expansion was calculated integrating GLO-PEM with remote sensing and GIS techniques in China during the period of 1989-2000. Using urban expansion and the mean NPP for the different land use types in the fourteen regions, the total loss of NPP was calculated as 0.95 Tg C, which accounted for 0.03% of the national NPP of 1989. The total loss of NPP due to the transformation from cropland to urban land accounted for 91.93%, followed by forest (7.17%) and grassland (0.69%). However, the conversion from unused land, industrial and construction land, and water bodies to urban land resulted in an increase in the NPP. The regions locating in eastern China and middle China had large reductions in the total NPP due to urban expansion. Copyright © 2013 Elsevier Ltd. All rights reserved.

  4. Reduction of missed appointments at an urban primary care clinic: a randomised controlled study

    Directory of Open Access Journals (Sweden)

    Calmy Alexandra

    2010-10-01

    Full Text Available Abstract Background Missed appointments are known to interfere with appropriate care and to misspend medical and administrative resources. The aim of this study was to test the effectiveness of a sequential intervention reminding patients of their upcoming appointment and to identify the profile of patients missing their appointments. Methods We conducted a randomised controlled study in an urban primary care clinic at the Geneva University Hospitals serving a majority of vulnerable patients. All patients booked in a primary care or HIV clinic at the Geneva University Hospitals were sent a reminder 48 hrs prior to their appointment according to the following sequential intervention: 1. Phone call (fixed or mobile reminder; 2. If no phone response: a Short Message Service (SMS reminder; 3. If no available mobile phone number: a postal reminder. The rate of missed appointment, the cost of the intervention, and the profile of patients missing their appointment were recorded. Results 2123 patients were included: 1052 in the intervention group, 1071 in the control group. Only 61.7% patients had a mobile phone recorded at the clinic. The sequential intervention significantly reduced the rate of missed appointments: 11.4% (n = 122 in the control group and 7.8% (n = 82 in the intervention group (p 1year (OR 2.2; CI: 1.15-4.2, substance abuse (2.09, CI 1.21-3.61, and being an asylum seeker (OR 2.73: CI 1.22-6.09. Conclusion A practical reminder system can significantly increase patient attendance at medical outpatient clinics. An intervention focused on specific patient characteristics could further increase the effectiveness of appointment reminders.

  5. Impact of Primary Language and Insurance on Pediatric Hearing Health Care in a Multidisciplinary Clinic.

    Science.gov (United States)

    Su, Brooke M; Park, Jason S; Chan, Dylan K

    2017-10-01

    Objective This study aims to describe the effects of primary language and insurance status on care utilization among deaf or hard-of-hearing children under active otolaryngologic and audiologic care. Study Design Cross-sectional analysis. Setting Multidisciplinary hearing loss clinic at a tertiary center. Subjects and Methods Demographics, hearing loss data, and validated survey responses were collected from 206 patients aged 0 to 19 years. Two-sided t tests and χ 2 tests were used to obtain descriptive statistics and hypothesis testing. Results Of the sample, 52.4% spoke primarily English at home. Non-English-speaking children and families were less likely to receive psychiatric counseling (12.2% vs 35.2% in the English group, P children were less likely to know the type or degree of their child's hearing loss (56.9% vs 75.4%, P = .022), and these children were older on presentation to the clinic (8.5 vs 6.5 years of age, P = .01) compared to privately insured children. Publicly insured children were less likely to receive cochlear implants ( P = .046) and reported increased difficulty obtaining hearing aids ( P = .047). While all patients reported impairment in hearing-related quality of life, publicly insured children aged 2 to 7 years were more likely to perform below minimum thresholds on measures of auditory/oral functioning. Conclusion Even when under active care, deaf or hard-of-hearing children from families who do not speak English at home or with public insurance face more difficulty obtaining educational services, cochlear implants, and hearing aids. These findings represent significant disparities in access to necessary interventions.

  6. [Outdoor activity and myopia among 681 primary students in urban and rural regions of Beijing].

    Science.gov (United States)

    Guo, Yin; Liu, Lijuan; Xu, Liang; Lü, Yanyun; Tang, Ping; Feng, Yi

    2014-01-21

    To explore the association between outdoor activity and myopia among 681 primary students from Beijing. School-based, cross-sectional investigation. Eye examination includes the visual acuity test, auto-refractor, slit lamp, ocular biometry and non-mydriatic fundus camera. Questionnaire includes regular items, near work, outdoor activity and social-economic status. The mean time spent outdoors was 1.6 ± 0.8 hours daily. Time spent on outdoor sports and outdoor leisure were 0.7 ± 0.1 hours daily, 1.0 ± 0.8 hours daily, respectively. Mean time of outdoor activity in urban was 1.1 ± 0.4 hours daily, compared with 2.2 ± 0.8 hours daily in rural (P = 0.000). In grade-1, total time spent outdoors is significantly different between myopia and non-myopia (1.4 ± 0.6 vs 1.8 ± 0.8 hours daily, P = 0.000), similar to outdoor leisure (0.8 ± 0.6 vs 1.1 ± 0.9 hours daily, P = 0.000). The same trend was also found in grade-4. The mean time spent outdoors was 1.6 ± 0.8 hours daily. Myopia spent a lower outdoor activity compared with non-myopia. More outdoor activity, e.g., in schools, may potentially be helpful to reduce the high prevalence of myopia in the young generation.

  7. Primary care utilisation patterns among an urban immigrant population in the Spanish National Health System

    Directory of Open Access Journals (Sweden)

    Bordonaba-Bosque Daniel

    2011-06-01

    Full Text Available Abstract Background There is evidence suggesting that the use of health services is lower among immigrants after adjusting for age and sex. This study takes a step forward to compare primary care (PC utilisation patterns between immigrants and the native population with regard to their morbidity burden. Methods This retrospective, observational study looked at 69,067 individuals representing the entire population assigned to three urban PC centres in the city of Zaragoza (Aragon, Spain. Poisson models were applied to determine the number of annual PC consultations per individual based on immigration status. All models were first adjusted for age and sex and then for age, sex and case mix (ACG System®. Results The age and sex adjusted mean number of total annual consultations was lower among the immigrant population (children: IRR = 0.79, p Conclusions Although immigrants make lower use of PC services than the native population after adjusting the consultation rate for age and sex, these differences decrease significantly when considering their morbidity burden. These results reinforce the 'healthy migration effect' and discount the existence of differences in PC utilisation patterns between the immigrant and native populations in Spain.

  8. Pediatric neurocritical care.

    Science.gov (United States)

    Murphy, Sarah

    2012-01-01

    Pediatric neurocritical care is an emerging multidisciplinary field of medicine and a new frontier in pediatric critical care and pediatric neurology. Central to pediatric neurocritical care is the goal of improving outcomes in critically ill pediatric patients with neurological illness or injury and limiting secondary brain injury through optimal critical care delivery and the support of brain function. There is a pressing need for evidence based guidelines in pediatric neurocritical care, notably in pediatric traumatic brain injury and pediatric stroke. These diseases have distinct clinical and pathophysiological features that distinguish them from their adult counterparts and prevent the direct translation of the adult experience to pediatric patients. Increased attention is also being paid to the broader application of neuromonitoring and neuroprotective strategies in the pediatric intensive care unit, in both primary neurological and primary non-neurological disease states. Although much can be learned from the adult experience, there are important differences in the critically ill pediatric population and in the circumstances that surround the emergence of neurocritical care in pediatrics.

  9. FDG PET/CT in pediatric primary bone tumours: comparison with conventional imaging (CI) and management impact assesment

    International Nuclear Information System (INIS)

    Stege, Claudia; London, Kevin; Cross, Siobhan; Howman-Giles, Robert; Onikul, Ella; Graf, Nicole; Pozza, L.D.

    2009-01-01

    Full text: To evaluate PET/CT in pediatric primary bone tumours (PBT), the accuracy, clinical impact, prognostic indicators in predicting tumour response to therapy and determining epiphyseal involvement were compared to Cl. Methods: A retrospective review of PET/CT scans with CI was performed. Lesions were compared to a reference standard: histopathology or follow up >6 mths. Pt based analysis was performed for clinical impact. Prognostic indicators (SUYmax, tumour size) were compared to histopathology response post chemotherapy. Results: 43 pts (average 12.9 yrs) with osteosarcoma (I 8), Ewing's sarcoma (21), PNE (4) were analysed. 109 PET/CT scans with CI scans were evaluated (371 lesions). 33 lesions were discordant. Accuracy of PET/CT was higher for all lesions than CI (95% vs92%) but sensitivity was lower (79% vs 83%). Excluding lung lesions, sensitivities increased for PET/CT and CI (92% vs 89%). 9pts had PET/CT staging and follow up with histopathological evaluation post chemotherapy: 2pts poor responders, 7 good responders. Good responders had a higher SUYmax at diagnosis compared to poor responders (av 13.84 vs 7.95) but reduced more [10.5(70%) vs 3.5( 45%)]following chemotherapy. There were no false negatives for epiphyseal involvement for PET/CT and CI but one PET/CT was false positive. Conclusion: PET/CT is less sensitive in small lung lesions, but more sensitive in other areas compared to Cl. SUYmax at diagnosis is a poor predictor of response, but percent decrease post therapy was associated with therapeutic response. Change in tumour size on MR is a poor predictor of response. There is improved clinical impact with PET/CT in patient management.

  10. Establishment of primary cell culture and an intracranial xenograft model of pediatric ependymoma: a prospect for therapy development and understanding of tumor biology.

    Science.gov (United States)

    Pavon, Lorena Favaro; Sibov, Tatiana Tais; Caminada de Toledo, Silvia Regina; Mara de Oliveira, Daniela; Cabral, Francisco Romero; Gabriel de Souza, Jean; Boufleur, Pamela; Marti, Luciana C; Malheiros, Jackeline Moraes; Ferreira da Cruz, Edgar; Paiva, Fernando F; Malheiros, Suzana M F; de Paiva Neto, Manoel A; Tannús, Alberto; Mascarenhas de Oliveira, Sérgio; Silva, Nasjla Saba; Cappellano, Andrea Maria; Petrilli, Antonio Sérgio; Chudzinski-Tavassi, Ana Marisa; Cavalheiro, Sérgio

    2018-04-24

    Ependymoma (EPN), the third most common pediatric brain tumor, is a central nervous system (CNS) malignancy originating from the walls of the ventricular system. Surgical resection followed by radiation therapy has been the primary treatment for most pediatric intracranial EPNs. Despite numerous studies into the prognostic value of histological classification, the extent of surgical resection and adjuvant radiotherapy, there have been relatively few studies into the molecular and cellular biology of EPNs. We elucidated the ultrastructure of the cultured EPN cells and characterized their profile of immunophenotypic pluripotency markers (CD133, CD90, SSEA-3, CXCR4). We established an experimental EPN model by the intracerebroventricular infusion of EPN cells labeled with multimodal iron oxide nanoparticles (MION), thereby generating a tumor and providing a clinically relevant animal model. MRI analysis was shown to be a valuable tool when combined with effective MION labeling techniques to accompany EPN growth. We demonstrated that GFAP/CD133+CD90+/CD44+ EPN cells maintained key histopathological and growth characteristics of the original patient tumor. The characterization of EPN cells and the experimental model could facilitate biological studies and preclinical drug screening for pediatric EPNs. In this work, we established notoriously challenging primary cell culture of anaplastic EPNs (WHO grade III) localized in the posterior fossa (PF), using EPNs obtained from 1 to 10-year-old patients ( n = 07), and then characterized their immunophenotype and ultrastructure to finally develop a xenograft model.

  11. Yield of Echocardiogram and Predictors of Positive Yield in Pediatric Patients: A Study in an Urban, Community-Based Outpatient Pediatric Cardiology Clinic.

    Science.gov (United States)

    Billa, Ramya Deepthi; Szpunar, Susan; Zeinali, Lida; Anne, Premchand

    2018-01-01

    The yield of outpatient echocardiograms varies based on the indication for the echocardiogram and the age of the patient. The purpose of this study was to determine the cumulative yield of outpatient echocardiograms by age group and reason for the test. A secondary aim was to determine the predictors of a positive echocardiogram in an outpatient cardiology clinic at a large community teaching hospital. We retrospectively reviewed the charts of 891 patients who had a first-time echocardiogram between 2011 and 2015. Positive yield was defined as echocardiographic findings that explained the reason for the echocardiogram. The overall positive yield was 8.2%. Children between birth and 3 months of age had the highest yield (34.2%), and children between 12 and 18 years of age had the lowest yield (1%). Patients with murmurs (18.1%) had the highest yield compared with patients with other signs or symptoms. By age group and reason, the highest yields were as follows: 0 to 3 months of age, murmur (39.2%); 4 to 11 months of age, >1 symptom (50%); and 1 to 5 years of age, shortness of breath (66.7%). Based on our study, the overall yield of echocardiograms in the outpatient pediatric setting is low. Age and symptoms should be considered before ordering an echocardiogram.

  12. [Development of national neglect norm for urban primary school students of China].

    Science.gov (United States)

    Pan, Jian-ping; Wang, Fei; Li, Min; Chen, Jing-qi; Zhang, Hui-ying; Wang, Gui-xiang; Gu, Gui-xiong; Guo, Wei-wei; Peng, Yu-lin; Shi, Shu-hua; Chen, Guang-hu; Yi, Hua-ni; Fu, Ping; Xia, Li; Yu, Hong; Lu, Biao; Duan, Zhi-xian; Wang, Ying-xiong; Zhong, Zhao-hui; Li, Jian; Wang, Lin; Cao, Chun-hong; Luo, Sha-sha; Zhang, Song-jie; Zhang, Hua

    2013-02-01

    To develop the national neglect norms for urban primary school students in China. According to multi-stage stratified cluster sampling principle, 24 cities of 13 provinces (municipalities) in China were selected during December 1 to 31, 2008. A total of 1491 students in grade 1 - 3 and 2236 students in grade 4 - 6 were selected. Questionnaire was designed by authors and the final norms were determined through several statistical analysis methods, such as item analysis method, factor analysis method, reliability analysis method. The reliability analysis and validity analysis were used to test the stability and reliability of the norms. The evaluation criteria of the scale was determined by the percentile method, then the initial development of the norm was completed. The two questionnaires of grade 1 - 3 and grade 4 - 6 students consisted of 55 and 57 items, respectively, whose item loadings were ranged from 0.301 to 0.687 and 0.321 to 0.730, which met the statistical requirements. For grade 1 - 3 students, the scale's total Cronbach α coefficients was 0.914, the total split-half reliability coefficients was 0.896, the Cronbach α coefficients of four level was above 0.737 except medical and social neglect, split-half reliability was ranged from 0.461 to 0.757; for grade 4-6 students, the scale's total Cronbach α coefficients was 0.916, split-half reliability was 0.883, except social neglect, the Cronbach α coefficients of other level was ranged 0.457 to 0.856, split-half reliability was ranged from 0.500 to 0.798. The total neglect cut-off score of the two scales grade 1-3 and 4-6 were 125 and 155, respectively. The structure of two norms was reasonable. The scales have good stability and reliability.

  13. Depression, anxiety and stress symptoms among diabetics in Malaysia: a cross sectional study in an urban primary care setting

    OpenAIRE

    Kaur, Gurpreet; Tee, Guat Hiong; Ariaratnam, Suthahar; Krishnapillai, Ambigga S; China, Karuthan

    2013-01-01

    Background Diabetes mellitus is a highly prevalent condition in Malaysia, increasing from 11.6% in 2006 to 15.2% in 2011 among individuals 18 years and above. Co-morbid depression in diabetics is associated with hyperglycemia, diabetic complications and increased health care costs. The aims of this study are to determine the prevalence and predictors of depression, anxiety and stress symptoms in Type II diabetics attending government primary care facilities in the urban area of Klang Valley, ...

  14. Screening and Follow-Up Monitoring for Substance Use in Primary Care: An Exploration of Rural-Urban Variations.

    Science.gov (United States)

    Chan, Ya-Fen; Lu, Shou-En; Howe, Bill; Tieben, Hendrik; Hoeft, Theresa; Unützer, Jürgen

    2016-02-01

    Rates of substance use in rural areas are close to those of urban areas. While recent efforts have emphasized integrated care as a promising model for addressing workforce shortages in providing behavioral health services to those living in medically underserved regions, little is known on how substance use problems are addressed in rural primary care settings. To examine rural-urban variations in screening and monitoring primary care- based patients for substance use problems in a state-wide mental health integration program. This was an observational study using patient registry. The study included adult enrollees (n = 15,843) with a mental disorder from 133 participating community health clinics. We measured whether a standardized substance use instrument was used to screen patients at treatment entry and to monitor symptoms at follow-up visits. While on average 73.6 % of patients were screened for substance use, follow-up on substance use problems after initial screening was low (41.4 %); clinics in small/isolated rural settings appeared to be the lowest (13.6 %). Patients who were treated for a mental disorder or substance abuse in the past and who showed greater psychiatric complexities were more likely to receive a screening, whereas patients of small, isolated rural clinics and those traveling longer distances to the care facility were least likely to receive follow-up monitoring for their substance use problems. Despite the prevalent substance misuse among patients with mental disorders, opportunities to screen this high-risk population for substance use and provide a timely follow-up for those identified as at risk remained overlooked in both rural and urban areas. Rural residents continue to bear a disproportionate burden of substance use problems, with rural-urban disparities found to be most salient in providing the continuum of services for patients with substance use problems in primary care.

  15. Primary tacrolimus (FK506) therapy and the long-term risk of post-transplant lymphoproliferative disease in pediatric liver transplant recipients.

    Science.gov (United States)

    Cacciarelli, T V; Reyes, J; Jaffe, R; Mazariegos, G V; Jain, A; Fung, J J; Green, M

    2001-10-01

    While the overall incidence of post-transplant lymphoproliferative disease (PTLD) in pediatric liver transplant recipients has been reported to be 4-11%, the long-term risk of PTLD associated with primary tacrolimus therapy is unknown. Therefore, in order to determine the incidence and long-term risk of PTLD, the present study examined 131 pediatric recipients who underwent liver transplantation (LTx) between October 1989 and December 1991 and received primary tacrolimus therapy. This cohort of children was evaluated over an extended time-period (until December 31 1996) with a mean follow-up of 6.3 yr. Actuarial Kaplan-Meier analysis was utilized to determine the risk of PTLD over time. The overall incidence of PTLD was 13% (17/131) with an average age of 4.3 +/- 0.75 yr at diagnosis. Pretransplant Epstein-Barr virus (EBV) serologies were negative in 82%, positive in 12%, and not available in 6% of the patients. The median time to diagnosis of PTLD post-Tx was 11.9 months (mean 16.4 +/- 3.9, range 1.7-63.0 months). Mean tacrolimus dose and plasma trough level (as evaluated by enzyme-linked immunosorbent assay [ELISA]) at the time of diagnosis was 0.32 +/- 0.06 mg/kg/day and 1.3 +/- 0.3 ng/mL, respectively. The cumulative long-term risk of PTLD was found to increase over time: 3% at 6 months, 8% at 1 yr, 12% at 2 yr, 14% at 3 yr, and 15% at 4 and 5 yr. Mortality from PTLD was 12% (two of 17 patients). Primary tacrolimus use in pediatric LTx has a long-term risk of PTLD approaching 15%, with the majority of episodes (78%) occurring in the first 2 yr, suggesting that intense EBV surveillance should occur early post-transplantation.

  16. Intertextuality in Read-Alouds of Integrated Science-Literacy Units in Urban Primary Classrooms: Opportunities for the Development of Thought and Language

    Science.gov (United States)

    Varelas, Maria; Pappas, Christine C.

    2006-01-01

    The nature and evolution of intertextuality was studied in 2 urban primary-grade classrooms, focusing on read-alouds of an integrated science-literacy unit. The study provides evidence that both debunks deficit theories for urban children by highlighting funds of knowledge that these children bring to the classroom and the sense they make of them…

  17. The Effect of Free Primary Education Policy on Late School Entry in Urban Primary Schools in Kenya

    Science.gov (United States)

    Ngware, Moses W.; Oketch, Moses; Ezeh, Alex C.; Mutisya, Maurice

    2013-01-01

    Late school entry is driven by several factors, one of the key ones being the cost barrier to schooling. Policies such as free primary education (FPE) that advocate for universal coverage are therefore partly aimed at removing the cost barrier. The Kenyan Government, like many in sub-Saharan Africa (SSA), introduced FPE in 2003 with the aim of…

  18. Pediatric Specialists

    Science.gov (United States)

    ... Healthy Children > Family Life > Medical Home > Pediatric Specialists Pediatric Specialists Article Body ​Your pediatrician may refer your child to a pediatric specialist for further evaluation and treatment. Pediatric specialists ...

  19. Environmental Factors Associated with Primary Care Access Among Urban Older Adults

    OpenAIRE

    Ryvicker, Miriam; Gallo, William T.; Fahs, Marianne C.

    2012-01-01

    Disparities in primary care access and quality impede optimal chronic illness prevention and management for older adults. Although research has shown associations between neighborhood attributes and health, little is known about how these factors – in particular, the primary care infrastructure – inform older adults’ primary care use. Using geographic data on primary care physician supply and surveys from 1,260 senior center attendees in New York City, we examined factors that facilitate and ...

  20. Using mHealth technologies to improve the identification of behavioral health problems in urban primary care settings.

    Science.gov (United States)

    Staeheli, Martha; Aseltine, Robert H; Schilling, Elizabeth; Anderson, Daren; Gould, Bruce

    2017-01-01

    Behavioral health disorders remain under recognized and under diagnosed among urban primary care patients. Screening patients for such problems is widely recommended, yet is challenging to do in a brief primary care encounter, particularly for this socially and medically complex patient population. In 2013, intervention patients at an urban Connecticut primary clinic were screened for post-traumatic stress disorder, depression, and risky drinking (n = 146) using an electronic tablet-based screening tool. Screening data were compared to electronic health record data from control patients (n = 129) to assess differences in the prevalence of behavioral health problems, rates of follow-up care, and the rate of newly identified cases in the intervention group. Results from logistic regressions indicated that both groups had similar rates of disorder at baseline. Patients in the intervention group were five times more likely to be identified with depression (p Post-traumatic stress disorder was virtually unrecognized among controls but was observed in 23% of the intervention group (p behavioral health problems identified in the intervention group were new cases. Follow-up rates were significantly higher in the intervention group relative to controls, but were low overall. This tablet-based electronic screening tool identified significantly higher rates of behavioral health disorders than have been previously reported for this patient population. Electronic risk screening using patient-reported outcome measures offers an efficient approach to improving the identification of behavioral health problems and improving rates of follow-up care.

  1. Environmental factors associated with primary care access among urban older adults.

    Science.gov (United States)

    Ryvicker, Miriam; Gallo, William T; Fahs, Marianne C

    2012-09-01

    Disparities in primary care access and quality impede optimal chronic illness prevention and management for older adults. Although research has shown associations between neighborhood attributes and health, little is known about how these factors - in particular, the primary care infrastructure - inform older adults' primary care use. Using geographic data on primary care physician supply and surveys from 1260 senior center attendees in New York City, we examined factors that facilitate and hinder primary care use for individuals living in service areas with different supply levels. Supply quartiles varied in primary care use (visit within the past 12 months), racial and socio-economic composition, and perceived neighborhood safety and social cohesion. Primary care use did not differ significantly after controlling for compositional factors. Individuals who used a community clinic or hospital outpatient department for most of their care were less likely to have had a primary care visit than those who used a private doctor's office. Stratified multivariate models showed that within the lowest-supply quartile, public transit users had a higher odds of primary care use than non-transit users. Moreover, a higher score on the perceived neighborhood social cohesion scale was associated with a higher odds of primary care use. Within the second-lowest quartile, nonwhites had a lower odds of primary care use compared to whites. Different patterns of disadvantage in primary care access exist that may be associated with - but not fully explained by - local primary care supply. In lower-supply areas, racial disparities and inadequate primary care infrastructure hinder access to care. However, accessibility and elder-friendliness of public transit, as well as efforts to improve social cohesion and support, may facilitate primary care access for individuals living in low-supply areas. Copyright © 2012 Elsevier Ltd. All rights reserved.

  2. Differences in Employee Motivation at Slovak Primary Schools in Rural and Urban Areas

    Science.gov (United States)

    Hitka, Miloš; Stachová, Katarína; Balážová, Žaneta; Stacho, Zdenko

    2015-01-01

    In spite of turbulent urbanisation in Slovakia we assume that the 21st century is also a period of differences in value criteria of people living in rural and urban areas. The level of urbanisation, i.e. inhabitant movement from the countryside to towns and the level of suburbanisation, i.e. inhabitant movement from towns to the countryside, are…

  3. Free Primary Education Policy and Pupil School Mobility in Urban Kenya

    Science.gov (United States)

    Oketch, Moses; Mutisya, Maurice; Ngware, Moses; Ezeh, Alex C.; Epari, Charles

    2010-01-01

    This paper examines pupil school mobility in urban Kenya using African Population and Health Research Centre (APHRC) household survey data which contain information on pupil transfers between schools. The aim is to identify which school characteristics attract the greatest demand for incoming transfers. The analysis reveals that there are frequent…

  4. Underdiagnosis and Lower Rates of Office Visits for Overweight/Obese Pediatric Patients in Rural Compared with Urban Areas.

    Science.gov (United States)

    SanGiovanni, Christine; McElligott, James; Morella, Kristen; Basco, William

    2017-07-01

    This study compared the number of children enrolled in Medicaid in rural and urban areas of South Carolina with an overweight/obesity diagnosis and the mean rates of office visits with overweight/obesity diagnosed. Medicaid claims data from 2012 for children in three South Carolina counties, categorized as urban, rural high resource, and rural low resource, were used to identify those who had been diagnosed as being overweight/obese during any encounter. Logistic and Poisson regressions were performed to predict whether overweight/obese children in each county would receive an overweight/obesity visit diagnosis and to calculate the mean rate of total office visits with an overweight/obesity diagnosis in each county. A total of 1233 children enrolled in Medicaid were diagnosed as being overweight/obese at any encounter in the designated counties. Well visits with overweight/obesity diagnosed varied significantly, with 42.6%, 28%, and 11% in urban, rural high-resource counties, and rural low-resource counties, respectively ( P overweight/obese at a well visit. All of the children had a low number of total office visits with overweight/obesity diagnosed. When comparing the counties, urban children (1.22 visits per year) had more visits than rural low-resource children (0.75 visits per year, P Overweight/obesity is underdiagnosed in rural children enrolled in Medicaid in South Carolina, which affects the number of children who receive help to manage their weight. Interventions to overcome barriers of diagnosis and management are necessary to address childhood obesity properly.

  5. Primary school teachers’ opinions and attitudes towards stuttering in two South African urban education districts

    OpenAIRE

    Kristen Abrahams; Michal Harty; Kenneth O. St. Louis; Lehana Thabane; Harsha Kathard

    2016-01-01

    Background: As teachers form an important part of the intervention process with childrenwho stutter in primary school, the primary aim was to describe primary school teachers’attitudes in South Africa. The secondary aim was to compare teachers’ attitudes towardsstuttering in South Africa with those from a pooled group of respondents in the Public OpinionSurvey of Human Attributes–Stuttering (POSHA-S) database from different countries collectedin 2009–2014. Method: A quantitative, cross-sec...

  6. Pediatric tracheostomy.

    Science.gov (United States)

    Campisi, Paolo; Forte, Vito

    2016-06-01

    Tracheotomy refers to a surgical incision made into a trachea. Tracheostomy, on the other hand, refers to a surgical procedure whereby the tracheal lumen is positioned in close proximity to the skin surface. Tracheostomy is an uncommon procedure in the pediatric population. When required tracheostomy is typically performed as an open surgical procedure under general anesthesia with the patient intubated. However, it may need to be performed under local anesthesia or over a rigid bronchoscope in the patient with a precarious airway. Over the past half century, the primary indication for pediatric tracheostomy has shifted from acute infectious airway compromise to the need for prolonged ventilatory support in neurologically compromised children. The surgical technique, choice of tracheostomy tube, and post-operative care requires a nuanced approach in infants and young children. This article will review these topics in a comprehensive fashion. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Effects of Language of Instruction on Learning of Literacy Skills among Pre-Primary School Children from Low-Income Urban Communities in Kenya

    Science.gov (United States)

    Hungi, Njora; Njagi, Joan; Wekulo, Patricia; Ngware, Moses

    2018-01-01

    This study investigates the relationship between the language of instruction and learning of literacy skills among pre-primary school children in a multilingual environment. The sample consists of 1867 learners from low-income urban households, attending 147 low-cost private pre-primary schools located in low-income areas of Nairobi, Kenya. About…

  8. Junior Primary Greek School Pupils' Perceptions of the City's Public Open Spaces and Especially of the Urban Square: A Case Study

    Science.gov (United States)

    Papageorgiou, Nikoletta; Galani, Apostolia; Mavrikaki, Evangelia

    2016-01-01

    This work--part of a wider project aimed at engaging first year primary school pupils in public open-space design--explores the perceptions of junior primary school children as to the urban square. Data collection tools comprised semi-structured interviews, sketches and storytelling via puppet-animation. Our findings have shown that--according to…

  9. Client waiting time in an urban primary health care centre in Lagos ...

    African Journals Online (AJOL)

    Background: Primary Health Care is the usual entry point into the health system and has the potential to touch the lives of most people. However one of the reasons for poor uptake of health services at primary health care facilities in Nigeria is long waiting time. This study was carried out to assess client waiting time and ...

  10. Prevalence of primary headaches in an urban slum in Enugu South East Nigeria: a door-to-door survey.

    Science.gov (United States)

    Ezeala-Adikaibe, Birinus A; Onyekonwu, Chinwe; Okudo, Grace; Onodugo, Obinna; Ekenze, Stella; Orjioke, Casmir; Chime, Peter; Ezeanosike, Obum; Mbadiwe, Nkiru; Chikani, Mark; Okwara, Celestine; Ulasi, Ifeoma; Ijoma, Uchenna

    2014-01-01

    This study aims to determine the prevalence of primary headache disorders using the second edition of international classification of headache disorders among urban slum dwellers. Headache is a common neurological disorder and one of the most common reasons for visiting the neurology clinics in Nigeria. Low socioeconomic status has been linked with primary headaches. Factors that may precipitate and sustain headaches are common in Africa especially in urban slums. There are limited population based data on the prevalence of headache from Nigeria and other African countries. A 3 phase cross-sectional descriptive study was done to survey at least 40% of the adult population (Igbos) living in an urban slum using the International Classification of Headache Disorders 2nd Edition (ICHD-I) criteria using a validated Igbo language adaptation (translation and back-translation into Igbo language) of a World Health Organization protocol for screening neurological disorders in the community. The lifetime prevalence of headache of any type was 66.7% (95% confidence interval [CI] 64.2-69.2), significantly higher in females (70.2% [95% CI 67.0-73.4]) than in males (62.3% [95% CI 58.5-66.1]; P = .0.002). The prevalence of primary headaches was also significantly lower in males than in females (44.9% [95% CI 45.5-53.3] vs 53.2% (95% CI 49.3-57.1), P = .002). Female (52.1%) drinkers had a statistically higher prevalence of primary headaches than male drinkers (43.6%; P = .004). The prevalence of migraine was 6.4% (95% CI 5.1-7.7); 7.5% (95% CI 5.6-9.4) in females and 5% (95% CI 3.3-6.7) in males (P = .058). Migraine with aura was similar in both males and females. Migraine without aura was significantly higher in females (5.7%) than males (3.1%) (P = .022). Tension-type headache (TTH) had an overall prevalence of 13.8% (95% CI 11.3-16.3), males 12.2% (95% CI 9.7-14.7), and females 15.1% (95% CI 12.6-17.6; P = .118.) The peak decade for all primary headaches

  11. Urban and rural implementation of pre-hospital diagnosis and direct referral for primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction

    DEFF Research Database (Denmark)

    Sørensen, Jacob Thorsted; Terkelsen, Christian Juhl; Nørgaard, Bjarne Linde

    2011-01-01

    Primary percutaneous coronary intervention (PCI) is the preferred treatment for ST-elevation myocardial infarction (STEMI). The distance to primary PCI centres and the inherent time delay in delivering primary PCI, however, limit widespread use of this treatment. This study aimed to evaluate...... the impact of pre-hospital diagnosis on time from emergency medical services contact to balloon inflation (system delay) in an unselected cohort of patients with STEMI recruited from a large geographical area comprising both urban and rural districts....

  12. Influence of the informal primary caretaker on glycemic control among prepubertal pediatric patients with type 1 diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Jessie Nallely Zurita-Cruz

    2017-03-01

    Full Text Available Objectives: In prepubertal type 1 diabetic patients (DM1, the availability of an informal primary caregiver (ICP is critical to making management decisions; in this study, the ICP-related risk factors associated with glycemic control were identified. Patients, materials, and methods: A comparative cross-sectional study was performed. Fifty-five patients with DM1 under the age of 11 years were included. The patient-related factors associated with glycemic control evaluated were physical activity, DM1 time of evolution, and adherence to medical indications. The ICP-related factors evaluated were education, employment aspects, depressive traits (Beck questionnaire, family functionality (family APGAR, support of another person in patient care, stress (Perceived Stress Scale, and socioeconomic status (Bronfman questionnaire. Multivariate logistic and linear regression analyses were performed. Results: The patients’ median age was 8 years; 29 patients had good glycemic control, and 26 were uncontrolled. The main risk factor associated with glycemic dyscontrol was stress in the ICP (OR 24.8; 95% CI 4.06–151.9, p = 0.001. While, according to the linear regression analysis it was found that lower level of education (β 0.991, 95% CI 0.238–1.743, p = 0.011 and stress (β 1.918, 95% CI 1.10–2.736, p = 0.001 in the ICP, as well as family dysfunction (β 1.256, 95% CI 0.336–2.177, p = 0.008 were associated with higher levels of glycated hemoglobin. Conclusions: Level of education and stress in the ICP, as well as family dysfunction, are factors that influence the lack of controlled blood glucose levels among prepubertal DM1 patients. Resumo: Objetivos: Em pacientes pré-púberes com diabetes tipo 1 (DM1, a disponibilidade de um cuidador familiar principal (CFP é fundamental para tomar decisões de administração; neste estudo, foram identificados os fatores de risco relacionados a CFPs associados ao controle glicêmico. Pacientes

  13. The family role in children׳s sleep disturbances: Results from a cross-sectional study in a Portuguese Urban pediatric population.

    Science.gov (United States)

    Martins, Andreia Luís; Chaves, Petra; Papoila, Ana Luísa; Loureiro, Helena Cristina

    2015-11-01

    Sleep Disorders (SlD) are frequently undervalued complaints in childhood. Several factors influence sleep, particularly socio-cultural environment and medical conditions such as breathing disorders. Poor sleep hygiene has physical, educational and social consequences. In Portugal, there are few published studies about children׳s sleep habits and rarely based on validated questionnaires. To study the prevalence of SlD and associated factors, in an outpatient pediatric population of a Primary Health Care Center (PHCC). Cross-sectional study of children admitted to a PHCC on a suburban area of Lisbon. Children Sleep Habits Questionnaire, validated for the Portuguese population (CSHQ-PT) for the screening of SlD (cut-off=44), was applied to parents, as well as a demographic inquiry. Body mass index z-score was evaluated. Children scoring 44 or above were sent to Pediatric Sleep Disorders consultation (PSDC). Parametric and non-parametric tests were used whenever appropriate. From 128 children, 57.8% were male; the median age was 6.0 years (P 25=5.0; P 75=8.0). The median of cohabitants per family was 4.0 (P 25=3.0; P 75=5.0); 21.1% lived in a single-parent family. From CSHQ-PT, 59.4% (76) scored above the cut-off. Data showed that children from a single-parent family have more SlD (p=0.048), particularly parasomnia (p=0.019). Children with sleep disordered breathing (SDB) suffer more daytime sleepiness (p=0.034). From 63 children sent to PSDC, 33 attended. Regarding these children, a difference was found between BMI z-scores of those with and without SDB (p=0.06). Family structure plays a non-negligible role in children's sleep habits. Daily performance of children with SDB may become compromised.

  14. Pediatric Sinusitis

    Science.gov (United States)

    ... ENTCareers Marketplace Find an ENT Doctor Near You Pediatric Sinusitis Pediatric Sinusitis Patient Health Information News media interested in ... sinuses are present at birth. Unlike in adults, pediatric sinusitis is difficult to diagnose because symptoms of ...

  15. Pediatric Asthma

    Science.gov (United States)

    ... Science Education & Training Home Conditions Asthma (Pediatric) Asthma (Pediatric) Make an Appointment Refer a Patient Ask a ... meet the rising demand for asthma care. Our pediatric asthma team brings together physicians, nurses, dietitians, physical ...

  16. Mothers' Perspectives on the Development of Their Preschoolers' Dietary and Physical Activity Behaviors and Parent-Child Relationship: Implications for Pediatric Primary Care Physicians.

    Science.gov (United States)

    Pratt, Keeley J; Van Fossen, Catherine; Cotto-Maisonet, Jennifer; Palmer, Elizabeth N; Eneli, Ihuoma

    2017-07-01

    The study explores female caregivers' reflections on their relationship with their child (2-5 years old) and the development of their child's dietary and physical activity behaviors. Five, 90-minute semistructured focus groups were conducted to inquire about children's growth, eating behaviors and routines, physical activity, personality, and the parent-child relationship. Nineteen female caregivers diverse in race/ethnicity, age, and educational attainment participated. Participants reported that they maintained a schedule, but needed to be flexible to accommodate daily responsibilities. Family, social factors, and day care routines were influences on their children's behaviors. The main physical activity barriers were safety and time constraints. Guidance from pediatric primary care providers aimed at supporting female caregivers to build a positive foundation in their parent-child relationship, and to adopt and model healthy diet and physical activity behaviors that are respectful of schedules and barriers should be a priority for childhood obesity prevention.

  17. An in-situ simulation-based educational outreach project for pediatric trauma care in a rural trauma system.

    Science.gov (United States)

    Bayouth, Lilly; Ashley, Sarah; Brady, Jackie; Lake, Bryan; Keeter, Morgan; Schiller, David; Robey, Walter C; Charles, Stephen; Beasley, Kari M; Toschlog, Eric A; Longshore, Shannon W

    2018-02-01

    Outcome disparities between urban and rural pediatric trauma patients persist, despite regionalization of trauma systems. Rural patients are initially transported to the nearest emergency department (ED), where pediatric care is infrequent. We aim to identify educational intervention targets and increase provider experience via pediatric trauma simulation. Prospective study of simulation-based pediatric trauma resuscitation was performed at three community EDs. Level one trauma center providers facilitated simulations, providing educational feedback. Provider performance comfort and skill with tasks essential to initial trauma care were assessed, comparing pre-/postsimulations. Primary outcomes were: 1) improved comfort performing skills, and 2) team performance during resuscitation. Provider comfort with the following improved (p-values education improves provider comfort and performance. Comparison of patient outcomes to evaluate improvement in pediatric trauma care is warranted. IV. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. A chart review of morbidity patterns among adult patients attending primary care setting in urban Odisha, India: An International Classification of Primary Care experience

    Directory of Open Access Journals (Sweden)

    Subhashisa Swain

    2017-01-01

    Full Text Available Introduction: Disease burden estimations based on sound epidemiological research provide the foundation for designing health services. Patients visiting a primary care often present with symptoms and signs. Understanding the burden is crucial for developing countries including India. The project aimed to record the reasons for encounter (RFE at primary care settings for estimating the burden at the health-care facility. Methodology: This cross-sectional study was undertaken at four urban health dispensaries of Bhubaneswar, Odisha, with the aim to explore the prevailing patterns of diseases among patients attending these facilities. Data collection spanned from May to October 2012. At each center, patients' information on age, sex, religion, and presenting illness was extracted from the outpatient records over these time period. Data were entered and analyzed in SPSS version 20, and the International Classification of Primary Care-2 was used for coding the illnesses. Results: In total, 2249 patient's records were extracted over 12 weeks. Out of them, 1241 (55.2% were male with mean age of 41.8 (±15.8 years vis-à -vis 38.2 (±14.1 years for females. Around 151 (6.7% had 2 or more symptoms or conditions. Overall, the most common categories were general and unspecified followed by digestive-related symptoms in both sexes. The most common symptoms among males were fever (11.4%, heart burn (8.1%, and vertigo or dizziness (3.6%. Similar pattern was seen among females. Respiratory (17.0% and cardiovascular (10.2% problems were the most common RFEs among males and females. The most common RFEs for acute care among males and females were fever, allergic rhinitis, upper respiratory tract infection, and acute bronchitis. Leading RFEs for chronic care among males were hypertension uncomplicated, heart burn, low back pain, whereas among females, hypertension and heartburn were mostly seen. Conclusion: Primary care settings are experiencing both communicable

  19. Morbidity pattern and personal hygiene in children among private primary school in urban area: are the trends changing?

    Science.gov (United States)

    Mhaske, Mayavati S; Khismatrao, Deepak S; Kevin, Fernandez; Pandve, Harshal T; Kundap, Ritesh P

    2013-07-01

    School health is an important intervention as a great deal of research tells us that schools can have a major effect on children's health, by teaching them about health and promoting healthy behaviors. The aim of this study is to determine common health problems and assess personal hygiene status among primary school children. A cross-sectional study was conducted in academic years 2009-2010 and 2010-2011, with three health check-up camps organized in private primary school of Pune city. A total of 450 students were assessed for health problems and composite score of personal hygiene status was calculated ranging from 0 to 5 by examination of hairs, nails, skin and clothes. Proportions calculated with application of Chi-square test and Pearson co-efficient applied to observe the relation between two quantitative variables. Out of 450 students examined, 56.2% were boys and 43.8% were girls with age ranging from 5 to 10 years. The major morbidities observed were dental caries (65.1%), upper respiratory tract infections (38.2%), ear wax (29.9%) and myopia (10.0%). Mean hygiene score was significantly higher in girls (4.32) than boys (3.95) and poor hygiene observed in older boys. Increasing myopia and poor dental hygiene denotes a changing morbidity pattern in private primary school of the urban area. The hygiene status of the girls is significantly better than boys.

  20. Early Childhood Behavioral Health Integration in Pediatric Primary Care: Serving Refugee Families in the Healthy Steps Program

    Science.gov (United States)

    Buchholz, Melissa; Fischer, Collette; Margolis, Kate L.; Talmi, Ayelet

    2016-01-01

    Primary care settings are optimal environments for providing comprehensive, family-centered care to young children and their families. Primary care clinics with integrated behavioral health clinicians (BHCs) are well-positioned to build trust and create access to care for marginalized and underserved populations. Refugees from around the world are…

  1. Primary organic pollutants in New Zealand urban aerosol in winter during high PM1 episodes

    International Nuclear Information System (INIS)

    Krivacsy, Zoltan; Blazso, Marianne; Shooter, David

    2006-01-01

    In the two biggest New Zealand cities, Auckland and Christchurch, the mass concentration of the PM 1 atmospheric aerosol can exceed the 50 μg m -3 24 h health guideline in winter. This high pollution level is thought to be caused mainly by old-fashioned domestic heating systems based on wood combustion. Therefore the chemistry of the carbonaceous aerosol has been investigated in several high-pollution level urban situations in order to assess the origin of the pollution. All the high concentration organic tracers, including levoglucosan and dehydroabietic acid, were characteristic for biomass burning. The findings have confirmed via advanced chemical analytical methods that domestic heating can be the main contributor to the high level of wintertime pollution, especially in Christchurch. The results are of great importance in supporting the ambition of authorities and environmental associations to change the domestic heating regimes. - PM 1 aerosol concentrations can exceed air quality guidelines during winter in Christchurch, New Zealand

  2. Primary school teachers' opinions and attitudes towards stuttering in two South African urban education districts.

    Science.gov (United States)

    Abrahams, Kristen; Harty, Michal; St Louis, Kenneth O; Thabane, Lehana; Kathard, Harsha

    2016-07-27

    As teachers form an important part of the intervention process with childrenwho stutter in primary school, the primary aim was to describe primary school teachers'attitudes in South Africa. The secondary aim was to compare teachers' attitudes towardsstuttering in South Africa with those from a pooled group of respondents in the Public OpinionSurvey of Human Attributes-Stuttering (POSHA-S) database from different countries collectedin 2009-2014. A quantitative, cross-sectional survey research design was used. Primary schools intwo education districts in Western Cape, South Africa, were sampled. The POSHA-S, a selfadministeredquestionnaire, was completed by a cluster sample of 469 participants. Overall positive attitudes towards stuttering were found, specifically related to thepotential of people who stutter, although the result should be interpreted with caution as thesample was not homogenously positive. Teachers still had misconceptions about personalitystereotypes and the cause of stuttering. The attitudes of the South African sample were slightlymore positive compared with the samples in the current POSHA-S database. When developing stuttering intervention strategies, there are a number of keyconsiderations to take into account. The study provides a basis for speech-language therapiststo think about intervention with teachers and which areas of stuttering to consider.

  3. Urban-rural inequality regarding drug prescriptions in primary care facilities - a pre-post comparison of the National Essential Medicines Scheme of China.

    Science.gov (United States)

    Yao, Qiang; Liu, Chaojie; Ferrier, J Adamm; Liu, Zhiyong; Sun, Ju

    2015-07-30

    To assess the impact of the National Essential Medicines Scheme (NEMS) with respect to urban-rural inequalities regarding drug prescriptions in primary care facilities. A stratified two-stage random sampling strategy was used to sample 23,040 prescriptions from 192 primary care facilities from 2009 to 2010. Difference-in-Difference (DID) analyses were performed to test the association between NEMS and urban-rural gaps in prescription patterns. Between-Group Variance and Theil Index were calculated to measure urban-rural absolute and relative disparities in drug prescriptions. The use of the Essential Medicines List (EML) achieved a compliance rate of up to 90% in both urban and rural facilities. An overall reduction of average prescription cost improved economic access to drugs for patients in both areas. However, we observed an increased urban-rural disparity in average expenditure per prescription. The rate of antibiotics and glucocorticoids prescription remained high, despite a reduced disparity between urban and rural facilities. The average incidence of antibiotic prescription increased slightly in urban facilities (62 to 63%) and reduced in rural facilities (67% to 66%). The urban-rural disparity in the use of parenteral administration (injections and infusions) increased, albeit at a high level in both areas (44%-52%). NEMS interventions are effective in reducing the overall average prescription costs. Despite the increased use of the EML, indicator performances with respect to rational drug prescribing and use remain poor and exceed the WHO/INRUD recommended cutoff values and worldwide benchmarks. There is an increased gap between urban and rural areas in the use of parenteral administration and expenditure per prescription.

  4. Access to primary care from the perspective of Aboriginal patients at an urban emergency department.

    Science.gov (United States)

    Browne, Annette J; Smye, Victoria L; Rodney, Patricia; Tang, Sannie Y; Mussell, Bill; O'Neil, John

    2011-03-01

    In this article, we discuss findings from an ethnographic study in which we explored experiences of access to primary care services from the perspective of Aboriginal people seeking care at an emergency department (ED) located in a large Canadian city. Data were collected over 20 months of immersion in the ED, and included participant observation and in-depth interviews with 44 patients triaged as stable and nonurgent, most of whom were living in poverty and residing in the inner city. Three themes in the findings are discussed: (a) anticipating providers' assumptions; (b) seeking help for chronic pain; and (c) use of the ED as a reflection of social suffering. Implications of these findings are discussed in relation to the role of the ED as well as the broader primary care sector in responding to the needs of patients affected by poverty, racialization, and other forms of disadvantage.

  5. Prevalence of depression among women attending a primary urban care clinic in Malaysia.

    Science.gov (United States)

    Sidik, Sherina Mohd; Arroll, Bruce; Goodyear-Smith, Felicity; Ahmad, Rozali

    2012-07-01

    Depression affects more women than men in Malaysia. The objective of this paper was to determine the prevalence of depression and its associated factors among women attending a government primary care clinic. A cross-sectional study was conducted in a government-funded primary care clinic in Malaysia. Consecutive adult female patients attending the clinic during the data collection period were invited to participate. The participants completed self-administered questionnaires (including the validated Patient Health Questionnaire [PHQ-9], which was translated into the Malay language). A total of 895 female patients participated in the study (response rate 87.5%). The prevalence of depression (PHQ-9 scores ≥ 10) was 12.1%. Based on multiple logistic regression analysis, certain stressful life events were found to be associated with depression (p depression among participants in this study was clinically significant and corresponded with the findings of other international studies. Factors associated with depression need to be highlighted and addressed accordingly. Clinicians in Malaysia should be aware of this prevalence when making diagnoses in primary care.

  6. Exploring the response of net primary productivity variations to urban expansion and climate change: a scenario analysis for Guangdong Province in China.

    Science.gov (United States)

    Pei, Fengsong; Li, Xia; Liu, Xiaoping; Lao, Chunhua; Xia, Gengrui

    2015-03-01

    Urban land development alters landscapes and carbon cycle, especially net primary productivity (NPP). Despite projections that NPP is often reduced by urbanization, little is known about NPP changes under future urban expansion and climate change conditions. In this paper, terrestrial NPP was calculated by using Biome-BGC model. However, this model does not explicitly address urban lands. Hence, we proposed a method of NPP-fraction to detect future urban NPP, assuming that the ratio of real NPP to potential NPP for urban cells remains constant for decades. Furthermore, NPP dynamics were explored by integrating the Biome-BGC and the cellular automata (CA), a widely used method for modeling urban growth. Consequently, urban expansion, climate change and their associated effects on the NPP were analyzed for the period of 2010-2039 using Guangdong Province in China as a case study. In addition, four scenarios were designed to reflect future conditions, namely baseline, climate change, urban expansion and comprehensive scenarios. Our analyses indicate that vegetation NPP in urban cells may increase (17.63 gC m(-2) year(-1)-23.35 gC m(-2) year(-1)) in the climate change scenario. However, future urban expansion may cause some NPP losses of 241.61 gC m(-2) year(-1), decupling the NPP increase of the climate change factor. Taking into account both climate change and urban expansion, vegetation NPP in urban area may decrease, minimally at a rate of 228.54 gC m(-2) year(-1) to 231.74 gC m(-2) year(-1). Nevertheless, they may account for an overall NPP increase of 0.78 TgC year(-1) to 1.28 TgC year(-1) in the whole province. All these show that the provincial NPP increase from climate change may offset the NPP decrease from urban expansion. Despite these results, it is of great significance to regulate reasonable expansion of urban lands to maintain carbon balance. Copyright © 2014 Elsevier Ltd. All rights reserved.

  7. Pediatric primary central nervous system germ cell tumors of different prognosis groups show characteristic miRNome traits and chromosome copy number variations

    Directory of Open Access Journals (Sweden)

    Liang Muh-Lii

    2010-02-01

    Full Text Available Abstract Background Intracranial pediatric germ cell tumors (GCTs are rare and heterogeneous neoplasms and vary in histological differentiation, prognosis and clinical behavior. Germinoma and mature teratoma are GCTs that have a good prognosis, while other types of GCTs, termed nongerminomatous malignant germ cell tumors (NGMGCTs, are tumors with an intermediate or poor prognosis. The second group of tumors requires more extensive drug and irradiation treatment regimens. The mechanisms underlying the differences in incidence and prognosis of the various GCT subgroups are unclear. Results We identified a distinct mRNA profile correlating with GCT histological differentiation and prognosis, and also present in this study the first miRNA profile of pediatric primary intracranial GCTs. Most of the differentially expressed miRNAs were downregulated in germinomas, but miR-142-5p and miR-146a were upregulated. Genes responsible for self-renewal (such as POU5F1 (OCT4, NANOG and KLF4 and the immune response were abundant in germinomas, while genes associated with neuron differentiation, Wnt/β-catenin pathway, invasiveness and epithelial-mesenchymal transition (including SNAI2 (SLUG and TWIST2 were abundant in NGMGCTs. Clear transcriptome segregation based on patient survival was observed, with malignant NGMGCTs being closest to embryonic stem cells. Chromosome copy number variations (CNVs at cytobands 4q13.3-4q28.3 and 9p11.2-9q13 correlated with GCT malignancy and clinical risk. Six genes (BANK1, CXCL9, CXCL11, DDIT4L, ELOVL6 and HERC5 within 4q13.3-4q28.3 were more abundant in germinomas. Conclusions Our results integrate molecular profiles with clinical observations and provide insights into the underlying mechanisms causing GCT malignancy. The genes, pathways and microRNAs identified have the potential to be novel therapeutic targets.

  8. The influence of patient characteristics on healthcare-seeking behavior: a multilevel analysis of 70 primary care practices in urban-suburban regions in Malta.

    NARCIS (Netherlands)

    Pullicino, G.; Sciortino, P.; Camilleri, L.; Schäfer, W.; Boerma, W.

    2016-01-01

    Background: Social homogeneity and an almost indiscernible rural-urban difference are generally assumed to be strong factors that reduce any tendency for health inequities in a small island community. A strong primary health care system is one of the components that protect populations against

  9. Primary school teachers’ opinions and attitudes towards stuttering in two South African urban education districts

    Directory of Open Access Journals (Sweden)

    Kristen Abrahams

    2016-07-01

    Method: A quantitative, cross-sectional survey research design was used. Primary schools intwo education districts in Western Cape, South Africa, were sampled. The POSHA-S, a selfadministeredquestionnaire, was completed by a cluster sample of 469 participants. Results: Overall positive attitudes towards stuttering were found, specifically related to thepotential of people who stutter, although the result should be interpreted with caution as thesample was not homogenously positive. Teachers still had misconceptions about personalitystereotypes and the cause of stuttering. The attitudes of the South African sample were slightlymore positive compared with the samples in the current POSHA-S database. Conclusion: When developing stuttering intervention strategies, there are a number of keyconsiderations to take into account. The study provides a basis for speech-language therapiststo think about intervention with teachers and which areas of stuttering to consider.

  10. Eruption of supernumerary permanent teeth in a sample of urban primary school population in Genoa, Italy.

    Science.gov (United States)

    Alberti, G; Mondani, P M; Parodi, V

    2006-06-01

    The aim of this epidemiological study was to describe the incidence and distribution of hyperdontia in the primary school population in Genoa (Italy) and to check its influence on the development of orthodontic problems in children. The collected data should also help to find out what is the best age range among children to direct a program for early diagnosis and prevention of malocclusion and oral diseases related to hyperdontia. The participating children (total number 1577, 814 males and 763 females, between 6 and 10 years of age) chosen in 19 public primary schools in Genoa have been examined by the same specialist through year 2004. Erupted permanent teeth, presence, position and form of supernumerary teeth, malocclusion presence and class, presence of orthodontic devices, age and sex have been noted down for each child. The global percentage of hyperdontia was 0.38%, more frequent in males (0.49%) than in females (0.26%). The most common kind of supernumerary tooth was mesiodens (83%). A significant increase of hyperdontia prevalence (from 0.64% to 1.06%) was noticed in children 9 years old. The incidence of malocclusion among children presenting hyperdontia was 83.3%, while the global incidence of malocclusion was 40%. An orthodontic treatment had been planned and started for 20% of children presenting malocclusion. The study has revealed an incidence of hyperdontia much more frequent in males than in females (2:1). The most common site of eruption of supernumerary teeth is maxillary anterior region. Hyperdontia is strictly related with dental malocclusion. The best age range to direct a program of early diagnosis and prevention of malocclusion and hyperdontia is 9 years old children.

  11. Molecular characterization of urban organic aerosol in tropical India: contributions of primary emissions and secondary photooxidation

    Directory of Open Access Journals (Sweden)

    P. Q. Fu

    2010-03-01

    small. This study demonstrates that, in addition to fossil fuel combustion and biomass burning, the open-burning of plastics in urban area also contributes to the organic aerosols in South Asia.

  12. Urbanization effects on leaf litter decomposition, foliar nutrient dynamics and aboveground net primary productivity in the subtropics

    Science.gov (United States)

    Heather A. Enloe; B. Graeme Lockaby; Wayne C. Zipperer; Greg L. Somers

    2015-01-01

    Urbanization can alter nutrient cycling. This research evaluated how urbanization affected nutrient dynamics in the subtropics. We established 17–0.04 ha plots in five different land cover types—slash pine (Pinus elliottii) plantations (n=3), rural natural pine forests (n= 3), rural natural oak forests (n=4), urban pine forests (n=3) and urban oak forests (n=4) in the...

  13. COMPARATIVE STUDY OF NUTRITIONAL STATUS OF PRIMARY SCHOOL CHILDREN IN URBAN AREA OF JHANSI

    Directory of Open Access Journals (Sweden)

    Ranjana Singh

    2010-06-01

    Full Text Available The present study is an attempt to find out the nutritional status including anthropometric assessment. A cross -sectional study was conducted in primary section of two governments and Iwo convent schools of Jhansi city during the study period of march 1999 to feb2000.Selected school children (n=840 aged 5-11 years, 453 children from municipal school and 387 children from convent school comprised the study material. Following results were observed -out of total children surveyed, 52.98% were male and rests 4 7.02% were females. Hindu formed majority (70.90% of children in both types of schools. Mean height and weight of boys and girls were higher than ICMR standards in both type of school. The mean mid arm circumference of all girls and boys from both type of schools had higher value than the ICMR standards but did not come up to WOLANSKI standard. Statistical analysis-percentage, mean, chi-square test.

  14. A 9-Year-Old Girl With Persistent Obsessive and Compulsive Behaviors in a Primary Care Pediatric Practice.

    Science.gov (United States)

    Gist, Lauren; Mathews, Carol; Williams, Katherine N; Stein, Martin T

    Chloe is a 9-year-old gal whose mother made an initial visit to a new pediatrician for concerns about her behavior. Chloe is apprehensive about the visit and frequently hides behind her mother.Her parents first noticed Chloe becoming angry and more emotional 3 years ago, which her parents did not initially understand. However, over the past year, she has started to have more worries and unusual behavior.Chloe and her mother report that when she walks through doorways, she will almost always go back and walks through again. At home, she will walk through doorways multiple times and at school, she will pretend she forgot something so her friends do not notice. She often will not walk downstairs and occasionally her mother has to carry her. Clothes are problematic for Chloe. If her father touches something of a specific color and then touches Chloe, she will have to change her clothes or take a shower. Sometimes, she will never be able to wear those clothes again. She had a recent episode where she could not stop tapping a red paper, because if she stopped, she said it would burst into flame. During the 2 weeks before the pediatric visit, symptoms increased to the point that she is now refusing to go to school. When she stays home, she lays in 1 place all day.Chloe is a fourth grade student. The family does not report academic concerns. She has friends. She denies any appetite or sleep problems. She endorses periods of sadness, lack of energy, and decreased interest in social activities, mostly because she worries and is embarrassed. She kept her behaviors hidden from her 5 siblings for the past year, and she talked only to her mother about them. She is worried her friends might discover her behaviors.The family history is notable for multiple paternal family members with anxiety and bipolar disorder and depression on mother's side. A few months ago, Chloe's family adopted a 7-year-old child with special needs from China.Her growth, vital signs, and physical

  15. The gap in human resources to deliver the guaranteed package of prevention and health promotion services at urban and rural primary care facilities in Mexico.

    Science.gov (United States)

    Alcalde-Rabanal, Jacqueline Elizabeth; Nigenda, Gustavo; Bärnighausen, Till; Velasco-Mondragón, Héctor Eduardo; Darney, Blair Grant

    2017-08-03

    The purpose of this study was to estimate the gap between the available and the ideal supply of human resources (physicians, nurses, and health promoters) to deliver the guaranteed package of prevention and health promotion services at urban and rural primary care facilities in Mexico. We conducted a cross-sectional observational study using a convenience sample. We selected 20 primary health facilities in urban and rural areas in 10 states of Mexico. We calculated the available and the ideal supply of human resources in these facilities using estimates of time available, used, and required to deliver health prevention and promotion services. We performed descriptive statistics and bivariate hypothesis testing using Wilcoxon and Friedman tests. Finally, we conducted a sensitivity analysis to test whether the non-normal distribution of our time variables biased estimation of available and ideal supply of human resources. The comparison between available and ideal supply for urban and rural primary health care facilities reveals a low supply of physicians. On average, primary health care facilities are lacking five physicians when they were estimated with time used and nine if they were estimated with time required (P human resources in primary health facilities.

  16. Theory-based development of an implementation intervention to increase HPV vaccination in pediatric primary care practices.

    Science.gov (United States)

    Garbutt, Jane M; Dodd, Sherry; Walling, Emily; Lee, Amanda A; Kulka, Katharine; Lobb, Rebecca

    2018-03-13

    The national guideline for use of the vaccine targeting oncogenic strains of the human papillomavirus (HPV) is an evidence-based practice that is poorly implemented in primary care. Recommendations include completion of the vaccine series before the 13th birthday for girls and boys, giving the first dose at the 11- to 12-year-old check-up visit, concurrent with other recommended vaccines. Interventions to increase implementation of this guideline have had little impact, and opportunities to prevent cancer continue to be missed. We used a theory-informed approach to develop a pragmatic intervention for use in primary care settings to increase implementation of the HPV vaccine guideline recommendation. Using a concurrent mixed methods design in 10 primary care practices, we applied the Consolidated Framework for Implementation Research (CFIR) to systematically investigate and characterize factors strongly influencing vaccine use. We then used the Behavior Change Wheel (BCW) and the Theoretical Domains Framework (TDF) to analyze provider behavior and identify behaviors to target for change and behavioral change strategies to include in the intervention. We identified facilitators and barriers to guideline use across the five CFIR domains: most distinguishing factors related to provider characteristics, their perception of the intervention, and their process to deliver the vaccine. Targeted behaviors were for the provider to recommend the HPV vaccine the same way and at the same time as the other adolescent vaccines, to answer parents' questions with confidence, and to implement a vaccine delivery system. To this end, the intervention targeted improving provider's capability (knowledge, communication skills) and motivation (action planning, belief about consequences, social influences) regarding implementing guideline recommendations, and increasing their opportunity to do so (vaccine delivery system). Behavior change strategies included providing information and

  17. Estimation Terrestrial Net Primary Productivity Based on CASA Model: a Case Study in Minnan Urban Agglomeration, China

    International Nuclear Information System (INIS)

    Hua, L Z; Liu, H; Zhang, X L; Zheng, Y; Man, W; Yin, K

    2014-01-01

    Net Primary Productivity (NPP) is a key component of the terrestrial carbon cycle. The research of net primary productivity will help in understanding the amount of carbon fixed by terrestrial vegetation and its influencing factors. Model simulation is considered as a cost-effective and time-efficient method for the estimation of regional and global NPP. In the paper, a terrestrial biosphere model, CASA (Carnegie Ames Stanford Approach), was applied to estimate monthly NPP in Minnan urban agglomeration (i.e. Xiamen, Zhangzhou and Quanzhou cities) of Fujian province, China, in 2009 and 2010, by incorporating satellite observation of SPOT Vegetation NDVI data together with other climatic parameters and landuse map. The model estimates average annual terrestrial NPP of Minnan area as 16.3 million Mg C. NPP decreased from southwest to the northeast. The higher NPP values exceeding 720 gC·m − 2 ·a −1 showed in North Zhangzhou city and lower values under 500 gC·m − 2 ·a −1 showed in the some areas of northeast Quanzhou city. Seasonal variations of NPP were large. It was about 45% of the total annual NPP in the three months in summer, and the NPP values were very low in winter. From 2009 to 2010, the value of annual NPP showed a slightly decrease trend, approximately 7.8% because the annual temperature for 2010 decline 13.6% compared with 2009 in despite of an increase in rainfall of about 34.3%. The results indicate that temperature was a main limiting factor on vegetation growth, but water is not a limiting factor in the rainy area

  18. The challenge of tetradic relationships in medically interpreted pediatric primary care visits: A descriptive study of communication practices.

    Science.gov (United States)

    Pope, C A; Escobar-Gomez, M; Davis, B H; Roberts, J R; O'Brien, E S; Hinton, E; Darden, P M

    2016-04-01

    To examine spoken interactions between pediatricians and community-based interpreters speaking with adolescents and parents with Limited English proficiency (LEP) in primary care to identify the challenges of interpreting in a four-person or tetradic visit, its sources of co-constructed errors, and specific practices for educational intervention. As part of a larger study of vaccine decision-making at six clinical sites in two states, this descriptive study used discourse analysis to examine 20 routine primary care visits in a Latino Clinic in interactions between adolescents, parents, community-based interpreters, and pediatricians. Specific patterns of communication practices were identified that contributed to inaccuracies in medical interpretation Practices needing improvement were tallied for simple frequencies and included: omissions; false fluency; substitutions; editorializing; added clarification, information, or questions; medical terminology; extra explanation to mother; and, cultural additions. Of these speaking practices, omissions were the most common (123 out of 292 total) and the most affected by pediatricians. The dynamics of both pediatricians and interpreters contributed to identification of areas for improvement, with more adolescent participation in bilingual than monolingual visits. These observations provide opportunities for mapping a communication skills training intervention based on observations for future testing of an evidence-based curriculum. Published by Elsevier Ireland Ltd.

  19. Submicrometer aerosol in rural and urban backgrounds in southern Poland: primary and secondary components of PM1.

    Science.gov (United States)

    Rogula-Kozłowska, Wioletta; Klejnowski, Krzysztof

    2013-01-01

    Diurnal samples of PM(1) (submicrometer particles, having aerodynamic diameters not greater than 1 μm) were collected at an urban background site in Zabrze (from 01.08. to 31.12.2009) and a rural background site in Racibórz (from 01.08. to 31.12.2010). The samples were analyzed for carbon (organic and elemental), water soluble ions (Na(+), NH(4) (+), K(+), Mg(2+), Ca(2+), Cl(-), NO(3)(-), SO(4)(2-)) and concentrations of 21 elements by using, respectively, a Sunset Laboratory carbon analyzer, a Herisau Metrohm AG ion chromatograph, a PANalitycal Epsilon 5 spectrometer. To perform the monthly mass closure calculations for PM(1), the chemical components were categorized into organic matter (OM), elemental carbon (EC), secondary inorganic aerosol (SIA), crustal matter (CM), marine components (MC), other elements (OE) and unidentified matter (UM). The mass contributions of secondary (SOM) and primary (POM) organic matter to PM(1) were also estimated. In average, 50 % of PM(1) in Zabrze and 40 % in Racibórz were secondary aerosol coming from the transformations of its gaseous precursors. High concentrations and mass contributions of EC and OM to PM, and probable PM acidic nature in Zabrze, indicate particularly high hazard from the ambient submicrometer particles to the inhabitants of southern Poland.

  20. Body Weight Status and Dietary Intakes of Urban Malay Primary School Children: Evidence from the Family Diet Study

    Directory of Open Access Journals (Sweden)

    Wai Yew Yang

    2017-01-01

    Full Text Available Malaysia is experiencing a rise in the prevalence of childhood obesity. Evidence for the relationship between dietary intake and body weight among Malaysian children is limited, with the impact of energy intake misreporting rarely being considered. This paper describes the dietary intakes of urban Malay children in comparison to national recommendations and by weight status. This cross-sectional Family Diet Study (n = 236 was conducted in five national primary schools in Malaysia (August 2013–October 2014. Data on socio-demographics, anthropometrics, 24-h dietary recalls, and food habits were collected from Malay families, consisting of a child aged 8 to 12 years and their main caregiver(s. Multivariable analyses were used to assess dietary intake-body weight relationships. The plausibility of energy intake was determined using the Black and Cole method. Approximately three in 10 Malay children were found to be overweight or obese. The majority reported dietary intakes less than national recommendations. Children with obesity had the lowest energy intakes relative to body weight (kcal/kg compared to children in other weight categories (F = 36.21, p < 0.001. A positive moderate correlation between energy intake and weight status was identified (r = 0.53, p < 0.001 after excluding energy intake mis-reporters (n = 95, highlighting the need for the validation of dietary assessment in obesity-related dietary research in Malaysia.

  1. Body Weight Status and Dietary Intakes of Urban Malay Primary School Children: Evidence from the Family Diet Study.

    Science.gov (United States)

    Yang, Wai Yew; Burrows, Tracy; MacDonald-Wicks, Lesley; Williams, Lauren T; Collins, Clare E; Chee, Winnie Siew Swee; Colyvas, Kim

    2017-01-20

    Malaysia is experiencing a rise in the prevalence of childhood obesity. Evidence for the relationship between dietary intake and body weight among Malaysian children is limited, with the impact of energy intake misreporting rarely being considered. This paper describes the dietary intakes of urban Malay children in comparison to national recommendations and by weight status. This cross-sectional Family Diet Study ( n = 236) was conducted in five national primary schools in Malaysia (August 2013-October 2014). Data on socio-demographics, anthropometrics, 24-h dietary recalls, and food habits were collected from Malay families, consisting of a child aged 8 to 12 years and their main caregiver(s). Multivariable analyses were used to assess dietary intake-body weight relationships. The plausibility of energy intake was determined using the Black and Cole method. Approximately three in 10 Malay children were found to be overweight or obese. The majority reported dietary intakes less than national recommendations. Children with obesity had the lowest energy intakes relative to body weight (kcal/kg) compared to children in other weight categories (F = 36.21, p < 0.001). A positive moderate correlation between energy intake and weight status was identified ( r = 0.53, p < 0.001) after excluding energy intake mis-reporters ( n = 95), highlighting the need for the validation of dietary assessment in obesity-related dietary research in Malaysia.

  2. Quantifying Impacts of Land-Use/Cover Change on Urban Vegetation Gross Primary Production: A Case Study of Wuhan, China

    Directory of Open Access Journals (Sweden)

    Shishi Liu

    2018-03-01

    Full Text Available This study quantified the impacts of land-use/cover change (LUCC on gross primary production (GPP during 2000–2013 in a typical densely urbanized Chinese city, Wuhan. GPP was estimated at 30-m spatial resolution using annual land cover maps, meteorological data of the baseline year, and the normalized difference vegetation index (NDVI, which was generated with the spatial and temporal adaptive reflectance fusion model (STARFM based on Landsat and MODIS images. The results showed that approximately 309.95 Gg C was lost over 13 years, which was mainly due to the conversion from cropland to built-up areas. The interannual variation of GPP was affected by the change of vegetation composition, especially the increasing relative fraction of forests. The loss of GPP due to the conversion from forest to cropland fluctuated through the study period, but showed a sharp decrease in 2007 and 2008. The gain of GPP due to the conversion from cropland to forest was low between 2001 and 2009, but increased dramatically between 2009 and 2013. The change rate map showed an increasing trend along the highways, and a decreasing trend around the metropolitan area and lakes. The results indicated that carbon consequences should be considered before land management policies are put forth.

  3. Effect of teaching motivational interviewing via communication coaching on clinician and patient satisfaction in primary care and pediatric obesity-focused offices.

    Science.gov (United States)

    Pollak, Kathryn I; Nagy, Paul; Bigger, John; Bilheimer, Alicia; Lyna, Pauline; Gao, Xiaomei; Lancaster, Michael; Watkins, R Chip; Johnson, Fred; Batish, Sanjay; Skelton, Joseph A; Armstrong, Sarah

    2016-02-01

    Studies indicate needed improvement in clinician communication and patient satisfaction. Motivational interviewing (MI) helps promote patient behavior change and improves satisfaction. In this pilot study, we tested a coaching intervention to teach MI to all clinic staff to improve clinician and patient satisfaction. We included four clinics (n=29 staff members). In the intervention clinics (one primary care and one pediatric obesity-focused), we trained all clinic staff in MI through meetings as a group seven times, directly observing clinicians in practice 4-10 times, and providing real-time feedback on MI techniques. In all clinics, we assessed patient satisfaction via anonymous surveys and also assessed clinician burnout and self-rated MI skills. Clinicians in the intervention clinics reported improvements in burnout scores, self-rated MI skills, and perceived cohesion whereas clinicians in the control clinic reported worse scores. Patient satisfaction improved in the intervention clinics more than in the control clinics. This is the first study to find some benefit of training an entire clinic staff in MI via a coaching model. It might help to train staff in MI to improve clinician satisfaction, team cohesion, perceived skills, and patient satisfaction. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  4. Acute effects of irradiation on cognition: changes in attention on a computerized continuous performance test during radiotherapy in pediatric patients with localized primary brain tumors

    International Nuclear Information System (INIS)

    Merchant, Thomas E.; Kiehna, Erin N.; Miles, Mark A.; Zhu Junhong; Xiong Xiaoping; Mulhern, Raymond K.

    2002-01-01

    Purpose: To assess sustained attention, impulsivity, and reaction time during radiotherapy (RT) for pediatric patients with localized primary brain tumors. Methods and Materials: Thirty-nine patients (median age 12.3 years, range 5.9-22.9) with primary brain tumors were evaluated prospectively using the computerized Conners' continuous performance test (CPT) before and during conformal RT (CRT). The data were modeled to assess the longitudinal changes in the CPT scores and the effects of clinical variables on these changes during the first 50 days after the initiation of CRT. Results: The CPT scores exhibited an increasing trend for errors of omission (inattentiveness), decreasing trend for errors of commission (impulsivity), and slower reaction times. However, none of the changes were statistically significant. The overall index, which is an algorithm-based weighted sum of the CPT scores, remained within the range of normal throughout treatment. Older patients (age >12 years) were more attentive (p<0.0005), less impulsive (p<0.07), and had faster reaction times (p<0.001) at baseline than the younger patients. The reaction time was significantly reduced during treatment for the older patients and lengthened significantly for the younger patients (p<0.04). Patients with a shunted hydrocephalus (p<0.02), seizure history (p<0.0006), and residual tumor (p<0.02) were significantly more impulsive. Nonshunted patients (p<0.0001), those with more extensive resection (p<0.0001), and patients with ependymoma (p<0.006) had slower initial reaction times. Conclusion: Children with brain tumors have problems with sustained attention and reaction time resulting from the tumor and therapeutic interventions before RT. The reaction time slowed during treatment for patients <12 years old. RT, as administered in the trial from which these data were derived, has limited acute effects on changes in the CPT scores measuring attention, impulsiveness, and reaction time

  5. Atypical choroid plexus papilloma: spontaneous resolution of diffuse leptomeningeal contrast enhancement after primary tumor removal in 2 pediatric cases.

    Science.gov (United States)

    Scala, Marcello; Morana, Giovanni; Milanaccio, Claudia; Pavanello, Marco; Nozza, Paolo; Garrè, Maria Luisa

    2017-09-01

    Atypical choroid plexus papillomas can metastasize in the form of leptomeningeal seeding. Postoperative chemotherapy is the recommended first-line treatment when gross-total removal is not achieved or in cases of disseminated disease. Here the authors report on 2 children with atypical choroid plexus papillomas and MRI findings of diffuse leptomeningeal enhancement at diagnosis, later presenting with spontaneous resolution of the leptomeningeal involvement after removal of the primary lesions. Observations in this report expand our knowledge about the natural history and biological behavior of these tumors and highlight the role of close neuroimaging surveillance in the management of atypical choroid plexus papillomas in cases with MRI evidence of diffuse leptomeningeal enhancement at presentation.

  6. Pediatric Stroke

    Science.gov (United States)

    ... and Patient Resources Home » Patients & Families » About Stroke » Pediatric Stroke » Introduction Introduction What is a Stroke? Ischemic Stroke Intracerebral Hemorrhage Subarachnoid Hemorrhage Pediatric Stroke Introduction Types of Stroke Diagnosis and Treatment ...

  7. Myocarditis - pediatric

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/007307.htm Myocarditis - pediatric To use the sharing features on this page, please enable JavaScript. Pediatric myocarditis is inflammation of the heart muscle in ...

  8. Depression, anxiety and stress symptoms among diabetics in Malaysia: a cross sectional study in an urban primary care setting.

    Science.gov (United States)

    Kaur, Gurpreet; Tee, Guat Hiong; Ariaratnam, Suthahar; Krishnapillai, Ambigga S; China, Karuthan

    2013-05-27

    Diabetes mellitus is a highly prevalent condition in Malaysia, increasing from 11.6% in 2006 to 15.2% in 2011 among individuals 18 years and above. Co-morbid depression in diabetics is associated with hyperglycemia, diabetic complications and increased health care costs. The aims of this study are to determine the prevalence and predictors of depression, anxiety and stress symptoms in Type II diabetics attending government primary care facilities in the urban area of Klang Valley, Malaysia. The study was cross sectional in design and carried out in 12 randomly selected primary care government clinics in the Klang Valley, Malaysia. A total of 2508 eligible consenting respondents participated in the study. The Depression, Anxiety and Stress Scale (DASS) 21 questionnaire was used to measure depression, anxiety and stress symptoms. Data was analyzed using the SPSS version 16 software using both descriptive and inferential statistics. The prevalence of depression, anxiety and stress symptoms among Type II diabetics were 11.5%, 30.5% and 12.5% respectively. Using multiple logistic regression, females, Asian Indians, marital status (never married, divorced/widowed/separated), a family history of psychiatric illness, less than 2 years duration of diabetes and current alcohol consumption were found to be significant predictors of depression. For anxiety, unemployment, housewives, HbA1c level of more than 8.5%, a family history of psychiatric illness, life events and lack of physical activity were independent risk factors. Stress was significantly associated with females, HbA1c level of more than 8.5%, presence of co-morbidity, a family history of psychiatric illness, life events and current alcohol consumption. For depression (adjusted OR 2.8, 95% CI 1.1; 7.0), anxiety (adjusted OR 2.4, 95% CI 1.1;5.5) and stress (adjusted OR 4.2, 95% CI 1.8; 9.8), a family history of psychiatric illness was the strongest predictor. We found the prevalence of depression, anxiety and stress

  9. [The medical and vaccination card for children--a document for the promotion of primary preventive care in pediatrics].

    Science.gov (United States)

    Hanousek, L

    1989-07-01

    The basis of a comprehensive approach to prevention of chronic diseases of childhood is a system of uniform preventive examinations which makes it possible to examine the child in the parent's presence. This system accentuates the systematic training of parents with the aim to promote health and prevent the development of chronic disease. Part of the effort to improve the health consciousness of parents is the newly developed document, the child's health and vaccination card. This card--contrary to the basic documentation of the child--is his property and is kept by his parents at home. The card provides the parents as well as class teacher with basic information on the child's health status. This information must be used by the parents and teachers for primary preventive regime provisions. By issuing these cards to all children it will be possible to do away with examinations, necessary so far, in conjunction with issuing of certificates on the child's health status before major sports contents. This will reduce the unproductive administrative work of health community doctors and health community paediatric nurses and will save the time of parents who accompanied the children attending these examinations.

  10. Chronicle of pediatric radiology

    International Nuclear Information System (INIS)

    Benz-Bohm, Gabriele; Richter, Ernst

    2012-01-01

    The chronicle of pediatric radiology covers the following issues: Development of pediatric radiology in Germany (BRD, DDR, pediatric radiological accommodations); development of pediatric radiology in the Netherlands (chronology and pediatric radiological accommodations); development of pediatric radiology in Austria (chronology and pediatric radiological accommodations); development of pediatric radiology in Switzerland (chronology and pediatric radiological accommodations).

  11. Influence of the informal primary caretaker on glycemic control among prepubertal pediatric patients with type 1 diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Jessie Nallely Zurita-Cruz

    Full Text Available Abstract Objectives: In prepubertal type 1 diabetic patients (DM1, the availability of an informal primary caregiver (ICP is critical to making management decisions; in this study, the ICP-related risk factors associated with glycemic control were identified. Patients, materials, and methods: A comparative cross-sectional study was performed. Fifty-five patients with DM1 under the age of 11 years were included. The patient-related factors associated with glycemic control evaluated were physical activity, DM1 time of evolution, and adherence to medical indications. The ICP-related factors evaluated were education, employment aspects, depressive traits (Beck questionnaire, family functionality (family APGAR, support of another person in patient care, stress (Perceived Stress Scale, and socioeconomic status (Bronfman questionnaire. Multivariate logistic and linear regression analyses were performed. Results: The patients' median age was 8 years; 29 patients had good glycemic control, and 26 were uncontrolled. The main risk factor associated with glycemic dyscontrol was stress in the ICP (OR 24.8; 95% CI 4.06-151.9, p = 0.001. While, according to the linear regression analysis it was found that lower level of education (β 0.991, 95% CI 0.238-1.743, p = 0.011 and stress (β 1.918, 95% CI 1.10-2.736, p = 0.001 in the ICP, as well as family dysfunction (β 1.256, 95% CI 0.336-2.177, p = 0.008 were associated with higher levels of glycated hemoglobin. Conclusions: Level of education and stress in the ICP, as well as family dysfunction, are factors that influence the lack of controlled blood glucose levels among prepubertal DM1 patients.

  12. Differences in Perceptions of and Practices Regarding Treatment of Alcohol Use Disorders Among VA Primary Care Providers in Urban and Rural Clinics.

    Science.gov (United States)

    Young, Jessica P; Achtmeyer, Carol E; Bensley, Kara M; Hawkins, Eric J; Williams, Emily C

    2018-01-23

    Effective behavioral and pharmacological treatments are available and recommended for patients with alcohol use disorders (AUD) but rarely received. Barriers to receipt and provision of evidence-based AUD treatments delivered by specialists may be greatest in rural areas. A targeted subanalysis of qualitative interview data collected from primary care providers at 5 Veterans Affairs clinics was conducted to identify differences in provider perceptions and practices regarding AUD treatment across urban and rural clinics. Key contacts were used to recruit 24 providers from 3 "urban" clinics at medical centers and 2 "rural" community-based outpatient clinics. Providers completed 30-minute semistructured interviews, which were recorded, transcribed, and analyzed using inductive content analysis. Thirteen urban and 11 rural providers participated. Urban and rural providers differed regarding referral practices and in perceptions of availability and utility of specialty addictions treatment. Urban providers described referral to specialty treatment as standard practice, while rural providers reported substantial barriers to specialty care access and infrequent specialty care referral. Urban providers viewed specialty addictions treatment as accessible and comprehensive, and perceived addictions providers as "experts" and collaborators, whereas rural providers perceived inadequate support from the health care system for AUD treatment. Urban providers desired greater integration with specialty addictions care while rural providers wanted access to local addictions treatment resources. Providers in rural settings view referral to specialty addictions treatment as impractical and resources inadequate to treat AUD. Additional work is needed to understand the unique needs of rural clinics and decrease barriers to AUD treatment. © 2018 National Rural Health Association.

  13. Epidemiologic profile of patients seen in primary care clinics in an urban and a rural setting in Haiti, 2010-11.

    Science.gov (United States)

    Dickstein, Yaakov; Neuberger, Ami; Golus, Miri; Schwartz, Eli

    2014-09-01

    This study examined the demographic and epidemiological differences between patient populations presenting to a rural and an urban clinic in Haiti. A primary health clinic was established in urban Leogane, and a once-weekly clinic was established in Magandou, a rural village. Patient data were recorded for all individuals presenting to each clinic. Over 7 months, 6632 patients (median age 25) were seen in the urban clinic, and 567 (median age 47) in the rural clinic. There was a female majority at both sites. Hypertension was diagnosed in 41.9% (238/567) of the rural population over 40 years of age, while 29.5% (1956/6632) of patients in the urban setting had the same diagnosis (pHaiti must address the wide rural prevalence. STDs are a major urban health issue requiring treatment for both patients and their partners. Vector-borne disease was unseen in the rural clinic, despite an altitude insufficient to prevent mosquito-borne illness. © The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  14. PEDIATRIC OPHTHALMLOGY AND STRABISMUS

    African Journals Online (AJOL)

    Pediatric Refractive Errors in Lautech Teaching Hospital Eye. Clinic ... carry on into adulthood and become a problem later in life such as ... Children with refractive errors but without associated organic ..... for which elevated intraocular pressure (IOP) is a primary risk factor. .... Medicine, University of Ibadan, Ibadan, Nigeria.

  15. Nutrient Intake Is Insufficient among Senegalese Urban School Children and Adolescents: Results from Two 24 h Recalls in State Primary Schools in Dakar

    Directory of Open Access Journals (Sweden)

    Marion Fiorentino

    2016-10-01

    Full Text Available Due to rapid urbanization and high food prices and in the absence of nutrition programs, school children from urban areas in West Africa often have insufficient and inadequate diet leading to nutrient deficiencies that affect their health and schooling performance. Acute malnutrition and micronutrient deficiencies are prevalent in children from primary state schools of Dakar (Senegal. The objectives of the present study were to assess the overall diet of these children, to report insufficient/excessive energy and nutrient intakes and to investigate association between insufficient nutrient intake and micronutrient deficiencies. Children attending urban state primary schools in the Dakar area were selected through a two-stage random cluster sampling (30 schools × 20 children. Dietary intake data were obtained from two 24 h recalls and blood samples were collected from 545 children (aged 5–17 years, 45% < 10 years, 53% girls and adjusted for intra-individual variability to estimate nutrient usual intakes. Energy intake was insufficient and unbalanced with insufficient contribution of protein and excessive contribution of fat to global energy intake in one third of the children. Proportions of children with insufficient intake were: 100% for calcium, 100% for folic acid, 79% for vitamin A, 69% for zinc, 53% for vitamin C and 46% for iron. Insufficient iron and protein intake were risk factors for iron deficiency (odds ratio, OR 1.5, 2.2. Insufficient zinc intake and energy intake from protein were risk factors for zinc deficiency (OR 1.8, 3.0, 1.7, 2.9. Insufficient iron and vitamin C intake, and insufficient energy intake from protein were risk factors for marginal vitamin A status (OR 1.8, 1.8, 3.3. To address nutritional deficiencies associated with a diet deficient in energy, protein and micronutrients, nutrition education or school feeding programs are needed in urban primary schools of Senegal.

  16. Nutrient Intake Is Insufficient among Senegalese Urban School Children and Adolescents: Results from Two 24 h Recalls in State Primary Schools in Dakar

    Science.gov (United States)

    Fiorentino, Marion; Landais, Edwige; Bastard, Guillaume; Carriquiry, Alicia; Wieringa, Frank T.; Berger, Jacques

    2016-01-01

    Due to rapid urbanization and high food prices and in the absence of nutrition programs, school children from urban areas in West Africa often have insufficient and inadequate diet leading to nutrient deficiencies that affect their health and schooling performance. Acute malnutrition and micronutrient deficiencies are prevalent in children from primary state schools of Dakar (Senegal). The objectives of the present study were to assess the overall diet of these children, to report insufficient/excessive energy and nutrient intakes and to investigate association between insufficient nutrient intake and micronutrient deficiencies. Children attending urban state primary schools in the Dakar area were selected through a two-stage random cluster sampling (30 schools × 20 children). Dietary intake data were obtained from two 24 h recalls and blood samples were collected from 545 children (aged 5–17 years, 45% < 10 years, 53% girls) and adjusted for intra-individual variability to estimate nutrient usual intakes. Energy intake was insufficient and unbalanced with insufficient contribution of protein and excessive contribution of fat to global energy intake in one third of the children. Proportions of children with insufficient intake were: 100% for calcium, 100% for folic acid, 79% for vitamin A, 69% for zinc, 53% for vitamin C and 46% for iron. Insufficient iron and protein intake were risk factors for iron deficiency (odds ratio, OR 1.5, 2.2). Insufficient zinc intake and energy intake from protein were risk factors for zinc deficiency (OR 1.8, 3.0, 1.7, 2.9). Insufficient iron and vitamin C intake, and insufficient energy intake from protein were risk factors for marginal vitamin A status (OR 1.8, 1.8, 3.3). To address nutritional deficiencies associated with a diet deficient in energy, protein and micronutrients, nutrition education or school feeding programs are needed in urban primary schools of Senegal. PMID:27775598

  17. Pediatric irritable bowel syndrome patient and parental characteristics differ by care management type

    Science.gov (United States)

    This study evaluates whether certain patient or parental characteristics are associated with gastroenterology (GI) referral versus primary pediatrics care for pediatric irritable bowel syndrome (IBS). A retrospective clinical trial sample of patients meeting pediatric Rome III IBS criteria was assem...

  18. The prevalence of uncorrected refractive error in urban, suburban, exurban and rural primary school children in Indonesian population

    Directory of Open Access Journals (Sweden)

    Indra Tri Mahayana

    2017-11-01

    Full Text Available Uncorrected refractive error (URE is a major health problem among school children. This study was aimed to determine the frequency and patterns of URE across 4 gradients of residential densities (urban, exurban, suburban and rural. This was a cross-sectional study of school children from 3 districts in Yogyakarta and 1 district near Yogyakarta, Indonesia. The information regarding age, sex, school and school grader were recorded. The Snellen’s chart was used to measure the visual acuity and to perform the subjective refraction. The district was then divided into urban, suburban, exurban and rural area based on their location and population. In total, 410 school children were included in the analyses (urban=79, exurban=73, suburban=160 and rural=98 school children. Urban school children revealed the worst visual acuity (P<0.001 and it was significant when compared with exurban and rural. The proportion of URE among urban, suburban, exurban and rural area were 10.1%, 12.3%, 3.8%, and 1%, respectively, and it was significant when compared to the proportion of ametropia and corrected refractive error across residential densities (P=0.003. The risk of URE development in urban, suburban, exurban, and rural were 2.218 (95%CI: 0.914-5.385, 3.019 (95%CI: 1.266-7.197, 0.502 (95%CI: 0.195-1.293, and 0.130 (95%CI:0.017-0.972, respectively. Urban school children showed the worst visual acuity. The school children in urban and suburban residential area had 2 and 3 times higher risk of developing the URE.

  19. Pediatric Dentistese

    Directory of Open Access Journals (Sweden)

    Sharath Asokan

    2017-01-01

    Full Text Available Successful practice of pediatric dentistry depends on the establishment of a good relationship between the dentist and the child. Such a relationship is possible only through effective communication. Pediatric dentistry includes both an art and a science component. The focus has been mostly on the technical aspects of our science, and the soft skills we need to develop are often forgotten or neglected. This paper throws light on the communication skills we need to imbibe to be a successful pediatric dentist. A new terminology “Pediatric Dentistese” has been coined similar to motherese, parentese, or baby talk. Since baby talk cannot be applied to all age groups of children, pediatric dentistese has been defined as “the proactive development-based individualized communication between the pediatric dentist and the child which helps to build trust, allay fear, and treat the child effectively and efficiently.”

  20. Primary health-care teams as adaptive organizations: exploring and explaining work variation using case studies in rural and urban Scotland.

    Science.gov (United States)

    Farmer, Jane; West, Christina; Whyte, Bruce; Maclean, Margaret

    2005-08-01

    It is acknowledged, internationally, that health-care practitioners' work differs between and urban areas. While several factors affect individual teams' activities, there is little understanding about how patterns of work evolve. Consideration of work in relation to local circumstances is important for training, devising contracts and redesigning services. Six case studies centred on Scottish rural and urban general practices were used to examine, in-depth, the activity of primary health-care teams. Quantitative workload data about patient contacts were collected over 24 months. Interviews and diaries revealed insightful qualitative data. Findings revealed that rural general practitioners and district nurses tended to conduct more consultations per practice patient compared with their urban counterparts. Conditions seen and work tasks varied between case study teams. Qualitative data suggested that the key reasons for variation were: local needs and circumstances; choices made about deployment of available time, team composition and the extent of access to other services. Primary care teams might be viewed as adaptive organization, with co-evolution of services produced by health professionals and local people. The study highlights limitations in the application of workload data and suggests that understanding the nature of work in relation to local circumstances is important in service redesign.

  1. Evaluation of primary immunization coverage of infants under universal immunization programme in an urban area of Bangalore city using cluster sampling and lot quality assurance sampling techniques

    Directory of Open Access Journals (Sweden)

    Punith K

    2008-01-01

    Full Text Available Research Question: Is LQAS technique better than cluster sampling technique in terms of resources to evaluate the immunization coverage in an urban area? Objective: To assess and compare the lot quality assurance sampling against cluster sampling in the evaluation of primary immunization coverage. Study Design: Population-based cross-sectional study. Study Setting: Areas under Mathikere Urban Health Center. Study Subjects: Children aged 12 months to 23 months. Sample Size: 220 in cluster sampling, 76 in lot quality assurance sampling. Statistical Analysis: Percentages and Proportions, Chi square Test. Results: (1 Using cluster sampling, the percentage of completely immunized, partially immunized and unimmunized children were 84.09%, 14.09% and 1.82%, respectively. With lot quality assurance sampling, it was 92.11%, 6.58% and 1.31%, respectively. (2 Immunization coverage levels as evaluated by cluster sampling technique were not statistically different from the coverage value as obtained by lot quality assurance sampling techniques. Considering the time and resources required, it was found that lot quality assurance sampling is a better technique in evaluating the primary immunization coverage in urban area.

  2. Evaluation of primary immunization coverage of infants under universal immunization programme in an urban area of bangalore city using cluster sampling and lot quality assurance sampling techniques.

    Science.gov (United States)

    K, Punith; K, Lalitha; G, Suman; Bs, Pradeep; Kumar K, Jayanth

    2008-07-01

    Is LQAS technique better than cluster sampling technique in terms of resources to evaluate the immunization coverage in an urban area? To assess and compare the lot quality assurance sampling against cluster sampling in the evaluation of primary immunization coverage. Population-based cross-sectional study. Areas under Mathikere Urban Health Center. Children aged 12 months to 23 months. 220 in cluster sampling, 76 in lot quality assurance sampling. Percentages and Proportions, Chi square Test. (1) Using cluster sampling, the percentage of completely immunized, partially immunized and unimmunized children were 84.09%, 14.09% and 1.82%, respectively. With lot quality assurance sampling, it was 92.11%, 6.58% and 1.31%, respectively. (2) Immunization coverage levels as evaluated by cluster sampling technique were not statistically different from the coverage value as obtained by lot quality assurance sampling techniques. Considering the time and resources required, it was found that lot quality assurance sampling is a better technique in evaluating the primary immunization coverage in urban area.

  3. Provider perceptions of the social work environment and the state of pediatric care in a downsized urban public academic medical center.

    Science.gov (United States)

    Tataw, David Besong

    2011-05-01

    The author's purpose through this study was to document and analyze health provider perceptions of their social work environment and the state of pediatric care at Los Angeles County King/Drew Hospital and Medical Center in 2000, after the restructuring and downsizing of the hospital and its community clinics. The research results showed nurses and physicians reporting that both the quality of pediatric care and the provider social work environment were poor. Negative factors in the social work environment included: low employee morale, poorly staffed clinical teams, lack of professional autonomy, perceptions of low quality of care for pediatric patients, and interpersonal issues of poor communication and collaboration among providers. Providers also perceived a non-supportive work environment, sense of powerlessness, poor quality of work, lack of goal clarity from leadership, lack of fairness in leadership behavior, and an organizational leadership that is abandoning its core mission and values, thereby making it difficult for providers to carry out their professional functions. The author's findings in this study suggest a relationship between intra-role conflict, social employment environment and quality of care at King/Drew Medical Center in 2000. Lessons for practice are presented.

  4. Characteristics and respiratory risk profile of children aged less than 5 years presenting to an urban, Aboriginal-friendly, comprehensive primary health practice in Australia.

    Science.gov (United States)

    Hall, Kerry K; Chang, Anne B; Anderson, Jennie; Dunbar, Melissa; Arnold, Daniel; O'Grady, Kerry-Ann F

    2017-07-01

    There are no published data on factors impacting on acute respiratory illness (ARI) among urban Indigenous children. We describe the characteristics and respiratory risk profile of young urban Indigenous children attending an Aboriginal-friendly primary health-care practice. We conducted a cross-sectional analysis of data collected at baseline in a cohort study investigating ARI in urban Indigenous children aged less than 5 years registered with an Aboriginal primary health-care service. Descriptive analyses of epidemiological, clinical, environmental and cultural factors were performed. Logistic regression was undertaken to examine associations between child characteristics and the presence of ARI at baseline. Between February 2013 and October 2015, 180 Indigenous children were enrolled; the median age was 18.4 months (7.7-35), 51% were male. A total of 40 (22%) children presented for a cough-related illness; however, ARI was identified in 33% of all children at the time of enrolment. A total of 72% of children were exposed to environmental tobacco smoke. ARI at baseline was associated with low birthweight (adjusted odds ratio (aOR) 2.54, 95% confidence interval (CI) 1.08-5.94), a history of eczema (aOR 2.67, 95% CI 1.00-7.15) and either having a family member from the Stolen Generation (aOR 3.47, 95% CI 1.33-9.03) or not knowing this family history (aOR 3.35, 95% CI 1.21-9.26). We identified an urban community of children of high socio-economic disadvantage and who have excessive exposure to environmental tobacco smoke. Connection to the Stolen Generation or not knowing the family history may be directly impacting on child health in this community. Further research is needed to understand the relationship between cultural factors and ARI. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

  5. Primary blood-hosts of mosquitoes are influenced by social and ecological conditions in a complex urban landscape.

    Science.gov (United States)

    Goodman, Heather; Egizi, Andrea; Fonseca, Dina M; Leisnham, Paul T; LaDeau, Shannon L

    2018-04-10

    Temperate urban landscapes support persistent and growing populations of Culex and Aedes mosquito vectors. Large urban mosquito populations can represent a significant risk for transmission of emergent arboviral infection. However, even large mosquito populations are only a risk to the animals they bite. The purpose of this study is to identify and assess spatial patterns of host-use in a temperate urban landscape with heterogeneous socio-economic and ecological conditions. Mosquito blood meals were collected from neighborhoods categorized along a socio-economic gradient in Baltimore, MD, USA. Blood meal hosts were identified for two Aedes (Ae. albopictus and Ae. japonicus) and three Culex (Cx. pipiens, Cx. restuans and Cx. salinarius) species. The brown rat (Rattus norvegicus) was the most frequently detected host in both Aedes species and Cx. salinarius. Human biting was evident in Aedes and Culex species and the proportion of human blood meals from Ae. albopictus varied significantly with neighborhood socio-economic status. Aedes albopictus was most likely to feed on human blood hosts (at 50%) in residential blocks categorized as having income above the city median, although there were still more total human bites detected from lower income blocks where Ae. albopictus was more abundant. Birds were the most frequently detected Culex blood hosts but were absent from all Aedes sampled. This study highlights fine-scale variation in host-use by medically important mosquito vectors and specifically investigates blood meal composition at spatial scales relevant to urban mosquito dispersal and human exposure. Further, the work emphasizes the importance of neighborhood economics and infrastructure management in shaping both the relative abundance of vectors and local blood feeding strategies. The invasive brown rat was an important blood source across vector species and neighborhoods in Baltimore. We show that social and economic conditions can be important predictors of

  6. Differences in the prevalence of overweight, obesity and underweight among children from primary schools in rural and urban areas

    Directory of Open Access Journals (Sweden)

    Katarzyna Wolnicka

    2016-06-01

    The prevalence of overweight and obesity among children from rural and urban areas of Poland is similar. Analysis of regional differences in the prevalence of obesity, overweight and underweight among children and adolescents may indicate the direction of national and local activities aiming to reduce the inequalities resulting from nutritional well-being.

  7. Virtual Pediatric Hospital

    Science.gov (United States)

    ... Thoracopaedia - An Imaging Encyclopedia of Pediatric Thoracic Disease Virtual Pediatric Hospital is the Apprentice's Assistant™ Last revised ... pediatric resources: GeneralPediatrics.com | PediatricEducation.org | SearchingPediatrics.com Virtual Pediatric Hospital is curated by Donna M. D' ...

  8. Prevalence of primary open-angle glaucoma in an urban south Indian population and comparison with a rural population. The Chennai Glaucoma Study.

    Science.gov (United States)

    Vijaya, Lingam; George, Ronnie; Baskaran, M; Arvind, Hemamalini; Raju, Prema; Ramesh, S Ve; Kumaramanickavel, Govindasamy; McCarty, Catherine

    2008-04-01

    To estimate the prevalence and risk factors of primary open-angle glaucoma (POAG) in an urban population and compare the same with that of our published rural population data in southern India. Population-based cross-sectional study. Four thousand eight hundred subjects 40 years or older were selected using a multistage random cluster sampling procedure in Chennai city. Three thousand eight hundred fifty (80.2%) subjects underwent a complete ophthalmic examination, including applanation tonometry, gonioscopy, pachymetry, optic disc photography, and automated perimetry. Glaucoma was diagnosed using the International Society of Geographical and Epidemiological Ophthalmology Classification. The distribution of intraocular pressure (IOP) and vertical cup-to-disc ratio (VCDR) was obtained from the right eye of the 2532 subjects with normal suprathreshold visual fields. Mean IOP was 16.17+/-3.74 mmHg (97.5th and 99.5th percentiles, 24 mmHg and 30 mmHg). The mean VCDR was 0.43+/-0.17 (97.5th and 99.5th percentiles, 0.7 and 0.8). One hundred thirty-five (64 men, 71 women) subjects had POAG (3.51%; 95% confidence interval [CI], 3.04-4.0). Primary open-angle glaucoma subjects (58.4+/-11.3 years) were older (P or =40-year-old south Indian urban population was 3.51%, higher than that of the rural population. The prevalence increased with age, and >90% were not aware of the disease.

  9. Use of support services in a sample of patients with high-risk primary melanomas in urban, regional and rural Queensland.

    Science.gov (United States)

    von Schuckmann, Lena A; Smithers, Bernhard M; Khosrotehrani, Kiarash; Beesley, Vanessa L; van der Pols, Jolieke C; Hughes, Maria B; Green, Adele C

    2017-06-01

    To characterise use of support services in patients diagnosed with high-risk primary melanoma by their location of residence. In a cross-sectional study of 787 patients with histologically-confirmed clinical stage 1B-2 melanoma, we estimated odds ratios (ORs) using regression models to assess the association of support service use with residence in rural, regional or urban areas. We also evaluated demographic and clinical correlates of support service use. Among 113 rural patients, 33 (29%) used support services around time of diagnosis compared to 88 (39%) of 224 regional participants and 164 of 448 (37%) urban participants. Regional participants more commonly used support services compared to rural participants (OR 1.84; CI 1.09-3.10), but there was no association with urban versus rural residence (OR 1.32; CI 0.82-2.13). As well, females (OR 1.58; CI 1.15-2.18), those <65 years (OR 1.96; CI 1.42-2.71), or with higher education (OR 2.30; CI 1.53-3.44), or those with T-stage 4B (OR 2.69; CI 1.36-5.32) were more likely to use support services than other patients. Use of support services is lower among rural patients and other sub-groups of primary melanoma patients who have poorer prognoses than others. Implications for public health: Appropriate triage to support services is required for rural and other vulnerable patient groups to ensure optimal patient care. © 2017 The Authors.

  10. Pediatric Terminology

    Science.gov (United States)

    The National Institute of Child Health and Human Development (NICHD) works with NCI Enterprise Vocabulary Services (EVS) to provide standardized terminology for coding pediatric clinical trials and other research activities.

  11. Pediatric MRI

    Data.gov (United States)

    U.S. Department of Health & Human Services — The NIH Study of Normal Brain Development is a longitudinal study using anatomical MRI, diffusion tensor imaging (DTI), and MR spectroscopy (MRS) to map pediatric...

  12. Pediatric sleep apnea

    Science.gov (United States)

    Sleep apnea - pediatric; Apnea - pediatric sleep apnea syndrome; Sleep-disordered breathing - pediatric ... Untreated pediatric sleep apnea may lead to: High blood pressure Heart or lung problems Slow growth and development

  13. Does the design and implementation of proven innovations for delivering basic primary health care services in rural communities fit the urban setting: the case of Ghana's Community-based Health Planning and Services (CHPS).

    Science.gov (United States)

    Adongo, Philip Baba; Phillips, James F; Aikins, Moses; Arhin, Doris Afua; Schmitt, Margaret; Nwameme, Adanna U; Tabong, Philip Teg-Nefaah; Binka, Fred N

    2014-04-01

    Rapid urban population growth is of global concern as it is accompanied with several new health challenges. The urban poor who reside in informal settlements are more vulnerable to these health challenges. Lack of formal government public health facilities for the provision of health care is also a common phenomenon among communities inhabited by the urban poor. To help ameliorate this situation, an innovative urban primary health system was introduced in urban Ghana, based on the milestones model developed with the rural Community-Based Health Planning and Services (CHPS) system. This paper provides an overview of innovative experiences adapted while addressing these urban health issues, including the process of deriving constructive lessons needed to inform discourse on the design and implementation of the sustainable Community-Based Health Planning and Services (CHPS) model as a response to urban health challenges in Southern Ghana. This research was conducted during the six-month pilot of the urban CHPS programme in two selected areas acting as the intervention and control arms of the design. Daily routine data were collected based on milestones initially delineated for the rural CHPS model in the control communities whilst in the intervention communities, some modifications were made to the rural milestones. The findings from the implementation activities revealed that many of the best practices derived from the rural CHPS experiment could not be transplanted to poor urban settlements due to the unique organizational structures and epidemiological characteristics found in the urban context. For example, constructing Community Health Compounds and residential facilities within zones, a central component to the rural CHPS strategy, proved inappropriate for the urban sector. Night and weekend home visit schedules were initiated to better accommodate urban residents and increase coverage. The breadth of the disease burden of the urban residents also requires a

  14. Differences in the prevalence of overweight, obesity and underweight among children from primary schools in rural and urban areas.

    Science.gov (United States)

    Wolnicka, Katarzyna; Jarosz, Mirosław; Jaczewska-Schuetz, Joanna; Taraszewska, Anna Małgorzata

    2016-06-02

    Overweight adversely affects not only the health and development of children and adolescents but also their health in adulthood, increasing the risk of chronic non-communicable diseases and disabilities. The frequency of nutritional disorders among children and adolescents is increasing in many countries worldwide, including Poland. To demonstrate differences in the nutritional well-being of school-age children depending on the school location: rural and urban areas. The study conducted in 2010 covered a total of 1,255 pupils, 627 girls and 628 boys, aged nine, from the area of five provinces of Poland: Pomorskie, Opolskie, Wielkopolskie, Podkarpackie and Masovian, representing the northern, southern, western, eastern and central regions of the country. Based on the height and weight measurements of children, the body mass index was calculated. The nutritional status was assessed according to the criteria of Cole et al. The prevalence of overweight and obesity in girls and boys in separate regions of the country (villages, cities with less than 100,000 residents and cities with more than 100,000 residents) did not differ significantly. The prevalence of overweight and obesity among children from rural and urban areas of Poland is similar. Analysis of regional differences in the prevalence of obesity, overweight and underweight among children and adolescents may indicate the direction of national and local activities aiming to reduce the inequalities resulting from nutritional well-being.

  15. Experiences with primary healthcare in Fuzhou, urban China, in the context of health sector reform: a mixed methods study.

    Science.gov (United States)

    McCollum, Rosalind; Chen, Lieping; ChenXiang, Tang; Liu, Xiaoyun; Starfield, Barbara; Jinhuan, Zheng; Tolhurst, Rachel

    2014-01-01

    China has recently placed increased emphasis on the provision of primary healthcare services through health sector reform, in response to inequitably distributed health services. With increasing funding for community level facilities, now is an opportune time to assess the quality of primary care delivery and identify areas in need of further improvement. A mixed methodology approach was adopted for this study. Quantitative data were collected using the Primary Care Assessment Tool-Chinese version (C-PCAT), a questionnaire previously adapted for use in China to assess the quality of care at each health facility, based on clients' experiences. In addition, qualitative data were gathered through eight semi-structured interviews exploring perceptions of primary care with health directors and a policy maker to place this issue in the context of health sector reform. The study found that patients attending community health and sub-community health centres are more likely to report better experiences with primary care attributes than patients attending hospital facilities. Generally low scores for community orientation, family centredness and coordination in all types of health facility indicate an urgent need for improvement in these areas. Healthcare directors and policy makers perceived the need for greater coordination between levels of health providers, better financial reimbursement, more formal government contracts and recognition/higher status for staff at the community level and more appropriate undergraduate and postgraduate training. Copyright © 2013 John Wiley & Sons, Ltd.

  16. Comparison of risk of acute kidney injury after primary percutaneous coronary interventions with the transradial approach versus the transfemoral approach (from the PRIPITENA urban registry).

    Science.gov (United States)

    Cortese, Bernardo; Sciahbasi, Alessandro; Sebik, Rodrigo; Rigattieri, Stefano; Alonzo, Alessandro; Silva-Orrego, Pedro; Belloni, Flavia; Seregni, Romano G; Giovannelli, Francesca; Tespili, Maurizio; Ricci, Roberto; Berni, Andrea

    2014-09-15

    The risk of acute kidney injury (AKI) is a major issue after percutaneous coronary interventions (PCIs), especially in the setting of ST-elevation myocardial infarction. Preliminary data from large retrospective registries seem to show a reduction of AKI when a transradial (TR) approach for PCI is adopted. Little is known about the relation between vascular access and AKI after emergent PCI. We here report the results of the Primary PCI from Tevere to Navigli (PRIPITENA), a retrospective database of primary PCI performed at high-volume centers in the urban areas of Rome and Milan. Primary end point of this study was the occurrence of AKI in the TR and transfemoral (TF) access site groups. Secondary end points were major adverse cardiovascular events, stent thrombosis, and Thrombolysis in Myocardial Infarction major and minor bleedings. The database included 1,330 patients, 836 treated with a TR and 494 with a TF approach. After a propensity-matched analysis performed to exclude possible confounders, we identified 450 matched patients (225 TR and 225 TF). The incidence of AKI in the 2 matched groups was lower in patients treated with TR primary PCI (8.4% vs 16.9%, p = 0.007). Major adverse cardiovascular events and stent thrombosis were not different among study groups, whereas major bleedings were more often seen in the TF group. At multivariate analysis, femoral access was an independent predictor of AKI (odds ratio 1.654, 95% confidence interval 1.084 to 2.524, p = 0.042). In conclusion, in this database of primary PCI, the risk of AKI was lower with a TR approach, and the TF approach was an independent predictor for the occurrence of this complication. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. Choice of primary health care source in an urbanized low-income community in Singapore: a mixed-methods study.

    Science.gov (United States)

    Wee, Liang En; Lim, Li Yan; Shen, Tong; Lee, Elis Yuexian; Chia, Yet Hong; Tan, Andrew Yen Siong; Koh, Gerald Choon-Huat

    2014-02-01

    Cost and misperceptions may discourage lower income Singaporeans from utilizing primary care. We investigated sources of primary care in a low-income Singaporean community in a mixed-methods study. Residents of a low-income public rental flat neighbourhood were asked for sociodemographic details and preferred source of primary care relative to their higher income neighbours. In the qualitative component, interviewers elicited, from patients and health care providers, barriers/enablers to seeking care from Western-trained doctors. Interviewees were selected via purposive sampling. Transcripts were analyzed thematically, and iterative analysis was carried out using established qualitative method. Participation was 89.8% (359/400). Only 11.1% (40/359) preferred to approach Western-trained doctors, 29.5% (106/359) preferred alternative medicine, 6.7% (24/359) approached family/friends and 52.6% (189/359) preferred self-reliance. Comparing against higher income neighbours, rental flat residents were more likely to turn to alternative medicine and family members but less likely to turn to Western-trained doctors (P Self-reliance was perceived as acceptable for 'small' illnesses but not for 'big' ones, communal spirit was cited as a reason for consulting family/friends and social distance from primary care practitioners was highlighted as a reason for not consulting Western-trained doctors. Western-trained physicians are not the first choice of lower income Singaporeans for seeking primary care. Knowledge, primary care characteristics and costs were identified as potential barriers/enablers.

  18. Environmental Management of Pediatric Asthma: Guidelines for Health Care Providers

    Science.gov (United States)

    Roberts, James R.; McCurdy, Leyla Erk

    2005-01-01

    These guidelines are the product of a new Pediatric Asthma Initiative aimed at integrating environmental management of asthma into pediatric health care. This document outlines competencies in environmental health relevant to pediatric asthma that should be mastered by primary health care providers, and outlines the environmental interventions…

  19. Educational Quality Differences in a Middle-Income Country: The Urban-Rural Gap in Malaysian Primary Schools

    Science.gov (United States)

    Othman, Mariam; Muijs, Daniel

    2013-01-01

    Shortcomings of educational quality in rural schools remain a key focus in the literature related to developing countries. This paper studies whether rural primary schools in Malaysia, an upper middle-income developing country, are still experiencing lower levels of educational resources, school climate, school leadership, and parental involvement…

  20. Assessing the impact of urbanization on net primary productivity using multi-scale remote sensing data: a case study of Xuzhou, China

    Science.gov (United States)

    Tan, Kun; Zhou, Songyang; Li, Erzhu; Du, Peijun

    2015-06-01

    An improved Carnegie Ames Stanford Approach (CASA) model based on two kinds of remote sensing (RS) data, Landsat Enhanced Thematic Mapper Plus (ETM +) and Moderate Resolution Imaging Spectro-radiometer (MODIS), and climate variables were applied to estimate the Net Primary Productivity (NPP) of Xuzhou in June of each year from 2001 to 2010. The NPP of the study area decreased as the spatial scale increased. The average NPP of terrestrial vegetation in Xuzhou showed a decreasing trend in recent years, likely due to changes in climate and environment. The study area was divided into four sub-regions, designated as highest, moderately high, moderately low, and lowest in NPP. The area designated as the lowest sub-region in NPP increased with expanding scale, indicating that the NPP distribution varied with different spatial scales. The NPP of different vegetation types was also significantly influenced by scale. In particular, the NPP of urban woodland produced lower estimates because of mixed pixels. Similar trends in NPP were observed with different RS data. In addition, expansion of residential areas and reduction of vegetated areas were the major reasons for NPP change. Land cover changes in urban areas reduced NPP, which could chiefly be attributed to human-induced disturbance.

  1. How Do US Pediatric Residency Programs Teach and Evaluate Community Pediatrics and Advocacy Training?

    Science.gov (United States)

    Lichtenstein, Cara; Hoffman, Benjamin D; Moon, Rachel Y

    2017-07-01

    In 2013, the Accreditation Council for Graduate Medical Education updated requirements for training in community pediatrics and advocacy in pediatric residency programs. In light of this update, the aim of this study was to better understand how community pediatrics is being taught and evaluated in pediatric residency programs in the United States. Cross-sectional exploratory study using a Web-based survey of pediatric residency program directors in September 2014. Questions focused on teaching and evaluation of 10 community pediatrics competencies. Of 85 programs (43% response rate), 30% offered a separate training track and/or 6-block individualized curriculum in community pediatrics or advocacy. More than 75% required all residents to learn 7 of 10 competencies queried. Respondents in urban settings were more likely to teach care of special populations (P = .02) and public speaking (P pediatrics and advocacy teaching among responding US pediatric residency programs. Although respondents reported a variety of teaching and evaluation methods, there were few statistically significant differences between programs. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  2. Pediatric AIDS

    International Nuclear Information System (INIS)

    Price, D.B.; Haller, J.O.; Kramer, J.; Hotson, G.C.; Loh, J.P.; Schlusselberg, D.; Inglese, C.M.; Jacobs, J.; Rose, A.L.; Menez-Bautista, R.; Fikrig, S.

    1988-01-01

    A group of 23 pediatric patients seropositive for HIV antibody were studied by computed tomography and evaluated neurodevelopmentally. Significant neurodevelopmental delays were found in over 95% of the patients studied. CT findings in six patients were normal and thirteen of 23 (57%) had prominence of the CSF spaces. Less frequent findings included calcifications in the basal ganglia and white matter. Cerebral mass lesions included one case of lymphoma and one case of hemorrhage. The CT findings in the pediatric age group differs from the adult population in that that contrast enhancing inflammatory mass lesions are uncommon. (orig.)

  3. Identifying behavioural determinants for interventions to increase handwashing practices among primary school children in rural Burundi and urban Zimbabwe.

    Science.gov (United States)

    Seimetz, Elisabeth; Slekiene, Jurgita; Friedrich, Max N D; Mosler, Hans-Joachim

    2017-07-14

    This article presents the development of a school handwashing programme in two different sub-Saharan countries that applies the RANAS (risk, attitudes, norms, ability, and self-regulation) systematic approach to behaviour change. Interviews were conducted with 669 children enrolled in 20 primary schools in Burundi and 524 children in 20 primary schools in Zimbabwe. Regression analyses were used to assess the influence of the RANAS behavioural determinants on reported handwashing frequencies. The results revealed that, in both countries, a programme targeting social norms and self-efficacy would be most effective. In Burundi, raising the children's perceived severity of the consequences of contracting diarrhoea, and in Zimbabwe, increasing the children's health knowledge should be part of the programme. The school handwashing programme should create awareness of the benefits of handwashing through educational activities, raise the children's ability and confidence in washing hands at school through infrastructural improvements, and highlight the normality of washing hands at school through events and poster creation.

  4. Glycaemic control of diabetic patients in an urban primary health care setting in Sarawak: the Tanah Puteh Health Centre experience.

    Science.gov (United States)

    Wong, J S; Rahimah, N

    2004-08-01

    Achieving glycaemic goals in diabetics has always been a problem, especially in a developing country with inadequate facilities such as in Sarawak in Malaysia. There are no reported studies on the control of diabetes mellitus in a diabetic clinic in the primary health care setting in Sarawak. This paper describes the profile of 1031 patients treated in Klinik Kesihatan Tanah Puteh Health Centre. The mean age was 59 years, the mean BMI 27 kg/m2. There was a female preponderance and mainly type-2 diabetes. Mean HbA1c was 7.4%. Glycaemic control was optimal in 28% (HbA1c 7.5%). Reasonable glycaemic control can be achieved in the primary health care setting in Sarawak.

  5. Recruiting and retaining primary care physicians in urban underserved communities: the importance of having a mission to serve.

    Science.gov (United States)

    Odom Walker, Kara; Ryan, Gery; Ramey, Robin; Nunez, Felix L; Beltran, Robert; Splawn, Robert G; Brown, Arleen F

    2010-11-01

    We examined factors influencing physician practice decisions that may increase primary care supply in underserved areas. We conducted in-depth interviews with 42 primary care physicians from Los Angeles County, California, stratified by race/ethnicity (African American, Latino, and non-Latino White) and practice location (underserved vs nonunderserved area). We reviewed transcriptions and coded them into themes by using standard qualitative methods. Three major themes emerged in relation to selecting geographic- and population-based practice decisions: (1) personal motivators, (2) career motivators, and (3) clinic support. We found that subthemes describing personal motivators (e.g., personal mission and self-identity) for choosing a practice were more common in responses among physicians who worked in underserved areas than among those who did not. By contrast, physicians in nonunderserved areas were more likely to cite work hours and lifestyle as reasons for selecting their current practice location or for leaving an underserved area. Medical schools and shortage-area clinical practices may enhance strategies for recruiting primary care physicians to underserved areas by identifying key personal motivators and may promote long-term retention through work-life balance.

  6. Imaging in the diagnosis of pediatric urolithiasis

    International Nuclear Information System (INIS)

    Colleran, Gabrielle C.; Callahan, Michael J.; Paltiel, Harriet J.; Chow, Jeanne S.; Nelson, Caleb P.; Cilento, Bartley G.; Baum, Michelle A.

    2017-01-01

    Pediatric urolithiasis is an important and increasingly prevalent cause of pediatric morbidity and hospital admission. Ultrasound (US) is the recommended primary imaging modality for suspected urolithiasis in children. There is, however, widespread use of CT as a first-line study for abdominal pain in many institutions involved in pediatric care. The objective of this review is to outline state-of-the-art imaging modalities and methods for diagnosing urolithiasis in children. The pediatric radiologist plays a key role in ensuring that the appropriate imaging modality is performed in the setting of suspected pediatric urolithiasis. Our proposed imaging algorithm starts with US, and describes the optimal technique and indications for the use of CT. We emphasize the importance of improved communication with a greater collaborative approach between pediatric and general radiology departments so children undergo the appropriate imaging evaluation. (orig.)

  7. Imaging in the diagnosis of pediatric urolithiasis

    Energy Technology Data Exchange (ETDEWEB)

    Colleran, Gabrielle C.; Callahan, Michael J.; Paltiel, Harriet J.; Chow, Jeanne S. [Boston Children' s Hospital, Department of Radiology, Boston, MA (United States); Nelson, Caleb P.; Cilento, Bartley G. [Boston Children' s Hospital, Department of Urology, Boston, MA (United States); Baum, Michelle A. [Boston Children' s Hospital, Department of Nephrology, Boston, MA (United States)

    2017-01-15

    Pediatric urolithiasis is an important and increasingly prevalent cause of pediatric morbidity and hospital admission. Ultrasound (US) is the recommended primary imaging modality for suspected urolithiasis in children. There is, however, widespread use of CT as a first-line study for abdominal pain in many institutions involved in pediatric care. The objective of this review is to outline state-of-the-art imaging modalities and methods for diagnosing urolithiasis in children. The pediatric radiologist plays a key role in ensuring that the appropriate imaging modality is performed in the setting of suspected pediatric urolithiasis. Our proposed imaging algorithm starts with US, and describes the optimal technique and indications for the use of CT. We emphasize the importance of improved communication with a greater collaborative approach between pediatric and general radiology departments so children undergo the appropriate imaging evaluation. (orig.)

  8. Pediatric vasculitis.

    Science.gov (United States)

    Barut, Kenan; Sahin, Sezgin; Kasapcopur, Ozgur

    2016-01-01

    The aim of this review is to define childhood vasculitis and to highlight new causative factors and treatment modalities under the guidance of recently published studies. Childhood vasculitis is difficult to diagnose because of the wide variation in the symptoms and signs. New nomenclature and classification criteria were proposed for the diagnosis of pediatric vasculitis. Recently, progress has been made toward understanding the genetic susceptibility to pediatric vasculitis as it was in other diseases. Various radiological techniques provide great opportunities in establishing the diagnosis of pediatric vasculitis. Mild central nervous system disease can accompany Henoch-Schonlein purpura and can go unnoticed. Antineutrophilic cytoplasmic antibody-associated vasculitis is rare in children. Increased severity of the disease, subglottic stenosis, and renal disease are described more frequently among children. Biological therapies are used with success in children as in adults. Future studies, whose aims are to evaluate treatment responses, prognosis and to design guidelines for activity, and damage index of vasculitis for children are required. Henoch-Schonlein purpura and Kawasaki disease are the most frequent vasculitides of children. Experience from adult studies for treatment and prognosis are usually used because of low incidence of other vasculitides in children. Multicenter studies of pediatric vasculitis should be conducted to detail treatment responses and prognosis in children.

  9. Integration of Pediatric Mental Health in General Pediatrics in Eritrea ...

    African Journals Online (AJOL)

    of mental health needs of America's youth, with 1 ... health services to children and adolescents in the primary ... Conclusion: The establishment of the Pediatric residency with a dedicated curriculum to address mental health ... However, there are few young patients being evaluated ... mental health care without stigma.

  10. Intrathecally enhanced spinal CT in the early diagnosis of cerebrospinal fluid-borne metastasis in pediatric patients with primary brain tumors

    International Nuclear Information System (INIS)

    Wang, H.; Rosenbaum, A.E.; Ahn, H.S.; Zinreich, S.J.; Diffley, D.M.; Killmond, T.A.; Strauss, L.C.

    1987-01-01

    Early diagnosis and treatment of asymptomatic intraspinal cerebrospinal fluid-borne metastases can obviate serious sequelae in pediatric patients with known intracranial tumors. MR imaging is a superior imaging modality; however, in very young patients who need general anesthesia for immobilization and also for evaluation of small subarachnoid seedings, the authors found CT to be a valuable alternative. Twelve patients ranging in age from 3 months to 13 years underwent CT screening of the entire spine after intrathecal enhancement with 3-5 ml of metrizamide (100 mg iodine per milliliter) via a lumbar puncture. Intrathecal spinal metastases were found in 67% of the studied patients and even in a patient whose MR imaging examination failed to disclose the lesion

  11. Comparison of the primary energy consumption and the CO2-emission of an urban vehicle with conventional and alternative drives

    International Nuclear Information System (INIS)

    Birnbreier, H.

    1992-01-01

    Based on a model car with its basic data corresponding to those of a series-produced small passenger car, conventional and alternative drives were compared. Cars shared the following features: same basic weight without tank, one energy storage system for the same driving range, same acceleration capacity from 0 to 50 km/h. Petrol and diesel were the conventional fuels; methanol, natural gas (pressurized, liquid), hydrogen (pressurized, liquid, hydride) and electric energy (NaS battery) were the alternative fuels. Both primary energy and CO 2 balancings take the different raw materials into account for the production of useful energies. (orig.) [de

  12. The Adoption of Roles by Primary Care Providers during Implementation of the New Chronic Disease Guidelines in Urban Mongolia: A Qualitative Study

    Directory of Open Access Journals (Sweden)

    Oyun Chimeddamba

    2016-04-01

    Full Text Available (1 Background: In 2011, new chronic disease guidelines were introduced across Mongolia. No formal advice was provided regarding role delineation. This study aimed to analyse the roles that different primary care providers adopted, and the variations in these, in the implementation of the guidelines in urban Mongolia; (2 Methods: Ten group interviews with nurses and ten individual interviews each with practice doctors and practice directors were conducted. Data was analysed using a thematic approach based on the identified themes relevant to role delineation; (3 Results: There was some variability and flexibility in role delineation. Factors involving teamwork, task rotation and practice flexibility facilitated well the guideline implementation. However, factors including expectations and decision making, nursing shortage, and training gaps adversely influenced in the roles and responsibilities. Some role confusion and dissatisfaction was identified, often associated with a lack of training or staff turnover; (4 Conclusions: Findings suggest that adequate ongoing training is required to maximize the range of roles particular provider types, especially primary care nurses, are competent to perform. Ensuring that role delineation is specified in guidelines could remove confusion and enhance implementation of such guidelines.

  13. Evaluating the association between the built environment and primary care access for new Medicaid enrollees in an urban environment using Walk and Transit Scores.

    Science.gov (United States)

    Chaiyachati, Krisda H; Hom, Jeffrey K; Hubbard, Rebecca A; Wong, Charlene; Grande, David

    2018-03-01

    Worse health outcomes among those living in poverty are due in part to lower rates of health insurance and barriers to care. As the Affordable Care Act reduced financial barriers, identifying persistent barriers to accessible health care continues to be important. We examined whether the built environment as reflected by Walk Score™ (a measure of walkability to neighborhood resources) and Transit Score™ (a measure of transit access) is associated with having a usual source of care among low-income adults, newly enrolled in Medicaid. We received responses from 312 out of 1000 new Medicaid enrollees in Philadelphia, a large, densely populated urban area, who were surveyed between 2015 and 2016 to determine if they had identified a usual source of outpatient primary care. Respondents living at an address with a low Walk Scores (< 70) had 84% lower odds of having a usual source of care (OR 0.16, 95% CI 0.04-0.61). Transit scores were not associated with having a usual source of care. Walk Score may be a tool for policy makers and providers of care to identify populations at risk for worse primary care access.

  14. Evaluating the association between the built environment and primary care access for new Medicaid enrollees in an urban environment using Walk and Transit Scores

    Directory of Open Access Journals (Sweden)

    Krisda H. Chaiyachati

    2018-03-01

    Full Text Available Worse health outcomes among those living in poverty are due in part to lower rates of health insurance and barriers to care. As the Affordable Care Act reduced financial barriers, identifying persistent barriers to accessible health care continues to be important. We examined whether the built environment as reflected by Walk Score™ (a measure of walkability to neighborhood resources and Transit Score™ (a measure of transit access is associated with having a usual source of care among low-income adults, newly enrolled in Medicaid. We received responses from 312 out of 1000 new Medicaid enrollees in Philadelphia, a large, densely populated urban area, who were surveyed between 2015 and 2016 to determine if they had identified a usual source of outpatient primary care. Respondents living at an address with a low Walk Scores (<70 had 84% lower odds of having a usual source of care (OR 0.16, 95% CI 0.04–0.61. Transit scores were not associated with having a usual source of care. Walk Score may be a tool for policy makers and providers of care to identify populations at risk for worse primary care access.

  15. Children's (Pediatric) CT (Computed Tomography)

    Medline Plus

    Full Text Available ... navigation Test/Treatment Patient Type Screening/Wellness Disease/Condition Safety En Español More Info Images/Videos About Us ... or better than those obtained by CT scanning. Working together, your primary care physician or ... Safety in Pediatric Imaging's "Image Gently" Campaign top of ...

  16. Correlation among academic performance, recurrent abdominal pain and other factors in Year-6 urban primary-school children in Malaysia.

    Science.gov (United States)

    Boey, C C M; Omar, A; Arul Phillips, J

    2003-07-01

    The present study aimed to investigate the extent to which recurrent abdominal pain and other factors were associated with academic achievement among Year-6 (12 years of age) schoolchildren. The present study was a cross-sectional survey conducted from September to November 2001. Schoolchildren were recruited from primary schools that were selected randomly from a list of all primary schools in Petaling Jaya, Malaysia, using random sampling numbers. Information concerning recurrent abdominal pain, socio-economic status, life events, demographic and other details was obtained using a combination of questionnaires and interviews. Academic achievement was assessed using a score based on the Malaysian Primary School Achievement Examination. An overall score at or above the mean was taken to indicate high academic achievement while a score below the mean indicated poor academic achievement. A total of 1971 children were studied (958 boys and 1013 girls: 1047 Malays, 513 Chinese and 411 Indians). Of these children, 456 (23.1%) fulfilled the criteria for recurrent abdominal pain. Using the method of binary logistic regression analysis, the following factors were found to be independently associated with poor academic performance: a low socio-economic status (odds ratio (OR) 1.30; 95% confidence interval (CI) 1.25-1.35); male sex (OR 1.61; 95% CI 1.26-2.05); the death of a close relative (OR 2.22; 95% CI 1.73-2.85); the divorce or separation of parents (OR 3.05; 95% CI 1.73-5.40); the commencement of work by the mother (OR 1.34; 95% CI 1.02-1.76); hospitalization of the child in the 12 months prior to the study (OR 1.83; 95% CI 1.12-3.01); lack of health-care consultation (OR 1.80; 95% CI 1.36-2.36); missing breakfast (OR 1.47; 95% CI 1.07-2.02); and lack of kindergarten education (OR 1.35; 95% CI 1.04-1.75). Many factors, such as socio-economic status and recent life events, were associated with poor academic performance. Recurrent abdominal pain did not correlate

  17. Not the usual suspect: a case of erythema induration of Bazin in an urban primary care clinic

    Directory of Open Access Journals (Sweden)

    Ling Xu

    2015-12-01

    Full Text Available Frontline clinicians in the United States, especially those working in safety net hospitals or with immigrant populations, will likely see cutaneous tuberculosis given the tremendous burden of tuberculosis infection worldwide. The tuberculid is a subtype of cutaneous tuberculosis that poses a diagnostic challenge because organisms are not found in smears or cultures taken from the lesions. Tuberculid lesions can mimic erythema nodosum, thrombophlebitis, and cellulitis. We describe the case of a 57-year-old woman immigrant from China who presented with tender, subcutaneous nodules on her ankle and thigh in the setting of prior exposure to tuberculosis. We describe the clinical, pathophysiologic, and histopathologic features of tuberculids in order to raise awareness among primary care clinicians about this difficult to diagnose but readily treatable manifestation of tuberculosis.

  18. Pediatric biobanking

    DEFF Research Database (Denmark)

    Salvaterra, Elena; Giorda, Roberto; Bassi, Maria T

    2012-01-01

    Ethical, legal, and social issues related to the collection, storage, and use of biospecimens and data derived from children raise critical concerns in the international debate. So far, a number of studies have considered a variety of the individual issues crucial to pediatric biobanking such as ......Ethical, legal, and social issues related to the collection, storage, and use of biospecimens and data derived from children raise critical concerns in the international debate. So far, a number of studies have considered a variety of the individual issues crucial to pediatric biobanking...... such as decision making, privacy protection, minor recontact, and research withdrawal by focusing on theoretical or empirical perspectives. Our research attempted to analyze such issues in a comprehensive manner by exploring practices, rules, and researcher opinions regarding proxy consent, minor assent, specimens...

  19. Pediatric stroke

    International Nuclear Information System (INIS)

    Hoermann, M.

    2008-01-01

    Stroke in childhood has gained increasingly more attention and is accepted as an important disease in childhood. The reasons for this severe event and the consequences for the rest of the life are totally different than for adults. This is also true for the diagnosis and therapy. This paper gives a comprehensive overview on the characteristics of pediatric stroke to assist radiologists in making a rapid and safe diagnosis in order to identify the underlying disease. (orig.) [de

  20. Children's (Pediatric) Nuclear Medicine

    Medline Plus

    Full Text Available ... Physician Resources Professions Site Index A-Z Children's (Pediatric) Nuclear Medicine Children’s (pediatric) nuclear medicine imaging uses ... limitations of Children's Nuclear Medicine? What is Children's (Pediatric) Nuclear Medicine? Nuclear medicine is a branch of ...

  1. Pediatric heart surgery - discharge

    Science.gov (United States)

    ... discharge; Heart valve surgery - children - discharge; Heart surgery - pediatric - discharge; Heart transplant - pediatric - discharge ... Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; 2016:chap 434. ...

  2. Children's (Pediatric) Nuclear Medicine

    Medline Plus

    Full Text Available ... Professions Site Index A-Z Children's (Pediatric) Nuclear Medicine Children’s (pediatric) nuclear medicine imaging uses small amounts ... Children's Nuclear Medicine? What is Children's (Pediatric) Nuclear Medicine? Nuclear medicine is a branch of medical imaging ...

  3. Children's (Pediatric) Nuclear Medicine

    Science.gov (United States)

    ... Professions Site Index A-Z Children's (Pediatric) Nuclear Medicine Children’s (pediatric) nuclear medicine imaging uses small amounts ... Children's Nuclear Medicine? What is Children's (Pediatric) Nuclear Medicine? Nuclear medicine is a branch of medical imaging ...

  4. Children's (Pediatric) Nuclear Medicine

    Medline Plus

    Full Text Available ... News Physician Resources Professions Site Index A-Z Children's (Pediatric) Nuclear Medicine Children’s (pediatric) nuclear medicine imaging ... the limitations of Children's Nuclear Medicine? What is Children's (Pediatric) Nuclear Medicine? Nuclear medicine is a branch ...

  5. Children's (Pediatric) Nuclear Medicine

    Medline Plus

    Full Text Available ... Resources Professions Site Index A-Z Children's (Pediatric) Nuclear Medicine Children’s (pediatric) nuclear medicine imaging uses small ... of Children's Nuclear Medicine? What is Children's (Pediatric) Nuclear Medicine? Nuclear medicine is a branch of medical ...

  6. Pediatric radiology

    International Nuclear Information System (INIS)

    Benz-Bohm, G.

    1997-01-01

    Pediatric radiology is an important subsection of diagnostic radiology involving specific difficulties, but unfortunately is quite too often neglected as a subject of further education and training. The book therefore is not intended for specialists in the field, but for radiologists wishing to plunge deeper into the matter of pediatric radiology and to acquire a sound, basic knowledge and information about well-proven modalities, the resulting diagnostic images, and interpretation of results. The book is a compact guide and a helpful source of reference and information required for every-day work, or in special cases. With patients who are babies or children, the challenges are different. The book offers all the information needed, including important experience from pediatric hospital units that may be helpful in diagnostic evaluation, information about specific dissimilarities in anatomy and physiology which affect the imaging results, hints for radiology planning and performance, as well as information about the various techniques and their indication and achievements. The book presents a wide spectrum of informative and annotated images. (orig./CB) [de

  7. Pediatric fibromyalgia

    Directory of Open Access Journals (Sweden)

    J. Ablin

    2012-09-01

    Full Text Available Fibromyalgia (FM is currently defined as chronic widespread pain (CWP with allodynia or hyperalgesia to pressure pain. It is classified as one of the large group of soft-tissue pain syndromes. Pain is the cardinal symptom of FM; however, most patients also experience additional symptoms such as debilitating fatigue, disrupted or non-restorative sleep, functional bowel disturbances, and a variety of neuropsychiatric problems, including cognitive dysfunction, anxiety and depressive symptoms. Its pathogenesis is not entirely understood, although it is currently believed to be the result of a central nervous system (CNS malfunction that increases pain transmission and perception. FMS usually involves females, and in these patients it often makes its first appearance during menopause. But it is often diagnosed both in young as well as elderly individuals. Pediatric FMS is a frustrating condition affecting children and adolescents at a crucial stage of their physical and emotional development. Pediatric FMS is an important differential diagnosis to be considered in the evaluation of children suffering from widespread musculoskeletal pain, and must be differentiated from a spectrum of inflammatory joint disorders such as juvenile idiopathic arthritis (JIA, juvenile ankylosing spondylitis, etc. The management of pediatric FMS is centered on the issues of education, behavioral and cognitive change (with a strong emphasis on physical exercise, and a relatively minor role for pharmacological treatment with medications such as muscle relaxants, analgesics and tricyclic agents.

  8. HealthNavigator: a mobile application for chronic disease screening and linkage to services at an urban Primary Health Network.

    Science.gov (United States)

    Seneviratne, Martin G; Hersch, Fred; Peiris, David P

    2018-03-26

    Mobile applications (apps) are promising tools to support chronic disease screening and linkage to health services. They have the potential to increase healthcare access for vulnerable populations. The HealthNavigator app was developed to provide chronic disease risk assessments, linkage to local general practitioners (GPs) and lifestyle programs, and a personalised health report for discussion with a GP. Assessments were either self-administered or facilitated by community health workers through a Primary Health Network (PHN) initiative targeting ethnically diverse communities. In total, 1492 assessments (80.4% self-administered, 19.6% facilitated) were conducted over a 12-month period in Queensland, Australia. Of these, 26% of people screened came from postcodes representing the lowest quartile of socioeconomic disadvantage. When compared against self-administered assessments, subjects screened by the facilitated program were more likely to be born outside Australia (80.5 v. 33.2%, P<0.001), and to fall within a high risk category based on cardiovascular risk scores (19.8 v. 13.7%, P<0.01) and type 2 diabetes mellitus risk scores (58.0 v. 40.1%, P<0.001). Mobile apps embedded into PHN programs may be a useful adjunct for the implementation of community screening programs. Further research is needed to determine their effect on health service access and health outcomes.

  9. New frontiers in pediatric Allo-SCT.

    Science.gov (United States)

    Talano, J M; Pulsipher, M A; Symons, H J; Militano, O; Shereck, E B; Giller, R H; Hancock, L; Morris, E; Cairo, M S

    2014-09-01

    The inaugural meeting of 'New Frontiers in Pediatric Allogeneic Stem Cell Transplantation' organized by the Pediatric Blood and Transplant Consortium (PBMTC) was held at the American Society of Pediatric Hematology and Oncology Annual Meeting. This meeting provided an international platform for physicians and investigators active in the research and utilization of pediatric Allo-SCT in children and adolescents with malignant and non-malignant disease (NMD), to share information and develop future collaborative strategies. The primary objectives of the conference included: (1) to present advances in Allo-SCT in pediatric ALL and novel pre and post-transplant immunotherapy; (2) to highlight new strategies in alternative allogeneic stem cell donor sources for children and adolescents with non-malignant hematological disorders; (3) to discuss timing of immune reconstitution after Allo-SCT and methods of facilitating more rapid recovery of immunity; (4) to identify strategies of utilizing Allo-SCT in pediatric myeloproliferative disorders; (5) to develop diagnostic and therapeutic approaches to hematological complications post pediatric Allo-SCT; (6) to enhance the understanding of new novel cellular therapeutic approaches to pediatric malignant and non-malignant hematological disorders; and (7) to discuss optimizing drug therapy in pediatric recipients of Allo-SCT. This paper will provide a brief overview of the conference.

  10. Acitretin in pediatric dermatoses

    Directory of Open Access Journals (Sweden)

    Manjyot Gautam

    2016-01-01

    Full Text Available Acitretin, a synthetic retinoid and the active metabolite of etretinate has been increasingly used over the past two decades. It has proved effective in the treatment of many conditions associated with hyperkeratosis and dyskeratosis. A Google scholar search for the use of acitretin in pediatric dermatoses was done using the words “pediatric dermatoses,” “acitretin,” “etretinate,” “systemic retinoids,” “psoriasis,” “pityriasis rubra pilaris,” “ichthyoses,” “disorders of keratinization,” “Darier's disease,” “palmoplantar keratoderma,” “verrucae,” “lichen planus,” “lupus erythematosus,” and “lichen sclerosus.” All the articles were retrieved and classified into review articles, studies, double-blinded trials, and case reports. The final data were then analyzed and presented in a narrative fashion. It has been found that acitretin is useful in a number of pediatric dermatoses. It is preferred over other drugs in pustular psoriasis. Good results can be obtained in various disorders of keratinization, and it may even prove life-saving in conditions like harlequin ichthyosis. However, long-term maintenance therapy is required and exacerbations are known on discontinuing the drug. It can also be used as alternative therapy for many other pediatric dermatoses where the primary treatment has failed. Acitretin should be used even in children for the proper indications. However, proper clinical and laboratory surveillance has to be maintained in patients on long-term acitretin.

  11. Community health centers and primary care access and quality for chronically-ill patients - a case-comparison study of urban Guangdong Province, China.

    Science.gov (United States)

    Shi, Leiyu; Lee, De-Chih; Liang, Hailun; Zhang, Luwen; Makinen, Marty; Blanchet, Nathan; Kidane, Ruth; Lindelow, Magnus; Wang, Hong; Wu, Shaolong

    2015-11-30

    Reform of the health care system in urban areas of China has prompted concerns about the utilization of Community Health Centers (CHC). This study examined which of the dominant primary care delivery models, i.e., the public CHC model, the 'gate-keeper' CHC model, or the hospital-owned CHC models, was most effective in enhancing access to and quality of care for patients with chronic illness. The case-comparison design was used to study nine health care organizations in Guangzhou, Dongguan, and Shenzhen cities within Guangdong province, China. 560 patients aged 50 or over with hypertension or diabetes who visited either CHCs or hospitals in these three cities were surveyed by using face-to-face interviews. Bivariate analyses were performed to compare quality and value of care indicators among subjects from the three cities. Multivariate analyses were used to assess the association between type of primary care delivery and quality as well as value of chronic care after controlling for patients' demographic and health status characteristics. Patients from all three cities chose their current health care providers primarily out of concern for quality of care (both provider expertise and adequate medical equipment), patient-centered care, and insurance plan requirement. Compared with patients from Guangzhou, those from Dongguan performed significantly better on most quality and value of care indicators. Most of these indicators remained significantly better even after controlling for patients' demographic and health status characteristics. The Shenzhen model (hospital-owned and -managed CHC) was generally effective in enhancing accessibility and continuity. However, coordination suffered due to seemingly duplicating primary care outpatients at the hospital setting. Significant associations between types of health care facilities and quality of care were also observed such that patients from CHCs were more likely to be satisfied with traveling time and follow-up care by

  12. Find a Pediatric Dentist

    Science.gov (United States)

    ... AAPD AAPD Publications Advertising Brochures Journals & Publications Full Journal Archives Access Pediatric Dentistry Today Practice Management and Marketing Newsletter Pediatric Dentistry Journal Open Access Articles Oral ...

  13. Childhood obesity, self-esteem and health-related quality of life among urban primary schools children in Kuching, Sarawak, Malaysia.

    Science.gov (United States)

    Lee, P Y; Cheah, W l; Chang, C T; Siti Raudzah, G

    2012-08-01

    There is limited data on childhood obesity and its impact on children from diverse cultural backgrounds. This study is aimed at determining the association between obesity, self-esteem and health-related quality of life (HRQOL) among Malaysian urban primary school children of different ethnicity. A cross-sectional study was conducted involving 311 children aged 11-13 years from primary schools in Kuching, Sarawak. Self-esteem and health-related quality of life (HRQOL) were measured using the Lawrence Self-esteem Questionnaire (LAWSEQ) questionnaire and the Paediatric Quality of Life Inventory (PedsQL), respectively. Body weight and height were taken and body mass index for age calculated. The prevalence of overweight and obesity among the children were 18.2% and 15.2% respectively. Parent-proxy and child self-reported PedsQL scores were higher for normal weight children compared to thin and obese children, but lower than overweight children. At the subscale level, only parent-proxy PedsQL scores in psychosocial health and emotional component were significantly different between overweight and obese children (p=0.019, p=0.02). The Self-esteem score was significantly correlated with parent and child PedsQL scores. Although obesity was associated with lower HRQOL among children, both parent and child PedsQL scores among the overweight group were higher than that for the normal weight group. Overweight and obesity did affect quality of life and self-esteem of children in this study, particularly in the areas of psychosocial and emotional health. Policy makers and programme managers should take into consideration the impact of obesity on children and parents in designing intervention programmes.

  14. Characterization of primary biogenic aerosol particles in urban, rural, and high-alpine air by DNA sequence and restriction fragment analysis of ribosomal RNA genes

    Directory of Open Access Journals (Sweden)

    V. R. Després

    2007-12-01

    Full Text Available This study explores the applicability of DNA analyses for the characterization of primary biogenic aerosol (PBA particles in the atmosphere. Samples of fine particulate matter (PM2.5 and total suspended particulates (TSP have been collected on different types of filter materials at urban, rural, and high-alpine locations along an altitude transect in the south of Germany (Munich, Hohenpeissenberg, Mt. Zugspitze.

    From filter segments loaded with about one milligram of air particulate matter, DNA could be extracted and DNA sequences could be determined for bacteria, fungi, plants and animals. Sequence analyses were used to determine the identity of biological organisms, and terminal restriction fragment length polymorphism analyses (T-RFLP were applied to estimate diversities and relative abundances of bacteria. Investigations of blank and background samples showed that filter materials have to be decontaminated prior to use, and that the sampling and handling procedures have to be carefully controlled to avoid artifacts in the analyses.

    Mass fractions of DNA in PM2.5 were found to be around 0.05% in urban, rural, and high-alpine aerosols. The average concentration of DNA determined for urban air was on the order of ~7 ng m−3, indicating that human adults may inhale about one microgram of DNA per day (corresponding to ~108 haploid bacterial genomes or ~105 haploid human genomes, respectively.

    Most of the bacterial sequences found in PM2.5 were from Proteobacteria (42 and some from Actinobacteria (10 and Firmicutes (1. The fungal sequences were characteristic for Ascomycota (3 and Basidiomycota (1, which are known to actively discharge spores into the atmosphere. The plant sequences could be attributed to green plants (2 and moss spores (2, while animal DNA was found only for one unicellular eukaryote (protist.

  15. A pediatric phase 1 trial of vorinostat and temozolomide in relapsed or refractory primary brain or spinal cord tumors: a Children's Oncology Group phase 1 consortium study.

    Science.gov (United States)

    Hummel, Trent R; Wagner, Lars; Ahern, Charlotte; Fouladi, Maryam; Reid, Joel M; McGovern, Renee M; Ames, Matthew M; Gilbertson, Richard J; Horton, Terzah; Ingle, Ashish M; Weigel, Brenda; Blaney, Susan M

    2013-09-01

    We conducted a pediatric phase I study to estimate the maximum tolerated dose (MTD), dose-limiting toxicities (DLT), and pharmacokinetic properties of vorinostat, a histone deacetylase (HDAC) inhibitor, when given in combination with temozolomide in children with refractory or recurrent CNS malignancies. Vorinostat, followed by temozolomide approximately 1 hour later, was orally administered, once daily, for 5 consecutive days every 28 days at three dose levels using the rolling six design. Studies of histone accumulation in peripheral blood mononuclear cells were performed on Day 1 at 0, 6, and 24 hours after vorinostat dosing. Vorinostat pharmacokinetics (PK) and serum MGMT promoter status were also assessed. Nineteen eligible patients were enrolled and 18 patients were evaluable for toxicity. There were no DLTs observed at dose level 1 or 2. DLTs occurred in four patients at dose level 3: thrombocytopenia (4), neutropenia (3), and leucopenia (1). Non-dose limiting grade 3 or 4 toxicities related to protocol therapy were also hematologic and included neutropenia, lymphopenia, thrombocytopenia, anemia, and leucopenia. Three patients exhibited stable disease and one patient had a partial response. There was no clear relationship between vorinostat dosage and drug exposure over the dose range studied. Accumulation of acetylated H3 histone in PBMC was observed after administration of vorinostat. Five-day cycles of vorinostat in combination with temozolomide are well tolerated in children with recurrent CNS malignancies with myelosuppression as the DLT. The recommended phase II combination doses are vorinostat, 300 mg/m(2) /day and temozolomide, 150 mg/m(2) /day. Copyright © 2013 Wiley Periodicals, Inc.

  16. Understanding practitioner professionalism in Aboriginal and Torres Strait Islander health: lessons from student and registrar placements at an urban Aboriginal and Torres Strait Islander primary healthcare service.

    Science.gov (United States)

    Askew, Deborah A; Lyall, Vivian J; Ewen, Shaun C; Paul, David; Wheeler, Melissa

    2017-10-01

    Aboriginal and Torres Strait Islander peoples continue to be pathologised in medical curriculum, leaving graduates feeling unequipped to effectively work cross-culturally. These factors create barriers to culturally safe health care for Aboriginal and Torres Strait Islander peoples. In this pilot pre-post study, the learning experiences of seven medical students and four medical registrars undertaking clinical placements at an urban Aboriginal and Torres Strait Islander primary healthcare service in 2014 were followed. Through analysis and comparison of pre- and post-placement responses to a paper-based case study of a fictitious Aboriginal patient, four learning principles for medical professionalism were identified: student exposure to nuanced, complex and positive representations of Aboriginal peoples; positive practitioner role modelling; interpersonal skills that build trust and minimise patient-practitioner relational power imbalances; and knowledge, understanding and skills for providing patient-centred, holistic care. Though not exhaustive, these principles can increase the capacity of practitioners to foster culturally safe and optimal health care for Aboriginal peoples. Furthermore, competence and effectiveness in Aboriginal health care is an essential component of medical professionalism.

  17. Pediatric fibromyalgia.

    Science.gov (United States)

    Buskila, Dan

    2009-05-01

    Fibromyalgia is an idiopathic chronic pain syndrome defined by widespread nonarticular musculoskeletal pain and generalized tender points. The syndrome is associated with a constellation of symptoms, including fatigue, nonrefreshing sleep, irritable bowel, and more. Central nervous system sensitization is a major pathophysiologic aspect of fibromyalgia; in addition, various external stimuli such as trauma and stress may contribute to development of the syndrome. Fibromyalgia is most common in midlife, but may be seen at any age. This article reviews the epidemiology, clinical characteristics, etiology, management, and outcome of pediatric fibromyalgia.

  18. Pediatric radiology

    International Nuclear Information System (INIS)

    Silverman, F.N.

    1982-01-01

    A literature review with 186 references of diagnostic pediatric radiology, a speciality restricted to an age group rather than to an organ system or technique of examination, is presented. In the present chapter topics follow the basic organ system divisions with discussions of special techniques within these divisions. The diagnosis of congenital malformations, infectious diseases and neoplasms are a few of the topics discussed for the head and neck region, the vertebrae, the cardiovascular system, the respiratory system, the gastrointestinal tract, the urinary tract, and the skeleton

  19. Pediatric neuroimaging

    International Nuclear Information System (INIS)

    Tidwell, A.S.; Solano, M.; Schelling, S.H.

    1994-01-01

    In this article, some of the common and not-so-common neuropediatric disorders were discussed. As in the full-grown animal, abnormalities of the CNS in the pediatric animal patient may be classified according to the type of insult present (eg, malformation, injury, neoplasia, inflammation, or degeneration). To recognize the imaging manifestations of such disorders, an appreciation of normal anatomy, the pathological response of nervous system tissue to insult, and the principles of image interpretation is required. These fundamentals may then be applied to any CNS disease, regardless of frequency and to any animal patient, regardless of age

  20. Pediatric radiology

    International Nuclear Information System (INIS)

    Kirkpatrick, J.A. Jr.

    1985-01-01

    Computed tomography has made possible the excellent and basic work having to do with the characteristics of the trachea, its caliber, shape, and length in children. Another group of articles has to do with interventional pediatric radiology. This year there were a number of articles of which only a sample is included, dealing with therapeutic procedures involving drainage of abscesses, angioplasty, nephrostomy, therapeutic embolization, and the removal of esophageal foreign bodies. Obviously, there is no reason to think that techniques developed for the adult may not be applicable to the infant or child; also, there is no reason to believe that processes peculiar to the child should not be amenable to intervention, for instance, use of embolization of hepatic hemangioma and transluminal balloon valvuloplasty for pulmonary valvular stenosis. Among the reports and reviews, the author would add that sonography remains a basic imaging technique in pediatric radiology and each year its application broadens. For example, there is an excellent article having to do with sonography of the neonatal and infant hip and evaluation of the inferior vena cava and the gallbladder. Nuclear medicine continues to play a significant role in diagnosis, which is featured in two articles concerned with problems of the hip

  1. Craniospinal irradiation with concurrent temozolomide for primary metastatic pediatric high-grade or diffuse intrinsic pontine gliomas. A first report from the GPOH-HIT-HGG Study Group

    International Nuclear Information System (INIS)

    Mueller, K.; Schlamann, A.; Pietschmann, S.; Kortmann, R.D.; Guckenberger, M.; Warmuth-Metz, M.; Glueck, A.; Wawer, A.; Kramm, C.; Bueren, A.O. von

    2014-01-01

    High-grade (HGG) and diffuse intrinsic pontine gliomas (DIPG) with primary metastatic spread are extremely rare and have a dismal prognosis. Analogous to simultaneous radiochemotherapy in non-metastatic HGG and DIPG, concurrent craniospinal irradiation (CSI) and metronomic temozolomide (metroTMZ) may represent a reasonable therapeutic approach. However, the antitumor efficacy and toxicity of this treatment still have to be investigated. Between March 2007 and December 2012, six children with primary metastatic HGG (n=4) or DIPG (n=2) received CSI and concurrent metroTMZ based on individual treatment recommendations and, in some cases, within the HIT-HGG 2007 multicenter trial. Outcome and treatment-related toxicities were evaluated. All patients received irradiation to the entire craniospinal axis (35.2 Gy, n=5; 36 Gy, n=1:) and 5 received a local boost to macroscopic tumor deposits. Simultaneously, metroTMZ (75 mg/m 2 /day, n=5; 60 mg/m 2 /day, n=1) was administered. Additionally, 1 patient received nimotuzumab once per week. Within a median follow-up of 10.0 months (range 6.5-18.7 months), all patients experienced disease progression and 5 patients died. Median progression-free survival was 4.0±0.8 months (range 2.4-10.7 months) and median overall survival was 7.6±3.5 months (range 4.0-17.6 months). Acute myelosuppression most severely limited application of this aggressive treatment strategy. Severe hematotoxicities (= grade 3) occurred in all patients and metroTMZ had to be interrupted or discontinued in 4 out of 6 cases. Concurrent CSI and metroTMZ might represent a feasible treatment approach for primary metastatic HGG and DIPG. On the basis of our experience, severe but manageable acute hematotoxicity has to be expected. An international effort is warranted to reassess the efficacy and toxicity of this approach within a prospective study. (orig.)

  2. Craniospinal irradiation with concurrent temozolomide for primary metastatic pediatric high-grade or diffuse intrinsic pontine gliomas. A first report from the GPOH-HIT-HGG Study Group

    Energy Technology Data Exchange (ETDEWEB)

    Mueller, K.; Schlamann, A.; Pietschmann, S.; Kortmann, R.D. [University Medical Center Leipzig, Department of Radiation Oncology, Leipzig (Germany); Guckenberger, M. [University Medical Center Wuerzburg, Department of Radiation Oncology, Wuerzburg (Germany); Warmuth-Metz, M. [University Medical Center Wuerzburg, Department of Neuroradiology, Wuerzburg (Germany); Glueck, A. [Clinic for Radiation Oncology Schwabing, Muenchen (Germany); Wawer, A. [University Medical Center Muenchen Schwabing, Department of Pediatric Hematology and Oncology, Muenchen (Germany); Kramm, C.; Bueren, A.O. von [University Medical Center Goettingen, Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Goettingen (Germany)

    2014-04-15

    High-grade (HGG) and diffuse intrinsic pontine gliomas (DIPG) with primary metastatic spread are extremely rare and have a dismal prognosis. Analogous to simultaneous radiochemotherapy in non-metastatic HGG and DIPG, concurrent craniospinal irradiation (CSI) and metronomic temozolomide (metroTMZ) may represent a reasonable therapeutic approach. However, the antitumor efficacy and toxicity of this treatment still have to be investigated. Between March 2007 and December 2012, six children with primary metastatic HGG (n=4) or DIPG (n=2) received CSI and concurrent metroTMZ based on individual treatment recommendations and, in some cases, within the HIT-HGG 2007 multicenter trial. Outcome and treatment-related toxicities were evaluated. All patients received irradiation to the entire craniospinal axis (35.2 Gy, n=5; 36 Gy, n=1:) and 5 received a local boost to macroscopic tumor deposits. Simultaneously, metroTMZ (75 mg/m{sup 2}/day, n=5; 60 mg/m{sup 2}/day, n=1) was administered. Additionally, 1 patient received nimotuzumab once per week. Within a median follow-up of 10.0 months (range 6.5-18.7 months), all patients experienced disease progression and 5 patients died. Median progression-free survival was 4.0±0.8 months (range 2.4-10.7 months) and median overall survival was 7.6±3.5 months (range 4.0-17.6 months). Acute myelosuppression most severely limited application of this aggressive treatment strategy. Severe hematotoxicities (= grade 3) occurred in all patients and metroTMZ had to be interrupted or discontinued in 4 out of 6 cases. Concurrent CSI and metroTMZ might represent a feasible treatment approach for primary metastatic HGG and DIPG. On the basis of our experience, severe but manageable acute hematotoxicity has to be expected. An international effort is warranted to reassess the efficacy and toxicity of this approach within a prospective study. (orig.)

  3. Bilateral primary renal lymphoma in a pediatric patient: staging and response evaluation with ¹⁸F-FDG PET/CT.

    Science.gov (United States)

    Dhull, V S; Mukherjee, A; Karunanithi, S; Durgapal, P; Bal, C; Kumar, R

    2015-01-01

    Primary renal lymphoma (PRL) is a rare disease. We here present the case of an 8-year-old child who presented with bilateral renal masses. On biopsy, it was confirmed to be B-cell non-Hodgkin's lymphoma. (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography-computed tomography (PET/CT) for staging demonstrated (18)F-FDG avid bilateral renal masses, with no other abnormal focus. Follow up (18)F-FDG PET/CT showed complete resolution of the disease after six cycles of chemotherapy. Here we have highlighted the potential role of (18)F-FDG PET/CT in staging and response evaluation of a patient with PRL and presented a brief review. Copyright © 2014 Elsevier España, S.L.U. and SEMNIM. All rights reserved.

  4. Pediatric Uveitis.

    Science.gov (United States)

    Chan, Nicole Shu-Wen; Choi, Jessy; Cheung, Chui Ming Gemmy

    2018-01-01

    Pediatric uveitis differs from adult-onset uveitis and is a topic of special interest because of its diagnostic and therapeutic challenges. Children with uveitis are often asymptomatic and the uveitis is often chronic, persistent, recurrent, and resistant to conventional treatment. Anterior uveitis is the most common type of uveitis in children; the prevalence of intermediate, posterior, and panuveitis varies geographically and among ethnic groups. Regarding etiology, most cases of pediatric uveitis are idiopathic but can be due to systemic inflammatory disorders, infections, or a manifestation of masquerade syndrome. Ocular complications include cataracts, hypotony or glaucoma, band keratopathy, synechiae formation, macular edema, optic disc edema, choroidal neovascular membranes, and retinal detachment. These complications are often severe, leading to irreversible structural damage and significant visual disability due to delayed presentation and diagnosis, persistent chronic inflammation from suboptimal treatment, topical and systemic corticosteroid dependence, and delayed initiation of systemic disease‒modifying agents. Treatment for noninfectious uveitis is a stepwise approach starting with corticosteroids. Immunomodulatory therapy should be initiated in cases where quiescence cannot be achieved without steroid dependence. Patients should be monitored regularly for complications of uveitis along with systemic and ocular adverse effects from treatments. The goals are to achieve steroid-free durable remission, to reduce the risk of sight-threatening complications from the uncontrolled ocular inflammation, and to avoid the impact of lifelong burden of visual loss on the child and their family. Multidisciplinary management will ensure holistic care of affected children and improve the support for their families. Copyright 2018 Asia-Pacific Academy of Ophthalmology.

  5. An overview of pediatric dysphagia.

    Science.gov (United States)

    Prasse, Jane E; Kikano, George E

    2009-04-01

    Difficulty swallowing or dysphagia can be present in children and adults alike. Pediatric dysphagias have long been recognized in the literature. Certain groups of infants with specific developmental and/or medical conditions have been identified as being at high risk for developing dysphagia. Still others may present with a swallowing or feeding problem as their primary symptom. Left untreated, these problems in infants and children can lead to failure to thrive, aspiration pneumonias, gastroesophageal reflux, and/or the inability to establish and maintain proper nutrition and hydration. Awareness of the prevalence of pediatric dysphagia in today's population and the signs and symptoms of this condition aids in its treatment. Early detection of dysphagia in infants and children is important to prevent or minimize complications. This article provides a review of symptoms, etiologies, and resources available regarding management of this condition to help the primary care physician and the families of young children and infants in its management.

  6. The Current Landscape of US Pediatric Anesthesiologists: Demographic Characteristics and Geographic Distribution.

    Science.gov (United States)

    Muffly, Matthew K; Muffly, Tyler M; Weterings, Robbie; Singleton, Mark; Honkanen, Anita

    2016-07-01

    There is no comprehensive database of pediatric anesthesiologists, their demographic characteristics, or geographic location in the United States. We endeavored to create a comprehensive database of pediatric anesthesiologists by merging individuals identified as US pediatric anesthesiologists by the American Board of Anesthesiology, National Provider Identifier registry, Healthgrades.com database, and the Society for Pediatric Anesthesia membership list as of November 5, 2015. Professorial rank was accessed via the Association of American Medical Colleges and other online sources. Descriptive statistics characterized pediatric anesthesiologists' demographics. Pediatric anesthesiologists' locations at the city and state level were geocoded and mapped with the use of ArcGIS Desktop 10.1 mapping software (Redlands, CA). We identified 4048 pediatric anesthesiologists in the United States, which is approximately 8.8% of the physician anesthesiology workforce (n = 46,000). The median age of pediatric anesthesiologists was 49 years (interquartile range, 40-57 years), and the majority (56.4%) were men. Approximately two-thirds of identified pediatric anesthesiologists were subspecialty board certified in pediatric anesthesiology, and 33% of pediatric anesthesiologists had an identified academic affiliation. There is substantial heterogeneity in the geographic distribution of pediatric anesthesiologists by state and US Census Division with urban clustering. This description of pediatric anesthesiologists' demographic characteristics and geographic distribution fills an important gap in our understanding of pediatric anesthesia systems of care.

  7. The current and ideal state of mental health training: pediatric resident perspectives.

    Science.gov (United States)

    Hampton, Elisa; Richardson, Joshua E; Bostwick, Susan; Ward, Mary J; Green, Cori

    2015-01-01

    PHENOMENON: Mental health (MH) problems are prevalent in the pediatric population, and in a setting of limited resources, pediatricians need to provide MH care in the primary medical home yet are uncomfortable doing so citing a lack of training during residency as one barrier. The purpose of this study is to describe pediatric residents' experiences and perspectives on the current and ideal states of MH training and ideas for curriculum development to bridge this gap. A qualitative study using focus groups of pediatric residents from an urban academic medical center was performed. Audio recordings were transcribed and analyzed using a grounded theory approach. Twenty-six residents participated in three focus groups, which is when thematic saturation was achieved. The team generated five major themes: capabilities, comfort, organizational capacity, coping, and education. Residents expressed uncertainty at every step of an MH visit. Internal barriers identified included low levels of comfort and negative emotional responses. External barriers included a lack of MH resources and mentorship in MH care, or an inadequate organizational capacity. These internal and external barriers resulted in a lack of perceived capability in handling MH issues. In response, residents reported inadequate coping strategies, such as ignoring MH concerns. To build knowledge and skills, residents prefer educational modalities including didactics, experiential learning through collaborations with MH specialists, and tools built into patient care flow. Insights: Pediatric residency programs need to evolve in order to improve resident training in MH care. The skills and knowledge requested by residents parallel the American Academy of Pediatrics statement on MH competencies. Models of collaborative care provide similar modalities of learning requested by residents. These national efforts have not been operationalized in training programs yet may be useful for curriculum development and

  8. Pediatric allergy and immunology in Spain.

    Science.gov (United States)

    Nieto, Antonio; Mazon, Angel; Martin-Mateos, Maria Anunciacion; Plaza, Ana-Maria; Garde, Jesus; Alonso, Elena; Martorell, Antonio; Boquete, Manuel; Lorente, Felix; Ibero, Marcel; Bone, Javier; Pamies, Rafael; Garcia, Juan Miguel; Echeverria, Luis; Nevot, Santiago; Martinez-Cañavate, Ana; Fernandez-Benitez, Margarita; Garcia-Marcos, Luis

    2011-11-01

    The data of the ISAAC project in Spain show a prevalence of childhood asthma ranging from 7.1% to 15.3%, with regional differences; a higher prevalence, 22.6% to 35.8%, is described for rhinitis, and atopic dermatitis is found in 4.1% to 7.6% of children. The prevalence of food allergy is 3%. All children in Spain have the right to be visited in the National Health System. The medical care at the primary level is provided by pediatricians, who have obtained their titles through a 4-yr medical residency training program. The education on pediatric allergy during that period is not compulsory and thus very variable. There are currently 112 certified European pediatric allergists in Spain, who have obtained the accreditation of the European Union of Medical Specialist for proven skills and experience in pediatric allergy. Future specialists in pediatric allergy should obtain their titles through a specific education program to be developed in one of the four accredited training units on pediatric allergy, after obtaining the title on pediatrics. The Spanish Society of Pediatric Allergy and Clinical Immunology (SEICAP) gathers over 350 pediatric allergists and pediatricians working in this field. SEICAP has a growing activity including yearly congresses, continued education courses, elaboration of technical clinical documents and protocols, education of patients, and collaboration with other scientific societies and associations of patients. The official journal of SEICAP is Allergologia et Immunophatologia, published every 2 months since 1972. The web site of SEICAP, http://www.seicap.es, open since 2004, offers information for professionals and extensive information on pediatric allergic and immunologic disorders for the lay public; the web site is receiving 750 daily visits during 2011. The pediatric allergy units are very active in clinical work, procedures as immunotherapy or induction of oral tolerance in food allergy, contribution to scientific literature, and

  9. Pediatric endocrine surgery development

    Directory of Open Access Journals (Sweden)

    Ivan I. Dedov

    2017-12-01

    Full Text Available Department of pediatric surgery at the Endocrinology Research Centre has been around for nearly two years. During operation, surgical treatment has received more than 500 patients with various endocrine disorders. The article discusses modern diagnostic approaches and surgical options for diseases included in the new direction of pediatric surgery – endocrine surgery in children. There are discussions about options for radical treatment of Graves disease in children, positive and negative aspects of surgical and radioactive iodine treatment. Is own stats of postoperative hyperparathyroidism. Is proposed to optimize the algorithm of actions in identifying thyroid nodules in children. In primary hyperparathyroidism, the emphasis is on the complexity of the postoperative management of patients related to the feature of children’s age in determining the severity of the reactions on the water-electrolyte disorders. Separately reviewed the literature of the adrenal glands diseases in children, demonstrating their own clinical cases which required surgical intervention. The authors describe the possibilities of modern neurosurgical equipment in the Endocrinology Research Centre in operations on the pituitary gland in children. Patients of different age groups performed transnasal transsphenoidal removal of tumors of the chiasm-sellar region using endoscopic assistance. The article also cited research data of pancreas diseases and their surgical treatment. Much attention is paid to the gender section of endocrine surgery in children. Discusses the tactics in disorders of sex development, gonadal tumors in children, diseases of the breast. In conclusion outlines the prospects for the development of endocrine surgery in children.

  10. What Is a Pediatric Rheumatologist?

    Science.gov (United States)

    ... Text Size Email Print Share What is a Pediatric Rheumatologist? Page Content Article Body If your child ... a pediatric rheumatologist. What Kind of Training Do Pediatric Rheumatologists Have? Pediatric rheumatologists are medical doctors who ...

  11. Sedation in Pediatric Esophagogastroduodenoscopy

    Directory of Open Access Journals (Sweden)

    Seak Hee Oh

    2018-03-01

    Full Text Available Pediatric esophagogastroduodenoscopy (EGD has become an established diagnostic and therapeutic modality in pediatric gastroenterology. Effective sedation strategies have been adopted to improve patient tolerance during pediatric EGD. For children, safety is a fundamental consideration during this procedure as they are at a higher risk of severe adverse events from procedural sedation compared to adults. Therefore, a detailed risk evaluation is required prior to the procedure, and practitioners should be aware of the benefits and risks associated with sedation regimens during pediatric EGD. In addition, pediatric advanced life support by endoscopists or immediate intervention by anesthesiologists should be available in the event that severe adverse events occur during pediatric EGD.

  12. Pediatric Headache: An Overview.

    Science.gov (United States)

    Langdon, Raquel; DiSabella, Marc T

    2017-03-01

    Headache represents the most common neurologic disorder in the general population including children and is increasingly being recognized as a major source of morbidity in youth related to missed school days and activities. In this article, we take a holistic approach to the child presenting with headache with a focus on the detailed headache history, physical and neurologic examinations, and diagnostic evaluation of these patients. Clinical presentations and classification schema of multiple primary and secondary headache types in children are discussed using the International Headache Criteria (IHCD-3) as a guide, and a summary provided of the various treatment modalities employed for pediatric headache including lifestyle modifications, behavioral techniques, and abortive and preventive medications. Copyright © 2017 Mosby, Inc. All rights reserved.

  13. Pediatric nuclear oncology

    International Nuclear Information System (INIS)

    Howman Giles, R.; Bernard, E.; Uren, R.

    1997-01-01

    Nuclear medicine plays an important and increasing role in the management of childhood malignancy. This is particularly true in the solid tumours of childhood. It is also helpful in the management of the complications of cancer treatment such as the infections which often accompany immune suppression in oncology patients. Scintigraphy is a complementary investigation to other radiological techniques and adds the functional dimension to anatomical investigations such as CT, MRI and ultrasound. In selected malignancies radionuclides are also used in treatment. This review discusses the technical considerations relating to children and the specific techniques relating to pediatric oncology. Specific tumours and the various applications of radionuclides are discussed in particular lymphoma, primary bone tumours, soft tissue sarcomas, neuroblastoma, Wilms' tumour, brain tumours and leukemia. Uncommon tumours are also discussed and how radionuclides are useful in the investigation of various complications which occur in oncology patients

  14. Moral Hazard in Pediatrics.

    Science.gov (United States)

    Brunnquell, Donald; Michaelson, Christopher M

    2016-07-01

    "Moral hazard" is a term familiar in economics and business ethics that illuminates why rational parties sometimes choose decisions with bad moral outcomes without necessarily intending to behave selfishly or immorally. The term is not generally used in medical ethics. Decision makers such as parents and physicians generally do not use the concept or the word in evaluating ethical dilemmas. They may not even be aware of the precise nature of the moral hazard problem they are experiencing, beyond a general concern for the patient's seemingly excessive burden. This article brings the language and logic of moral hazard to pediatrics. The concept reminds us that decision makers in this context are often not the primary party affected by their decisions. It appraises the full scope of risk at issue when decision makers decide on behalf of others and leads us to separate, respect, and prioritize the interests of affected parties.

  15. Biomarkers of Pediatric Brain Tumors

    Directory of Open Access Journals (Sweden)

    Mark D Russell

    2013-03-01

    Full Text Available Background and Need for Novel Biomarkers: Brain tumors are the leading cause of death by solid tumors in children. Although improvements have been made in their radiological detection and treatment, our capacity to promptly diagnose pediatric brain tumors in their early stages remains limited. This contrasts several other cancers where serum biomarkers such as CA 19-9 and CA 125 facilitate early diagnosis and treatment. Aim: The aim of this article is to review the latest literature and highlight biomarkers which may be of clinical use in the common types of primary pediatric brain tumor. Methods: A PubMed search was performed to identify studies reporting biomarkers in the bodily fluids of pediatric patients with brain tumors. Details regarding the sample type (serum, cerebrospinal fluid or urine, biomarkers analyzed, methodology, tumor type and statistical significance were recorded. Results: A total of 12 manuscripts reporting 19 biomarkers in 367 patients vs. 397 controls were identified in the literature. Of the 19 biomarkers identified, 12 were isolated from cerebrospinal fluid, 2 from serum, 3 from urine, and 2 from multiple bodily fluids. All but one study reported statistically significant differences in biomarker expression between patient and control groups.Conclusions: This review identifies a panel of novel biomarkers for pediatric brain tumors. It provides a platform for the further studies necessary to validate these biomarkers and, in addition, highlights several techniques through which new biomarkers can be discovered.

  16. Spatial and temporal shifts in gross primary productivity, respiration, and nutrient concentrations in urban streams impacted by wastewater treatment plant effluent

    Science.gov (United States)

    Ledford, S. H.; Toran, L.

    2017-12-01

    Impacts of wastewater treatment plant effluent on nutrient retention and stream productivity are highly varied. The working theory has been that large pulses of nutrients from plants may hinder in-stream nutrient retention. We evaluated nitrate, total dissolved phosphorus, and dissolved oxygen in Wissahickon Creek, an urban third-order stream in Montgomery and Philadelphia counties, PA, that receives effluent from four wastewater treatment plants. Wastewater treatment plant effluent had nitrate concentrations of 15-30 mg N/L and total dissolved phosphorus of 0.3 to 1.8 mg/L. Seasonal longitudinal water quality samples showed nitrate concentrations were highest in the fall, peaking at 22 mg N/L, due to low baseflow, but total dissolved phosphorous concentrations were highest in the spring, reaching 0.6 mg/L. Diurnal dissolved oxygen patterns above and below one of the treatment plants provided estimates of gross primary productivity (GPP) and ecosystem respiration (ER). A site 1 km below effluent discharge had higher GPP in April (80 g O2 m-2 d-1) than the site above the plant (28 g O2 m-2 d-1). The pulse in productivity did not continue downstream, as the site 3 km below the plant had GPP of only 12 g O2 m-2 d-1. Productivity fell in June to 1-2 g O2 m-2 d-1 and the differences in productivity above and below plants were minimal. Ecosystem respiration followed a similar pattern in April, increasing from -17 g O2 m-2 d-1 above the plant to -47 g O2 m-2 d-1 1 km below the plant, then decreasing to -8 g O2 m-2 d-1 3 km below the plant. Respiration dropped to -3 g O2 m-2 d-1 above the plant in June but only fell to -9 to -10 g O2 m-2 d-1 at the two downstream sites. These findings indicate that large nutrient pulses from wastewater treatment plants spur productivity and respiration, but that these increases may be strongly seasonally dependent. Examining in-stream productivity and respiration is critical in wastewater impacted streams to understanding the seasonal and

  17. Pediatric Celiac Disease

    Science.gov (United States)

    ... a protein found in wheat, rye, and barley. Pediatric Celiac Disease If your child has celiac disease, ... physician. Established by the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) Celiac Disease Eosinophilic ...

  18. American Pediatric Surgical Association

    Science.gov (United States)

    American Pediatric Surgical Association Search for: Login Resources + For Members For Professionals For Training Program Directors For Media For ... Surgical Outcomes Surveys & Results Publications Continuing Education + ExPERT Pediatric Surgery NaT Annual Meeting CME MOC Requirements Residents / ...

  19. Pediatric Voiding Cystourethrogram

    Science.gov (United States)

    Scan for mobile link. Children's (Pediatric) Voiding Cystourethrogram A children’s (pediatric) voiding cystourethrogram uses fluoroscopy – a form of real-time x-ray – to examine a child’s bladder ...

  20. Pediatric MATCH Infographic

    Science.gov (United States)

    Infographic explaining NCI-COG Pediatric MATCH, a cancer treatment clinical trial for children and adolescents, from 1 to 21 years of age, that is testing the use of precision medicine for pediatric cancers.

  1. Pediatric Brain Tumor Foundation

    Science.gov (United States)

    ... navigate their brain tumor diagnosis. WATCH AND SHARE Brain tumors and their treatment can be deadly so ... Pediatric Central Nervous System Cancers Read more >> Pediatric Brain Tumor Foundation 302 Ridgefield Court, Asheville, NC 28806 ...

  2. Pediatric Thyroid Cancer

    Science.gov (United States)

    ... Marketplace Find an ENT Doctor Near You Pediatric Thyroid Cancer Pediatric Thyroid Cancer Patient Health Information News media ... and neck issues, should be consulted. Types of thyroid cancer in children: Papillary : This form of thyroid cancer ...

  3. Pediatric Endocrinology Nurses Society

    Science.gov (United States)

    ... Join Now International Welcome to PENS The Pediatric Endocrinology Nursing Society (PENS) is committed to the development ... nurses in the art and science of pediatric endocrinology nursing. Learn More Text1 2018 PENS Call for ...

  4. National Pediatric Program Update

    International Nuclear Information System (INIS)

    2008-01-01

    The book of the National Pediatric Program Update, issued by the Argentina Society of Pediatrics, describes important issues, including: effective treatment of addictions (drugs); defects of the neural tube; and the use of radiation imaging in diagnosis. [es

  5. Nuclear imaging in pediatrics

    International Nuclear Information System (INIS)

    Siddiqui, A.R.

    1985-01-01

    The author's intent is to familiarize practicing radiologists with the technical aspects and interpretation of nuclear medicine procedures in children and to illustrate the indications for nuclear medicine procedures in pediatric problems. Pediatric doses, dosimetry, sedation, and injection techniques, organ systems, oncology and infection, testicular scanning and nuclear crystography, pediatric endocrine and skeletal systems, ventilation and perfusion imaging of both congenital and acquired pediatric disorders, cardiovascular problems, gastrointestinal, hepatobiliary, reticuloendothelial studies, and central nervous system are all topics which are included and discussed

  6. Annals of Pediatric Surgery

    African Journals Online (AJOL)

    The Annals of Pediatric Surgery is striving to fill an important niche that provides focus to clinical care, technical innovation and clinical research. The Annals of Pediatric Surgery has the responsibility to serve not only pediatric surgeons in the Middle East and North Africa but also should be an important conduit for scientific ...

  7. Radiodiagnosis in pediatrics today

    International Nuclear Information System (INIS)

    Baklanova, V.F.

    1982-01-01

    The fields of radiodiagnosis application in pediatrics are considered. The improvement of roentgenologic methods and application of various contrast proparations enable to study and precisely differentiate congenital and acquired diseases. The scope of roentgenology application in pediatrics extends due to differentiation of pediatric specialities. New methods of investigation with decreasing radiation exposure to minimal are realized [ru

  8. Lead related behavioral and psychological performance changes in primary school children from industrial, urban and rural areas in Egypt. Verhalten und psychologische Leistungsfaehigkeit bei Grundschulkindern in industriellen, staedtischen und laendlichen Gebieten in Abhaengigkeit vom Bleigehalt im Blut, Haar und Urin

    Energy Technology Data Exchange (ETDEWEB)

    Faris, R.; Kamal, A.A.M.; Shoman, A. (Dept. of Community, Environmental and Occupational Medicine, Ain Shams Univ., Abbasia Cairo (Egypt)); Beshary, Z.; Massoud, A. (Dept. of Psychiatry, Ain Shams Univ., Abbasia Cairo (Egypt))

    1991-11-01

    We measured indicators of lead absorption (capillary blood lead, scalp hair lead and urine delta aminoleviolenic acid) as well as parameters of behavior and psychoperformance among three groups of children. These were 100, 100 and 76 children which constituted the total children of the fifth year of three primary schools from industrial, urban and rural areas respectively. The three indicators of lead absorption differed significantly between the three groups in the sense that: Indicators of those from industrial area > that of those from urban area > that of those from rural area. Psychological parameters showed a corresponding increased hyperactivity and lowered psychoperformance. The psychological parameters were significantly correlated with all the three indicators of lead absorption. In this domain hyperactivity scale was the most correlated one. The study confirms the opinion that environmental low lead level exposure constitutes a potential risk for behavioral and psycho-performance development among children with its possible negative consequences. (orig./MG).

  9. Exposure to violence among urban school-aged children: is it only on television?

    Science.gov (United States)

    Purugganan, O H; Stein, R E; Silver, E J; Benenson, B S

    2000-10-01

    To measure exposure to different types of violence among school-aged children in a primary care setting. Child interviews using an instrument measuring 4 types of exposure (direct victimization, witnessing, hearing reports, media). Violent acts measured include being beaten up, chased/threatened, robbed/mugged, stabbed/shot, killed. Pediatric primary care clinic of large urban hospital. Convenience sample of 175 children 9-12 years old and their mothers. A total of 53% of the children were boys, 55% were Hispanic, and 40% received public assistance. All children had been exposed to media violence. A total of 97% (170/175) had been exposed to more direct forms of violence; 77% had witnessed violence involving strangers; 49% had witnessed violence involving familiar persons; 49% had been direct victims; and 31% had witnessed someone being shot, stabbed, or killed. Exposure to violence was significantly associated with being male. Most school-aged children who visited a pediatric primary care clinic of a large urban hospital had directly experienced violence as witnesses and/or victims.

  10. Gender and Sexuality in Pediatrics.

    Science.gov (United States)

    Merens, Teri A

    2016-05-01

    The terms gender and sexuality, once rarely discussed in a public forum, are now dominant topics of conversation on social media, in all forms of entertainment, politics, law, and medicine. The pediatric primary care physician, like all people and institutions involved in the delivery of health care, must be diligent about providing compassionate and competent care to patients and families contending with gender issues. The complex variety of obstacles these patients may face require a well-informed, sensitive clinician who can offer sound medical advice and appropriate referral. This article guides pediatricians through some of the challenges related to gender identity so they can assist their patients in navigating through any difficulties. [Pediatr Ann. 2016;45(5):e158-e161.]. Copyright 2016, SLACK Incorporated.

  11. CADDIS Volume 2. Sources, Stressors and Responses: Urbanization - Energy Sources

    Science.gov (United States)

    Introduction to changes in basal energy sources with urbanization, overview of terrestrial leaf litter dynamics in urban streams, overview of how urbanization can affect primary production, respiration, and dissolved organic carbon quantity and quality.

  12. The Role of Urban Primary and Secondary Schools in Minimizing Disease Outbreak Caused by Environmental Contamination: A Case of Chinhoyi, Zimbabwe

    Science.gov (United States)

    Mutungwe, Edlight; Tsvere, Maria; Dondo, Beauty; Munikwa, Simbarashe

    2011-01-01

    Waste management is a major challenge facing urban councils in Zimbabwe and Chinhoyi Municipality is no exception. Lack of resources and technical and administrative know-how is hindering proper waste management. Raw sewage and industrial waste flow into streams and rivers and uncollected rubbish bins and strewn litter is a common feature in the…

  13. Psycho-Spatial Disidentification and Class Fractions in a Study of Social Class and Identity in an Urban Post-Primary School Community in Ireland

    Science.gov (United States)

    Cahill, Kevin

    2018-01-01

    This paper draws on a three-year critical ethnography which interrogated intersections of social class, school and identity in an urban Irish community. The focus here is on the psycho-spatial disidentifications, inscriptions and class fractioning enacted throughout the school and community of Portown by a cohort of succeeding students from this…

  14. The Management of Pediatric Polytrauma: Review

    NARCIS (Netherlands)

    H. Mevius; M. van Dijk (Monique); A. Numanoglu (Alp); A.B. van As (Àrjan Bastiaan)

    2014-01-01

    textabstractPolytrauma is a major cause of mortality and morbidity in both developed and developing countries. The primary goal of this review is to provide a comprehensive overview on current knowledge in the management of pediatric polytrauma patients (PPPs). A database review was con- ducted

  15. Child and youth telepsychiatry in rural and remote primary care.

    Science.gov (United States)

    Pignatiello, Antonio; Teshima, John; Boydell, Katherine M; Minden, Debbie; Volpe, Tiziana; Braunberger, Peter G

    2011-01-01

    Young people with psychological or psychiatric problems are managed largely by primary care practitioners, many of whom feel inadequately trained, ill equipped, and uncomfortable with this responsibility. Accessing specialist pediatric and psychological services, often located in and near large urban centers, is a particular challenge for rural and remote communities. Live interactive videoconferencing technology (telepsychiatry) presents innovative opportunities to bridge these service gaps. The TeleLink Mental Health Program at The Hospital for Sick Children in Toronto offers a comprehensive, collaborative model of enhancing local community systems of care in rural and remote Ontario using videoconferencing. With a focus on clinical consultation, collaborative care, education and training, evaluation, and research, ready access to pediatric psychiatrists and other specialist mental health service providers can effectively extend the boundaries of the medical home. Medical trainees in urban teaching centers are also expanding their knowledge of and comfort level with rural mental health issues, various complementary service models, and the potentials of videoconferencing in providing psychiatric and psychological services. Committed and enthusiastic champions, a positive attitude, creativity, and flexibility are a few of the necessary attributes ensuring viability and integration of telemental health programs. Copyright © 2011 Elsevier Inc. All rights reserved.

  16. Impact of Obesity on Clinical Outcomes in Urban Children Hospitalized for Status Asthmaticus.

    Science.gov (United States)

    Aragona, Elena; El-Magbri, Eussra; Wang, Justin; Scheckelhoff, Tessa; Scheckelhoff, Trevor; Hyacinthe, Assata; Nair, Suja; Khan, Amina; Nino, Gustavo; Pillai, Dinesh K

    2016-04-01

    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.

  17. Pediatric blunt splenic trauma: a comprehensive review

    Energy Technology Data Exchange (ETDEWEB)

    Lynn, Karen N.; Werder, Gabriel M.; Callaghan, Rachel M.; Jafri, Zafar H. [William Beaumont Hospital, Department of Diagnostic Radiology, Royal Oak, MI (United States); Sullivan, Ashley N. [St. George' s University School of Medicine, Grenada, West Indies (Grenada); Bloom, David A. [William Beaumont Hospital, Department of Diagnostic Radiology, Royal Oak, MI (United States); William Beaumont Hospital, Section of Pediatric Radiology, Department of Radiology, Royal Oak, MI (United States)

    2009-09-15

    Abdominal trauma is a leading cause of death in children older than 1 year of age. The spleen is the most common organ injured following blunt abdominal trauma. Pediatric trauma patients present unique clinical challenges as compared to adults, including different mechanisms of injury, physiologic responses, and indications for operative versus nonoperative management. Splenic salvage techniques and nonoperative approaches are preferred to splenectomy in order to decrease perioperative risks, transfusion needs, duration/cost of hospitalization, and risk of overwhelming postsplenectomy infection. Early and accurate detection of splenic injury is critical in both adults and children; however, while imaging findings guide management in adults, hemodynamic stability is the primary determinant in pediatric patients. After initial diagnosis, the primary role of imaging in pediatric patients is to determine the level and duration of care. We present a comprehensive literature review regarding the mechanism of injury, imaging, management, and complications of traumatic splenic injury in pediatric patients. Multiple patients are presented with an emphasis on the American Association for the Surgery of Trauma organ injury grading system. Clinical practice guidelines from the American Pediatric Surgical Association are discussed and compared with our experience at a large community hospital, with recommendations for future practice guidelines. (orig.)

  18. Pediatric blunt splenic trauma: a comprehensive review

    International Nuclear Information System (INIS)

    Lynn, Karen N.; Werder, Gabriel M.; Callaghan, Rachel M.; Jafri, Zafar H.; Sullivan, Ashley N.; Bloom, David A.

    2009-01-01

    Abdominal trauma is a leading cause of death in children older than 1 year of age. The spleen is the most common organ injured following blunt abdominal trauma. Pediatric trauma patients present unique clinical challenges as compared to adults, including different mechanisms of injury, physiologic responses, and indications for operative versus nonoperative management. Splenic salvage techniques and nonoperative approaches are preferred to splenectomy in order to decrease perioperative risks, transfusion needs, duration/cost of hospitalization, and risk of overwhelming postsplenectomy infection. Early and accurate detection of splenic injury is critical in both adults and children; however, while imaging findings guide management in adults, hemodynamic stability is the primary determinant in pediatric patients. After initial diagnosis, the primary role of imaging in pediatric patients is to determine the level and duration of care. We present a comprehensive literature review regarding the mechanism of injury, imaging, management, and complications of traumatic splenic injury in pediatric patients. Multiple patients are presented with an emphasis on the American Association for the Surgery of Trauma organ injury grading system. Clinical practice guidelines from the American Pediatric Surgical Association are discussed and compared with our experience at a large community hospital, with recommendations for future practice guidelines. (orig.)

  19. Apneic oxygenation reduces hypoxemia during endotracheal intubation in the pediatric emergency department.

    Science.gov (United States)

    Vukovic, Adam A; Hanson, Holly R; Murphy, Shelley L; Mercurio, Danielle; Sheedy, Craig A; Arnold, Donald H

    2018-04-18

    Apneic oxygenation (AO) has been evaluated in adult patients as a means of reducing hypoxemia during endotracheal intubation (ETI). While less studied in pediatric patients, its practice has been largely adopted. Determine association between AO and hypoxemia in pediatric patients undergoing ETI. Observational study at an urban, tertiary children's hospital emergency department. Pediatric patients undergoing ETI were examined during eras without (January 2011-June 2011) and with (August 2014-March 2017) apneic oxygenation. The primary outcome was hypoxemia, defined as pulse oximetry (SpO 2 ) < 90%. The χ 2 and Wilcoxon rank-sum tests examined differences between cohorts. Multivariable regression models examined adjusted associations between covariates and hypoxemia. 149 patients were included. Cohorts were similar except for greater incidence of altered mental status in those receiving AO (26% vs. 7%, p = 0.03). Nearly 50% of the pre-AO cohort experienced hypoxemia during ETI, versus <25% in the AO cohort. Median [IQR] lowest SpO 2 during ETI was 93 (69, 99) for pre-AO and 100 [95, 100] for the AO cohort (p < 0.001). In a multivariable logistic regression model, hypoxemia during ETI was associated with AO (aOR 0.3, 95% confidence interval [CI] 0.1-0.8), increased age (for 1 year, aOR 0.8, 95% CI 0.7-1.0), lowest SpO 2 before ETI (for 1% increase, aOR 0.9, 95% CI 0.8-1.0), and each additional intubation attempt (aOR 4.0, 95% CI 2.2-7.2). Apneic oxygenation is an easily-applied intervention associated with decreases in hypoxemia during pediatric ETI. Nearly 50% of children not receiving AO experienced hypoxemia. Copyright © 2018 Elsevier Inc. All rights reserved.

  20. Free Tax Services in Pediatric Clinics.

    Science.gov (United States)

    Marcil, Lucy E; Hole, Michael K; Wenren, Larissa M; Schuler, Megan S; Zuckerman, Barry S; Vinci, Robert J

    2018-05-18

    The earned income tax credit (EITC), refundable monies for America's working poor, is associated with improved child health. Yet, 20% of eligible families do not receive it. We provided free tax preparation services in clinics serving low-income families and assessed use, financial impact, and accuracy. Free tax preparation services ("StreetCred") were available at 4 clinics in Boston in 2016 and 2017. We surveyed a convenience sample of clients ( n = 244) about experiences with StreetCred and previous tax services and of nonparticipants ( n = 100; 69% response rate) and clinic staff ( n = 41; 48% response rate) about acceptability and feasibility. A total of 753 clients received $1 619 650 in federal tax refunds. StreetCred was associated with significant improvement in tax filing rates. Of surveyed clients, 21% were new filers, 47% were new users of free tax preparation, 14% reported new receipt of the EITC, and 21% reported new knowledge of the EITC. StreetCred had high client acceptability; 96% would use StreetCred again. Families with children were significantly more likely to report StreetCred made them feel more connected to their doctor ( P = .02). Clinic staff viewed the program favorably (97% approval). Free tax services in urban clinics are a promising, feasible financial intervention to increase tax filing and refunds, save fees, and link clients to the EITC. With future studies, we will assess scalability and measure impact on health. StreetCred offers an innovative approach to improving child health in primary care settings through a financial intervention. Copyright © 2018 by the American Academy of Pediatrics.

  1. Age Limit of Pediatrics.

    Science.gov (United States)

    Hardin, Amy Peykoff; Hackell, Jesse M

    2017-09-01

    Pediatrics is a multifaceted specialty that encompasses children's physical, psychosocial, developmental, and mental health. Pediatric care may begin periconceptionally and continues through gestation, infancy, childhood, adolescence, and young adulthood. Although adolescence and young adulthood are recognizable phases of life, an upper age limit is not easily demarcated and varies depending on the individual patient. The establishment of arbitrary age limits on pediatric care by health care providers should be discouraged. The decision to continue care with a pediatrician or pediatric medical or surgical subspecialist should be made solely by the patient (and family, when appropriate) and the physician and must take into account the physical and psychosocial needs of the patient and the abilities of the pediatric provider to meet these needs. Copyright © 2017 by the American Academy of Pediatrics.

  2. Children's (Pediatric) CT (Computed Tomography)

    Medline Plus

    Full Text Available ... Physician Resources Professions Site Index A-Z Children's (Pediatric) CT (Computed Tomography) Pediatric computed tomography (CT) is ... a CT scan. View full size with caption Pediatric Content Some imaging tests and treatments have special ...

  3. What Is a Pediatric Gastroenterologist?

    Science.gov (United States)

    ... Text Size Email Print Share What is a Pediatric Gastroenterologist? Page Content Article Body If your child ... children, and teens. What Kind of Training Do Pediatric Gastroenterologists Have? Pediatric gastroenterologists are medical doctors who ...

  4. What Is a Pediatric Endocrinologist?

    Science.gov (United States)

    ... Text Size Email Print Share What is a Pediatric Endocrinologist? Page Content Article Body If your child ... the teen years. What Kind of Training Do Pediatric Endocrinologists Have? Pediatric endocrinologists are medical doctors who ...

  5. What Is a Pediatric Geneticist?

    Science.gov (United States)

    ... Text Size Email Print Share What is a Pediatric Geneticist? Page Content Article Body Fortunately, most children ... with similar problems. What Kind of Training Do Pediatric Geneticists Have? Pediatric geneticists are medical doctors who ...

  6. What is Pediatric Palliative Care?

    Science.gov (United States)

    ... FAQ Handout for Patients and Families What Is Pediatric Palliative Care? Pediatric Palliative care (pronounced pal-lee-uh-tiv) is ... life for both the child and the family. Pediatric palliative care is provided by a team of ...

  7. Children's (Pediatric) Abdominal Ultrasound Imaging

    Medline Plus

    Full Text Available ... Physician Resources Professions Site Index A-Z Children's (Pediatric) Ultrasound - Abdomen Children’s (pediatric) ultrasound imaging of the ... abdomen using ultrasound. View full size with caption Pediatric Content Some imaging tests and treatments have special ...

  8. What Is a Pediatric Urologist?

    Science.gov (United States)

    ... Text Size Email Print Share What is a Pediatric Urologist? Page Content Article Body If your child ... treat your child. What Kind of Training Do Pediatric Urologists Have? Pediatric urologists are medical doctors who ...

  9. Children's (Pediatric) Abdominal Ultrasound Imaging

    Science.gov (United States)

    ... Physician Resources Professions Site Index A-Z Children's (Pediatric) Ultrasound - Abdomen Children’s (pediatric) ultrasound imaging of the ... abdomen using ultrasound. View full size with caption Pediatric Content Some imaging tests and treatments have special ...

  10. Atenção básica e dinâmica urbana nos grandes municípios paulistas, Brasil Primary health care and urban dynamics in large cities in São Paulo State, Brazil

    Directory of Open Access Journals (Sweden)

    Ana Luiza d'Ávila Viana

    2008-01-01

    Full Text Available Os Estudos de Linha de Base do Projeto de Expansão e Consolidação do Saúde da Família construíram indicadores e modelos de atenção básica para os 62 municípios paulistas com mais de 100 mil habitantes, e apontaram uma diversidade de comportamento destes indicadores e modelos em relação às diferentes dinâmicas urbanas do estado. Nesse sentido, houve a necessidade de realizar uma reflexão sobre saúde e uso urbano do território. O principal objetivo desta reflexão foi compreender melhor sobre como a dinâmica urbana tem influência no perfil, na organização e no funcionamento do sistema de saúde. A partir daí, foi possível extrair algumas hipóteses e discussões sobre como a urbanização paulista impõe desafios à expansão e consolidação da atenção básica e do Programa Saúde da Família nos municípios estudados.The Baseline Studies on the Project for Expansion and Consolidation of the Family Health Strategy created primary health care indicators and models for the 62 municipalities with more than 100,000 inhabitants in São Paulo State, Brazil, and identified varying patterns for these indicators and models in relation to different urban dynamics in the State. The studies showed the need to reflect on health in relation to urban land use. The main objective was to gain a better understanding of how urban dynamics influence the health system's profile, organization, and operation, based on which it was possible to extract some hypotheses and discussions regarding how urbanization in São Paulo State creates challenges for the expansion and consolidation of primary health care and the Family Health Program in these municipalities.

  11. Bone Canopies in Pediatric Renal Osteodystrophy

    DEFF Research Database (Denmark)

    Pereira, Renata C; Levin Andersen, Thomas; Friedman, Peter A

    2016-01-01

    Pediatric renal osteodystrophy (ROD) is characterized by changes in bone turnover, mineralization, and volume that are brought about by alterations in bone resorption and formation. The resorptive and formative surfaces on the cancellous bone are separated from the marrow cavity by canopies...... and their association with biochemical and bone histomorphometric parameters in 106 pediatric chronic kidney disease (CKD) patients (stage 2-5) across the spectrum of ROD. Canopies in CKD patients often appeared as thickened multilayered canopies, similar to previous reports in patients with primary hyperparathyroidism....... This finding contrasts with the thin appearance reported in healthy individuals with normal kidney function. Furthermore, canopies in pediatric CKD patients showed immunoreactivity to the PTH receptor (PTHR1) as well as to the receptor activator of nuclear factor kappa-B ligand (RANKL). The number of surfaces...

  12. Challenges of pediatric residency training in Taiwan.

    Science.gov (United States)

    Tsai, Tsuen-Chiuan; Harasym, Peter H

    2006-01-01

    A crisis in pediatric residency training today has raised serious concerns about the healthcare quality for children in Taiwan. The purpose of this study was to document the problems and to propose possible solutions for improvement. The problems include: 1) manpower shortage due to the difficulty of recruiting pediatric residents; 2) heavy workload that hinders learning; 3) lack of assessment and poor program planning; and 4) inadequate institutional and financial support. As a result, physicians' competencies are not guaranteed at the end of residency training, even with the pediatric board certification. Possible solutions may include: 1) conducting research on physician manpower statistics, work hours and environment; 2) establishing a Residency Program Review Committee and provision of standards for accreditation; 3) defining the competencies mandated as a general pediatrician and developing a set of measurable qualitative standards; 4) encouraging new programs with flexibility (e.g., primary care); and 5) pursuing adequate institutional and financial supports.

  13. Biomarkers for CNS involvement in pediatric lupus

    Science.gov (United States)

    Rubinstein, Tamar B; Putterman, Chaim; Goilav, Beatrice

    2015-01-01

    CNS disease, or central neuropsychiatric lupus erythematosus (cNPSLE), occurs frequently in pediatric lupus, leading to significant morbidity and poor long-term outcomes. Diagnosing cNPSLE is especially difficult in pediatrics; many current diagnostic tools are invasive and/or costly, and there are no current accepted screening mechanisms. The most complicated aspect of diagnosis is differentiating primary disease from other etiologies; research to discover new biomarkers is attempting to address this dilemma. With many mechanisms involved in the pathogenesis of cNPSLE, biomarker profiles across several modalities (molecular, psychometric and neuroimaging) will need to be used. For the care of children with lupus, the challenge will be to develop biomarkers that are accessible by noninvasive measures and reliable in a pediatric population. PMID:26079959

  14. Advances in pediatric dentistry.

    Science.gov (United States)

    Yoon, Richard K; Best, Jed M

    2011-07-01

    This article addresses advances in 4 key areas related to pediatric dentistry: (1) caries detection tools, (2) early interventions to arrest disease progression, (3) caries-risk assessment tools, and (4) trends in pediatric procedures and dental materials. Copyright © 2011 Elsevier Inc. All rights reserved.

  15. Pediatric magnetic resonance imaging

    International Nuclear Information System (INIS)

    Cohen, M.D.

    1986-01-01

    This book defines the current clinical potential of magnetic resonance imaging and focuses on direct clinical work with pediatric patients. A section dealing with the physics of magnetic resonance imaging provides an introduction to enable clinicians to utilize the machine and interpret the images. Magnetic resonance imaging is presented as an appropriate imaging modality for pediatric patients utilizing no radiation

  16. Pediatric oncologic endosurgery.

    Science.gov (United States)

    Boo, Yoon Jung; Goedecke, Jan; Muensterer, Oliver J

    2017-08-01

    Despite increasing popularity of minimal-invasive techniques in the pediatric population, their use in diagnosis and management of pediatric malignancy is still debated. Moreover, there is limited evidence to clarify this controversy due to low incidence of each individual type of pediatric tumor, huge diversity of the disease entity, heterogeneity of surgical technique, and lack of well-designed studies on pediatric oncologic minimal-invasive surgery. However, a rapid development of medical instruments and technologies accelerated the current trend toward less invasive surgery, including oncologic endosurgery. The aim of this article is to review current literatures about the application of the minimal-invasive approach for pediatric tumors and to give an overview of the current status, indications, individual techniques, and future perspectives.

  17. Urban bioclimatology.

    Science.gov (United States)

    Mayer, H

    1993-11-15

    This article deals with the part of urban climatology which is of particular relevance to human beings. Presented first is a summary of all human biometerologically effective complexes, as well as other factors which are relevant to urban planning and which depend on atmospheric conditions in urban structures in a direct or indirect manner. Later, methods for human biometerologically significant assessment of thermal and air pollution components of the urban climate are discussed in detail, because these components can be strongly influenced by urban planning. The application of these methods is illustrated by some results of appropriate investigations in urban areas.

  18. Participatory urbanism

    DEFF Research Database (Denmark)

    Ejsing-Duun, Stine

    2016-01-01

    cannot directly influence their structures, they can influence their contours through such leisure practices. In this chapter focus will be on how citizens’ engagement in locative leisure activities may allow them to co-create urban space. This participatory urbanism is a form of everyday democracy......Urban areas are planned structures that cannot easily be changed. Urban areas do however still afford physical spaces for various types of leisure expression and participation, from street art to parkour and from urban gaming to artistic happenings. Thus, while citizens who inhabit the urban areas...

  19. Providing pediatric palliative care: PACT in action.

    Science.gov (United States)

    Duncan, Janet; Spengler, Emily; Wolfe, Joanne

    2007-01-01

    High-quality pediatric palliative care should be an expected standard in the United States, especially since the publication of the numerous position statements such as "Precepts of Palliative Care for Children and Adolescents and Their Families," a joint statement created by the Association of Pediatric Oncology Nurses, the National Association of Neonatal Nurses, and the Society of Pediatric Nurses. Although many barriers still exist, dedicated individuals and teams strive to promote models of excellence and improve care for children with life-threatening conditions and their families. The Pediatric Advanced Care Team, a joint project of Dana-Farber Cancer Institute and Children's Hospital, Boston, is one such interdisciplinary pediatric palliative care consultation service. Founded in 1997, we have grown and learned from formal study and our extensive clinical work with families, children, and our colleagues. This article describes our journey as an interdisciplinary team forging a new service within two renowned medical institutions in which historically the primary emphasis of care has been on cure and innovation. Although these values remain, our work has resulted in an increased acceptance of balancing treatment of the underlying disease or condition along with treatment of the physical, psychosocial, and spiritual needs of the child and family through life or death. One of our goals is to help promote a balance of hope for cure with hope for comfort, dignity, and integrity for every child and family.

  20. Urban lifestyle and urban biodiversity

    DEFF Research Database (Denmark)

    Petersen, L. K.; Lyytimäki, J.; Normander, B.

    2007-01-01

    This report is concerned with the relations between lifestyles of urban populations on one hand and protection of biodiversity in urban areas on the other. Urban areas are of importance for the general protection of biodiversity. In the surroundings of cities and within urban sprawls there can...... biodiversity, recreational, educational and other needs. However, uncovered and unsealed space is constantly under pressure for building and infrastructure development in the urban landscape, and the design and usages of urban green structure is a matter of differing interests and expectations. Integrating...... the green needs of urban lifestyle in the planning process does not come by itself. Nor does finding the synergies between urban lifestyle and urban biodiversity. Careful planning including stakeholder involvement is required. In this process various mapping techniques and use of indicators can be most...

  1. Gender and urban-rural difference in anthropometric indices predicting dyslipidemia in Chinese primary school children: a cross-sectional study.

    Science.gov (United States)

    Zheng, Wei; Zhao, Ai; Xue, Yong; Zheng, Yingdong; Chen, Yun; Mu, Zhishen; Wang, Peiyu; Zhang, Yumei

    2016-04-30

    Childhood dyslipidemia is a critical factor of lifelong health. Therefore, screening and controlling dyslipidemia from childhood is a practical healthy strategy. However, few studies have examined the performance of anthropometric predictors of dyslipidemia in Chinese children, let alone the potential gender and urban-rural disparity. Thus, we evaluated anthropometric indices predicting dyslipidemia by genders and living areas in Chinese children. Data were from a health and nutrition survey conducted in seven urban areas and two rural areas in China between 2011 and 2012. The serum lipid levels of the participants were compared between genders and living areas. The body mass index z-score (BMI z-score), waist-hip ratio (WHR), waist-height ratio (WHtR), and mid-upper arm height ratio (MaHtR) were used as predictors. The receiver operating characteristic (ROC) analysis was performed to investigate the ability of anthropometric indices predicting dyslipidemia. A total of 773 participants (average age = 9.3 ± 1.7 y) were included. The prevalence of dyslipidemia was 10.9%. Anthropometric indices were all significantly related to blood lipid profiles in boys after adjustment for age. The areas under the ROC curves (ACUs) were significantly larger than 0.5 in boys (ranged between 0.66-0.73), and were larger in rural boys (ranged between 0.68 and 0.94). MaHtR and WHR were associated with the highest specificity (93.8%) and highest sensitivity (100%), respectively. Using anthropometric indices, screening for dyslipidemia may be more appropriate in boys than in girls in China, especially in rural boys. The BMI z-score, WHR, WHtR, and MaHtR were all significantly associated with dyslipidemia in boys; using WHR and MaHtR as indicators achieved the highest sensitivity and specificity, respectively.

  2. Social pediatrics: weaving horizontal and vertical threads through pediatric residency.

    Science.gov (United States)

    van den Heuvel, Meta; Martimianakis, Maria Athina Tina; Levy, Rebecca; Atkinson, Adelle; Ford-Jones, Elizabeth; Shouldice, Michelle

    2017-01-13

    Social pediatrics teaches pediatric residents how to understand disease within their patients' social, environmental and political contexts. It's an essential component of pediatric residency training; however there is very little literature that addresses how such a broad-ranging topic can be taught effectively. The aim of this study was to determine and characterize social pediatric education in our pediatric residency training in order to identify strengths and gaps. A social pediatrics curriculum map was developed, attending to 3 different dimensions: (1) the intended curriculum as prescribed by the Objectives of Training for Pediatrics of the Royal College of Physicians and Surgeons of Canada (RCPSC), (2) the formal curriculum defined by rotation-specific learning objectives, and (3) the informal/hidden curriculum as reflected in resident and teacher experiences and perceptions. Forty-one social pediatric learning objectives were extracted from the RCPSC Objectives of Training for Pediatrics, most were listed in the Medical Expert (51%) and Health Advocate competencies (24%). Almost all RCPSC social pediatric learning objectives were identified in more than one rotation and/or seminar. Adolescent Medicine (29.2%), Pediatric Ambulatory Medicine (26.2%) and Developmental Pediatrics (25%) listed the highest proportion of social pediatric learning objectives. Four (10%) RCPSC social pediatric objectives were not explicitly named within learning objectives of the formal curriculum. The informal curriculum revealed that both teachers and residents viewed social pediatrics as integral to all clinical encounters. Perceived barriers to teaching and learning of social pediatrics included time constraints, particularly in a tertiary care environment, and the value of social pediatrics relative to medical expert knowledge. Despite the lack of an explicit thematic presentation of social pediatric learning objectives by the Royal College and residency training program

  3. Urban physics

    NARCIS (Netherlands)

    Blocken, B.J.E.

    2012-01-01

    Urban Physics is the multiscale and interdisciplinary research area dealing with physical processes in urban environments that influence our everyday health, comfort and productivity. It involves disciplines ranging from mesoscale meteorology to human thermophysiology. The introductory lecture

  4. Urban Times

    DEFF Research Database (Denmark)

    Nielsen, Morten

    2017-01-01

    This is a proposed special issue with six thematic articles by different contributors on 'urban times' edited by me.......This is a proposed special issue with six thematic articles by different contributors on 'urban times' edited by me....

  5. Pediatric maxillary fractures.

    Science.gov (United States)

    Yu, Jack; Dinsmore, Robert; Mar, Philip; Bhatt, Kirit

    2011-07-01

    Pediatric craniofacial structures differ from those of adults in many ways. Because of these differences, management of pediatric craniofacial fractures is not the same as those in adults. The most important differences that have clinical relevance are the mechanical properties, craniofacial anatomy, healing capacity, and dental morphology. This article will review these key differences and the management of pediatric maxillary fractures. From the mechanical properties' perspective, pediatric bones are much more resilient than adult bones; as such, they undergo plastic deformation and ductile failure. From the gross anatomic perspective, the relative proportion of the cranial to facial structures is much larger for the pediatric patients and the sinuses are not yet developed. The differences related to dentition and dental development are more conical crowns, larger interdental spaces, and presence of permanent tooth buds in the pediatric population. The fracture pattern, as a result of all the above, does not follow the classic Le Fort types. The maxillomandibular fixation may require circum-mandibular wires, drop wires, or Ivy loops. Interfragmentary ligatures using absorbable sutures play a much greater role in these patients. The use of plates and screws should take into consideration the future development with respect to growth centers and the location of the permanent tooth buds. Pediatric maxillary fractures are not common, require different treatments, and enjoy better long-term outcomes.

  6. Urban streets

    NARCIS (Netherlands)

    Schönfeld, von Kim Carlotta; Bertolini, Luca

    2017-01-01

    Today's urban streets are usually planned for purposes of mobility: pedestrians, as well as a variety of vehicles such as cars, trucks, and sometimes bicycles, are usually factored into an urban street plan. However, urban streets are also increasingly recognized as public spaces, accommodating

  7. Assessing adherence to accepted national guidelines for immigrant and refugee screening and vaccines in an urban primary care practice: a retrospective chart review.

    Science.gov (United States)

    Waldorf, Barbara; Gill, Christopher; Crosby, Sondra S

    2014-10-01

    In the United States, 38.5 million people are foreign-born, one in three arriving since 2000. Health issues include high rates of hepatitis B, humanimmunodeficiency virus infection, parasitic infections, and M. tuberculosis. We sought to determine rates of provider adherence to accepted national guidelines for immigrant and refugee health screening and vaccines done at the primary care clinics at Boston Medical Center. Randomized, retrospective chart review of foreign born patients in the primary care clinics. We found low screening and immunization rates that do not conform to CDC/ACIP guidelines. Only 43 % of immigrant patients had tuberculosis screening, 36 % were screened for HIV and hepatitis B, and 33 % received tetanus vaccinations. Organizational changes incorporating multi-disciplinary approaches such as creative use of nursing staff, protocols, standing orders, EMR reminders, and web based educational tools can contribute to better outcomes by identifying patients and improving utilization of guidelines.

  8. Factors Affecting Non-Attendance in Irish Primary Schools and Reasons for Differences between Urban and Rural levels of Non-attendance

    OpenAIRE

    Gurhy, Anne Marie; Perry, Glen; Farrell, Mark

    2018-01-01

    This study will investigative the factors that influence school non-attendance, in designated disadvantaged Irish primary schools (DEIS1). Currently, no comprehensive data exists on the factors contributing to the levels and types of non-attendance within the Irish context. Since 2003/2004, the National Educational Welfare Board (NEWB, Appendix A) the agency with responsibility for school attendance, has collected specific data on attendance levels and the frequency of non-attendance across a...

  9. Parent assessment of medical student skills in ambulatory pediatrics

    OpenAIRE

    Erika Persson; Christina Haines; Mia Lang

    2013-01-01

    Background: Partnership with parents is a vital part of pediatric medical education, yet few studies have examined parent attitudes towards learners in pediatric settings. Methods: Questionnaires were used to determine parent and student assessment of professional and clinical skills (primary outcome) and parent attitudes towards 3rd year medical students (secondary outcome) at the University of Alberta. Chi Square, Kendall’s Tau and Kappa coefficients were calculated to compare parent an...

  10. [Robotics in pediatric surgery].

    Science.gov (United States)

    Camps, J I

    2011-10-01

    Despite the extensive use of robotics in the adult population, the use of robotics in pediatrics has not been well accepted. There is still a lack of awareness from pediatric surgeons on how to use the robotic equipment, its advantages and indications. Benefit is still controversial. Dexterity and better visualization of the surgical field are one of the strong values. Conversely, cost and a lack of small instruments prevent the use of robotics in the smaller patients. The aim of this manuscript is to present the controversies about the use of robotics in pediatric surgery.

  11. Pediatric emergence delirium: Canadian Pediatric Anesthesiologists' experience.

    Science.gov (United States)

    Rosen, H David; Mervitz, Deborah; Cravero, Joseph P

    2016-02-01

    Pediatric emergence agitation/delirium (ED) is a cluster of behaviors seen in the early postanesthetic period with negative emotional consequences for families and increased utilization of healthcare resources. Many studies have looked at identifying risk factors for ED and at pharmacologic regimens to prevent ED. There are few published reports on treatment options and efficacy for established ED episodes, and essentially no data concerning current practice in the treatment of ED. We sought to elicit the experience and opinions of Canadian Pediatric Anesthesiologists on the incidence of ED in their practice, definitions and diagnostic criteria, preventative strategies, treatments, and their perceived efficacy. A web-based survey was sent to pediatric anesthesiologists working at academic health science centers across Canada. The participants were selected based on being members of the Canadian Pediatric Anesthesia Society (CPAS), which represents the subspecialty in Canada. All members of CPAS who had e-mail contact information available in the membership database were invited to participate. A total of 209 members out of the total of 211 fulfilled these criteria and were included in the study population. The response rate was 51% (106/209). Of respondents, 42% felt that ED was a significant problem at their institutions, with 45% giving medication before or during anesthesia to prevent the development of ED. Propofol was the most common medication given to prevent ED (68%) and to treat ED (42%). Total intravenous anesthesia (TIVA) was considered by 38% of respondents as a technique used to prevent ED. Medications used for treatment included propofol (42%), midazolam (31%), fentanyl (10%), morphine (7%), and dexmedetomidine (5%), with 87% of respondents rating effectiveness of treatment as 'usually works quickly with one dose'. We present information on current practice patterns with respect to prophylaxis and treatment of ED among a specialized group of pediatric

  12. Urban architecture in urban renewal

    DEFF Research Database (Denmark)

    Holmgren, Steen; Svensson, Ole

    2001-01-01

    and without obvious architectural value. These issues raise pertinent questions: what urban architectural problems and qualities exist in the complex, inner suburbs? What differences exist between professionals' and residents' perceptions and assessments of urban architecture? How can a shared language...

  13. Beyond urban penalty and urban sprawl: back to living conditions as the focus of urban health.

    Science.gov (United States)

    Freudenberg, Nicholas; Galea, Sandro; Vlahov, David

    2005-02-01

    Researchers have long studied urban health, both to describe the consequences of urban living and to design interventions to promote the health of people living in cities. Two approaches to understanding the impact of cities on health have been dominant, namely, urban health penalty and urban sprawl. The urban penalty approach posits that cities concentrate poor people and expose them to unhealthy physical and social environments. Urban sprawl focuses on the adverse health and environmental effects of urban growth into outlying areas. We propose a model that integrates these approaches and emphasizes urban living conditions as the primary determinant of health. The aim of the model is to move beyond describing the health-related characteristics of various urban populations towards identifying opportunities for intervention. Such a shift in framework enables meaningful comparisons that can inform public health activities at the appropriate level and evaluate their effectiveness in improving the health of urban populations. The model is illustrated with two examples from current urban public health practice.

  14. Assessing the impact of a waiting time survey on reducing waiting times in urban primary care clinics in Cape Town, South Africa

    Directory of Open Access Journals (Sweden)

    Johann Daniels

    2017-09-01

    Full Text Available A waiting time survey (WTS conducted in several clinics in Cape Town, South Africa provided recommendations on how to shorten waiting times (WT. A follow-up study was conducted to assess whether WT had reduced. Using a stratified sample of 22 clinics, a before and after study design assessed changes in WT. The WT was measured and perceptions of clinic managers were elicited, about the previous survey’s recommendations. The overall median WT decreased by 21 minutes (95%CI: 11.77- 30.23, a 28% decrease from the previous WTS. Although no specific factor was associated with decreases in WT, implementation of recommendations to reduce WT was 2.67 times (95%CI: 1.33-5.40 more likely amongst those who received written recommendations and 2.3 times (95%CI: 1.28- 4.19 more likely amongst managers with 5 or more years’ experience. The decrease in WT found demonstrates the utility of a WTS in busy urban clinics in developing country contexts. Experienced facility managers who timeously receive customised reports of their clinic’s performance are more likely to implement changes that positively impact on reducing WT.

  15. Affective Urbanism

    DEFF Research Database (Denmark)

    Samson, Kristine

    Urban design and architecture are increasingly used as material and affective strategies for setting the scene, for manipulation and the production of urban life: The orchestration of atmospheres, the framing and staging of urban actions, the programming for contemplation, involvement, play......, experience and consumption are all strategic design tools applied by planners and architects. Whereas urban design in former modernist planning served merely functional or political means, urban design has increasingly become an aesthetical mediator of ideologies embedded in the urban field of life forces....... Under these circumstances affective aesthetics operate strategically within the urban field of interests, capital flows and desires of the social. This ‘affective urbanism’ (Anderson & Holden 2008) is linked to a society influenced by new kinds of information flows, where culture is mediated and enacted...

  16. [Complications in pediatric anesthesia].

    Science.gov (United States)

    Becke, K

    2014-07-01

    As in adult anesthesia, morbidity and mortality could be significantly reduced in pediatric anesthesia in recent decades. This fact cannot conceal the fact that the incidence of anesthetic complications in children is still much more common than in adults and sometimes with a severe outcome. Newborns and infants in particular but also children with emergency interventions and severe comorbidities are at increased risk of potential complications. Typical complications in pediatric anesthesia are respiratory problems, medication errors, difficulties with the intravenous puncture and pulmonal aspiration. In the postoperative setting, nausea and vomiting, pain, and emergence delirium can be mentioned as typical complications. In addition to the systematic prevention of complications in pediatric anesthesia, it is important to quickly recognize disturbances of homeostasis and treat them promptly and appropriately. In addition to the expertise of the performing anesthesia team, the institutional structure in particular can improve quality and safety in pediatric anesthesia.

  17. Children's (Pediatric) Nuclear Medicine

    Medline Plus

    Full Text Available ... What are some common uses of the procedure? Children's (pediatric) nuclear medicine imaging is performed to help diagnose childhood disorders that are congenital (present at birth) or that develop during childhood. Physicians use nuclear medicine imaging to ...

  18. Pediatric Urinary Tract Infection

    Science.gov (United States)

    SBA National Resource Center: 800-621-3141 Pediatric Urinary Tract Infections and Catheterization in Children with Neurogenic Bladder and Bowel Why is it important to begin urologic care in infancy and ...

  19. Pediatric Nephrolithiasis: A Review.

    Science.gov (United States)

    Miah, Tayaba; Kamat, Deepak

    2017-06-01

    The incidence of pediatric nephrolithiasis is on the rise. The composition of kidney stones in children is different than in adults, as most stones in children have a composition of calcium oxalate and calcium phosphate mixed with a small amount of uric acid. The symptoms of pediatric nephrolithiasis are nonspecific. Computed tomography (CT) is the gold standard for diagnosis; however, because of radiation exposure associated with a CT scan, ultrasonography is also an accepted modality for the diagnosis. Extensive metabolic evaluation is important to rule out an underlying metabolic disorder. Urinary decompression, medical expulsion therapy, and surgical interventions such as ureteroscopy and extracorporeal shockwave lithotripsy are some of the options available for treating pediatric nephrolithiasis. [Pediatr Ann. 2017;46(6):e242-e244.]. Copyright 2017, SLACK Incorporated.

  20. Children's (Pediatric) Nuclear Medicine

    Medline Plus

    Full Text Available ... Nuclear Medicine Children’s (pediatric) nuclear medicine imaging uses small amounts of radioactive materials called radiotracers, a special ... is a branch of medical imaging that uses small amounts of radioactive material to diagnose and determine ...

  1. Children's (Pediatric) Nuclear Medicine

    Medline Plus

    Full Text Available ... imaging techniques. top of page Additional Information and Resources The Alliance for Radiation Safety in Pediatric Imaging's " ... To locate a medical imaging or radiation oncology provider in your community, you can search the ACR- ...

  2. Children's (Pediatric) Nuclear Medicine

    Medline Plus

    Full Text Available ... interventions. Children's (pediatric) nuclear medicine refers to imaging examinations done in babies, young children and teenagers. Nuclear ... nuclear medicine procedure work? With ordinary x-ray examinations, an image is made by passing x-rays ...

  3. Children's (Pediatric) Nuclear Medicine

    Medline Plus

    Full Text Available ... MRI. top of page What are some common uses of the procedure? Children's (pediatric) nuclear medicine imaging ... at birth) or that develop during childhood. Physicians use nuclear medicine imaging to evaluate organ systems, including ...

  4. Children's (Pediatric) Nuclear Medicine

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    Full Text Available ... type your comment or suggestion into the following text box: Comment: E-mail: Area code: Phone no: Thank ... View full size with caption Pediatric Content Some imaging tests ...

  5. Children's (Pediatric) Nuclear Medicine

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    Full Text Available ... child is taking as well as vitamins and herbal supplements and if he or she has any ... What are the limitations of Children's (Pediatric) Nuclear Medicine? Nuclear medicine procedures can be time consuming. It ...

  6. Children's (Pediatric) Nuclear Medicine

    Medline Plus

    Full Text Available ... Children's (Pediatric) Nuclear Medicine? What are some common uses of the procedure? How does the nuclear medicine procedure work? What does the equipment look like? How is ...

  7. Children's (Pediatric) Nuclear Medicine

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    Full Text Available ... to Children's (Pediatric) Nuclear Medicine Sponsored by Please note RadiologyInfo.org is not a medical facility. Please ... is further reviewed by committees from the American College of Radiology (ACR) and the Radiological Society of ...

  8. Children's (Pediatric) Nuclear Medicine

    Medline Plus

    Full Text Available ... MRI. top of page What are some common uses of the procedure? Children's (pediatric) nuclear medicine imaging ... community, you can search the ACR-accredited facilities database . This website does not provide cost information. The ...

  9. Children's (Pediatric) Nuclear Medicine

    Medline Plus

    Full Text Available ... exams at the same time. An emerging imaging technology, but not readily available at this time is PET/MRI. top of page What are some common uses of the procedure? Children's (pediatric) nuclear medicine imaging ...

  10. Causes of Pediatric Cardiomyopathy

    Science.gov (United States)

    ... inherited metabolic or congenital muscle disorder such as Noonan syndrome, Pompe disease, fatty acid oxidation defect or Barth ... where a specific chromosome is deleted or duplicated. Noonan syndrome is the most common form associated with pediatric ...

  11. Children's (Pediatric) Nuclear Medicine

    Medline Plus

    Full Text Available ... The teddy bear denotes child-specific content. Related Articles and Media General Nuclear Medicine Children's (Pediatric) CT ( ... About Us | Contact Us | FAQ | Privacy | Terms of Use | Links | Site Map Copyright © 2018 Radiological Society of ...

  12. The pediatric knee.

    Science.gov (United States)

    Orth, Robert C

    2013-03-01

    Knee pain is a common problem in children and adolescents, and MRI of the knee is the most commonly performed pediatric cross-sectional musculoskeletal imaging exam. The purpose of this pictorial review is to highlight differences between adult and pediatric knee imaging with an emphasis on normal developmental variants, injury and disease patterns unique to children and adolescents, and differences in response and presentation to conditions affecting both adults and children.

  13. Trends in pediatric echocardiography and the yield for congenital heart disease in a major cardiac referral hospital in Cameroon.

    Science.gov (United States)

    Nkoke, Clovis; Balti, Eric; Menanga, Alain; Dzudie, Anastase; Lekoubou, Alain; Kingue, Samuel; Kengne, Andre Pascal

    2017-01-01

    Congenital heart disease (CHD) is a common condition in children in Sub-Saharan Africa (SSA), where it is associated with poor outcomes. Diagnosis of CHD in SSA depends essentially on echocardiography, which is available only in few urban referral centers. Our aim was to assess time changes in the pattern of referral for pediatric echocardiography and the subsequent diagnosis of structural CHD in a major SSA city. All pediatric echocardiography performed between 2004 and 2013 at the echocardiography laboratory of the Yaounde General Hospital were reviewed. The primary indication of the study and the presence of structural CHD were recorded. Between 2004 and 2013, 9,390 echocardiograms were performed and 834 (8.9%) children aged 1 day to 15 years underwent echocardiography at the center, and 227 (27.2%) cases of definite structural CHD were diagnosed, with 123 (54.2%) in boys. The most frequent indications for echocardiography were heart murmurs (40%) and the suspicion of CHD (37.4%). The commonest CHD was ventricular septal defect (VSD) (30%) with tetralogy of Fallot being the most frequent cyanotic heart lesion (5.3%). The proportion of pediatric echocardiography decreased from 13.3% in 2004-2005 to 6.1% in 2012-2013 (P=0.001) but not in a linear fashion (P=0.072 for linear trend).The diagnosis of structural CHD increased from 25.1% in 2004-2005 to 27.1% in 2012-2013. This increase however was non-significant (P=0.523) and did not follow a linear trend (P=0.230). The pattern of referral for pediatric echocardiography at this center has changed over time, but diagnosis of structural CHD has remained the same. Improving access to this diagnostic procedure and subsequent treatment of diagnosed CHD will help improving the outcome of the disease in this setting.

  14. How Accountable Care Organizations Responded to Pediatric Incentives in the Alternative Quality Contract.

    Science.gov (United States)

    Chien, Alyna T; Schiavoni, Katherine H; Sprecher, Eli; Landon, Bruce E; McNeil, Barbara J; Chernew, Michael E; Schuster, Mark A

    2016-03-01

    From 2009 to 2010, 12 accountable care organizations (ACOs) entered into the alternative quality contract (AQC), BlueCross BlueShield of Massachusetts's global payment arrangement. The AQC included 6 outpatient pediatric quality measures among 64 total measures tied to pay-for-performance bonuses and incorporated pediatric populations in their global budgets. We characterized the pediatric infrastructure of these adult-oriented ACOs and obtained leaders' perspectives on their ACOs' response to pediatric incentives. We used Massachusetts Health Quality Partners and American Hospital Association Survey data to characterize ACOs' pediatric infrastructure as extremely limited, basic, and substantial on the basis of the extent of pediatric primary care, outpatient specialist, and inpatient services. After ACOs had 16 to 43 months of experience with the AQC, we interviewed 22 leaders to gain insight into how organizations made changes to improve pediatric care quality, tried to reduce pediatric spending, and addressed care for children with special health care needs. ACOs' pediatric infrastructure ranged from extremely limited (eg, no general pediatricians in their primary care workforce) to substantial (eg, 42% of workforce was general pediatricians). Most leaders reported intensifying their pediatric quality improvement efforts and witnessing changes in quality metrics; most also investigated pediatric spending patterns but struggled to change patients' utilization patterns. All reported that the AQC did little to incentivize care for children with special health care needs and that future incentive programs should include this population. Although ACOs involved in the AQC were adult-oriented, most augmented their pediatric quality improvement and spending reduction efforts when faced with pediatric incentives. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  15. Pediatric vascular access

    International Nuclear Information System (INIS)

    Donaldson, James S.

    2006-01-01

    Pediatric interventional radiologists are ideally suited to provide vascular access services to children because of inherent safety advantages and higher success from using image-guided techniques. The performance of vascular access procedures has become routine at many adult interventional radiology practices, but this service is not as widely developed at pediatric institutions. Although interventional radiologists at some children's hospitals offer full-service vascular access, there is little or none at others. Developing and maintaining a pediatric vascular access service is a challenge. Interventionalists skilled in performing such procedures are limited at pediatric institutions, and institutional support from clerical staff, nursing staff, and technologists might not be sufficiently available to fulfill the needs of such a service. There must also be a strong commitment by all members of the team to support such a demanding service. There is a slippery slope of expected services that becomes steeper and steeper as the vascular access service grows. This review is intended primarily as general education for pediatric radiologists learning vascular access techniques. Additionally, the pediatric or adult interventional radiologist seeking to expand services might find helpful tips. The article also provides education for the diagnostic radiologist who routinely interprets radiographs containing vascular access devices. (orig.)

  16. Cerebral imaging in pediatrics

    International Nuclear Information System (INIS)

    Gordon, I.

    1998-01-01

    Radioisotope brain imaging has focused mainly on regional cerebral blood flow (rCBF). However the use of ligand which go to specific receptor sites is being introduced in pediatrics, mainly psychiatry. rCBF is potentially available in many institutions, especially with the availability of multi-headed gamma cameras. The use of this technique in pediatrics requires special attention to detail in the manner of data acquisition and handling the child. The interpretation of the rCBF study in a child requires knowledge of normal brain maturation. The major clinical use in pediatrics is epilepsy because of the advances in surgery and the frequency of complex partial seizures. Other indications in pediatric neurology include brain death, acute neurological loss including stroke, language disorders, cerebral palsy, hypertension due to renovascular disease, traumatic brain injury and migraine. There are pediatric physiological conditions in which rCBF has been undertaken, these include anorexia nervosa, autism, Gilles de la Tourette syndrome (GTS) and attention deficit disorder-hyperactivity (ADHD). Research using different ligands to specific receptor sites will also be reviewed in pediatrics

  17. Cerebral imaging in pediatrics

    Energy Technology Data Exchange (ETDEWEB)

    Gordon, I [London, Great Ormond Street Hospital for Children (United Kingdom)

    1998-06-01

    Radioisotope brain imaging has focused mainly on regional cerebral blood flow (rCBF). However the use of ligand which go to specific receptor sites is being introduced in pediatrics, mainly psychiatry. rCBF is potentially available in many institutions, especially with the availability of multi-headed gamma cameras. The use of this technique in pediatrics requires special attention to detail in the manner of data acquisition and handling the child. The interpretation of the rCBF study in a child requires knowledge of normal brain maturation. The major clinical use in pediatrics is epilepsy because of the advances in surgery and the frequency of complex partial seizures. Other indications in pediatric neurology include brain death, acute neurological loss including stroke, language disorders, cerebral palsy, hypertension due to renovascular disease, traumatic brain injury and migraine. There are pediatric physiological conditions in which rCBF has been undertaken, these include anorexia nervosa, autism, Gilles de la Tourette syndrome (GTS) and attention deficit disorder-hyperactivity (ADHD). Research using different ligands to specific receptor sites will also be reviewed in pediatrics.

  18. Pediatric acute gastroenteritis: understanding caregivers' experiences and information needs.

    Science.gov (United States)

    Albrecht, Lauren; Hartling, Lisa; Scott, Shannon D

    2017-05-01

    Pediatric acute gastroenteritis (AGE) is a common condition with high health care utilization, persistent practice variation, and substantial family burden. An initial approach to resolve these issues is to understand the patient/caregiver experience of this illness. The objective of this study was to describe caregivers' experiences of pediatric AGE and identify their information needs, preferences, and priorities. A qualitative, descriptive study was conducted. Caregivers of a child with AGE were recruited for this study in the pediatric emergency department (ED) at a tertiary hospital in a major urban centre. Individual interviews were conducted (n=15), and a thematic analysis of interview transcripts was completed using a hybrid inductive/deductive approach. Five major themes were identified and described: 1) caregiver management strategies; 2) reasons for going to the ED; 3) treatment and management of AGE in the ED; 4) caregivers' information needs; and 5) additional factors influencing caregivers' experiences and decision-making. A number of subthemes within each major theme were identified and described. This qualitative descriptive study has identified caregiver information needs, preferences, and priorities regarding pediatric AGE. This study also identified inconsistencies in the treatment and management of pediatric AGE at home and in the ED that influence health care utilization and patient outcomes related to pediatric AGE.

  19. Pediatric Obesity: Looking into Treatment

    Directory of Open Access Journals (Sweden)

    Marcella Malavolti

    2009-11-01

    Full Text Available Prevalence of pediatric obesity continues to rise worldwide. Increasing the number of health care practitioners as well as pediatricians with expertise in obesity treatment is necessary. Because many obese patients suffer obesity-associated cardiovascular, metabolic and other health complications that could increase the severity of obesity, it is fundamental not only to identify the child prone to obesity as early as possible, but to recognize, treat and monitor obesity-related diseases during adolescence. This short review outlines the treatment of pediatric obesity that may have applications in the primary care setting. It examines current information on eating behavior, sedentary behavior, and details studies of multidisciplinary, behavior-based, obesity treatment programs. We also report the less common and more aggressive forms of treatment, such as medication and bariatric surgery. We emphasize that health care providers have the potential to improve outcomes by performing early identification, helping families create the best possible home environment, and by providing structured guidance to obese children and their families.

  20. Geospatial Analysis of Pediatric EMS Run Density and Endotracheal Intubation

    Directory of Open Access Journals (Sweden)

    Matthew Hansen

    2016-09-01

    Full Text Available Introduction: The association between geographic factors, including transport distance, and pediatric emergency medical services (EMS run clustering on out-of-hospital pediatric endotracheal intubation is unclear. The objective of this study was to determine if endotracheal intubation procedures are more likely to occur at greater distances from the hospital and near clusters of pediatric calls. Methods: This was a retrospective observational study including all EMS runs for patients less than 18 years of age from 2008 to 2014 in a geographically large and diverse Oregon county that includes densely populated urban areas near Portland and remote rural areas. We geocoded scene addresses using the automated address locator created in the cloud-based mapping platform ArcGIS, supplemented with manual address geocoding for remaining cases. We then use the Getis-Ord Gi spatial statistic feature in ArcGIS to map statistically significant spatial clusters (hot spots of pediatric EMS runs throughout the county. We then superimposed all intubation procedures performed during the study period on maps of pediatric EMS-run hot spots, pediatric population density, fire stations, and hospitals. We also performed multivariable logistic regression to determine if distance traveled to the hospital was associated with intubation after controlling for several confounding variables. Results: We identified a total of 7,797 pediatric EMS runs during the study period and 38 endotracheal intubations. In univariate analysis we found that patients who were intubated were similar to those who were not in gender and whether or not they were transported to a children’s hospital. Intubated patients tended to be transported shorter distances and were older than non-intubated patients. Increased distance from the hospital was associated with reduced odds of intubation after controlling for age, sex, scene location, and trauma system entry status in a multivariate logistic

  1. Do pediatric gastroenterology doctors address pediatric obesity?

    OpenAIRE

    Batra, Suruchi; Yee, Caitlin; Diez, Bernadette; Nguyen, Nicholas; Sheridan, Michael J; Tufano, Mark; Sikka, Natalie; Townsend, Stacie; Hourigan, Suchitra

    2017-01-01

    Objectives: To assess how often obesity is acknowledged at pediatric gastroenterology outpatient visits. Methods: A retrospective chart review was performed to identify obese children seen at a gastroenterology subspecialty clinic over a 1-year period of time; 132 children were identified. Demographics, obesity comorbidities, reasons for referral, diagnosis of obesity, and a plan to address obesity were abstracted. Chi-square or Fisher?s exact tests were used to examine statistical associatio...

  2. Simulation in pediatric anesthesiology.

    Science.gov (United States)

    Fehr, James J; Honkanen, Anita; Murray, David J

    2012-10-01

    Simulation-based training, research and quality initiatives are expanding in pediatric anesthesiology just as in other medical specialties. Various modalities are available, from task trainers to standardized patients, and from computer-based simulations to mannequins. Computer-controlled mannequins can simulate pediatric vital signs with reasonable reliability; however the fidelity of skin temperature and color change, airway reflexes and breath and heart sounds remains rudimentary. Current pediatric mannequins are utilized in simulation centers, throughout hospitals in-situ, at national meetings for continuing medical education and in research into individual and team performance. Ongoing efforts by pediatric anesthesiologists dedicated to using simulation to improve patient care and educational delivery will result in further dissemination of this technology. Health care professionals who provide complex, subspecialty care to children require a curriculum supported by an active learning environment where skills directly relevant to pediatric care can be developed. The approach is not only the most effective method to educate adult learners, but meets calls for education reform and offers the potential to guide efforts toward evaluating competence. Simulation addresses patient safety imperatives by providing a method for trainees to develop skills and experience in various management strategies, without risk to the health and life of a child. A curriculum that provides pediatric anesthesiologists with the range of skills required in clinical practice settings must include a relatively broad range of task-training devises and electromechanical mannequins. Challenges remain in defining the best integration of this modality into training and clinical practice to meet the needs of pediatric patients. © 2012 Blackwell Publishing Ltd.

  3. Pediatric allergy and immunology in Italy.

    Science.gov (United States)

    Tozzi, Alberto E; Armenio, Lucio; Bernardini, Roberto; Boner, Attilio; Calvani, Mauro; Cardinale, Fabio; Cavagni, Giovanni; Dondi, Arianna; Duse, Marzia; Fiocchi, Alessandro; Marseglia, Gian L; del Giudice, Michele Miraglia; Muraro, Antonella; Pajno, Giovanni B; Paravati, Francesco; Peroni, Diego; Tripodi, Salvatore; Ugazio, Alberto G; Indinnimeo, Luciana

    2011-05-01

    In Italy, according to the International Study on Asthma and Allergies in Childhood study, the prevalence of current asthma, allergic rhinoconjunctivitis, and atopic eczema in 2006 was 7.9%, 6.5%, and 10.1% among children aged 6-7 and 8.4%, 15.5%, and 7.75% among children aged 13-14 yr. University education in this field is provided by the Postgraduate Schools of Pediatrics and those of Allergology and Clinical Immunology, as well as several annual Master courses. The Italian Society of Pediatric Allergology and Immunology (SIAIP) was founded in 1996 and counts about 1000 members. SIAIP promotes evidence-based management of allergic children and disseminates information to patients and their families through a quite innovative website and the National Journal 'Rivista Italiana di Allergologia Pediatrica'. In the last decade, four major regional, inter-regional, and national web-based networks have been created to link pediatric allergy centers and to share their clinical protocols and epidemiologic data. In addition, National Registers of Primary Immune-deficiencies and on Pediatric HIV link all clinical excellence centers. Research projects in the field of pediatric allergy and immunology are founded by the Italian Ministry of Education, University and Research (MIUR) and by the National Research Council (CNR), but the overall investments in this research area are quite low. Only a handful Italian excellence centers participate in European Projects on Pediatric Allergy and Immunology within the 7th Framework Program. The European Academy of Allergy and Clinical Immunology currently hosts two Italians in its Executive Committee (EC) and one in the EC of the Pediatric Section; moreover, major European Academy of Allergy and Clinical Immunology meetings and courses in the area of pediatrics (e.g., PAAM, Venice, 2009) have been held in Italy in the last 3 yr. Italian hallmarks in the management of allergic diseases in childhood are a quite alive and spread interest in

  4. Pediatric lower extremity mower injuries.

    Science.gov (United States)

    Hill, Sean M; Elwood, Eric T

    2011-09-01

    Lawn mower injuries in children represent an unfortunate common problem to the plastic reconstructive surgeon. There are approximately 68,000 per year reported in the United States. Compounding this problem is the fact that a standard treatment algorithm does not exist. This study follows a series of 7 pediatric patients treated for lower extremity mower injuries by a single plastic surgeon. The extent of soft tissue injury varied. All patients were treated with negative pressure wound therapy as a bridge to definitive closure. Of the 7 patients, 4 required skin grafts, 1 required primary closure, 1 underwent a lower extremity amputation secondary to wounds, and 1 was repaired using a cross-leg flap. Function limitations were minimal for all of our patients after reconstruction. Our basic treatment algorithm is presented with initial debridement followed by the simplest method possible for wound closure using negative pressure wound therapy, if necessary.

  5. The Pediatric Cancer Genome Project

    Science.gov (United States)

    Downing, James R; Wilson, Richard K; Zhang, Jinghui; Mardis, Elaine R; Pui, Ching-Hon; Ding, Li; Ley, Timothy J; Evans, William E

    2013-01-01

    The St. Jude Children’s Research Hospital–Washington University Pediatric Cancer Genome Project (PCGP) is participating in the international effort to identify somatic mutations that drive cancer. These cancer genome sequencing efforts will not only yield an unparalleled view of the altered signaling pathways in cancer but should also identify new targets against which novel therapeutics can be developed. Although these projects are still deep in the phase of generating primary DNA sequence data, important results are emerging and valuable community resources are being generated that should catalyze future cancer research. We describe here the rationale for conducting the PCGP, present some of the early results of this project and discuss the major lessons learned and how these will affect the application of genomic sequencing in the clinic. PMID:22641210

  6. Pediatric allergy and immunology in China.

    Science.gov (United States)

    Wong, Gary W K; Li, Jing; Bao, Yi-Xiao; Wang, Jiu-Yao; Leung, Ting Fan; Li, Luan-Luan; Shao, Jie; Huang, Xin-Yuan; Liu, En-Mei; Shen, Kun-Ling; Chen, Yu-Zhi

    2018-03-01

    Over the past 30 years, China has enjoyed rapid economic development along with urbanization at a massive scale that the world has not experienced before. Such development has also been associated with a rapid rise in the prevalence of allergic disorders. Because of the large childhood population in the country, the burden of childhood allergic disorders has become one of the major challenges in the healthcare system. Among the Chinese centers participating in the International Study of Asthma and Allergies in Childhood, the data clearly showed a continuing rise in the prevalence of asthma, allergic rhinitis, and atopic eczema. However, the discipline of pediatric allergy in mainland China is still in its infancy due to the lack of formal training program and subspecialty certification. Clinicians and researchers are increasingly interested in providing better care for patients with allergies by establishing pediatric allergy centers in different regions of the country. Many of them have also participated in national or international collaborative projects hoping to answer the various research questions related to the discipline of pediatric allergy and immunology. It is our hope that the research findings from China will not only improve the quality of care of affected children within this country but also the millions of patients with allergies worldwide. © 2017 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.

  7. Tissue quantification for development of pediatric phantom

    International Nuclear Information System (INIS)

    Alves, A.F.F.; Miranda, J.R.A.; Pina, D.R.

    2013-01-01

    The optimization of the risk- benefit ratio is a major concern in the pediatric radiology, due to the greater vulnerability of children to the late somatic effects and genetic effects of exposure to radiation compared to adults. In Brazil, it is estimated that the causes of death from head trauma are 18 % for the age group between 1-5 years and the radiograph is the primary diagnostic test for the detection of skull fracture . Knowing that the image quality is essential to ensure the identification of structures anatomical and minimizing errors diagnostic interpretation, this paper proposed the development and construction of homogeneous phantoms skull, for the age group 1-5 years. The construction of the phantoms homogeneous was performed using the classification and quantification of tissue present in the skull of pediatric patients. In this procedure computational algorithms were used, using Matlab, to quantify distinct biological tissues present in the anatomical regions studied , using pictures retrospective CT scans. Preliminary data obtained from measurements show that between the ages of 1-5 years, assuming an average anteroposterior diameter of the pediatric skull region of the 145.73 ± 2.97 mm, can be represented by 92.34 mm ± 5.22 of lucite and 1.75 ± 0:21 mm of aluminum plates of a provision of PEP (Pacient equivalent phantom). After its construction, the phantoms will be used for image and dose optimization in pediatric protocols process to examinations of computerized radiography

  8. Factors influencing rural and urban emergency clinicians' participation in an online knowledge exchange intervention.

    Science.gov (United States)

    Curran, Janet A; Murphy, Andrea L; Sinclair, Douglas; McGrath, Patrick

    2013-01-01

    Rural emergency departments (EDs) generally have limited access to continuing education and are typically staffed by clinicians without pediatric emergency specialty training. Emergency care of children is complex and the majority of children receive emergency care in non-pediatric tertiary care centers. In recent decades, there has been a call to action to improve quality and safety in the emergency care of children. Of the one million ED visits by children in Ontario in 2005-2006, one in three visited more than once in a year and one in 15 returned to the ED within 72 hours of the index visit. This study explored factors influencing rural and urban ED clinicians' participation in a Web-based knowledge exchange intervention that focused on best practice knowledge about pediatric emergency care. The following questions guided the study: (i) What are the individual, context of practice or knowledge factors which impact a clinician's decision to participate in a Web-based knowledge exchange intervention?; (ii) What are clinicians' perceptions of organizational expectations regarding knowledge and information sources to be used in practice?; and (iii) What are the preferred knowledge sources of rural and urban emergency clinicians? A Web-based knowledge exchange intervention, the Pediatric Emergency Care Web Based Knowledge Exchange Project, for rural and urban ED clinicians was developed. The website contained 12 pediatric emergency practice learning modules with linked asynchronous discussion forums. The topics for the modules were determined through a needs assessment and the module content was developed by known experts in the field. A follow-up survey was sent to a convenience sample of 187 clinicians from nine rural and two urban Canadian EDs participating in the pediatric emergency Web-based knowledge exchange intervention study. The survey response rate was 56% (105/187). Participation in the knowledge exchange intervention was related to individual

  9. Children's (Pediatric) Magnetic Resonance Imaging

    Medline Plus

    Full Text Available ... the exam. MRI scanners are air-conditioned and well-lit. Music may be played through the headphones ... full size with caption Pediatric Content Some imaging tests and treatments have special pediatric considerations. The teddy ...

  10. Children's (Pediatric) Magnetic Resonance Imaging

    Medline Plus

    Full Text Available ... a risk, depending on their nature and the strength of the MRI magnet. Many implanted devices will ... full size with caption Pediatric Content Some imaging tests and treatments have special pediatric considerations. The teddy ...

  11. NCI Pediatric Preclinical Testing Consortium

    Science.gov (United States)

    NCI has awarded grants to five research teams to participate in its Pediatric Preclinical Testing Consortium, which is intended to help to prioritize which agents to pursue in pediatric clinical trials.

  12. Children's (Pediatric) Abdominal Ultrasound Imaging

    Medline Plus

    Full Text Available ... need to be returned to the transducer for analysis. top of page This page was reviewed on ... using ultrasound. View full size with caption Pediatric Content Some imaging tests and treatments have special pediatric ...

  13. Children's (Pediatric) CT (Computed Tomography)

    Medline Plus

    Full Text Available ... in CT scans should have no immediate side effects. Risks The risk of serious allergic reaction to ... Pediatric Content Some imaging tests and treatments have special pediatric considerations. The teddy bear denotes child-specific ...

  14. Children's (Pediatric) CT (Computed Tomography)

    Medline Plus

    Full Text Available ... your child. top of page Additional Information and Resources The Alliance for Radiation Safety in Pediatric Imaging's " ... A child being prepared for a CT scan. View full size with caption Pediatric Content Some imaging ...

  15. Children's (Pediatric) CT (Computed Tomography)

    Medline Plus

    Full Text Available ... Z Children's (Pediatric) CT (Computed Tomography) Pediatric computed tomography (CT) is a fast, painless exam that uses special ... the limitations of Children's CT? What is Children's CT? Computed tomography, more commonly known as a CT or CAT ...

  16. Children's (Pediatric) Abdominal Ultrasound Imaging

    Medline Plus

    Full Text Available ... Imaging? Ultrasound waves are disrupted by air or gas; therefore ultrasound is not an ideal imaging technique ... with caption Pediatric Content Some imaging tests and treatments have special pediatric considerations. The teddy bear denotes ...

  17. Children's (Pediatric) CT (Computed Tomography)

    Medline Plus

    Full Text Available ... News Physician Resources Professions Site Index A-Z Children's (Pediatric) CT (Computed Tomography) Pediatric computed tomography (CT) ... are the limitations of Children's CT? What is Children's CT? Computed tomography, more commonly known as a ...

  18. Children's (Pediatric) Abdominal Ultrasound Imaging

    Medline Plus

    Full Text Available ... News Physician Resources Professions Site Index A-Z Children's (Pediatric) Ultrasound - Abdomen Children’s (pediatric) ultrasound imaging of ... 30 minutes. top of page What will my child experience during and after the procedure? Ultrasound examinations ...

  19. Children's (Pediatric) Magnetic Resonance Imaging

    Medline Plus

    Full Text Available ... MRI) exam. View full size with caption Pediatric Content Some imaging tests and treatments have special pediatric considerations. The teddy bear denotes child-specific content. Related Articles and Media Catheter Angiography Magnetic Resonance, ...

  20. Children's (Pediatric) Abdominal Ultrasound Imaging

    Medline Plus

    Full Text Available ... scans, your doctor may ask you to withhold food and drink for several hours before your child's ... full size with caption Pediatric Content Some imaging tests and treatments have special pediatric considerations. The teddy ...

  1. Pediatric psoriasis: an update

    Directory of Open Access Journals (Sweden)

    Nanette B Silverberg

    2009-10-01

    Full Text Available Nanette B SilverbergPediatric and Adolescent Dermatology, St. Luke’s-Roosevelt Hospital Center, New York, NY, USAAbstract: Pediatric psoriasis consists broadly of 3 age groups of psoriatic patients: infantile psoriasis, a self-limited disease of infancy, psoriasis with early onset, and pediatric psoriasis with psoriatic arthritis. About one-quarter of psoriasis cases begin before the age of 18 years. A variety of clinical psoriasis types are seen in childhood, including plaque-type, guttate, erythrodermic, napkin, and nail-based disease. Like all forms of auto-immunity, susceptibility is likely genetic, but environmental triggers are required to initiate disease activity. The most common trigger of childhood is an upper respiratory tract infection. Once disease has occurred, treatment is determined based on severity and presence of joint involvement. Topical therapies, including corticosteroids and calcipotriene, are the therapies of choice in the initial care of pediatric patients. Ultraviolet light, acitretin and cyclosporine can clear skin symptoms, while methotrexate and etanercept can clear both cutaneous and joint disease. Concern for psychological development is required when choosing psoriatic therapies. This article reviews current concepts in pediatric psoriasis and a rational approach to therapeutics. Keywords: psoriasis, autoimmunity, Streptococcus, etanercept, calcipotriene, topical corticosteroids

  2. A Structural Equation Analysis of Family Accommodation in Pediatric Obsessive-Compulsive Disorder

    Science.gov (United States)

    Caporino, Nicole E.; Morgan, Jessica; Beckstead, Jason; Phares, Vicky; Murphy, Tanya K.; Storch, Eric A.

    2012-01-01

    Family accommodation of symptoms is counter to the primary goals of cognitive-behavioral therapy for pediatric obsessive-compulsive disorder (OCD) and can pose an obstacle to positive treatment outcomes. Although increased attention has been given to family accommodation in pediatric OCD, relatively little is known about associated child and…

  3. Urban blight and urban redesign

    OpenAIRE

    Zsilincsar, Walter

    2018-01-01

    The phenomenon of urban blight dates back to the 19th century when industrialisation starting in Europe and North America initiated an uncontrolled urban growth in combination with strong demand in cheap an quickly constructed housing. Ghettoisation of mainly the working-class population and other “marginal groups” were the consequence together with a constant decay of single buildings, whole blocks and quarters. These general aspects of urban blight with its additional facettes or aspects re...

  4. PET imaging in pediatric oncology

    International Nuclear Information System (INIS)

    Shulkin, B.L.

    2004-01-01

    High-quality PET imaging of pediatric patients is challenging and requires attention to issues commonly encountered in the practice of pediatric nuclear medicine, but uncommon to the imaging of adult patients. These include intravenous access, fasting, sedation, consent, and clearance of activity from the urinary tract. This paper discusses some technical differences involved in pediatric PET to enhance the quality of scans and assure the safety and comfort of pediatric patients. (orig.)

  5. Pediatric Electrocardiographic Imaging (ECGI) Applications

    Science.gov (United States)

    Silva, Jennifer N. A.

    2014-01-01

    Summary Noninvasive electrocardiographic imaging (ECGI) has been used in pediatric and congenital heart patients to better understand their electrophysiologic substrates. In this article we focus on the 4 subjects related to pediatric ECGI: 1) ECGI in patients with congenital heart disease and Wolff-Parkinson-White syndrome, 2) ECGI in patients with hypertrophic cardiomyopathy and pre-excitation, 3) ECGI in pediatric patients with Wolff-Parkinson-White syndrome, and 4) ECGI for pediatric cardiac resynchronization therapy. PMID:25722754

  6. Primary Meningeal Rhabdomyosarcoma

    Science.gov (United States)

    Palta, Manisha; Riedel, Richard F.; Vredenburgh, James J.; Cummings, Thomas J.; Green, Scott; Chang, Zheng; Kirkpatrick, John P.

    2011-01-01

    Primary meningeal rhabdomyosarcoma is a rare primary brain malignancy, with scant case reports. While most reports of primary intracranial rhabdomyosarcoma occur in pediatric patients, a handful of cases in adult patients have been reported in the medical literature. We report the case of a 44-year-old male who developed primary meningeal rhabdomyosarcoma. After developing episodes of right lower extremity weakness, word finding difficulty, and headaches, a brain magnetic resonance imaging (MRI) demonstrated a vertex lesion with radiographic appearance of a meningeal-derived tumor. Subtotal surgical resection was performed due to sagittal sinus invasion and initial pathology was interpreted as an anaplastic meningioma. Re-review of pathology demonstrated rhabdomyosarcoma negative for alveolar translocation t(2;13). Staging studies revealed no evidence of disseminated disease. He was treated with stereotactic radiotherapy with concurrent temozolamide to be followed by vincristine, actinomycin-D, and cyclophosphamide (VAC) systemic therapy. PMID:21772793

  7. Primary Meningeal Rhabdomyosarcoma

    Directory of Open Access Journals (Sweden)

    Manisha Palta

    2011-01-01

    Full Text Available Primary meningeal rhabdomyosarcoma is a rare primary brain malignancy, with scant case reports. While most reports of primary intracranial rhabdomyosarcoma occur in pediatric patients, a handful of cases in adult patients have been reported in the medical literature. We report the case of a 44-year-old male who developed primary meningeal rhabdomyosarcoma. After developing episodes of right lower extremity weakness, word finding difficulty, and headaches, a brain magnetic resonance imaging (MRI demonstrated a vertex lesion with radiographic appearance of a meningeal-derived tumor. Subtotal surgical resection was performed due to sagittal sinus invasion and initial pathology was interpreted as an anaplastic meningioma. Re-review of pathology demonstrated rhabdomyosarcoma negative for alveolar translocation t(2;13. Staging studies revealed no evidence of disseminated disease. He was treated with stereotactic radiotherapy with concurrent temozolamide to be followed by vincristine, actinomycin-D, and cyclophosphamide (VAC systemic therapy.

  8. Primary meningeal rhabdomyosarcoma.

    Science.gov (United States)

    Palta, Manisha; Riedel, Richard F; Vredenburgh, James J; Cummings, Thomas J; Green, Scott; Chang, Zheng; Kirkpatrick, John P

    2011-01-01

    Primary meningeal rhabdomyosarcoma is a rare primary brain malignancy, with scant case reports. While most reports of primary intracranial rhabdomyosarcoma occur in pediatric patients, a handful of cases in adult patients have been reported in the medical literature. We report the case of a 44-year-old male who developed primary meningeal rhabdomyosarcoma. After developing episodes of right lower extremity weakness, word finding difficulty, and headaches, a brain magnetic resonance imaging (MRI) demonstrated a vertex lesion with radiographic appearance of a meningeal-derived tumor. Subtotal surgical resection was performed due to sagittal sinus invasion and initial pathology was interpreted as an anaplastic meningioma. Re-review of pathology demonstrated rhabdomyosarcoma negative for alveolar translocation t(2;13). Staging studies revealed no evidence of disseminated disease. He was treated with stereotactic radiotherapy with concurrent temozolamide to be followed by vincristine, actinomycin-D, and cyclophosphamide (VAC) systemic therapy.

  9. Hyperuricemia in Childhood Primary Hypertension

    OpenAIRE

    Feig, Daniel I.; Johnson, Richard J.

    2003-01-01

    Experimental animal models suggest that uric acid might have a pathogenic role in the early development of primary hypertension. We hypothesized that serum uric acid is correlated with blood pressure in children with new-onset, untreated, primary hypertension. We evaluated 125 consecutive children referred to the Baylor Pediatric Renal Program for evaluation of hypertension. None of the subjects had previously been evaluated or treated for hypertension. The children ranged in age from 6 to 18...

  10. Urban Mobility

    DEFF Research Database (Denmark)

    2017-01-01

    This anthology is the proceedings publication from the 2015 NAF Symposium in Malmö, Sweden. The aim of the 2015 NAF Symposium “Urban Mobility – Architectures, Geographies and Social Space” was to facilitate a cross-disciplinary discussion on urban mobility in which the juxtaposition of different...

  11. Urban Mobility

    DEFF Research Database (Denmark)

    2017-01-01

    This anthology is the proceedings publication from the 2015 NAF Symposium in Malmö, Sweden. The aim of the 2015 NAF Symposium “Urban Mobility – Architectures, Geographies and Social Space” was to facilitate a cross-disciplinary discussion on urban mobility in which the juxtaposition of different ...

  12. Urban Forests

    Science.gov (United States)

    David Nowak

    2016-01-01

    Urban forests (and trees) constitute the second forest resource considered in this report. We specifically emphasize the fact that agricultural and urban forests exist on a continuum defined by their relationship (and interrelationship) with a given landscape. These two forest types generally serve different purposes, however. Whereas agricultural forests are...

  13. Prophylactic ketoconazole shampoo for tinea capitis in a high-risk pediatric population.

    Science.gov (United States)

    Bookstaver, P Brandon; Watson, Holly J; Winters, Shauna D; Carlson, Adrian L; Schulz, Richard M

    2011-07-01

    Although topical agents for the treatment of tinea capitis decrease viable fungal elements and reduce shedding, their use as a prophylactic agent has not been investigated. This study evaluated the effectiveness of a prophylactic ketoconazole shampoo (Nizoral 2%) protocol to reduce the number of clinically evident tinea capitis infections in a high-risk African American, urban population. We conducted a retrospective analysis of a ketoconazole prophylaxis protocol that was implemented at an urban pediatric clinic for medically fragile children. Patients at high risk for tinea capitis received twice-weekly ketoconazole shampoo. The primary outcome of the study was a reduction in the number of documented tinea capitis infections between the 12-month preprotocol and 12-month postprotocol periods. A secondary outcome included the evaluation of predisposing risk factors for acquiring tinea infections. Ninety-seven patients, with a mean age of 8.06 years, were included. Most patients (78%) were African American. There were a total of 13 tinea capitis infections during the 12-month preprotocol period. During the 12-month postprotocol period, 41 infections were documented: 37 (90.2%) in the prophylaxis group and 4 (9.8%) in the nonprophylaxis group. The average numbers of per-patient infections in the postprotocol period were 0.79 and 0.08 in the prophylaxis and nonprophylaxis groups, respectively. Initiation of prophylaxis did not reduce tinea capitis infections (p=NS). Previous history of infection and a high level of care were significant predictors of infections (pshampoo) prophylaxis protocol.

  14. Children's (Pediatric) Magnetic Resonance Imaging

    Science.gov (United States)

    ... Physician Resources Professions Site Index A-Z Children’s (Pediatric) Magnetic Resonance Imaging Children’s magnetic resonance imaging (MRI) ... limitations of Children’s (Pediatric) MRI? What is Children’s (Pediatric) MRI? Magnetic resonance imaging (MRI) is a noninvasive ...

  15. Children's (Pediatric) Magnetic Resonance Imaging

    Medline Plus

    Full Text Available ... Physician Resources Professions Site Index A-Z Children’s (Pediatric) Magnetic Resonance Imaging Children’s magnetic resonance imaging (MRI) ... limitations of Children’s (Pediatric) MRI? What is Children’s (Pediatric) MRI? Magnetic resonance imaging (MRI) is a noninvasive ...

  16. Children's (Pediatric) Magnetic Resonance Imaging

    Medline Plus

    Full Text Available ... News Physician Resources Professions Site Index A-Z Children’s (Pediatric) Magnetic Resonance Imaging Children’s magnetic resonance imaging ( ... the limitations of Children’s (Pediatric) MRI? What is Children’s (Pediatric) MRI? Magnetic resonance imaging (MRI) is a ...

  17. Pediatric nuclear medicine

    Energy Technology Data Exchange (ETDEWEB)

    1986-01-01

    This symposium presented the latest techniques and approaches to the proper medical application of radionuclides in pediatrics. An expert faculty, comprised of specialists in the field of pediatric nuclear medicine, discussed the major indications as well as the advantages and potential hazards of nuclear medicine procedures compared to other diagnostic modalities. In recent years, newer radiopharmaceuticals labeled with technetium-99m and other short-lived radionuclides with relatively favorable radiation characteristics have permitted a variety of diagnostic studies that are very useful clinically and carry a substantially lower radiation burden then many comparable X-ray studies. This new battery of nuclear medicine procedures is now widely available for diagnosis and management of pediatric patients. Many recent research studies in children have yielded data concerning the effacacy of these procedures, and current recommendations will be presented by those involved in conducting such studies. Individual papers are processed separately for the Energy Data Base.

  18. Sleeping beauties in pediatrics.

    Science.gov (United States)

    Završnik, Jernej; Kokol, Peter

    2016-10-01

    Sleeping beauties (SBs) in science have been known for few decades; however, it seems that only recently have they become popular. An SB is a publication that "sleeps" for a long time and then almost suddenly awakes and becomes highly cited. SBs present interesting findings in science. Pediatrics research literature has not yet been analyzed for their presence, and 5 pediatrics SBs were discovered in this research. Their prevalence was approximately 0.011%. Some environments or periods are more "SB fertile" than others: 3 of 5 SBs were published in the journal Pediatrics, 4 originated from the United States, and 4 were published in the period from 1992 to 1993. No institutions or authors published more than 1 SB.

  19. Pediatric nuclear cardiology

    International Nuclear Information System (INIS)

    Gelfand, M.J.; Hannon, D.W.

    1987-01-01

    Nuclear cardiology methods have had less impact upon pediatric cardiology than upon adult cardiology. Most pediatric heart disease results from congenital malformations of the heart and great vessels, which is usually discovered in infancy, and is most often treated definitively in infancy or early childhood. Unfortunately, nuclear medicine techniques are limited in their spatial resolution - structures that overlie each other are separated with difficulty. As a result, nuclear cardiology is usually of limited value in the anatomic characterization of the congenital heart abnormalities. Nevertheless, it has been useful in the detection and quantification of the pathophysiologic consequences of many congenital cardiac malformations. The authors review application of nuclear medicine in pediatric cardiology, and attempt to assess each in terms of its clinical utility

  20. Pediatric nuclear medicine

    International Nuclear Information System (INIS)

    1986-01-01

    This symposium presented the latest techniques and approaches to the proper medical application of radionuclides in pediatrics. An expert faculty, comprised of specialists in the field of pediatric nuclear medicine, discussed the major indications as well as the advantages and potential hazards of nuclear medicine procedures compared to other diagnostic modalities. In recent years, newer radiopharmaceuticals labeled with technetium-99m and other short-lived radionuclides with relatively favorable radiation characteristics have permitted a variety of diagnostic studies that are very useful clinically and carry a substantially lower radiation burden then many comparable X-ray studies. This new battery of nuclear medicine procedures is now widely available for diagnosis and management of pediatric patients. Many recent research studies in children have yielded data concerning the effacacy of these procedures, and current recommendations will be presented by those involved in conducting such studies. Individual papers are processed separately for the Energy Data Base

  1. Radiology illustrated. Pediatric radiology

    Energy Technology Data Exchange (ETDEWEB)

    Kim, In-One (ed.) [Seoul National Univ. College of Medicine (Korea, Republic of). Dept. of Radiology

    2014-11-01

    Depicts characteristic imaging findings of common and uncommon diseases in the pediatric age group. Will serve as an ideal diagnostic reference in daily practice. Offers an excellent teaching aid, with numerous high-quality illustrations. This case-based atlas presents images depicting the findings typically observed when imaging a variety of common and uncommon diseases in the pediatric age group. The cases are organized according to anatomic region, covering disorders of the brain, spinal cord, head and neck, chest, cardiovascular system, gastrointestinal system, genitourinary system, and musculoskeletal system. Cases are presented in a form resembling teaching files, and the images are accompanied by concise informative text. The goal is to provide a diagnostic reference suitable for use in daily routine by both practicing radiologists and radiology residents or fellows. The atlas will also serve as a teaching aide and a study resource, and will offer pediatricians and surgeons guidance on the clinical applications of pediatric imaging.

  2. Pediatric glaucoma: current perspectives

    Directory of Open Access Journals (Sweden)

    Marchini G

    2014-05-01

    Full Text Available Giorgio Marchini, Marco Toscani, Francesca Chemello Eye Clinic, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy Abstract: “Childhood glaucoma” is a heterogeneous group of severe pediatric conditions often associated with significant visual loss and characterized by elevated intraocular pressure (IOP and optic-disk cupping. Successful IOP control is crucial but challenging and most often achieved surgically, with medical therapy playing a supportive role. There are many classifications of childhood glaucoma, but they can simply be divided into primary, in which a developmental abnormality of the anterior chamber angle only exists, and secondary, in which aqueous outflow is reduced due to independent mechanisms that secondarily impair the function of the filtration angle. The worldwide prevalence of childhood blindness ranges from 0.03% in high-income countries to 0.12% in undeveloped countries. The majority of cases do not have an identified genetic mutation and, where the mutation is known, the genes often account for only a small proportion of cases. Several pathogenetic mechanisms are known to contribute to the development of childhood glaucoma. Whatever the cause, it results in a reduced aqueous outflow at the level of the trabecular meshwork. Age of onset and magnitude of the elevated IOP largely determine the clinical manifestation the high variability of clinical manifestations. Glaucoma from any cause in a neonate and infant is characterized by the classic triad of epiphora, photophobia, and blepharospasm, and could be associated with eye enlargement (buphthalmos and Haab striae. The eye examination, usually performed under general anesthesia, includes: tonometry, anterior-segment examination, gonioscopy, corneal diameter and axial length measurement, dilated fundoscopy with optic-nerve-head evaluation. Medical therapy, considering the high frequency of side effects, is generally used as

  3. Urbane Projekter

    DEFF Research Database (Denmark)

    Andersen, Anne Juel

    2013-01-01

    of Chapter 1 ’problem and research questions’, Chapter 2 ’place, discourse and planning as a theoretical framework’ and Chapter 3 ’research design’. Part 2 ’urban practice locally, nationally and globally’ consisting of Chapter 4 ’background and context, urban trans- formations in Aalborg from 1950 to 2013...... of Chapter 9 with the same name. The analysis results and thus the conclusions are at 3 levels of knowledge: Historically specific development in terms of urban planning practices respectively in Aalborg and natio- nally/internationally The tools here have been a focus on different rationales or urban...... projects as a strategic tool in urban policy, development of place perceptions, the use of narratives in the planning processes, the functions of representations as discursive devised imagined realities, power structures and planning approaches - knowledge that can be used in the future practice of other...

  4. Urban performances

    DEFF Research Database (Denmark)

    Samson, Kristine

    2012-01-01

    Through three different urban performances, the paper investigates how, when and under which circumstances urban space is transformed and distorted from its every day use and power relations. Distortion is an annual street festival in Copenhagen with the objective to distort the functional city...... creates an intensive space for the empowerment and liberation of the body. Occupy Wall street and its action in the autumn 2001 is the ultimate example of how urban political performances intensifies and transform every day spaces. Through examples of how OWS tactically appropriates and transforms urban...... space, I seek to show how representational space, for instance the public square, is transformed and distorted by heterogeneous and unforeseen modes of operating. Despite differing in their goal and outset, I wish to unfold an alternative to urban transformation practices in planning and architecture...

  5. Serum tumor markers in pediatric osteosarcoma: a summary review

    Directory of Open Access Journals (Sweden)

    Savitskaya Yulia A

    2012-03-01

    Full Text Available Abstract Osteosarcoma is the most common primary high-grade bone tumor in both adolescents and children. Early tumor detection is key to ensuring effective treatment. Serum marker discovery and validation for pediatric osteosarcoma has accelerated in recent years, coincident with an evolving understanding of molecules and their complex interactions, and the compelling need for improved pediatric osteosarcoma outcome measures in clinical trials. This review gives a short overview of serological markers for pediatric osteosarcoma, and highlights advances in pediatric osteosarcoma-related marker research within the past year. Studies in the past year involving serum markers in patients with pediatric osteosarcoma can be assigned to one of four categories, i.e., new approaches and new markers, exploratory studies in specialized disease subsets, large cross-sectional validation studies, and longitudinal studies, with and without an intervention. Most of the studies have examined the association of a serum marker with some aspect of the natural history of pediatric osteosarcoma. As illustrated by the many studies reviewed, several serum markers are emerging that show a credible association with disease modification. The expanding pool of informative osteosarcoma-related markers is expected to impact development of therapeutics for pediatric osteosarcoma positively and, it is hoped, ultimately clinical care. Combinations of serum markers of natural immunity, thyroid hormone homeostasis, and bone tumorigenesis may be undertaken together in patients with pediatric osteosarcoma. These serum markers in combination may do better. The potential effect of an intrinsic dynamic balance of tumor angiogenesis residing within a single hormone (tri-iodothyronine is an attractive concept for regulation of vascularization in pediatric osteosarcoma.

  6. Risk in pediatric anesthesia.

    Science.gov (United States)

    Paterson, Neil; Waterhouse, Peter

    2011-08-01

    Risk in pediatric anesthesia can be conveniently classified as minor or major. Major morbidity includes cardiac arrest, brain damage and death. Minor morbidity can be assessed by clinical audits with small patient samples. Major morbidity is rare. It is best assessed by very large clinical studies and by review of closed malpractice claims. Both minor and major morbidity occur most commonly in infants and children under three, especially those with severe co-morbidities. Knowledge of risk profiles in pediatric anesthesia is a starting point for the reduction of risk. © 2010 Blackwell Publishing Ltd.

  7. Contact Dermatitis in Pediatrics.

    Science.gov (United States)

    Pelletier, Janice L; Perez, Caroline; Jacob, Sharon E

    2016-08-01

    Contact dermatitis is an umbrella term that describes the skin's reaction to contacted noxious or allergenic substances. The two main categories of contact dermatitis are irritant type and allergic type. This review discusses the signs, symptoms, causes, and complications of contact dermatitis. It addresses the testing, treatment, and prevention of contact dermatitis. Proper management of contact dermatitis includes avoidance measures for susceptible children. Implementation of a nickel directive (regulating the use of nickel in jewelry and other products that come into contact with the skin) could further reduce exposure to the most common allergens in the pediatric population. [Pediatr Ann. 2016;45(8):e287-e292.]. Copyright 2016, SLACK Incorporated.

  8. Attention for pediatric interventional radiology

    International Nuclear Information System (INIS)

    Zhu Ming; Cheng Yongde

    2005-01-01

    Radiological interventions possess wide utilization in the diagnosis and treatment for pediatric patients. Pediatric interventional radiology is an important branch of interventional radiology and also an important branch of pediatric radiology. Pediatric interventional radiology has grown substantially over the last 30 years, radiologists closely cooperation with surgeons and other physicians providing a new horizon in the management of pediatric diseases in western countries. It includes pediatric cardiac interventional radiology, pediatric neuro-interventional radiology, pediatric vascular interventional radiology, pediatric nonvascular interventional radiology, pediatric tumor interventional radiology and others. In the United States, every children hospital which owns two hundred beds has to have special trained interventional radiologists in radiologic department installing with advanced digital subtraction angiographic equipment. Interventional therapeutic procedures and diagnostic angiography have been proceeding more and more for the congenital and acquired diseases of children. The promising results give use uprising and interventional therapy as an alternative or a replacement or supplement to surgical operation. Pediatric interventional radiology is rather underdeveloped in China with a few special pediatric interventional radiologist, lack of digital subtraction angiography equipment. Pediatric radiologists have no enough field for interventional procedures such as pediatric neuro-interventional radiology and pediatric vascular interventional radiology. In the contrary adult interventional radiologists do have better interventional jobs in China and Pediatric cardiologists also share the same trend. They perform angiocardiography for congenital heart diseases and treat congenital heart disease with interventional procedures including balloon dilation of valves and vessels, coil embolization of collaterals, patent ducts and other arterial fistulae

  9. Psychological issues in pediatric obesity

    Directory of Open Access Journals (Sweden)

    Gurvinder Kalra

    2012-01-01

    Full Text Available Pediatric obesity is a major health problem and has reached epidemiological proportions today. The present paper reviews major psychological issues in pediatric obesity from a developmental perspective. Research and literature has shown that a number of developmental, family, maternal and child factors are responsible in the genesis of pediatric obesity. Family food habits, early developmental lifestyle of the child, parenting, early family relationships and harmony all contribute towards the growth and development of a child. The present review focuses on the role of developmental psychological factors in the pathogenesis of pediatric obesity and highlights the developmental factors that must be kept in mind when evaluating a case of pediatric obesity.

  10. Pediatric feeding and swallowing rehabilitation: An overview.

    Science.gov (United States)

    van den Engel-Hoek, Lenie; Harding, Celia; van Gerven, Marjo; Cockerill, Helen

    2017-05-16

    Children with neurological disabilities frequently have problems with feeding and swallowing. Such problems have a significant impact on the health and well-being of these children and their families. The primary aims in the rehabilitation of pediatric feeding and swallowing disorders are focused on supporting growth, nutrition and hydration, the development of feeding activities, and ensuring safe swallowing with the aim of preventing choking and aspiration pneumonia. Pediatric feeding and swallowing disorders can be divided into four groups: transient, developmental, chronic or progressive.This article provides an overview of the available literature about the rehabilitation of feeding and swallowing disorders in infants and children. Principles of motor control, motor learning and neuroplasticity are discussed for the four groups of children with feeding and swallowing disorders.

  11. Pediatric gastric ganglioneuroma presenting as anemia

    Directory of Open Access Journals (Sweden)

    Katrina M. Morgan

    2018-04-01

    Full Text Available Primary gastric masses are rare in childhood, and a gastric ganglioneuroma has not been reported in the pediatric population. In this report, we describe a 12-year-old female who presented with iron deficiency anemia and melena. Endoscopy was performed to elucidate the source of her symptoms, and revealed a gastric mass with overlying ulceration. Following resection and pathologic examination, the mass was diagnosed as a solitary polypoid ganglioneuroma. A solitary polypoid ganglioneuroma is an uncommon, benign tumor of neural crest cell origin. They are most often asymptomatic and found incidentally, but can present with rectal bleeding, obstruction, pain, and changes in bowel function. Complete resection is the therapy of choice to prevent progression of symptoms or rare transformation into a malignant neuroblastic tumor, like neuroblastoma. As of the patient's last post-operative appointment, she was healthy with resolution of her anemia. Keywords: Ganglioneuroma, Pediatric, Gastric mass, Anemia, Neuroblastic tumor

  12. Petrous apex lesions in the pediatric population

    Energy Technology Data Exchange (ETDEWEB)

    Radhakrishnan, Rupa [University of Cincinnati College of Medicine, Department of Radiology, Cincinnati, OH (United States); Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Son, Hwa Jung [University of Cincinnati College of Medicine, Department of Otolaryngology-Head and Neck Surgery, Cincinnati, OH (United States); Koch, Bernadette L. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States)

    2014-03-15

    A variety of abnormal imaging findings of the petrous apex are encountered in children. Many petrous apex lesions are identified incidentally while images of the brain or head and neck are being obtained for indications unrelated to the temporal bone. Differential considerations of petrous apex lesions in children include ''leave me alone'' lesions, infectious or inflammatory lesions, fibro-osseous lesions, neoplasms and neoplasm-like lesions, as well as a few rare miscellaneous conditions. Some lesions are similar to those encountered in adults, and some are unique to children. Langerhans cell histiocytosis (LCH) and primary and metastatic pediatric malignancies such as neuroblastoma, rhabomyosarcoma and Ewing sarcoma are more likely to be encountered in children. Lesions such as petrous apex cholesterol granuloma, cholesteatoma and chondrosarcoma are more common in adults and are rarely a diagnostic consideration in children. We present a comprehensive pictorial review of CT and MRI appearances of pediatric petrous apex lesions. (orig.)

  13. A atuação do nutricionista na Atenção Básica à Saúde em um grande centro urbano The participation of the nutritionist in Primary Health Care in a large urban center

    Directory of Open Access Journals (Sweden)

    Ana Maria Cervato-Mancuso

    2012-12-01

    Full Text Available O nutricionista é um profissional importante na implementação de ações de promoção, tratamento e reabilitação da saúde. Porém, sua participação na Atenção Básica (AB é reduzida. A cidade de São Paulo vem passando por um processo desigual de urbanização, produzindo novas situações de insegurança alimentar e nutricional. Este trabalho analisará a atuação do nutricionista na AB em um grande centro urbano. Trata-se de estudo de abordagem quantitativa no qual foram utilizados dados populacionais da Secretaria Municipal de Saúde e um questionário semiestruturado aplicado em entrevistas individuais. Encontraram-se 123 nutricionistas atuando na rede Básica de Saúde e 51 em Núcleos de Apoio à Saúde da Família (NASF. Todas as regiões do município apresentaram-se com menor número de nutricionistas quando comparada à recomendação do Conselho Federal de Nutricionistas. Em 57,3% dos NASF do município identificou-se a presença deste profissional. Cada nutricionista de NASF acompanha, em média, 7,1 equipes de saúde da família. As faixas etárias que correspondem à infância são as atendidas com menor frequência pelos nutricionistas das UBS e dos NASF. Comparando-se as atividades desenvolvidas, observa-se a transição de um modelo de assistência primária centrado no atendimento individual para um que prioriza o atendimento em grupo.Nutritionists are important professionals for ensuring the implementation of health promotion, treatment and rehabilitation. However, their participation in primary healthcare from a quantitative standpoint is limited. The city of São Paulo has experienced an uneven urbanization process triggering new problems of insecurity in terms of food and nutrition. This article analyzes the performance of the primary healthcare nutritionist in a large urban center. It is a quantitative study that used data from the Municipal Health Department, population data of São Paulo and a semi

  14. Urban Perspectives

    DEFF Research Database (Denmark)

    Reeh, Henrik

    2016-01-01

    . Kracauer’s essay may even provide a conceptual basis for critical studies of modern urbanity. Yet one has to establish a clear distinction between culture industry (e.g. the Tiller Girls) and urban culture. In everyday life as well as in Kracauer’s writings about it, the sphere of city culture may...... transcend capitalist Ratio and enter the domain of utopian fantasy. Far from automatically reproducing the logic of capital, the ornaments of the city provide occasions for cultural and social change. This is what Kracauer is hinting at when he makes improvisation the prime criterion of urban quality....

  15. Children's (Pediatric) Nuclear Medicine

    Medline Plus

    Full Text Available ... Test/Treatment Patient Type Screening/Wellness Disease/Condition Safety En Español More Info About Us News Physician ... such low-dose exposure. For more information about safety in pediatric radiology procedures, visit the Image Gently ...

  16. Children's (Pediatric) Nuclear Medicine

    Medline Plus

    Full Text Available Toggle navigation Test/Treatment Patient Type Screening/Wellness Disease/Condition Safety En Español More Info Images/Videos About Us News Physician Resources Professions Site Index A-Z Children's (Pediatric) Nuclear Medicine ...

  17. Pediatric acute lung injury

    NARCIS (Netherlands)

    Dahlem, P.; van Aalderen, W. M. C.; Bos, A. P.

    2007-01-01

    Among ventilated children, the incidence of acute lung injury (ALI) was 9%; of that latter group 80% developed the acute respiratory distress syndrome (ARDS). The population-based prevalence of pediatric ARDS was 5.5 cases/100.000 inhabitants. Underlying diseases in children were septic shock (34%),

  18. Pediatric brainstem oligodendroglioma

    Directory of Open Access Journals (Sweden)

    Sandeep Mohindra

    2012-01-01

    Full Text Available The authors present the first report of pediatric brainstem oligodendroglioma, infiltrating midbrain, and medulla oblongata. The report details clinical features, radiological findings, and surgical steps. As this entity is exceedingly uncommon, the overall epidemiology, prognosis, and long-term outcome remain far from established.

  19. Children's (Pediatric) Nuclear Medicine

    Medline Plus

    Full Text Available ... Pediatric) Nuclear Medicine Sponsored by Please note RadiologyInfo.org is not a medical facility. Please contact your ... links: For the convenience of our users, RadiologyInfo .org provides links to relevant websites. RadiologyInfo.org , ACR ...

  20. Children's (Pediatric) Nuclear Medicine

    Medline Plus

    Full Text Available ... exams at the same time. An emerging imaging technology, but not readily available at this time is PET/MRI. top of page What are some common uses of the procedure? Children's (pediatric) nuclear medicine imaging is performed to help ...

  1. Children's (Pediatric) Nuclear Medicine

    Medline Plus

    Full Text Available ... both imaging exams at the same time. An emerging imaging technology, but not readily available at this time is PET/MRI. top of page What are some common uses of the procedure? Children's (pediatric) nuclear medicine imaging is performed to help diagnose childhood disorders ...

  2. Pharmacotherapy of Pediatric Insomnia

    Science.gov (United States)

    Owens, Judith A.

    2009-01-01

    General guidelines for the use of medication to treat pediatric insomnia are presented. It should be noted that medication is not the first treatment choice and should be viewed within the context of a more comprehensive treatment plan. The pharmacological and clinical properties of over the counter medications and FDA-approved insomnia drugs are…

  3. Children's (Pediatric) Nuclear Medicine

    Medline Plus

    Full Text Available ... radioactive energy that is emitted from the patient's body and converts it into an image. The gamma camera itself does not emit any ... bear denotes child-specific content. Related Articles and Media General Nuclear ... (Pediatric) Nuclear Medicine Videos related ...

  4. Pediatric Low Vision

    Science.gov (United States)

    ... Asked Questions Español Condiciones Chinese Conditions Pediatric Low Vision What is Low Vision? Partial vision loss that cannot be corrected causes ... and play. What are the signs of Low Vision? Some signs of low vision include difficulty recognizing ...

  5. Annals of Pediatric Surgery

    African Journals Online (AJOL)

    The Annals of Pediatric Surgery is striving to fill an important niche that provides focus to clinical care, technical innovation and clinical research. ... Nonconventionalmesocaval prosthetic shunt interposition in refractory case with portal hypertension in a 10-kg female infant · EMAIL FREE FULL TEXT EMAIL FREE FULL ...

  6. Pediatric acquired brain injury.

    Science.gov (United States)

    Bodack, Marie I

    2010-10-01

    Although pediatric patients are sometimes included in studies about visual problems in patients with acquired brain injury (ABI), few studies deal solely with children. Unlike studies dealing with adult patients, in which mechanisms of brain injury are divided into cerebral vascular accident (CVA) and traumatic brain injury (TBI), studies on pediatric patients deal almost exclusively with traumatic brain injury, specifically caused by accidents. Here we report on the vision problems of 4 pediatric patients, ages 3 to 18 years, who were examined in the ophthalmology/optometry clinic at a children's hospital. All patients had an internally caused brain injury and after the initial insult manifested problems in at least one of the following areas: acuity, binocularity, motility (tracking or saccades), accommodation, visual fields, and visual perceptual skills. Pediatric patients can suffer from a variety of oculo-visual problems after the onset of head injury. These patients may or may not be symptomatic and can benefit from optometric intervention. Copyright © 2010 American Optometric Association. Published by Elsevier Inc. All rights reserved.

  7. Children's (Pediatric) Nuclear Medicine

    Medline Plus

    Full Text Available ... Test/Treatment Patient Type Screening/Wellness Disease/Condition Safety En Español More Info Images/Videos About Us ... such low-dose exposure. For more information about safety in pediatric radiology procedures, visit the Image Gently ...

  8. Pitfalls in pediatric radiology

    International Nuclear Information System (INIS)

    Engelkemier, Dawn R.; Taylor, George A.

    2015-01-01

    This essay depicts some of the diagnostic errors identified in a large academic pediatric imaging department during a 13-year period. Our aim is to illustrate potential situations in which errors are more likely to occur and more likely to cause harm, and to share our difficult cases so other radiologists might learn without having to experience those situations themselves. (orig.)

  9. Pediatric heart surgery

    Science.gov (United States)

    Heart surgery - pediatric; Heart surgery for children; Acquired heart disease; Heart valve surgery - children ... There are many kinds of heart defects. Some are minor, and others are more serious. Defects can occur inside the heart or in the large blood vessels ...

  10. American Academy of Pediatrics

    Science.gov (United States)

    ... this site from a secured browser on the server. Please enable scripts and reload this page. Early Career Pediatric Trainees Medical Students International HealthyChildren.org Become a Member Sign In Professional Resources Practice Transformation Economics of Healthcare Managing Your ...

  11. Pediatric liver transplantation in 31 consecutive children

    Institute of Scientific and Technical Information of China (English)

    SHEN Zhong-yang; WANG Zi-fa; ZHU Zhi-jun; ZANG Yun-jin; ZHENG Hong; DENG Yong-lin; PAN Cheng; CHEN Xin-guo

    2008-01-01

    Background Although liver transplantation has become a standard therapy for end-stage liver diseases, the experience of pediatric liver transplantation is limited in China. In this article we report our experience in pediatric liver transplantation, and summarize its characters in their indications, surgical techniques, and postoperative managements. Methods Thirty-one children (≤18 years old) underwent liver transplantation in our centers. The mean age at transplantation was 12.4 years old (ranged from 5 months to 18 years) with 7 children being less than 4 years of age at transplantation. The most common diagnosis of patients who underwent liver transplantation were biliary atresia, Wilson's disease, primary biliary cirrhosis, glycogen storage disease, hepatoblastoma, urea cycle defects, fulminant hepatic failure, etc. The surgical procedures included 12 standard (without venovenous bypass), 6 pigyback, 6 reduced-size, 3 split, 3 living donor liver transplantation, and 1 Domino liver transplantation. The triple-drug (FK506, steroid, and mycophenolate mofetil) immunosuppressive regimen was used in most of patients. Patients were followed up for a mean of 21.8 months. Results Five of the 31 patients died during perioperative time; mortality rate was 16.1%. The reasons of death were infections, primary non-function, heart failure, and hypovolemic shock. Postoperative complications in 10 patients included biliary leakage, acute rejection, abdominal infection, hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, and pulmonary infection. Overall patient cumulative survival rate at 1-, 3-, and 5-year was 78.1%, 62.6%, 62.6%, respectively.Conclusions The most common indications of pediatric liver transplantation were congenital end-stage liver diseases. According to patients' age and body weight, standard, piggyback, reduced-size, split, or living donor liver transplantation should be performed. Pediatric liver transplantation especially requires higher

  12. Interventional radiology in pediatric oncology

    International Nuclear Information System (INIS)

    Hoffer, Fredric A.

    2005-01-01

    There are many radiological interventions necessary for pediatric oncology patients, some of which may be covered in other articles in this publication. I will discuss a number of interventions including percutaneous biopsy for solid tumor and hematological malignancy diagnosis or recurrence, for the diagnosis of graft versus host disease after stem cell or bone marrow transplantation, and for the diagnosis of complications of immunosuppression such as invasive pulmonary aspergillosis. In the past, tumor localization techniques have been necessary to biopsy or resect small lesions. However improved guidance techniques have allowed for more precise biopsy and the use of thermal ablation instead of excision for local tumor control. A percutaneously placed radio frequency, microwave, laser or cryogen probe can ablate the primary and metastatic tumors of the liver, lung, bone, kidney and other structures in children. This is an alternative treatment for the local control of tumors that may not be amenable to surgery, chemotherapy or radiotherapy. I will also describe how chemoembolization can be used to treat primary or metastatic tumors of the liver that have failed other therapies. This treatment delivers chemotherapy in the hepatic artery infused with emboli to increase the dwell time and concentration of the agents

  13. Urban Modality

    Directory of Open Access Journals (Sweden)

    Jorge Gil

    2016-02-01

    Full Text Available This thesis proposes a framework for evaluating the mobility potential and performance of urban areas in the city region, as an instrument to support urban development that contributes positively to regional sustainable mobility objectives. The research takes a quantitative approach, modelling and measuring the characteristics of a city-region and of its individual urban areas, in terms of travel patterns and socioeconomic characteristics of the resident population, and in terms of built environment characteristics. It then explores how the built environment defines the affordances of urban areas for travelling by particular modes of transport, i.e. its walk-ability, cycleability, drive-ability and transit-ability, by developing a typology of what I call their ‘urban modality’. And finally the work combines this typology with the socio-economic characteristics of urban areas to determine their sustainable mobility potential and performance. It focuses on the case of the Randstad region of the Netherlands and its VINEX neighbourhoods, which are an emblematic example of new urban areas created under a policy programme with sustainable mobility objectives. A key stance in this work is the understanding that the location of an urban area in the region can be indicative of its population’s travel patterns, because the built environment (infrastructural and socio-economic characteristics are interrelated and present strong regional spatial patterns. What types of urban areas support sustainable travel patterns, and what are their spatial characteristics? How do new neighbourhoods compare to the best performing urban areas, and to other areas of the same ‘modality’ type? These are some of the questions addressed in this study. There are two main contributions of this research: the methods for building and analysing integrated multimodal network models, and the framework for contextual performance evaluation using urban area typologies. The

  14. Informational Urbanism

    Directory of Open Access Journals (Sweden)

    Wolfgang G. Stock

    2015-10-01

    Full Text Available Contemporary and future cities are often labeled as "smart cities," "ubiquitous cities," "knowledge cities" and "creative cities." Informational urbanism includes all aspects of information and knowledge with regard to urban regions. "Informational city" is an umbrella term uniting the divergent trends of information-related city research. Informational urbanism is an interdisciplinary endeavor incorporating on the one side computer science and information science and on the other side urbanism, architecture, (city economics, and (city sociology. In our research project on informational cities, we visited more than 40 metropolises and smaller towns all over the world. In this paper, we sketch the theoretical background on a journey from Max Weber to the Internet of Things, introduce our research methods, and describe main results on characteristics of informational cities as prototypical cities of the emerging knowledge society.

  15. Urban hydrology

    Science.gov (United States)

    The Third International Conference on Urban Storm Drainage will be held in Goteborg, Sweden, June 4-8, 1984. Contact A. Sjoborg, Chalmers Univ. of Technology, Goteborg, Sweden, for more information. The Fourth Conference will be in late August 1987 in Lausanne, Switzerland, and the Fifth Conference is planned for Tokyo in 1990. The proceedings of the First International Conference, held in Southampton, England, in April 1978, are available from Wiley-Interscience under the title “Urban Storm Drainage.”The proceedings of the Second International Conference, held in Urbana, Illinois, in June 1981, are available from Water Resources Publications, Littleton, Colo., under the title, “Urban Stormwater Hydraulics and Hydrology” and “Urban Stormwater Quality, Management, and Planning.”

  16. Urban interventions

    DEFF Research Database (Denmark)

    Pinder, David

    2008-01-01

    Challenging perspectives on the urban question have arisen in recent years from beyond academic realms through the work of artists and cultural practitioners. Often in dialogue with urban theory and political activism, and employing a range of tactical practices, they have engaged critically......, relationships and situations. Such interventionist practices may rarely be seen as part of the traditional purview of urban studies. Yet in asserting their significance here, this essay argues that growing dialogues across and between urban and spatial theory, and artistic and cultural practice, have...... considerable potential for inspiring and developing critical approaches to cities. The essay highlights a number of specific challenges thrown up by such interconnections that are of political and pedagogical significance and in need of further debate....

  17. Urban Mining

    DEFF Research Database (Denmark)

    2015-01-01

    The catalogue is one of the results of a small taught course at teh Aarhus School of Architecture. The course was offered to bachelor students and was specific focused on harvesting materials in an urban context and on building with waste.......The catalogue is one of the results of a small taught course at teh Aarhus School of Architecture. The course was offered to bachelor students and was specific focused on harvesting materials in an urban context and on building with waste....

  18. Clinical outcomes of seasonal influenza and pandemic influenza A (H1N1 in pediatric inpatients

    Directory of Open Access Journals (Sweden)

    Budd Alicia

    2010-10-01

    Full Text Available Abstract Background In April 2009, a novel influenza A H1N1 (nH1N1 virus emerged and spread rapidly worldwide. News of the pandemic led to a heightened awareness of the consequences of influenza and generally resulted in enhanced infection control practices and strengthened vaccination efforts for both healthcare workers and the general population. Seasonal influenza (SI illness in the pediatric population has been previously shown to result in significant morbidity, mortality, and substantial hospital resource utilization. Although influenza pandemics have the possibility of resulting in considerable illness, we must not ignore the impact that we can experience annually with SI. Methods We compared the outcomes of pediatric patients ≤18 years of age at a large urban hospital with laboratory confirmed influenza and an influenza-like illness (ILI during the 2009 pandemic and two prior influenza seasons. The primary outcome measure was hospital length of stay (LOS. All variables potentially associated with LOS based on univariable analysis, previous studies, or hypothesized relationships were included in the regression models to ensure adjustment for their effects. Results There were 133 pediatric cases of nH1N1 admitted during 2009 and 133 cases of SI admitted during the prior 2 influenza seasons (2007-8 and 2008-9. Thirty-six percent of children with SI and 18% of children with nH1N1 had no preexisting medical conditions (p = 0.14. Children admitted with SI had 1.73 times longer adjusted LOS than children admitted for nH1N1 (95% CI 1.35 - 2.13. There was a trend towards more children with SI requiring mechanical ventilation compared with nH1N1 (16 vs.7, p = 0.08. Conclusions This study strengthens the growing body of evidence demonstrating that SI results in significant morbidity in the pediatric population. Pandemic H1N1 received considerable attention with strong media messages urging people to undergo vaccination and encouraging improved

  19. Survey of the professors of child neurology: neurology versus pediatrics home for child neurology.

    Science.gov (United States)

    Pearl, Phillip L; McConnell, Emily R; Fernandez, Rosamary; Brooks-Kayal, Amy

    2014-09-01

    The optimal academic home for child neurology programs between adult neurology versus pediatric departments remains an open question. The Professors of Child Neurology, the national organization of child neurology department chairs, division chiefs, and training program directors, was surveyed to evaluate the placement of child neurology programs. Professors of Child Neurology members were surveyed regarding the placement of child neurology programs within adult neurology versus pediatric departments. Questions explored academic versus clinical lines of reporting and factors that may be advantages and disadvantages of these affiliations. Issues also addressed were the current status of board certification and number of clinics expected in academic child neurology departments. Of 120 surveys sent, 95 responses were received (79% response rate). The primary academic affiliation is in neurology in 54% of programs versus 46% in pediatrics, and the primary clinical affiliation is 45% neurology and 55% pediatrics. Advantages versus disadvantages of one's primary affiliation were similar whether the primary affiliation was in neurology or pediatrics. While 61% of respondents are presently board certified in pediatrics, only 2% of those with time-limited certification in general pediatrics plan to be recertified going forward. Typically six to eight half-day clinics per week are anticipated for child neurologists in academic departments without additional funding sources. Overall, leaders of child neurology departments and training programs would not change their affiliation if given the opportunity. Advantages and disadvantages associated with current affiliations did not change whether child neurology was located in neurology or pediatrics. Board certification by the American Board of Psychiatry and Neurology in child neurology is virtually universal, whereas pediatric board certification by the American Board of Pediatrics is being maintained by very few. Most academic

  20. [Spanish Society of Pediatric Infectious Diseases, Spanish Society of Paediatric Clinical Immunology and Allergy, Spanish Association of Paediatric Primary Care, and the Spanish Society of Extra-hospital Paediatrics and Primary Health Care consensus document on antibiotic treatment in penicillin or amoxicillin allergy].

    Science.gov (United States)

    Baquero-Artigao, Fernando; Michavila, Antonio; Suárez-Rodriguez, Ángeles; Hernandez, Anselmo; Martínez-Campos, Leticia; Calvo, Cristina

    2017-02-01

    The suspected allergy to beta-lactam antibiotics, especially penicillin and amoxicillin, is the most frequent reason for consultation in Child Allergy Units. In this consensus document, the clinical and diagnostic criteria of allergic reactions are described, as well as alternative antibiotic treatment for the most common infections diagnosed in paediatrics for patients with known or suspected allergy. Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. Considerations for the long term treatment of pediatric sarcoma survivors

    Directory of Open Access Journals (Sweden)

    Kurt R Weiss

    2018-01-01

    Full Text Available Sarcomas are primary malignancies of the connective tissues. They are exceedingly rare in adults, but much more common in children. The historically recent advent of cytotoxic chemotherapy for pediatric sarcomas has revolutionized the treatment of these diseases and dramatically improved their prognoses. There is thus a population of pediatric sarcoma survivors that are “coming of age” as adults. However, this progress is not without consequences. Due to aggressive treatment protocols that include various combinations of surgery, chemotherapy, and radiation therapy, pediatric sarcoma survivors are at risk of myriad physical, medical, and psychological difficulties as they enter adulthood. These include but are not limited to physical disabilities, chemotherapy-induced cardiac issues, second malignancies, and anxiety. These patients pose unique challenges to their adult primary care physicians. One possible solution to these challenges is multidisciplinary sarcoma survivorship clinics. By paying greater attention to the unique issues of pediatric sarcoma survivors, involved physicians can maximize the physical and emotional health of pediatric sarcoma survivors.

  2. Pediatric asthma and ambient pollutant levels in industrializing nations.

    Science.gov (United States)

    Jassal, Mandeep S

    2015-01-01

    Asthma is one of the most common chronic diseases in childhood and its prevalence has been increasing within industrializing nations. The contribution of ambient pollutants to asthma symptomatology has been explored in some countries through epidemiological investigations, molecular analysis and monitoring functional outcomes. The health effects of rising environmental pollution have been of increasing concern in industrializing nations with rising urbanization patterns. This review article provides an overview of the link between pediatric asthma and exposure to rising sources of urban air pollution. It primarily focuses on the asthma-specific effects of sulfur dioxide, nitrogen dioxide, ozone and particulate matter. Worldwide trends of asthma prevalence are also provided which detail the prominent rise in asthma symptoms in many urban areas of Africa, Latin America and Asia. The molecular and functional correlation of ambient pollutants with asthma-specific airway inflammation in the pediatric population are also highlighted. The final aspect of the review considers the correlation of motor vehicle, industrial and cooking energy sources, ascribed as the major emitters among the pollutants in urban settings, with asthma epidemiology in children. © The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  3. Improving the urban environment.

    Science.gov (United States)

    Rotibi, A

    1992-11-01

    An effective environmental sanitation program should encompass key features considered necessary for a primary health care (PHC) program such as availability, accessibility, affordability, acceptability, and practicability. Poor housing conditions give rise to stress, delinquency, and crime, as well as to helminthic and other parasitic infestations. In Africa, urbanization has accelerated since the 1950s because of rural-urban migration. In Nigeria new housing construction has been poor, with inadequate provision of physical facilities and community services in residential areas. Overcrowding is rampant, with occupancy rates of 2-3 persons per room recorded for many cities including Owerri, Abba, Warri and Ontisha. In a survey of rooming-house facilities in Lagos, the average was 5-7 persons per room. 47% of households were living in just one rooms in Sokoto and 80% in the Lagos metropolitan area. An urban household survey by the Federal Office of Statistics found that 45% of households were without electricity. Similarly, 46% of households were found to be without running water, 29% obtained their water from wells, and 14% from streams. The inadequate provision of toilets poses major health risks. Many Nigerian cities lack efficient waste disposal systems: in Ibadan mounds of uncollected rubbish obstruct the roads. According to a Statistics Office survey 48% of refuse is estimated to be dumped illegally, while 23% is simply heaped in family compounds. A recently launched campaign on environmental sanitation is the start of improving the health of urban dwellers which could cut expenditure on curative health measures.

  4. Pediatric digital chest imaging.

    Science.gov (United States)

    Tarver, R D; Cohen, M; Broderick, N J; Conces, D J

    1990-01-01

    The Philips Computed Radiography system performs well with pediatric portable chest radiographs, handling the throughout of a busy intensive care service 24 hours a day. Images are excellent and routinely provide a conventional (unenhanced) image and an edge-enhanced image. Radiation dose is decreased by the lowered frequency of repeat examinations and the ability of the plates to respond to a much lower dose and still provide an adequate image. The high quality and uniform density of serial PCR portable radiographs greatly enhances diagnostic content of the films. Decreased resolution has not been a problem clinically. Image manipulation and electronic transfer to remote viewing stations appear to be helpful and are currently being evaluated further. The PCR system provides a marked improvement in pediatric portable chest radiology.

  5. Pediatric digital chest imaging

    International Nuclear Information System (INIS)

    Tarver, R.D.; Cohen, M.; Broderick, N.J.; Conces, D.J. Jr.

    1990-01-01

    The Philips Computed Radiography system performs well with pediatric portable chest radiographs, handling the throughout of a busy intensive care service 24 hours a day. Images are excellent and routinely provide a conventional (unenhanced) image and an edge-enhanced image. Radiation dose is decreased by the lowered frequency of repeat examinations and the ability of the plates to respond to a much lower dose and still provide an adequate image. The high quality and uniform density of serial PCR portable radiographs greatly enhances diagnostic content of the films. Decreased resolution has not been a problem clinically. Image manipulation and electronic transfer to remote viewing stations appear to be helpful and are currently being evaluated further. The PCR system provides a marked improvement in pediatric portable chest radiology

  6. Hippocrates on Pediatric Dermatology.

    Science.gov (United States)

    Sgantzos, Markos; Tsoucalas, Gregory; Karamanou, Marianna; Giatsiou, Styliani; Tsoukalas, Ioannis; Androutsos, George

    2015-01-01

    Hippocrates of Kos is well known in medicine, but his contributions to pediatric dermatology have not previously been examined. A systematic study of Corpus Hippocraticum was undertaken to document references of clinical and historical importance of pediatric dermatology. In Corpus Hippocraticum, a variety of skin diseases are described, along with proposed treatments. Hippocrates rejected the theory of the punishment of the Greek gods and supported the concept that dermatologic diseases resulted from a loss of balance in the body humors. Many of the terms that Hippocrates and his pupils used are still being used today. Moreover, he probably provided one of the first descriptions of skin findings in smallpox, Henoch-Schönlein purpura (also known as anaphylactoid purpura, purpura rheumatica, allergic purpura), and meningococcal septicemia. © 2015 Wiley Periodicals, Inc.

  7. Telemedicine: Pediatric Applications

    Science.gov (United States)

    Burke, Bryan L.; Hall, R. W.

    2017-01-01

    Telemedicine is a technological tool that is improving the health of children around the world. This report chronicles the use of telemedicine by pediatricians and pediatric medical and surgical specialists to deliver inpatient and outpatient care, educate physicians and patients, and conduct medical research. It also describes the importance of telemedicine in responding to emergencies and disasters and providing access to pediatric care to remote and underserved populations. Barriers to telemedicine expansion are explained, such as legal issues, inadequate payment for services, technology costs and sustainability, and the lack of technology infrastructure on a national scale. Although certain challenges have constrained more widespread implementation, telemedicine’s current use bears testimony to its effectiveness and potential. Telemedicine’s widespread adoption will be influenced by the implementation of key provisions of the Patient Protection and Affordable Care Act, technological advances, and growing patient demand for virtual visits. PMID:26122813

  8. Pediatric allergy and immunology in Brazil.

    Science.gov (United States)

    Rosario-Filho, Nelson A; Jacob, Cristina M; Sole, Dirceu; Condino-Neto, Antonio; Arruda, Luisa K; Costa-Carvalho, Beatriz; Cocco, Renata R; Camelo-Nunes, Inês; Chong-Neto, Herberto J; Wandalsen, Gustavo F; Castro, Ana P M; Yang, Ariana C; Pastorino, Antonio C; Sarinho, Emanuel S

    2013-06-01

    The subspecialty of pediatric allergy and immunology in Brazil is in its early years and progressing steadily. This review highlights the research developed in the past years aiming to show the characteristics of allergic and immunologic diseases in this vast country. Epidemiologic studies demonstrated the high prevalence of asthma in infants, children, and adolescents. Mortality rates and average annual variation of asthma hospitalization have reduced in all pediatric age groups. Indoor aeroallergen exposure is excessively high and contributes to the high rates of allergy sensitization. Prevalence of food allergy has increased to epidemic levels. Foods (35%), insect stings (30%), and drugs (23%) are the main etiological agents of anaphylaxis in children and adolescents. Molecular diagnosis of primary immunodeficiencies (PID) showed a high incidence of fungal infections including paracoccidioidomycosis in X-linked hyper-IgM syndrome, and the occurrence of BCG adverse reactions or other mycobacterial infections in patients with chronic granulomatous disease. Education in pediatric allergy and immunology is deficient for medical students, but residency programs are effective in training internists and pediatricians for the practice of allergy. The field of PID requires further training. Last, this review is a tribute to Prof. Dr. Charles Naspitz, one of the pioneers of our specialty in Brazil. © 2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.

  9. Pediatric brain tumors

    Energy Technology Data Exchange (ETDEWEB)

    Poussaint, Tina Y. [Department of Radiology, Boston, MA (United States); Panigrahy, Ashok [Children' s Hospital of Pittsburgh of University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA (United States); Huisman, Thierry A.G.M. [Charlotte R. Bloomberg Children' s Center, Johns Hopkins Hospital, Division of Pediatric Radiology and Pediatric Neuroradiology, Baltimore, MD (United States)

    2015-09-15

    Among all causes of death in children from solid tumors, pediatric brain tumors are the most common. This article includes an overview of a subset of infratentorial and supratentorial tumors with a focus on tumor imaging features and molecular advances and treatments of these tumors. Key to understanding the imaging features of brain tumors is a firm grasp of other disease processes that can mimic tumor on imaging. We also review imaging features of a common subset of tumor mimics. (orig.)

  10. ANALGESICS ANTIPYRETICS IN PEDIATRICS

    Directory of Open Access Journals (Sweden)

    O.V. Zaitseva

    2008-01-01

    Full Text Available The article considers one of the most critical issues in the pediatrics: the problem of children's hyperthermia. The article features the fever pathogenesis and 'points of application' for antipyretics, the data on efficiency and side effects of this group of medications, as well as indications to reduce heightened body temperature of children. The author demonstrates her own experience: an application of an antipyretic — ibuprofen.Key words: fever, antipyretics, medications of choice, medical indications, children.

  11. Pediatric esophagopleural fistula

    OpenAIRE

    Cui, Yun; Ren, Yuqian; Shan, Yijun; Chen, Rongxin; Wang, Fei; Zhu, Yan; Zhang, Yucai

    2017-01-01

    Abstract Esophagopleural fistula (EPF) is rarely reported in children with a high misdiagnosis rate. This study aimed to reveal the clinical manifestations and managements of EPF in children. Two pediatric cases of EPF in our hospital were reported. A bibliographic search was performed on the PubMed, WANFANG, and CNKI databases for EPF-related reports published between January 1980 and May 2016. The pathogeny, clinical manifestations, diagnosis, treatments, and prognosis of EPF patients were ...

  12. Internationalization of pediatric sleep apnea research.

    Science.gov (United States)

    Milkov, Mario

    2012-02-01

    Recently, the socio-medical importance of obstructive sleep apnea in infancy and childhood increases worldwide. The present investigation aims at analyzing the dynamic science internationalization in this narrow field as reflected in three data-bases and at outlining the most significant scientists, institutions and primary information sources. A scientometric study of data from a retrospective problem-oriented search on pediatric sleep apnea in three data-bases such as Web of Science, MEDLINE and Scopus was carried out. A set of parameters of publication output and citations was followed-up. Several scientometric distributions were created and enabled the identification of some essential peculiarities of the international scientific communications. There was a steady world publication output increase. In 1972-2010, 4192 publications from 874 journals were abstracted in MEDLINE. In 1985-2010, more than 8100 authors from 64 countries published 3213 papers in 626 journals and 256 conference proceedings abstracted in Web of Science. In 1973-2010, 152 authors published 687 papers in 144 journals in 19 languages abstracted in Scopus. USA authors dominated followed by those from Australia and Canada. Sleep, Int. J. Pediatr. Otorhinolaryngol., Pediatr. Pulmonol. and Pediatrics belonged to 'core' journals concerning Web of Science and MEDLINE while Arch. Dis. Childh. and Eur. Respir. J. dominated in Scopus. Nine journals being currently published in 5 countries contained the terms of 'sleep' or 'sleeping' in their titles. David Gozal, Carole L. Marcus and Christian Guilleminault presented with most publications and citations to them. W.H. Dietz' paper published in Pediatrics in 1998 received 764 citations. Eighty-four authors from 11 countries participated in 16 scientific events held in 12 countries which were immediately devoted to sleep research. Their 13 articles were cited 170 times in Web of Science. Authors from the University of Louisville, Stanford University, and

  13. What Is a Pediatric Allergist / Immunologist?

    Science.gov (United States)

    ... Text Size Email Print Share What is a Pediatric Allergist/Immunologist? Page Content Article Body If your ... immune system problems. What Kind of Training Do Pediatric Allergists/Immunologists Have? Pediatric allergists/immunologists are medical ...

  14. What Is a Pediatric Infectious Diseases Specialist?

    Science.gov (United States)

    ... Text Size Email Print Share What is a Pediatric Infectious Diseases Specialist? Page Content Article Body If ... the teen years. What Kind of Training Do Pediatric Infectious Diseases Specialists Have? Pediatric infectious diseases specialists ...

  15. What Is a Pediatric Heart Surgeon?

    Science.gov (United States)

    ... Text Size Email Print Share What is a Pediatric Heart Surgeon? Page Content Article Body If your ... require heart surgery. What Kind of Training Do Pediatric Heart Surgeons Have? Pediatric heart surgeons are medical ...

  16. What Is a Pediatric Critical Care Specialist?

    Science.gov (United States)

    ... Text Size Email Print Share What is a Pediatric Critical Care Specialist? Page Content Article Body If ... in the PICU. What Kind of Training Do Pediatric Critical Care Specialists Have? Pediatric critical care specialists ...

  17. Primary care physician perceptions of the nurse practitioner in the 1990s.

    Science.gov (United States)

    Aquilino, M L; Damiano, P C; Willard, J C; Momany, E T; Levy, B T

    1999-01-01

    To evaluate factors associated with primary care physician attitudes toward nurse practitioners (NPs) providing primary care. A mailed survey of primary care physicians in Iowa. Half (N = 616) of the non-institutional-based, full-time, primary care physicians in Iowa in spring 1994. Although 360 (58.4%) responded, only physicians with complete data on all items in the model were used in these analyses (n = 259 [42.0%]). There were 2 principal dependent measures: physician attitudes toward NPs providing primary care (an 11-item instrument) and physician experience with NPs in this role. Bivariate relationships between physician demographic and practice characteristics were evaluated by chi 2 tests, as were both dependent variables. Ordinary least-squares regression was used to determine factors related to physician attitudes toward NPs. In bivariate analyses, physicians were significantly more likely to have had experience with an NP providing primary care if they were in pediatrics or obstetrics-gynecology (78.3% and 70.0%, respectively; P < .001), had been in practice for fewer than 20 years (P = .045), or were in practices with 5 or more physicians. The ordinary least-squares regression indicated that physicians with previous experience working with NPs providing primary care (P = .01), physicians practicing in urban areas with populations greater than 20,000 but far from a metropolitan area (P = .03), and general practice physicians (P = .04) had significantly more favorable attitudes toward NPs than did other primary care physicians. The association between previous experience with a primary care NP and a more positive attitude toward NPs has important implications for the training of primary care physicians, particularly in community-based, multidisciplinary settings.

  18. Pediatric Acute Kidney Injury.

    Science.gov (United States)

    Fragasso, Tiziana; Ricci, Zaccaria; Goldstein, Stuart L

    2018-01-01

    Acute kidney injury (AKI) in children is a serious condition with an important impact on morbidity and mortality. Onset can be insidious and it is frequently unrecognized in the early phase when the therapeutic opportunities are theoretically more effective. The present review focuses on the most recent epidemiology studies and the progress in pediatric AKI (pAKI) research. Standardization of definition (presented in the Kidney Disease: Improving Global Outcomes) and novel biomarkers have been developed to help clinicians recognize kidney injury in a timely manner, both in adult and pediatric populations. Strengths and weaknesses of these diagnostic tools are discussed and the clinical scoring system (Renal Angina Index), which aims to provide a rational context for biomarker utilization, is also presented. Even if effective treatments are not currently available for established AKI, specific preventive approaches and some promising pharmacological treatments will be detailed. Renal replacement therapy is currently considered the most effective way to manage fluid balance when severe AKI occurs. Key Messages: Great efforts in pAKI research have today led to new strategies for early AKI detection and prevention strategies. Further studies have to be conducted in the next future in order to definitely improve the outcomes of pediatric patients experiencing this deadly syndrome. © 2018 S. Karger AG, Basel.

  19. Obesity in pediatric trauma.

    Science.gov (United States)

    Witt, Cordelie E; Arbabi, Saman; Nathens, Avery B; Vavilala, Monica S; Rivara, Frederick P

    2017-04-01

    The implications of childhood obesity on pediatric trauma outcomes are not clearly established. Anthropomorphic data were recently added to the National Trauma Data Bank (NTDB) Research Datasets, enabling a large, multicenter evaluation of the effect of obesity on pediatric trauma patients. Children ages 2 to 19years who required hospitalization for traumatic injury were identified in the 2013-2014 NTDB Research Datasets. Age and gender-specific body mass indices (BMI) were calculated. Outcomes included injury patterns, operative procedures, complications, and hospital utilization parameters. Data from 149,817 pediatric patients were analyzed; higher BMI percentiles were associated with significantly more extremity injuries, and fewer injuries to the head, abdomen, thorax and spine (p values Obese children also had significantly longer lengths of stay and more frequent ventilator requirement. Among children admitted after trauma, increased BMI percentile is associated with increased risk of death and potentially preventable complications. These findings suggest that obese children may require different management than nonobese counterparts to prevent complications. Level III; prognosis study. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Pediatric liver tumors - a pictorial review

    International Nuclear Information System (INIS)

    Jha, Priyanka; Tavri, Sidhartha; Patel, Chirag; Gooding, Charles; Daldrup-Link, Heike; Chawla, Soni C.

    2009-01-01

    Hepatic masses constitute about 5-6% of all intra-abdominal masses in children. The majority of liver tumors in children are malignant; these malignant liver tumors constitute the third most common intra-abdominal malignancy in the pediatric age group after Wilms' tumor and neuroblastoma. Only about one third of the liver tumors are benign. A differential diagnosis of liver tumors in children can be obtained based on the age of the child, clinical information (in particular AFP) and imaging characteristics. The purpose of this review is to report typical clinical and imaging characteristics of benign and malignant primary liver tumors in children. (orig.)

  1. Magnetic resonance imaging of the pediatric airway

    International Nuclear Information System (INIS)

    Auringer, S.T.; Bisset, G.S. III; Myer, C.M.

    1991-01-01

    Evaluation of the pediatric airway is often complex and may require multiple imaging techniques and invasive procedures. We performed magnetic resonance (MR) imaging of the airway in 34 children with clinical evidence of chronic airway obstruction and compared MR findings with those obtained by surgery and/or endoscopy. MR diagnoses included vascular compression in 15 patients, primary tracheomalacic states in 12 patients, and mediastinal masses in 4 patients. Findings were normal for 3 patients. The MR findings were in agreement with the endoscopic findings in 25 to 28 cases and in agreement with the surgical findings in 21 to 21 cases. (orig./GDG)

  2. Urban atmospheres.

    Science.gov (United States)

    Gandy, Matthew

    2017-07-01

    What is an urban atmosphere? How can we differentiate an 'atmosphere' from other facets of urban consciousness and experience? This essay explores some of the wider cultural, political, and philosophical connotations of atmospheres as a focal point for critical reflections on space and subjectivity. The idea of an 'affective atmosphere' as a distinctive kind of mood or shared corporeal phenomenon is considered in relation to recent developments in phenomenology, extended conceptions of agency, and new understandings of materialism. The essay draws in particular on the changing characteristics of air and light to reflect on different forms of sensory experience and their wider cultural and political connotations. The argument highlights some of the tensions and anomalies that permeate contemporary understandings of urban atmospheres.

  3. Urbane spil

    DEFF Research Database (Denmark)

    Løssing, Tobias

    2006-01-01

    PhD afhandling: 1: Urbane spil 2: [brand TILST] - den nye forstad. 3: 6400:Kollision - udstilling på Sønderborg Slot 2001 4: 4: [0.2:Kollision] - Charlottenborgs Forårsudstilling 2002 5: Havnen på spil - debatten om de bynære havnearealer i Århus 2002-2004 Manual - uddybet guide til PhD-projektet......PhD afhandling: 1: Urbane spil 2: [brand TILST] - den nye forstad. 3: 6400:Kollision - udstilling på Sønderborg Slot 2001 4: 4: [0.2:Kollision] - Charlottenborgs Forårsudstilling 2002 5: Havnen på spil - debatten om de bynære havnearealer i Århus 2002-2004 Manual - uddybet guide til Ph......D-projektet Urbane spil Se også www.urbanespil.dk...

  4. Children's (Pediatric) Abdominal Ultrasound Imaging

    Medline Plus

    Full Text Available ... through blood vessels. Ultrasound imaging is a noninvasive medical test that helps physicians diagnose and treat medical conditions. Children's (pediatric) abdominal ultrasound imaging produces pictures ...

  5. Pediatric Melanoma and Drug Development

    Directory of Open Access Journals (Sweden)

    Klaus Rose

    2018-03-01

    Full Text Available Importance—Pediatric melanoma occurs, albeit rarely. Should patients be treated by today’s medical standards, or be subjected to medically unnecessary clinical studies? Observations—We identified international, industry-sponsored pediatric melanoma studies triggered by regulatory demands in www.clinicaltrials.gov and further pediatric melanoma studies demanded by European Union pediatric investigation plans. We retrieved related regulatory documents from the internet. We analyzed these studies for rationale and medical beneficence on the basis of physiology, pediatric clinical pharmacology and rationale. Regulatory authorities define children by chronological age, not physiologically. Newborns’ organs are immature but they develop and mature rapidly. Separate proof of efficacy in underage patients is justified formally/regulatorily but lacks medical sense. Children—especially post-puberty—and adults vis-a-vis medications are physiologically very similar. Two adolescent melanoma studies were terminated in 2016 because of waning recruitment, while five studies in pediatric melanoma and other solid tumors, triggered by European Union pediatric investigation plans, continue recruiting worldwide. Conclusions and Relevance—Regulatory-demanded pediatric melanoma studies are medically superfluous. Melanoma patients of all ages should be treated with effective combination treatment. Babies need special attention. Children need dose-finding and pharmacokinetic studies but adolescents metabolize and respond to drugs similarly to adults. Institutional Review Boards/ethics committees should suspend ongoing questionable pediatric melanoma studies and reject newly submitted questionable studies.

  6. Pediatric imaging. Rapid fire questions and answers

    International Nuclear Information System (INIS)

    Quattromani, F.; Lampe, R.

    2008-01-01

    The book contains the following contributions: Airway, head, neck; allergy, immunology rheumatology; pediatric cardiac imaging; child abuse; chromosomal abnormalities; conscious sedation; contrast agents and radiation protection; pediatric gastrointestinal imaging; genetic disorders in infants and children; pediatric genitourinary imaging; pediatric hematology, oncology imaging; pediatric intenrventional radiology; metabolic and vitamin disorders; muscoskeletal disorders (osteoradiology); neonatology imaging; pediatric neuroimaging; imaging of the respiratory tract in infants and children; vascular anomalies

  7. Pediatric imaging. Rapid fire questions and answers

    Energy Technology Data Exchange (ETDEWEB)

    Quattromani, F.; Lampe, R. (eds.) [Texas Tech Univ. Health Sciences Center, School of Medicine, Lubbock, TX (United States); Handal, G.A. [Texas Tech Univ. Health Sciences Center, School of Medicine, El Paso, TX (United States)

    2008-07-01

    The book contains the following contributions: Airway, head, neck; allergy, immunology rheumatology; pediatric cardiac imaging; child abuse; chromosomal abnormalities; conscious sedation; contrast agents and radiation protection; pediatric gastrointestinal imaging; genetic disorders in infants and children; pediatric genitourinary imaging; pediatric hematology, oncology imaging; pediatric intenrventional radiology; metabolic and vitamin disorders; muscoskeletal disorders (osteoradiology); neonatology imaging; pediatric neuroimaging; imaging of the respiratory tract in infants and children; vascular anomalies.

  8. Novel gender-specific visceral adiposity index for Mexican pediatric population

    Directory of Open Access Journals (Sweden)

    María J. Garcés

    2014-10-01

    Conclusions: VAI formula construction seemed to be different in children compared to adults. In the present study we propose a new gender-specific visceral adipose index for pediatric Mexican population living in urban areas that could be further used to predict abnormal cardiometabolic outcomes.

  9. Pediatric regional anesthesia: what is the current safety record?

    Science.gov (United States)

    Polaner, David M; Drescher, Jessica

    2011-07-01

    The use of regional anesthetics, whether as adjuncts, primary anesthetics or postoperative analgesia, is increasingly common in pediatric practice. Data on safety remain limited because of the paucity of very large-scale prospective studies that are necessary to detect low incidence events, although several studies either have been published or have reported preliminary results. This paper will review the data on complications and risk in pediatric regional anesthesia. Information currently available suggests that regional blockade, when performed properly, carries a very low risk of morbidity and mortality in appropriately selected infants and children. © 2010 Blackwell Publishing Ltd.

  10. EVALUATION OF URBANIZATION INFLUENCES ON URBAN ...

    African Journals Online (AJOL)

    Osondu

    2012-07-27

    Jul 27, 2012 ... climate over the cities that affect human comfort and his environment. Proper urban ... Key Words: Urbanization, Comfort, Pollution, Modification, Albedo, Urban Heat Island ... effects of land surface change on the climate of a.

  11. Innovations in urban agriculture

    NARCIS (Netherlands)

    Schans, van der J.W.; Renting, Henk; Veenhuizen, Van René

    2014-01-01

    This issuehighlights innovations in urban agriculture. Innovation and the various forms of innovations are of particular importance because urban agriculture is adapted to specific urban challenges and opportunities. Innovation is taking place continuously, exploring the multiple fundions of urban

  12. Increased ultrafine particles and carbon monoxide concentrations are associated with asthma exacerbation among urban children

    Science.gov (United States)

    Evans, Kristin A.; Halterman, Jill S.; Hopke, Philip K.; Fagnano, Maria; Rich, David Q.

    2014-01-01

    Objectives Increased air pollutant concentrations have been linked to several asthma-related outcomes in children, including respiratory symptoms, medication use, and hospital visits. However, few studies have examined effects of ultrafine particles in a pediatric population. Our primary objective was to examine the effects of ambient concentrations of ultrafine particles on asthma exacerbation among urban children and determine whether consistent treatment with inhaled corticosteroids could attenuate these effects. We also explored the relationship between asthma exacerbation and ambient concentrations of accumulation mode particles, fine particles (≤ 2.5 micrograms [μm]; PM2.5), carbon monoxide, sulfur dioxide, and ozone. We hypothesized that increased 1 to 7 day concentrations of ultrafine particles and other pollutants would be associated with increases in the relative odds of an asthma exacerbation, but that this increase in risk would be attenuated among children receiving school-based corticosteroid therapy. Methods We conducted a pilot study using data from 3–10 year-old children participating in the School-Based Asthma Therapy trial. Using a time-stratified case-crossover design and conditional logistic regression, we estimated the relative odds of a pediatric asthma visit treated with prednisone (n=96 visits among 74 children) associated with increased pollutant concentrations in the previous 7 days. We re-ran these analyses separately for children receiving medications through the school-based intervention and children in a usual care control group. Results Interquartile range increases in ultrafine particles and carbon monoxide concentrations in the previous 7 days were associated with increases in the relative odds of a pediatric asthma visit, with the largest increases observed for 4-day mean ultrafine particles (interquartile range=2088 p/cm3; OR=1.27; 95% CI=0.90–1.79) and 7-day mean carbon monoxide (interquartile range=0.17 ppm; OR=1.63; 95

  13. Urban Poverty in Asia

    OpenAIRE

    Asian Development Bank (ADB); Asian Development Bank (ADB); Asian Development Bank (ADB); Asian Development Bank (ADB)

    2014-01-01

    This report provides an overview of important urban poverty questions. What defines urban poverty and how is urban poverty being measured? What other factors beyond consumption poverty need to be tackled? Who are the urban poor? What relations exist between urban poverty and city size? What linkages exist between urbanization, income, and urban poverty? What policy responses to urban poverty are implemented in selected Asian countries? The report served as a background study for the Internati...

  14. Contested Urbanism

    DEFF Research Database (Denmark)

    Pløger, John

    2010-01-01

    Iconic architecture plays a crucial role in cities' interurban competition. This is also the case with Copenhagen which has used iconic architecture as part of its boosterism to gain investment, to increase tourism and to attract the creative class. This battle over the symbolic representation of...... intertwined through symbolic, visual and virtual representations of the wrongs of current urban planning...

  15. Virtual Urbanism.

    Science.gov (United States)

    Sirc, Geoffrey

    2001-01-01

    Considers how visual literacy implies a poetics of technology, one rooted in basic human passion. Notes that most academic forms sanctioned for students to inhabit are as monumentally dull as the urban forms in which they pass an extra-academic portion of their lives. Concludes that technology is most useful when it allows the poetic spirit to…

  16. Strengthening the Coordination of Pediatric Mental Health and Medical Care: Piloting a Collaborative Model for Freestanding Practices

    Science.gov (United States)

    Greene, Carolyn A.; Ford, Julian D.; Ward-Zimmerman, Barbara; Honigfeld, Lisa; Pidano, Anne E.

    2016-01-01

    Background: Collaborative pediatric mental health and primary care is increasingly recognized as optimal for meeting the needs of children with mental health problems. This paper describes the challenges faced by freestanding specialty mental health clinics and pediatric health practices to provide such coordinated mind-and-body treatment. It…

  17. Prevention of complications after pulpi-tis treatment in pediatrics at the stage of root system formation and its resorption

    Directory of Open Access Journals (Sweden)

    Makhonova E.M.

    2011-03-01

    Full Text Available Most frequently pulpitis develops as a complication of caries. In pediatric practice both acute and chronic forms of pulpitis are observed. However, primary chronic process is more often among milk teeth. The devital amputation is the most popular method of pulpitis treatment in pediatrics. Its professional and accurate implementation is the first step to avoid any possible future complications

  18. A survey of pediatric dentists' caries-related treatment decisions and restorative modalities – A web-based survey

    Directory of Open Access Journals (Sweden)

    Hassan S. Halawany

    2017-04-01

    Conclusion: The prevalence of use of composite resin to restore primary teeth was higher compared to glass ionomer cements and amalgam whereas a limited use of esthetic pediatric crowns was found among the sample surveyed. Esthetic pediatric crowns were more utilized by male compared to female participants.

  19. Using a Multimedia Presentation to Enhance Informed Consent in a Pediatric Emergency Department.

    Science.gov (United States)

    Spencer, Sandra P; Stoner, Michael J; Kelleher, Kelly; Cohen, Daniel M

    2015-08-01

    Informed consent is an ethical process for ensuring patient autonomy. Multimedia presentations (MMPs) often aid the informed consent process for research studies. Thus, it follows that MMPs would improve informed consent in clinical settings. The aim of this study was to determine if an MMP for the informed consent process for ketamine sedation improves parental satisfaction and comprehension as compared with standard practice. This 2-phase study compared 2 methods of informed consent for ketamine sedation of pediatric patients. Phase 1 was a randomized, prospective study that compared the standard verbal consent to an MMP. Phase 2 implemented the MMP into daily work flow to validate the previous year's results. Parents completed a survey evaluating their satisfaction of the informed consent process and assessing their knowledge of ketamine sedation. Primary outcome measures were parental overall satisfaction with the informed consent process and knowledge of ketamine sedation. One hundred eighty-four families from a free-standing, urban, tertiary pediatric emergency department with over 85,000 annual visits were enrolled. Different demographics were not associated with a preference for the MMP or improved scores on the content quiz. Intervention families were more likely "to feel involved in the decision to use ketamine" and to understand that "they had the right to refuse the ketamine" as compared with control families. The intervention group scored significantly higher overall on the content section than the control group. Implementation and intervention families responded similarly to all survey sections. Multimedia presentation improves parental understanding of ketamine sedation, whereas parental satisfaction with the informed consent process remains unchanged. Use of MMP in the emergency department for informed consent shows potential for both patients and providers.

  20. Pharmacological treatments and infectious diseases in pediatric inflammatory bowel disease.

    Science.gov (United States)

    Dipasquale, Valeria; Romano, Claudio

    2018-03-01

    The incidence of pediatric inflammatory bowel disease (IBD) is rising, as is the employment of immunosuppressive and biological drugs. Most patients with IBD receive immunosuppressive therapies during the course of the disease. These molecules are a double-edged sword; while they can help control disease activity, they also increase the risk of infections. Therefore, it is important that pediatricians involved in primary care, pediatric gastroenterologists, and infectious disease physicians have a thorough knowledge of the infections that can affect patients with IBD. Areas covered: A broad review of the major infectious diseases that have been reported in children and adolescents with IBD was performed, and information regarding surveillance, diagnosis and management were updated. The possible correlations with IBD pharmacological tools are discussed. Expert commentary: Opportunistic infections are possible in pediatric IBD, and immunosuppressive and immunomodulator therapy seems to play a causative role. Heightened awareness and vigilant surveillance leading to prompt diagnosis and treatment are important for optimal management.